Drug use-various effects on foetus, babies, children and youth

There is current research into the probable genotoxicity of marijuana and this has been likened to the harm to the foetus in the womb from the drug Thalidomide in the 1960’s.

In the annals of modern medicine, it was a horror story of international scope: thousands of babies dead in the womb and at least 10,000 others in 46 countries born with severe deformities. Some of the children were missing limbs. Others had arms and legs that resembled a seal’s flippers. In many cases, eyes, ears and other organs and tissues failed to develop properly. The cause, scientists discovered by late 1961, was thalidomide, a drug that, during four years of commercial sales in countries from Germany to Australia, was marketed to pregnant women as a miracle cure for morning sickness and insomnia.

The tragedy was largely averted in the United States, with much credit due to Frances Oldham Kelsey, a medical officer at the Food and Drug Administration in Washington, who raised concerns about thalidomide before its effects were conclusively known. For a critical 19-month period, she fastidiously blocked its approval while drug company officials maligned her as a bureaucratic nitpicker. Dr. Kelsey, a physician and pharmacologist later lauded as a heroine of the federal workforce, died Aug. 7 at her daughter’s home in London, Ontario. She was 101. Her daughter, Christine Kelsey, confirmed her death but did not cite a specific cause.

Dr. Kelsey did not single-handedly uncover thalidomide’s hazards. Clinical investigators and health authorities around the world played an important role, as did several of her FDA peers. But because of her tenacity and clinical training, she became the central figure in the thalidomide episode.

In July 1962, The Washington Post directed national attention on the matter — and on Dr. Kelsey — with a front-page article reporting that her “scepticism and stubbornness … prevented what could have been an appalling American tragedy.” [From 1962: ‘Heroine’ of FDA keeps bad drug off the market].

 

The global thalidomide calamity precipitated legislation signed by President John F. Kennedy in October 1962 that substantially strengthened the FDA’s authority over drug testing. The new regulations, still in force, required pharmaceutical companies to conduct phased clinical trials, obtain informed consent from participants in drug testing, and warn the FDA of adverse effects, and granted the FDA with important controls over prescription-drug advertising.

As the new federal law was being hammered out, Kennedy rushed to include Dr. Kelsey in a previously scheduled White House award ceremony honouring influential civil servants, including an architect of NASA’s manned spaceflight program.“In a way, they tied her to the moonshot in showing what government scientists were capable of,” said Stephen Fried, a journalist who investigated the drug industry in the book “Bitter Pills.” “It was an act of incredible daring and bravery to say we need to wait longer before we expose the American people to this drug.”

Dr. Kelsey became, Fried said, “the most famous government regulator in American history.”

‘I was the newest person there and pretty green’

Dr. Kelsey had landed at the FDA in August 1960, one of seven full-time medical officers hired to review about 300 human drug applications per year.The number of women pursuing careers in science was minuscule, but Dr. Kelsey had long been comfortable in male-dominated environments. Growing up in Canada, she spent part of her childhood in an otherwise all-boys private school. She had two daughters while shouldering the demands of medical school in the late 1940s.

In Washington, she joined a corps of reform-minded scientists who, although not yet empowered by the 1962 law that required affirmative FDA approval of any new drug, demanded strong evidence of effectiveness before giving their imprimatur.At the time, a drug could go on the market 60 days after the manufacturer filed an application with the FDA. If the medical officer determined that the submission was incomplete, the drug company could provide additional information, and the clock would start anew.

Meanwhile, pharmaceutical drug companies commonly supplied doctors with new drugs and encouraged them to test the product on patients, an uncontrolled and dangerous practice that relied almost entirely on anecdotal evidence. Thalidomide, which was widely marketed as a sedative as well as a treatment for pregnancy-related nausea during the first trimester of pregnancy, had proven wildly popular in Europe and a boon for its German manufacturer, Chemie Grünenthal.

By the fall of 1960, a Cincinnati-based drug company, William S. Merrell, had licensed the drug and began to distribute it under the trade name Kevadon to 1,200 U.S. doctors in advance of what executives anticipated would be its quick approval by the FDA.The government later estimated that more than 2.5 million tablets were given to about 20,000 patients, several hundred of whom were pregnant.

The Merrell application landed on Dr. Kelsey’s desk within weeks of her arrival at the agency. “I was the newest person there and pretty green,” she later said in an FDA oral history, “so my supervisors decided, ‘Well, this is a very easy one. There will be no problems with sleeping pills.’ ” Immediately the application alarmed her. Despite what she called the company’s “quite fulsome” claims, the absorption and toxicity studies were so incomplete as to be almost meaningless.

Dr. Kelsey rejected the application numerous times and requested more data. Merrell representatives, who had large potential profits riding on the application, began to complain to her bosses and show up at her office, with respected clinical investigators in tow, to protest the hold-up. Dr. Kelsey’s FDA superiors backed her as she conducted her research. By February 1961, she had found more evidence to support her suspicions, including a letter in the British Medical Journal by an English doctor who reported that his patients on thalidomide experienced a painful “tingling” in the arms and feet.

 

Dr. Kelsey also discovered that, despite warnings of side effects printed on British and German drug labels, Merrell had not notified the FDA of any adverse reactions.  Another reason for her concern was that the company had apparently done no studies on pregnant animals. At the time, a prevailing view among doctors held that the placental barrier protected the foetus from what Dr. Kelsey once called “the indiscretions of the mother,” such as abuse of alcohol, tobacco or illegal drugs. Earlier in her career, however, she had investigated the ways in which drugs did in fact pass through the placenta from mother to baby.

While Dr. Kelsey stood her ground on Kevadon, infant deaths and deformities were occurring at an alarming rate in places where thalidomide had been sold. The development of seal-like flippers, a condition known as phocomelia that previously affected an estimated 1 in 4 million infants, began to crop up by the dozens in many countries.

Clinical investigators, because of a variety of complications including spotty tracking systems, only belatedly made the link to thalidomide.  Grünenthal began pulling the drug from the market in Germany in late 1961. Health authorities in other countries issued warnings. Merrell waited until March 1962 to withdraw its U.S. application. By then, at least 17 babies were born in the United States with thalidomide-related defects, according to the FDA

Influence beyond thalidomide

Dr. Kelsey might have remained an anonymous bureaucrat if not for the front-page story in The Post. The newspaper had received a tip about her from staffers working for Sen. Estes Kefauver, a Tennessee Democrat who had been stalled in his years-long battle with the pharmaceutical industry to bolster the country’s drug laws. The coverage of Dr. Kelsey gave her — and Kefauver — a lift. As thousands of grateful letters flowed in to Dr. Kelsey from the public, the proposed legislation became hard to ignore or to water down. The new law was widely known as the Kefauver-Harris Amendments.

“She had a huge effect on the regulations adopted in the 1960s to help create the modern clinical trial system,” said Daniel Carpenter, a professor of government at Harvard University and the author of “Reputation and Power,” a definitive history of the FDA. “She may have had a bigger effect after thalidomide than before.”

In 1963, Dr. Kelsey was named chief of the FDA’s investigational drug branch. Four years later, she was named director of the new Office of Scientific Investigations, a position she held until 1995.  She spent another decade, until her retirement at 90, working at the FDA’s Center for Drug Evaluation and Research. In that role, she advised the director of its compliance office on scientific and medical issues and analyzed historical drug review issues.

According to historians of the FDA, she was instrumental in establishing the institutional review boards — a cornerstone of modern clinical drug development — that were created after abusive drug testing trials were exposed in prisons, hospitals and nursing homes. For decades, Dr. Kelsey played a critical role at the agency in enforcing federal regulations for drug development — protocols that were credited with forcing more rigorous standards around the world.

Name mistaken for a man’s

Frances Kathleen Oldham was born near Cobble Hill, on Vancouver Island, British Columbia, on July 24, 1914. Her father was a retired British army officer, and her mother came from a prosperous Scottish family.  The young “Frankie,” as she was called, grew up exploring the woods and shorelines, sometimes bringing home frogs for dissection. At McGill University in Montreal, she studied pharmacology — the effects of drugs on people — and received a bachelor’s degree in 1934 and a master’s degree in 1935.

A McGill professor urged her to apply for a research assistant job at the University of Chicago, where pharmacology professor Eugene Geiling accepted her without an interview. Geiling, who had mistaken the names Frances for the masculine Francis, addressed her by mail as “Mr. Oldham.”

“When a woman took a job in those days, she was made to feel as if she was depriving a man of the ability to support his wife and child,” Dr. Kelsey told the New York Times in 2010. “But my professor said: ‘Don’t be stupid. Accept the job, sign your name and put “Miss” in brackets afterward.’ ”

In Chicago, she helped Geiling investigate the 107 deaths that occurred nationwide in 1937 from the newly marketed liquid form of sulfanilamide, a synthetic antibacterial drug used to treat streptococcal infections. In tablet form, it had been heralded as a wonder-drug of the age, but it tasted unpleasant.Because the drug was not soluble in water or alcohol, the chief chemist of its manufacturer, S.E. Massengill Co. of Bristol, Tenn., dissolved the sulfanilamide with an industrial substance that was a chemical relative of antifreeze. He then added cherry flavouring and pink colouring to remedy the taste and appearance.

Massengill rushed the new elixir to market without adequately testing its safety. Many who took the medicine — including a high number of children — suffered an agonizing death.  At the time, the FDA’s chief mandate, stemming from an obsolete 1906 law, was food safety. At the agency’s request, Geiling joined the Elixir Sulfanilamide investigation and put Dr. Kelsey to work on animal testing of the drug. She recalled observing rats as they “shrivelled up and died.”

Amid national outrage over Elixir Sulfanilamide, Congress passed the Federal Food, Drug and Cosmetic Act of 1938, legislation that vastly expanded federal regulatory oversight over drugs and set a new benchmark for drug safety before marketing. Massengill’s owner ultimately was fined a maximum penalty of $26,000 for mislabelling and misbranding; by technical definition, an elixir contains alcohol.

‘We need to take precautions’

Dr. Kelsey received a doctorate from Chicago in 1938, then joined the faculty. In 1943, she wed a pharmacology colleague, Fremont Ellis Kelsey.  After graduating from Chicago’s medical school in 1950, Frances Kelsey taught pharmacology at the University of South Dakota medical school and was a fill-in doctor at practices throughout the state. She also became a U.S. citizen before arriving in Washington in 1960 when her husband was hired by the National Institutes of Health. He died in 1966 after a heart attack.

Survivors include their daughters, Susan Duffield of Shelton, Wash., and Christine Kelsey of London, Ontario; a sister; and two grandchildren. Dr. Kelsey moved to Ontario from suburban Maryland in 2014.

Babies who suffered from the effects of thalidomide and survived grew up with a range of impairment. Some required lifelong home care. Others held jobs and were not severely hindered by their disabilities. Many legal settlements were reached between drug companies and the victims of thalidomide, and new claims continue to surface. Grünenthal formally apologized to victims of thalidomide in 2012.

The drug, however, never disappeared entirely. Researchers have investigated thalidomide’s effects on H.I.V. and Crohn’s disease and have conducted clinical trials for on its use for rheumatoid arthritis and macular degeneration, a leading cause of blindness.

In 1998, the FDA approved the drug for the treatment of lesions from leprosy. In 2006, thalidomide was cleared for use with the medicine dexamethasone for certain cases of multiple myeloma, a cancer of the bone marrow.

The agency enforced strict safeguards, including pregnancy testing, for such new uses. “We need to take precautions,” Dr. Kelsey told an interviewer in in 2001, “because people forget very soon.”

Source:https://www.washingtonpost.com/national/health-science/frances-            oldham-kelsey-heroine-of-thalidomide-tragedy-dies-at-101/2015/08/07

Researchers at Western University have found a way to use pharmaceuticals to reverse the negative psychiatric effects of THC, the psychoactive chemical found in marijuana. Chronic adolescent marijuana use has previously been linked to the development of psychiatric diseases, such as schizophrenia, in adulthood. But until now, researchers were unsure of what exactly was happening in the brain to cause this to occur.

“What is important about this study is that not only have we identified a specific mechanism in the prefrontal cortex for some of the mental health risks associated with adolescent marijuana use, but we have also identified a mechanism to reverse those risks,” said Steven Laviolette, professor at Western’s Schulich School of Medicine & Dentistry.

In a study published online today in Scientific Reports the researchers demonstrate that adolescent THC exposure modulates the activity of a neurotransmitter called GABA in the prefrontal cortex region of the brain. The team, led by Laviolette and post-doctoral fellow Justine Renard, looked specifically at GABA because of its previously shown clinical association with schizophrenia.

“GABA is an inhibitory neurotransmitter and plays a crucial role in regulating the excitatory activity in the frontal cortex, so if you have less GABA, your neuronal systems become hyperactive leading to behavioural changes consistent with schizophrenia,” said Renard.

The study showed that the reduction of GABA as a result of THC exposure in adolescence caused the neurons in adulthood to not only be hyperactive in this part of the brain, but also to be out of synch with each other, demonstrated by abnormal oscillations called ‘gamma’ waves. This loss of GABA in the cortex caused a corresponding hyperactive state in the brain’s dopamine system, which is commonly observed in schizophrenia.

By using drugs to activate GABA in a rat model of schizophrenia, the team was able to reverse the neuronal and behavioural effects of the THC and eliminate the schizophrenia-like symptoms.

Laviolette says this finding is especially important given the impending legalization of marijuana in Canada. “What this could mean is that if you are going to be using marijuana, in a recreational or medicinal way, you can potentially combine it with compounds that boost GABA to block the negative effects of THC.”

The research team says the next steps will examine how combinations of cannabinoid chemicals with compounds that can boost the brains GABA system may serve as more effective and safer treatments for a variety of mental health disorders, such as addiction, depression and anxiety.

Source:  The Marijuana Report.Org, Sept. 2017

Mathias B. Forrester and Ruth D. Merz

Hawaii Birth Defects Program, Honolulu, Hawaii, USA

Extracts from Study 

The literature on the association between prenatal illicit drug use and birth defects is inconsistent. The objective of this study was to determine the risk of a variety of birth defects with prenatal illicit drug use.

Data were derived from an active, population based adverse pregnancy outcome registry. Cases were all infants and foetuses with any of 54 selected birth defects delivered during 1986–2002.

The prenatal methamphetamine, cocaine, or marijuana use rates were calculated for each birth defect and compared to the prenatal use rates among all deliveries.

Among all deliveries, the prenatal use rate was 0.52% for methamphetamine,0.18% for cocaine, and 0.26% for marijuana.

Methamphetamine rates were significantly higher than expected for 14 (26%) of the birth defects.

Cocaine rates were significantly higher than expected for 13 (24%) of the birth defects.

Marijuana rates were significantly higher than expected for 21 (39%) of the birth defects. Increased risk for the three drugs occurred predominantly among birth defects associated with the central nervous system, cardiovascular system, oral clefts, and limbs. There was also increased risk of marijuana use among a variety of birth defects associated with the gastrointestinal system. Prenatal uses of methamphetamine, cocaine, and marijuana are all associated with increased risk of a variety of birth defects.

The affected birth defects are primarily associated with particular organ systems.

DISCUSSION

Using data from a Statewide, population-based registry that covered over 300,000 births and a 17-yr period, this investigation examined the association between over 50 selected birth defects and maternal use of methamphetamine, cocaine, or marijuana during pregnancy. Much of the literature on prenatal illicit drug use and birth defects involved case reports, involved a small number of cases, were not population-based, or focused on only one or a few particular birth defects.

There are various limitations to this investigation. The number of cases for many of the birth defects categories was relatively small, limiting the ability to identify statistically significant differences and resulting in large confidence intervals.

In spite of this, a number of statistically significant analyses were identified. Some statistically significant results might be expected to occur by chance. If 1 in every 20 analyses is expected to result in statistically significant differences solely by chance, then among the 162 analyses performed in this study, 8 would be expected to be statistically significant by chance. However, 48 statistically significant differences were identified. Thus, not all of the statistically significant results are likely to be due to chance.

This study included all pregnancies where methamphetamine, cocaine, or marijuana use was identified through either report in the medical record or positive toxicology test. This was done because neither self-report nor toxicology testing is likely to identify all instances of prenatal illicit drug use (Christmas et al., 1992).

In spite of using both methods for determining prenatal illicit drug use, all pregnancies involving methamphetamine, cocaine, or marijuana were not likely to have been identified. The degree of under ascertainment is unknown. A previous study examined the maternal drug use rate around the time of delivery in Hawaii during 1999 (Derauf et al., 2003). This study found 1.4% of the pregnancies involved methamphetamine use and 0.2% involved marijuana use. Among 1999 deliveries, the HBDP identified a prenatal methamphetamine use rate of 0.7% and a marijuana use rate of 0.4%. However, comparisons between the 2 studies should be made with caution because the previous study collected data from a single hospital during only a 2-mo period.

Another limitation is that the present study did not control for potential confounding factors such as maternal demographic characteristics, health behaviors, and prenatal care. Increased risk of birth defects has been associated with inadequate prenatal care (Carmichael et al., 2002), maternal smoking (Honein et al., 2001), and maternal alcohol use (Martinez-Frias et al., 2004).

These factors are also found with maternal illicit drug use (Cosden et al., 1997; Hutchins, 1997; Norton-Hawk, 1997). Thus the increased risk of selected birth defects with illicit drug use in this study might actually be due to one of these other underlying factors. Unfortunately, informationon some of the potential confounding factors such as socioeconomic status are not collected by the HBDP. Information collected on some other factors such as smoking and alcohol use is suspect because of negative attitudes toward their use during pregnancy. Moreover, the small number of cases among many of the birth defects groups would make controlling for these factors difficult.

Finally, this investigation included use of the illicit drugs at any time during the pregnancy. Most birth defects are believed to occur at 3–8 wk after conception (Makri et al., 2004; Sadler, 2000). In a portion of the cases, the drug use might have occurred at a time when it could not have caused the birth defect. Furthermore, this study does not include information on dose; however, teratogenicity of a substance may depend on its dose (Werler et al., 1990). In spite of the various potential concerns of the present study, data may suggest future areas of investigation where the limitations inherent in the present one are excluded.

This investigation found significantly higher than expected rates for prenatal use of methamphetamine, cocaine, and marijuana among a number of specific birth defects. Although not identical, there were general similarities between the three illicit drugs and the birth defects with which they were associated. Increased rates for methamphetamine, cocaine, and marijuana occurred predominantly among birth defects affecting the central nervous system, cardiovascular system, oral clefts, and limbs. There were also increased rates of marijuana use with a variety of birth defects associated with the gastrointestinal  system. With the exception of marijuana and encephalocele, none of illicit drugs were associated with neural-tube defects (anencephaly, spina bifida, encephalocele). The rates of use for the three illicit drugs were not significantly elevated with eye defects other than anophthalmia/microphthalmia, genitourinary defects, and musculoskeletal defects aside from limb defects.

In the majority of instances, the associations between particular illicit drugs and birth defects were found whether or not those cases involving use of multiple types of drugs were included.

Of the 14 significant associations between methamphetamine and specific birth defects, 10 (71.4%) remained once multiple drug cases were excluded. Corresponding rates were 61.5% (8 of 13) for cocaine and 81.0% (17 of 21) for marijuana.

The similarities in the patterns of birth defects with which methamphetamine, cocaine, and marijuana are associated might suggest that the three drugs exert similar effects on embryonic and foetal development. This might not be expected, considering that the three illicit drugs differ in their mechanisms of action and clinical effects (Leiken & Paloucek, 1998).

Some of the associations between methamphetamine, cocaine, and marijuana observed in the present investigation were previously reported. Other studies observed similar associations, or lack thereof, of methamphetamine or amphetamine with neural-tube defects (Shaw et al., 1996) and cardiovascular and musculoskeletal defects (McElhatton et al., 2000); cocaine with neural-tube defects (Shaw et al., 1996), cardiovascular defects (Lipshultz et al., 1991), ventricular septal defect and atrial septal defect (Ferencz et al., 1997c; Martin & Edmonds, 1991), tricuspid atresia (Ferencz et al., 1997d), craniosynostosis (Gardner et al., 1998), and situs inversus (Kuehl & Loffredo, 2002); and marijuana with neural-tube defects (Shaw et al., 1996), single ventricle (Steinberger et al., 2002), ventricular septal defect (Williams et al., 2004), tricuspid atresia (Ferencz et al., 1997d), and gastroschisis (Torfs et al., 1994).

In contrast, this study differed from other research with respect to their findings regarding methamphetamine or amphetamine and gastroschisis (Torfs et al., 1994); cocaine and microcephaly (Martin & Edmonds, 1991), conotruncal defects (Adams et al., 1989), endocardial cushion defect (Ferencz et al., 1997b), situs inversus (Ferencz et al., 1997a), oral clefts (Beatyet al., 2001), and genitourinary defects (Abe et al., 2003; Battin et al., 1995; Martin & Edmonds, 1991); and marijuana and conotruncal defects (Adams et al., 1989), Ebstein anomaly (Ferencz et al., 1997e; Correa-Villasenor et al., 1994), and oral clefts (Beaty et al., 2001).

The inconsistent findings between this and the other studies could be due to differences in study methodology, case classification, or number of cases. The mechanisms by which methamphetamine, cocaine, and marijuana might contribute to the rates for birth defects is currently unknown. Any potential explanation would have to take into account the observation that each of the illicit drugs was associated with a variety of specific birth defects affecting different organ systems. This might suggest that these three drugs would need to influence a basic, common factor involved in embryonic development.

Folic acid is involved in nucleic acid synthesis and cellular division (Scholl & Johnson, 2000) and thus would play an important role in the early growth and cellular proliferation of the embryo. Folic acid has been found to prevent a variety of birth defects (Forrester & Merz, 2005). Thus, anything that interferes with the activity of folic acid might be expected to increase the risk for these birth defects. Many of these birth defects were associated with methamphetamine, cocaine, and/or marijuana in the present study.

However, two of the birth defects most closely affected by folic acid—anencephaly and spina bifida—were not associated with any of the three illicit drugs. Vascular disruption has been suggested as a potential cause for a variety of different birth defects such as intestinal atresia/stenosis, limb reduction defects, and gastroschisis.

Since cocaine is a vasoconstrictor, it has been hypothesized that cocaine use could increase the risk of these vascular disruption defects (Hume et al., 1997; Martin et al., 1992; Hoyme et al., 1983; de Vries, 1980). Although this investigation found an association between cocaine and limb reduction deformities, no association was found with intestinal atresia/stenosis or gastroschisis.

In conclusion, this study found that prenatal use of methamphetamine, cocaine, or marijuana were associated with increased risk of a variety of birth defects. The affected birth defects were primarily associated with particular organ systems. Because of various limitations of the study, further research is recommended.

Source:  Journal of Toxicology and Environmental Health, Part A, 70: 7–18, 2007

Fetal alcohol spectrum disorder (FASD) is a common condition that affects a substantial number of children, adolescents, and adults. Individuals can manifest FASD in a variety of ways, with many co-morbidities. They can present with birth defects, learning difficulties, intellectual disability, academic struggles, behavioral and psychiatric issues (e.g. attention-deficit/hyperactivity disorder, conduct disorder, depression, and drug and alcohol addiction), and difficulties with the law, with a risk for incarceration, unemployment, poverty, and dependency. Fetal alcohol spectrum disorder is important because it can potentially be prevented, and early recognition and diagnosis can lead to earlier interventions and supports that are associated with improved outcomes. Prevention is important because FASD is associated with a high cost to affected individuals, families, systems of care, and communities.

Source:   http://jamanetwork.com/journals/jamapediatrics/article-abstract/2649222

See also:

Taylor & Francis. “Fathers drinking: Also responsible for fetal disorders?.” ScienceDaily,   www.sciencedaily.com/releases/2014/02/140214075405.htm.

Am J Stem Cells 2016;5(1):11-18 www.AJSC.us /ISSN:2160-4150/AJSC0030217 Review Article Influence of paternal preconception exposures on their offspring: through epigenetics to phenotype

A new study provides credible evidence that marijuana legalization will lead to decreased academic success. (Elaine Thompson/AP)

The most rigorous study yet of the effects of marijuana legalization has identified a disturbing result: College students with access to recreational cannabis on average earn worse grades and fail classes at a higher rate. Economists Olivier Marie and Ulf Zölitz took advantage of a decision by Maastricht, a city in the Netherlands, to change the rules for “cannabis cafes,” which legally sell recreational marijuana. Because Maastricht is very close to the border of multiple European countries (Belgium, France and Germany), drug tourism was posing difficulties for the city. Hoping to address this, the city barred noncitizens of the Netherlands from buying from the cafes.

This policy change created an intriguing natural experiment at Maastricht University, because students there from neighboring countries suddenly were unable to access legal pot, while students from the Netherlands continued.

The research on more than 4,000 students, published in the Review of Economic Studies, found that those who lost access to legal marijuana showed substantial improvement in their grades. Specifically, those banned from cannabis cafes had a more than 5 percent increase in their odds of passing their courses. Low performing students benefited even more, which the researchers noted is particularly important because these students are at high-risk of dropping out. The researchers attribute their results to the students who were denied legal access to marijuana being less likely to use it and to suffer cognitive impairments (e.g., in concentration and memory) as a result.

Other studies have tried to estimate the impact of marijuana legalization by studying those U.S. states that legalized medicinal or recreational marijuana. But marijuana policy researcher Rosalie Pacula of RAND Corporation noted that the Maastricht study provide evidence that “is much better than anything done so far in the United States.”

States differ in countless ways that are hard for researchers to adjust for in their data analysis, but the Maastricht study examined similar people in the same location — some of them even side by side in the same classrooms — making it easier to isolate the effect of marijuana legalization. Also, Pacula pointed out that since voters in U.S. states are the ones who approve marijuana legalization, it creates a chicken and egg problem for researchers (i.e. does legalization make people smoke more pot, or do pot smokers tend to vote for legalization?). This methodological problem was resolved in the Maastricht study because the marijuana policy change was imposed without input from those whom it affected.

Although this is the strongest study to date on how people are affected by marijuana legalization, no research can ultimately tell us whether legalization is a good or bad decision: That’s a political question and not a scientific one. But what the Maastricht study can do is provides highly credible evidence that marijuana legalization will lead to decreased academic success — perhaps particularly so for struggling students — and that is a concern that both proponents and opponents of legalization should keep in mind.

Source:https://www.washingtonpost.com/news/wonk/wp/2017/07/25/these-       college-students-lost-access-to-legal-pot-and-started-getting-better-grades/?   

Werewolf in London? Or maybe it’s a Skunk.

Cannabis is now the most popular illicit drug in the world. Several US states have legalized cannabis for medical or recreational use and more are in the process of doing the same. Numerous prospective epidemiological studies have reported that use of cannabis is a modifiable risk factor for schizophrenia-like psychosis. In 2012, the Schizophrenia Commission in the UK concluded that research to quantify the link between cannabis use and serious mental illness should be pursued.

Between May 1, 2005, and May 31, 2011, researchers culled data from 410 patients with first-episode psychosis and 370 controls. The risk of individuals having a psychotic disorder was approximately three-fold higher among users of “skunk-like” cannabis, compared with those who never used cannabis (adjusted odds ratio [OR] 2•92, 95% CI 1•52–3•45, p=0•001). Further, daily use of skunk-like cannabis resulted in the highest risk of psychotic disorders, compared with no use of cannabis (adjusted OR 5•4, 95% CI 2•81–11•31, p=0•002).

The population attributable fraction of first episode psychosis for skunk use for the geographical area of south London was 24% (95% CI 17–31), possibly because of the high prevalence of high-potency cannabis (218 [53%] of 410 patients) in the study.

Clearly, and as seen elsewhere, availability of high potency cannabis in south London most likely resulted in a greater proportion of first onset psychosis than in previous studies where the cannabis is less potent.

Why Does this Matter?

Changes in marijuana potency and the increased prevalence of use by adolescents and young adults increases the risk of serious mental illness and the burden on the mental health system.

Chronic, relapsing psychotic illness produced by cannabis is similar to that produced naturally in Schizophrenia. However, treatment responses are not the same. Indeed, skunk use appears to contribute to 24% of cases of first episode psychosis in south London. Our findings show the importance of raising awareness among young people of the risks associated with the use of high-potency cannabis. The need for such public education is emphasized by the worldwide trend of liberalization of the constraints on cannabis and the fact that high potency varieties are becoming increasingly available.

Finally, in both primary care and mental health services, developing a simple screening instrument as simple as yes-or-no questions of whether people use skunk or other drugs will aid public health officials to identify epidemiological maps and “hot spots” of increased drug use and to develop interdiction, education and prevention efforts.

Source:  https://www.rivermendhealth.com/resources/cannabis-induced-psychosis-now-spreading-uk     July 2017

An UdeM study confirms the link between marijuana use and psychotic-like experiences in a Canadian adolescent cohort. Credit: © Syda Productions / Fotolia

Going from an occasional user of marijuana to a weekly or daily user increases an adolescent’s risk of having recurrent psychotic-like experiences by 159%, according to a new Canadian study published in the Journal of Child Psychology and Psychiatry.

The study also reports effects of marijuana use on cognitive development and shows that the link between marijuana use and psychotic-like experiences is best explained by emerging symptoms of depression.

“To clearly understand the impact of these results, it is essential to first define what psychotic-like experiences are: namely, experiences of perceptual aberration, ideas with unusual content and feelings of persecution,” said the study’s lead author, Josiane Bourque, a doctoral student at Université de Montréal’s Department of Psychiatry. “Although they may be infrequent and thus not problematic for the adolescent, when these experiences are reported continuously, year after year, then there’s an increased risk of a first psychotic episode or another psychiatric condition.”

She added: “Our findings confirm that becoming a more regular marijuana user during adolescence is, indeed, associated with a risk of psychotic symptoms. This is a major public-health concern for Canada.”

What are the underlying mechanisms?

One of the study’s objectives was to better understand the mechanisms by which marijuana use is associated with psychotic-like experiences. Bourque and her supervisor, Dr. Patricia Conrod at Sainte Justine University Hospital Research Centre hypothesized that impairments in cognitive development due to marijuana misuse might in turn exacerbate psychotic-like experiences.

This hypothesis was only partially confirmed, however. Among the different cognitive abilities evaluated, the development of inhibitory control was the only cognitive function negatively affected by an increase in marijuana use. Inhibitory control is the capacity to withhold or inhibit automatic behaviours in favor of a more contextually appropriate behaviour. Dr. Conrod’s team has shown that this specific cognitive function is associated with risk for other forms of substance abuse and addiction.

“Our results show that while marijuana use is associated with a number of cognitive and mental health symptoms, only an increase in symptoms of depression — such as negative thoughts and low mood — could explain the relationship between marijuana use and increasing psychotic-like experiences in youth,” Bourque said.

What’s next

These findings have important clinical implications for prevention programs in youth who report having persistent psychotic-like experiences. “While preventing adolescent marijuana use should be the aim of all drug strategies, targeted prevention approaches are particularly needed to delay and prevent marijuana use in young people at risk of psychosis,” said Patricia Conrod, the study’s senior author and a professor at UdeM’s Department of Psychiatry.

Conrod is optimistic about one thing, however: the school-based prevention program that she developed, Preventure, has proven effective in reducing adolescent marijuana use by an overall 33%. “In future programs, it will be important to investigate whether this program and other similar targeted prevention programs can delay or prevent marijuana use in youth who suffer from psychotic-like experiences,” she said. “While the approach seems promising, we have yet to demonstrate that drug prevention can prevent some cases of psychosis.”

A large youth cohort from Montreal

The study’s results are based on the CIHR-funded Co-Venture project, a cohort of approximately 4,000 adolescents aged 13 years old from 31 high schools in the Greater Montreal area. These teens are followed annually from Grade 7 to Grade 11. Every year they fill out computerized questionnaires to assess substance use and psychiatric symptoms. The teens also complete cognitive tasks to allow the researchers to evaluate their IQ, working memory and long-term memory as well as their inhibitory control skills.

To do their study, the research team first confirmed results from both the United Kingdom and Netherlands showing the presence of a small group of individuals (in Montreal, 8%) among the general population of adolescents who report recurrent psychotic-like experiences. Second, the researchers explored how marijuana use between 13 and 16 years of age increases the likelihood of belonging to the 8%. Finally, they examined whether the relationship between increasing use of marijuana and increasing psychotic-like experiences can be explained by emerging symptoms of anxiety or depression, or by the effects of substance use on developing cognitive abilities.

Source:  University of Montreal. “Marijuana and vulnerability to psychosis.” ScienceDaily. ScienceDaily, 5 July 2017. www.sciencedaily.com/releases/2017/07/170705104042.htm.

 

Canada’s Liberal government has stated that marijuana will be decriminalized by July 2018. This means the removal, or at the least, a lessening of laws and restrictions related to marijuana use and associated pot services.

While people on both sides of the debate have strongly held and differing opinions, the protection of youth is an area of agreement.

Marijuana, also known as cannabis, has been illegal in Canada for close to 100 years. Marijuana can’t be produced, sold or even possessed. If caught, one faces fines, jail time or both.

Despite this, Canada has one of the highest rates of cannabis use in the world. Over 40 per cent of Canadians have used cannabis during their lifetime. Furthermore, studies conducted by Health Canada indicate that between 10.2 and 12.2 per cent of Canadians use cannabis at least once a year.

As changes in cannabis regulation occur, new research has been conducted. The findings are, in a word, alarming. According to published research, someone who uses marijuana regularly has, on average, less grey matter in the orbital frontal cortex of the brain. Other research has found increasing evidence of a link between pot and schizophrenia symptoms.

A major factor is the potency of cannabis, which has gone through the roof for the last two decades. In the 1960s, THC levels were reported to have been in the one-to-four-per-cent range. Research reported in the science journal, Live Science, in 21014 indicates that marijuana’s main psychoactive ingredient, THC, in random marijuana samples, rose from about four per cent in 1995 to about 12 per cent in 2014. In a more-recent article, the leader of the American Chemical Society stated: “We’ve seen potency values close to 30-per-cent THC, which is huge.”

Despite these clear and increasing dangers, the Government of Canada’s stated objective is to “legalize, strictly regulate and restrict access to cannabis for non-medical purposes.” Unfortunately, the government’s approach has serious flaws.  Most importantly, their approach lacks protections for youth, despite this being another specifically stated objective of the Canadian government’s new law.

While supporters of cannabis often compare it with alcohol, a legal, but carefully controlled substance in Canada, there is an important difference. Cannabis is commonly consumed by smoking, which leads to significant, second-hand affects and, as a result, second-hand structural changes in the brain.

In my neighbourhood, cannabis-users in one house, taking advantage of the decreasing legal response to cannabis in B.C. these days, happily smoke the substance on their back deck, only to have the blue smoke waft across to the trampoline next door, where my younger brother and his friends often play.

The government’s proposed new policy actually encourages youth exposure by making it legal for citizens to grow cannabis in their homes. There is no mention of the protection of children living in those residences, where cannabis is grown, consumed and potentially sold.

The Canadian Association of Chiefs of Police makes this point well. They warn that allowing home-grown cultivation will fuel the cannabis black market and that the four-plant limit proposed under the legislation is impossible to enforce. The chiefs further note that home cultivation is a direct contradiction to the government’s promise to create a highly regulated environment that minimizes youth access to the drug.

The biggest concern that the youth of Canada should have about the government’s approach to decriminalization is, however, drug quality — potentially with deadly results. The opportunity for tampering is obvious. A high school friend and classmate of mine casually uses cannabis and landed in the hospital for a few weeks. She believes that some of the cannabis she used was laced with another substance. I often wonder how close my friend came to dying like another of our fellow students at New Westminster Secondary School.

Canada isn’t ready for the decriminalization of cannabis. The Canadian government, and our health-care and legal systems, aren’t fully prepared for the problems and long-term effects that’ll have serious consequences for our youth. Important issues, including second-hand effects and basic safety, not to mention enforcement and legal implications, have yet to be fully defined and planned for. The federal government’s plan to decriminalize pot, as it stands now, doesn’t provide enough protection for Canada’s young people.

Mitchell Moir is a Grade 12 student at New Westminster Secondary.

Source:  http://vancouversun.com/opinion/op-ed/opinion-proposed-cannabis-policy-doesnt-do-enough-to-protect-youth   23rd June 2017

Mass Illness from Marijuana Edibles in San Francisco There’s more potential for overdose from edibles than smoked marijuana, although the teen in Seattle who jumped to his death last December did it after smoking pot for the first time.  Two shocking incidents in California suggest that overdose emergencies will increase if that states vote to legalize marijuana in November.  Here’s a summary of recent cases of toxicity from edibles:

· 19 people were hospitalized in San Francisco on August 7 from THC, after attending a quinceañera party.  The source is believed be marijuana-infused candies, perhaps gummy bears. Several children were among those poisoned, one as young as six.  A 9-year-old had severe difficulty breathing.

· Pot brownies sent a bachelorette party to the emergency room in South Lake Tahoe over the weekend of July 30-31. Eight of the 10 women were admitted to the hospital according to the City of South Lake Tahoe’s website.

· A JAMA Paediatrics article explains the dramatic rise in children’s hospitalizations related to marijuana in Colorado since legalization.  In 10 cases, the product was not in a child-resistant container; in 40 scenarios (34%) there was poor child supervision or product storage.  Edible products were responsible for 51 (52% ) of exposures.  The report claimed that child-resistant packaging has not been as effective in reducing kids’ unintended exposure to pot as hoped.

· The report mentions the death of one child, an 11-month-old baby.  Nine of the children had symptoms so serious that they ended up in the intensive care unit of Colorado Children’s Hospital.  Two children needed breathing tubes.

· The state of Washington has a similar problem with edibles, as reported on the King County Health Department’s website.  From 2013 to May 2015, there were 46 cases of children’s intoxications related to marijuana edibles reported in Washington.  However, reporting is voluntary and the state estimates that number could be much higher.

·  In May, a father plead guilty to deliberately giving his 4-year-old daughter marijuana-laced cake in Vancouver, Washington.  He was sentenced to two years in prison.

Intoxication from marijuana edibles has risen steadily since legalization. Source: King County Department of Health. Top photo: AP

· In Hingham, MA, there was a 911 related to teen girl who ingested marijuana edibles.  The candies were in a package labelled Conscious Creations, which didn’t disclose ingredients.   Massachusetts has a medical marijuana program, but it is not clear how or to whom they were sold or dispensed.

 

· July, 2016: Two California teens were hospitalized after eating a marijuana-laced cookie. The teens reported purchasing the cookie from a third teenager who was subsequently arrested.

· July, 2016: A California man was arrested for giving candy laced with marijuana to a 6-year-old boy and an 8-year-old boy; the 6-year-old was hospitalized for marijuana poisoning.

· July, 2016: Police in Arizona arrested a mother for allegedly giving her 11- and 12-year-old children gummy candy infused with marijuana. Police say the marijuana-infused candy was originally purchased by an Arizona medical marijuana user, but was illegally transferred to the mother in question.  (State medical marijuana programs have poor track records of assuring the “medicine” goes to whom it is intended.)

· On April 27, a Georgia woman was arrested after a 5- year-old said he ate a marijuana cake for breakfast.  The child was taken to the hospital for treatment following the incident; according to officials, his pulse was measured at over 200 beats per minute.

· Last year there were more than 4,000 treatments at hospitals and poison center treatments in the US related to marijuana toxicity in children and teens.

Growth of marijuana edibles intoxication by age. Source: King County, Washington

Edible marijuana poses a “unique problem,” because “no other drug is infused into a palatable and appetizing form” – such as cookies, brownies and candy.    Many household items cause poisonings, but marijuana edibles are different because they’re made to look appealing and they appeal to children.

 

Source:  http://www.poppot.org/2016/08/08/latest-child-dangers-marijuana-e

Drinking alcohol during pregnancy could harm not just a woman’s unborn child, but her grandchildren and beyond.

Researchers in the US have found brain abnormalities linked to foetal alcohol spectrum disorder (FASD), at least in mice, can be passed down through the generations.

“Traditionally, prenatal ethanol exposure from maternal consumption of alcohol was thought to solely impact directly exposed offspring, the embryo or foetus in the womb,” says Kelly Huffman from the University of California.

“However, we now have evidence that the effects of prenatal alcohol exposure could persist transgenerationally and negatively impact the next-generations of offspring who were never exposed to alcohol.”

In the experiment, Prof Huffman’s team found the children of mice with FASD also had reduced body weight and brain size, and were more likely to show signs of anxiety and depression. The defects were present in further generations.

“By demonstrating the strong transgenerational effects of prenatal ethanol exposure in a mouse model of FASD, we suggest that FASD may be a heritable condition in humans,” says Prof Huffman.

Babies born with FASD often have intellectual and physical disabilities, behavioural problems and distinct facial features. It is irreversible. A study in 2015 found almost third of Kiwi women continue to drink alcohol during their first trimester, and 11 percent right up until birth. · Concerns over number of women drinking while pregnant

The Ministry of Health says there is no known safe level of drinking, and recommends women abstain from alcohol from the time they decide to have a baby, through conception and the entire pregnancy.

The discovery that FASD affects children who were never exposed to alcohol is a clue to future potential therapies and perhaps even prevention, the researchers say.

The research was published in journal Cerebral Cortex.

Source:  http://www.newshub.co.nz/home/health/2017/07/drinking-alcohol-while-pregnant-harms-kids-for-generations-study.html

INTRODUCTION

Drug addiction is a chronic and relapsing disease that often begins during adolescence.

Epidemiological evidence documents an association between marijuana use during adolescence and subsequent abuse of drugs such as heroin and cocaine (1, 2). While many factors including societal pressures, family, culture, and drug availability can contribute to this apparent `gateway’ association, little is known about the neurobiological basis underlying such potential vulnerability.

Of the neural substrates that have been investigated, the enkephalinergic opioid system is  consistently altered by developmental marijuana exposure (3–5), perhaps reflecting neuroanatomical interactions between cannabinoid receptor type 1 and the enkephalinergic system (6, 7).

Debates exist, however, regarding the relationship between proenkephalin (Penk) dysregulation and opiate susceptibility. We previously reported that adult rats exposed to Δ9-tetrahydrocannabinol (THC; primary psychoactive component of marijuana) during adolescence exhibit increased heroin self administration (SA) as well as increased expression of Penk, the gene encoding the opioid neuropeptide enkephalin, in the nucleus accumbens shell (NAcsh), a mesolimbic structure critically involved in reward-related behaviors (3).

Although these data suggest that increased NAcsh Penk expression and heroin SA behavior are independent consequences of adolescent THC exposure, they do not address a possible causal relationship between THCinduced  Penk upregulation in NAcsh and enhanced behavioral susceptibility to opiates.

Moreover, insights regarding the neurobiological mechanisms by which adolescent THC exposure maintains upregulation of Penk into adulthood remain unknown.

Here, we take advantage of viral-mediated gene transfer strategies to show that adulthood addiction-like behaviors induced by adolescent THC exposure are dependent on discrete regulation of NAcsh Penk gene expression. A number of recent studies have demonstrated an important role for histone methylation in the regulation of drug-induced behaviors and transcriptional plasticity, particularly alteration of repressive histone H3 lysine 9 (H3K9) methylation at NAc gene promotors (8, 9).

We report here that one mechanism by which adolescent THC exposure may mediate Penk upregulation in adult NAcsh is through reduction of H3K9 di- and trimethylation, a functional consequence of which may be decreased transcriptional repression of Penk.

ABSTRACT

Background

Marijuana use by teenagers often predates the use of harder drugs, but the neurobiological underpinnings of such vulnerability are unknown. Animal studies suggest enhanced heroin self-administration (SA) and dysregulation of the endogenous opioid system in the nucleus accumbens shell (NAcsh) of adults following adolescent Δ9-tetrahydrocannabinol (THC) exposure. However, a causal link between Penk expression and vulnerability to heroin has yet to be established.

Methods

To investigate the functional significance of NAcsh  Penk tone, selective viral mediated knockdown and overexpression of Penk was performed, followed by analysis of subsequent heroin SA behavior. To determine whether adolescent THC exposure was associated with chromatin alteration, we analyzed levels of histone H3 methylation in the NAcsh via ChIP atfive sites flanking the Penk gene transcription start site.

Results

Here, we show that regulation of the proenkephalin (Penk) opioid neuropeptide gene in NAcsh directly regulates heroin SA behavior. Selective viral-mediated knockdown of Penk in striatopallidal neurons attenuates heroin SA in adolescent THC-exposed rats, whereas Penk overexpression potentiates heroin SA in THC-naïve rats. Furthermore, we report that adolescent THC exposure mediates Penk upregulation through reduction of histone H3 lysine 9 (H3K9) methylation in the NAcsh, thereby disrupting the normal developmental pattern of H3K9 methylation.

Conclusions

These data establish a direct association between THC-induced NAcsh Penk upregulation and heroin SA and indicate that epigenetic dysregulation of Penk underlies the long term effects of THC.

Source:  Biol Psychiatry. 2012 November 15; 72(10): 803–810. doi:10.1016/j.biopsych.2012.04.026.

SPOKANE, Wash. – The release of more data on the effects of marijuana on a baby has led researchers to the conclusion that moms should think twice before using pot during and after pregnancy.

Many moms turn to marijuana for relief of symptoms such as nausea and anxiety, yet scientific research is emerging that identifies associated risks.

Confusion over the safety of these products prompted multiple agencies, including the Spokane Regional Health District, to launch a new component to its Weed to Know campaign: Weed to Know for Baby and You.

The campaign educates families and caregivers about harms associated with marijuana use while pregnant, breastfeeding, or caring for children. The campaign stresses the results of several peer-reviewed studies, which revealed: Marijuana use before pregnancy could:  -Cause a baby to be born before his or her body and brain are ready. This  could mean serious health problems at birth and throughout life.

-Change how a baby’s brain develops. These changes may cause life-long  behavior problems like trouble paying attention or following rules.  for them to do well in school. Marijuana use during breastfeeding is associated with these risks:  -Feeding problems, as THC, the active ingredient in marijuana, can lower milk  supply.

-Increased risk for sudden infant death syndrome

Using marijuana can affect a person’s ability to safely care for a baby or other children. Marijuana use decreases a person’s ability to concentrate, impairs judgment, and slows response time.

“We hear all the time from mothers who feel they used marijuana ‘successfully’ in previous pregnancies, or know someone who did, but it is also likely the child is not old enough yet to exhibit the long-term health consequences,” said Melissa Charbonneau, a public health nurse in the health district’s Children and Youth with Special Health Care Needs program. “To be on the safe side, your best bet is to avoid marijuana altogether while you’re expecting.”

Source: http://www.kxly.com/news/local-news/marijuana-use-during-pregnancy-associated-with-many-risks-studies-reveal/531202931

Prenatal exposure to smoke and alcohol may increase the risk of children developing conduct problems in adolescence, researchers said.

Conduct disorder (CD) is a mental disorder where children demonstrate aggressive behaviour that causes or threatens harm to other people or animals such as bullying or intimidating others, often initiating physical fights, or being physically cruel to animals.

The findings, led by researchers from the King’s College London, showed that exposure to smoke and alcohol, especially during foetal development, may lead to some epigenetic changes — chemical modifications of DNA that turns our genes on or off — particularly in genes related to addiction and aggression, leading to conduct problems in children.

One of the genes which showed the most significant epigenetic changes is MGLL — known to play a role in reward, addiction and pain perception.  Previous research have revealed that conduct problems are often accompanied by substance abuse and there is also evidence indicating that some people who engage in antisocial lifestyles show higher pain tolerance. The researchers also found smaller differences in a number of genes previously associated with aggression and antisocial behaviour.

“There is good evidence that exposure to maternal smoking and alcohol is associated with developmental problems in children, yet we don’t know how increased risk for conduct problems occurs”.

These results suggest that epigenetic changes taking place in the womb are a good place to start,” said Edward Barker from King’s College London. The results highlight the neonatal period as a potentially important window of biological vulnerability, as well as pinpointing novel genes for future investigation.

For the study, published in the journal Development and Psychopathology, the team measured the influence of environmental factors previously linked to an early onset of conduct problems, including maternal diet, smoking, alcohol use and exposure to stressful life events. They found epigenetic changes in seven sites across the DNA of those who went on to develop early-onset of conduct problems. Some of these epigenetic differences were associated with prenatal exposures, such as smoking and alcohol use during pregnancy.

Source: http://www.thehealthsite.com/news/prenatal-exposure-to-smoke-alcohol-may-increase-behaviour-problems-in-kids-ag0617/ Published: June 13, 2017 

Study Finds Users Are 26 Times More Likely To Turn To Other Substances By The Age Of 21

Study is first clear evidence that cannabis is gateway to cocaine and heroin

Teen marijuana smokers are 37 times more likely to be hooked on nicotine

Findings from Bristol University provide authoritative support for those warning against the liberalisation of drugs laws

Teenagers who regularly smoke cannabis are 26 times more likely to turn to other drugs by the age of 21.

The study of the lives of more than 5,000 teenagers produced the first resounding evidence that cannabis is a gateway to cocaine, amphetamines, hallucinogens and heroin.

It also discovered that teenage cannabis smokers are 37 times more likely to be hooked on nicotine and three times more likely to be problem drinkers than non-users of the drug.

The findings from Bristol University provide authoritative support for those warning against the liberalisation of drugs laws.

Medical researchers have argued for years that cannabis is far from harmless and instead carries serious mental health risks.

Dr Michelle Taylor, who led the study, said: ‘It has been argued that cannabis acts as a gateway to other drug use. However, historically the evidence has been inconsistent.

‘The most important findings from this study are that one in five adolescents follow a pattern of occasional or regular cannabis use and that those individuals are more likely to be tobacco dependent, have harmful levels of alcohol consumption or use other illicit drugs in early adulthood.

‘Our study does not support or refute arguments for altering the legal status of cannabis use.

‘This study and others do, however, lend support to public health strategies and interventions that aim to reduce cannabis exposure in young people.’

The Bristol evidence was gathered from a long-term survey of the lives of young people around the city, the Avon Longitudinal Study of Parents and Children.

The survey, which was published in the Journal of Epidemiology & Community Health, examined 5,315 teenagers between the ages of 13 and 18. One in five used cannabis.

Dr Tom Freeman of King’s College London said: ‘This is a high quality study using a large UK cohort followed from birth. It provides further evidence that early exposure to cannabis is associated with subsequent use of other drugs.’

The study of the lives of more than 5,000 teenagers produced the first resounding evidence that cannabis is a gateway to cocaine amphetamines, hallucinogens and heroin .

Ian Hamilton, who is a mental health researcher at York University, said: ‘It adds to evidence that cannabis acts as a gateway to nicotine dependence, as the majority of people using cannabis in the UK combine tobacco with cannabis when they roll a joint.

‘This habit represents one of the greatest health risks to the greatest number of young people who use cannabis.  It suggests that adolescent cannabis use serves as a gateway to a harmful relationship with drugs as an adult.’

The report said: ‘After taking account of other influential factors, those who used cannabis in their teens were at greater risk of problematic substance misuse by the age of 21.

‘Teens who regularly used cannabis were 37 times more likely to be nicotine dependent and three times more likely to have a harmful drinking pattern than non-users by the time they were 21. And they were 26 times more likely to use other illicit drugs.

‘Both those who used cannabis occasionally early in adolescence and those who started using it much later during the teenage years had a heightened risk of nicotine dependence, harmful drinking, and other illicit drug use.

‘And the more cannabis they used the greater was the likelihood of nicotine dependence by the age of 21.’

Source:  http://www.dailymail.co.uk/news/article-4582548/Proof-cannabis-DOES-lead-teenagers-harder-drugs.html   8th June 2017

 

Changes may increase risk of continued drug use and addiction

ANN ARBOR, Mich. — Most people would get a little ‘rush’ out of the idea that they’re about to win some money. In fact, if you could look into their brain at that very moment, you’d see lots of activity in the part of the brain that responds to rewards.

But for people who’ve been using marijuana, that rush just isn’t as big – and gets smaller over time, a new study finds.

And that dampened, blunted response may actually open marijuana users up to more risk of becoming addicted to that drug or others.

The new results come from the first long-term study of young marijuana users that tracked brain responses to rewards over time. It was performed at the University of Michigan Medical School.

Published in JAMA Psychiatry, it shows measurable changes in the brain’s reward system with marijuana use – even when other factors like alcohol use and cigarette smoking were taken into account.

“What we saw was that over time, marijuana use was associated with a lower response to a monetary reward,” says senior author and U-M neuroscientist Mary Heitzeg, Ph.D. “This means that something that would be rewarding to most people was no longer rewarding to them, suggesting but not proving that their reward system has been ‘hijacked’ by the drug, and that they need the drug to feel reward — or that their emotional response has been dampened.”

Watching the reward centers

The study involved 108 people in their early 20s – the prime age for marijuana use. All were taking part in a larger study of substance use, and all had brain scans at three points over four years. Three-quarters were men, and nearly all were white.

While their brain was being scanned in a functional MRI scanner, they played a game that asked them to click a button when they saw a target on a screen in front of them. Before each round, they were told they might win 20 cents, or $5 – or that they might lose that amount, have no reward or loss.

The researchers were most interested at what happened in the reward centers of the volunteers’ brains – the area called the nucleus accumbens. And the moment they cared most about was that moment of anticipation, when the volunteers knew they might win some money, and were anticipating performing the simple task that it would take to win.

In that moment of anticipating a reward, the cells of the nucleus accumbens usually swing into action, pumping out a ‘pleasure chemical’ called dopamine. The bigger the response, the more pleasure or thrill a person feels – and the more likely they’ll be to repeat the behavior later.

But the more marijuana use a volunteer reported, the smaller the response in their nucleus accumbens over time, the researchers found.

While the researchers didn’t also look at the volunteers’ responses to marijuana-related cues, other research has shown that the brains of people who use a high-inducing drug repeatedly often respond more strongly when they’re shown cues related to that drug.

The increased response means the drug has become associated in their brains with positive, rewarding feelings. And that can make it harder to stop seeking out the drug and using it.

If this is true with marijuana users, says first author Meghan Martz, doctoral student in developmental psychology at U-M, “It may be that the brain can drive marijuana use, and that the use of marijuana can also affect the brain. We’re still unable to disentangle the cause and effect in the brain’s reward system, but studies like this can help that understanding.

Change over time

Regardless, the new findings show that there is change in the reward system over time with marijuana use. Heitzeg and her colleagues also showed recently in a paper in Developmental Cognitive Neuroscience that marijuana use impacts emotional functioning.

The new data on response to potentially winning money may also be further evidence that long-term marijuana use dampens a person’s emotional response – something scientists call anhedonia.

“We are all born with an innate drive to engage in behaviors that feel rewarding and give us pleasure,” says co-author Elisa Trucco, Ph.D., psychologist at the Center for Children and Families at Florida International University. “We now have convincing evidence that regular marijuana use impacts the brain’s natural response to these rewards. In the long run, this is likely to put these individuals at risk for addiction.”

Marijuana’s reputation as a “safe” drug, and one that an increasing number of states are legalizing for small-scale recreational use, means that many young people are trying it – as many as a third of college-age people report using it in the past year.

But Heitzeg says that her team’s findings, and work by other addiction researchers, has shown that it can cause effects including problems with emotional functioning, academic problems, and even structural brain changes. And, the earlier in life someone tries marijuana, the faster their transition to becoming dependent on the drug, or other substances.

“Some people may believe that marijuana is not addictive or that it’s ‘better’ than other drugs that can cause dependence,” says Heitzeg, who is an assistant professor of psychiatry at the U-M Medical School and member of the U-M Addiction Research Center. “But this study provides evidence that it’s affecting the brain in a way that may make it more difficult to stop using it. It changes your brain in a way that may change your behavior, and where you get your sense of reward from.”

She is among the neuroscientists and psychologists leading a nationwide study called ABCD, for Adolescent Brain Cognitive Development. That study will track thousands of today’s pre-teens nationwide over 10 years, looking at many aspects of their health and functioning, including brain development via brain scans. Since some of the teens in the study are likely to use marijuana, the study will provide a better chance of seeing what happens over time.

Source: JAMA Psychiatry, doi:10.1001/jamapsychiatry.2016.1161

A Colorado children’s hospital reports visits by teens to its emergency department and satellite urgent care centers more than quadrupled after the state legalized marijuana, a new study finds.

Researchers examined the hospital’s records for 13- to 21-year-olds between 2005 and 2015.

Colorado legalized medical marijuana in 2010 and recreational marijuana in 2014.

The annual number of visits related to marijuana or involving a positive marijuana urine drug screen more than quadrupled, from 146 in 2005 to 639 in 2014, the researchers found.

They will present their research at the 2017 Paediatric Academic Societies Meeting in San Francisco.

“The state-level effect of marijuana legalization on adolescent use has only begun to be evaluated,” lead author George Sam Wang, MD said in a news release. “As our results suggest, targeted marijuana education and prevention strategies are necessary to reduce the significant public health impact of the drug can have on adolescent populations, particularly on mental health.”

Source:  https://www.ncadd.org/blogs/in-the-news/teen-marijuana-related-visits-to-colorado-er-rose-rapidly-after-legalization   8th May 2017

In this guest blog, Kate Fleming, Senior Lecturer, Public Health Institute, Liverpool John Moores University, and Raja Mukherjee, Consultant Psychiatrist, Lead Clinician UK National FASD clinic, Surrey and Borders Partnership NHS Foundation Trust consider the context and future for Foetal Alcohol Spectrum Disorders in the UK.

A recent opinion piece in The Guardian entitled Nothing prepared me for pregnancy- apart from the never ending hangover of my 20s took a, presumably, humorous take on the tiredness, vomiting, dehydration, and secrecy that so many women live through in early pregnancy, likening this to days spent hungover after excessive drinking in the author’s early 20s.

In an article that was entirely about alcohol and pregnancy there was reassuringly no mention of the author consuming alcohol during pregnancy, indeed quite the reverse “I don’t actually want booze in my body”.  But neither was there explicit reference to the harms that alcohol can cause in pregnancy.

The harms caused by consuming alcohol in pregnancy

Foetal Alcohol Spectrum Disorders (FASD) is an umbrella term that encompasses the broad range of conditions that are related to maternal alcohol consumption.  The most severe end of the spectrum is Foetal Alcohol Syndrome (FAS) associated with distinct facial characteristics, growth restriction and permanent brain damage.  However, the spectrum includes conditions displaying mental, behavioural and physical effects on a child which can be difficult to diagnose.  Confusingly, these conditions also go under several other names including Neuro-developmental Disorder associated with Prenatal Alcohol Exposure (ND-PAE) the preferred term by the American Psychiatric Association’s fifth version of its Diagnostic and Statistical Manual (APA DSM-V), alcohol-related birth defects, alcohol-related neuro-developmental disorder, and partial foetal alcohol syndrome.

How common is FASD? A recent study which brought together information from over 300 studies estimates the prevalence of drinking in pregnancy to be close to 10%, and around 1 in 4 women in Europe drinking during pregnancy. Their estimates of FAS (the most severe end of the spectrum) were 14.6 per 10000 people worldwide or 37.4 per 10000 people in Europe, corresponding to 1 child in every 67 women who drank being born with FAS.

Given the figure for alcohol consumption in pregnancy is even higher in the UK, with some studies suggesting up to 75% of women drink at some point in their pregnancy, conservatively in the UK we might expect a prevalence of FASD of at least 1%.  We also know that it is highly unlikely that anything close to this number of individuals have formally had a diagnosis.  This lack of knowledge of the prevalence in the UK is hampering efforts to ensure the required multi-sector support for those affected by FASD and their families.

Current policy

For some time a significant focus of alcohol in pregnancy research was to try and identify a safe threshold of consumption, without demonstrable success.  No evidence of harm at low levels does not however equate to evidence of no harm and as such in 2016 the Chief Medical Officer revised guidance on alcohol consumption in pregnancy to recommend that women should avoid alcohol when trying to conceive or when pregnant.  Though this clarity of guidelines has been well received by the overwhelming majority of health professionals there are barriers to its implementation with few professionals “very prepared to deal with the subject”.  In addition, knowledge of the guideline amongst the general public has yet to be evaluated.

As part of the 2011 public health responsibility deal a commitment to 80% of products having labels which include warnings about drinking when pregnant forms part of the alcohol pledges. A study in 2014 showed that 90% of all labels did indeed include this information. However, it has also been shown that this form of education is amongst the least effective in terms of alcohol interventions, and the pledge is no longer in effect.

Pregnancy is recognised as a good time for the initiation of behaviour change yet in the context of alcohol consumption it is arguably too late. An estimated half of all pregnancies are unplanned and there remains therefore a window of early pregnancy before a woman is likely to have had contact with a health professional and before the guidelines can be explained during which unintentional damage to her unborn baby could occur.  The same argument can be used when considering the suggestion of banning the sale of alcohol to pregnant women – visible identification of pregnancy tends only to be possible at the very latest stages.

How then to address consumption of alcohol during pregnancy? 

Consumption of alcohol is doubtless shaped by the culture and context of the society in which one is living.  Highest levels of alcohol consumption in pregnancy are, unsurprisingly, seen in countries where the population consumption of alcohol is also highest.  Current UK policy that is directed to reducing population consumption of alcohol will likely have a knock-on effect of reducing alcohol consumption in pregnancy.

Many women will however be familiar with the barrage of questions that they encounter when not drinking on a night out.  From the not-so-subtle “Not drinking, eh… Wonder why that is? <nudge, nudge, wink, wink>” to the more overt “Are you pregnant?”.  The road to conception and pregnancy is littered with enough stumbling blocks and pressures that the additional unintentional announcement of either fact of conception or intention to conceive is an unnecessary cause of potential further anxiety. Until society accepts that not drinking is an acceptable choice, without any need for clarification or explanation, then pregnant women or those hoping to conceive who are adhering to guidelines will continue to identify themselves, perhaps before they want to.

What next?

The UK’s All Party Parliamentary Group for FASD had its inaugural meeting in June 2015.  This group calls for an increased awareness of FASD particularly regarding looked

after children and individuals within the criminal justice system, sectors where the prevalence of FASD is particularly high. Concerted efforts need to be made to identify children with FASD to ensure that the appropriate support pathways are in place. Alongside this, efforts to ensure the best mechanisms for education of the dangers of alcohol consumption in pregnancy need to be increased, including training for midwives, and other health professionals who may be able to offer brief intervention and advice to women both before and after conception.

The views expressed by the authors are theirs alone and do not represent the views of Liverpool John Moores University, the UK National FASD clinic at Surrey and Borders Partnership NHS Foundation Trust. NOFAS run a national FASD helpline on on 020 8458 5951 as do the FASD Trust on 01608 811 599.

Source:  http://www.alcoholpolicy.net/2017/05/drinking-in-pregnancy-where-next-for-fasd-in-the-uk.html

Researchers at Canada’s Waterloo University studied what happens to academic goals, engagement, preparedness, and performance when high school students shift from no marijuana use to marijuana use. Their sample included 26,475 students in grades 9-12 in the COMPASS study, Canada’s largest survey of youth substance use. The researchers found that compared to students who do not use marijuana, those who use it at least once a month were:

· four times more likely to skip class,

· two to four times less likely to complete homework,

· two to four times less likely to value getting good grades, and

· half as likely to actually get good grades.

Moreover, half of those who smoked marijuana daily were less likely to report plans to attend college compared to nonusers. “We found that the more frequently students started using the drug, the greater their risk for poor school performance and engagement,” says Karen Patte, lead author of the study. Read more here.

Source: srusche@nationalfamilies.org  National Families in Action’s The Marijuana Report 17TH May 2017

SAN FRANCISCO – Visits by teens to a Colorado children’s hospital emergency department and its satellite urgent care centers increased rapidly after legalization of marijuana for commercialized medical and recreational use, according to new research being presented at the 2017 Paediatric Academic Societies Meeting in San Francisco.

The study abstract, “Impact of Marijuana Legalization in Colorado on Adolescent Emergency Visits” on Monday, May 8 at the Moscone West Convention Center in San Francisco.

Colorado legalized the commercialization of medical marijuana in 2010 and recreational marijuana use in 2014. For the study, researchers reviewed the hospital system’s emergency department and urgent care records for 13- to 21-year-olds seen between January 2005 and June 2015.

They found that the annual number of visits with a cannabis related diagnostic code or positive for marijuana from a urine drug screen more than quadrupled during the decade, from 146 in 2005 to 639 in 2014.

Adolescents with symptoms of mental illness accounted for a large proportion (66%) of the 3,443 marijuana-related visits during the study period, said lead author George Sam Wang, M.D., FAAP, with psychiatry consultations increasing from 65 to 442. More than half also had positive urine drug screen tests for other drugs. Ethanol, amphetamines, benzodiazepines, opiates and cocaine were the most commonly detected.

Dr. Wang, an assistant professor of paediatrics at the University of Colorado Anschutz Medical Campus, said national data on teen marijuana use suggest rates remained roughly the same (about 7%) in 2015 as they’d been for a decade prior, with many concluding no significant impact from legalization. Based on the findings of his study, however, he said he suspects these national surveys do not entirely reflect the effect legalization may be having on teen usage.

“The state-level effect of marijuana legalization on adolescent use has only begun to be evaluated,” he said. “As our results suggest, targeted marijuana education and prevention strategies are necessary to reduce the significant public health impact of the drug can have on adolescent populations, particularly on mental health.”

Dr. Wang will present the abstract, “Impact of Marijuana Legalization in Colorado on Adolescent Emergency Department (ED) Visits,” from 8 a.m. to 10 a.m. Numbers in this news release reflect updated information provided by the researchers. The abstract is available at https://registration.pas-meeting.org/2017/reports/rptPAS17_abstract.asp?abstract_final_id=3160.11.

The Paediatric Academic Societies (PAS) Meeting brings together thousands of individuals united by a common mission: to improve child health and well-being worldwide. This international gathering includes paediatric researchers, leaders in academic paediatrics, experts in child health, and practitioners. The PAS Meeting is produced through a partnership of four organizations leading the advancement of paediatric research and child advocacy: Academic Paediatric Association, American Academy of Paediatrics, American Paediatric Society, and Society for Paediatric Research. For more information, visit the PAS Meeting online at www.pas-meeting.org, follow us on Twitter @PASMeeting and #pasm17, or like us on Facebook. For additional AAP News coverage, visit http://www.aappublications.org/collection/pas-meeting-updates.

Source:   http://www.aappublications.org/news/2017/05/04/PASMarijuana050417

In Southern Ohio, the number of drug-exposed babies in child protection custody has jumped over 200%.  The problem is so dire that workers agreed to break protocol to invite a reporter to hear their stories.  Foster care placements are at record levels, and the number of drug-exposed newborns in their custody has jumped over 200% in the past decade

Inside the Clinton County child protection office, the week has been tougher than most.

Caseworkers in this thinly populated region of southern Ohio, east of Cincinnati, have grown battle-weary from an opioid epidemic that’s leaving behind a generation of traumatized children. Drugs now account for nearly 80% of their cases. Foster-care placements are at record levels, and the number of drug-exposed newborns in their custody has jumped over 200% in the past decade. Funding, meanwhile, hasn’t budged in years.

“Many of our children have experienced such high levels of trauma that they can’t go into traditional foster homes,” said Kathi Spirk, director of Clinton County job and family services. “They need more specialized care, which is very expensive.”

The problem is so dire that workers agreed to break protocol and invite a reporter to camp out in a conference room and hear their stories. For three days, they relived their worst cases and unloaded their frustrations, in scenes that played out like marathon group therapy, for which they have no time. Many agreed that talking about it only made them feel worse, yet still they continued, one after another.

Hence the bad week.

Given the small size of their community, they asked that their names be changed out of concern for their own safety and the privacy of the children.

The caseworkers, like most, are seasoned in despair. Many worked in the 1990s when crack cocaine first arrived, followed by crystal meth in the early 2000s. In 2008, after the shipping giant DHL shuttered its domestic hub here in Wilmington and shed more than 7,000 jobs, prescription pill mills flourished while the economy staggered. Back then, a typical month saw 30 open cases, only a few of them drug-related. But the flood of cheap heroin and fentanyl, now at its highest point yet, has changed everything. A typical month now brings four times as many cases, while institutional knowledge has been flipped on its head.

“At least with meth and cocaine, there was a fight,” said Laura, a supervisor with over 20 years of experience. “Parents used to challenge you to not take their kids. And now you have them say: ‘Here’s their stuff. Here’s their formula and clothes.’ They’re just done. They’re not going to fight you any more.”

Heroin has changed how they approach every step of their jobs, they said, from the first intake calls to that painstaking decision to place a child into temporary foster care or permanent custody. Intake workers now fear what used to be routine.

“Occasionally, we’d get thrown a dirty house, something easy to close and with little trauma to the child,” said Leslie, another worker. “We’re not getting those any more.

Now they’re all serious, and most of them have a drug component. So you may get a dirty house, but it’s never just a dirty house.”

‘I had a four-year old whose mom had died in front of her and she described it like it was nothing’ Children come into the system in two ways. The first is through a court order after caseworkers deem their environment unsafe, and if no friends or family can be found.

Because of the added trauma, removing a child is always the last option, caseworkers said. But in a county with only 42,000 people spread out over 400 square miles, the magnitude of the epidemic has compromised an already delicate safety net. Relatives are overwhelmed financially. Multiple generations are now addicted, along with cousins, uncles, and neighbors. In many cases, a safe house with a grandparent or other relative will eventually attract drug activity.

Law enforcement will also bring children in, usually after parents overdose. These cases often reveal the most horrendous neglect: a three-year old who needed every tooth pulled because he’d never been made to brush them, or kids found sleeping on bug-infested mattresses, going to the toilet in buckets because the water had been shut off. Children are coming in more hardened, they said, older than their years.

“I had a four-year-old whose mom had died in front of her and she described it like it was nothing,” said Bridgette, another caseworker. “She knew how to roll up a dollar bill and snort white powder off the counter. That’s what she thought dollar bills were for.” She added that many of the children could detail how to cook heroin. One foster family had a five-year-old boy who put his medicine dropper in his shoe. “Because that’s where daddy hid his needles,” she said.

“The kids are used to surviving in that mess,” added Carole, another veteran. “Now all the sudden the system is going in and saying it’s not safe. All their survival instincts are taken away and they go ballistic. They don’t know what to do.”

During the first weeks of foster care, meltdowns, tantrums, and violence are common as children navigate new landscapes and begin to process what they’ve experienced.

One afternoon, the caseworkers brought in a foster couple who’d taken in two sisters, an infant born drug-exposed, and her four-year old sister. The baby had to be weaned off opioids and now suffered chronic respiratory problems. Part of her withdrawal had included non-stop hiccups. The older girl had lived with her parents in a drug house and displayed clear signs of post-traumatic stress. Once, a family friend sitting next to her in a car had overdosed and turned purple. She’d witnessed domestic abuse, and one day a neighbor shot and killed her dog while she watched (she’d let the dog out). After a meltdown at a classmate’s pool party, over a year after entering foster care, she revealed having seen a toddler drown in a pond while adults got high. Through therapy, she’d also revealed sexual assault. The foster mother described how the girl suffered flashbacks, triggered by stress and certain anniversaries, like the day of her removal, and other seemingly random events. When this happened, she slipped into catatonic seizures.

“Her eyes are closed and you can’t wake her,” she said. “It’s like narcolepsy, a deep, unconscious sleep. We later discovered it was a coping mechanism she’d developed in order to survive.”

Despite what they’ve endured, most children wish desperately to return to their parents. Many come to see themselves as their parents’ caretakers and feel guilty for being taken away, especially if they were the ones to report an overdose, as in the case of a four-year-old girl who climbed out of a window to alert a neighbor. “She asked me: if I took her away, who was going to take care of mommy?” Bridgette remembered.

For caseworkers, reunification is the endgame. After children enter temporary foster care, the agency spends up to two years working closely with the family while the parents try to stay sober. The only contact with their children comes in the form of twice-weekly visits held in designated rooms here at the office. Each contains a tattered sofa and some second-hand toys. Currently, the agency runs about 200 visits each week. The encounters are monitored through closed-circuit cameras. For everyone involved, it can be the most trying period.

Many parents use the time to build trust and re-establish bonds. “During those first four years, a child gets such good stuff from their parents,” said Sherry, the caseworker who monitors the visits. “The kids are just trying to get that back.” Some parents bring doughnuts and pictures, while others need more guidance. Caseworkers hold parenting classes. Some moms lost newborns at the hospital after they tested positive for drugs; workers teach them how to feed and hold the child, and encourage them to bring outfits to dress their babies.

For other children, the visits trigger a storm of emotion that churns up the trauma of removal. “We had one girl who’d scream and wail at the end of every visit,” Laura, the supervisor, remembered. “Each time she thought she’d never see her mother again. We’d have to pry her out of mom’s arms and carry her down the hallway.”

“We’d sit in our offices and just sob,” added another worker. “But that girl’s cries weren’t enough to keep Mom off heroin.”

The number of available foster families is dwindling, while the cost of supporting them has never been higher

Perhaps the greatest difference with heroin and opioids, caseworkers said, is their iron grasp. Staying sober is a herculean task, especially in this rural community short on resources, where the nearest treatment facilities are over 30 miles away in Dayton, Cincinnati, or Columbus. At some point, nearly every parent falls off the wagon. They disappear and miss visits, leaving children to wait. One of the hardest parts of the job is telling a child that mom or dad isn’t coming, or that they can’t even be found.

“You see the hurt in their eyes,” Sherry said. “It’s a look of defeat, and it just breaks your heart.” She remembered a mother who’d failed to show up for months, then made it for her twin boys’ birthday. “The next day she overdosed and died.”

A tally sheet is used to track how many times prospective clients waiting to enter the program call a detox center, in Huntington, West Virginia. Photograph: Brendan Smialowski/AFP/Getty Images

When parents fail drug screenings during the 18-month period, caseworkers use discretion. Parents might be doing better in other areas like landing a job, or finding secure housing, so workers help them to get back on the wagon. “It’s all about showing progress,” Laura said. Some parents make it 16, 17 months sober and fully engaged. “And they’re the toughest cases, because we’ve been rooting for them this whole time and helping them. We’re giving kids pep talks, saying: ‘Mom’s doing great, she’s getting it together!’ They’re so happy to be going home. And then it all falls apart.”

With heroin, defeat is something the workers have learned to reckon with. Lately they’ve started snapping photos of parents and children during their first visit together, getting medical histories and other vital information – something they used to do much later. “Because we know the parents probably aren’t going to make it,” Laura admitted. “And if we never see them again, this is the info we need.” When asked how many opioid cases had ended in reunification, only two workers raised their hands.

The repeated disappointments come as resources and morale have reached their tipping point. The number of available foster families is dwindling, they said, while the cost of supporting them – over $1.5m a year – has never been higher.

Spirk, the agency’s director, said that all the agency’s budget was paid for with federal dollars and a county tax levy, although they’ve been flat-funded for nearly 10 years. The state contributes just 10%. When it comes to investing in child protection, Ohio ranks last in the country – despite having spent nearly $1bn fighting its opioid problem in 2016 alone.

The Ohio house of representatives recently passed a new state budget with an additional $15m for child protective services, but the state senate has yet to pass its own version. The only bit of hope came in March, when the Ohio attorney general’s office announced a pilot program that will give Clinton County, along with others, additional resources to help treat children for trauma, and to assist with drug treatment. It starts in October.

The epidemic’s unrelenting barrage has also taken a toll on mental health. “Our caseworkers are experiencing secondary trauma and frustration at not being able to reunify children with their parents because of relapses,” Spirk said.

Almost every caseworker said they had experienced depression or some form of PTSD, although no one had sought professional help. The privacy of their cases also means that few can speak openly with friends or family members. Some chose to drink, while others leaned on their faiths. But most said coping mechanisms they once relied on had failed.

“I used to have a routine on my drive home,” Laura said. “I’d stop in front of a church, roll down my window, and throw out all the day’s problems. The next morning I’d pick them back up. These days, I can’t do that anymore.”

“There’s no more outlet,” added Shelly, another supervisor. “You think you’re able to separate but you can’t let it go anymore. You try to eat healthy, do yoga, whatever they tell you to do. But it’s just so horrific now, and it keeps getting worse.”

At some point, the inevitable happens. When a parent can’t stay sober, or stops showing progress, the decision is made to place the child into permanent custody and put them up for adoption. For everyone, including caseworkers, it’s the most wrenching day.

The final act of every case is the “goodbye visit”, held in one of the nicer conference rooms. It’s a chance for parents to let their children know they love them and will miss them, and that it’s time to move on. Adoptive parents can choose to stay in contact, but it isn’t mandatory.

To make the time less stressful, Sherry, the worker who monitors the visits, has them draw pictures together, which she scans and gives to them as mementoes. She also tapes the meetings for them to keep. Watching from her tiny room full of TV screens, she can’t help but cry. “What people don’t realize is that when a baby comes into our custody, they’re still in a carrier seat. By the time the case is over, we’ve helped to potty train them. Two years is a very long time with a child. So in a way, it’s like my goodbye visit, too.”

Caseworkers have started making “life books” for kids once they come into the system. It’s where they put the photos they’ve taken, plus any pictures of birth parents or relatives they can find, report cards, ribbons and medals – the souvenirs of any childhood.  “It’s their history,” Sherry said, “so that one day they can make sense of their lives.”   She noted that one kid, after turning 18, tore his to pieces, taking with him only the good memories.

Source:  https://www.theguardian.com/us-news/2017/may/17/ohio-drugs-child-protection-workers

Abstract

Marijuana (Cannabis sativa) is the most commonly used illicit drug by pregnant women, but information is limited about the effects of prenatal cannabis exposure on foetal development. The present study evaluated the influence of early maternal marijuana use on foetal growth.

Women electing voluntary saline-induced abortions were recruited at a mid-gestational stage of pregnancy (weeks 17-22), and detailed drug use and medical histories were obtained. Toxicological assays (maternal urine and foetal meconium) were used in conjunction with the maternal report to assign groups. Subjects with documented cocaine and opiate use were excluded.

Main developmental outcome variables were foetal weight, foot length, body length, and head circumference; ponderal index was also examined. Analyses were adjusted for maternal alcohol and cigarette use. Marijuana (n=44)- and non-marijuana (n=95)-exposed foetuses had similar rates of growth with increased age. However, there was a 0.08-cm (95% CI -0.15 to -0.01) and 14.53-g (95% CI -28.21 to 0.86) significant reduction of foot length and body weight, respectively, for marijuana-exposed foetuses.

Moreover, foetal foot length development was negatively correlated with the amount and frequency of marijuana use reported by the mothers. These findings provide evidence of a negative impact of prenatal marijuana exposure on the mid-gestational foetal growth even when adjusting for maternal use of other substances well known to impair foetal development. PMID: 15734273    DOI: 10.1016/j.ntt.2004.11.002

Source:  https://www.ncbi.nlm.nih.gov/pubmed/15734273

ABSTRACT

Background

It has long been established that smoking tobacco during pregnancy causes increased risk of miscarriage, increased placental problems, reduction of birth weight, and a variety of birth defects [1].

In light of the recent legalization of marijuana in Colorado, Washington, Alaska and Washington, D.C., we felt it important to establish and publicize the causative relationship between cannabis usage and embryological outcomes. The main psychoactive cannabinoid in marijuana is delta-9-tetrahydrocannabinol (THC), which has a half-life of approximately 8 days in fat deposits and can be detected in blood for up to 30 days before becoming entirely eliminated from the blood [2]. These characteristics act as a direct risk factor to the developing embryo, as the maternal tissues act as reservoirs for THC and other cannabinoids.

Certain drugs cross the placenta to reach the embryo in the same manner as oxygen and other nutrients [3]. Drugs consumed during pregnancy can act directly on the embryo, or they can alter placental function, which is critical for normal growth and development.

Ingestion of drugs can interfere with these functions, resulting in compromised fetal development and growth [3]. THC readily crosses the placenta, which, in conjunction with slow fetal clearance, results in prolonged fetal exposure to THC, even after consumption is discontinued [2].

The use of marijuana in early pregnancy is associated with many of the same risks as tobacco, including miscarriage, congenital malformations, and learning disabilities [4]. Adverse effects of marijuana use during pregnancy have been exacerbated over the years, as THC levels in marijuana have increased nearly 25-fold since 1970 [5]. This paper looks to examine recent studies on cannabinoids and embryonic development in order to establish the mechanisms through which these cannabinoids act.

Source:  Friedrich, Joseph et al. “The Grass Isn’t Always Greener: The Effects of Cannabis on Embryological Development.” BMC Pharmacology & Toxicology 17 (2016): 45. PMC. Web. 21 Apr. 2017.

Kuei Y. Tseng was awarded $1.95 million by NIH for a five-year study of “Adolescent Maturation of the Prefrontal Cortex: Modulation by Cannabinoids.” Regular marijuana use by teens can stop the brain from maturing, according to a new study by scientists at Rosalind Franklin University of Medicine and Science, North Chicago, IL. Published March 4 in the journal Molecular Psychiatry, the study is the first to establish a causal link between repeated cannabinoid exposure during adolescence and an interruption of the normal maturation processes in the prefrontal cortex, a region in the brain’s frontal lobe, which regulates decision making and working memory and undergoes critical development during adolescence.

The findings apply to natural cannabinoids, including those in marijuana, and a new generation of more potent, synthetic cannabinoid products. THC, the compound in marijuana that produces feelings of euphoria, is of particular concern. The chemical can be manipulated, resulting in varying concentrations between marijuana strains – from 2 to 28 percent. A higher concentration of THC and increasing use by younger teens poses a greater risk for long term negative effects, the study finds. Kuei Y. Tseng, MD, PhD, associate professor of cellular and molecular pharmacology at the Chicago Medical School at RFUMS and principal investigator of the study, blames the CB1 cannabinoid receptor, which governs neuronal communication, for the drug’s long -lasting effect.

Tseng and his team of researchers used rat models in testing the effect of cannabinoid exposure during narrow age windows and analyzed the way information is later processed by the adult prefrontal cortex. They discovered that when CB1 receptors are repeatedly activated by cannabinoids during early adolescence, development of the prefrontal cortex stalls in that phase. The window of vulnerability represents two thirds of the span of adolescence. Test animals showed no such effect when exposure occurred in late adolescence or adulthood.

“We have conclusively demonstrated that an over activation of the CB1 receptor during the window equivalent to age 11 to 17 in humans, when the prefrontal cortex is still developing, will inhibit its maturation and have a long lasting effect on its functions,” Tseng said.

The study shows how chronic cannabis use by teens can cause persistent behavioral deficits in adulthood, including problems with attention span and impulse control. The findings also add to prior research that draws a correlation between adolescent marijuana abuse and the development of schizophrenia.

The discovery, which comes as a growing number of states are considering legalization of marijuana for both medicinal and recreational use, calls for the attention of physicians who prescribe medical marijuana and policy makers who, according to Tseng, “will have to establish regulations to take advantage of the beneficial effects of marijuana while minimizing its detrimental potential.”

Researchers are focusing on developing outcome measures to reveal the degree of frontal lobe maturation and history of drug exposure. The challenge now, Tseng said, is to find ways to return the frontal lobe back to a normal state either through pharmacological or cognitive interventions.

“Future research will tell us what other mechanisms can be triggered to avoid this type of impairment of the frontal lobe,” Tseng said. “Ultimately, we want to restore the prefrontal cortex.”

Supported by RFUMS, the research was funded primarily through NIH Grant R01-MH086507 to Tseng and also by a 2012 seed grant from the Brain Research Foundation.

Source:  https://www.rosalindfranklin.edu/news/profiles/study-shows-marijuana-use-interrupts-adolescent-brain-development/   4th March 2017

Whether it’s knocking on a nearby door, making a quick call, or agreeing a deal on the way to school, there’s no ID necessary and no questions asked: teenagers in London never have to venture too far to find skunk.

In fact, they find the highly potent form of the Class B drug cannabis much easier to buy than both alcohol and cigarettes, where regulation steps in and requires them to prove that they are old enough.  No such barriers seem to exist when it comes to buying cannabis.

The country’s most popular illicit drug, the average age people start smoking it is 14.

But, for most young people today, it is the stronger, more harmful and seemingly ubiquitous variety of cannabis, high in the cannabinoid THC and low in CBD, and known universally as skunk, that is finding its way into their hands.  To investigate how easy it is for young people to buy cannabis and the risks that come with this, Volteface carried out a nationwide survey and spoke to a group of users and non-users, aged 15-17, from London.

Without chemical analysis, we can’t know for certain what type of cannabis young people are consuming, but we could find out what they thought it was, and the overwhelming majority of people said they used skunk, with many reporting that was the only form of cannabis they could get. And when it comes to getting skunk, it is very easy for young people, particularly in urban areas, to get hold of it.

Indeed, when asked how easy it is to buy cannabis, how often they smoked it or whether any of them had ever had any trouble getting the drug because of their age, the teenagers Volteface interviewed collapsed into laughter at how “ridiculous” these questions were.

In their world, these aren’t things they need to think much about, they’re a given.

The cannabis most commonly smoked in the UK in and before the 1990s was the low-potency hash. This changed as the decade progressed and the development of high potency strains such as skunk came to dominate the market in the Netherlands – a trend which found its way here.

With this in mind, Volteface’s research raises important questions about how much autonomy young people living in areas like London really have when it comes to the cannabis they are smoking.

Unlike previous generations, skunk and closely related strains, high in THC and low in CBD, is perhaps all they will have known, with these varieties accounting for 80-95 percent of the cannabis sold illegally on Britain’s streets according to most recent analyses.

How clued-up are today’s young cannabis users as to where and how to find regular weed and safer strains and the benefits of why they might want to do this?

Under the Misuse of Drugs Act 1971, anyone caught in possession of cannabis could (in theory, but rarely in practice) face five years in prison or an unlimited fine.  Deterrence and censure – the law’s intentions are clear, and young people are well aware of the prohibition. Nevertheless, this doesn’t stop them from wanting to buy cannabis.  76 percent of those who completed Volteface’s survey, and several of the teenagers interviewed, said they were worried about getting into trouble with the police.

But, one 16-year-old Volteface spoke to was still smoking it, despite one occasion on which “I went straight to the cells for having 0.6 grams of weed on me” and his mother being called to collect him.

It appears that the only real barrier when it comes to young people getting cannabis is money.

The rest, they don’t have to worry about – the supply comes to them.  “If you’ve got the money, you can get cannabis, no problem,” said a 17-year-old user from London.  A 16-year-old added: “When we’re walking to school people come up and ask if we want to buy weed.  “If they think you’re the kind of person who smokes weed, they might just come up to you and ask you to take their number and then you just call them,” said another.

One teenager said that if a group are seen smoking cigarettes, they could be approached by cannabis dealers.  Although those interviewed in London for our research said cigarettes were seen as the most “socially acceptable” substance, most said it was still much easier to buy cannabis than tobacco.

As regulated products with a minimum age requirement, young people wanting to buy alcohol and cigarettes from any retail outlet must be able to show they are at least 18.

With cannabis, no such difficulty gets in the way.

96 percent of those who completed Volteface’s nationwide survey and said it was “extremely easy” for them to find cannabis were from cities.  “Getting tobacco is harder than getting cannabis, 100 percent,” said one of the group interviewed.   “It’s too easy.”“Knock on a door,” said one 16-year-old.

“It’s legit if you have the money. There’s times when you got the money for tobacco, but you’re not going to get served inside the shop as you’re too young.”  “Weed is the easiest thing out of cannabis, cigarettes and alcohol to get because you don’t have to have ID.”

Some of the teenagers said they sometimes tried their luck by asking an older young person standing outside the shop to go in and buy some drinks for them, but that this was rare.

In any case, as some of them pointed out, shops shut.

Dealers don’t close for business at 11pm on a Friday night.

Cannabis, more than cigarettes and alcohol, is seen as a greater part of the ‘every day’ lives of the young people smoking it, our research showed.

“You don’t need a motive to smoke it” is how one 16-year-old from London summed up its popularity.

“When I wake up, at lunch… any time I can” said another teenager about when they smoked it. “If I’m not doing anything and I’ve got money, I’ll buy some and smoke it”.  “It just chills you out,” another added.

Whereas, other drugs such as LSD, ecstasy and magic mushrooms, as well as alcohol, are used by young people “every few weeks” at parties or on nights out, the young people we interviewed said they often smoked a joint while listening to music, gaming, relaxing by themselves or with friends.

Most of the teenagers we spoke to in London said they smoked cannabis more commonly on weekends and week nights, but some said they smoked it during school hours, with one 16-year-old stating: “I smoke when I wake up”.

On average, the group spent £30 every three days on the drug. In fact, this seemed to be the group’s biggest problem with cannabis, someone commenting “If I think about all the money I could have saved by now…”

Another added: “We get deals init, so our dealers bus us a gram for £10, a z [ounce] for £200, should be £240.”

The most striking finding confirmed by Volteface’s research was the extent to which young people, to their knowledge at least, are smoking skunk, rather than any other form of weed.

The majority of the teenagers Volteface interviewed in London said they smoked skunk, which has come to dominate the market as the cheapest way to get really high.

Cannabis, made from a natural plant, contains two important ingredients: THC (tetrahydrocannabinol) and CBD (cannabidiol). THC gets smokers ‘high’. It has also been correlated, particularly when consumed in high concentrations, with greater incidence of psychosis and development of dependence. CBD while not psychoactive itself, modified the effects of THC, including reducing its anxiety and paranoia inducing effects. It also, crucially, drastically lessens both the incidence of psychosis when people consume it alongside THC, and seems to make cannabis less dependence forming.

Whereas other forms of weed often contain the two substances in more equal ratios, skunk tends to contain solely high amounts of THC and hardly any CBD.

Significantly, the teenagers Volteface interviewed were aware of the distinction between weed and skunk, and the difference in their potential harmfulness, but the sheer ease of availability of the latter meant they were continuing to smoke it. Convenience trumps effort.

“We don’t smoke weed, we smoke skunk. But skunk is more available,” one 16-year-old said. “Skunk is bare chemicals and THC to make it stronger. It’s much more available,” another added. One 17-year-old said: “I don’t even think it’s that great, but it’s all you can get, there’s just bare THC in it.”

“My mum thinks I should smoke Thai because skunk will make you crazy,” said another 17-year-old.  A 16-year-old agreed: “My mum says I should smoke high grade rather than skunk because it’s gonna turn me mental.”

“When you first start buying weed, you don’t actually know what you’re buying. Now you can ask them what it is and they’ll tell you,” another teenager added.

In a 2015 study published in The Lancet Psychiatry, scientists from Kings College London found that 24 percent of all new cases of psychosis are associated with the use of skunk and the risk of psychosis was three times higher for skunk users and five times higher for those who use it every day. No increased risk of psychosis was found for those regularly smoking other forms of cannabis.

The causality between cannabis use and psychosis has been questioned though, with the possibility that those more likely to take the drug are also more prone to psychosis in the first place.

When asked whether they worried about the effects of skunk on their mental health, one teenager said: “Yeah – it’s when I’m older isn’t it? Long-term effects.”  But another added: “I can’t see myself getting something like depression.”

Some said they could feel cannabis having a negative effect on their physical health, with their ability to run and play sports affected.

After getting stopped by the police, parents were the second biggest concern for young cannabis users who participated in Volteface’s research, but this was mainly the case in non-urban areas and those outside of London.

For most of the young cannabis users interviewed in London, their parents were not so concerned as to stop them smoking it, although they did try to advise their children against smoking stronger strains.  “I think part of the reason my mum is okay with me smoking is because I do well in school,” one 17-year-old told us.

Another said: “They lecture me about it but they don’t try and stop me taking it. If my mum found weed in my room she probably wouldn’t take it.”

Skunk is in the lives of young people because it’s in the dealers’ interest to keep it there.

The environment in which they are operating, particularly in urban areas such as London, mean teenagers are regularly smoking a highly potent strain of a drug, which can result in severe mental health problems in later life, even though much less harmful strains are available.

As Volteface’s research suggests, young people today don’t have much control over the quality or type of the cannabis they are smoking. They only know the dealers they know, many of whom will have targeted them specifically.

When something is so easy, the incentive to look elsewhere and acquire knowledge about other options diminishes. We are also creatures of habit – the behaviours we start with and become accustomed to, we come to accept as a part of our lives. Particularly if any adverse effects of these behaviours fail to manifest themselves in the here and now. Make hay while the sun shines.

In young people, dealers seem to have found an ideal target market to push skunk and make a tidy profit, all within a context which runs counterintuitive to what many of us may believe: that making something illegal is keeping us safer.  Teenagers may be laughing at our ignorance on this issue now, but it’s skunk’s dexterous dealers who may well be having the last laugh in the end.

Source:  http://volteface.me/features/easy-young-people-access-skunk-uk/   April 2017

The surrender of more than 2,000 minors involved in drugs in Cebu shows the need to step up efforts to educate the youth on the ill effects of illegal drugs. The Cebu Provincial Anti-Drug Abuse Office has produced a module on this for integration in Grades 7 to 9 classes starting this school year.

Jane Gurrea, Education Supervisor I of the Department of Education’s Division of Cebu Province, says anti-drug activities in schools have been strengthened by a memorandum issued by the department mandating the establishment of Barkada Kontra Droga chapters in schools.

Barkada Kontra Droga is a preventive education and information program to counter the dangers of drug abuse. HALF of the 2,203 minors rounded up under Project Tokhang were out-of-school youth, according to data collected by the Police Regional Office 7 from July 1, 2016 to Feb. 2, 2017.

Tokhang is the Philippine National Police’s program to knock on the doors of homes to persuade those suspected of involvement in illegal drugs to surrender. Some 2,166 of the minors in Cebu were drug users, 28 were sellers, while nine were mules. Could the rampant involvement of out-of-school youth in drugs have been prevented if Section 46 of the Comprehensive Dangerous Drugs Act of 2002 had been implemented?

Section 46 requires the establishment of a Special Drug Education Center (SDEC) for out-of-school youth and street children in every province to implement drug abuse prevention programs and activities. The SDEC should be led by the Provincial Social Welfare Officer. “Cebu Province still has to establish one,” however, said Grace Yana, social welfare officer  in charge of social technology unit of the Department of Social Welfare and Development (DSWD) . But areas in Cebu with active Pag-Asa Youth Association of the Philippines (PYAP) chapters, like Talisay, Naga, Danao and Mandaue cities, already have SDECs, she said. PYAP is the organization of out-of-school youth organized by the local government units.

“When the local government units hear the word center, they think they will need a building, and it needs a budget. So we tell them, even if it’s just a corner,” Yana said of the challenges of setting up the SDEC. Cebu Province may not have an SDEC, but the Cebu Provincial Anti-Drug Abuse Office (Cpadao) unveiled last November Project YMAD (Youth Making a Difference) that aims to provide out-of-school youth with socio-economic, physical, psychological, cultural and spiritual support through the PYAP.

Barkada Kontra Droga For in-school youth, the Cpadao is facilitating the implementation of the Barkada Kontra Droga drug prevention program, said Cpadao executive director Carmen Remedios Durano-Meca. Dangerous Drugs Board (DDB) Regulation 5, Series of 2007 calls for the institutionalization of the Barkada Kontra Droga (BKD), a preventive education and information program to counter the dangers and disastrous effects of drug abuse. It empowers the individual to be the catalyst in his peer groups in advocating healthy and drug-free lifestyles, the regulation says. “Cpadao is the one facilitating that this be implemented in every school,” Meca said. “We tap the Supreme Student Government officers. We have a Student Assistance Program (SAP) designed to help children who get into trouble with drugs in the school setting.”

SAP includes an intervention program to reduce substance abuse and behavioral problems by having the parent-teacher association take up school and home concerns. Under SAP, which will be established through the guidance office, the school will establish drug policies and regulations.

In addition, Cpadao made a module, which it has given to the Department of Education (DepEd) to distribute to schools. “It’s been agreed to be integrated in the Grades 7, 8 and 9 classes starting school year 2017. It will be one hour a week from MAPEH (Music, Arts, Physical Education and Health) for the whole school year. Later, we plan to teach it to the younger children, like Grade 4,” she said. “We’ve had a review of the module,” Jane Gurrea, Education Supervisor I of DepEd’s Division of Cebu Province, said last month. “If we receive that module, this will be integrated initially for public schools as additional reference materials.”

The DepEd Division of Cebu Province covers the 44 towns in Cebu. This month, the division will have a training of teachers for the integration of drug abuse prevention education, which will include a discussion of the Cpadao module. But even now, under the present K to 12 curriculum, basic concepts on illegal drugs can already be tackled as early as in Grade 4, as teachers could integrate these concepts in subjects like Health, when the subject of medicine use and abuse is discussed, she said. Gurrea, who is also the National Drug Education Program coordinator in the Division, said drug prevention education can be taught in subjects dealing with values education, social studies or MAPEH. “For music, students can write a poem or song on drug use prevention. They can have role playing. In art, they can do drawing (on drugs).”

Additionally, under Section 42 of the Dangerous Drugs Act, all student councils and campus organizations in elementary and secondary schools should include in their activities “a program for the prevention of and deterrence in the use of dangerous drugs, and referral for treatment and rehabilitation of students for drug dependence.” It is unclear how actively these student groups have campaigned against illegal drugs, but Gurrea said that every third week of November, students join the celebration of Drug Abuse Prevention and Control Week under the Supreme Student Government.

“The officers have to campaign room to room to talk about issues related to prevention of drug use. In the public schools in rural areas, you can see signs on fences or pergolas saying, ‘Get high on grades, not on drugs.’ They invite speakers for drug symposiums, like the police,” she said. The Supreme Student Government is for high school, while the Supreme Pupil Government is for elementary school. “In every town, we have a federated Supreme Student Government (SSG) and Supreme Pupil Government (SPG), and also a Division Federation of SSG and SPG. One of the programs is drug education,” Gurrea said. The Department of Education mandates all schools to have a student council organization strengthened. Gurrea said the anti-drug activities in schools were already there, but the term Barkada Kontra Droga was not used then. It was only when the DepEd coordinated with Cpadao that the term BKD was used. With the assistance of Cpadao that spent for resource speakers and meals of the students last year, BKD was institutionalized. BKD was strengthened further by DepEd Memorandum 200, Series of 2016 issued on Nov. 23, 2016 mandating the establishment of BKD chapters in schools, Gurrea said. “With this institutionalization, on the part of the budget for activities, students now have access through the Municipal Anti-Drug Abuse Councils (Madac).

So instead of spending their SSG funds for their activities, they can present their planned activities to the Madac, from which they can seek financial or other assistance (like for speakers),” she said. With the memo, the SSG has been recognized as an entity, enabling it to connect with the community, such as with agencies and non-government organizations for anti-drug activities, she said. “We have continuous advocacy and awareness programs. Some schools have a walk for a cause or caravan,” Gurrea said. The public schools in the division also have their student handbook. “One thing stipulated there is that no student is allowed to be involved in illegal drugs. There are schools that let students sign that piece of paper containing the rules and regulations, for their commitment to follow the rules in that handbook,” she said.

So if awareness of the dangers of illegal drugs is not the problem, what accounts for the high number of minors involved in drugs? “We are looking at peer pressure or circumstances in the family,” Gurrea said.

Source:  http://www.sunstar.com.ph/cebu/local-news/2017/03/04/who-watching-children-529169

(Extracts from above paper shown below – log-on to source document to read whole paper).

Abstract

Data from the 2013 Canadian Tobacco, Alcohol and Drugs Survey, and  two other surveys are used to determine the effects of cannabis use on self-reported physical and mental health. Daily or almost daily marijuana use is shown to be detrimental to both measures of health for some age groups but not all. The age group specific effects depend on gender. Males and females respond differently to cannabis use.

The health costs of regularly using cannabis are significant but they are much smaller than those associated with tobacco use. These costs are attributed to both the presence of delta9-tetrahydrocannabinol and the fact that smoking cannabis is itself a health hazard because of the toxic properties of the smoke ingested. Cannabis use is costlier to regular smokers and age of first use below the age of 15 or 20 and being a former user leads to reduced physical and mental capacities which are permanent.

These results strongly suggest that the legalization of marijuana be accompanied by educational programs, counselling services, and a delivery system, which minimizes juvenile and young adult usage. access to marijuana for all individuals under the age of 18.

Adolescents need to be encouraged not to use marijuana and strict government control over its production and distribution is needed to protect them. Price, THC content, and advertising also have to be regulated. At a more general level public policy should promote caution and awareness of the harmful consequences of marijuana use.

Source:  Hassunah, R and  McIntosh, J. (2016)  Quality of Life and  Cannabis Use: Results from Canadian Sample Survey Data Health,  8, 1576-1588. http://dx.doi.org/10.4236/health.2016.814155

* Waste firm Businesswaste.co.uk claims it is getting reports of bins being burned out across the country

* It believes youngsters are getting high from the fumes the burning bins create

* Certain dyes that makes the bins green can help people ‘get wasted’

* It’s 10 years since this ‘craze’ was last seen in the UK, when it his south Yorkshire

Children are burning bins and ‘getting high off the fumes’ in the latest drug craze which could be more dangerous than sniffing glue or petrol.

According to a waste management company, kids are setting plastic wheelie bins alight and then getting high on the fumes.  The experts say there are certain fumes created in the bin by the dyes which users can ‘get wasted’ from.

Officials at the firm say they have had reports from around Britain of youths burning wheelie bins to sniff the smoke.   Mark Hall, from waste firm businesswaste.co.uk, said cases were up 100 per cent in the last few months.  He said: ‘We’ve seen reports from Wolverhampton, Hull, Glasgow and Swindon over recent weeks, and they’re all the same.

‘Idiots stealing wheeled bins from outside homes and businesses, taking them to waste ground or parks, and torching them for whatever kicks they can derive.  ‘While some of them could just be arson, others include quotes from police officers who acknowledge that they’re doing it for weird drug-related kicks.’

The company has received ‘hundreds’ of reports from clients who discovered ruined bins.

He said ‘There was a craze about ten years ago and it died out.  ‘All of a sudden we are getting reports again. We have got a huge amount of them being burnt at the moment.  ‘It is growing – there is 100 per cent more than there was last month.’

The trend surfaced a decade ago in South Yorkshire but appeared to have made a revival, he said.  In 2007 South Yorkshire Police issued a warning to leave bins alone after 40 bins went up in smoke in the space of four months.

The risk of aerosol cans being contained in the rubbish, which could explode if they came into contact with fire, is high, particularly on business premises.  Anti-solvent abuse charities said inhaling the bin fumes could be more dangerous than sniffing glue or petrol.

Mr Hall said many people were not reporting the bin fires to police, making it hard to provide statistics on the crimes.  He said: ‘Just one aerosol might cause a potentially fatal explosion.’ And bins stolen from business premises could contain just about anything that can cause fatal injury to the unwary.  ‘Our people are sick of having to scrape melted plastic from pavements and parks, and our clients hate the inconvenience of having their bins stolen.’

The trend first surfaced about 10 years ago, and was a particular problem in south Yorkshire, but died out. It appears to have reared its head again

Stephen Ream, a spokesman for solvent abuse charity Re-Solv, said: ‘It would be very dangerous, it sounds like it would make you sick before you got high. ‘The fumes it would give off would be toxic.’

In 2007 it was reported that in Scotland it is known for people to burn bus shelters to get the same effect.   The craze was behind more than fifty bin fires in Barnsley, Yorkshire.

PC Jonathan Reed, of South Yorkshire Police, said in 2007 that officers were looking at ways to lock up the bins.  He said: ‘It is the drug of choice, setting fire to the bins and inhaling the fumes.  ‘The health and safety implications are terrible. It is only a matter of time before someone harms themselves.’

Wheelie bins are made from high density polyethylene – composed of double-bonded carbon and hydrogen molecules.  Burning an empty one releases carbon monoxide and carbon dioxide.

These deadly gases starve the brain of oxygen, giving a headache-heavy short high.

Source:  businesswaste.co.uk   23rd  March 2017 

HARRISBURG, Pa. (AP) – They’re the tiniest and most innocent victims of the heroin addiction crisis but it doesn’t spare them their suffering.

They cry relentlessly at a disturbing pitch and can’t sleep. Their muscles get so tense their bodies feel hard. They suck hungrily but lack coordination to successfully feed. Or they lack an appetite. They sweat, tremble, vomit and suffer diarrhea. Some claw at their faces.

It’s because they were born drug-dependent and are suffering the painful process of withdrawal. “It’s very sad,” says Dr. Christiana Oji-Mmuo, who cares for them at Penn State Hershey Children’s Hospital. “You would have to see a baby in this condition to understand.”

As the heroin and painkiller addiction epidemic gripping Pennsylvania and the whole country worsens, the number of babies born drug dependent has surged.   Geisinger Medical Center in Danville, Pa. saw two or three drug-dependent babies annually when Dr. Lauren Johnson-Robbins began working there 17 years ago. Now Geisinger cares for about twice that many per month between its neonatal intensive care unit in Danville and the NICU at Geisinger Wyoming Valley Medical Center in Wilkes-Barre.

Penn State Children’s Hospital is averaging about 20 per year, although it had cared for 18 through last June, with the final 2016 number not yet available, says Oji-Mmuo.

PinnacleHealth System’s Harrisburg Hospital also sees about 20 per year. That’s less than a few years ago, but only because a hospital that used to transfer drug dependent babies to Harrisburg Hospital equipped itself to care for them. “Now everybody is facing it and trying to deal with it one way or another,” says Dr. Manny Peregrino, a neonatologist involved with their care.

The babies suffer from neonatal abstinence syndrome, or NAS, which results from exposure to opioid drugs while in the womb. An estimated 1 in 200 babies in the United States are born dependent on an opioid drug. More than half end up in a NICU, which care for unusually sick babies.

In 2015, 2,691 babies received NICU care in Pennsylvania as the result of a mother’s substance abuse, according to the Pennsylvania Health Care Cost Containment Council. That’s up from 788 in 2000, or a 242 percent increase in 15 years.

Nearly all babies born to opioid-addicted moms suffer withdrawal. The severity varies. About 60 percent need an opioid such as morphine or methadone to ease them through withdrawal. These babies typically spend about 25 days in the hospital.

Often, the only way to calm them is to hold them for long periods – so long that many hospitals enlist volunteer “cuddlers.” ”It really is a whole village. Everybody pitches in,” Peregrino says.

Giving medications to newborns can lead to other problems, so the preference is to get them through withdrawal without it. A scale based on their symptoms is used to determine which ones need medication. In cases where withdrawal isn’t so severe,

symptoms can be managed by keeping the baby away from noise and bright light, cuddling them, and using devices such as mechanical swings to sooth them.

Logan Keck of Carlisle feared the worst upon learning what her baby might face. The 23-year-old became addicted to heroin several years ago. She says it was prominent in her circle of high school classmates, and she became “desensitized” to the danger, figuring it couldn’t be as bad as some claimed.   Keck has been in recovery for more than two years with the help of methadone, a prescription drug used to prevent withdrawal and craving. She was a few weeks away from being fully tapered off methadone when Keck learned she was pregnant.

She was told stopping methadone during pregnancy would put her at risk of miscarriage. Keck further learned her baby might be born addicted. She gave birth on Feb. 1 at Holy Spirit-Geisinger in Cumberland County.

Her baby had difficulty latching on during breastfeeding and vomited milk into her lungs, but seemed fine otherwise. Keck expected she and her baby would go home soon after delivery.  But after a few days, withdrawal became obvious. Keck knows how withdrawal feels. “That’s when it really hit home for me – seeing her feel it,” she says.  Then she was hit again: she was discharged, but her baby remains in the NICU, possibly for several more weeks.

The opioid addiction epidemic affects people of all backgrounds and regions – rich, poor, urban, suburban. It’s prevalent in economically-stressed areas, including many of Pennsylvania’s rural counties.

Geisinger has found a bit of brightness within the 30-plus rural counties it serves. Some of the region’s doctors realized there was little access to methadone, which is dispensed from clinics usually located in more populated areas. That meant pregnant rural women lacked access to a legal drug that could keep them away from the risks of street drugs while also getting them onto the road to recovery. So the doctors became licensed to prescribe buprenorphine, another drug that staves off withdrawal and cravings for opioids. As a result, the majority of mothers of NAS babies at Geisinger have been taking buprenorphine during pregnancy, according to Johnson-Robbins.

Geisinger doctors have been pleased to find that buprenorphine, while it does cause NAS, withdrawal isn’t as severe as with methadone. It also impacts another major concern surrounding NAS babies: that the mother will continue to struggle with addiction and live a lifestyle that will prevent her from properly caring for her baby. Most Geisinger moms, being in recovery for a while, are better-equipped to care for their baby.

Still, there’s great concern about what happens to NAS babies after they leave the hospital. The mother might go back to heroin and become unable to properly care for her baby – there have been many news reports of addicted parents or fathers who neglected or otherwise hurt their babies, including a Pennsylvania woman who rolled over and suffocated her baby while high on opioids and other drugs. The mother might lack adequate housing or other means of having a stable home. There might be criminal activity in the home.

Delaware County woman says she didn’t know their whereabouts until news reports of their hospitalizations for alleged severe abuse.

“We are sending children out into compromised environments,” says Dr. Lori Frasier, who leads the division of child abuse paediatrics at Penn State Hershey Children’s Hospital. Those babies often return to the hospital as victims of abuse or neglect, Frasier says.

Another cause for worry is the fact that NAS babies can remain unusually fussy after leaving the hospital, potentially putting extra stress on a parent already dealing with the stress of addiction. “We know that crying, fussy babies can be triggers for abuse,” Frasier says. Cathleen Palm, founder of the Pennsylvania-based Center for Children’s Justice, said much more needs to done to provide help for mothers of NAS babies, and to monitor and protect the babies. “We have really been trying to get policy makers to understand the nuances,” she says.

Keck goes to Holy Spirit-Geisinger daily to breastfeed and hold her baby for one to two hours. Her time is limited by distance and the fact the baby’s father needs their only car for work. Looking forward, Keck says she’s in a stable relationship with the baby’s father, who is not an addict and accompanies her to the hospital. They have family support, and a Holy Spirit program will provide additional help.

Ultimately, Keck’s pregnancy and motherhood have taught her things that might have inspired her to make a different choice regarding heroin, including the fact it caused her newborn to suffer and forced her to go home without her baby. She agreed to be interviewed out of desire to get others to think and talk about such realities. “I want people to understand it’s something that’s not pretty,” Keck said. “It’s something that’s important to talk about.”

Source:  http://www.washingtontimes.com/news/2017/feb/18/born-addicts-opioid-babies-in-withdrawal

Summary:

Long-term heavy use of alcohol in adolescence alters cortical excitability and functional connectivity in the brain, according to a new study. These alterations were observed in physically and mentally healthy but heavy-drinking adolescents, who nevertheless did not fulfil the diagnostic criteria for a substance abuse disorder.

Long-term heavy use of alcohol in adolescence alters cortical excitability and functional connectivity in the brain, according to a new study from the University of Eastern Finland and Kuopio University Hospital. These alterations were observed in physically and mentally healthy but heavy-drinking adolescents, who nevertheless did not fulfil the diagnostic criteria for a substance abuse disorder. The findings were published in Addiction Biology.

Constituting part of the Adolescents and Alcohol Study, the study analysed the effects of heavy adolescent drinking on the electrical activity and excitability of the cortex. The study did a follow-up on 27 adolescents who had been heavy drinkers throughout their adolescence, as well as on 25 age-matched, gender-matched and education-matched controls with little or no alcohol use. The participants were 13 to 18 years old at the onset of the study.

At the age of 23-28, the participants’ brain activity was analysed using transcranial magnetic stimulation (TMS) combined with simultaneous electroencephalogram (EEG) recording. In TMS, magnetic pulses are directed at the head to activate cortical neuronal cells. These magnetic pulses pass the skull and other tissues, and they are safe and pain-free for the person undergoing TMS. The method allows for an analysis of how different regions of the cortex respond to electrical stimulation and what the functional connectivities between the different regions are. Indirectly, the method also makes it possible to analyse chemical transmission, i.e. mediator function. The effects of long-term alcohol use haven’t been studied among adolescents this way before.

The cortical response to the TMS pulse was stronger among alcohol users. They demonstrated greater overall electrical activity in the cortex as well as greater activity associated with the gamma-aminobutyric acid, GABA, neurotransmission system. There were also differences between the groups in how this activity spread into the different regions of the brain. Earlier research has shown that long-term, alcoholism-level use of alcohol alters the function of the GABA neurotransmission system. GABA is the most important neurotransmitter inhibiting brain and central nervous system function, and GABA is known to play a role in anxiety, depression and the pathogenesis of several neurological disorders.

The study found that alcohol use caused significant alterations in both electrical and chemical neurotransmission among the study participants, although none of them fulfilled the diagnostic criteria of a substance abuse disorder. Moreover, in an earlier study completed at the University of Eastern Finland, also within the Adolescents and Alcohol Study, cortical thinning was observable in young people who had been heavy drinkers throughout their adolescence. For young people whose brain is still developing, heavy alcohol use is especially detrimental. The findings of the study warrant the question of whether the diagnostic criteria for substance abuse disorders should be tighter for adolescents, and whether they should be more easily referred to treatment. The use of alcohol may be more detrimental to a developing brain than previously

thought, although it takes time for alcohol-related adverse effects to manifest in a person’s life

Source:  https://www.sciencedaily.com/releases/2016/12/161208085850.htm? February_2017)

During her pregnancy, Stacey never drank alcohol or had a cigarette. But nearly every day, then 24, she smoked marijuana.

With her fiancé’s blessing, she began taking a few puffs in her first trimester to quell morning sickness before going to work at a sandwich shop. When sciatica made it unbearable to stand during her 12-hour shifts, she discreetly vaped marijuana oil on her lunch break.

“I wouldn’t necessarily say, ‘Go smoke a pound of pot when you’re pregnant,’” said Stacey, now a stay-at-home mother in Deltona, Fla., who asked that her full name be withheld because street-bought marijuana is illegal in Florida. “In moderation, it’s O.K.”

Many pregnant women, particularly younger ones, seem to agree, a recent federal survey shows. As states legalize marijuana or its medical use, expectant mothers are taking it up in increasing numbers — another example of the many ways in which acceptance of marijuana has outstripped scientific understanding of its effects on human health.

Often pregnant women presume that cannabis has no consequences for developing infants. But preliminary research suggests otherwise: Marijuana’s main psychoactive ingredient — tetrahydrocannabinol, or THC — can cross the placenta to reach the foetus, experts say, potentially harming brain development, cognition and birth weight. THC can also be present in breast milk.

“There is an increased perception of the safety of cannabis use, even in pregnancy, without data to say it’s actually safe,” said Dr. Torri Metz, an obstetrician at Denver Health Medical Center who specializes in high-risk pregnancies. Ten percent of her patients acknowledge recent marijuana use. In the federal survey, published online in December, almost 4 percent of mothers-to-be said they had used marijuana in the past month in 2014, compared with 2.4 percent in 2002. (By comparison, roughly 9 percent of pregnant women ages 18 to 44 acknowledge using alcohol in the previous month.)

Stacey’s son just had his first birthday. He’s walking, talking and breast-feeding, and she isn’t worried about his development. Credit Jennifer Sens for The New York Times

Young mothers-to-be were particularly likely to turn to marijuana: Roughly 7.5 percent of 18- to 25-year-olds said they had used pot in the past month in 2014, compared with 2 percent of women ages 26 to 44.

Evidence on the effects of prenatal marijuana use is still limited and sometimes contradictory. Some of the most extensive data come from two sets of researchers, in Pittsburgh and in Ottawa, who have long studied children exposed to THC in the womb.

In Pittsburgh, 6-year-olds born to mothers who had smoked one joint or more daily in the first trimester showed a decreased ability to understand concepts in listening and reading. At age 10, children exposed to THC in utero were more impulsive than other children and less able to focus their attention.

Most troubling, children of mothers who used marijuana heavily in the first trimester had lower scores in reading, math and spelling at age 14 than their peers.

“Prenatal exposure can affect the adolescent pretty significantly,” said Dr. Lauren M. Jansson, the director of paediatrics at the Center for Addiction and Pregnancy at the Johns Hopkins University School of Medicine.

Several studies have found changes in the brains of foetuses, 18 to 22 weeks old, linked to maternal marijuana use. In male foetuses that were exposed, for instance, researchers have noted abnormal function of the amygdala, the part of the brain that regulates emotion.

“Even early in development, marijuana is changing critical circuits and neurotransmitting receptors,” said Dr. Yasmin Hurd, a neuroscientist and the director of the addiction center at Icahn School of Medicine at Mount Sinai in Manhattan. “Those are important for regulation of emotions and reward, even motor function and cognition.”

It is already well documented that the developing brains of teenagers can be altered with regular marijuana use, even eventually reducing I.Q.

“The effects are not dramatic, but that doesn’t mean they are not important,” said Jodi Gilman, an assistant professor of psychiatry at Harvard Medical School who studies adolescent users of cannabis. “It could make the difference between getting an A and getting a B.”

“You could imagine that a similar subtle effect may be present in those who were exposed prenatally to marijuana,” she added. The American Academy of Paediatrics and the American College of Obstetricians and Gynaecologists both advise against prenatal cannabis use because of its links to cognitive impairment and academic underachievement. But many state and federal agencies avoid the topic.

Of five federal agencies, only the National Institute on Drug Abuse had any information about prenatal marijuana use on its website as of last February, according to a study published online in December in the journal Substance Abuse. Only 10 state health departments did. Until recently, the Centers for Disease Control and Prevention offered nothing.

“I don’t think public health officials should be alarming people,” said Marian Jarlenski, the study’s lead author and an assistant professor at the University Of Pittsburgh Graduate School Of Public Health. “They just have to say, ‘There have been studies done, and there is some risk.’”

In a statement, C.D.C. officials expressed concern about memory and attention problems among children exposed to THC in utero.

“While current evidence on health consequences is inconsistent, some studies have found risks associated with marijuana use during pregnancy, such as low birth weight or preterm birth,” the agency said. Dr. Marie McCormick, a paediatrician and the chairwoman of a new report on cannabis from the National Academies of Sciences, Engineering and Medicine, said smoking cannabis “does confer, in terms of birth weight, the same risk as cigarettes.”

Some of the gathering evidence is reassuring. So far, prenatal cannabis exposure does not appear to be linked to obvious birth defects. “That’s why some providers and lay

people alike think there’s no effect,” said Dr. Erica Wymore, a neonatologist at Children’s Hospital Colorado. But she warned, “Just because they don’t have a major birth defect or overt withdrawal symptoms doesn’t mean the baby’s neurological development is not impacted.”

Most research in this area was done when the drug was far less potent. Marijuana had 12 percent THC in 2014, while in 1995 it was just 4 percent, according to the National Institute on Drug Abuse.

“All those really good earlier studies on marijuana effects aren’t telling us what we need to know now about higher concentration levels,” said Therese Grant, an epidemiologist and director of the University of Washington’s foetal alcohol and drug unit. “We need to do a whole lot more research now.”

There are two additional problems with studies of maternal cannabis use. Research is often based on reports by pregnant women — instead of, say, tests of urine or the umbilical cord — and they consistently underreport their use. (Researchers know of underreporting because samples reveal discrepancies.) And pregnant women who roll joints also tend to smoke tobacco or drink alcohol; it can be hard to tease out the risks of cannabis itself.

Few realize that THC is stored in fat and therefore can linger in a mother’s body for weeks, if not months. It’s not known whether the foetus’s exposure is limited to the hours a woman feels high.

The American College of Obstetricians and Gynaecologists advises clinicians to ask pregnant women about marijuana use and to urge them to quit. To find out whether that’s happening, Dr. Judy Chang, an obstetrician-gynaecologist at the University of Pittsburgh, and her colleagues recorded more than 450 first visits with pregnant patients.

Medical staff were more likely to warn patients that child protective services might be called if they used marijuana, the researchers found, than to advise them of potential risks. When mothers-to-be admitted to marijuana use, almost half of obstetric clinicians did not respond at all.  Pregnant women aren’t eager to discuss it, either, because they are afraid of legal repercussions or a lecture. Depression, anxiety, stress, pain, nausea and vomiting were the most common reasons women reported using marijuana in a 2014 survey of low-income mothers getting federal nutrition help in Colorado. Roughly 6 percent were pot users; a third were pregnant. “Women are thinking of this as medical marijuana in that they are treating some condition,” said Elizabeth Nash, a policy analyst at the Guttmacher Institute who researches substance abuse in pregnancy.  “If you’re going to consider it like medicine,” she said, “then treat it like medicine and talk to your doctor about it.” Stacey’s son just had his first birthday. He’s walking, talking and breast-feeding, and she isn’t worried about his development.  She still smokes pot — indeed, her son plays on a rug emblazoned with a marijuana leaf. But the severe cramps that plagued her before pregnancy are easing now.  “I don’t have to smoke as much anymore,” she said.

Source: https://www.nytimes.com/2017/02/02/health/marijuana-and-pregnancy.

FRAMINHAM, Mass. – A Framingham middle school student was hospitalized Monday after he and another student ate a marijuana edible on the school bus, according to a letter released by Fuller Middle School.   School officials are trying to find out who brought the edibles on the bus and how to make sure it doesn’t happen again.

Stacy Velasquez says her 12-year-old son was riding the bus to school Monday morning when he found a container of gummy bears that got him very sick.   He called her crying.

“He said, ‘I ate something.’ I said, ‘what did you eat?’ He said candy. Where did you get it? He said he found it on the bus,” Velasquez explained.   When she arrived at Fuller Middle School, she says he was in a trance-like state, barely able to speak. She rushed him to the emergency room, snapping a video of his behavior.

“Once the tox screen came back, they said they’d never seen this before in a child so small, like an overdose so to speak of marijuana, but basically it would run its course and he would sleep it off.  And that’s what he did last night,” said Velasquez.

The district superintendent says they have no comment in regards to what happened, just that the police are now investigating.   Though marijuana is now legal in the state of Massachusetts, it’s not legal for anyone under the age of 21 to handle or ingest the drug.

“I would just like someone to make sure the school is doing their part and the bus drivers are doing their part to make sure the children get to and from school safely and that something like this doesn’t happen to someone else’s child,” Velasquez said. “I think the teenager involved [should be charged], because right now, it’s expected to be one of the high schoolers.”

Velasquez said her son is doing fine, he’s just embarrassed about what happened.   As for possible charges, police are looking through video taken on the bus to see who the edibles link back to.

Source:  http://www.fox25boston.com/news/framingham-middle-schooler-hospitalized-after-eating-marijuana-edible-on-school-bus/483211673?utm_source=January 11th 2017

Earlier this week, the Journal of the American Academy of Child & Adolescent Psychiatry (JAACAP), released a study that claims a 24 percent decline in marijuana-related problems among teenagers, such as becoming dependent on the drug or having trouble in school and in relationships. The researchers also claim there is an association between drops in problems related to cannabis and reductions in behavioural issues, such as fighting, property crimes and selling drugs. Pro-marijuana bloggers have picked this up as “proof” that legalization is not harmful to kids, but an editorial in the very same journal says that “no such inference is warranted.”

At first blush this study seems encouraging, however, there are several facts that are not consistent with media headlines and interpretations:

* The study examines data from 2002 to 2013, and thus does not examine any time period with retail marijuana legalization even though researchers state that they did look at legalization policies. Legalization was not in place until late 2012 in two states only, and retail sales started in 2014. Also, data show that marijuana use declined from 2002 to 2009, but increased after.

* The findings of this study contradict data from the US Department of Health and Human Services, National Survey on Drug Use and Health, and the US Monitoring the Future Study which all show an increase in kids using marijuana and needing treatment.

* The article lumps together all states and does not differentiate between those with less restrictive “medical” marijuana policies and those with stricter controls. * Finally, as Hopfer discusses in his editorial, it is possible “a decrease in conduct problems accounted for the decrease in the development of marijuana use disorders. Although this is not proof of a causal effect, one potential inference is that as marijuana use becomes more acceptable, more individuals without conduct or adult antisocial problems will use marijuana and that the risk of developing a use disorder is lower in individuals without comorbid conduct or adult antisocial problems.”

The legalization lobby will try and tout this research as proving that legalization works. In reality, legalization is ushering in the advent of marijuana candies and other kid-friendly items by big business. Colorado is the top state in the nation for youth marijuana use. Problems related to marijuana in Colorado and Washington are mounting, as evidenced here, with an out-of-control marijuana industry focused on hooking kids and retaining lifelong customers. The World Health Organization report on marijuana found several negative effects for teens, including “several components of cognitive function, with the most robust effects on short term episodic and working memory, planning and decision-making, response speed, accuracy and latency.” The report also detailed studies that found “heavy cannabis use over several decades produced substantial declines in cognitive performance that may not be wholly reversible… (and) an association between poorer verbal memory and sustained daily use of cannabis throughout adult life.”

Source:  https://learnaboutsam.org/despite-study-marijuana-still-linked-problems-among-teenagers/

ASK THE DOCTOR  column –  – by Dr. Robert Ashley – Erie Times-News, December 30, 2016

Q:  Marijuana seems to be increasingly accepted in our country.  But I worry about my kids using it.  Is it addictive?

A:  Marijuana has gained greater acceptance in this country, not in small part because its medical use can stimulate appetite, control nausea and control pain.  One potential problem with this degree of acceptance is how adolescents view the drug.

In 2015, 70 percent of high school seniors viewed marijuana as not harmful, according to the National Institute on Drug Abuse’s Monitoring the Future survey;  in 1990, only 20 percent felt this way.

Perhaps the biggest risk with marijuana is how it affects the adolescent brain.  The endocannabinoid system, a vast system of receptors within the brain, spinal cord and smaller nerves, affects multiple brain and body functions.  The system continues to develop in humans until the age of 21 or so.

If used frequently in adolescence, marijuana can rewire many of these nerve pathways.  These changes aren’t seen as much in the adult brain and, if they surface, can be easily reversed by stopping use.  In adolescents, however, this rewiring of the nervous system may create addiction.  According to the NIDA, only 9 percent of people who try marijuana become addicted.  However, this number increases to 16 percent among those who start using marijuana in adolescence.  It increases further if marijuana is used daily in adolescence.

Marijuana not only causes short–term memory loss, it also affects mental abilities for days after its use.  That means a person’s ability to plan, organize, solve problems and make decisions is impaired, which has significant ramifications for adolescents trying to retain information learned in school.

Further, for those predisposed to schizophrenia, marijuana can induce psychosis and, in younger users, can decrease the age of schizophrenia’s onset.  People with a familial predisposition to schizophrenia should certainly avoid use.

Send your questions to askthedoctors@mednet.ucla.edu,, or Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles CA  90095.

Currently, 29 states and Washington, DC, have passed laws to legalize medical marijuana. Although evidence for the effectiveness of marijuana or its extracts for most medical indications is limited and in many cases completely lacking, there are a handful of exceptions. For example, there is increasing evidence for the efficacy of marijuana in treating some forms of pain and spasticity, and 2 cannabinoid medications (dronabinol and nabilone) are approved by the US Food and Drug Administration for alleviating nausea induced by cancer chemotherapy.

A systematic review and meta-analysis by Whiting et al1 found evidence, although of low quality, for the effectiveness of cannabinoid drugs in the latter indication. The anti -nausea effects of tetrahydrocannabinol (THC), the main psychoactive ingredient in marijuana, are mediated by the interactions of THC with type cannabinoid (CB1) receptors in the dorsal vagal complex. Cannabidiol, another cannabinoid in marijuana, exerts antiemetic properties through other mechanisms. Nausea is a medically approved indication for marijuana in all states where medical use of this drug has been legalized. However, some sources on the internet are touting marijuana as a solution for the nausea that commonly accompanies pregnancy, including the severe condition hyperemesis gravidarum.

Although research on the prevalence of marijuana use by pregnant women is limited, some data suggest that this population is turning to marijuana for its antiemetic properties, particularly during the first trimester of pregnancy, which is the period of greatest risk for the deleterious effects of drug exposure to the foetus. Marijuana is the most widely used illicit drug during pregnancy, and its use is increasing. Using data from the National Survey of Drug Use and Health, Brown et al report in this issue of JAMA that 3.85%of pregnant women between the ages of 18 and 44 years reported past-month marijuana use in 2014, compared with 2.37%in 2002. In addition, an analysis of pregnancy data from Hawaii reported that women with severe nausea during pregnancy, compared with other pregnant women, were significantly more likely to use marijuana (3.7%vs 2.3%, respectively).

Although the evidence for the effects of marijuana on human prenatal development is limited at this point, research does suggest that there is cause for concern. A recent review and a meta-analysis found that infants of women who used marijuana during pregnancy were more likely to be anaemic, have lower birth weight, and require placement in neonatal intensive care than infants of mothers who did not use marijuana. Studies have also shown links between prenatal marijuana exposure and impaired higher-order executive functions such as impulse control, visual memory, and attention during the school years.

The potential for marijuana to interfere with neurodevelopment has substantial theoretical justification. The endocannabinoid system is present from the beginning of central nervous system development, around day 16 of human gestation, and is increasingly thought to play a significant role in the proper formation of neural circuitry early in brain development, including the genesis and migration of neurons, the outgrowth of their axons and dendrites, and axonal pathfinding. Substances that interfere with this system could affect foetal brain growth and structural and functional neurodevelopment.

An ongoing prospective study, for example, found an association between prenatal cannabis exposure and foetal growth restriction during pregnancy and increased frontal cortical thickness among school-aged children. Some synthetic cannabinoids, such as those found in “K2/Spice” products, interact with cannabinoid receptors even more strongly than THC and have been shown to be teratogenic in animals.

A recent study in mice found brain abnormalities, eye deformations, and facial disfigurement (cleft palate) in mouse foetuses exposed at day 8 of gestation to a potent full cannabinoid agonist, CP-55,940. The percentage of mouse foetuses with birth defects increased in a linear fashion with dose. (The eighth day of mouse gestation is roughly equivalent to the third or fourth week of embryonic development in humans, which is before many mothers know they are pregnant.) It is unknown whether these kinds of effects translate to humans; thus far, use of synthetic cannabinoids has not been linked to human birth defects, although use of these substances is still relatively new.

THC is only a partial agonist at the CB1 receptor, but the marijuana being used both medicinally and recreationally today has much higher THC content than in previous generations (12% in 2014 vs 4% in 1995), when many of the existing studies of the teratogenicity of marijuana were performed. Marijuana is also being used in new ways that have the potential to expose the user to much higher THC concentrations—such as the practice of using concentrated extracts (eg, hash oil). More research is needed to clarify the neurodevelopmental effects of prenatal exposure to marijuana, especially high-potency formulations, and synthetic cannabinoids.

One challenge is separating these effects from those of alcohol, tobacco, and other drugs, because many users of marijuana or K2/Spice also use other substances. In women who use drugs during pregnancy, there are often other confounding variables related to nutrition, prenatal care, and failure to disclose substance use because of concerns about adverse legal consequences.    Even with the current level of uncertainty about the influence of marijuana on human neurodevelopment, physicians and other health care providers in a position to recommend medical marijuana must be mindful of the possible risks and err on the side of caution by not recommending this drug for patients who are pregnant. Although no states specifically list pregnancy-related conditions among the allowed recommendations for medical marijuana, neither do any states currently prohibit or include warnings about the possible harms of marijuana to the foetus when the drug is used during pregnancy. (Only 1 state, Connecticut, currently includes an exception to the medical marijuana exemption in cases in which medical marijuana use could harm another individual, although potential harm to a foetus is not specifically listed.)

In 2015, the American College of Obstetricians and Gynecologists issued a committee opinion discouraging physicians from suggesting use of marijuana during preconception, pregnancy, and lactation. Pregnant women and those considering becoming pregnant should be advised to avoid using marijuana or other cannabinoids either recreationally or to treat their nausea.

Source:  http://jamanetwork.com/ on 12/21/2016

Abstract

INTRODUCTION:

The social developmental processes by which child maltreatment increases risk for marijuana use are understudied. This study examined hypothesized parent and peer pathways linking preschool abuse and sexual abuse with adolescent and adult marijuana use.

METHODS:

Analyses used data from the Lehigh Longitudinal Study. Measures included child abuse (physical abuse, emotional abuse, domestic violence, and neglect) in preschool, sexual abuse up to age 18, adolescent (average age=18years) parental attachment and peer marijuana approval/use, as well as adolescent and adult (average age=36years) marijuana use.

RESULTS:

Confirming elevated risk due to child maltreatment, path analysis showed that sexual abuse was positively related to adolescent marijuana use, whereas preschool abuse was positively related to adult marijuana use. In support of mediation, it was found that both forms of maltreatment were negatively related to parental attachment, which was negatively related, in turn, to having peers who use and approve of marijuana use. Peer marijuana approval/use was a strong positive predictor of adolescent marijuana use, which was a strong positive predictor, in turn, of adult marijuana use.

CONCLUSIONS:

Results support social developmental theories that hypothesize a sequence of events leading from child maltreatment experiences to lower levels of parental attachment and, in turn, higher levels of involvement with pro-marijuana peers and, ultimately, to both adolescent and adult marijuana use. This sequence of events suggests developmentally-timed intervention activities designed to prevent maltreatment as well as the initiation and progression of marijuana use among vulnerable individuals.

Source:  Addict Behav. 2016 Nov 17;66:70-75. doi: 10.1016/j.addbeh.2016.11.013. 

A new study by researchers at the University of Rochester sheds light on how parents and caregivers of children with foetal alcohol spectrum disorders (FASD) can best help their kids achieve to the best of their abilities, and at the same time, maintain peace at home and at school.

Children with FASD often have problems with executive functioning, including deficiencies in impulse control and task planning, information processing, emotion regulation, and social and adaptive skills. Young people with FASD are at high risk for school disruptions and getting into trouble with the law.

The study involved 31 parents and caregivers of children with FASD ages four through eight. The research team looked at data taken from standardized questionnaires and qualitative interviews that focused on parenting practices.

The findings reveal that parents of children with FASD who attribute their child’s misbehavior to their underlying disabilities — rather than to wilful disobedience — are more likely to use pre-emptive strategies designed to help prevent undesirable behaviors.

Given the brain damage associated with FASD, pre-emptive strategies are typically more effective than incentive-based strategies, such as the use of consequences or punishment for misbehavior.   The study shows that educating families and caregivers about the disorder is critical.

“Children with FASD often have significant behavior problems due to neurological damage,” said Dr. Christie Petrenko, a research psychologist at the University’s Mt. Hope Family Center.   She adds that parents who use pre-emptive strategies “change the environment in a way that fits their child’s needs better. They give one-step instructions rather than three-steps because their child has working memory issues.”

“They may buy clothes with soft seams if their child has sensory issues, or post stop signs to cue the child to not open the door. All of these preventive strategies help reduce the demands of the environment on the child,” said Petrenko.

The findings also reveal that parenting practices correlate with levels of caregiver confidence and frustration.   Families of children with FASD are frequently judged and blamed for their children’s misbehavior. However, parents who are successful in preventing unwanted behaviors have greater confidence in their parenting skills and lower levels of frustration with their children than parents who respond to unwanted behaviors with consequences after the fact.

Petrenko and her team at Mt. Hope Family Center are continuing to test new parenting strategies and interventions in order to identify which practices are most effective.

Source:  http://psychcentral.com/news/2016/11/20/best-parenting-strategies-for-kids-with-fetal-alcohol-syndrome/112788.html

Repeated binge drinking during adolescence can affect brain functions in future generations, potentially putting offspring at risk for such conditions as depression, anxiety, and metabolic disorders, a Loyola University Chicago Stritch School of Medicine study has found.

“Adolescent binge drinking not only is dangerous to the brain development of teenagers, but also may impact the brains of their children,” said senior author Toni R. Pak, PhD, an associate professor in the Department of Cell and Molecular Physiology of Loyola University Chicago Stritch School of Medicine.

The study by Dr. Pak, first author Anna Dorothea Asimes, a PhD student in Dr. Pak’s lab, and colleagues was presented Nov. 14, 2016 at Neuroscience 2016, the annual meeting of the Society for Neuroscience

The study, which was based on an animal model, found that adolescent binge drinking altered the on-off switches of multiple genes in the brains of offspring. When genes are turned on, they instruct cells to make proteins, which ultimately control physical and behavioral traits. The study found that in offspring, genes that normally are turned on were turned off, and vice versa.

Teenage binge drinking is a major health concern in the United States, with 21 percent of teenagers reporting they have done it during the past 30 days. Among drinkers under age 21, more than 90 percent of the alcohol is consumed during binge drinking episodes. Binge drinking is defined as raising the blood alcohol concentration to 0.08 percent, the legal driving limit, within two hours (generally about five drinks for a male and four drinks for a female).

In the study, one group of adolescent male and female rats was exposed to alcohol in amounts comparable to six binge drinking episodes. The rats mated after becoming sober and the females remained sober during their pregnancies. (Thus, any effects on offspring could not be attributed to fetal alcohol syndrome.) The alcohol-exposed rats were compared to a control group of rats that were not exposed to alcohol.

In the offspring of alcohol-exposed rats, researchers examined genes in the hypothalamus, a region of the brain involved in many functions, including reproduction, response to stress, sleep cycles and food intake. Researchers looked for molecular changes to DNA that would reverse the on-off switches in individual genes. They found 159 such changes in the offspring of binge-drinking mothers, 93 gene changes in the offspring of binge-drinking fathers and 244 gene changes in the offspring of mothers and fathers who both were exposed to binge drinking.

The study is the first to show a molecular pathway that teenage binge drinking by either parent can cause changes in the neurological health of subsequent generations.  While findings from an animal model do not necessarily translate to humans, there are significant similarities between the study’s animal model and humans, including their metabolism of alcohol, the function of the hypothalamus, and the pattern and amount of binge drinking, Pak said.

The study was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism. It is titled “Binge alcohol consumption during puberty causes altered DNA methylation in the brain of alcohol-naive offspring.”

Source: Loyola University Health System Article ID: 664605 http://www.newswise.com/articles/view/664605/?sc=dwtn  10th Nov. 2016

Introduction

Within Jamaica there is a cultural belief that cannabis use is associated with enhanced creativity, improved concentration [1] and even improved reflexes [2]. These mythical beliefs have resulted in high rates of cannabis use, particularly among the youth, despite cannabis use being illegal in Jamaica.

A 1987 survey of patterns of substance misuse among post primary Jamaican students identified a 19.8% lifetime prevalence for cannabis use, while a 2000 Jamaican National School’s Survey found the lifetime prevalence to have increased to 26.9% [3]. Research findings have suggested that cannabis use may impair neuro-cognitive functioning [4-6].

However, some researchers have suggested that the residual effects of heavy cannabis use on cognitive functions are reversible, lasting only a few days after cessation [7].

Results from one longitudinal study found that cannabis use does not have a long-term negative impact on intelligence [9], while others have found that heavy cannabis users had memory and  learning impairments even after six weeks of supervised abstention [8].

There is a paucity of research on cannabis and neuro-cognitive performance in the Caribbean Region, including Jamaica.   Given the widespread use of cannabis and its easy availability for Jamaican adolescents, it is important to identify if there are any neuro-cognitive effects  associated  with cannabis use, among the youth population. This study therefore investigates whether cannabis use among Jamaican adolescent males will result in lowered performances on neurocognitive tasks.

Metabolites of cannabis in their urine, were excluded from the study. Cannabis users were required to abstain from using for a period of 24 – 48 hours prior to participating in the testing.

Of the 35 participants initially recruited for the cannabis use group, 3 were expelled from school and 2 chose to withdraw from the study. Of the 35 participants in the non-user control group, 3 were excluded from the study because their urine contained metabolites of cannabis. A total of 30 cannabis users and 32 non-users were inter viewed for the study. version 14 (SPSS v.14) and t-tests were conducted to assess if there were any significant differences between the performances of cannabis users and non-users.

Discussion

The mean age of cannabis initiation in this study was found to be early adolescence as seen in other Caribbean studies [3,11].  As adolescence is the developmental period  for

experimentation and risky behaviours,  along with the cultural acceptability of cannabis use during adolescence is a cause for serious concern as the adolescent brain is still undergoing neural development and may be susceptible to impairments in neuro-cognitive functioning.

Cannabis users exhibited lower scores on all assessed neuropsychological functions as compared to non-users. However, the greatest mean differences were observed  through significantly lowered Verbal Comprehension as well as Digit Span scores.  This finding implicates cannabis use during adolescence with impairing the neurocognitive functions of working memory, attention, concentration, mental manipulation, language  development and verbal intelligence. Cannabis users also had significantly lower visual,  verbal and working memory scores than those of non-cannabis users with the largest differences being seen on the delayed subtests. The observance of significantly lower  scores on the delayed subtests implies that the long term memory of cannabis user  may be more susceptibility to neurocognitive decline.

Cannabis users had lower scores on all tests of learning, attention and memory than non-users. This is consistent with findings from previous research neuropsychological performance [13-18]. A meta-analytic study by Grant, et al. [19] also identified impairment in the ability of chronic users of cannabis to recall new information, though findings by Schwartz [20] and Lyons [21] indicate an absence of long-term residual effects of cannabis use on cognitive abilities. Traditionally, Jamaicans view cannabis use as providing many benefits.  These findings are an important step in providing empirical evidence for possible cognitive impairment from cannabis use, among the adolescent population. Further research is needed to determine dose-related, in addition to long-term residual effects of cannabis use on neuropsychological performance in the Caribbean. Understanding the relationship between the complex factors that influence neurocognitive performance of cannabis users should further help to inform the development of public policy and legislation in Jamaica and the Caribbean.

Limitations

The sample size of 30 for the user group even though deemed sufficient, was still small and the present study consisted of male participants only. It would be of interest to know if there is a gender difference in cannabis users’ in performance on neurocognitive tests of memory.

Conclusion

The findings suggest that there is a significant difference in performance between Jamaican male adolescent cannabis users and non-users on neuro-cognitive tests. Users of cannabis displayed cognitive deficits on all tests of memory, intelligence, language and attention that were conducted. The present findings lend new support to the notion that cannabis use may impair neurocognitive functioning.

There are implications for poor school performance by adolescent users of cannabis in Jamaica. These results support the need for public health policies aimed at targeting early prevention strategies, demand reduction, identification and treatment of adolescent cannabis users in Jamaica.

Source:     Ment Health Addict Res, 2016 doi: 10.15761/MHAR.1000118  

Karyl Powell-Booth1,et al

The marijuana industry would rather you didn’t know this nasty truth about weed use before and during pregnancy.

Nine states are carrying measures to legalize marijuana on the Nov. 8 ballot — California, Nevada, Maine, Arizona, Massachusetts, Florida, Arkansas, Montana, and North Dakota. Pot peddlers claim the industry will boost jobs and grow the economy.

But the marijuana industry isn’t interested in the occasional or casual adult user. Like any drug industry, this group is interested in addicts — people who start using early and make it a lifetime habit. Maybe that’s why they don’t care about how their drugs are affecting babies — and why they occasionally take measures to market their products to pregnant women.

Between 7 and 10 percent of newborns at the [Pueblo] hospital are testing positive for THC, the mind-altering ingredient in cannabis.

The data is only now starting to roll in. Recently, 237 physicians from Pueblo, Colorado, banded together to detail some of the health risks associated with marijuana legalization. In particular, Dr. Steven Simerville, a paediatrician at St. Mary-Corwin Hospital, has found that between 7 and 10 percent of newborns at the hospital are testing positive for THC, the mind-altering ingredient in cannabis.

Researchers have found that THC levels in babies lead to decreased spatial reasoning, I.Q., learning, and memory, as well as an increased risk for suicide and later drug use.

Marijuana use in pregnancy takes a toll, said Pamela McColl of British Columbia. She has eyewitness proof. Her sister, who was married to a longtime marijuana user, had a newborn baby who suffered a cerebral haemorrhage at three weeks old. Her sister’s two other children also experienced complications, including reproductive abnormalities and heart defects.

A 2015 study from the University of Copenhagen confirmed that male use of marijuana damages sperm and can lead to birth defects. “So nobody is going to tell me that this isn’t related to marijuana,” she told LifeZette. McColl has been working for years as national director of Smart Approaches to Marijuana in British Columbia in order to spread awareness of the health risks of marijuana. Related: The Heavy Price of Persistent Pot Smoking

Women have been a target market for marijuana use for a while. Whoopi Goldberg and Maya Elisabeth have been instrumental in pushing marijuana as a solution for menstrual cramps — and many government officials are listening. States such as New Jersey are moving to add menstrual cramps to the list of medically approved maladies that could be addressed with marijuana usage. Dispensaries and midwives have been peddling marijuana as a cure-all for morning sickness.

Warning labels on prescription medications, cigarette boxes, and other hazardous products help women understand the risks of casual usage during pregnancy. Pot products carry no such warning.

But using marijuana during pregnancy can lead to a myriad of health problems, including cerebral haemorrhage, spina bifida, Down syndrome — even babies who are born with only half a brain. Research from the University of Adelaide in South Australia shows that marijuana use even before conception can damage the foetus.

“The risk to the foetus is not only cognitive development damage, which shows up in the early preschool years, but also in DNA studies,” McColl explained. “So we’re seeing preliminary research now that shows that use of marijuana by men or women is detrimental to chromosomal health. You can see generational damage here. This is really quite terrifying. People who use marijuana — it may not just be their own children but their grandchildren. This is a 100-year problem we may now be facing.”

By not requiring warning labels on cannabis products, the government is leaving itself open to lawsuits. Warning labels on prescription medications, cigarette boxes, and other hazardous products help women understand the risks of casual usage during pregnancy. Marijuana products carry no such warning.

By not condemning the marijuana movement, the U.S. government violates the United Nations Drug Control Conventions and betrays its allies. “When I was at the U.N. in April, they reamed out the Americans, saying, ‘You cannot do this. We all agreed,’” McColl said. Sweden, Zimbabwe, Nigeria, and numerous other countries are worried that the U.S. drug industry would leak across to their borders and pose public health problems for their rising generations.

Nobody knows what will happen to the babies who are born THC-positive. Previous studies in the 1970s on THC-positive infants had levels around 2.5 percent; many of these infants today are measuring around 15 percent. “We don’t know what it means now,” Dr. Simerville said in a press conference about the marijuana crisis. He explained the brain doesn’t finish developing until the late twenties — and early exposure to cannabis will have devastating neurological effects on the developing brain.

There may not be enough research to document exactly what neurological trauma will occur for some of these babies. But McColl confirmed that the 20,000-plus scientific studies have shown clearly that cannabis is “unsafe for human consumption” and could cost taxpayers billions of dollars down the road in health care costs.

Source:  http://www.lifezette.com/healthzette/littlest-most-vulnerable-going-to-pot/  6th Nov.2016A

Teens who take opioid painkillers without a prescription also often use cannabis, according to a new study.

Researchers analyzed information from more than 11,000 children and teens ages 10 to 18, in 10 U.S. cities. Participants were asked whether they had used prescription opioids in the past 30 days, and whether they had ever used cannabis.

Overall, about 29 percent of the teens said they had used cannabis at some point in their lives. But among the 524 participants who said they had used prescription opioids in the past 30 days, nearly 80 percent had used cannabis. The findings show that among young opioid users, the prevalence of cannabis use is high, said Vicki Osborne, a doctoral student in epidemiology at the University of Florida. Osborne presented the study Oct. 31 at the meeting of the American Public Health Association in Denver.

Among teens who said they used opioids without a prescription (meaning they obtained the drugs through a friend, family member or other avenue), about 88 percent had used cannabis, compared with 61 percent of those who did have a prescription for the opioids they used.

The study also found that the teens who reported having used alcohol or tobacco in addition to opioids were much more likely to use cannabis as well. Of the participants who had used opioids, those who also reported recent alcohol use were nearly 10 times more likely to have used cannabis, compared with those who didn’t use alcohol recently. And those who currently smoked tobacco were 24 times more likely to have used cannabis than those who were not tobacco users, the study found.

Efforts to prevent young people who use opioid painkillers from also using cannabis should target those who use alcohol and tobacco, Osborne said. Efforts should also target males, who were more likely to report using cannabis than females were, she said.

Interventions should also target young people who use opioids without a prescription, Osborne said. Even though such use of opioids among youth is not as high as it is among adults, the proportion of youth using opioids without a prescription is still concerning, she said.

The researchers plan to study the data further, and look at when young people start using cannabis versus when they start using opioids, Osborne said. Previous studies have found that legalizing medical marijuana actually appears to lead to a reduction in opioid use among adults. However, Osborne said the new findings among youth may be different from those in adults, because even in states that have legalized the use of marijuana, the drug is still illegal for teens to use.

Source:  http://www.livescience.com/56784-teen-opioid-cannabis-use.html  7 Nov16

Childhood Emotional Abuse Linked to Adult Migraine

DENVER — There is an association between childhood trauma, especially sexual trauma, and the misuse of prescription pain pills and injectable drugs, according to a large nationwide sample that followed subjects from adolescence into adulthood.

The more types of trauma that subjects experienced during childhood, the greater the odds of pain pill misuse, and those odds increase with increasing age, said Kelly Quinn, PhD, assistant professor of population health at the NYU Langone Medical Center in New York City.

“That speaks to the fact that childhood trauma potentially has down-the-road consequences that may not manifest immediately, but could have implications for the later course of health,” she told Medscape Medical News.

Dr Quinn presented the research here at the American Public Health Association 2016 Annual Meeting.

She and her colleagues analyzed a range of trauma types in a diverse nationwide population using data from the National Longitudinal Study of Adolescent to Adult Health.

Of the 12,288 participants, 54% were female, 66% white, 16% were black, and 12% were Hispanic.

The cohort was stratified into three waves: adolescence, which involved participants 12 to 21 years of age; emerging adulthood, which involved participants 18 to 28 years; and adulthood, which involved participants 24 to 34 years.

The researchers looked at the exposure to trauma before the age of 18, and assessed nine specific traumas: neglect; emotional, physical, and sexual abuse; parental incarceration and binge drinking; and witness to, being threatened with, or experiencing violence.

Overall, 16% of participants experienced emotional abuse during childhood and 5% experienced personal violence. In the cohort, 47% of participants reported no childhood trauma, 28% reported one, 13% reported two, 7% reported three, 3% reported four, and 2% reported at least five.

The risk for injectable drug use in adulthood was highest for people who had experienced sexual abuse (odds ratio [OR], 4.77; 95% confidence interval [CI], 2.44 – 9.34) and for people who had witnessed violence (OR, 2.82; 95% CI, 1.24 – 6.44).

During emerging adulthood, 20.25% of the participants misused pain pills, and during adulthood, 10.46% did. After adjustment for sociodemographic factors, the more traumas experienced, the higher the probability of pain pill misuse during emerging adulthood and adulthood.  The relation between the number of trauma types experienced and injectable drug use during emerging adulthood was particularly striking.

Dr Quinn ascribed the drop-off in risk at five or more traumas to the infrequency of injectable drug use in the population, which was approximately 1%. But “regardless of the drop-off, those are compelling findings,” she said.

These results are similar to those seen in the 2003 Adverse Childhood Experiences (ACE) study of an HMO population in California (Pediatrics. 2003;111:564-572).

Dr Quinn ascribed the drop-off in risk at five or more traumas to the infrequency of injectable drug use in the population, which was approximately 1%. But “regardless of the drop-off, those are compelling findings,” she said.

These results are similar to those seen in the 2003 Adverse Childhood Experiences (ACE) study of an HMO population in California (Pediatrics. 2003;111:564-572).

Dr Quinn ascribed the drop-off in risk at five or more traumas to the infrequency of injectable drug use in the population, which was approximately 1%. But “regardless of the drop-off, those are compelling findings,” she said.

These results are similar to those seen in the 2003 Adverse Childhood Experiences (ACE) study of an HMO population in California (Pediatrics. 2003;111:564-572).

The causative relation remains unclear, according to Laurens Holmes, MD, DrPH, director of health disparity research at the Nemours Alfred I. duPont Hospital for Children in Wilmington, Delaware.

He said he is impressed by the ability of Dr Quinn’s team to control for a wide range of variables, but noted that causal relations are notoriously difficult to confirm. Before being completely convinced, a closer look at the data is required, he explained.

Still, “the fact they were able to control for other traumas that were not central or fundamental to the study makes the study a bit more reasonable and realistic,” Dr Holmes told Medscape Medical News.

If the relation is causative, it could have implications for the treatment and prevention of drug use.

“If you can get a sense of trauma that may have  happened in childhood and address it early on, maybe you can avoid the misuse of drugs altogether,” Dr Quinn said. This has “implications for drug users later down the road. You wouldn’t expect to successfully treat them and prevent relapse if you weren’t addressing the constellation of issues that go on in their life. That’s when trauma-informed treatment comes into play.”

This study could also have implications for the dispensation of pain medication, according to session moderator Judith Weissman, PhD, JD, research manager in the division of general internal medicine and clinical innovation at the NYU Langone Medical Center.

The results could help identify patients who might be at high risk for addiction, she pointed out.

In the United States, the misuse of prescription pain pills quadrupled from 1999 to 2008 (J Safety Res. 2012;43:283-289).

“There has to be much more consideration and discretion in how opioids are passed out by physicians who are not pain experts. A prescription gets a person out of pain, but ultimately it can create a problem down the road,” Dr Weissman said.

Source:  American Public Health Association (APHA) 2016 Annual Meeting: Abstract 354983. Presented November 2, 2016.

In a report aired on Sunday’s 60 Minutes on CBS — and previewed in a piece on Friday’s CBS Evening News — medical correspondent Dr. Jon LaPook highlighted some of the problems seen in Colorado that have increased in the couple of years since the state legalized marijuana use in 2014.

LaPook spoke with a doctor from Pueblo County who recalled a substantial increase in women giving birth whose newborn babies test positive for marijuana, threatening the babies with permanent brain development problems. After also recounting a substantial increase in illegal production forcing many more law enforcement actions, the CBS correspondent also recalled the difficulty in detecting marijuana use in drivers.

LaPook began by forwarding the views of Dr. Steven Simerville of Pueblo’s St. Mary Corwin Medical Center, who supports an effort in his county to ban marijuana use there. LaPook:

He supports the ballot initiative to ban recreational pot — in part because he says he’s noticed more babies being born with marijuana in their system. His observations are anecdotal, but he’s concerned by what he has seen in his own hospital. In the first nine months of this year, 27 babies born at this hospital tested positive for THC — the psychoactive ingredient in marijuana. That’s on track to be about 15 percent higher than last year.

After Dr. Simerville was seen informing LaPook that there are currently newborn babies at the hospital being treated for marijuana exposure, LaPook followed up: “What does the mother say when you say, ‘Your baby just tested positive for marijuana and it can possibly harm the baby’? What does the mother say?”

Dr. Simerville recalled that pot legalization has contributed to the misconception that, because it is legal, it is not harmful for the babies of pregnant women:

SIMERVILLE: They are not surprised that they tested positive. Obviously they know they’ve been smoking marijuana. But they’re in disbelief that it’s harmful. They frequently say, “How can it be harmful? It’s a legal drug.”

LAPOOK: Dr. Simerville says that’s a common misconception, especially because 25 states have approved marijuana for medical use for conditions like epilepsy, pain, and stimulation of appetite. But on the federal level, it’s still illegal. Today’s pot is, on average, four to five times stronger than it was in the 1980s. It can also get passed on to babies in high concentrations in breast milk.

Viewers were then informed of the dangers for babies in brain development:

SIMERVILLE: I try to explain to them that even though you’re not smoking very much, the baby is getting seven time more than you’re taking, and that this drug has been shown to cause harm in developing brains.

LAPOOK: Research suggests babies exposed to marijuana in utero may develop verbal, memory, and behavioral problems during early childhood.

After recalling a 70 percent increase in teenagers visiting the emergency room testing positive for marijuana, LaPook informed viewers of the possible ill effects for teens using marijuana:

That worries Dr. Simerville because evidence is emerging that heavy teenage use — using four to five days a week — may be linked to long-term damage in areas of the brain that help control cognitive functions like attention, memory, and decision-making.

It’s not known if there’s any amount of marijuana that is safe for the developing brain, which may still be maturing during the mid to late 20s.

The piece then moved to dealing with the burdens on law enforcement in having to find increased illegal growing of marijuana, and the difficulty in detecting the substance in the bodies of those illegally driving under the influence.

Source: http://blabber.buzz/index.php?option=com_k2&amp;view=item&amp;id=47494:cbs-highlights-problems-after-marijuana-legalization-in-colorado&amp;Itemid=1005 c

In this new era of legalized marijuana, far too little research has been conducted on the effect of cannabis on the development of human embryos, say researchers at Georgetown University Medical Center who scoured medical literature on the topic and found what they say is worrisome animal research.

Their study, in the journal BioMed Central (BMC) Pharmacology and Toxicology, suggests an urgent need for human epidemiological and basic research that examines the link between maternal cannabinoid use, either smoked or eaten in candy bars, and the health of newborns. Cannabinoids are chemicals like THC, the primary psychoactive compound in marijuana, that act on cannabinoid receptors in neurons, repressing the normal release of neurotransmitters.

“We know from limited human studies that use of marijuana in early pregnancy is associated with many of the same risks as tobacco, including miscarriage, birth defects, developmental delays and learning disabilities, but animal research suggests the potential for many more developmental issues linked with the drug,” says the study’s senior investigator, G. Ian Gallicano, PhD, associate professor of biochemistry and molecular & cellular biology at Georgetown.

Gallicano says one reason for limited research is that the classification of marijuana as a Schedule I drug creates challenges to conducting research.

“All of the model systems point to the notion that cannabinoids affects many aspects of human development because THC and other chemicals alter molecular pathways that shouldn’t be disrupted during development of a fetus,” he says. “We also know that THC is a promising agent for treating cancer, because it negatively affects tumor growth and can cause the death of cancer cells. Embryo development has similarities to tumor formation – it turns on growth pathways that are necessary for development,” Gallicano says. “The fact that THC seems to stop cancer growth suggests how damaging the chemical could be for a fetus.”

The study grew from a project of four current Georgetown medical students (Joseph Friedrich, Dara Khatib, Keon Parsa, and Ariana Santopietro) for a course, Sexual Development and Reproduction, taught by Gallicano. They undertook the analysis given that although four states have legal recreational marijuana use and 24 allow use of medical marijuana, little research has been conducted on outcomes from use of the drug in pregnancy and biological mechanisms that cause these issues.

The students reviewed the scientific literature for studies on cannabinoids and embryonic development published between 1975 and 2015. They cite the following findings:

* THC lasts in the body for weeks, especially in maternal tissues that act as reservoirs for THC and other cannabinoids, according to studies of pregnant dogs. Human cells studies have shown that THC has a half-life of eight days in fat deposits and can be detected in blood for up to 30 days;

* THC readily crosses the human placenta, which can slow clearance of the drugs while prolonging fetal exposure;

* THC levels in smoked marijuana have increased nearly 25-fold since 1970, and can be substantially stronger in edible preparations of cannabis; * THC and other cannabinoids interfere with use of folic acid (vitamin B9), which has long been known to be essential for normal development and growth of the human

placenta and embryo. Deficiencies in folic acid are linked to low human birth weight, increased risk of spontaneous abortion, and neural tube defects such as spina bifida.

* Cannabinoid signaling plays important roles in development of a mouse embryo. It is required for proper pre-implantation development, embryo transport to the uterus, and implantation.

* In post-implantation development, cannabinoid signaling functions in a multitude of pathways, including, but not limited to blood vessel growth, fate of embryonic stem cells, and normal cognitive development. For example, disruption of one key neural pathway, BDNF, has been linked to increased risk of congenital malformations and impaired cognition, including autism and low IQ in humans.

The authors also say the harms found in animal studies cited in this study do not include the damaged induced from the act of smoking marijuana.

No funding for the study was provided or sought. Article: The grass isn’t always greener: The effects of cannabis on embryological development, Joseph Friedrich, Dara Khatib, Keon Parsa, Ariana Santopietro and G. Ian Gallicano, BMC Pharmacology and Toxicology, doi: 10.1186/s40360-016-0085-6, published 29 September 2016.

A new study finds the number of young children and teens hospitalized for opioid painkiller overdoses has almost tripled in recent years.

Opioid overdoses increased 205 percent from 1997 to 2012 among children ages 1 to 4, HealthDay reports. Among teens ages 15 to 19, overdoses increased 176 percent.

Most poisonings due to opioid painkillers among children under 10 were accidental. Lead researcher Julie Gaither of the Yale School of Medicine says young children are “eating them like candy.” Most overdoses among teens were accidental, although some were suicide attempts, Dr. Gaither noted.

Source: The study appears in JAMA Pediatrics. Partnership News Service thepartnership@drugfree.org  3rd Nov.2016

Thanks to advances in science, we have never known so much about the effects marijuana use has on the human body, particularly, the fragile brain. Yet, in a political era when scientific research is regularly marshalled to end public policy debates, the powerful, growing scholarship on marijuana has largely been ignored or dismissed. Indeed, marijuana use seems to be one of the glaring areas in modern life where wishful thinking reigns over rationality.

Yet, as the lesson of tobacco demonstrates, when Americans are given the scientific facts about serious threats to their health, they adjust their behavior and insist on measures to safeguard their communities. In the instance of marijuana, the public can be forgiven for not knowing the true threat. With the assistance of a sympathetic media, marijuana legalization advocates, many seeking to profit off the drug, continue to sell romantic falsehoods and outright lies. They casually dismiss the growing list of serious concerns about marijuana emerging from scientific scholarship and survey research, or just cry “reefer madness” without examining the evidence.

Amidst the current marijuana public policy discussion, more than ever, concerned citizens, community leaders, lawmakers, educators, and parents need to better understand the growing body of research about this drug. What follows is a compilation and discussion of the latest research, including reports that are beginning to come in on the effects legalization has had in Colorado and neighbouring states—including increased criminal activity even with legalization. While all research has limitations, what we do know is becoming clearer by the day, and it will make many question what they thought they knew about this drug of abuse.

Key Recent Findings:

Journal of the American Medical Association: “There is little doubt about the existence of an association between substance use and psychotic illness…studies suggest that the association between cannabis use and later psychosis might be causal, a conclusion supported by studies showing that cannabis use is associated with an earlier age at onset of psychotic disorders, particularly schizophrenia.”

Society for the Study of Addiction: “Regular cannabis use in adolescence approximately doubles the risks of early school-leaving and of cognitive impairment and psychoses in adulthood. Regular cannabis use in adolescence is also associated strongly with the use of other illicit drugs

World Psychiatric Association: “Evidence that is a component cause of psychosis is now sufficient for public health messages outlining the risk, especially of regular use of high-potency cannabis and synthetic cannabinoids.”

American Academy of Paediatrics: “The adverse effects of marijuana have been well documented” and include “impaired short-term memory, decreased concentration, attention span, and problem solving” which “interfere[s] with learning.”

American Psychological Association: “Heavy marijuana use in adolescence or early adulthood has been associated with a dismal set of life outcomes including poor school performance, higher dropout rates, increased welfare dependence, greater unemployment and lower life satisfaction.”

Proceedings of the National Academy of Sciences: “Persistent adolescent-onset cannabis users” showed “an average 8-point IQ decline from childhood to adulthood.”

Clinical Psychological Science Journal: Duke University and UC Davis researchers “found that those dependent on cannabis experienced more financial difficulties, such as paying for basic living expenses and food, than those who were alcohol dependent.”

Journal of Drug and Alcohol Dependence: States that have legalized “medical” marijuana find an association with higher 12th grade drop-out rates, lessened college attainment, and increases in daily smoking. Further, there is a dose/response relationship between adverse impact and years of increased exposure under legalization.

U.S. Department of Health and Human Services, SAMHSA: Since legalizing marijuana, Colorado climbed to number one among states for both youth (12-17) and college age adults (18-25) marijuana use.

Discussion:

The further acceptance of marijuana legalization and commercialization in some states will lead to a greater availability of the drug. Greater availability and acceptance will lead to greater use of marijuana, both in the sense of more users, and likely further in the sense of more frequent and greater consumption.

In states that have legalized already there is strong evidence that adult use has surged upward. There is further evidence that use by youth will also increase.

Youth use of marijuana in states that have now commercialized sales was already more extensive than national norms, however, reports since the first commercialization began in January, 2014, indicate growing use amongst all age groups.

As marijuana use intensifies, the consequences of such use and abuse accelerates. These consequences are considerable, and will impose significant costs, both personal and economic, on health and social well-being.

Finally, and perversely, evidence is strong that the consequences will include not only continued, but intensified and entrenched criminal activity associated with drug use. Indications are clear that the criminal and violent black market capitalizes on increased marijuana availability and use. Marijuana commercialization/legalization is advancing both a public health and a public safety disaster.

We shall review recent evidence of the health-related consequences in this document. In a later accompanying document we will assess the impact on use of drugs beyond marijuana, as well as the impact on further criminal drug markets.

Though comparisons between marijuana and other substances of abuse are frequently made to the effect that marijuana is not proportionally lethal, there are nevertheless other measures of the drug’s dangers. Former National Institute on Drug Abuse Director Dr. Bob DuPont has termed marijuana “the most dangerous drug,” in part because of the sheer prevalence of what is the most widely used illegal substance in the world, and in part because the effects are not always felt or experienced by those affected. They can nevertheless be measured and are real. In some instances, research shows that they appear irreversible, even after abstinence.

Among the more troubling findings are those showing a relationship between marijuana use and psychotic episodes, diminished memory, verbal skill, and other cognitive performance, lowered life achievements, criminal and anti-social behavior, school leaving and academic failure, and even lowered life satisfaction.

Most concerning, perhaps, are the findings that heavy, early marijuana use is associated with a loss of intelligence over the life course. Specific supporting citations for other statements will be found below.

Further, Dr. Wayne Hall’s twenty-year review of the literature in the journal Addiction, as we will present in greater detail in the review, showed a clear relationship between youth marijuana use and subsequent use of other drugs. As Hall has argued:

The relationships between regular cannabis use and other illicit drug use have persisted after statistical adjustment for the effects of confounding variables in both longitudinal studies and discordant twin studies… The order of involvement with cannabis and other illicit drugs, and the increased likelihood of using other illicit drugs, are the most consistent findings in epidemiological studies of drug use in young adults.

In general, the health risks of marijuana use are reasonably well known, and based on long-standing research that now consists in multiple studies across many nations, exploring many dimensions of what is a very complex drug.

The last decade has witnessed an intensification of concern and stimulated even more studies of marijuana’s manifold impact, involving several areas of the body and the mind. The comprehensive nature of the physiological impact mirrors, to some extent, the widespread dispersal of the body’s naturally-occurring endocannabinoid receptor system.

There are additional physiological concerns, many based on smoking as the manner of consumption, focused on its effects on the cardiac and respiratory systems. These threats are real and mounting.

But the most compelling investigations regarding risk are emerging from studies of the brain, however the drug is consumed. These include both the structure and the functioning of the neurophysiology of the brain, and they further extend into discoveries regarding the consequences of brain activity, as we have mentioned, such as cognition, memory, learning, executive performance, and general behavior. Moreover, they also include examinations of drug dependency and what is termed “marijuana use disorder.”

That is, both the brain as an organ as well as “the mind,” the very personhood, of the individual are affected by the chemistry of the drug. Most concern is focused on the principle intoxicating element, THC , which shows signs of being actively toxic to the nervous system, the potency of which in modern forms is escalating dramatically under marijuana commercialization.

We must acknowledge that many studies demonstrate a risk that is emergent, and not fully known; multiple factors and confounders do coincide and must be accounted for before we argue “causation” for the effects that have been shown. Nevertheless, a substantial and repeated body of research that, taken piece by piece, showing “associations” or “correlations” or “predispositions,” must now be seen as sufficient, when taken together, to establish a clear and present danger.

In some measure, the worst effects are contingent, in the sense that not all forms of use by all individuals will produce the direst impact. But by now the evidence is compelling that certain forms of use, under certain circumstances, is deeply damaging.

Simply put, any honest observers must accept that the preponderance of evidence, as suggested by our review of recent literature which follows, demonstrates a high risk from marijuana use that is now overwhelming.

What we find is research from several related lines of inquiry, all pointing in the same direction. The risks are only worsening with time, in each line of inquiry, serving to confirm a congruence with the findings from other arena.

Studies of various marijuana disorders of behavior are being underpinned and given a basis by studies of the brain and its performance; showing consistent patterns from several interrelated domains of impact. Moreover, as over time the tools brought to bear have become more sophisticated and able to measure subtle and consequential effects, the sense of concern over what we are doing to youth is only mounting.

Though all users, even adult non-frequent users, have been shown to suffer some deficits through marijuana intoxication, and though there are further indications that even young adult casual users undergo structural brain changes, the evidence is far more robust and more worrying in other circumstances.

Danger increases, that is, when any of the following conditions are co-present with marijuana use: the existence of co-morbidities (or even predispositions), especially collateral substance dependencies or psychological deficits; certain genetic profiles that confer greater susceptibility; heavy, frequent use (daily use being the most threatening), especially of high-potency varieties; and especially exposure at a developmentally young age, during periods of highly consequential brain formation and calibration, generally ranging from prenatal or paediatric exposure up to young adulthood.

Where more than one of these factors is present, the risks escalate; where the developmentally young smoke high-potency cannabis frequently for an extended period – most markedly those with predisposing psychological deficits – the effects can be catastrophic in their lives, including dramatic “psychotic breaks.” These effects appear to be, in some cases, largely irreversible.

And it is this “worst-case scenario” that, perversely, is being fostered by state legalization and commercialization measures, thereby ensuring the greatest magnitude of damage.

A further implication of these facts concerns our emerging knowledge of the risks, given that most longitudinal studies showing long-term adult impacts were carried out without an appreciation of how the various factors above conferred greater vulnerability.

Often, studies that failed to find major impact were based on samples of adults, not adolescents, who were not exposed to heavy, frequent, newly-potent doses. Yet the commercialization of marijuana has resulted in marijuana potency that eclipses anything we have ever previously seen, in some cases by orders of magnitude. Highly potent “edibles” and concentrated cannabis extractions, like “shatter” are taking potency levels once common in the two- to three-percent range up to 80 percent. The consequence is that most everything we thought we knew about marijuana’s risks needs to be re-assessed under contemporary conditions, and most every danger, as we progressively uncover them, turns out to be heightened.

These finding are warnings of grave danger, with the promise of yet more to be discovered. Not all is “proven,” and not all establishes independent causation, but the evidence is strong enough, and growing daily, to activate in public policy a “precautionary principle.” That is, the evidence is strong enough to warrant a clear directive not to proceed further. Simply put, the pathway of legalization must not be pursued.

Recent Research and Findings: An Annotated Review

What has research over the past two decades revealed about the adverse health effects of recreational cannabis use? (full article), Addiction, (2014).

“Regular cannabis use in adolescence approximately doubles the risks of early school-leaving and of cognitive impairment and psychoses in adulthood. Regular cannabis use in adolescence is also associated strongly with the use of other illicit drugs.”

Unintentional Pediatric Exposures to Marijuana in Colorado: 2009-2015, Pediatrics, (2016).

“Annual pediatric marijuana cases increased more than 5-fold from 2009 (9) to 2015 (47). Colorado had an average increase in cases of 34% (P < .001) per year while the remainder of the United States had an increase of 19% (P < .001).”

Wants Marijuana Products to Have Warnings Against Use in Pregnancy, National Council on Alcoholism and Drug Dependence, (2015).

The American Medical Association seeks warnings against marijuana use in pregnancy.

Cannabis Use and Earlier Onset of Psychosis, Psychiatry, (2011).

“There is little doubt about the existence of an association between substance use and psychotic illness. National mental health surveys have repeatedly found more substance use, especially cannabis use, among people with a diagnosis of a psychotic disorder. There is a high prevalence of substance use among individuals treated in mental health settings,6 and patients with schizophrenia are more likely to use substances than members of the wider community. Prospective birth cohort and population studies suggest that the association between cannabis use and later psychosis might be causal, a conclusion supported by studies showing that cannabis use is associated with an earlier age at onset of psychotic disorders, particularly schizophrenia.”

The Impact of Marijuana Policies on Youth: Clinical, Research, and Legal Update, American Academy of Pediatrics, (2015).

“The adverse effects of marijuana have been well documented, and studies have demonstrated the potential negative consequences of short- and long-term recreational use of marijuana in adolescents. These consequences include impaired short- term memory and decreased concentration, attention span, and problem solving, which clearly interfere with learning. Alterations in motor control, coordination, judgment, reaction time, and tracking ability have also been documented; these may contribute to unintentional deaths and injuries among adolescents (especially those associated with motor vehicles if adolescents drive while intoxicated by marijuana).

Negative health effects on lung function associated with smoking marijuana have also been documented, and studies linking marijuana use with higher rates of psychosis in patients with a predisposition to schizophrenia have recently been published, raising concerns about longer-term psychiatric effects. New research has also demonstrated that the adolescent brain, particularly the prefrontal cortex areas controlling judgment and decision-making, is not fully developed until the mid-20s, raising questions about how any substance use may affect the developing brain. Research has shown that the younger an adolescent begins using drugs, including marijuana, the more likely it is that drug dependence or addiction will develop in adulthood. A recent analysis of 4 large epidemiologic trials found that marijuana use during adolescence is associated with reductions in the odds of high school completion and degree attainment and increases in the use of other illicit drugs and suicide attempts in a dose-dependent fashion that suggests that marijuana use is causative.”

American Academy of Pediatrics Reaffirms Opposition to Legalizing Marijuana for Recreational or Medical Use, American Academy of Pediatrics, (2015).

The American Academy of Pediatrics () reaffirms its opposition to legalizing marijuana, citing the potential harms to children and adolescents.

Half-Baked — The Retail Promotion of Marijuana Edibles, New England Journal of Medicine, (2015).

“Edibles that resemble sugary snacks pose several clear risks. One is over-intoxication….At high doses, can produce serious anxiety attacks and psychotic-like symptoms. This problem is augmented by differences in the pharmacokinetic and metabolic effects of marijuana when it is ingested rather than smoked. In addition, case reports document respiratory insufficiency in young children who have ingested marijuana.”

Adverse Health Effects of Marijuana Use, New England Journal of Medicine, (2014).

A review of the current state of the science related to the adverse health effects of the recreational use of marijuana, focusing on those areas for which the evidence is strongest.

A New England Journal of Medicine Article about Marijuana, Psychology Today, (2014) summarizes the adverse health effects as published in the New England Journal of Medicine.

UN: cannabis law changes pose ‘very grave danger to public health’, The Guardian, (2014).

United Nations International Narcotics Control Board warns of “very grave danger” from legalizing marijuana.

Damaging Effects of Cannabis Use on the Lungs, Advances in Experimental Medicine and Biology, (2016).

“Cannabis smoke affects the lungs similarly to tobacco smoke, causing symptoms such as increased cough, sputum, and hyperinflation. It can also cause serious lung diseases with increasing years of use. Cannabis can weaken the immune system, leading to pneumonia. Smoking cannabis has been further linked with symptoms of chronic bronchitis. Heavy use of cannabis on its own can cause airway obstruction. Based on immuno-histopathological and epidemiological evidence, smoking cannabis poses a potential risk for developing lung cancer.”

Marijuana use in adolescence may increase risk for psychotic symptoms, American Journal of Psychiatry, (2016).

Regular marijuana use significantly increased risk for subclinical psychotic symptoms, particularly paranoia and hallucinations, among adolescent males.

Heavy, persistent pot use linked to economic, social problems at midlife: Study finds marijuana not ‘safer’ than alcohol, Clinical Psychological Science, (2016).

Science Daily’s review of a research study that followed children from birth up to age 38 has found that people who smoked cannabis four or more days of the week over many years ended up in a lower social class than their parents, with lower-paying, less skilled and less prestigious jobs than those who were not regular cannabis smokers. These regular and persistent users also experienced more financial, work-related and relationship difficulties, which worsened as the number of years of regular cannabis use progressed.

The impact of adolescent exposure to medical marijuana laws on high school completion, college enrolment and college degree completion, Drug & Alcohol Dependence, (2016).

States that have legalized marijuana find an association with higher 12th grade drop out rates, lessened college attainment, and increases in daily smoking. Further, there is a dose/response relationship between adverse impact and years of increased exposure under legalization.

Early marijuana use associated with abnormal brain function, lower IQ, Lawson Health Research Institute, (2016).

“Previous studies have suggested that frequent marijuana users, especially those who begin at a young age, are at a higher risk for cognitive dysfunction and psychiatric illness, including depression, bipolar disorder and schizophrenia.”

Marijuana Users Have Abnormal Brain Structure and Poor Memory, Northwestern Medicine, (2013).

“Teens who were heavy marijuana users — smoking it daily for about three years — had abnormal changes in their brain structures related to working memory and performed poorly on memory tasks, reports a new Northwestern Medicine® study. A poor working memory predicts poor academic performance and everyday functioning. The brain abnormalities and memory problems were observed during the individuals’ early twenties, two years after they stopped smoking marijuana, which could indicate the long-term effects of chronic use. Memory-related structures in their brains appeared to shrink and collapse inward, possibly reflecting a decrease in neurons.”

Young adult sequelae of adolescent cannabis use: an integrative analysis, Lancet Psychiatry, (2014).

Adolescent cannabis use has adverse consequences in young adulthood:

“We recorded clear and consistent associations and dose-response relations between the frequency of adolescent cannabis use and all adverse young adult outcomes. After covariate adjustment, compared with individuals who had never used cannabis, those who were daily users before age 17 years had clear reductions in the odds of high-school completion…and degree attainment…, and substantially increased odds of later cannabis dependence…, use of other illicit drugs…, and suicide attempt.”

Traditional marijuana, high-potency cannabis and synthetic cannabinoids: increasing risk for psychosis, World Psychiatry, (2016).

“Evidence that [THC] is a component cause of psychosis is now sufficient for public health messages outlining the risk, especially of regular use of high-potency cannabis and synthetic cannabinoids.”

Monitoring Marijuana Use in the United States; Challenges in an Evolving Environment, (2016).

“Use of marijuana or any of its components, especially in younger populations, is associated with an increased risk of certain adverse health effects, such as problems with memory, attention, and learning, that can lead to poor school performance and reduced educational and career attainment, early-onset psychotic symptoms in those at elevated risk, addiction in some users, and altered brain development.”

Marijuana use and use disorders in adults in the , 2002–14: analysis of annual cross-sectional surveys, Lancet Psychiatry, (2016).

Commenting on this study to the Associated Press, Dr. Wilson Compton, Deputy Director of said, “if anything, science has shown an increasing risk that we weren’t as aware of years ago.” He added that other research has increasingly linked marijuana use to mental impairment, and early, heavy use by people with certain genes to increased risk of developing

psychosis.

Prenatal marijuana exposure, age of marijuana initiation, and the development of psychotic symptoms in young adults, Psychological Medicine, (2015).

Prenatal marijuana exposure linked to bad childhood outcomes; if effect is further “mediated” through early onset marijuana use, strong association with negative adult outcomes, such as arrest, low educational performance, unemployment.

One in six children hospitalized for lung inflammation positive for marijuana exposure, American Academy of Pediatrics, (2016).

Colorado: 16% of exposed children admitted to hospital for lung inflammation tested positive for MJ metabolite.

Cannabis use increases risk of premature death, American Journal of Psychiatry, (2016).

Cannabis use in youth increases the risk of early death.

Scientists Call for Action Amidst Mental Health Concerns, The Guardian, (2016).

“Most research on cannabis, particularly the major studies that have informed policy, are based on older low-potency cannabis resin.” According to Sir Robin Murray, professor of psychiatric research at King’s College London: “It’s not sensible to wait for absolute proof that cannabis is a component cause of psychosis. There’s already ample evidence to warrant public education around the risks of heavy use of cannabis, particularly the high-potency varieties. For many reasons, we should have public warnings.””

Marijuana use in adolescence may increase risk for psychotic symptoms, American Journal of Psychiatry, (2016).

Chronic marijuana use in adolescent boys increases risk of developing persistent subclinical psychotic symptoms (hallucinations, paranoia). “For each year adolescent boys engaged in regular marijuana use … subsequent symptoms increased by 21% and… paranoia or hallucinations increased by 133% and 92%, respectively. This effect persisted even when [study] participants stopped using marijuana for 1 year.”

Heavy, persistent pot use linked to economic, social problems at midlife, Clinical Psychological Science, (2016).

“Regular long-term [marijuana] users also had more antisocial behaviors at work, such as stealing money or lying to get a job, and experienced more relationship problems, such as intimate partner violence and controlling abuse.”

Effects of Cannabis Use on Human Behavior, Including Cognition, Motivation, and Psychosis: A Review, Psychiatry, (2016).

This longitudinal study documented adolescent-onset (but not adult-onset) persistent cannabis users showed neuropsychological decline ages 13 to 38 years. “Longitudinal investigations show a consistent association between adolescent cannabis use and psychosis. Cannabis use is considered a preventable risk factor for psychosis… strong

physiological and epidemiological evidence supporting a mechanistic link between cannabis use and schizophrenia… raise[s] the possibility that our current, limited knowledge may only apply to the ways in which the drug was used in the past.”

Marijuana use disorder is common and often untreated, National Institute of Health/NESARC, (2016).

“People with marijuana use disorder are vulnerable to other mental health disorders … onset of the disorder was found to peak during late adolescence. …People with marijuana use disorder…experience considerable mental disability. …Previous studies have found that such disabilities persist even after remission of marijuana use disorder.”

The health and social effects of nonmedical cannabis use, World Health Organization, (2016).

“There is a worrying increasing demand for treatment for cannabis use disorders and associated health conditions in high- and middle-income countries, and there has been increased attention to the public health impacts of cannabis use and related disorders in international policy dialogues.”

AKT1 genotype moderates the acute psychotomimetic effects of naturalistically smoked cannabis in young cannabis smokers, Translational Psychiatry, (2016).

“Smoking cannabis daily doubles an individual’s risk of developing a psychotic disorder, yet indicators of specific vulnerability have proved largely elusive. Genetic variation is one potential risk modifier.”

What’s That Word? Marijuana May Affect Verbal Memory, Internal Medicine, (2016).

Researchers found a “dose-dependent independent association between cumulative lifetime exposure to marijuana and worsening verbal memory in middle age.”

Adolescent Cannabinoid Exposure Induces a Persistent Sub-Cortical Hyper-Dopaminergic State and Associated Molecular Adaptations in the Prefrontal Cortex., Cerebral Cortex, (2016).

“We report that adolescent, but not adult, exposure induces long-term neuropsychiatric-like phenotypes similar to those observed in clinical populations…. findings demonstrate a profound dissociation in relative risk profiles for adolescent versus adulthood exposure to in terms of neuronal, behavioral, and molecular markers resembling neuropsychiatric pathology.”

Cannabis increases the noise in your brain, Biological Psychiatry, (2015).

“At doses roughly equivalent to half or a single joint, ∆9- produced psychosis-like effects and increased neural noise in humans. The dose-dependent and strong positive relationship between these two findings suggest that the psychosis-like effects of cannabis may be related to neural noise which disrupts the brain’s normal information processing activity.”

Marijuana Use: Detrimental to Youth, American College of Pediatricians, (2016).

“Marijuana is the leading illicit substance mentioned in adolescent emergency department admissions and autopsy reports, and is considered one of the major contributing factors leading to violent deaths and accidents among adolescents.”

Chronic Adolescent Marijuana Use as a Risk Factor for Physical and Mental Health Problems in Young Adult Men, Psychology of Addictive Behaviors, (2015).

Evidence suggests that youth who use marijuana heavily during adolescence may be particularly prone to health problems in later adulthood (e.g., respiratory illnesses, psychotic symptoms).

Developmental Trajectories of Marijuana Use among Men, Journal of Research in Crime and Delinquency, (2015).

“Young men who engage in chronic marijuana use from adolescence into their 20s are at increased risk for exhibiting psychopathic features, dealing drugs, and enduring drug-related legal problems in their mid-30s.”

Appraising the Risks of Reefer Madness, Cerebrum, (2015).

“Cannabis is generally accepted as a cause of schizophrenia (though less so in North America, where this topic has received little attention),” notes Dr. R. Murray, an Oxford University Professor of Psychiatry.

Prenatal exposure to cannabinoids evokes long-lasting functional alterations by targeting CB1 receptors on developing cortical neurons, Adán de Salas-Quiroga, (2015).

“Prenatal exposure to cannabinoids evokes long-lasting functional alterations by targeting CB1 receptors on developing cortical neurons.” “This study demonstrates that remarkable detrimental consequences of embryonic exposure on adult-brain function, which are evident long after withdrawal, are solely due to the impact of on CB1 receptors located on developing cortical neurons.” Embryonic exposure increased seizures in adulthood and the consequences of prenatal were lifelong; even though the cannabinoid receptors after withdrawal appear normal, there is an apparent impact on connectivity.

Association Between Use of Marijuana and Male Reproductive Hormones and Semen Quality: A Study Among 1,215 Healthy Young Men, American Journal of Epidemiology, (2015).

“Regular marijuana smoking more than once per week was associated with a 28% … lower sperm concentration and a 29% … lower total sperm count after adjustment for confounders.”

Is Marijuana Use Associated With Health Promotion Behaviors Among College Students? Health-Promoting and Health-Risk Behaviors Among Students Identified Through Screening in a University Student Health Services Center, Journal of Drug Issues, (2015).

“Results showed marijuana users were more likely to use a variety of substances and engage in hazardous drinking than non-users.”

Psychosocial sequelae of cannabis use and implications for policy: findings from the Christchurch Health and Development Study, Social Psychiatry and Psychiatric Epidemiology, (2015).

“Findings…suggest that individuals who use cannabis regularly, or who begin using cannabis at earlier ages, are at increased risk of a range of adverse outcomes, including: lower levels of educational attainment; welfare dependence and unemployment; using other, more dangerous illicit drugs; and psychotic symptomatology.”

Young brains on cannabis: It’s time to clear the smoke, Clinical Pharmacology and Therapeutics, (2015).

“There is certainly cause for concern about the amount and frequency of cannabis use among youth….Recent evidence shows that early and frequent use of cannabis has been linked with deficits in short-term cognitive functioning, reduced IQ, impaired school performance, and increased risk of leaving school early – all of which can have significant consequences on a young person’s life trajectory….Heavy cannabis use in adolescence is also a risk factor for psychosis….Youth aged 15-24 spent the largest number of days in a hospital for a primary diagnosis of mental and behavioral disorders due to the use of cannabinoids.”

Association Between Lifetime Marijuana Use and Cognitive Function in Middle Age and Long-term Marijuana Use and Cognitive Impairment in Middle Age, Internal Medicine, (2016).

“These studies have generally shown reduced activity in those with long-term marijuana use in brain regions involved in memory and attention, as well as structural changes in the hippocampus, prefrontal cortex, and cerebellum.”

Denial of Petition To Initiate Proceedings To Reschedule Marijuana, Federal Register/DEA Review of “Scientific Evidence of [Marijuana’s] Pharmacological Effects, If Known”, (2016).

“Individuals with a diagnosis of marijuana misuse or dependence who…initiated marijuana use before the age of 15 years, showed deficits in performance on tasks assessing sustained attention, impulse control, and general executive functioning compared to non-using controls. These deficits were not seen in individuals who initiated marijuana use after the age of 15 years…. Additionally, in a prospective longitudinal birth cohort study of 1,037 individuals, marijuana dependence or chronic marijuana use was associated with a decrease in IQ and general neuropsychological performance compared to pre-marijuana exposure levels in adolescent onset users.

The decline in adolescent-onset users’ IQ persisted even after reduction or abstinence of marijuana use for at least 1 year…. The deficits in IQ seen in adolescent-onset users increased with the amount of marijuana used. Moreover, when comparing scores for measures of IQ, immediate memory, delayed memory, and information-processing speeds to pre-drug-use levels, the current, heavy, chronic marijuana users showed deficits in all three measures.”

The health and social effects of nonmedical cannabis use, World Health Organization, (2016).

“Cannabis is globally the most commonly used psychoactive substance under international control. In 2013, an estimated 181.8 million people aged 15−64 years used cannabis for nonmedical purposes globally (uncertainty estimates 128.5–232.1 million) (UNODC, 2015). There is a worrying increasing demand for treatment for cannabis use disorders and associated health conditions in high- and middle-income countries, and there has been increased attention to the public health impacts of cannabis use and related disorders in international policy dialogues.[…] This publication builds on contributions from a broad range of experts and researchers from different parts of the world. It aims to present the current knowledge on the impact of nonmedical cannabis use on health.”

Source:  https://hudson.org/research/12975-marijuana-threat-assessment-part-one-recent-evidence-for-health-risks-of-marijuana-use

Abstract

BACKGROUND:

There is concern that medical marijuana laws (MMLs) could negatively affect adolescents. To better understand these policies, we assess how adolescent exposure to MMLs is related to educational attainment.

METHODS:

Data from the 2000 Census and 2001-2014 American Community Surveys were restricted to individuals who were of high school age (14-18) between 1990 and 2012 (n=5,483,715). MML exposure was coded as: (i) a dichotomous “any MML” indicator, and (ii) number of years of high school age exposure. We used logistic regression to model whether MMLs affected: (a) completing high school by age 19; (b) beginning college, irrespective of completion; and (c) obtaining any degree after beginning college. A similar dataset based on the Youth Risk Behavior Survey (YRBS) was also constructed for confirmatory analyses assessing marijuana use.

RESULTS:

MMLs were associated with a 0.40 percentage point increase in the probability of not earning a high school diploma or GED after completing the 12th grade (from 3.99% to 4.39%). High school MML exposure was also associated with a 1.84 and 0.85 percentage point increase in the probability of college non-enrollment and degree non-completion, respectively (from 31.12% to 32.96% and 45.30% to 46.15%, respectively). Years of MML exposure exhibited a consistent dose response relationship for all outcomes. MMLs were also associated with 0.85 percentage point increase in daily marijuana use among 12th graders (up from 1.26%).

CONCLUSIONS:

Medical marijuana law exposure between age 14 to 18 likely has a delayed effect on use and education that persists over time.

Source:  https://www.ncbi.nlm.nih.gov/pubmed/27742490 Drug Alcohol Depend. 2016 Nov 1;168:320-327. doi: 10.1016/j.drugalcdep.2016.09.002. Epub 2016 Oct 11.

An intriguing new NIAAA-funded study offers a glimpse at how the adolescent brain responds to the language of therapists. Led by Sarah W. Feldstein Ewing, Ph.D., Professor of Psychiatry and Director of the Adolescent Behavioral Health Clinic at Oregon Health & Science University, the study assessed 17 young people ages 15–19 who were self-reported binge drinkers. Following a psychosocial assessment, the youths received two sessions of motivational interviewing aimed at reducing drinking. Between sessions, the participants underwent a brain scan using functional magnetic resonance imaging, or fMRI.

During the fMRI, the therapist presented two types of statements: one set of “closed questions” based on standard language used within addiction treatment (e.g., “Do your parents know you were drinking?”); the other set included more effortful “complex reflections” (e.g., “You’re worried about your drinking.”)

The youth were re-evaluated one month after treatment. At the follow-up evaluation, the youth showed significant reductions in number of drinking days and binge drinking days. Furthermore, in the fMRI sessions, the researchers observed greater brain activation for complex reflections versus closed questions within the bilateral anterior cingulate gyrus, a brain region associated with decisionmaking, emotions, reward anticipation, and impulse control.

The scientists also noted that greater blood-oxygen level dependent (BOLD) response in the parietal lobe during closed questions was significantly associated with less post-treatment drinking. BOLD response is a way to measure activity in specific brain areas. Previous research has shown that this region’s secondary function is related to a person’s ability to navigate, plan, and make decisions.

The study team also observed lower brain activation in the precuneus was associated with study participants’ post-treatment ratings of the importance of changing their drinking. The precuneus, a subregion of the parietal lobe located inside the fissure that separates the brain’s hemispheres, is related to self-reflection and introspection and is involved in risk behavior. It is considered to be a hub of the brain’s key resting-state network.

The researchers also noted what they did not find from the brain scans—any link between treatment outcome and activation of the frontal lobes, which are a region tied to complex reasoning. The authors commented that this lack of activation might be

because the frontal lobes of the adolescent brain are still developing, making it difficult for teens to bring their frontal lobes “online.”

The study authors note that their findings have important implications for the treatment of addiction in adolescents and can improve our understanding of youth brain systems and inform how to influence mechanisms of behavior change in this population.

Reference:

Feldstein Ewing, S.W.; Houck, J.M.; Yezhuvath, U.; Shokri-Kojori, E.; Truitt, D.; and Filbey, F.M. The impact of therapists’ words on the adolescent brain: In the context of addiction treatment. Behavioural Brain Research 297:359–369, 2016. PMID: 26455873

Source:  http://www.spectrum.niaaa.nih.gov/news-from-the-field/news-from-the-field-01.html  Volume 8 Issue 3  September 2016.

Despite the increasing use of cannabis among adolescents, there are little and often contradictory studies on the long-term neurobiological consequences of cannabis consumption in juveniles.

Adolescence is a critical phase for cerebral development, where the endocannabinoid system plays an important role influencing the release and action of different neurotransmitters.

Therefore, a strong stimulation by the psychoactive component of marijuana, delta-9-tetrahydrocannabinol (THC), might lead to subtle but lasting neurobiological changes that can affect adult brain functions and behaviour.

The literature here summarized by use of experimental animal models, puts forward that heavy cannabis consumption in adolescence may induce subtle changes in the adult brain circuits ending in altered emotional and cognitive performance, enhanced vulnerability for the use of more harmful drugs of abuse in selected individuals, and may represent a risk factor for developing schizophrenia in adulthood.

Therefore, the potential problems arising in relation to marijuana consumption in adolescence suggest that this developmental phase is a vulnerable period for persistent adverse effects of cannabinoids.

Source: Mol Cell Endocrinol. 2008 Apr 16;286

The nature of the teenage brain makes users of cannabis amongst this population particularly at risk of developing addictive behaviours and suffering other long-term negative effects, according to researchers at the Univ. of Montreal and Icahn School of Medicine at Mount Sinai.

 

“Of the illicit drugs, cannabis is most used by teenagers since it is perceived by many to be of little harm. This perception has led to a growing number of states approving its legalization and increased accessibility. Most of the debates and ensuing policies regarding cannabis were done without consideration of its impact on one of the most vulnerable population, namely teens, or without consideration of scientific data,” write Prof. Didier Jutras-Aswad of the Univ. of Montreal and Yasmin Hurd of Mount Sinai. “While it is clear that more systematic scientific studies are needed to understand the long-term impact of adolescent cannabis exposure on brain and behaviour, the current evidence suggests that it has a far-reaching influence on adult addictive behaviours particularly for certain subsets of vulnerable individuals.”

 

The researchers reviewed over 120 studies that looked at different aspects of the relationship between cannabis and the adolescent brain, including the biology of the brain, chemical reaction that occurs in the brain when the drug is used, the influence of genetics and environmental factors, in addition to studies into the “gateway drug” phenomenon. “Data from epidemiological studies have repeatedly shown an association between cannabis use and subsequent addiction to heavy drugs and psychosis (i.e. schizophrenia). Interestingly, the risk to develop such disorders after cannabis exposure is not the same for all individuals and is correlated with genetic factors, the intensity of cannabis use and the age at which it occurs.

When the first exposure occurs in younger versus older adolescents, the impact of cannabis seems to be worse in regard to many outcomes such as mental health, education attainment, delinquency and ability to conform to adult role,” Jutras-Aswad says.

 

Although it is difficult to confirm in all certainty a causal link between drug consumption and the resulting behaviour, the researchers note that rat models enable scientists to explore and directly observe the same chemical reactions that happen in human brains. Cannabis interacts with our brain through chemical receptors (namely cannabinoid receptors such as CB1 and CB2.) These receptors are situated in the areas of our brain that govern our learning and management of rewards, motivated behavior, decision-making, habit formation and motor function. As the structure of the brain changes rapidly during adolescence (before settling in adulthood), scientists believe that the cannabis consumption at this time greatly influences the way these parts of the user’s personality develop. In adolescent rat models, scientists have been able to observe differences in the chemical pathways that govern addiction and vulnerability – a receptor in the brain known as the dopamine D2 receptor is well known to be less present in cases of substance abuse.

 

Only a minority (approximately one in four) of teenage users of cannabis will develop an abusive or dependent relationship with the drug. This suggests to the researchers that specific genetic and behavioural factors influence the likelihood that the drug use will continue. Studies have also shown that cannabis dependence can be inherited through the genes that produce the cannabinoid receptors and an enzyme involved in the processing of THC. Other psychological factors are also likely involved. “Individuals who will develop cannabis dependence generally report a temperament characterized by negative affect, aggressivity and impulsivity, from an early age. Some of these traits are often exacerbated with years of cannabis use, which suggests that users become trapped in a vicious cycle of self-medication, which in turn becomes a dependence” Jutras-Aswad says.

 

The researchers stress that while a lot remains unknown about the mechanics of cannabis abuse, the body of existing research has clear implications for society. “It is now clear from the scientific data that cannabis is not harmless to the adolescent brain, specifically those who are most vulnerable from a genetic or psychological standpoint. Identifying these vulnerable adolescents, including through genetic or psychological screening, may be critical for prevention and early intervention of addiction and psychiatric disorders related to cannabis use. The objective is not to fuel the debate about whether cannabis is good or bad, but instead to identify those individuals who might most suffer from its deleterious effects and provide adequate measures to prevent this risk” Jutras-Aswad says.

 

“Continuing research should be performed to inform public policy in this area. Without such systematic, evidenced-based research to understand the long-term effects of cannabis on the developing brain, not only the legal status of cannabis will be determined on uncertain ground, but we will not be able to innovate effective treatments such as the medicinal use of cannabis plant components that might be beneficial for treating specific disorders,” Hurd says.

 

Source:  Tue, 08/27/2013 – Univ. of Montreal and Icahn School of Medicine at Mount Sinai.

  • Participants in study who smoked drug daily for around three years had abnormally shaped hippocampus brain region which is vital to memory

  • They also performed around 18 per cent worse in long-term memory tests than individuals who had never touched cannabis

  • Results were uncovered using sophisticated brain-mapping scans taken two years after participants stopped smoking cannabis   

 

Teenagers who smoke cannabis for just three years could be damaging their long- term memory, researchers have warned.

Participants in a study who had used the drug daily for around three years in their teens had an abnormally shaped hippocampus – a region of the brain vital to memory – by the time they were in their early 20s.

They also performed around 18 per cent worse in long-term memory tests than individuals who had never touched the drug. The results were uncovered using sophisticated brain-mapping scans taken two years after they stopped smoking cannabis.

Professor John Csernansky, from Northwestern University in the US, who co-led the research, said: ‘The memory processes that appear to be affected by cannabis are ones that we use every day to solve common problems and to sustain our relationships with friends and family.’

cannabis-smoking

Those who took part in the Northwestern University study who smoked cannabis in their teens performed around 18 per cent worse in long-term memory tests than individuals who had never touched the drug.

The study is one of the first to suggest that abnormally shaped brains in heavy cannabis users are directly related to memory impairment. The longer a participant had been exposed to cannabis the more misshapen their hippocampus appeared on scans. This could mean brain regions related to memory may be more susceptible to the effects of the drug the longer the abuse occurs.

In total, 97 people took part in the study, including some who started smoking cannabis daily between the ages of 16 and 17 and continued for around three years. At the time of the study, they had been cannabis-free for around two years. The scientists used new computer software to fine-map MRI scans of the hippocampus.

Beforehand participants had taken a memory test in which they listened to a series of stories for around one minute before recalling as much of the content as possible 20 to 30 minutes later.

Results of the memory test were correlated with the scans and cannabis use for each individual. Lei Wang, a senior author of the study and assistant professor of psychiatry and behavioural sciences at the university, said: ‘Advanced brain mapping tools allowed us to examine detailed and sometimes subtle changes in small brain structures.’

The study also found that young adults with schizophrenia who abused cannabis in their teens performed about 26 per cent worse on memory tests than young adults with schizophrenia who had never smoked cannabis.

Previous research by the same team has linked poor short- term and working memory performance to abnormal shapes of three other brain regions: the striatum, globus pallidus and thalamus.

Co-author Dr Matthew Smith, whose study is published in journal Hippocampus, said: ‘Both our recent studies link the chronic use of marijuana during adolescence to these differences in the shape of brain regions that are critical to memory and that appear to last for at least a few years after people stop using it.

‘It is possible that the abnormal brain structures reveal a pre-existing vulnerability to marijuana abuse.

‘But evidence that the longer the participants were abusing marijuana, the greater the differences in hippocampus shape suggests marijuana may be the cause.’

Source:http://www.dailymail.co.uk/news/article-2990806/Smoking-cannabis-three-years-teens-ruin-long-term-memory-Using-drug-daily-changes-shape-brain-linked-recall.html#ixzz3XVpmGmKI 

Hospital maternity units and new-born care nurseries would have to report the number of infants born addicted to drugs under a bill headed to Ohio’s governor. The state Senate unanimously passed the measure Wednesday, and Gov. John Kasich was expected to sign it.

The measure is one of several aimed at reducing the state’s prescription painkiller addiction epidemic. Supporters say tracking the number of drug-addicted babies will help the state monitor Ohio’s progress in fighting drug addiction.

The facilities would be required to report the information to the state Health Department every three months. Patients would not be identified, and the information could not be used for law enforcement purposes. Should a maternity unit, maternity home or new-born care nursery fail to comply with the requirement, the state could impose a fine or revoke or suspend its license.

Overdose drug deaths have been the leading cause of accidental death in Ohio since 2007, surpassing car crashes. Many of those deaths are from painkillers and heroin.

Opiates and narcotics taken by the mother during pregnancy can pass through the placenta through the baby, causing the infant to be born dependent on harmful drugs. The babies experience neonatal abstinence syndrome and face an array of health complications, said state Sen. Shannon Jones, a Springboro Republican.

“These new-borns are thrown into painful withdrawal symptoms, such as rapid breathing, vomiting and seizures immediately following their birth,” she said.  Jones told her colleagues on the Senate floor that she had witnessed children withdrawing. “It is the most horrifying thing that I have personally experienced,” she said.

Caring for the drug-addicted new-borns and mothers, who are often on Medicaid, can be costly to the system.  Jones said officials hope to use the information to help measure opiate and illegal drug abuse across the state and better target resources to help women and babies struggling from addiction.

Source:    www.sfgate.com Wednesday, April 2, 2014

When an award-winning movie star recently lost his battle with substance abuse and addiction, the headlines and tributes were ubiquitous, and mostly without moral judgment. He was a sick man and his tragedy became our tragedy, because we knew him through his work.

Do we have the same relationship with mostly unknown people throughout our communities, who cannot be free of the scourge of their addiction even during pregnancy? Are we as understanding and supportive of their struggles, of the consequences to the foetuses they carry and the children they bear?

We should be. For their struggles with drugs, and with children born addicted to or affected by the drugs their mothers could not stop taking even during pregnancy, are our struggles, too. If they are to get well and even have a chance at healthy, productive lives, they need medical attention and education and more. They require treatment and other help in a state that continues to be plagued by too many long-term problems and too few long-term solutions.

Courier-Journal Reporter Laura Ungar has visited the life- and resource-shredding issues of substance abuse, addiction and pregnancy several times in recent years. Her latest instalment was a special report in Sunday’s C-J, which outlined the surge of hospitalizations of drug-addicted babies in Kentucky. That surge is attributed in large part to the availability and use of heroin that has filled the vacuum left by the recent crackdown on prescription pain-killers.

Ungar reported that those hospitalizations have increased 30-fold from 2000 to 2012, and that Kentucky is on track for more than 900 for last year — up from 824 in 2012.  Kentucky fares badly in national statistics, with one health official saying that this state has one of the nation’s worst problems with drug-dependent babies.

“The latest national statistics come from a 2012 study in the Journal of the American Medical Association, which said hospitalizations for drug-dependent babies rose 330 percent from 2000 to 2009. Kentucky’s hospitalizations rose more than 1,400 percent during that same time,” Ms. Ungar wrote.

State officials are well aware of the epidemic. The restrictions placed on prescription pain pills were an attempt to curb access to addictive drugs, but heroin has filled the gap left by them. And a recent $32 million settlement the state won with two drug companies has been a windfall for cash- and resource-strapped drug-treatment programs throughout Kentucky, including $1 million dedicated to treatment centres for pregnant addicts.

But $1 million is still not nearly enough — not for the women who struggle with addiction while pregnant, not for the people who try to care for them, not for the drug-dependent babies who are born with a variety of symptoms ranging from low weight, vomiting, inconsolability, hyperactivity, poor feeding and seizures; not for the taxpayers who cover millions in costs associated with the spike in hospitalizations.

Which is why Kentuckians ought to ramp up the same interest in the women and babies struggling with heroin and addiction in our communities as they managed to muster for a tragic movie star whose life ended with a needle hanging from his arm.

That means demanding more up-front education about drugs and their dangers to girls and boys before they start dabbling or using. That means educating their parents, or other caring adults, on the signs and symptoms of drug use in children.  That means demanding more funding for current facilities, and more drug-treatment centers for pregnant women who want help, but often can’t get it; Kentucky’s 55 such centers, most of them outpatient, are not nearly enough, either.

“Ultimately,” Kentucky Attorney General Jack Conway said, “it’s an issue that affects all of society.” So it is. And so it does.

Source: www.harlandaily.com  March 2014

Should heavy drinking in pregnancy be a crime? A recent test case in the UK was thrown out, but in the US hundreds of women have been imprisoned. We meet women and children affected by foetal alcohol syndrome

I’d had problems all my life and I didn’t know why,’ says Stella, who found out at 19 that she has foetal alcohol syndrome.

Stella was 19 when she discovered she has foetal alcohol syndrome. “I found out in a horrible way, to be honest,” she says. She had taken her boyfriend to meet her father for the first time. Stella and her father had only limited contact, but her boyfriend hoped that he might help to explain some of Stella’s erratic, unreliable behaviour, and asked him upfront, “What’s wrong with your daughter? Why is she the way she is?”

“That’s when he paused, and he breathed, and he said it,” Stella says, still distressed at the memory of the conversation. “I was shocked. I asked, ‘Why wasn’t I told about it?’ He said he didn’t want me to dwell on something like that.

“My heart felt like it was jumping out of my mouth,” the 25-year-old remembers. “It killed me inside. Why have I lived all my life without knowing about it? It was a really bad time.”

Stella and I arrange to meet at her friend’s flat, and she arrives two hours late, hugely apologetic that she forgot all about it. She tells me she has struggled with timekeeping all her life. Articulate and thoughtful, she gives no real indication of having the disorder, aside from occasionally trailing off and losing her train of thought, asking, “What was I just saying there?” But she describes how catastrophically her life has been affected by the legacy of her mother’s drinking.

Foetal alcohol spectrum disorder (FASD) is the umbrella term for a range of birth defects associated with drinking in pregnancy. At the extreme end of the spectrum is foetal alcohol syndrome (FAS), a very rare condition caused by heavy or frequent alcohol consumption during pregnancy. FAS can cause a range of physical and cognitive problems. Some babies are born with facial abnormalities – thin upper lips, a flatter area between the lip and the nose, smaller eyes. Babies with both FAS and FASD are often smaller than other babies, and typically remain small throughout their lives. Some children may have no physical signs of the condition, but a range of developmental disorders – attention deficit, hyperactivity, poor coordination, language problems and learning disabilities. There is no reliable research on how common it is in the UK; some doctors believe FAS may affect one child in 1,000, and FASD between three and four times more. Adolescents and adults with FASD are overrepresented in the criminal justice system.

Stella spent much of her childhood in care, until she was 11, when her aunt took her in. Her mother died before her father broke the news, so she was never able to ask her about the past. Instead, she went to her GP, who looked at her files. “She said, ‘Yes, you do have this. Your mum was a heavy alcoholic.’” The GP printed out a document that said Stella had been diagnosed in 1993, aged three.

She took to researching the condition online. “It described things that made sense,” Stella says. “All my life, things had been happening to me, and it was suddenly explained. I’m not good with organisation, bills, day-to-day things. I can’t read and write. I’m not good at maths. I’d had these problems and I didn’t know why.” She has never had a job and wonders if she would manage. “I want everything to be simple. If it isn’t, my head feels scattered. I can’t focus. I can’t concentrate.”

Women shouldn’t be prosecuted – they should be given alcohol rehabilitation

At the end of last year, a controversial British court case hinged on whether a woman should be considered to be committing a crime if she drinks heavily during pregnancy. The case looked at whether the council caring for a seven-year-old girl with FAS was entitled to extract compensation from the Criminal Injuries Compensation Authority on her behalf. Lawyers examined the legal rights of an unborn child and asked whether alcohol consumption by the mother constituted the crime of poisoning.

The court of appeal ruled in December that the mother, who inflicted lifelong damage on her child by consuming large quantities of alcohol while pregnant, had not committed a criminal offence, and that her daughter was not, therefore, entitled to compensation. To date, no woman has been prosecuted under English law for harm she caused to her child in utero, but hundreds of women in the US have been imprisoned for drinking or taking drugs during pregnancy. And the legal battle here is far from over; lawyers representing the seven-year-old (who remains anonymous), and around 80 other children affected by FASD, are considering whether to pursue the case in the supreme court.

We’re not talking here about the effects of drinking a couple of glasses of wine at a friend’s wedding. The test case involved a woman who drank, by her own account, half a bottle of vodka and several cans of strong lager daily. But there is a growing sense among politicians and doctors that drinking during pregnancy is an issue that is not taken seriously enough. In Westminster, politicians have been debating whether official guidance over drinking in pregnancy is sufficiently clear. The Royal College of Obstetricians & Gynaecologists recently hardened its advice, saying women should avoid alcohol altogether in the first three months of pregnancy. NHS Choices, the government’s health advisory website, states that the UK chief medical officers’ advice is that abstinence is best, but adds, “If they do choose to drink, to minimise the risk to the baby, we recommend they should not drink more than one or two units once or twice a week and should not get drunk.” The chief medical officer for England is currently reviewing these guidelines.

Lost in all these discussions, however, have been the voices of adults affected by the condition, and those of mothers who have given birth to, and brought up, children with FAS. Among them, there is little appetite for further stigmatising of mothers. But there is agreement that pregnant women need clearer guidance and help, and that affected children need much more support.

Stella thinks she can identify in herself the facial characteristics that sometimes go with the condition (although they are not discernible to others, or me; she looks lovely). But, she says, “It is more mental. I am not capable of doing things. I was hyperactive when I was young. I never listened. I got picked on a lot at primary school; there was a lot of spiteful behaviour. I went to a special needs secondary school – that was better – but I should have had more support as a teenager.”

Although she finds it painful to talk about her childhood, Stella is determined to raise awareness of the syndrome. Recently, she has spoken at conferences arranged by support group the National Organisation for Foetal Alcohol Syndrome (Nofas), which has helped find a charity that provides regular support sessions, allowing her to live independently: “They help with finances and forms, things I am not capable of doing.”

Stella feels ambivalent towards her mother. “I feel some sort of hate and some sort of love,” she says. “I want to be able to go back and ask her questions – questions that will never be answered, because she is dead.” She wishes she had known earlier what the cause of her difficulties was, but she is clear that moving towards prosecuting women is not the right answer. “What difference will it make? She hasn’t committed a crime – she has an issue with alcohol.”

No woman I have met ever wants to harm her baby. This is an illness, not a choice

 Laura has two sons with FASD: ‘I need to make sure this doesn’t happen to other people.’ Photograph: Sophia Spring for the Guardian

Laura has two teenage sons who were diagnosed with FASD a few years ago. She was pregnant with them in the 1990s, when – as she remembers it – there was real ambiguity about the levels of safe alcohol consumption for pregnant women, and she doesn’t remember being confronted by her midwives. Her partner was violent, she was beaten during the first pregnancy, and had panic attacks. “I was a social drinker, but increasingly I was using alcohol to cope. I went to all my appointments, they were aware that I drank – I was drinking beer, mainly, Holsten Pils. The midwife knew I was a four-times-a-week drinker.”

Laura’s first pregnancy progressed without any problems, and she “gave birth to a beautiful child”. Over the next few years, her relationship with the child’s father deteriorated, she lost her job and her home, and began to drink more and more. By the time she was pregnant with her second son, she was an alcoholic. “I had to go into hospital early, and by that time I was drinking 24/7 – mainly beer, a few cans a day, not massive binges. But nobody mentioned the drink: not the doctors, not the midwives. They didn’t advise about the risk of FAS. I had no suspicion that my child could be affected.”

Her second son was born a few weeks prematurely. Neither child had any of the physical features of FAS, and both went to mainstream schools, but their behaviour was very challenging. Gradually, as her life became more stable and she stopped drinking, Laura began to be aware that both her sons had serious issues.

Her younger son had learning difficulties and was diagnosed with ADHD. She had taken him to a hospital appointment and was carrying his notes from one doctor to another, when she spotted a note on his file that said: “Possible FAS.”

“I was devastated,” Laura says. “I knew in my gut that’s what it was.” Both children were later given a formal diagnosis at Great Ormond Street hospital.

Laura is dynamic and energetic; she has a good job now, as she did when she was first pregnant. We meet in a cafe near Hampstead Heath in London, at teatime, and it soon becomes obvious from the discreet twitching of other customers’ heads that her calm, powerful account of this rarely discussed subject has them all engrossed.

She knows people will blame her for her actions, and is very conscious of her own responsibility for her sons’ difficulties, but she is adamant that mothers need support, not criminalisation. “There is sometimes a witch-hunt to go after the mothers, but I am living with my guilt every day. That’s a real life sentence.” She has coped by devoting herself to making sure her sons get all the support they need, and by volunteering to help other mothers who also drank during pregnancy, through the European Birth Mother Network.

“I need to make sure this doesn’t happen to other people,” Laura says. “Women shouldn’t be prosecuted – they should be given alcohol-rehabilitation services. No woman I have ever met ever wants to harm her baby. This is an illness, not a choice. But people need to be told if they do drink, what will happen. There aren’t enough clear guidelines. I think midwives are scared sometimes to confront women.”

Although Laura drank more during her second pregnancy, she thinks her older child has struggled more with the consequences of his condition. “My younger son got support earlier. For the older one, it was harder – we didn’t understand, so he was always being told, ‘You are awful – why do you behave like that?’ He had an organic brain injury; he couldn’t read people’s facial expressions, he had problems with social skills, he was overwhelmed by noise. We didn’t understand that.”

“There is a witch-hunt to go after the mothers, but I am living with my guilt every day. That’s a real life sentence”

Twenty years on from Laura’s pregnancy, the medical guidance is still confusing and contradictory. There are those, such as paediatrician and former children’s commissioner Sir Al Aynsley-Green, who argue for total abstinence. “Exposure to alcohol before birth is the most important preventable cause of brain damage in children, that could affect up to one in every 100 babies in England,” he says. “Its effects range from devastating physical and learning disabilities to subtle damage causing bad behaviour, violence and criminality.”

At the other end of the spectrum are groups such as the British Pregnancy Advisory Service, who point out that most women are already very sensible and warn against demonising their behaviour. According to BPAS, the main consequence of publishing excessively frightening advice is that women come to its clinics unnecessarily considering abortions, concerned about damage they might have inflicted on their foetus before they knew they were pregnant.

In the submission made by BPAS to the court case last year, it was pointed out that there are a wide variety of substances that may cause damage to an unborn baby, from food to plastics and household products. Lawyers in the case questioned whether demanding criminal injuries compensation for alcohol poisoning could mean by extension that “a pregnant mother who eats unpasteurised cheese or a soft-boiled egg, knowing that there is a risk of harm to the foetus might also find herself accused of a crime”.

At the frontline, Jo Austin, a midwife who works with vulnerable mothers in London, says it’s easier to get women to talk about heroin or crack addiction than it is to get them to confront their drinking during pregnancy. “We have lots of leaflets for women who take heroin and crack, who are quite a small minority of the women we see. But alcohol is more socially acceptable and it is legal. A large proportion of society drinks, at least socially. Our feeling is that it is a problem that women don’t admit to, perhaps because of stigma, guilt or fear of social services involvement.”

Austin says most of the pregnant women she sees are better informed about the risks of smoking during pregnancy. “There has been so much health promotion done on smoking, but the effects of alcohol are potentially much worse.”

Gail Priddey, CEO of Haringey Advisory Group on Alcohol, which supports families affected by alcohol, says she is currently writing an advice leaflet for midwives that attempts to navigate a line between being straightforward with the facts without “scaring pregnant women witless”. “It is such an emotive and difficult subject,” Priddey says. “You say, ‘Best not to drink when you’re pregnant,’ then someone says, ‘Well, actually, I’ve been drinking heavily. I didn’t realise.’ Where do you go from there? Do you say, ‘You may have done some damage’? It’s an area professionals don’t want to touch.”

The flipside of this is that children with FAS and FASD are not diagnosed early enough, and often do not receive the help they need. Raja Mukherjee, a neurodevelopmental psychiatrist and lead clinician at the national FASD clinic, says awareness of the condition has risen dramatically in the 12 years he has worked in the area, but diagnosis remains complicated. He believes doctors are often unwilling to label a child as suffering from FASD because it is “too stigmatising”. “It is easier to say, ‘You have ADHD,’” he says.

Yet Mukherjee is uncomfortable about the fight for criminal injuries compensation for children, because “criminalisation just pushes it underground. We struggle already with people who tell us, ‘I didn’t drink at all in pregnancy’ – yet they were an alcoholic before and an alcoholic afterwards.”

Neil Sugarman, the lawyer for the unidentified local authority in the north-west that took the legal action, said they were motivated by a quest to get adequate funding for the girl’s care. “This wasn’t about trying to get women prosecuted,” he says. “My job as a lawyer is to look at the interests of terribly badly impaired children. We have a state scheme that if you can show you are a victim of a crime, you are entitled to compensation.

“The Criminal Injuries Compensation Scheme has never required someone to be prosecuted – no one needs to be taken to court, charged, sentenced or convicted. All it requires is that a judge has to be satisfied that what happened can be recognised as a crime. It is very difficult for young people to get access to their therapeutic needs on the NHS – the occupational therapy and speech therapy they need is not always readily available. The true benefit of compensation would be to open up access to private treatment for these children and enhance their lives.”

I didn’t know the kids’ mother was an alcoholic. She loved them, but couldn’t cope. It didn’t put me off adopting them

 Kay Collins adopted three children, two of whom have foetal alcohol spectrum disorder. Photograph: Sophia Spring for the Guardian

Kay Collins, 61, would also like to see more funding for children with FASD, but not if it means prosecuting their mothers. Ten years ago, she adopted three children, two of whom have the condition. She knew them before she adopted them, because they lived in a flat upstairs in the west London mansion block where they still live.

“We’d meet on the stairs and say hello, and I got to know them – they were lovely kids. I didn’t know their mother was an alcoholic. It was only as time went on, I realised. She was somebody who needed help, not someone to abuse or to judge.

“You saw that she loved the kids, but she couldn’t manage. She was in her 20s, the children’s father was there on and off. She never harmed the kids in any way. She loved them – she just didn’t know how to care for them.”

Eventually, the children were taken into care. Collins, who was working as a teaching assistant and had four, much older children of her own, decided to adopt them – a girl of 17 months and boys of four and five. She knew nothing about FASD until she was called by a paediatrician who was helping to prepare the adoption papers. She was told the two younger children might have learning disabilities and was asked how she would cope. “I said, ‘If I knew that now, I would be a genius. I can only know when I am dealing with it.’ It didn’t put me off. I knew that the children just needed a lot of love and attention.”

Now that she knows more about the condition, she can see some of the facial characteristics of FASD in pictures of the youngest as a baby. These have become less noticeable as she has grown up, but her cognitive problems have become more evident over time. “When they were about seven, it was clear things were not happening as with normal children. They both didn’t speak very well for a long time, they didn’t understand a lot of things. The younger one still doesn’t. Her brother understands better, but his behaviour is worse. If you try to correct him, he gets very angry.”

Collins is fighting for the youngest, now 12, to be given a place in a special needs school. “She has language difficulties. If things are not explained to her at a slower pace, she is not going to understand them. At the moment, I’m at loggerheads with the local authority and in a tribunal because they don’t think that’s necessary. They don’t want to pay for it. It’s down to cost.”

Collins thinks her 12-year-old daughter won’t take GCSEs and knows that, long-term, life will be complicated for her. “She will live independently, but she will need a lot of support – she is quite vulnerable because she thinks everyone is her friend.” But she doesn’t like the idea of fighting for compensation through the Criminal Injuries Compensation Scheme. “It would be nice to have the money; we could use it to get them educated in the right environment,” she says, but she is uncomfortable with the idea that this might be a step in the direction of criminalising troubled women. “Mothers who drink when pregnant need more support and understanding. No one sits down and just starts drinking. There has to be something that triggered it.”

Meanwhile, she just tries to help her children understand. “My daughter keeps asking, ‘Is there something wrong with me?’ I say, ‘Yes, you have foetal alcohol spectrum disorder.’” The middle child is angry about his mother’s role in his condition. “He says, ‘I hate my mum’, but I try to explain: ‘She couldn’t look after you. It doesn’t mean she didn’t love you. She was never a bad mum.’”

• Some names have been changed. To contact Nofas UK, call 020-8458 5951 or go to nofas-uk.org.

Source: http://gu.com/p/475mq April 2015 http://www.theguardian.com/society/2015/apr/04

Underage youth who cite alcohol marketing and the influence of adults, movies or other media as the main reasons for choosing to consume a specific brand of alcohol are more likely to drink more and report adverse consequences from their drinking than youth who report other reasons for selecting a specific brand, new research suggests.

The findings, published in the May issue of the Journal of Adolescent Health, add to a growing body of research suggesting youth exposure to alcohol marketing affects their drinking behavior. The study was conducted by researchers from the Johns Hopkins Bloomberg School of Public Health’s Center on Alcohol Marketing and Youth and the Boston University School of Public Health.

The researchers conducted an Internet survey in 2012 of 1,031 people between the ages of 13 and 20 who reported having consumed alcohol in the previous 30 days. Of those, 541 reported having a choice of multiple alcohol brands the last time they drank and researchers wanted to know why they chose the brand they did. They classified the underage drinkers into five groups:

· Brand Ambassadors, who selected a brand because they identified with its marketed image (32.5 percent of respondents)
· Tasters, who selected a brand because they expected it to taste good (27.2 percent of respondents)
· Bargain Hunters, who selected a brand because it was inexpensive (18.5 percent of respondents)
· Copycats, who selected a brand because they’d seen adults drinking it, or seen it consumed in movies or other media (10.4 percent of respondents)
· Others (11.5 percent of respondents)

“Almost one in three underage drinkers reports choosing a brand of alcohol to drink based on branding and marketing,” says lead study author Craig Ross, PhD, president of Fiorente Media, Inc. and a consultant to the Johns Hopkins Bloomberg School of Public Health’s Center on Alcohol Marketing and Youth. “These findings suggest that alcohol advertisements, media portrayals of alcohol use, and celebrity endorsements play a significant role in alcohol brand selection among young people.”

Alcohol is the most commonly used drug among youth in the United States and is responsible on average for the deaths of 4,300 underage persons each year, researchers say. Approximately 33 percent of eighth graders and 70 percent of twelfth graders have consumed alcohol, and 13 percent of eighth graders and 40 percent of twelfth graders drank during the past month.

The researchers also examined whether different reasons for selecting a brand of alcohol were associated with riskier drinking behaviors. Brand Ambassadors and Copycats reported consuming the largest amount of alcohol and were most likely to report both heavy episodic drinking and negative alcohol-related health consequences, such as being injured while drinking or suffering an injury serious enough to require medical attention.

“The prevalence of heavy drinking among these two groups and the high rates of negative health consequences they report are of particular concern,” says study author David Jernigan, PhD, director of the Center on Alcohol Marketing and Youth at the Johns Hopkins Bloomberg School of Public Health. “Further research to explore methods of offsetting negative influences of alcohol marketing and promotion on our children’s health is sorely needed, as are more effective restrictions on advertising placement to reduce youth exposure to alcohol marketing and promotion.”

Alcohol advertising in the U.S. is primarily regulated by the industry itself. Several leading public health groups and officials, including the National Research Council, the Institute of Medicine and 24 state and territorial attorneys general, have called upon the alcohol industry to strengthen its standards to reduce youth exposure to alcohol advertising and marketing.

“Selection of Branded Alcohol Beverages by Underage Drinkers” was written by Craig S. Ross, PhD, MBA; Josh Ostroff; Timothy Naimi, MD, MPH; William DeJong, PhD; Michael Siegel, MD, MPH; and David H. Jernigan, PhD. This research was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (R01AA020309-01).

Source: www.newswise.com 20th April 2015 Journal of Adolescent Health, May 2015

Hendriks V., van der Schee E., Blanken P.
Drug and Alcohol Dependence: 2011, 119, p. 64–71.

US research led by the programme’s developers has found that a family therapy which intervenes across a child’s social environment is more effective than alternatives for problem substance using teenagers, but this independent European study found individually-focused cognitive-behavioural therapy overall just as effective.

SUMMARY Cognitive-behavioural therapy is a mainstay of addiction treatment, but young problem substance users might benefit more from approaches which intervene with their families and wider environments. The featured study tested this proposition among cannabis users in The Netherlands, pitting multidimensional family therapy against a more conventional, individually-focused cognitive-behavioural therapy.

Key points

  • Multidimensional family therapy is one of a family of approaches which intervene not just with the individual young problem substance user but with their family and other important influences in their lives.

  • US research led by the programme’s developers has found this approach more effective than alternatives or usual treatment or criminal justice procedures.

  • The featured study offers a test of the approach on a non-US caseload and in a study by independent researchers not involved in the programme’s development.

  • As with another independent study, the approach was not found preferable overall to a well-structured alternative, but – again as in other studies – it might have been more effective with the more multiply and severely problematic youngsters.

  • Extra cost and the relative scarcity of qualified practitioners are an obstacle to implementation.

Multidimensional family therapy addresses problem drug use and related problems among adolescents not through a set regimen, but by applying principles and a therapeutic framework to the individual seen as situated within a particular set of environmental influences and constraints. What distinguishes it from some other family therapies is that therapists see substance use as potentially a problem in its own right, and that the intervention extends beyond the child and family to all the social systems (school, juvenile justice, etc) in which the child may be involved.

US studies involving young cannabis users have shown promising results, but almost all these were obtained by one research group. Independent replication studies are needed, and it is unclear whether the impacts of multidimensional family therapy observed in the United States can be generalised to a country such as The Netherlands, where attitudes to cannabis use are more permissive.

To answer these questions the featured study compared the effectiveness of multidimensional family therapy and cognitive-behavioural therapy among adolescent cannabis users in The Netherlands. Between 2006 and 2009 it recruited 109 children aged from 13 to 18 diagnosed as experiencing cannabis abuse or dependence within the past year. They were among the intake at two treatment centres for adolescents in The Hague, one specialising in substance use problems, the other in mental and behavioural health. Patients in the study had to have regularly used cannabis in the past three months and have at least one parent figure who agreed to participate in treatment and in study assessments.

Participants averaged just under 17 years of age and 80% were male. According to their own accounts, they had on average been using cannabis for two years and at study entry had averaged 162 ‘joints’ in the past 90 days – equivalent to nearly two a day. Other substances were used relatively little. They reported an average of about six violent or property crimes in the past three months and a substantial minority were diagnosed with a conduct disorder or oppositional defiant disorder. Four in 10 lived in single-parent households and the same proportion had been imprisoned.

They were allocated at random to multidimensional family therapy or cognitive-behavioural therapy, each planned to last five to six months and delivered on an outpatient basis. In weekly one-hour sessions, the cognitive-behavioural option focused on enhancing patients’ motivation to change their addictive behaviour, and then on changing problem behaviours by means of training in self-control, social and coping skills, and relapse prevention. Monthly sessions were also scheduled for the parents to provide information and support, but not to intervene in family dynamics or parenting.

Multidimensional family therapy was more intensive, scheduled to occupy two one-hour sessions a week with the adolescent, parent(s) and/or family, plus contacts with schools and court staff and other people. It was delivered by trained and supervised therapists who followed a manual by the approach’s developers and were trained by the developers, whose unit in the USA was contacted monthly for feedback and consultation.

An attempt was made to reassess patients to track their progress, the final assessment being 12 months after the baseline assessment conducted just before patients were allocated to the treatments. At the final follow-up, just over 94% of patients were reassessed.

Main findings

Though continued cannabis use was the norm, the general picture was of improvements between the 90 days before starting treatment and the 90 days before the final 12-month assessment. However, these improvements were not significantly greater depending on the treatment to which patients had been allocated. This was the case despite multidimensional family therapy being far better attended; 8 in 10 children completed this treatment compared under 3 in 10 allocated to the cognitive-behavioural option, and they attended sessions totalling 35 hours compared to 10. Significant others in the child’s life also spent much more time engaged in the multidimensional than in the cognitive-behavioural programme.

The number of days in which the children had used cannabis fell from 62–63 days out of 90 to 43 with multidimensional family therapy and 47 with cognitive-behavioural therapy, and the number of joints smoked fell respectively by 38% and 46%. In both options a good treatment response – at least 30% fewer cannabis-using days without substantial increases in use of other substances – was recorded by 42–44% of patients. In both options the number of crimes the children said they had committed fell by over a third.

Despite overall near equivalence, there were indications that children with the severest problems reduced their cannabis use more when allocated to multidimensional family therapy. This was the case whether severity was assessed in terms of intensity of cannabis use or substance use in general, criminality, presence of conduct and/or oppositional defiant disorders (among whom the extra reduction in days of cannabis use peaked at 42 days), and whether the child’s family was assessed as dysfunctional. Differential impacts among children with severe substance use or exhibiting conduct and/or oppositional defiant disorders reached statistical significance.

The authors’ conclusions

The study indicates that multidimensional family therapy and cognitive-behavioural therapy are equally effective in reducing cannabis use and delinquency among adolescents with a cannabis use disorder in The Netherlands, though neither was sufficient to eliminate problem substance use altogether among most of the children. Despite some limitations, the results are robust and applicable to most treatment-seeking adolescents with problem cannabis use in The Netherlands. The results are notable given the much higher treatment ‘dose’ – and consequently, higher costs – of multidimensional family therapy. As others have done, the study also found indications that multidimensional family therapy is differentially effective with adolescents and families with more severe problems.

It should be acknowledged that without a no-treatment control group, it cannot be said for certain that the treatments caused the observed improvements. Also the results derived from youngsters who frequently used cannabis, but not other substances, and who often had a history of delinquency and psychiatric treatment, and from a country with a relatively permissive attitude to cannabis.

COMMENTARY This well designed study has considerable clinical relevance since participants were seeking treatment in the normal way and were clearly using cannabis excessively as well as having other serious problems in their lives – the kind of caseload one would expect at substance use and mental health treatment services for young people, and the kind seen in the UK, where among under-18s cannabis is now by far the most common primary drug in relation to which treatment is provided. Numbers in England in 2013/14 continued to increase to a record 13,659, 71% of all young patients in specialist treatment. Forms of cognitive-behavioural therapy are a common component of treatment in Britain, but family-based therapeutic work is surprisingly rare, given that for example in England, over 80% of young patients were living with their families. Based on the evidence, British practice standardsfrom the Royal College of Psychiatrists on the care of young people with substance misuse problems commend family work, but say it is not standard in British services.

The featured study offers some guidance on whether for young, frequent cannabis users, UK services would do better to replace cognitive-behavioural therapies with family work in the form of multidimensional family therapy. Overall the answer is no; this would cost more without substantially improving outcomes. The finding is particularly important since it derives from a rare test conducted with a European caseload and by a research team independent of the developers of the programme. Independence is important because in several social research areas (1 2 3), programme developers and other researchers with an interest in the programme’s success have been found to record more positive findings than fully independent researchers.

Promising as US studies led by the developers of the programme have been (for example, 1 2), an independent US study found multidimensional family therapy slightly (but not significantly) less effective at promoting recovery from substance use problems than two other therapies, and substantially less cost-effective. Like the featured study, the focus was on young problem cannabis users, and cognitive-behavioural therapy featured among the alternatives.

Multidimensional family therapy is one of a similar set of programmes which integrate intervention in to several domains of a child’s life. Such approaches can improve on typically less well organised and less extensive usual practices (1 2), but this is not always the case, and performance against stronger alternative approaches focused on the individual young cannabis user has been equivalent. Evaluations conducted independently of programme developers have usually been unconvincing, and results overall have not been as impressive as investment in these programmes might be seen to require, especially if they supplement rather than replace legally or socially required procedures. A major obstacle to their use is the expensive training and supervision and considerable skills required to implement them in ways which have been associated with good outcomes.

Best for the hardest cases?

Britain’s National Institute for Health and Clinical Excellence (NICE) has recommended the types of programmes exemplified by multidimensional family therapy for problem-drinking children who also have other major problems and/or limited social support, signalling their particular suitability for the most severely affected and multiply problematic youngsters. In line with this recommendation, the featured study and others suggest that investment in multidimensional family therapy might be warranted for more problematic youngsters – particularly in the featured study, those so at odds with families and society that they can be diagnosed as exhibiting these traits to a pathological degree. That suggestion is tentative, however, primarily because these analyses were not planned in advance so may have capitalised on chance variations in outcomes.

The same limitation applies to the US trials which found multidimensional family therapy particularly suitable for high-severity youngsters. Other limitations too make the US findings an unreliable guide to whether multidimensional family therapy really is best for the most severely affected youngsters (details below), though the plausibility of the findings and the similar findings in The Netherlands mean this contention cannot be dismissed.

One of the US studies compared multidimensional family therapy with cognitive-behavioural therapy. In this study the researchers identified a set of youngsters (about 4 in 10 of the sample) initially more strongly engaged with and affected by substance use, and among whom this engagement weakened less over the course of treatment and a 12-month post-treatment follow-up. They also had more psychological problems. Among this sub-sample, engagement with substance use weakened significantly more when they had been allocated to multidimensional family therapy. Less engaged youngsters were affected about equally by both treatments. But these results were extracted only by a complex analysis which divided the sample up based not just on initial severity, but on their progress in and after treatment. The formation of these categories itself partly depended on the effects of the treatments, then the analysis tested whether the treatments affected each class differently – a circularity which complicates assessment of just what the results mean in practice. This analysis also had to contend with the fact that at each follow-up around 40% or more of the sample could not be reassessed, presumably meaning it had to estimate how they would have scored based on the available data. Such estimates can only be relied on if the data is randomly missing – in this case, if the reasons why a young person did not attend for reassessment had nothing to do with the factors which affected their response to treatment, an unlikely assumption.

Less affected by these complications, a simpler analysis of whether youngsters who started treatment with a deeper engagement with substance use became more disengaged when allocated to multidimensional family therapy was negative, as was one which tested initial psychological problems as a predictor of differential response to treatment. Nor were any relationships found between frequency of substance use and differentially benefiting from multidimensional family therapy. In a similar analysis of a second study comparing multidimensional family therapy to usual criminal justice procedures, the reverse was the case; here it was not the more deeply engaged youngsters who benefited more from multidimensional family therapy, but those who used substances most often. Such inconsistency heightens concerns over cherry-picking of results to demonstrate that multidimensional family therapy is best for most severely affected youngsters.

Last First uploaded 18 April 2015

Source:http://findings.org.uk/PHP/dl.php?file=Hendriks_V_2.tx

Revised 27th April 2015

Almost one in 500 babies in hospitals in England is born dependent on substances their mother took while pregnant, a BBC investigation has found.

Of 72 NHS hospital trusts who responded to a Freedom of Information request, the average rate for babies born with neonatal abstinence syndrome was 0.2%.

It is caused by women taking legal and illegal drugs while pregnant.  Health experts say it is a declining trend.

BBC’s Look North and the English regions data unit asked NHS hospital trusts to provide details about the number of babies born who were addicted to drugs between 2011 and 2015.  The figures show a wide geographical variation in the number of newborns who were dependent on harmful substances.

One in 100 babies born at Bedford Hospital in 2015 displayed signs of neonatal abstinence syndrome. In contrast, Leicester General had one of the lowest rates with one in every 5,000 babies born addicted to a harmful substance.  In Leeds, around one in 250 babies was born with the condition.

Lisa Batty, 37, from Bradford, gave birth to four children who were addicted to heroin.

“I didn’t care that my kids were addicted to drugs, I was more concerned about where I was getting my next fix from. I know it’s selfish but that’s how it felt at the time,” she said.

“I remember visiting my children in hospital as they suffered withdrawal symptoms from the methadone they were being given as part of their treatment. I remember seeing them trembling and shaking in their cots. I admit I was a bad mum but I’ve turned my life around now”.

Lisa has now recovered from drug addiction and has become involved with the charity Narcotics Anonymous to help others.

The data for England also shows that over the past four years there has been general decline in the number of babies being diagnosed with neonatal abstinence syndrome.   Those working to treat mothers and babies with a drug addiction say the majority of parents they deal with come from a disadvantaged socio-economic background, with most cases involving an abuse of drugs like heroin, cocaine or alcohol.

Susan Flynn is a specialist midwife in Leeds who helps treat mothers who have a drug addiction.   “I have seen the numbers begin to fall slightly in the past three years,” she said. “I don’t think we can say there is one single reason for the decline but maybe the message is getting out there that it’s not right to take drugs or alcohol whilst you’re pregnant.

“There are of course people who say that women who take drugs whilst they’re pregnant should have their children removed from them, but for me I believe everyone should have the chance to turn their life around.”

Liz Butcher, from Public Health England in Yorkshire and the Humber, said: ‘It is particularly important pregnant women who use drugs get supportive, collaborative care

to reduce the risks to the health of their babies.      Many places in the region have specialist staff and well-established training to make sure that happens.”

 Source:  http://www.bbc.co.uk/news/uk-england-36703939    5th July 2016

Tamara D. Warner, PhD1, Dikea Roussos-Ross, MD2, and Marylou Behnke, MD1

Tamara D. Warner: warnertd@peds.ufl.edu; Dikea Roussos-Ross: kroussos@ufl.edu; Marylou Behnke: behnkem@peds.ufl.edu

1University of Florida, Department of Pediatrics, P.O. Box 100296, Gainesville, FL 32610-0296, (352) 273-8985

2University of Florida, Department of Obstetrics and Gynecology, P.O. Box 100294, Gainesville, FL 32610-0294, (352) 273-7660

SYNOPSIS

Pro-marijuana advocacy efforts exemplified by the “medical” marijuana movement, coupled with the absence of conspicuous public health messages about the potential dangers of marijuana use during pregnancy, could lead to greater use of today’s more potent marijuana, which could have significant short- and long-term consequences. This article will review the current literature regarding the effects of prenatal marijuana use on the pregnant woman and her offspring.

INTRODUCTION

Societal attitudes towards marijuana use in the United States are undergoing an historical shift. In the 1960s, a generation of young people embraced marijuana for personal recreational use. Today, “medical” marijuana (cannabis sativa) has been approved for use in 22 states and the District of Columbia either by legislation or by popular vote in statewide referenda or ballot initiatives; 15 of the 22 legal actions were passed in the last decade (since 2004).1 As of May, 2014, another seven states have pending legislation or ballot measures to legalize medical marijuana.2 In addition, two states, Colorado and Washington state, have legalized marijuana for recreational use. The attitudinal shift is apparent not just among adults but among teens as well. The most recent annual survey of adolescent drug use indicates that the annual prevalence of marijuana use has been trending upward since 2008 for 8th, 10th, and 12th graders; perhaps more importantly, the perceived risk of regular marijuana use has declined sharply in recent years, a trend that started in 2005.3

Source:  Clin Perinatal 2014 December 41(4):  877-894  doi 10.1016/j.clp  2014.0.009

PSA Warning Issued in 2005 was Ignored

Eleven years ago the ONDCP and SAMHSA held a press conference to inform of research that confirms what many families already knew–that marijuana use was a trigger for psychosis and mental illness.

The ONDCP is the White House Office of National Drug Control Policy; SAMHSA is the Substance Abuse and Mental Health Services Administration.  Each agency has a crucial role in trying to ascertain usage and reduce demand for drugs. Specifically, Dr. Neil McKehaney from the University of Glasgow came to the US and spoke at the national Press Club on May 5, 2005. The agencies went to great effort to share important information.  A video was recently found online.

Cover up of the Marijuana – Mental Illness  Risk

At this same Press Conference, a couple who had lost their 15-year-old son to suicide due to the mental health problems arising from marijuana use, spoke.  The Press covered the story, but did not use their considerable investigative skills to probe into what those parents and Dr. McKenagey were describing.  It is true that about one quarter of American high school students are depressed, which points to multiple problems of American culture, not just drugs. However, knowing how vulnerable teens are, and then not exposing the factors that could make their outcomes worse, is lamentable.

In addition to depression, anxiety and suicide, there are the risks of psychosis, bipolar disorder and schizophrenia that arise from marijuana use.  Pot proponents love to state that anyone who has a psychotic reaction to pot already had the problem before they used it.  They tend to blame family members for not  wanting to admit  mental health problems, and argue that pot is used as a scapegoat.

Several studies have shown a link between marijuana and schizophrenia.  Explains pharmacologist Christine Miller, Ph.D:  “No one is destined to develop schizophrenia. With identical twins, one can develop the disease and the other one will do so only 50% of the time, illustrating the importance of environmental factors in the expression of the disease.  Marijuana is one of those environmental factors and it is one we can do something about.”

A Missed Opportunity

One person who worked in the office of ONDCP Director John Walters told Parents Opposed to Pot, “They accused us of being pot-crazy during a time when there was a methamphetamine crisis going on.  Marijuana is almost always the first drug introduced to young people and the evidence for the mental health risks were very strong by 2005.  Although pot was getting stronger as it is today, the warning was falling on deaf ears.  Members of Congress wanted us to focus on the meth crisis, but marijuana was a growing issue and we had a myriad of issues.”

This Public Service Announcement reached audiences in the Press, and some newspapers and magazines reported about it.  Since the Internet and search engines were not as they are  today,  few parents, children,  schools and mental health professionals took notice.   (Did the marijuana lobbying groups bully and try squelch the information?)

Lori Robinson, whose son suffered the mental health consequences of marijuana said:  “I will always deeply regret Shane not hearing this PSA .  Shane was a smart, gregarious and fun-loving young man who naively began using pot never knowing he was playing Russian roulette with his brain in ’05-’06 at the age of 19.   Dr McKeganey so clearly stated that the public views marijuana as harmless, not realizing the potency of THC was rising while the “antipsychotic” property of CBD was being bred out.  Sadly, despite both parents never used an illegal drug in our lives, our son assumed that since a few of his friend had smoked in high school, it was just a “harmless herb.”   Shane’s story is on the Moms Strong website.

Robinson added, “This video is absolutely current TODAY.  Let’s keep this video circulating & it WILL save young brains & families the destruction that lies ahead when marijuana hijacks your kid’s brain.

The research has expanded since that time and scientific evidence on each of the following outcomes from marijuana use is voluminous: marijuana & psychosis, marijuana & violence and marijuana & psychiatric disorders.

Lessons to be Learned

Lives could have been saved, and so many cases of depression, psychotic breakdowns and crimes could have been prevented – if the public had become more aware back in 2005.   Congress, the Press and most of all, the American psychiatric community was wrong to ignore the warnings that were issued with this PSA. Let’s not continue to ignore  the evidence. Today in the US, mental health is worse than it’s ever been, and the promotion of drug usage may be a huge factor in this problem.  Harm reduction in preference to primary prevention strategies is practiced in many jurisdictions.  Drug overdose deaths have overtaken gun violence deaths and traffic fatalities in the USA — by far — under this strategy. Today Dr. McKeganey is the Director of the Center for Substance Use Research in Glasgow.

Parents Opposed to Pot is totally funded by private donations, rather than industry or government. If you have an article to submit, or want to support us, please go to Contact or Donate page.

Source:  http://www.poppot.org/2016/07/06/warning-pot-causes-mental-illness

Children born to mothers who use cannabis during pregnancy are more likely to have an abnormal brain structure, which may have long-term consequences for mental health.  This is the conclusion of a new study published in the journal Biological Psychiatry,led by Dr. Hanan El Marroun, of Erasmus University Medical Center in the Netherlands.

According to the researchers, around 2-13 percent of women worldwide use cannabis during pregnancy.  Previous research has suggested that expectant mothers who use the drug are more likely to have children with behavioral and mental health problems.

Exactly how cannabis use affects the brain structure of offspring, however, has been unclear, and this is what Dr. El Marroun and colleagues set out to investigate.

“This study is important because cannabis use during pregnancy is relatively common and we know very little about the potential consequences of cannabis exposure during pregnancy and brain development later in life,” says Dr. El Marroun.  “Understanding what happens in the brain may give us insights in how children develop after being exposed to cannabis.”

Thicker prefrontal cortex for children prenatally exposed to cannabis

The team analyzed the data of 263 children aged 6-8 years who were part of the Generation R Study – a population-based study in the Netherlands, in which they were followed from birth.

Of these children, 96 were born to mothers who used cannabis during pregnancy, and most of these mothers were also smokers. A total of 54 children were prenatally exposed to tobacco only, while 113 were not prenatally exposed to either substance. All of the children underwent magnetic resonance imaging (MRI) scans, which allowed the researchers to assess their brain volume and cortical thickness.

Overall, the researchers found no difference in total brain volume, gray matter volume, or white matter volume between the three groups.

However, compared with children who were prenatally exposed to tobacco only, the researchers found those who were prenatally exposed to both cannabis and tobacco had a thicker prefrontal cortex.

The prefrontal cortex is a brain region that plays a role in complex cognitive behavior, planning, decision-making, working memory, and social behavior.

Given the increase in legalization of cannabis across the United States, Dr. John Krystal, editor of Biological Psychiatry, believes expectant mothers should take note of these findings. “The growing legalization, decriminalization, and medical prescription of cannabis increases the potential risk of prenatal exposure. This important study suggests that prenatal exposure to cannabis could have important effects on brain development.” Dr. John Krystal

Additionally, the researchers found that children who were prenatally exposed to tobacco only had a thinner prefrontal cortex than those who were not prenatally exposed to tobacco or cannabis.

Dr. El Marroun says the study results should be interpreted with caution, noting that further studies are needed to determine the underlying mechanisms that link prenatal cannabis exposure to changes in brain structure.

“Nevertheless,” she adds, “the current study combined with existing literature does support the importance of preventing smoking cannabis and cigarettes during pregnancy.”

Source:   www.medicalnewstoday.com   21st  June 2016

Marijuana remains the most commonly used illicit drug in the United States, and its use is particularly widespread among adolescents. Now, a new study has identified the ages at which adolescents are most likely to try the drug, which may have implications for current marijuana intervention programs.

According to the National Institute on Drug Abuse (NIDA), last year, around 6.5 percent of eighth-grade students, 14.8 percent of 10th-graders, and 21.3 percent of 12th-graders reported current marijuana use. Among 12th-graders, 6 percent reported using the drug daily. Marijuana use can pose a number of risks to physical and mental health, including mood changes, altered senses, impaired movement and breathing problems.

Additionally, use of the drug in adolescence may raise the risk of long-term problems, such as poor cognitive functioning; studies have shown that teenagers who use marijuana have a lower IQ and poorer academic outcomes.

Previous research has also indicated that teenagers who use marijuana are more likely to engage in the use of other illicit drugs.  However, NIDA report that adolescent awareness of these risks is gradually decreasing, likely due to increased legalization of marijuana for medical or recreational use across the U.S.

For this latest study, published in the American Journal of Drug and Alcohol Abuse, researchers from the University of Florida (UF) set out to determine the ages at which adolescents are most likely to try marijuana – information that they say could help guide drug prevention programs.

‘Drug education needs to start earlier’

Lead author Dr. Xinguang Chen, a professor in the Department of Epidemiology at UF, and colleagues analyzed data from the 2013 National Survey on Drug Use and Health, which included 26,659 participants aged 12-21 years.

The researchers used the data to estimate the risk of marijuana use initiation among the participants from birth.   Overall, the team found that 54 percent of adolescents had started using marijuana by the age of 21. They found that adolescents are at risk of trying marijuana from the age of 11. This risk steadily increases until the age of 16, at which point it hits a peak, the researchers report.

The authors note that current marijuana intervention programs focus on adolescents aged 15 and older. Based on their results, the authors suggest such programs should be initiated earlier. “Our findings demonstrate the need to start drug education much earlier, in the fourth or fifth grade. This gives us an opportunity to make a preemptive strike before they actually start using marijuana.”

Dr. Xinguang Chen

Marijuana use risk drop at age 17

At the age of 17, the team found that the risk of first-time marijuana use drops. The authors say this could be because teenagers are more focused on their studies and college entrance exams at this age, rather than drug use.

At the age of 18, however, the researchers found the risk of marijuana use initiation hits another peak – a finding they say might be explained by the life changes that occur at this age.  “At 18, many adolescents leave their parents’ homes to start college or enter the workforce,” says study co-author Dr. Bin Yu, also of UF’s Department of Epidemiology. “They may be more susceptible to influence from peers and they have less monitoring by their parents and the community.”

On analyzing the risk of marijuana use by race/ethnicity, the researchers were surprised to find it varied; adolescents from a multiracial background were significantly more likely to use the drug than those from other backgrounds.

The authors say future research should investigate why people from multicultural backgrounds may be at greater risk for marijuana use, as well as why certain age groups are at heightened risk.

They believe such information could aid the development of more targeted marijuana prevention programs.  “This study finding supports the idea of precision intervention. Intervention programs should be developed for both parents and adolescents, and delivered to the right target population at the right time for the best prevention effect.”    Dr. Xinguang Chen

Source:  http://www.medicalnewstoday.com/articles/311391.php  3rd July 2016  Alcohol / Addiction / Illegal Drugs Pediatrics / Children’s HealthNeurology / NeurosciencePublic Health

Regular marijuana use significantly increased risk for subclinical psychotic symptoms, particularly paranoia and hallucinations, among adolescent males.

“Nearly all prior longitudinal studies examining the association between marijuana use and future psychotic symptoms have not controlled for recent patterns of use, have not repeatedly assessed marijuana use across adolescence, or have combined prior and recent use. Therefore, it is impossible to delineate the enduring effect that regular use has on emergent psychotic symptoms and whether this effect is sustained when individuals remain abstinent for several months,”Jordan Bechtold, PhD, of University of Pittsburgh Medical Center, and colleagues wrote.

To determine associations between regular marijuana use in adolescence and subclinical psychotic symptoms, researchers evaluated 1,009 males from as early as first grade through age 18 years. Study participants were recruited in first and seventh grades. Marijuana use, subclinical psychotic symptoms, and time-varying covariates such as other substance use and internalizing/externalizing problems were determined via self-reports from ages 13 to 18 years.

Analysis indicated that for each year adolescent boys engaged in regular marijuana use, their projected level of subsequent subclinical psychotic symptoms increased by 21% and projected risk for subclinical paranoia or hallucinations increased by 133% and 92%, respectively.

This effect persisted even when participants stopped using marijuana for 1 year.

Further, these associations remained after controlling for all time-stable and several time-varying covariates.

Researchers did not find evidence for reverse causation.

“This study demonstrates that adolescents are more likely to experience subclinical psychotic symptoms (particularly paranoia) during and after years of regular marijuana use. Perhaps the most concerning finding is that the effect of prior weekly marijuana use persists even after adolescents have stopped using for 1 year,” the researchers wrote. “Given the recent proliferation of marijuana legalization across the country, it will be important to enact preventive policies and programs to keep adolescents from engaging in regular marijuana use, as chronic use seems to increase their risk of developing persistent subclinical psychotic symptoms.” – by Amanda Oldt

Disclosure: Bechtold reports no relevant financial disclosures. Please see the full study for a list of all authors’ relevant financial disclosures.

Source: Bechtold J, et al. Am J Psychiatry. 2016;doi:10.1176/appi.ajp.2016.15070878.   June 15, 2016

Teen Marijuana Use And The Risks Of Psychosis

Doctors in Germany have noted an alarming rise in psychotic episodes linked to excessive marijuana use among young people, which follows other studies around the world raising alarms.

BERLIN — Miklos has survived the worst of it. He doesn’t hear voices anymore. And if he did, he’d know it’s just an hallucination. “This isn’t real,” he would tell himself.

The 21-year-old can also interact with people again — even look them in the eye. As soon as his therapist enters the room he starts smiling. This would have seemed impossible just a few weeks ago. Miklos was admitted a while back to the psychiatric ward of the Hamburg University Hospital, which diagnosed him as having suffered from an “extreme psychotic episode after abuse of cannabis.”

Initially the help he received there seemed to have little effect. He suffered from paranoia, and even broke out of the hospital and caused a major traffic accident while on the run. He had frequent violent outbursts, refused to speak to anyone, and was fixated on just one thought: “I want to leave, just leave, leave, leave.” But he eventually came to embrace his treatment.

Miklos had slid into addiction three years earlier. Nothing in his life seemed to be working at the time. A girl he liked laughed in his face when he confessed his love for her. His math teacher let it be known she thought he was a failure. He was in constant conflict with his parents. “Every time things went wrong, I would hide in my room and smoke weed,” he recalls.

Miklos smoked with a bong, or water pipe, so the relaxing effect of marijuana would kick in faster. He’d take his first puffs as soon as he woke up in the morning. Smoking pot became his full-time job.

Miklos stopped going to school and ended up failing his final exams. He became indifferent, avoided his friends and ultimately had virtually no social connections. And then the voices appeared. “Oh good God, you are such a loser, you never do anything right,” they would say. Finally, he turned to his parents for help and was admitted to the university hospital.

Playing with fire

The number of patients admitted with psychotic episodes after having consumed cannabis has more than tripled in Germany over the last 15 years, from 3,392 in 2000 to 11,708 in 2013. More than half of the patients are younger than 25.

Andreas Bechdolf is the chief of medicine for psychiatry and psychotherapy at the Berlin Urban Hospital and heads a two-year-old facility called the Center for Early Intervention and Therapy, or FRITZ, which focuses specifically on adolescents. It is the country’s only such project to date. “All major psychological disorders usually begin in adulthood,”
Bechdolf says. “But until now the welfare system has paid very little attention to young adults.”

FRITZ employs psychologists, psychiatrists, care providers and social workers as well as young people who cannot, at first glance, be distinguished from patients. They don’t wear white clothing. Some have nose piercings or large rings inserted in their earlobes. And they are purposely informal in how they relate with the patients. Bechdolf calls this a “subcultural” strategy.

“The truly awful thing is that it often takes years before young adults with psychoses receive treatment, and many feel stigmatized,” Bechdolf says. “It often takes another year from the point they start hearing voices before they finally take the step to open up to a doctor.” This is something FRITZ aims to change.

The program works with several hundred patients between the ages of 18 to 25. Some spend several weeks in the hospital ward. Others are outpatients, and some are treated at home. The vast majority (between 80% and 90%) were smoking marijuana on a regular basis before their treatment began. “Not all of them are addicted, but many of them are,” Bechdolf says.

Those who start smoking marijuana on a regular basis before the age of 15 are six times more likely to suffer from psychosis in later years. Adolescent cannabis consumers suffer from more anxiety and depression than their non-consuming counterparts. Cognitive performance is diminished and the loss of concentration is a common side effect. Quite often, these adolescents are unable to recall the content of a text they read only a few days before.

British scientists have established that people who smoked cannabis on a regular basis when young ended up, 10 years later, in a lower social standing, had worse academic results and a lower income than people who didn’t smoke.

“Dramatic effects”

The active ingredient is cannabis is Tetrahydrocannabinol (THC), which has been shown to inhibit brain maturation. The connecting of nervous cells in the brain takes place until about 25 years of age. THC impedes certain connections and certain areas remain underdeveloped while others connections are made by mistake.

A University of Melbourne study has even shown that the amygdala area of the brain, responsible for regulating the feelings of anxiety and depression, shrinks with regular cannabis abuse.

The abuse of marijuana also causes an unusually large amount of the neurotransmitter dopamine to be distributed throughout the brain. This in turn causes the feeling of relaxation but can, if abused over a long period of time, lead to hallucinations. The THC content in artificially cultivated cannabis, the most common form of cannabis production nowadays, is often quite high, up to 20%.

“This cannot be compared to the joints that were smoked in the 1960s and 1970s,” Bechdolf says. “The THC content of cannabis back then may have been only as high as 5%. But the cultivation of cannabis has become an industry that strives for optimization.”

High TCH levels are less of a problem for older people. “Those who are in their late 40s and smoke the occasional joint on the weekends don’t need to fear any repercussions,” the FRITZ head explains. “But the regular consumption of cannabis can have very dramatic effects on a 14- or 15-year-old.”

Bechdolf believes that nearly 20% of people who suffer from psychoses — extreme psychological disorders and loss of the concept of reality — could be healthy had they not smoked cannabis.

Trying to refocus

Psychoses often develop over several years. At first people have difficult concentrating and putting thoughts together. Things that used to be second nature become increasingly difficult. People are unable to understand the meaning of once-familiar words. Perceptions begin to change. Colors become more intense. A car that is 10 meters away might seem to be right in front of you.

“Those are the early symptoms,” Bechdolf explains. “This stage develops at a very slow pace over three or four years.” Then, when the psychosis manifests itself perceptively, acoustic hallucinations are added to the mix. Often the voices divulge secrets or utter a running commentary on the person’s shortcomings. People also feel they are being constantly followed or spied on.

The prognosis with a so-called substance-induced psychosis is usually relatively good. “Those who stop smoking pot have a very good chance of being healed,” Bechdolf says. Continued outpatient therapy after being released from the hospital is part of this healing process. Instead of going back to thinking, “If I have a joint, everything will be fine,” patients need to find a different approach to tackling their issues. “It is a huge challenge for those affected to re-learn how to deal with problems,” he says.

For Miklos, that’s meant nurturing a passion for longboarding. “It doesn’t give you the same kick as smoking pot, but it’s still pretty cool,” he says.

If his condition continues to be stable for the next two weeks, he will be discharged from the clinic and will have sessions with his therapist twice weekly. Miklos will not be moving back in with his parents when he’s discharged. Instead, he’ll be going to a supervised communal residence.

He even wants to try to repeat his final exams during the summer. Miklos says he’s also now able to appreciate the help he’s getting from the hospital’s doctors and social workers. “I know that I never would have been able to get better without them.”


Source: worldcrunch.com 3rd May 2015

BY MATTHEW ROBINSON, VANCOUVER SUN APRIL 29, 2015

Vancouver police make arrests at Weeds marijuana store amid regulation debate

The political showdown between the Harper government and Vancouver intensified Tuesday in advance of city council’s consideration of a plan to strictly regulate the fast-growing pot dispensary business.

Photograph by: Gerry Kahrmann , PNG

Vancouver police officers raided a marijuana dispensary in Kitsilano on Wednesday, one day after city councillors voted to send a plan to regulate the illegal shops to public hearing.

Police began investigating Weeds Glass and Gifts at 2916 West 4th Avenue in March after a 15-year-old allegedly bought marijuana-infused edibles at the shop, according to a Vancouver Police Department news release.

Officers armed with a search warrant seized evidence during the raid, arrested staff and identified customers. They were all released pending further investigation, according to the release.

Don Briere, the owner of 11 Weeds Glass and Gifts shops in Vancouver, said in a statement he supported police and believed they were just doing their job. “The 4th avenue store was raided today because there was an employee who might have sold to a minor and I do believe overdosed on it. The employee will be reprimanded and most likely fired for it,” he said. The shop will reopen after police leave, according to the statement.

Police warned operators and staff at marijuana dispensaries in the VPD release, stating they could be subject to criminal charges while owners or landlords could potentially face asset forfeiture. Sergeant Randy Fincham, a VPD spokesman, used the analogy “the tallest nail gets hit first” to describe the department’s policy on marijuana earlier this month. He said officers deal first with drug dealers who supply to children, draw community concern and complaints, or are violent or prey on marginalized people.

The federal government opposes the city’s plan to regulate pot shops and told police Tuesday they should crack down on them instead. A Weeds Glass and Gifts shop on Kingsway was raided last August “for operating in an unsafe manner,” according to VPD. A month later, officers raided Budzilla at 2267 Kingsway for selling products “to virtually anyone that walked in the door.” Earlier that year police raided Jim’s Weeds Lounge at 882 East Hastings St., alleging that marijuana was being purchased at the store then sold to neighbourhood youth.

The department has obtained nine search warrants for marijuana dispensaries in the past 18 months, according to police.

Source: mrobinson@vancouversun.com 29th April 2015

By Jeanette McDougal, MM, CCDP, Chair
William R. Walluks, Member Hemp Committee, Drug Watch Intl.
August 2000

Fiber Cannabis hemp seed, though containing tetrahydrocannabinol (THC, the main psychoactive ingredient in hemp/marijuana) and other cannabinoid residue, is being heavily marketed and promoted by the hemp industry as a source of food, nutraceuticals, and cosmetics. The harmful effects of THC on humans and other animals is well documented. Hemp advocates, however, mimicking the tactics of tobacco industry apologist, challenge and “call into question” every statement substantiating harm caused by the use of Cannabis sativa L. hemp. (Where used in this paper, the term hemp refers to cannabis sativa, aka marijuana, and not to any of the numerous other plant fibers also commonly referred to as hemp.)

The campaign to use hemp fiber for paper, biomass, textiles, etc. has largely failed because hemp is neither economically viable nor technically feasible. However, because the handling, storage, and processing of hemp seed is more adaptable to present technologies than for hemp fiber, hemp seed production and products are now being aggressively promoted.

Low THC Cannabis sativa hemp that contains less than .3% (w/w) THC became legal to grow in Canada in March, 1998. THC and the other cannabinoids are found in food and other products made from fiber hemp seed. According to Canada’s national health department, Health Canada, “In theory the ripened seeds of Cannabis contain no detectable quantity of THC. However, because of the nature of the material it is almost impossible to obtain the seeds free from extraneous THC in the form of residues arising from other parts of the plant which are in close proximity to the seeds. Although it is required for the seeds to be cleaned before any subsequent use, the resinous nature of some of the material makes complete cleaning extremely difficult.” [1]

Since THC and the over 60 other cannabinoids are fat-soluble, i.e., store themselves in the fatty tissues of the brain and body, even a very small amount may be damaging, especially if ingested regularly. Fat-soluble substances accumulate in the body.

THC has a half-life of about seven days, meaning that one-half of the THC ingested or inhaled stays in the brain and body tissue for seven days. Traces can stay in body tissues for a month or more. The only important substance that exceeds THC in fat solubility is DDT. [2]

A risk assessment done for Health Canada states that, “New food products and cosmetics made from hemp – the marijuana plant – pose an unacceptable risk to the health of consumers. It also says that hemp products may not be safe because even small amounts of THC may cause developmental problems. “Those most at risk,” the study says, “are children exposed in the womb or through breast milk, or teen-agers whose reproductive systems are developing.” [3]

Hazards associated with exposure to THC include acute neurological effects and long-term effects on brain development, the reproductive system and the immune system,” the study says. “Overall, the data considered for this assessment support the conclusions that inadequate margins of safety exist between potential exposure and adverse effect levels for cannabinoids (the bio-active ingredients) in cosmetics, food and nutraceutical products made from hemp.” [3]

The study reviewed the results of existing tests on lab animals. Health Canada may require warning labels or new regulations that could stop some products from being sold. It is considering new animal studies to examine the effects of low-level exposure to THC over several generations. [3]

To cast further doubt about safety, the Journal of Immunology (July 2000) recently reported that THC, the major psychoactive component of marijuana (hemp), “can promote tumor growth by impairing the body’s anti-tumour immunity system.” [4]

Another unknown is hemp as forage for animals. According to Stan Blade, a director of crop diversification for Alberta Agriculture, a program that will test hemp over the next year as feed for livestock is being considered in Canada. Forage hemp will be tested on cattle against a more traditional mixture of oats and barley. [5]

Buffalo, the common dairy animal of Pakistan, are allowed to graze on Cannabis sativa (hemp), which, after absorption, is metabolized into a number of psychoactive agents. These agents are ultimately excreted through the urine and milk, making the milk, used by the people of the region, subject to contamination. Depending on the amount of milk ingested and the degree of contamination, the milk could result in a low to moderate level of chronic exposure to THC and other metabolites, especially among the children raised on this milk. Analysis from the urine obtained from children who were being raised on the milk from these animals, indicated that 29% of them had low levels of THC-COOH (THC-carboxylixc acid, which is a major metabolite for THC) in their urine. This study indicates that the passive consumption of marijuana through milk products is a serious problem in this region where wild marijuana grows unrestricted, and that children are likely to be exposed more than adults.” [6]

Hemp use could compromise drug testing. In his book, “Fats that Heal, Fats that Kill,” Udo Erasmus warns that people whose jobs require mandatory drug screening should avoid the use of hemp products, since THC residues in hemp products can show up in urine tests. 7. THC-positive urine tests from hemp product use were also reported in the August 1997 Journal of Analytical Toxicology. 8. For drug-testing reasons, the U.S. Air Force, the Air Force National Guard, the New York Police Dept., and the U.S. Coast Guard have banned the use of hemp foods and health supplements by their personnel. [8. & 9]

Dr. Hugh Davis, Acting Head of Microbiology and Cosmetics at Health Canada, is quoted as saying that he has been looking at studies on hemp and has found research showing hemp (i.e., fat soluble cannabinoids) is accumulative in the body because of its long half-life and has the same adverse physiological (but not hallucinatory) effects that smoking marijuana does. One study states that cannabinoids may postpone puberty. There are 60 known cannabinoids, only three of which have been widely studied. This means that the potential harmful aspects of the remaining 57 cannabinoids, when used in a cream or shampoo, are unknown.” [10]

John Bailey, Microbiology and Cosmetics Division, US-FDA, (US-Federal Drug Administration) is concerned as well, stating that there is no definitive information about THC in food and cosmetics. [10]

Dr. Mohmoud ElSohly, Ph.D., Marijuana Project Director, NIDA (National Institute of Drug Abuse), states that “Fiber hemp can have significant potential for narcotic application….The threshold THC concentration (below which Cannabis would have no significant psychoactive properties) has not been determined.” [11] [Emphasis added] Dr. Roy H. Hart, Clinical Psychiatrist and research chemist (ret.), asserts that it is possible to experience chronic intoxication without being high. [12]

In addition to THC, there are other bioactive, but non-psychoactive, cannabinoids [cannabinol (CBN), cannabidiol (CBD), and cannabigerol (CG)] in Cannabis sativa marijuana(hemp). [13] David West, Ph.D., pro-hemp activist (HI), claims that CBD blocks the effects of THC in the nervous system. [14] However, Dr. Carlton Turner, Director of the Federal NIDA Marijuana Project (1970-1981) and former US Drug Czar (1980s) counters that “CBD is abundant in hashish and if CBD blocked THC’s action, why would hashish be so popular? I know of no known definitive study that shows that CBD blocks THC’s affects. Fiber cannabis is rich in CBD with little THC. However, naive users can sometimes get high but regular users will not.” [15]

The non-psychoactive cannabinoids may be even more toxic than THC. According to Dr. Roy Hart, “Cannabidiol (CBD) exerts an important effect on the hippocampus which is part of the limbic system of the brain, a collection of inter-functioning units concerned with emotion. CBD produces a depression of hippocampal function…Thus far experimental evidence indicates that CBD is even more toxic to tissues than THC.” [16] [Emphasis added] Dr. Gabriel Nahas, Research Professor, New York University, states that cannabionids other than THC (CBN and CBD) also impair dividing cells, and “are even more potent than THC when it comes to inhibiting DNA production.” [17]

Dr. Hart further states that “Both the psychoactive and non-psychoactive cannabinoids occurring in nature interfere with protein synthesis, deoxyribonucleic acid (DNA) synthesis, and ribonucleic acid (RNA) synthesis. This is without doubt the most important statement to be made about marijuana(hemp) and is based upon the burgeoning literature of basic and applied research into cannabis. Cell-tissue-organ damage follows inevitably from these alternations occurring at the molecular level.” [18]

Longtime and internationally renowned Cannabis researcher, Dr. Gabriel Nahas says that research has shown that the most serious adverse consequences of consumption of THC and other cannabinoids have been observed at the earliest state of reproductive function, on the “gametes” or germ cells of man. These drugs cause damage to the genetic information contained in DNA, causing apoptosis (programmed cell death and deletion). This threatens future generations before they are conceived. [19]

A 1996 study conducted in the Ukraine (formerly Russia) showed that there are no varieties that completely lack(ed) cannabinoids. A rather high content of these substances (cannabinoids) was found in some varieties. The results obtained have shown that hemp cultivated in more northerly areas is naturally rich in cannabinoids. [20]

European Union (EU) hemp regulations for the year 2000 state that hemp subsidies will be paid on condition the farmer uses certified seed of hemp varieties with a THC content of less than 0.3%. From the years 2001/02, that upper limit will be lowered to 0.2%. [21]

The European Union (EU) too is concerned about any inclusion of hemp products’ in food, stating in their regulations, “…Hemp seed has one traditional but limited application as food for fish and birds. The oil from hemp seed can be used for specialist cosmetics applications. The use of hemp seed or the leafed parts of the plant for human consumption would, however, even in the absence of THC, contribute towards making the narcotic use of cannabis acceptable and, in any event, there is no nutritional justification for this. [Emphasis added] None of these products should be encouraged in their own right by Community aid….Moreover, the International Narcotics Control Board (INCB, a United Nations body) states that: ‘while illicit cannabis cultivation (sic) have soared, a considerable market for food products and beverages produced with cannabis has developed in the European Union (…). The health effects of these products have not been adequately researched.’(…) [Emphasis added] The wide and unrestricted availability of such products in shops, where cannabis candy bars can be sold to minors without restriction, contribute to the overall benign image of cannabis, a drug under international control.” [OICS note of 12.3.1999.] [21]

It is therefore important to remain vigilant and step up controls to ensure that illegal crops do not tarnish the reputation of the sector producing hemp for fibre. To avert such dangers, the cultivation of hemp for fibre must be strictly controlled, which means the area cultivated will have to be restricted, and the uses to which it is put must NOT include human nutrition.” [Emphasis added] These EU regulations apply from July 1, 2000. [21]

The findings of the previously mentioned Health Canada THC Assessment are quite alarming from a consumer health and safety standpoint. Two key areas of health hazards to humans were reviewed, and the potential for risks from consumption of hemp products was characterized. [22]

One health area was neuroendocrine disruption during developmental states (perinatal, pre-pubertal and pubertal) that leads to permanent adverse effects on the brain and reproductive systems. The second area was neurological impairment manifested as deficits in cognitive and motor skills’ performance. [22]

The study could not, due to data gaps, develop definitive conclusions regarding the degree of potential risk from ingesting THC through hemp products. However, even without considering the bio-accumulative hazard potential of THC through repeated or multiple-product use, or the risk from chemicals other than THC in Cannabis sativa hemp, it nevertheless came to the following conclusions:

CHARACTERIZATIONS OF RISKS FROM THC
IN HEMP PRODUCTS FOR HUMAN USE & CONSUMPTION
HEALTH CANADA STUDY (DRAFT of November 23, 1999)

HEALTH RISK/ PRODUCT FOOD COSMETICS NUTRACEUTICALS
RISK OF
NEUROENDOCRINE
DISRUPTION *
LIKELY POSSIBLE LIKELY
RISK OF NEUROLOGICALIMPAIRMENT ANDPSYCHOACTIVITY LIKELY, PARTICULARLYFOR CHILDREN
(also risk ofpsychoactivity for children)
UNLIKELY, THOUGH CANNOT BE EXCLUDED ENTIRELY DUE TO LIMITATIONS OF STUDY POSSIBLE,PARTICULARLY IN CHILDREN.

*Developing fetus, nursing infant, and prepubertal/pubertal child are at greatest risk of long-term effects. THC is rapidly transferred from mother to fetus within minutes of exposure. THC accumulates and is transferred via breast-milk. [22]

The in-depth Health Canada Risk Assessment on THC and Other Cannabinoids (in products) Made with Industrial Hemp (11/23/99) warns “On the basis of currently available data it is concluded that the present Canadian limit of 10ug/g (i.e.,10 ppm) THC in raw materials and products made from industrial hemp (Cannabis sativa cultivars with less than 0.3% THC) would likely not protect the Canadian consumer using industrial hemp-based food, cosmetic and personal care, and nutraceutical products from potential health risks of neurological impairment and neuroendocrine disruption associated with low level exposure to THC and other cannabinoids.” [22]

In the United States even salad oils must be examined and certified by the US-FDA as “generally recognized as safe.” This has not been done for hemp.

Allowing or introducing toxic chemicals in our food and cosmetic systems through use of THC-containing industrial hemp products is unthinkable. To do so would jeopardize public health and safety. U.S. citizens and government agencies and officials should do everything possible to prevent this from happening, thus protecting future generations from both known and unknown health and genetic hazards.

REFERENCES: THC in Food and Cosmetics

1. Industrial Hemp Technical Manual, Health Canada, Standard Operating Procedures for Sampling and Testing Methodology Basic Method for determination of THC in hempseed oil, 1998.

2. Hart, R.H.: Bitter Grass, The Bitter Truth About Marijuana, April 1980,13-14.

3. Mcilroy, A.: “Health Canada study says THC poses health risk,” Globe and Mail, Ottawa Canada, July 27, 1999.

4. Zhu,LX., Sharma,S., Stolina,M., Gardner,B., Roth,MD., Tashkin,DP., Dubinett,SM., -9-Tetrahydrocannabinol Inhibits Antitumor Immunity by a CB2 Receptor-Mediated, Cytokine-Dependent Pathway, The Journal of Immunology, 2000, 165: 373-380.

5. “Alberta Farmers Slow To Try Growing Hemp,” Calgary Herald, Calgary Canada, August 14, 1999.

6. Ahmad, GR; Ahmad, N., “Passive consumption of marijuana through milk: a low level chronic exposure to Delta-9-tetrahydrocannabinol (THC)., Journal of Toxicology, Clinical Toxicology, 1990,28:2,255-260;ref.

7. Erasmus, U., Fats that Heal, Fats that Kill, Alive Books, 1993, p. 287.

8. Pulley, J., Air Force Snuffs Out Hemp-Seed Extract, Air Force Times, 2/8/99.

9. Cooper, M., New Police Policy Takes On Hemp Oil!, New York Times, 7/22/99.

10. Begoun, P., “Hemp Claims Can’t be Confirmed,” Tampa Tribune (FL), February 4, 2000.

11. Report to the (KY) Governor’s Hemp and Related Fiber Crops Task Force, June 13, 1995, Letter from Mahmoud A. Elsohly, Project Director, NIDA, Marijuana Project, University of Mississippi, to Prof. M. Scott Smith, Ph.D., University of Kentucky College of Agriculture, 1995.

12. Hart, R.H.: Bitter Grass, The Bitter Truth About Marijuana, April 1980, p 17

13. Ibid, p 17.

14. West, DP., Hemp and Marijuana: Myths & Realities, North American Industrial Hemp Council, Inc., 1998, p5.

15. Personal Correspondence from: Carlton Turner, Ph.D., Carrington Laboratories, Inc., Irving, TX., March 22, 1999, to: Jeanette McDougal.

16. Hart, R.H.: Bitter Grass, The Bitter Truth About Marijuana, April 1980, p 18.

17. Nahas, GG, M.D., PhD., D.Sc., Keep Off The Grass; Paul S. Ericksson, Publisher, 1990, p148

18. Hart, R.H.: Bitter Grass, The Bitter Truth About Marijuana, April 1980, p 17.

19. Nahas, GG, M.D., PhD.,D.Sc., Keep Off The Grass; Paul S. Ericksson, Publisher, 1990, p282. and Stedman’s Medical Dictionary, Lippincott Williams & Wilkins, Baltimore 2000.

20. Virovets, V.G.: Selection for Non-Psychoactive Hemp Varieties (Cannabis sativa L.) In the CIS (former USSR), 1996, Journal of the International Hemp Association 3(1): 13-15.

21. Community preparatory acts, Document 599PC0576(02): Http://europe.eu.int/eur- lex/en/com/dat/1999/en_599PC0576_02.html

22. Tetrahydrocannabinol (THC) and Other Cannabinoids in Foods, Cosmetics and Nutraceuticals Made with Industrial Hemp – A risk Assessment – (Draft) Prepared for Health Canada, November 23, 1999 (available through Access of Information, Canada). Final Report due fall of 2000, available through Health Canada.

Source: www.drugwatch.org/resources Aug.2000

April 30, 2015 Special Reports, Addiction, Substance Use Disorder

By Robin M. Murray, MD

Attitudes toward cannabis are changing. Uruguay has legalized its use as have 4 American states; Jamaica is in the process of following suit. In addition, 17 US states have decriminalized cannabis, while 23 others have passed medical marijuana laws.

In many ways, cannabis is similar to alcohol; most of those who use it do so moderately, enjoy it, and suffer few if any adverse effects. However, in a minority of heavy users, problems develop. Given the likelihood that cannabis will become more available, it is important to establish any harms its use may cause so clinicians can identify and treat these. The main psychological harms that have been reported are dependence, cognitive impairment, and psychosis.

Why do people enjoy smoking cannabis?

The cannabis plant produces compounds known as cannabinoids in glandular trichomes, mostly around the flowering tops of the plant. Recreational cannabis is derived from these and has been traditionally available as herb (marijuana, grass, weed) or resin (hashish, hash). The cannabis plant produces more than 70 cannabinoids, but the one responsible for the “high” that users enjoy is tetrahydrocannabinol (THC). This activates the CB1 receptor, part of the endocannabinoid system, which, in turn, affects the dopaminergic reward system that is altered by all drugs of abuse.

Psychological dependence and tolerance can occur with cannabis. It remains in the body for several weeks, so withdrawal is very gradual but anxiety, insomnia, appetite disturbance, and depression can develop. Some reports claim that in 10% of persons who use cannabis and in 25% of daily users, dependence develops.1 Cannabis dependence is an increasingly common reason why patients seek help from drug treatment clinics.

Cognitive impairment

Many studies implicate adolescent cannabis use with poor subsequent educational achievement. Silins and colleagues2 observed more than 2500 young people in Australia and New Zealand. Their findings suggest that daily cannabis use before age 17 was associated with “clear reductions” in the likelihood of completing high school and obtaining a university degree.

THC disrupts the function of the hippocampus, a structure crucial to memory, and when it is given to volunteers, transient cognitive impairment is seen. Such impairment likely is why drivers under the influence of cannabis are at double the risk for traffic accidents.2 Long-term users show more obvious deficits, but questions remain about what happens when they stop. Some studies suggest they can recover fully, while others indicate that only partial recovery is possible.3

Risk of psychosis

It has long been known that persons with schizophrenia are more likely to smoke cannabis than is the rest of the population. Until recently, the general view was that they must be smoking to self-medicate or otherwise help them to cope with their illness. If this were so, then one might expect psychotic cannabis users to have a better outcome than non-users. However, the opposite is the case; the patients who continue to use cannabis are much more likely to continue to have delusions and hallucinations.4

However, this does not prove that cannabis use causes the poor outcomes. The possible causal role of cannabis can only be answered by prospective epidemiological studies. In the first of these, 45,750 young men were asked about their drug use when they were conscripted into the Swedish army.5 Those who had used cannabis more than 50 times when conscripted, were 6 times more likely to receive a diagnosis of schizophrenia over the next 15 years(Figure 1). Since 2002, a series of prospective studies have confirmed that individuals who used cannabis at the baseline evaluation had a great-er risk of subsequently developing psychotic symptoms or full-blown schizophrenia than non-users.4-7

Some skeptics have suggested that perhaps those who are predisposed to schizophrenia are especially likely to use cannabis. However, in the Dunedin birth cohort study, the subjects were intensively studied since childhood, so those who had already appeared psychosis-prone at age 11 were excluded.6 The researchers found a link between cannabis use and later schizophrenia, even when the effects of other drugs known to increase risk of psychosis were excluded (Figure 2). Another criticism was that some individuals might have been using cannabis in an attempt to ameliorate symptoms of psychosis or its precursors. However, a second New Zealand study, this time from Christchurch, showed that once minor psychotic symptoms developed, individuals tended to smoke less.7

Anyone familiar with the effects of alcohol would immediately accept that the frequency of drinking is relevant to its adverse effects. The same is true with cannabis; long-term daily users are most at risk. Nevertheless, the majority of daily users will not become psychotic. Indeed, when a young man in whom schizophrenia has developed after years of smoking cannabis is asked whether he thinks his habit may have contributed to the disorder, he might answer, “No, my friends smoke as much as I do, and they’re fine.” It seems that some people are especially vulnerable.

Individuals with a paranoid personality are at greatest risk, along with those who have a family history of psychosis. Inheriting certain variants of genes that influence the dopamine system, which is implicated in psychosis, may also make some users especially susceptible; examples include AKT1, DRD2, and possibly COMT.8,9

Changes in potency

In 1845, French psychiatrist Jacques-Joseph Moreau used cannabis and gave it to some of his students and patients. He concluded that cannabis could precipitate “acute psychotic reactions, generally lasting but a few hours, but occasionally as long as a week.”10 Modern experimental studies confirm that intravenous administration of THC in healthy volunteers can produce acute psychotic symptoms in a dose-dependent manner.8

The proportion of THC in traditional marijuana and resin in the 1960s was approximately 1% to 3%. Potency began to rise in the 1980s, when cannabis growers such as David Watson, commonly known as “Sam the Skunkman,” fled the Reagan-inspired “War on Drugs” and brought cannabis seeds to Amsterdam, where cannabis could be sold legally in “coffee shops.” Together with Dutch enthusiasts, they bred more potent plants, setting the scene for a slow but steady increase in new varieties of marijuana, including sensimilla (often called “skunk” because of its strong smell) harvested from unpollinated female flowers. The proportion of THC in sensimilla has risen to between 16% and 20% in England and Holland, respectively, and high-potency varieties have taken over much of the traditional market9,11; the same trend, although lagging a few years behind, has occurred in the US.12

Traditional cannabis often contained not only THC but an equivalent amount of cannabidiol. This has been shown in experimental studies to ameliorate the psychotomimetic effects of THC, and possibly to have antipsychotic properties (Figure 3).13 However, plants bred to produce a high concentration of THC cannot also produce much cannabidiol, so the high THC types of cannabis contain little or no cannabidiol. Such varieties are more psychotogenic; one study showed that persons who used high-THC–low-cannabidiol cannabis on a daily basis were 5 times more likely than non-users to suffer from a psychotic disorder.14 Another study that tested hair for cannabinoids showed that users with both detectable THC and cannabidiol in their hair had fewer psychotic symptoms than those with only THC.15

The increasing availability of high-potency cannabis explains why psychiatrists are more concerned about cannabis now than they were in the 1960s and 1970s. The trend toward greater potency continues: new forms of resin oil reportedly contain up to 60% of THC.11 These very potent forms remain unusual, but synthetic cannabinoids, often termed “spice” or “K2,” are now commonly advertised and sold on Web sites that keep within the law by labeling their products as incense—or adding “not for human consumption.” While THC only partially activates the CB1 receptor, most spice/K2 molecules fully activate the receptor and, consequently, acute adverse reactions are more common. A survey of 80,000 drug users showed that those who used synthetic cannabinoids were 30 times more likely to end up in an emergency department than users of traditional cannabis.16

Cannabis and the developing brain

It seems that starting cannabis use in early adolescence increases the likelihood of problems. For example, in the Dunedin study, those starting at 18 years or later showed only a nonsignificant increase in the risk of psychosis by age 26, but among those starting at age 15 or earlier, risk was increased 4-fold (Figure 2).6

Those starting cannabis use early also appear more likely to develop cognitive impairment. Pope and colleagues17 found that long-term heavy cannabis users who began smoking before age 17 had lower verbal IQ scores than those who began smoking at age 17 or older. Meier and colleagues18 followed a birth cohort in Dunedin, New Zealand, up to age 38 years. Their findings suggest that persistent cannabis use over several decades causes a decline of up to 8 points in IQ; such dramatic findings need to be replicated before they can be accepted.

The results from animal studies also show that THC administration produces a greater effect on cognitive function in juvenile rats than in adult rats. Moreover, imaging studies in persons with long-term, very heavy cannabis use indicate detectable brain changes, especially in those who started smoking in adolescence.19 Although the studies remain contentious, a possible explanation is that beginning cannabis use at an age when the brain is still developing might permanently impair the endocannabinoid system; this may affect other neurotransmitters, such as dopamine—known to be implicated in both learning and in psychosis.

Implications

Cannabis is now generally recognized as a contributory cause of schizophrenia. Although psychosis develops in only a small minority of cannabis users, when you consider that almost 200 million people worldwide use cannabis, the number of people who suffer cannabis-induced psychosis is likely to be in the millions, and the impact on mental health services is significant. The proportion of psychosis that has been attributed to cannabis use in different countries ranges from 8% to 24%, depending, in part, on the prevalence of use and the potency of the cannabis.16

Politicians have the difficult job of balancing the enjoyment that many people get from cannabis against the harm that afflicts some people. Furthermore, cannabis can alleviate chronic pain or symptoms associated with chemotherapy. Medical marijuana may be largely a cover used by the increasingly powerful marijuana industry to introduce recreational use, but research into the numerous components of cannabis should be encouraged, since it may produce drugs with important therapeutic uses.

Current trends are toward relaxing laws on cannabis, but no one knows the likely outcome. Will legalization mean an increase in consumption? Early reports from Colorado and Washington suggest an increase. Will this have knock-on effects on use by those in their early teens who seem most susceptible to adverse effects? Will the mental health and addiction services be able to cope? How effective will educational campaigns regarding the risks of regular use of high-potency cannabis or synthetic cannabinoids be? Might a simple genetic test reveal who is most likely to suffer adverse mental effects?

Many questions remain to be answered. In the meantime, as cannabis use continues to win acceptance, psychiatrists are likely to see more of the casualties.

Increasing numbers of Belgian teenagers are seeking help for cannabis use, De Standaard reported on Monday.

According to a report by the Flemish Association of Addiction Treatment Centres Care (VVBV), in 2013 495 boys and 78 girls aged between 15 and 19 sought assistance over continued use of the drug.

In addition, 36 children under the age of 15 also asked for help.

The report also found that more and more women are seeking help for heroin and cocaine use.

Counselling services are now been targeted at the young.

“Young men with a cannabis addiction used to be all in their twenties before they took the step to recovery.

In recent years, more and more 15- to 19-year olds are added, and they became a separate group in health care,” said VVBV Chairman Dirk Vandevelde.

“Based on these figures, it is difficult to estimate whether it is youth who are experimenting or already have an advanced addiction, and how long they remain in counselling,” he said.

Last week, a law allowing for the sale of medical marijuana was published in Belgium.

The law will come into effect at the beginning of July.

Amongst the drug’s medical properties is the alleviation of pain for sufferers of conditions such as multiple sclerosis.

Source:

http://news.xinhuanet.com/english/2015-06/15/c_134328368.htm  15th June 2015

Scientific studies increasingly suggest marijuana may not be the risk-free high that teens — and sometimes their parents — think it is, researchers say. Yet pot is still widely perceived by young smokers as relatively harmless, said Dr. Romina Mizrahi, director of the Focus on Youth Psychosis Prevention clinic and research program at the Centre for Addiction and Mental Health.

She cites a growing body of research that warns of significantly higher incidence of hallucinations, paranoia and the triggering of psychotic illness in adolescent users who are most predisposed.

“When you look at the studies in general, you can safely say that in those that are vulnerable, it doubles the risk.”  Such fallout is increasingly evident in the 19-bed crisis monitoring unit at the Children’s Hospital of Eastern Ontario in Ottawa.

“I see more and more cases of substance-induced psychosis,” said Dr. Sinthu Suntharalingam, a child and adolescent psychiatrist. “The most common substance that’s abused is cannabis.” One or two cases a week are now arriving on average. “They will present with active hallucinations,” Suntharalingam said. “Parents will be very scared. They don’t know what’s going on. They’ll be seeing things, hearing things, sometimes they will try to self-harm or go after other people.”

She and Mizrahi, an associate professor in psychiatry at University of Toronto, are among other front-line professionals who say more must be done to help kids understand potential effects.

“They know the hard drugs, what they can do,” Suntharalingam said. “Acid, they’ll tell us it can cause all these things so they stay away from it. But marijuana? They’ll be: ‘Oh, everybody does it.”‘  Mizrahi said the message isn’t getting through.

“Teenagers think that cannabis is harmless. It is not. And for some people, it’s particularly dangerous.” She stressed that risk depends on many factors. “Not every 14-year-old who smokes marijuana will have schizophrenia,” she said in an interview. Genetics, social issues, marijuana strength and frequency of use are among complex variables along with how young a person starts using the drug. “We are starting to see this as a very important issue,” Mizrahi said. “I think we have to start to talk about this.”

Brain development in childhood continues through teenage years and into the early 20s, she explained. Cannabis affects how the brain’s regulator — called the endocannabinoid system — controls things like mood and memory, she said. “You’re kind of tampering with or altering the system that’s there to regulate other things.”

Mizrahi said she typically gets feedback when she discusses this topic from people who say they’ve used marijuana for decades with no psychotic effect. There are also those who point out myriad medical benefits. But psychotic episodes, when they occur, could be short-lived or trigger a longer-term illness.

The Centre for Addiction and Mental Health says marijuana use in Canada is most common among teens and young adults. It estimates past-year use in Ontario at 23 per cent for students in Grade 7 to 12, and 40 per cent for those aged 18 to 29.

Amir Englund of King’s College London specializes in the effects of cannabis on the brain and behaviour. Pot with higher THC or tetrahydrocannabinol content, the ingredient that induces most psychological effects, can pack the punch of three shots of scotch versus a pint of beer, he said.  Studies of frequent adolescent users suggest those who start smoking earlier have a higher tendency to develop psychotic illnesses, he said in an interview. “People who get an illness much earlier, their likelihood of having a bad prognosis is higher.”

In Canada, pot is often more accessible to under-agers than alcohol but with no content controls. The Centre for Addiction and Mental Health, the country’s largest teaching hospital of its kind, called last fall for legalization with strict regulation to reduce harm.

Mizrahi advises all young people to avoid pot until they’re at least in their early 20s. “Certainly don’t do it when your brain is developing,” she said. “Don’t put yourself at risk.”

Source:  http://www.ctvnews.ca/health    5th May 2015

The young woman was shocked when the addiction-treatment clinic’s drug test showed extraordinary levels of THC in her system. She knew she had a drug problem. But she wasn’t like those acquaintances who sat around smoking pipes, bongs and joints all day.

“We asked how she could have had such an extremely high level of THC in her system,” explained Joanie Lewis, founder of Insight Services, an outpatient addictions treatment facility in Colorado Springs. “We learned her parents were preparing almost all of their food in a marijuana butter. You got the feeling they didn’t really consider it drug abuse. But her level of intoxication was much higher than if she had been a traditional user who sat down and smoked pot several times a day. The impairment crept up on her slowly but profoundly. This kind of thing may be why we’re seeing more impairment, more addiction and more serious withdrawals.”

The proliferation of foods infused or coated with THC has become a growing concern, even among some marijuana advocates. Several high-profile marijuana crimes and deaths involve consumption of edible THC products.

“When THC is available in food, it’s even harder for people to see it as a drug,” Lewis said. “But it is a drug. It is a depressant, a hallucinogen and an addictive substance that changes chemistry in the brain. Research shows all of the above.”

Given the United States’ hard-fought and continuing battles against tobacco and illness caused by its use, Americans would rebuff sales of lemon drops, cookies and soda pops infused with nicotine. Yet, the marijuana industry — quickly emerging as Big Tobacco 2.0 — infuses child-friendly snacks and drinks with doses of mind-
altering and brain-damaging THC up to 50 times stronger than 1960s-era pot.

“Practically nobody had even heard of THC concentrates until after Colorado voted to legalize marijuana, and, honestly, this state had no idea what it was unleashing before it made that decision,” said Dr. Ken Finn, a Colorado Springs physician who is board certified in pain medicine. “Even today, a lot of people don’t seem to understand how potent and addictive this drug is or how easily it is concealed.”

When voters enacted Amendment 64, which sanctioned marijuana for recreational use, many did not envision a cookie more potent than dozens of Woodstock joints. Concealed in Amendment 64’s definitions of “marijuana” and “marihuana” is the phrase “marihuana concentrate.” It means the law allows sale, transport, possession and use of up to one1 ounce of leafy marijuana. It also means one 1 ounce of any form of THC concentrate, which can compare to 50 ounces or more of traditional pot that is smoked.

“I would appreciate it very much if people would send me links to news stories or government-sponsored communications explaining the THC levels that were established by Amendment 64,” Dr. Christian Thurstone, an associate professor of psychiatry at the University of Colorado who treats adolescent addiction and serves on the board of Safe Approaches to Marijuana, wrote on his website in February 2013. “I am unaware of any attempt of this nature to educate the public before Election Day, Nov. 6, 2012.”

Now the threats THC concentrates pose to public health and safety loom large. A new study from researchers at Ohio’s Nationwide Children’s Hospital finds more American children are exposed to marijuana before reaching their fifth birthday. The report, published in the peer-reviewed journal Clinical Pediatrics, found that between 2006 and 2013, the marijuana exposure rate rose 147.5 percent among children age 5 and under. In that same period, the rate rose nearly 610 percent in states that sanctioned medical marijuana before 2000, the year Colorado followed suit.

While consequences of most exposures reportedly were minor, the study’s researchers found 17 marijuana-exposed children fell comatose and 10 had seizures.

In Colorado, the number of exposures to THC-infused edibles in young children increased fourfold in one year, from 19 cases in 2013 to 95 in 2014, according to the Rocky Mountain Poison and Drug Center.

Experts overwhelmingly attribute spikes in marijuana exposure among children to THC-infused “edibles.” The drug-laced food is the most promising aspect of Big Marijuana’s economic future. Edibles make up about 45 percent of Colorado’s marijuana sales, based on state figures, and are projected to quickly surpass the sale of THC products that are smoked.

Advocates for edibles say the products provide a healthy alternative to inhaling smoke. Others go further, marketing drug-infused foods and drinks as health food.

“Here comes the Whole Foods-
ification of Marijuana,” states the headline for a story published by Fast Company, a news organization founded by former editors of Harvard Business Review, touting its focus on “ethical economics.” . The report describes the author’s experience with ordering front-door delivery of a jar of “organic, sun-grown marijuana from farmers Casey and Amber in Mendocino, Calif.”

“There’s a whole industry being built around the upscale branding of weed,” author Ariel Schwartz explains. “Marijuana is now something that should be organic, grown by friendly farmers…”

For marijuana sellers, edibles mean a potentially boundless market share. “Edibles are the future of the industry due to their familiarity,” explains an article on a website that markets “The Stoner’s Cookbook.” “Non-smokers are not inclined to medicate with a joint, but an infused cookie is something familiar that they’re comfortable ingesting.”

Indeed, THC-infused foods and drinks — all fashioned from marijuana the state doesn’t yet test for contaminants — are sold in hundreds of store-front establishments throughout the state. They are shared and traded on the campuses of middle schools and high schools, where young users with developing brains are especially susceptible to addiction. They are stowed in lunch boxes in the workplace.

Employers, law enforcement officials, educators and addiction treatment providers say Colorado has cooked up a poorly regulated THC-food fiasco that crisscrosses the country with the ease of exporting gummy bears in glove compartments, pockets and handbags. For taxpayers, the growing edibles market means an array of social costs — including hospitalizations, traffic accidents, school dropouts and lost work productivity — that state and federal officials haven’t fully investigated, estimated and made public.

Known as hash oil, wax, dabs, and shatter, concentrates deliver a high so fast and intense many users refer to them as “green crack.” One ounce of the highest potency THC concentrate can yield 560 average tokes on an electronic cigarette. In edibles, Colorado law defines an average serving of THC as 10 milligrams.

“That average serving size? That’s a political number, not anything rooted in real, reputable science,” said Kevin Sabet, a former senior White House drug policy advisoer and co-founder of Smart Approaches to Marijuana, an organization opposed to marijuana legalization and supported by several of the country’s top addiction treatment experts.

The 10-milligram serving size established by Colorado lawmakers means one1 ounce of high-potency THC oil — the amount one adult is allowed to buy or possess at any given time — also can equal 2,800 average servings. That’s a well-stocked bakery.

“I don’t need scientific evidence to show me that students are completely zoned out and that more stoned kids are showing up for class,” said Kelly Landen, a high school teacher in Denver. “If they’ve smoked marijuana, you smell it on them. But students also show up with candy and cookies and whatever … and there’s no way to know for certain what’s in that food. They could be eating (THC) right in front of me.”

Unregulated by the U.S. Food and Drug Administration, concentrated THC is practically undetectable. There is no pill. Unlike alcohol and cigarettes, there is no smell. Users can get high on food and beverages while hiding in plain sight in almost any location.

“There is great danger in how easy these food products are to conceal,” said Frank Szachta, director of The Cornerstone Program, an adolescent addiction treatment center in Centennial. “Someone could do this drug in front of you, or in front of a teacher, in front of the boss. … No one would have to know.”

Colorado legislators have grappled with the problem of people — particularly children and adolescents — consuming marijuana in common snacks that land them in emergency rooms with panic attacks and hallucinations. Authorities have linked at least three deaths in Colorado, including a murder, to excessive consumption of THC-laced foods.

When ingested through the stomach, the user may not experience effects for an hour or more. The delayed effect is blamed in part for new users becoming impatient and eating too much.

“Like a bottle of vodka, you can’t just drink the entire bottle. You have to take it slow and understand what you’re doing,” said Julie Berliner in a YouTube video. She’s the founder of Sweet Grass Kitchen, an edibles manufacturing company in Denver.

But edibles are not like a bottle of vodka in important ways. The vodka’s contents are exactly known, and drinks can be measured precisely. The label on a THC-infused brownie or candy bar might state “servings per package: 10,” but the maker can’t say whether the consumer will ingest all of those servings in one small bite. The folly is akin to cutting a cupcake into tenths and presuming each piece contains exactly one serving of vanilla extract.

Making matters worse, said Lewis of Insight Services, is that many people are not inclined to follow recommended serving sizes.

“The state says a serving size is 10 milligrams, so that’s how much THC you might find in one small piece of candy,” she said. “But very few people sit down with a bag of candy and eat only one piece.”

State lawmakers’ efforts to regulate edibles and their packaging have done little to stop accidental overdoses and deter underage use — in part because they haven’t applied to homemade goods infused with THC, health professionals say. State law also is undermined when someone removes the contents of a package and stores the THC-infused food in a bowl, jar or other container.

A law enacted in 2014 instructs the Colorado Department of Public Health and the Environment to devise standards and procedures that will make unpackaged, commercial food products easily stand out if they contain THC. It’s a tall order when dealing with small pieces of food — such as crumbs of granola — and the agency continues to grasping for a solution.

Since legalization and the mass marketing of highly potent, THC foods began, Colorado addiction treatment providers have reported increasing levels of toxicity among clients, more severe addiction and poorer prognoses for recovery from substance use disorders.

For example, the average level of THC found in the urine of about 5,000 adolescents ages 13-19 by researchers at the University of Colorado jumped from 358 nanograms per milliliter in 2007 through 2009 — just before the state’s boom in medical marijuana dispensaries — to 536 milliliters from 2010 through 2013.

The rapidly widening scope of THC-infused food is shaping up to be a recipe for great losses for individuals, families and the entire state, Lewis said.

“People are coming to us later in the addiction cycle than they used to,” she said. “When people get high on food, there is the perception that they’re not really using a drug. It seems less harmful than taking pills or smoking. By the time they realize there’s a problem, some of them are quite a ways further into the addiction than if they had been smoking it.”

Source: http://m.gazette.com/clearing-the-haze-thc-extracts-concentrate-problems/article/1554097   June 2015

Dakof G.A., Cohen J.B., Henderson C.E. et al.

Journal of Substance Abuse Treatment: 2010, 38, p. 263–274..

US researchers may have found a better way to support mothers at risk of losing custody of their children so they engage in and benefit from substance use treatment and meet family court requirements, meaning more children can safely stay with their parents.

SUMMARY The family environment of the children of problem substance users is often compromised by instability, neglect, and poor parenting. Improving parental functioning – especially reducing substance use – makes children safer and improves child welfare outcomes. However, substance use treatment completion rates among parents who come into contact with the child welfare system are low. For solutions to these problems, many communities have turned to family drug courts. Adapted from the adult drug court model, family drug courts were established to enhance the effectiveness of child welfare agencies by increasing enrolment and retention in substance use treatment, motivating parents to address their addiction, and coordinating the many services needed to stabilise families. Unlike typical drug courts, these courts do not operate in the criminal justice system, most participants are women, and the court addresses the dual issues of parental addiction/recovery and child safety and custody. Most family drug courts employ court counsellors who refer clients to substance use treatment and other services, develop a recovery plan, and monitor and report clients’ ongoing progress to the court.

 

Key points 

Family drug courts aim to enhance the effectiveness of child welfare agencies by promoting engagement in substance use treatment, motivating parents to address their addiction, and coordinating the services needed to stabilise families. 

To further promote treatment engagement and family court compliance of mothers facing loss of custody of their children, a programme was developed for court counsellors which involved the mother’s family and other significant figures in their lives. 

Compared to a more typical case management role, the tested programme led to more mothers retaining their parental rights and greater improvements in substance use, health, family functioning, and risk of child abuse. 

However, samples were small and by the end of the study several of the differences between the two sets of mothers were also small. 

The Engaging Moms Program – the focus of this study – is a family-oriented intervention shown to have succeeded in its objectives of facilitating treatment entry and short-term retention among mothers of infants who have been exposed to parental substance use. It was then adapted for use in a family drug court context and (relative to usual case management services) found in a non-randomised trial to improve completion of the drug court programme (72% versus 38%) and the proportion of mothers reunited with their children (70% versus 40%). Although the results were encouraging, this study had several limitations, leading to the current randomised trial comparing in a family drug court context the effectiveness of the Engaging Moms Program versus intensive case management of the kind recommended for such courts.

During the recruitment period of the trial, 62 of the 69 mothers who attended a family drug court in Miami in the USA agreed to join the study. They averaged 30 years of age, were mainly black or Hispanic, poor, unemployed and poorly educated. Just 1 in 10 were married. As children, many had been victims of physical and sexual abuse and most currently suffered serious mental health problems. They used a mixture of drugs including alcohol and cocaine and averaged about three lifetime arrests.

Mothers in the study were subject to the usual 12–15 month regimen of court hearings, supervision and support. Additionally, court counsellors were specially trained and supervised to deliver one of the programmes being compared as alternative ways to engage and retain these mothers in substance treatment and improve child and parental outcomes. The 62 women were randomly selected such that equal numbers were allocated to the Engaging Moms option or the comparator.

Neither option was a treatment in its own right, but sought to promote treatment entry, retention and benefit, as well as satisfactory completion of the drug court programme. Intensive case management counsellors aimed to develop a strong therapeutic relationship with the mother, assess her needs, plan support, link her to services, monitor progress, and advocate on her behalf. In contrast, the Engaging Moms Program (based on  multidimensional family therapy) engaged not just with the mother and with services but with the mother’s social network, especially her family. For example, in stage two of the programme focused on changing behaviour, counsellors conducted individual and joint sessions with the mother and her family and or partner. These dealt with: the mother’s motivation and commitment to succeed in drug court and to change her life; the emotional attachment between the mother and her children; her relationships with her family of origin; her parenting skills; her romantic relationships; and emotional regulation, problem solving, and communication skills. Considerable attention was devoted to repairing the mother’s relationship with her family, often damaged by hurts, betrayals, and resentments. Also the counsellor facilitated the mother’s relationship with court personnel and service providers and helped prepare her for court appearances, during which they advocated for the mother.

Regardless of the approach to which they had been allocated, during the trial mothers saw their counsellors for on average about 40 hours, but the Engaging Moms Program included seven hours of family sessions versus just under four in the case management option.

Research workers assessed the mothers several times up to 18 months following drug court intake (97% of assessments were completed), when information on child welfare status was extracted from court records. This primary outcome was defined as positive if the mother retained her parental rights, either having sole or joint custody of the children, or when the children were under the guardianship of a relative. Other outcomes considered not to be positive involved termination of the mother’s parental rights and the child being placed with a relative or in foster care.

The small number of mothers in this pilot study limited the chances of statistically significant findings, so the focus instead was on whether the differences between outcomes from the Engaging Moms Program and case management were large enough that with a bigger sample they might have proved statistically significant.

Main findings

Of the 31 Engaging Moms mothers, 24 had retained their parental rights compared to 17 of the 31 case management mothers, an advantage for Engaging Moms which narrowly missed the conventional criterion for statistical significance. These figures included 16 Engaging Moms mothers who had sole custody of their child compared to 12 allocated to case management. Over twice as many case management mothers had their children removed to foster care – 9 versus 4. Two-thirds of Engaging Moms mothers satisfactorily completed the drug court programme compared to about half the case management mothers.

Over the first three months both sets of mothers significantly improved in terms of their substance use, mental and physical health, family functioning, risk posed to child, and employment, improvements maintained or augmented through the remainder of the 18-month follow-up. In no case were these improvements significantly greater among Engaging Moms mothers, but several outcomes substantially favoured these mothers. They were more likely to further reduce their drinking, experience greater improvements in mental and physical health and family functioning, and more steeply decreased their risk of child abuse. At the three-month follow-up, on all three relationship dimensions they also reported significantly stronger therapeutic relationships with their counsellors.

The authors’ conclusions

The Engaging Moms Program delivered in the context of a family drug court increased the likelihood of positive outcomes for mothers (retention of parental rights and improved welfare and functioning) in comparison to intensive case management. In all domains of functioning, families assigned to Engaging Moms showed improvement that was equal to or better than families assigned to case management. Arguably the primary mechanisms leading to better results were a stronger therapeutic alliance with the counsellor and more extensive family involvement.

Although the results of this pilot study are encouraging, there are important limitations. The primary one is that a small sample size limits the scope for testing differences between outcomes in the two sets of mothers and weakens the reliability of the results; different results might be obtained with larger samples.
COMMENTARY Commending the Engaging Moms Program is its apparent non-punitive humanity and the plausibility of its strategy of repairing what may have been a damaging social network and engaging it in supporting the mother, promising not just the short-term gains which the study was able to document, but a more stable, long-term future for mother and child. Particularly encouraging is the non-diminution of the gains and sometimes their augmentation over the period after the interventions ended. As well as benefiting the families involved, long-term reduction in social costs can be expected. With family drug and alcohol courts spreading in the UK, the Engaging Moms model might be adapted to further improve their outcomes for parent and child.

However, convincingly demonstrating the advantages of the approach for maternal and child welfare is a difficult task when so much else is going on in the mothers’ lives, when the basic family drug court programme is the same for both intervention and comparison mothers, and when the comparator is itself seemingly a humane and well structured approach. Details below.

As the authors observed, if replicated with a larger sample, the difference in the retention of parental rights, and probably too in resort to foster care, would have been statistically significant, but also a larger sample may show these to have been unreliable findings. On the other measures of maternal welfare and family functioning and safety, though there were substantial extra improvements among the Engaging Moms group, in some cases this mainly reflected a drop from an initially higher level of severity. By the end of the study the differences in absolute terms between the two sets of mothers were generally very small. Several of the researchers were involved in developing the programme they evaluated, raising the possibility of their somehow favouring the programme, a  risk endemic  in substance use research. Also it has to be acknowledged that termination of a mother’s parental rights and placement of the child elsewhere is not necessarily a negative outcome from the point of view of the child’s long-term welfare. On this issue we can only rely on the professionalism and child-centredness of the Engaging Moms counsellors, and on the presumption that if there had been over-enthusiastic advocacy, the court would not have been unduly swayed.

UK research and practice

The first family drug and alcohol court in Britain was piloted at an inner London family court initially for three years to the end of 2010. Researchers concluded that more parents seen by these specialist courts than by comparison courts had controlled their substance misuse by the end of proceedings and been reunited with their children. They were also engaged in more substance misuse services over a longer period. Evidence of cost savings were noted in relation to court hearings, out-of-home placements, and fewer contested proceedings. Parents and staff felt this was a better approach than ordinary care proceedings. A  later report  from the same study with a longer follow-up of more families reinforced the earlier findings. More family drug and alcohol court parents had stopped misusing substances and dealt with other problems, and more mothers had been reunited with their children, but this 36% v 24% gap was not statistically significant.

The main weakness of this UK study is that in some known respects and perhaps in others not known, the comparison families differed from the family drug court families in ways which might have affected child welfare outcomes, regardless of the type of court proceedings. Also, through a preceding feasibility study the researchers had been involved in developing the programme they evaluated. As with the featured study, this raises the possibility of their somehow favouring the new intervention they helped to create.

Three NHS professionals who helped develop the first court in London  have explained that it differs from normal family courts in its multi-disciplinary assessment and intervention team made up of both child workers (child protection social workers and a child and adolescent psychiatrist) and adult workers (substance misuse workers and an adult psychiatrist), plus volunteers with personal experience of overcoming substance misuse, some of whom are court ‘graduates’. Court proceedings form an integral part of the treatment process. The family works with the same judge throughout and compared to normal courts, the court takes a less adversarial approach to care proceedings, the parent speaking directly to the judge in the absence of lawyers.

Similar courts have now opened in Gloucestershire and Milton Keynes and  as reported  in 2015, more were due to open in 2015/16 in areas including East Sussex, Kent and Medway, Plymouth, Torbay and Exeter, and West Yorkshire, funded by the Department for Education. Despite this significant expansion, as in London, these courts  will sit  once a week and hear relatively few cases.

Large-scale US evaluation

From the USA the  first large-scale outcome study  of a family drug court compared the progress (as revealed by court and administrative records) of mothers and children processed through three such courts with those processed through normal channels either in the same areas or in similar areas without a family drug court. An attempt was made to statistically even out relevant differences between the two sets of families. Findings favoured the family drug courts. Mothers processed through these courts were more likely to be unified with their children, who spent less time in out-of-home placements. More drug court mothers entered substance use treatment and they did so more rapidly, stayed longer and were more likely to complete the programme. However, the relative benefits arising from the family drug courts were at best a minor influence on child custody outcomes, and the study could not be sure that all relevant differences between the two sets of families had been accounted for.

An Effectiveness Bank hot topic  has explored  the issues involved in protecting children and offers one-click access to all Findings analyses relevant to child protection.

Source:   A randomized pilot study of the Engaging Moms Program for family drug court http://findings.org.uk/PHP/dl.php?file=Dakof_GA_2.txt Last revised 28 May 2015. First uploaded 20 May 2015

Two years ago, the Georgia Legislature tried but failed to legalize artisanal cannabidiol (CBD) oils for children suffering from epilepsy. Artisanal CBD oils are products marijuana growers are making in states that have legalized marijuana for medical use. No grower in these states has submitted its CBD product to FDA for approval as a safe or effective medicine.

In contrast, two pharmaceutical companies, GW Pharmaceuticals of Great Britain and Insys Therapeutics of the US, are developing pharmaceutical-grade CBD oils. GW’s version, Epidiolex, is in FDA Phase III clinical trials and Insys Therapeutics is about to undergo FDA testing. The Insys drug is 100% synthesized CBD, meaning it is an exact chemical duplicate of cannabidiol found in the marijuana plant but is made of pure chemicals to eliminate impurities and contaminants. Epidiolex is an extract of marijuana that has been purified to remove impurities and contaminants and is 98% CBD with trace amounts of THC and other cannabinoids. Both drugs must be tested in animals to ensure safety before companies can apply to FDA for permission to test their drugs in humans.

Artisanal CBD oils offer no such protections to patients. Random tests have shown that many contain THC, which can cause seizures, contaminants, and in some cases little to no CBD.

When the Georgia bill failed last year, Governor Nathan Deal formed a partnership with GW to conduct clinical trials of Epidiolex in Georgia as well as a statewide FDA expanded access program for children not able to enroll in the clinical trials. Both programs are up and running.

Despite this, the legislature came back with a bill this year to legalize artisanal CBD oils not only for childhood epilepsy but also for seven other diseases. Moreover, this bill permits possession of up to 20 ounces of CBD oil containing up to 5% THC. The bill passed and the governor signed it in April. It provides immunity from prosecution to those who possess CBD and calls for a special commission to recommend how best to grow marijuana, process it into CBD oils, and distribute it to patients.

Like the researchers whose work is published in JAMA today, specialists who treat epilepsy also are beginning to speak out. The NBC-TV affiliate in Atlanta interviewed several this week. Dr. Yong Park, who is helping run the clinical trials in Georgia, says doctors don’t know what the drug interactions are or what the side effects might be because they don’t have the evidence yet. Nor do they know how many pesticides artisanal CBD oils may contain nor what the long-term effects of daily exposure on the brain might be.

Under the new state law, when doctors sign a letter approving patients for the state registry that allows them to possess CBD oils, says Atlanta pediatrician Cynthia Wetmore, M.D., Ph.D., “they are required to keep track of the patients. But how do we know what dose to recommend? The oil patients have access to is not standardized. Each batch can be different. There’s a lot of variability in each batch. What side effects is it causing, if any? We have to report to the state on each patient, quarterly. It will be hard to know if it’s helping or hurting.”

Perhaps the most haunting concerns come from Dr. Amy Brooks-Kayal, a Colorado pediatric neurologist and president of the American Epilepsy Society. The Atlanta NBC-TV affiliate published her letter to a Pennsylvania representative who held hearings a few months ago on a similar bill in his state. In part, she writes:

The families and children coming to Colorado are receiving unregulated, highly variable artisanal preparations of cannabis oil prescribed, in most cases, by physicians with no training in pediatrics, neurology, or epilepsy. As a result, the epilepsy specialists in Colorado have been at the bedside of children having severe dystonic reactions and other movement disorders, developmental regression, intractable vomiting, and worsening seizures that can be so severe they have to put the child into a coma to get the seizures to stop. Because these products are unregulated, it is impossible to know if these dangerous adverse reactions are due to the CBD or because of contaminants found in these artisanal preparations. The Colorado team has also seen families who have gone into significant debt, paying hundreds of dollars a month for oils that do not appear to work for the vast majority. For all these reasons not a single pediatric neurologist in Colorado recommends the use of artisanal cannabis preparations. Possibly of most concern is that some families are now opting out of proven treatments, such as surgery or the ketogenic diet, or newer antiseizure medications because they have put all their hope in CBD oils.

All three epilepsy specialists want parents to know that giving artisanal CBD oils to children exposes them to risks that cannot be defined. They urge parents instead to enroll their children in clinical trials or expanded access programs that are testing pharmaceutical-grade CBD where doctors can monitor the children closely.

Read Atlanta story and full text of Dr. Brooks-Kayal’s letter here

Source:

http://us2.campaign-archive2.com/?u=2138d91b74dd79cbf58e302bf&id=71df2f126e&e=7ee41d6c49

The photos below show just how the marijuana business in the USA is targeting the youth market. Young children who would hesitate to smoke a joint are encouraged by the packaging to believe these products are safe.

All these ‘edibles’ are on sale openly. Look at the cynical way they use genuine products:

Kit Kat ok, Kif Kat not ok

Kellogs Pop Tarts ok,  Pot tarts not ok

Twix bars ok, Twigz not ok.

We are amazed that Nestle, Kellogs and Mars have not sued over this.

There have already been severe problems from young people overdosing on marijuana edibles. Those parents who do not want their children using cannabis must teach their family that marijuana edibles are just as harmful as smoking joints ( – perhaps more so because of the risk of overdosing) and they are not products to use like sweets.

Learn more by logging on to: https://learnaboutsam.org/

Students demonstrating better prosocial behavior were more likely to have graduated college, to be gainfully employed and to not have been arrested than students with lesser prosocial skills. Image: © iStock Photo Christopher Futcher

UNIVERSITY PARK, Pa. — Kindergarteners’ social-emotional skills are a significant predictor of their future education, employment and criminal activity, among other outcomes, according to Penn State researchers.

In a study spanning nearly 20 years, kindergarten teachers were surveyed on their students’ social competence. Once the kindergarteners reached their 20s, researchers followed up to see how the students were faring, socially and occupationally. Students demonstrating better prosocial behavior were more likely to have graduated college, to be gainfully employed and to not have been arrested than students with lesser prosocial skills.

“This research by itself doesn’t prove that higher social competence can lead to better outcomes later on,” said Damon Jones, senior research associate, Bennett Pierce Prevention Research Center. “But when combined with other research, it is clear that helping children develop these skills increases their chances of success in school, work and life.”

Jones and colleagues analyzed data collected from more than 700 students who were participating in the Fast Track Project, a study conducted by four universities — Penn State, Duke University, Vanderbilt University and the University of Washington. The Fast Track Project is a prevention program for children at high risk for long-term behavioral problems. The individuals studied for this research were part of the control group and did not receive any preventive services. Overall, the sample was representative of children living in lower socio-economic status neighborhoods.

Kindergarten teachers rated students on eight items using a five-point scale assessing how each child interacted socially with other children. Items included statements such as “is helpful to others,” “shares materials” and “resolves peer problems on own.”

The researchers compared the teachers’ assessments to the students’ outcomes in five areas during late adolescence through age 25 — including education and employment, public assistance, criminal activity, substance abuse, and mental health. Jones and colleagues report their results online and in a future issue of the American Journal of Public Health.

Overall, the researchers found that a higher rating for social competency as a kindergartener was significantly associated with all five of the outcome domains studied. For every one-point increase in a student’s social competency score, he or she was twice as likely to graduate from college and 46 percent more likely to have a full-time job by the age of 25.

For every one-point decrease in the child’s score, he or she had a 67 percent higher chance of having been arrested and an 82 percent higher chance of being in or on a waiting list for public housing at age 25. The study controlled for the effects of poverty, race, having teenage parents, family stress and neighborhood crime, and for the children’s aggression and reading levels in kindergarten.

“The good news is that social and emotional skills can improve, and this shows that we can inexpensively and efficiently measure these competencies at an early age,” said Jones. Evidence from numerous intervention studies indicate that social and emotional learning skills can be improved throughout childhood and adolescence.

Jones and colleagues plan to continue this work in order to further understand how social competency can predict future life outcomes, and further understand intermediary developmental processes whereby early social-emotional skills influence long-term adult outcomes.

Jones is also a research assistant professor of health and human development at Penn State. Mark Greenberg, the Bennett Endowed Chair in Prevention Research, founding director of the Bennett Pierce Prevention Research Center and professor of human development and family studies; and Max Crowley, assistant professor of human development and family studies, both at Penn State, also worked on this research.

The Robert Wood Johnson Foundation supported this research. The Fast Track Study also received grant support from the National Institute of Mental Health, the National Institute on Drug Abuse, the U.S. Department of Education and the Center for Substance Abuse Prevention.

Source: http://news.psu.edu/

Marijuana Use: Detrimental to Youth

ABSTRACT: Although increasing legalization of marijuana has contributed to the growing belief that marijuana is harmless, research documents the risks of its use by youth are grave. Marijuana is addicting, has adverse effects upon the adolescent brain, is a risk for both cardio-respiratory disease and testicular cancer, and is associated with both psychiatric illness and negative social outcomes. Evidence indicates limited legalization of marijuana has already raised rates of unintended marijuana exposure among young children, and may increase adolescent use. Therefore, the American College of Pediatricians supports legislation that continues to restrict the availability of marijuana except in the context of well controlled scientific studies which demonstrate medicinal benefit together with evidence-based guidelines for optimal routes of delivery and dosing for specific medical conditions.

Introduction

Federal Law has prohibited the manufacture, sale, and distribution of marijuana for more than 70 years. However, with the discovery of potential medicinal properties of marijuana and the increasing misperception that the drug is harmless, there have arisen increased efforts to achieve its broad legalization despite persistent problems of abuse. Medical use of marijuana has prompted many states to establish programs for sale of medically-prescribed marijuana. As public perception of marijuana’s safety has grown, some states have also passed voter-approved referenda legalizing recreational use of marijuana by adults. The result has been the same: limited legalization has led to greater availability of marijuana to youth.

How is Marijuana Used?

Whether used licitly or illicitly, marijuana is smoked or ingested. It may be smoked in hand-rolled cigarettes (joints), pipes or water pipes (bongs), and cigars that have been refilled with a mixture of marijuana and tobacco (blunts). Marijuana emits a distinctive pungent usually sweet-and-sour odour when it is smoked. Marijuana is not so easily detectable, however, when ingested in candy, other foods or as a tea.

 

Has Legalization Escalated Youth Exposure to Marijuana?

There is evidence legalization of marijuana limited to medical dispensaries and/or adult recreational use has led to increased unintended exposure to marijuana among young children. By 2011, rates of poison center calls for accidental paediatric marijuana ingestion more than tripled in states that decriminalized marijuana before 2005. In states which passed legislation between 2005 and 2011 call rates increased nearly 11.5% per year. There was no similar increase in states that had not decriminalized marijuana as of December 31, 2011. Additionally, exposures in decriminalized states where marijuana use was legalized were more likely than those in non-legal states to present with moderate to severe symptoms requiring admission to a paediatric intensive care unit. The median age of children involved was 18-24 months.1

Marijuana use by adolescents has grown steadily as more states enact various decriminalization laws.2 According to CDC data, more teens now smoke marijuana than cigarettes.3 It is unclear, however, whether this trend indicates a causal relationship or mere correlation. There is some evidence legalization may encourage more youth to experiment with the drug. A national study of 6116 high school seniors, prior to legalization of recreational use in any state, found 10% of nonusers said they would try marijuana if the drug were legal in their state. Significantly, this included large subgroups of students normally at low risk for drug experimentation, including non-cigarette smokers, those with strong religious affiliation, and those with peers who frown upon drug use. Among high school seniors already using marijuana, 18% said they would use more under legalization.

There is also evidence of medical marijuana diversion having a significant impact upon adolescents. For example, researchers in Colorado found that approximately 74% of adolescents in substance abuse treatment had used someone else’s medical marijuana. After adjusting for sex, race and ethnicity, those who used medical marijuana had an earlier age of regular marijuana use, and more marijuana abuse and dependence symptoms than those who did not use medical marijuana.4-5 Conclusions from this study may not apply to adolescents as a whole due to the select population surveyed. There are broader adolescent population studies suggesting no significant increase in use due to enactment of medical marijuana laws.6-10 These authors, however, caution that their results may not be definitive for five reasons: not all states with medical marijuana laws are represented in the various studies; the studies rely upon survey data from a voluntary survey (the Youth Risk Behavior Survey) which has the potential for reporting bias; there are gaps in the annual youth risk behavior data; the primary outcome measure was obtained from a single survey item; and the research is not long-term relative to when medical marijuana laws were implemented. Consequently, while all reported their data did not find medical marijuana laws to significantly increase teen use, they also advised continued long-term observation and research.

 

Is Marijuana Medicine?

A recent article in the Journal of the American Medical Association noted there is very little scientific evidence to support the use of medical marijuana. Authors Samuel Wilkinson and Deepak D’Souza explain that medical marijuana is considerably different from all other prescription medications in that “evidence supporting its efficacy varies substantially and in general falls short of the standards required for approval of other drugs by the US Food and Drug Administration (FDA).”11 The FDA requires carefully conducted studies consisting of hundreds to thousands of patients in order to accurately assess the benefits and risks of a potential medication.

Although some studies suggest marijuana may palliate chemotherapy-induced vomiting, cachexia in HIV/AIDS patients, spasticity associated with multiple sclerosis, and neuropathic pain, there is no significant evidence marijuana is superior to FDA approved medications currently available to treat these conditions. Additionally, support for use of marijuana in other conditions, including post-traumatic stress disorder, Crohn’s disease and Alzheimer’s, is not scientific, relying on emotion-laden anecdotes instead of adequately powered, double-blind, placebo-controlled randomized clinical trials.11

Also, to be considered a legitimate medicine, a substance must have well-defined and measurable ingredients that are consistent from one unit (such as a pill or injection) to the next. This consistency allows researchers to determine optimal dosing and frequency. Drs. Samuel Wilkinson and Deepak D’Souza state:

Prescription drugs are produced according to exacting standards to ensure uniformity and purity of active constituents … Because regulatory standards of the production process vary by state, the composition, purity, and concentration of the active constituents of marijuana are also likely to vary. This is especially problematic because unlike most other prescription medications that are single active compounds, marijuana contains more than 100 cannabinoids, terpenoids, and flavonoids that produce individual, interactive, and entourage effects.”11

 As a consequence, there are no dosing guidelines for marijuana for any of the conditions it has been approved to treat. And finally, there is no scientific evidence that the potential healthful effects of marijuana outweigh its documented adverse effects.11 Sound ethics demands that physicians “First do no harm.” This is why a dozen national health organizations, including the College, presently oppose further legalization of marijuana for medicinal purposes.12 If and when rigorous research delineates marijuana’s true benefits relative to its hazards, compares its efficacy with current medications on the market, determines its optimal routes of delivery and dosing, and standardizes its production and dispensing (to match that of schedule II medications like narcotics and opioids), then medical opposition will dissipate.

 

The Extent of Marijuana Abuse

In the United States, marijuana is the most frequently used illicit drug,13-14 with 23.9 million of those at least 12 years old having used an illegal drug within the past month in 2012.15 The National Institute on Drug Abuse (NIDA)-funded 2013 Monitoring the Future study of the year 2012 showed that 12.7 percent of 8th graders, 29.8 percent of 10th graders, and 36.4 percent of 12th graders had used marijuana at least once in the year prior to being surveyed. They also found that 7, 18 and 22.7 percent respectively for these groups used marijuana in the past month.13

Figure 1. Long-Term Trends in Annual Marijuana Use by Grade14

After a period of decline in the last decade, marijuana use has generally increased among young people since 2007, corresponding with both its increased availability through limited legalization and a diminishing perception of the drug’s risks. The number of current (past month) users aged 12 and up increased from 14.5 to 18.9 million.15

In 2010, 7.3 percent of all persons admitted to publicly funded treatment facilities were aged 12-17. Marijuana is the leading illicit substance mentioned in adolescent emergency department admissions and autopsy reports, and is considered one of the major contributing factors leading to violent deaths and accidents among adolescents.16

Figure 2.  Emergency Department Visits by Type of Substance Abuse16

 

Such data indicate that marijuana use in adolescents is a major and growing problem. Given the widespread availability and abuse of marijuana, and its increasing decriminalization, it is important to examine the adverse clinical consequences of marijuana use.

Marijuana and Addiction

Marijuana is addictive. While approximately 9 percent of users overall become addicted to marijuana, about 17 percent of those who start during adolescence and 25-50 percent of daily users become addicted. Thus, many of the nearly 6.5 percent of high school seniors who report smoking marijuana daily or almost daily are well on their way to addiction, if not already addicted.13 In fact, between 70-72% of 12-17 year olds who enter drug treatment programs, do so primarily because of marijuana addiction.18,13

Long-term marijuana users trying to quit report various withdrawal symptoms including irritability, sleeplessness, decreased appetite, anxiety, and drug craving, all of which can make it difficult to remain abstinent.  These withdrawal symptoms can begin within the first 24 hours following cessation, peak at two to three days, and subside within one or two weeks follow drug cessation. Behavioral interventions, including cognitive-behavioral therapy and motivational incentives (i.e., providing vouchers for goods or services to patients who remain abstinent) have proven to be effective in treating marijuana addiction.19 Although no medications are currently available, recent discoveries about the workings of the endocannabinoid system offer promise for the development of medications to ease withdrawal, block the intoxicating effects of marijuana, and prevent relapse.20

Is Marijuana a Gateway Leading to the Abuse of Other Illicit Drugs?

An additional danger associated with marijuana use observed in adolescents is a sequential pattern of involvement in other legal and illegal drugs. Marijuana is frequently a stepping stone that bridges the gap between cigarette and alcohol use and the use of other more powerful and dangerous substances like cocaine and heroin. This stage-like progression of substance abuse, known as the gateway phenomenon, is common among youth from all socioeconomic and racial backgrounds.19, 21 Additionally, marijuana is often intentionally used with other substances, including alcohol or crack cocaine, to magnify its effects. Phencyclidine (PCP), formaldehyde, crack cocaine, and codeine cough syrup are also often mixed with marijuana without the user’s knowledge.21

 

Other Effects of Marijuana on the Brain

The main active chemical in marijuana is delta-9-tetrahydrocannabinol (THC). When marijuana is smoked, THC rapidly passes from the lungs into the bloodstream, which carries the chemical to the brain and other organs throughout the body. It is absorbed more slowly when ingested in food or drink.13 In all cases, however, THC acts upon specific molecular targets on brain cells, called cannabinoid receptors. These receptors are ordinarily activated by chemicals similar to THC called endocannabinoids, such as anandamide. These receptors are naturally occurring in the body and are part of a neural communication network (the endocannabinoid system) that plays an important role in normal brain development and function. The highest density of cannabinoid receptors is found in parts of the brain that influence pleasure, memory, thinking, concentration, sensory and time perception, and coordinated movement. Marijuana over activates the endocannabinoid system, causing the high and other effects that users experience. These effects include distorted perceptions, psychotic symptoms, difficulty with thinking and problem solving, disrupted learning and memory, and impaired reaction time, attention span, judgment, balance and coordination.21 Chronic exposure to THC may also hasten the age-related loss of nerve cells.22

 Numerous mechanisms have been postulated to link cannabis use, attentional deficits, psychotic symptoms, and neural desynchronization.23 The hippocampus, a component of the brain’s limbic system, is necessary for memory, learning, and integrating sensory experiences with emotions and motivations. THC suppresses neurons in the information-processing system of the hippocampus, thus learned behaviors, dependent on the hippocampus, also deteriorate.24 Brain MRI studies now report that in young recreational marijuana users, structural abnormalities in gray matter density, volume, and shape occur in areas of the brain associated with drug craving and dependence. There also was significant abnormality measures associated with increasing drug use behavior. In addition to the regions of the nucleus accumbens and amygdala, the whole-brain gray matter density analysis revealed other brain regions that showed reduced density in marijuana users compared with control participants, including several regions in the prefrontal cortex: right/left frontal pole, right dorsolateral prefrontal cortex, and right middle frontal gyrus (although another small region in the right middle frontal gyrus showed higher gray matter density in marijuana users). Countless studies have also shown that prefrontal cortex dysfunction is involved with decision-making abnormalities and functional MRI and magnetic resonance spectroscopy studies have shown that cannabis use may affect the function of this region.25 Brain imaging with MRI was used to map areas of working memory in the brain and showed similar findings in normal and schizophrenic subjects who did not use marijuana, but decreases in the size of the working memory areas of the striatum and thalamus for those who had a history of cannabis use, that was more marked in those who used marijuana at a younger age and in users with schizophrenia.26

 In chronic adolescent users, marijuana’s adverse impact on learning and memory persists long after the acute effects of the drug wear off. A major study published in 2012 in Proceedings of the National Academy of Sciences provides objective evidence that marijuana is harmful to the adolescent brain. As part of this large-scale study of health and development, researchers in New Zealand administered IQ tests to over 1,000 individuals at age 13 (born in 1972 and 1973) and assessed their patterns of cannabis use at several points as they aged. Participants were again IQ tested at age 38, and their two scores were compared as a function of their marijuana use.

The results were striking: Participants who used cannabis heavily in their teens and continued through adulthood showed a significant drop in IQ between the ages of 13 and 38—an average of eight points for those who met criteria for cannabis dependence. Those who started using marijuana regularly or heavily after age 18 showed minor declines. By comparison, those who never used marijuana showed no declines in IQ.27 This is the first prospective study to test young people before their first use of marijuana and again after long-term use (as much as 20+ years later) thereby ruling out a pre-existing difference in IQ. This means the finding of a significant mental decline among those who used marijuana heavily before age 18, even after they quit taking the drug, is consistent with the theory that drug use during adolescence—when the brain is still rewiring, pruning, and organizing itself—has long-lasting negative effects on the brain.

Other studies have also shown a link between prolonged marijuana use and cognitive or neural impairment. A recent report in Brain, for example, reveals neural-connectivity impairment in some brain regions following prolonged cannabis use initiated in adolescence or young adulthood.28

 

Effects on Activities of Daily Living

Consistent with marijuana’s impact upon the brain, research demonstrates marijuana has the potential to cause difficulties in daily life and/or worsen a person’s existing problems. Heavy marijuana users generally report lower life satisfaction, reduced mental and physical health, more relationship problems, and less academic and career success compared to their peers who come from similar backgrounds. Marijuana use is also associated with a higher likelihood of dropping out of school, workplace tardiness and absence, more accidents on the job with concomitant workman compensation claims, and increased job turnover.29-30

A 2014 study combined the data of 3 investigations from Australia and New Zealand which compared a series of outcome measures of young adults according to their marijuana use at age 17. The researchers found a significant dose-response effect for each of these.  After adjusting for co-variables, compared to those who never used cannabis prior to age 17 (OR 1.0), the odds of graduating from high school by age 25 dropped to 0.78 (95% CI,0.67-0.90) for those who used cannabis less than monthly to 0.61 (95% CI,0.45-0.81) for those using it monthly or more to 0.47 (95% CI,0.30-0.73) for those using it weekly or more to 0.37 (95% CI,0.20-0.66) for daily users.  The decrease in attaining a university degree was almost identical.  The odds of dependence on cannabis between the ages of 17 and 25 rose progressively from 2.06 (95% CI,1.75-2.42) for less than monthly users to 17.95 (95% CI,9.44-34.12) for daily users, and the odds of other illicit drug use between the ages of 23-25 rose from 1.67 (95% CI,1.45-1.92) for less than monthly users to 7.80 (95% CI,4.46-13.63) for those who were daily users prior to age 17.  The odds of a making a suicide attempt between the ages of 17 and 25 were increased from 1.62 (95% CI,1.19-2.19) for less than monthly users to 6.83 (95% CI,2.04-22.9) for daily users.  While unadjusted odds ratios were progressively higher for progressively higher amounts of cannabis used before age 17 for both depression (between ages 17-25) and for welfare dependence (at ages 27-30 depending on the study), these differences were no longer significant after adjusting for co-variables.31Although the greatest harm was among heavier users, it is most concerning that even less than monthly usage prior to age 17 was associated with a significantly lower educational achievement, and significantly higher rates of drug dependence and suicide attempts.

 Marijuana and Mental Illness

Figure 3.  Mood and Anxiety Disorders Among Users and Non-Users of Marijuana32

 A number of studies have shown an association between chronic marijuana use and mental illness. People who are dependent on marijuana frequently have other comorbid mental disorders including but not limited to anxiety, depression, suicidal ideation, and personality disturbances, including amotivation and failure to engage in activities that are typically rewarding (see figure 3).13 Marijuana use is associated with a 7-fold increased risk of depression (OR 7.10, 95% CI,4.39-11.73) and a 5-fold increased risk of suicidal ideation (OR 5.38, 95% CI,3.31-8.73) when used alone, and with a 9-fold increased risk of depression (OR 9.15, 95% CI,4.58-18.29) and nearly 9 fold increased risk of suicidal ideation when marijuana plus other drugs are involved (OR 8.74, 95% CI 4.29-17.79).17 Daily marijuana use in young women has been associated with a five-fold increase in depression and anxiety.33

Population studies also reveal an association between cannabis use and increased risk of schizophrenia. In the short term, high doses of marijuana can produce a temporary psychotic reaction involving hallucinations and paranoia. There is also sufficient data indicating that chronic marijuana use may trigger the onset or relapse of schizophrenia in people predisposed to it, perhaps also intensifying their symptoms .13,34,32A series of large prospective studies showed a link between marijuana use and the later development of psychosis with genetic variables, the amount of drug used, and the younger the age at which use began increasing the risk of occurrence.13 Although it is possible that pre-existing mental illness may lead some individuals to self-medicate with (abuse) marijuana and other illicit drugs, further prospective studies similar to those examining psychosis, will more firmly establish marijuana as a causative factor for other forms of mental illness.

 Marijuana and Driving

Marijuana contributes to accidents while driving due to its significant impairment of judgment and motor coordination. Data from several studies was analyzed and documented that use of marijuana more than doubles a driver’s risk of involvement in an accident.13 Because they impede different driving functions, the combination of even low levels of marijuana and alcohol is worse than either substance alone.35 Studies have shown a statistically significant increase in non-alcohol drugs detected in fatally injured drivers in the past decade. The most commonly detected non-alcohol drug was cannabinol, the prevalence of which increased from 4.2% in 1999 to 12.2% in 2010 (Z = -13.63, P < 0.0001).  The increase in the prevalence of non-alcohol drugs was observed in all age groups and in both sexes. In this study, increases in the prevalence of narcotics and cannabinol detected in fatally injured drivers were particularly apparent.36

 Other Health Effects of Marijuana

Since marijuana contains many of the same compounds as tobacco, it has the same adverse effects on the respiratory system when smoked as tobacco. These include chronic cough, respiratory infections, and bronchitis.19 In the longer term emphysema and lung cancer are also among its effects.21In fact, smoking marijuana is more harmful than tobacco for two reasons: first, because it contains more tar and carcinogens than tobacco, and secondly, because marijuana smokers tend to inhale more deeply and for a longer period of time as compared to tobacco smokers.

Marijuana use also has a variety of adverse, short- and long-term effects, especially on the cardiopulmonary system. Marijuana raises the heart rate by 20-100 percent shortly after smoking; this effect can last up to three hours. In one study, it was estimated that marijuana users had a 4.8-fold increase in the risk of heart attack in the first hour after smoking the drug. This elevated risk may be due to increased heart rate as well as the effects of marijuana on heart rhythms, causing palpitations and arrhythmias. This risk may be greater in older individuals or in those with cardiac vulnerabilities. Marijuana use has been found to increase blood pressure and heart rate and to decrease the oxygen-carrying capacity of the blood.37

 Chronic smoking of marijuana and its active chemical THC has consistently been shown to increase the risk of developing testicular cancer, in particular a more aggressive form of the disease. One study compared 369 Seattle-area men aged 18-44 with testicular cancer, to 979 men in the same age bracket without the disease. The researchers found that current marijuana users were 1.7 times more likely to develop testicular cancer than nonusers, and that the younger the age of initiation (below 18) and the heavier the use, the greater the risk of developing testicular cancer.38,39,40 A similar study of 455 men in Los Angeles found that men with testicular germ cell tumors were twice as likely to have used marijuana as men without these tumors.41 THC can also cause endocrine disruption resulting in gynecomastia, decreased sperm count, and impotence.42

 

Effects of prenatal exposure to marijuana

The risk of using marijuana during pregnancy is unrecognized by the general public, but infants and children exposed prenatally to marijuana have a higher incidence of neurobehavioral problems. THC and other compounds in marijuana mimic the human brain’s cannabinoid-like chemicals, thus prenatal marijuana exposure may alter the developing endocannabinoid system in the fetal brain, which may result in attention deficit, difficulty with problem solving, and poorer memory.13 Evidence especially suggests an association between prenatal marijuana exposure and impaired executive functioning skills beyond the age of three. Specifically, children with a history of exposure are found to have an increased rate of impulsivity, attention deficits, and difficulty solving problems requiring the integration and manipulation of basic visuoperceptual skills.43

 

Rising Potency and Contaminants

The potency of marijuana has been increasing for decades, with THC concentrations rising from 4% in the 1980s to 14.5% in 2012 in samples confiscated by police.  Some strains now contain as much as 30% THC.19 For a new user, this may mean exposure to higher concentrations of THC, with a greater chance of an adverse or unpredictable reaction. Increases in potency may account for the rise in emergency department visits involving marijuana use. For experienced users, it may mean a greater risk for addiction if they are exposing themselves to high doses on a regular basis. However, the full range of consequences associated with marijuana’s higher potency is not well understood, nor is it known whether experienced marijuana users adjust for the increase in potency by using less. Since the legalization in Colorado, one certified lab there has reported that much of the marijuana they have studied and tested has been found to be laced with heavy metals, pesticides, fungus and bacteria.44

 

Health Risks Underestimated

 Health risks associated with marijuana use are often underestimated by adolescents, their parents, and health professionals. As explained above, there are newer, stronger forms of marijuana available than that which existed in 1960; current forms of marijuana are known to be three to five times more potent. Parents underestimate the availability of marijuana to teens, the extent of their use of the drug, and the risks associated with its use. In a 1995 survey, the Hazelden Foundation found that only 40 percent of parents advised their teenagers not to use marijuana, 20 percent emphasized its illegal status, and 19 percent communicated to their teenagers that it is addictive.45

 

Parental Monitoring Important

 Research shows that appropriate parental monitoring can reduce drug use, even among those adolescents who may be prone to marijuana use, such as those with conduct, anxiety, or affective mood disorders.45

Columbia University’s National Center on Addiction and Substance Abuse (CASA) found that adolescents were much less likely to use marijuana if their parents stated their disapproval. “Parents who do not want their kids getting drunk and using drugs should begin by sending a strong message to their kids about the importance of avoiding alcohol. Our survey results this year show how important it is for teens to get a clear anti-use message from their parents, especially from Dad. Teens who get drunk monthly are 18 times more likely to report marijuana use than teens who do not drink; those who believe their father is okay with them drinking are two and a half times more likely to get drunk in a typical month.  Therefore, parents who do not want their kids getting drunk and using drugs should begin by sending a strong message to their children about the importance of avoiding alcohol.”45

 

In 2011, past month use of illicit drugs, cigarettes, and binge alcohol use were lower among youth aged 12 to 17 who reported that their parents always or sometimes engaged in monitoring behaviors compared to youths whose parents seldom or never engaged in monitoring behaviors. The rate of past month use of any illicit drug was 8.2 percent for youths whose parents always or sometimes helped with homework compared with 18.7 percent among youth who indicated that their parents seldom or never helped.

Columbia Center for Alcohol and Substance Abuse found that teens who have frequent family dinners (five to seven per week) were less likely to have used marijuana.46

Compared to teens who had infrequent family dinners (2 or fewer per week), teens who had frequent family dinners were almost 1.5 times likelier to have said they had an excellent relationship with their mother and their father. The report also found that compared to teens who said they had an excellent relationship with their fathers, teens that had a less than very good relationship with their father were:

o    Almost 4 times likelier to have used marijuana

o    Twice as likely to have used alcohol

o    2.5 times as likely to have used tobacco

 

Compared to teens who said they had an excellent relationship with their mothers, teens who had a less than very good relationship with their mother were:

o    Almost 3 times likelier to have used marijuana

o    2.5 times as likely to have used alcohol

o    2.5 times likelier to have used tobacco

 

Consequently, the College encourages parents to take advantage of the “family table,” and to become involved in drug abuse prevention programs in the community or in the child’s school in order to minimize the risk of their children experimenting with drug use.

In Conclusion

In summary, marijuana use is harmful to children and adolescents.  For this reason, the American College of Pediatricians opposes its legalization for recreational use and urges extreme caution in legalizing it for medicinal use.  Likewise, the American Academy of Child and Adolescent Psychiatry (AACAP) recently offered their own policy statement opposing efforts to legalize marijuana. They similarly pointed out that “marijuana’s deleterious effects on adolescent brain development, cognition, and social functioning may have immediate and long-term implications, including increased risk of motor vehicle accidents, sexual victimization, academic failure, lasting decline in intelligence measures, psychopathology, addiction, and psychosocial and occupational impairment.”

Thus the AACAP (a) opposes efforts to legalize marijuana, (b) supports initiatives to increase awareness of marijuana’s harmful effects on adolescents, (c) supports improved access to evidence-based treatment, rather than emphasis on criminal charges, for adolescents with cannabis use disorder, and (d) supports careful monitoring of the effects of marijuana-related policy changes on child and adolescent mental health.47  The College agrees with this position on marijuana.

 

The College urges parents to do all they can to oppose the legalization of marijuana, such as working with elected officials against the drug’s legalization and scrutinizing a candidate’s positions on this important children’s issue when making voting decisions. The College encourages legislators to consider the establishment and generous funding of more facilities to treat marijuana addiction. Children look to their parents for help and guidance in working out problems and in making decisions, including the decision to not use drugs. Therefore, parents should be role models, and not use marijuana or other illicit drugs. Finally, these reports strikingly emphasize the need for parents to recognize and discuss these serious health consequences of marijuana use with their children and adolescents. They also point to the requirement for medical experts and legislators to seriously discuss and review these observations prior to promoting any state or federal effort considering legalization.

For more information on this topic, the National Clearinghouse for Alcohol and Drug Information (NCADI) offers an extensive collection of publications, videotapes, and educational materials to help parents talk to their children about drug use. For more information on marijuana and other drugs, contact: National Clearinghouse for Alcohol and Drug Information, P. O. Box 2345, Rockville, MD 20847; 1-800-729-6686. Additional helpful information is provided at the following websites: www.drugabuse.gov, www.marijuana-info.org, and www.teens.drugabuse.gov.

Primary Author: Donald Hagler, MD, FCP

Original: January 2007

Revised March 2015

Revised September 2015

 

ADDENDUM added September 2015:

The Legalization of Marijuana in Colorado: The Impact”48 is a compilation of data by the Rocky Mountain High Intensity Drug Trafficking Area that analyzes the effects of marijuana legalization in the state. This third volume allows readers to compare and contrast statistics observed from 2006 – 2009 during Colorado’s early medical marijuana era with those from 2009 to 2013 as medical marijuana commercialization grew, and also with those from the current legalized recreational marijuana era from 2013 to the present. The statistics reveal that between 2013 and 2014 there was a 45% increase in marijuana-associated impaired driving, a 32% increase in marijuana-related motor vehicle deaths (with a 92% increase from 2010 to 2014), as well as 29% and 38% increases in emergency room visits and hospital admissions secondary to marijuana use. By 2013, marijuana use in Colorado was 55% above the national average among teens and young adults, and 86% higher among those over age 25. Diversion of marijuana from Colorado to other states has also increased several fold. This new data further supports the College Position Statement above emphasizing concerns that marijuana legalization will result in increased adolescent usage, addiction and its associated risks for them.

 A downloadable web source for parents can be found at this link, Marijuana Talk Kit, from Partnership for Drug-free Kids.

The American College of Pediatricians is a national medical association of licensed physicians and healthcare professionals who specialize in the care of infants, children, and adolescents. The mission of the College is to enable all children to reach their optimal physical and emotional health and well-being.

A PDF copy of this statement is available here: Marijuana Use Detrimental to Youth

 

Source: http://www.acpeds.org/marijuana-use-detrimental-to-youth  Sept.2015

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9. Choo EK, Benz M, Zaller N, Warren O, Rising KL, McConnell KJ. TheImpact of State Medical Marijuana Legislation on Adolescent Marijuana Use. Journal of Adolescent Health, 2014.

 

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12. The American Medical Association, American Society of Addiction Medicine, National Institute on Drug Abuse of the NIH, American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, American Academy of Ophthalmology, American Glaucoma Society, National Multiple Sclerosis Society, National Comprehensive Cancer Network, American Cancer Society, and the Narcotics Enforcement Officers Association.

13. Drug Facts. National Institute on Drug Abuse. www.drugabuse.gov/drugs-abuse/marijuana. Published December 2012.

 

14. What is the Scope of Marijuana Use in the United States? National Institute on Drug Abuse. http://www.drugabuse.gov/publications/research-reports/marijuana/what-scope-marijuana-use-in-united-states. Published July 2012.

 

15.National Survey on Drug Use and Health. Substance Abuse and Mental Health Administration.http://www.samhsa.gov/data/NSDUH/2012SummNatFindDetTables/NationalFindings/NSDUHresults2012.htm#ch2.13Published 2014.

 

16. National Survey on Drug Use and Health. Center for Behavioral Health Statistics and Quality. http://www.samhsa.gov/data/2K13/CBHSQ128/sr128-typical-day-adolescents-2013.htm. Published 2013.

 

17. Hallfors DD, Waller MW, Ford CA, Halpern CT, Brodeish PH, and Iritani B. Adolescent depression and suicide risk: Association with sex and drug behavior. American Journal of Preventive MedicineVolume 27, Issue 3, October 2004, Pages 224–231, Tables 3 and 4.

18. Hall W, Degenhardt L. Adverse health effects of non-medical cannabis use.Lancet. 2009 Oct 17;374(9698):1383-91.

 

19. Want to know more? Some FAQs about marijuana. National Institute on Drug Abuse. http://www.drugabuse.gov/publications/marijuana-facts-parents-need-to-know/want-to-know-more-some-faqs-about-marijuana. Updated March 2014. Accessed July 10, 2012.

 

20. Available treatments for marijuana use disorders. National Institute on Drug Abuse. http://www.drugabuse.gov/publications/research-reports/marijuana/available-treatments-marijuana-use-disorders. Updated March 2014.

 

21. Nistler C, Hodgson H, Nobrega FT, Hodgson CJ, Wheatley R, Solberg G. Marijuana and adolescents. Minn Med. 2006 Sept:49-51.

22. How Does Marijuana Affect Your Brain and Body? National Institute on Drug Abuse. http://www.drugabuse.gov/publications/research-reports/marijuana/how-does-marijuana-use-affect-your-brain-body. Accessed September 23, 2014. Brain. 2012 Jul;135(7):2245-55. Accessed June 4, 2012. http://www.ncbi.nlm.nih.gov/pubmed?term=effect of long-term cannabis use and zalesky.

 

23. Ashton CH. Pharmacology and effects of cannabis: A brief review. Brit Jrnl Psych. 2001;178: 101-106.

 

24.   Iowa Department of Public Safety. Division of Narcotics Enforcement.http://www.dps.state.ia.us/DNE/marijuana.shtml. Accessed September 23, 2014.

 

25. Gilman JM, Kuster JK, Lee S, et al. Cannabis use is quantitatively associated with nucleus accumbens and amygdala abnormalities in young adult recreational users. J Neurosci. 2014;34(16): 5529-5538.

 

26. Smith MJ, Cobia DJ, Wang L, et al. Cannabis-related working memory deficits and associated subcortical morphological differences in healthy individuals and schizophrenia subjects. Schizophr Bull. 2014 Mar;40(2):287-99.

 

27. Meier MH, Caspi A, Harrington H, et al. Persistent cannabis users show neuropsychological decline from childhood to midlife. ProcNatlAcadScie 2012 Oct 2;109(40):E2657-64.Available at http://www.ncbi.nlm.nih.gov/pubmed?term=persistent%20cannabis%20users%20and%20meier. Accessed on August 27, 2012.

 

28. Zalesky A, Solowji N, Yucel M, et al. Effect of long-term cannabis use on axonal fibre connectivity. Brain. 2012 Jul;135(7):2245-55. Accessed June 4, 2012. http://www.ncbi.nlm.nih.gov/pubmed?term=effect of long-term cannabis use and zalesky.

 

29. How does marijuana use affect school, work, and social life? National Institute of Drug Abuse. http://www.drugabuse.gov/publications/research-reports/marijuana/how-does-marijuana-use-affect-school-work-social-life. Published July 2012.

30. Polen, MR, Sidney, S, Tekawa, IS, Sadler, M, Friedman, GD. Health care use by frequent marijuana smokers who do not smoke tobacco. West J Med. 1993;158(6):596–601.

 

31. Silins E, Horwood LJ, Patton GC, Ferguson DM, Olsson CM, Hutchinson DM, et.al. Young adult sequelae of adolescent cannabis use: an integrative analysis The Lancet Psychiatry, Volume 1, Issue 4, Pages 286 – 293, September 2014 http://www.thelancet.com/journals/lancet/article/PIIS2215036614703074/table?tableid=tbl2&tableidtype=table_id&sectionType=red.

32. Topics in brief: Marijuana. National Institute on Drug Abuse.http://www.drugabuse.gov/publications/topics-in-brief/marijuana. Published December 2011. Accessed September 22, 2014.

 

33. Patton, G.C., Coffey, C., Carlin, J.B., Degenhardt, L., Lynskey, M. & Hall, W. “Cannabis Use and Mental Health in Young People: Cohort Study,” British Medical Journal 325, no. 7374 (November 23, 2002):1195-8.

 

34. Caspi, A, Moffitt, TE, Cannon, M, et al. Moderation of the effect of adolescent-onset cannabis use on adult psychosis by a functional polymorphism in the catechol-Omethyltransferase gene: Longitudinal evidence of a gene X environment interaction. Biol Psych. 2005;57(10):1117–1127. Cited inhttp://www.drugabuse.gov/publications/research-reports/marijuana/there-link-between-marijuana-use-mental-illness.

 

35.Sewell RA, Poling J, and Sofuoglu M. The effect of cannabis compared with alcohol on driving. Am J Addict. 2009; 18(3): 185-193.http://222.ncbi.nlm.nih.gov/pmc/articles/PMC2722956/

 

36. Brady J, Li G. Trends in alcohol and other drugs detected in fatally injured drivers in the United States, 1999-2010. Am J Epidemio. (2014); 10.1093/aje/kwt327.

 

37. Mittleman MA, Lewis RA, Maclure M. Triggering myocardial infarction by marijuana. Circ. 2001;103(23): 2805-9.

 

38. Daling JR, Doody DR, Sun X. Association of marijuana use and the incidence of testicular germ cell tumors. Can. 2009; 115: 1215–1223.

39. Simon S. Study links marijuana use to testicular cancer. American Cancer Society. http://www.cancer.org/cancer/news/study-links-marijuana-use-to-testicular-cancer. Published September 12, 2012. Accessed March 28, 2013.

40. Meeks JJ, Sheinfeld J, Eggener SE. Environmental toxicology of testicular cancer. UrolOnc: SemOrigInv. 2012 Mar/Apr; 30(2): 212-215.

 

41. Lacson JCA, Carroll JD, Tuazon E, Castelao EJ, Bernstein L, Cortessis VK. Population-Based Case-Control Study of Recreational Drug Use and Testis Cancer Risk Confirms an Association Between Marijuana Use and Nonseminoma Risk. Cancer. 2012 September:5374-5383.http://onlinelibrary.wiley.com/doi/10.1002/cncr.27554/pdf. Accessed September 30, 2014.

 

42. The Encyclopedia of Psychoactive Drugs: Marijuana – Its Effects on Mind and Body; Hermes, Galperin, Chelsea House Publishers; 1992.Fried PA, Smith AM. A literature review of the consequences of prenatal marijuana exposure. An emerging theme of a deficiency in aspects of executive function.NeurotoxicolTeratol. 2001;23(1):1-11.

 

43. Fried PA, Smith AM. A literature review of the consequences of prenatal marijuana exposure. An emerging theme of a deficiency in aspects of executive function. NeurotoxicolTeratol. 2001;23(1):1-11.

 

44. Smithsonian.com, Modern Marijuana is Often Laced with Heavy Metals and Fungus. Published March 2015. http://www.smithsonianmag.com/science-nature/modern-marijuana-more-potent-often-laced-heavy-metals-and-fungus-180954696/?no-ist. Accessed March 26, 2015.

 

45. National Survey of American Attitudes on Substance Abuse XIV: Teens and Parents. Columbia Center for Alcohol & Substance Abuse. http://www.casacolumbia.org/addiction-research/reports/national-survey-american-attitudes-substance-abuse-teens-2012. Published 2012.

46. The Importance of Family Dinners VII. Columbia Center for Alcohol & Substance Abuse. http://www.casacolumbia.org/upload/2011/2011922familydinnersVII.pdf. Published September 2011. Accessed January 29, 2013.

47. AACAP Marijuana Legalization Policy Statement. American Academy of Child & Adolescent Psychiatry. https://www.aacap.org/AACAP/Policy_Statements/2014/aacap_marijuana_legalization_policy.aspx. Published April 15, 2014.

48.   The Legalization of Marijuana in Colorado: The Impact. http://www.rmhidta.org/html/2015%20PREVIEW%20Legalization%20of%20MJ%20in%20Colorado%20the%20Impact.pdf. Accessed 9/22/15.

According to the National Institute on Drug Abuse, “Besides the risk of spontaneous abortion, heroin abuse during pregnancy (together with related factors like poor nutrition and inadequate prenatal care) is also associated with low birth weight, an important risk factor for later delays in development. Additionally, if the mother is regularly abusing the drug, the infant may be born physically dependent on heroin and could suffer from neonatal abstinence syndrome (NAS), a drug withdrawal syndrome in infants that requires hospitalization. According to a recent study, treating opioid-addicted pregnant mothers with buprenorphine (a medication for opioid dependence) can reduce NAS symptoms in babies and shorten their hospital stays.”

Source:   http://www.wmdt.com/news    Sept 18th 2015

Consumption of illegal drugs begins at the age of 10

The National Council Against Addictions (Conadic) has estimated that over 2.38 million Mexican youths are in need of some kind of rehabilitation treatment for abuse of substances, mainly marijuana and alcohol.

This is but one of the staggering figures presented in the 2014 National Survey on Drug Use Among Students, conducted in public and private schools in the 32 states, which also indicated that children are beginning to consume illegal drugs at 10 years old, two years younger than had been thought.

The survey also established that addiction among youths in secondary and preparatory schools – nearly 80,000 young men and 50,000 young women – requires immediate intervention.

A broader number of the same spectrum of students, about 311,000 men and 260,000 women, were found to need brief support interventions, which could consist of counselling sessions or a short rehabilitation internment period.

The course of action to take in the case of younger, elementary school students is still being assessed.

Conadic chief Manuel Mondragón wants to know the how and where of treatment: “713,963 secondary and preparatory school students need to be treated for use of drugs, and 1.674 million for abuse of alcohol. The question is, where are we going to treat them, and who will provide the treatment? What are our infrastructural capabilities?”

Mondragón said nearly 1.8 million children and teenagers – from elementary to preparatory – have tried illegal drugs, 152,000 of which are fifth and sixth-grade students, and whose first experience was with marijuana, followed by inhalants and cocaine.  Of that 1.8 million, over 108,000 have used marijuana between one and five times.

The abuse of alcohol is no less worrisome: 1.5 million secondary and preparatory school students have abused it, consuming over five drinks at a time and becoming drunk. Over 110,000 elementary school students have done the same.

The states with the most substance abuse among children are Chihuahua, Jalisco, State of México, the Federal District and San Luis Potosí.

Nine out of every 10 children in Michoacán, Campeche and Quintana Roo are experimenting with and abusing harder substances like cocaine.

Mondragón stated that immediate measures to deal with the issue could consist of shutting down all establishments that sell alcohol to minors, as well as signing agreements in every state to strengthen the use of breathalyzers and control the sale of legal and illegal drugs.  Mondragón also said the federal government is open to raising the limit of recreational drugs an individual can carry, currently set at five grams. This would permit the reinsertion into society of non-violent, first-offender youths who are currently in jail for possession of illegal substances.

Meanwhile, in Congress, the first round of discussions around the use of marijuana and its derivatives is taking place with the participation of representatives from the United Nations and parents’ associations.  The discussion is focusing on the legalization of medicinal cannabinoid-based products.

Source: http://mexiconewsdaily.com/news/study-finds-2-million-students-need-rehab/#sthash.yh7m6JYS.dpuf   26th Jan. 2016

Two recent measures of educational performance, one at the national level (National Assessment of Educational Progress, or NEAP) and one among 11 regional states and the District of Columbia showed not only poor and deteriorating performance for all students, but staggering differences between white students and black students.

At the national level, the NEAP reported that 66 percent of all 8th graders were “not proficient” in reading, rising to 67 percent in math. But for black 8th graders, fully 84 percent were “not proficient” in reading, with 87 percent “not proficient” in math.

And the report on students in the District of Columbia revealed an educational disaster. In 3rd through 8th grade, only 79 percent of whites were “proficient” in English, with 70 percent so for math. For black students, proficiency in either skill fell to 17 percent.

In high school, it got worse. Only 52 percent of whites were proficient in geometry, compared to four percent of blacks. In English, only 20 percent of black students were proficient, compared to 82 percent of whites.

Importantly, the blame falls not on the expectant students. It falls squarely on the institutions—and the adults—entrusted with the task of educating them. (The District spent $17,953 per pupil, outranking all states but Alaska, in the most recent, reported year.) Teaching youth is the most fundamental operation of any culture, upon which acquisition of other capacities will depend. If they can’t read, write, or calculate, we are failing to render self-sufficient in the tools of daily life the coming generation.

We may not have the power to fix all the things that are wrong with public schools. But surely we have the power, and the responsibility, to not make things worse, particularly for those already struggling. And making things worse is just what the District, and now other places in America, are doing, by making marijuana use more normalized and widespread.

According to the latest results from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), marijuana use doubled between the period 2001-2002 and the most recent wave of findings, the years 2012-2013. There was also a near-doubling of “marijuana-related disorders,” such that three-in-ten users now suffer problems.

But an equally troubling finding was what NESARC termed “significant increases across demographic subgroups.” In fact, “Black and Hispanic individuals showed especially notable increases in the prevalence of marijuana use and marijuana use disorders, trends consistent with other studies showing that marijuana use is now more prevalent in black than white individuals.”

These disturbing results for marijuana only add to the bad news, which most affects youth — and perhaps critically affects disadvantaged youth.   No one says that drug use is the single factor “causing” student failure; there are documented institutional and social deficiencies enough for that. But who will not face that marijuana use will most penalize those most at risk? Minority youth are both using more dope and suffering more of the consequences, and the impact hits hardest those without support.

The clear science on adolescent marijuana use and school failure is undeniable. The loss of 8 IQ points from heavy use, the measurable detriment to memory and learning, the risks of depression and psychosis for the vulnerable, the greatly increased risk of school drop-out; these are now well-established associations, and they seem to worsen as marijuana potency skyrockets, while dependency becomes “more severe.”

We can anticipate the objections from legalization advocates. Under the District’s rules, marijuana is still illegal for kids. But there is strong evidence showing that where marijuana is legalized and normalized, youth use soars, damaging learning and bringing addiction to the young.

It could also be that the “causation” is reversed; the reason that those failing in school are turning to marijuana is because they’re already failing in school. It’s possible, and may be true for some facing social disadvantage and psychological co-morbidities.  But surely that is no argument to therefore make dope wall-to-wall. One-in-every-eight high school kids in Colorado is now a current marijuana smoker. Moreover, teachers tell routinely another tale, of the high-performing youth who in a single semester changes dramatically—for the worse—and becomes a “stoner.” And then they lose them.

We should at least examine the true nature of the impact, and plan a response. We could explore programs like in-school screening for at-risk kids; if they’re starting to use drugs, it could be a chance to intervene and bring help.  Fixing this will require serious educational reform. Instead, inexplicably, the District determined to take us in the wrong direction – they legalized.

For education advocates and those of us especially concerned by the worsening failure of at-risk Americans in the classroom, it is time to recognize that the brain-altering effects of marijuana are now a dangerous and growing educational threat. David W. Murray

David W. Murray

Source: http://hudson.org/research/12095-last-thing-struggling-students-need-is-more-marijuana

Developmental trajectories of adolescent cannabis use and their relationship to young adult social and behavioural adjustment: A longitudinal study of Australian youth.

Abstract

This study aimed to identify distinct developmental trajectories (sub-groups of individuals who showed similar longitudinal patterns) of cannabis use among Australian adolescents, and to examine associations between trajectory group membership and measures of social and behavioural adjustment in young adulthood. Participants (n=852, 53% female) were part of the International Youth Development Study. Latent class growth analysis was used to identify distinct trajectories of cannabis use frequency from average ages 12 to 19, across 6 waves of data. Logistic regression analyses and analyses of covariance were used to examine relationships between trajectory group membership and young adult (average age: 21) adjustment, controlling for a range of covariates. Three trajectories were identified: abstainers (62%), early onset users (11%), and late onset occasional users (27%). The early onset users showed a higher frequency of antisocial behaviour, violence, cannabis use, cannabis-related harms, cigarette use, and alcohol harms, compared to the abstinent group in young adulthood. The late onset occasional users reported a higher frequency of cannabis use, cannabis-related harms, illicit drug use, and alcohol harms, compared to the abstinent group in young adulthood. There were no differences between the trajectory groups on measures of employment, school completion, post-secondary education, income, depression/anxiety, or alcohol use problems. In conclusion, early onset of cannabis use, even at relatively low frequency during adolescence, is associated with poorer adjustment in young adulthood. Prevention and intervention efforts to delay or prevent uptake of cannabis use should be particularly focussed on early adolescence prior to age 12.

Source:  Pub Med  http://www.ncbi.nlm.nih.gov/pubmed/26414206 Author information:  Scholes-Balog KE1, Hemphill SA2, Evans-Whipp TJ3, Toumbourou JW4, Patton GC5.

Medical Director at Victoria Hospital, Dr. Lisa Charles says there is an increase in the number of young people developing COPD.

CASTRIES, St. Lucia, Thursday January 7, 2016 – Health officials in St. Lucia are advising against a dangerous practice they say is turning people into “respiratory cripples” before killing them – mixing marijuana and tobacco.

Medical Director at Victoria Hospital (VH) Dr. Lisa Charles said over the past 10 years she has seen an epidemic emerging with an increased number of young patients suffering with Chronic Obstructive Pulmonary Disease (COPD).

She says patients who smoke marijuana mixed with tobacco are developing COPD at a very young age.  “We are talking about young men and women in their 30s with end-stage lung disease. And by end stage lung disease, I mean they are no longer able to carry out any normal activity, such as cooking [or] walking from the bed to the bathroom because of severe shortness of breath,” the doctor said.

COPD is an extremely debilitating, progressive disease which directly affects the lungs. The effects of COPD cannot be reversed.

Patients with the disease are literally confined to a bed with oxygen tanks to aid in breathing “because any degree of exertion, any degree of activity causes shortness of breath to the point where you have to stop, you have to sit, you cannot do any of those normal functions that you can do for yourself,” Dr. Charles explained.

The medical director said available bed space at the Victoria Hospital was severely compromised as a result of increasing cases of COPD.

“Upwards of 12 patients per day require some degree of treatment for their breathing difficulty. In terms of patients who are end stage, which is my primary concern, we probably have what we call a revolving-door patient population of close to 15 to 20. These are patients who literally come to A&E either daily or weekly, because their disease is so far progressed that they need that level and that frequency of attention in the emergency department and on the wards,” Dr. Charles disclosed.

“We do also have patients who have lived at VH for the last several months because they can’t take care of themselves at home and they have no option but to stay with us because they need continuous oxygen and full care.”

Sherman Esnard is one of the patients with COPD. He once earned a living as a carpenter and was an avid football player – activities he can no longer participate in. “Who wouldn’t miss that? To be a young active fella and you cannot do any of these things again . . .” lamented  Esnard.  He spends most of his time between his home and the Victoria Hospital and can’t last a minute disconnected from an oxygen tank.

Dr. Charles said the cost of treating COPD is tremendous, with most of the expense being absorbed by Victoria Hospital, the government and the taxpayers.

“Look at oxygen alone without looking at the nursing cost, the cost of physicians, the cost of other medications, the cost of nebulization, the cost of treating heart failure and the cost of inpatient hospital stays . . . I wouldn’t even know where to start to measure, but it’s very significant,” she said.

The Pan American Health Organization says COPD is a leading cause of morbidity and mortality in the Americas, representing an important public health challenge that is both preventable and treatable.

The World Health Organization has designated November 16 annually as World Chronic Obstructive Pulmonary Disease Day.

Source: http://www.caribbean360.com/news/health-officials-warn-of-deadly-effects-of-combining-marijuana-and-tobacco#ixzz3wahTD4VB

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 alcohol 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 foetus.”

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 foetus.  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. New borns should be screened for prenatal alcohol exposure, especially among populations at high risk. And alerting clinicians to these co-occurring conditions should trigger questions about prenatal alcohol exposure.”

“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.

Source:  http://m.medicalxpress.com/news/2016-01-conditions-co-occur-fetal-alcohol-

According to the National Institute on Drug Abuse, “Besides the risk of spontaneous abortion, heroin abuse during pregnancy (together with related factors like poor nutrition and inadequate prenatal care) is also associated with low birth weight, an important risk factor for later delays in development. Additionally, if the mother is regularly abusing the drug, the infant may be born physically dependent on heroin and could suffer from neonatal abstinence syndrome (NAS), a drug withdrawal syndrome in infants that requires hospitalization. According to a recent study, treating opioid-addicted pregnant mothers with buprenorphine (a medication for opioid dependence) can reduce NAS symptoms in babies and shorten their hospital stays.”

Source:   http://www.wmdt.com/news    Sept 18th 2015

The Food and Drug Administration recently announced it intends to require warning labels and child-resistant packaging on liquid nicotine products such as those used in e-cigarettes.

The Centers for Disease Control and Prevention said the popularity of e-cigarettes has resulted in a number of cases of nicotine poisoning in recent years.

Jonathan Foulds, professor of public health sciences at  Penn State College of Medicine, says nicotine poisoning is not a new problem. “There is a long history of very young children getting a hold of their parents’ tobacco,” he says. “The most common scenario is that a toddler consumes something, and the parents don’t know how much. Then they call the poison control center or end up in the emergency room.”  In the best case that leads to anxiety, and possibly unpleasant investigations for the families, and in the worst case it could lead to loss of consciousness or death for the child, Foulds says.

He adds any substance that could be harmful to children should come in a childproof container. “There are hundreds of cases of poisoning from cigarettes every year, and so all nicotine products, including cigarettes, should be in childproof packages.”  Nicotine replacement lozenges and other novelty smokeless tobacco products that resemble candy can also be dangerous.

The liquid used in e-cigarettes is often flavored – anything from strawberry to cookies’n’cream – and may therefore smell appealing to children who come across it.

“All nicotine is a poison as are all tobacco products containing nicotine, so people using any of them should take great care to keep them out of reach of kids,” Foulds says.

A nicotine overdose usually makes a person sweaty, clammy, dizzy and nauseous. It proceeds to vomiting and loss of consciousness. It can also lead to death.  Luckily for most children, nicotine doesn’t taste good, so most do not continue to consume it once they have had a taste. But with the highly concentrated liquid nicotine, a child who drinks even a small amount could end up with a lethal dose.

Foulds says the proposed measures alone won’t solve the problem. He adds consumers need to be vigilant about using provided childproofing measures and making sure that any substances that could be harmful to children stay out of reach: “Simply put, nicotine is a poison and consumers need to take responsibility for keeping it away from children, whether it is in a childproof container or not.”

Source:  Newsroom:  Penn State Milton S. Hershey Medical Center   23-Jul-2015

Colorado, March 2014. Hancock-Allen JB, Barker L, VanDyke M, Holmes DB.

Abstract

In March 2014, the Colorado Department of Public Health and Environment (CDPHE) learned of the death of a man aged 19 years after consuming an edible marijuana product.   CDPHE reviewed autopsy and police reports to assess factors associated with his death and to guide prevention efforts.

The decedent’s friend, aged 23 years, had purchased marijuana cookies and provided one to the decedent. A police report indicated that initially the decedent ate only a single piece of his cookie, as directed by the sales clerk. Approximately 30-60 minutes later, not feeling any effects, he consumed the remainder of the cookie.

During the next 2 hours, he reportedly exhibited erratic speech and hostile behaviors.   Approximately 3.5 hours after initial ingestion, and 2.5 hours after consuming the remainder of the cookie, he jumped off a fourth floor balcony and died from trauma.

The autopsy, performed 29 hours after time of death, found marijuana intoxication as a chief contributing factor. Quantitative toxicologic analyses for drugs of abuse, synthetic cannabinoid, and cathinones (“bath salts”) were performed on chest cavity blood by gas chromatography and mass spectrometry. The only confirmed findings were cannabinoids (7.2 ng/mL delta-9 tetrahydrocannabinol [THC] and 49 ng/mL delta-9 carboxy-THC, an inactive marijuana metabolite). The legal whole blood limit of delta-9 THC for driving a vehicle in Colorado is 5.0 ng/mL.

This was the first reported death in Colorado linked to marijuana consumption without evidence of polysubstance use since the state approved recreational use of marijuana in 2012.

Source: MMWR Morb Mortal Wkly Rep. 2015 Jul 24;64(28):771-2.

Research Summary

Observational studies suggest that heavy, habitual marijuana use in adolescence may be associated with cognitive decline and adverse educational outcomes. However, conflicting data exists. The authors of this study used data from a large population-based prospective cohort of 1155 individuals from the United Kingdom to investigate the effects of cannabis use by age 15 on subsequent educational outcomes. They also explored the relationship between tobacco use and educational outcomes to assess for possible bias. The primary educational outcomes were performance in standardized English and mathematics assessments at age 16, completion of 5 or more assessments at a grade level C or higher, and leaving school having achieved no qualifications. Exposure was measured by self-report and serum cotinine levels.

* In fully adjusted models both cannabis and tobacco use were associated with adverse educational outcomes.

* A dose response effect was seen with higher frequency of cannabis use associated with worse outcomes.

* Adjustment for other substance use and conduct disorder attenuated these effects and tobacco had a stronger association than cannabis.

Comments:

This data sheds more light on a possible association between early exposure to cannabis and tobacco and subsequent poor educational outcomes. However, given the nature of the analysis, causality cannot be implied. Further research is needed at longer follow-up periods to gain more understanding of the relationship between cannabis use in adolescence and educational outcomes.  Jeanette M. Tetrault, MD

Source: Addiction. 2015;110(4):658–668.

The number of babies born in Florida with neonatal abstinence syndrome (NAS) soared more than 10-fold in the past 20 years, according to a new report by the Centers for Disease Control and Prevention (CDC). During the same period, these births increased three-fold nationally.  Babies born with NAS undergo withdrawal from the addictive drugs their mothers took during pregnancy, such as oxycodone, morphine or hydrocodone, HealthDay reports.  Almost all of the babies identified in the Florida study required admission to the neonatal intensive care unit, where they stayed an average of 26 days.

“These infants can experience severe symptoms that usually appear within the first two weeks of life,” said lead researcher Jennifer Lind. Symptoms can include seizures, fever, excessive crying, tremors, vomiting and diarrhoea, she said. Withdrawal can take several weeks to a month.

A majority of babies with NAS need treatment with morphine or the anticonvulsant phenobarbital to reduce seizures and other symptoms of withdrawal, the article notes.

Only about 10 percent of the babies’ mothers were referred for drug counselling or rehabilitation during pregnancy, even though urine drug tests were performed on 87 percent of the mothers, and 90 percent of those tests came back positive. In 2013, Florida launched an initiative to tackle the growing problem of NAS. A task force of doctors, public health experts and social workers in Florida made recommendations in the areas of prevention, intervention and best practices, and treatment. It recommended that hospitals be required to report babies born with symptoms of NAS, as they do with babies born with infectious diseases such as measles and tuberculosis. The group recommended considering new laws to offer pregnant women immunity for seeking substance abuse treatment. According to the CDC report, NAS is now a mandatory reportable condition in Florida.

Source:  http://www.drugfree.org/join-together     10th March 2015

The hippocampus is important to long-term memory (also known as episodic memory), which is the ability to remember autobiographical or life events.  The brain abnormalities and memory problems were observed during the individuals’ early twenties, two years after they stopped smoking marijuana.

Young adults who abused cannabis as teens performed about 18 percent worse on long-term memory tests than young adults who never abused cannabis.

“The memory processes that appear to be affected by cannabis are ones that we use every day to solve common problems and to sustain our relationships with friends and family,” said senior author Dr. John Csernansky, the Lizzie Gilman professor and chair of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital.

The study will be published March 12 in the journal Hippocampus.

The study is among the first to say the hippocampus is shaped differently in heavy marijuana smokers and the different looking shape is directly related to poor long-term memory performance. Previous studies of cannabis users have shown either the oddly shaped hippocampus or poor long-term memory but none have linked them.

Previous research by the same Northwestern team showed poor short-term and working memory performance and abnormal shapes of brain structures in the sub-cortex including the striatum, globus pallidus and thalamus.

“Both our recent studies link the chronic use of marijuana during adolescence to these differences in the shape of brain regions that are critical to memory and that appear to last for at least a few years after people stop using it,” said lead study author Matthew Smith, assistant professor of psychiatry and behavioral sciences at the Feinberg School of Medicine.

The longer the individuals were chronically using marijuana, the more abnormal the shape of their hippocampus, the study reports. The findings suggest that these regions related to memory may be more susceptible to the effects of the drug the longer the abuse occurs.

The abnormal shape likely reflects damage to the hippocampus and could include the structure’s neurons, axons or their supportive environments.

“Advanced brain mapping tools allowed us to examine detailed and sometimes subtle changes in small brain structures, including the hippocampus,” said Lei Wang, also a senior study author and an assistant professor of psychiatry and behavioral sciences at Feinberg. The scientists used computerized programs they developed with collaborators that performed fine mappings between structural MRIs of different individuals’ brains.

Subjects took a narrative memory test in which they listened to a series of stories for about one minute, then were asked to recall as much content as possible 20 to 30 minutes later. The test assessed their ability to encode, store, and recall details from the stories.

The groups in the study started using marijuana daily between 16 to 17 years of age for about three years. At the time of the study, they had been marijuana free for about two years. A total of 97 subjects participated, including matched groups of healthy controls, subjects with a marijuana use disorder, schizophrenia subjects with no history of substance use disorders, and schizophrenia subjects with a marijuana use disorder. The subjects who used marijuana did not abuse other drugs.

The study also found that young adults with schizophrenia who abused cannabis as teens performed about 26 percent more poorly on memory tests than young adults with schizophrenia who never abused cannabis.

In the U.S., marijuana is the most commonly used illicit drug, and young adults have the highest — and growing — prevalence of use. Decriminalization of the drug may lead to greater use. Four states have legalized marijuana for recreational use, and 23 states plus Washington D.C. have legalized it for medical use.

Because the study results examined one point in time, a longitudinal study is needed to definitively show if marijuana is responsible for the observed differences in the brain and memory impairment, Smith said.

“It is possible that the abnormal brain structures reveal a pre-existing vulnerability to marijuana abuse,” Smith said. “But evidence that the longer the participants were abusing marijuana, the greater the differences in hippocampus shape suggests marijuana may be the cause.”

The study was funded by the National Institute of Mental Health of the National Institutes of Health, grants R01 MH056584 and P50 MH071616.

Source:  Info.from Drugwatch International abut a study tobe published on 12th March 2015 in the journal Hippocampus.

A study identified 242 infants with neonatal abstinence syndrome (NAS) in three Florida hospitals during a 2-year period. Most of the infants were admitted to the NICU, and the mean length of stay was 26 days. A total of 99.6% of the infants with NAS were exposed to opioids in utero.

A study identified 242 infants with neonatal abstinence syndrome (NAS) in three Florida hospitals during a 2-year period. Most of the infants were admitted to the NICU, and the mean length of stay was 26 days. A total of 99.6% of the infants with NAS were exposed to opioids in utero. Four out of five of the mothers were reported as using one or more opioids such as oxycodone, morphine, hydrocodone, hydromorphone, tramadol, or meperidine, while about three in five were reported as using methadone. However, only about 10% of mothers with NAS received or were referred for drug addiction rehabilitation or counseling during their baby’s birth hospitalization. The standard of care for pregnant women with opioid addiction is medication assisted treatment (MAT) — comprehensive MAT combined with prenatal care has been shown to reduce complications linked to untreated opioid use disorder. Measures that should be considered when addressing NAS prevention and management include encouraging mothers in supervised drug treatment programs to breastfeed, unless otherwise indicated; boosting the number of community resources available to women of reproductive age for substance abuse and smoking cessation, and improving drug addiction counseling and rehabilitation referral and documentation policies.

Morbidity and Mortality Weekly Report (03/06/15) Vol. 64, No. 8, P. 213 Lind, Jennifer N.; Petersen, Emily E.; Lederer, Philip A.; et al.

Source:     http://www.cdc.gov/mmwr/preview/           6th  March 2015  

These remarkable scans clearly reveal how smoking during pregnancy harms an unborn baby’s development.

New ultrasound images show how babies of mothers who smoke during pregnancy touch their mouths and faces much more than babies of non-smoking mothers.

Foetuses normally touch their mouths and faces much less the older and more developed they are. Experts said the scans show how smoking during pregnancy can mean the development of the baby’s central nervous system is delayed. Doctors have long urged pregnant women to give up cigarettes because they heighten the risk of premature birth, respiratory problems and even cot death.

Now researchers believe they can show the effects of smoking on babies in the womb – and use the images to encourage mothers who are struggling to give up.

Image shows the 4-D ultrasound scan of two foetuses at 32 weeks gestation, one whose mother was a smoker (top) and the other carried by a non-smoker (bottom). The foetus carried by the smoker touches its face and mouth much more, indicating its development is delayed

As part of the study, Dr Nadja Reissland, of Durham University, used 4-D ultrasound scan images to record thousands of tiny movements in the womb.

She monitored 20 mothers attending the James Cook University Hospital in Middlesbrough, four of whom smoked an average of 14 cigarettes a day.

After studying their scans at 24, 28, 32 and 36 weeks, she detected that foetuses whose mothers smoked continued to show significantly higher rates of mouth movement and self-touching than those carried by non-smokers. Foetuses usually move their mouths and touch themselves less as they gain more control the closer they get to birth, she explained.

The pilot study, which Dr Reissland hopes to expand with a bigger sample, found babies carried by smoking mothers may have delayed development of the central nervous system. Dr Reissland said: ‘A larger study is needed to confirm these results and to investigate specific effects, including the interaction of maternal stress and smoking.’

She believed that videos of the difference in pre-birth development could help mothers give up smoking.

But she was against demonising mothers and called for more support for them to give up. Currently, 12 per cent of pregnant women in the UK smoke but the rate is over 20 per cent in certain areas in the North East. All the babies in her study were born healthy, and were of normal size and weight.

Dr Reissland, who has an expertise in studying foetal development, thanked the mothers who took part in her study, especially those who smoked. ‘I’m really grateful, they did a good thing,’ she said. ‘These are special people and they overcame the stigma to help others.’

Co-author Professor Brian Francis, of Lancaster University, added: ‘Technology means we can now see what was previously hidden, revealing how smoking affects the development of the foetus in ways we did not realise.

‘This is yet further evidence of the negative effects of smoking in pregnancy.’ The research was published in the journal Acta Paediatrica. 


Read more: http://www.dailymail.co.uk  23 March 2015

Dutch study finds mathematics results suffer most from dope consumption – findings sure to fuel debate over steps towards legalisation If you want to do well in your exams, especially maths, don’t smoke dope.

This is the finding of a unique study that is likely to be fiercely debated by those in favour of and those against the liberalisation of cannabis laws.

Economists Olivier Marie of Maastricht University and Ulf Zölitz of IZA Bonn examined what happened in Maastricht in 2011 when the Dutch city allowed only Dutch, German and Belgian passport-holders access to the 13 coffee shops where cannabis was sold.

The temporary restrictions were introduced because of fears that nationals from other countries, chiefly France and Luxembourg, were visiting the city simply to smoke drugs, which would tarnish its genteel image.

After studying data on more than 54,000 course grades achieved by students from around the world who were enrolled at Maastricht University before and after the restrictions were introduced, the economists came to a striking conclusion.

In a paper recently presented at the Royal Economic Society conference in Manchester they revealed that those who could no longer legally buy cannabis did better in their studies.  The restrictions, the economists conclude, constrained consumption for some users, whose cognitive functioning improved as a result.

“The effects we find are large, consistent and statistically very significant,” Marie told the Observer.  “For example, we estimate that students who were no longer able to buy cannabis legally were 5% more likely to pass courses.

The grade improvement this represents is about the same as having a qualified teacher and, more relevantly, similar to decreases in grades observed from reaching legal drinking age in the US.”

For low performers, there was a larger effect on grades. They had a 7.6% better chance of passing their courses.  Interestingly, Marie and Zölitz found the effects were even more pronounced when it came to particular disciplines.

“The policy effect is five times larger for courses requiring numerical/mathematical skills,” the pair write.This, they argue, is not that surprising.  “In line with how THC consumption affects cognitive functioning, we find that performance gains are larger for courses that require more numerical/mathematical skills,” Marie said.  THC – tetrahydrocannabinol – is the active ingredient in skunk cannabis, which some studies have linked with psychosis.

The ground breaking research comes at a significant moment.  The clamour for liberalisation of cannabis laws is growing.

In Germany, Berlin is considering opening the country’s first legal cannabis shop. Uruguay plans to be the first nation in the world to fully legalise all aspects of the cannabis trade. In the US, more than 20 states now allow medical marijuana use, while recreational consumption has become legal in Alaska, Oregon, Washington and Colorado.

But, as Marie and Zölitz observe in their paper: “With scarce empirical evidence on its societal impact, these policies are mainly being implemented without governments knowing about their potential impact.

“We think this newfound effect on productivity from a change in legal access to cannabis is not negligible and should be, at least in the short run, politically relevant for any societal drug legalisation and prohibition  decision-making,” Marie said. “In the bigger picture, our findings also indicate that soft drug consumption behaviour is affected by their legal accessibility, which has not been causally demonstrated before.”

The research is likely to be seized upon by anti-legalisation campaigners.  But Marie was at pains to say the research should simply be used to raise awareness of an often overlooked aspect of drug use: its impact on the individual’s cognitive ability.  “If marijuana is legalised like it is in many states in the US, we should at least inform consumers about the negative consequences of their drug choices.”

It will also feed into the debate about THC levels in cannabis, which are becoming ever stronger. Levels of THC in marijuana sold in Maastricht’s coffee shops are around double those in the US. “Considering the massive impact on cognitive performance high levels of THC have, I think it is reasonable to at least inform young users much more on consequences of consuming such products as compared with that of having a beer or pure vodka,” Marie said.  History suggests that prohibition often results in the illicit drug or alcohol trade producing ever stronger products.

Campaigners for liberalisation argue that it could help bring THC levels down and allow users to know what they are buying. The authors concede that their findings could turn out to be different if they were to replicate their study in a country that did not have restrictions on cannabis use.  Marie said his work had helped inform his discussions with his teenage son.  “I have a 13-year old boy and I do extensively share this with him as a precautionary measure so that he can make the best informed choice if he is faced with the decision of whether to consume cannabis or not.”

http://www.theguardian.com/society/2015/apr/11/cannabis-smokers-risk-poorer-grades-dutch-study-legalisation

December 16, 2014

At the end of a year that has seen further tragic deaths from addiction and new designer drugs that put young people at risk, today’s results from the 2014 Monitoring the Future (MTF) survey of drug use among adolescents provide a dose of welcome optimism. No major drug use indicators increased significantly between last year and this year; use of alcohol, cigarettes, and illicit and prescription drugs either held at the same level or, in many cases, declined among American teens.

Particularly heartening was the fact that students’ marijuana use has not increased in the past two years: This year, 21.2 percent of seniors, 16.6 percent of 10th graders, and 6.5 percent of 8th graders used marijuana in the past month—high percentages, but not significantly different from 2013. Cigarette and alcohol use (including binge drinking) continued their steady downward trend that we’ve seen for several years now. Abuse of prescription opioids also declined since 2013 and is down by a third to a half over the last 5 years (depending on the opioid and the grade).

We have also seen diminished abuse of inhalants by the youngest teens, who historically are most likely to abuse these readily available substances, as well as diminished abuse of over-the-counter drugs like cough syrups. And although synthetic cannabinoids like “K2” and “Spice” (also known as “synthetic marijuana”) have only been tracked in the survey for the past two years for all three grades, use of these very dangerous and unpredictable drugs is also down from last year.

Although there are no doubt many possible contributing factors to these trends, I like to think that prevention messages are making an impact. Teens are getting the message from various sources that drugs are not good for their developing brains, and there are much better, healthier, and more enjoyable ways to spend their time.

An exception to the good news may be teens’ perception of the risks associated with marijuana. Although use has not increased since 2012, the numbers of teens who believe marijuana is not harmful continued the steady decline we have seen for a decade; this perception of safety could be linked to the drug’s greater visibility and public debates over its legality and its possible uses as medicine.

The survey also showed that edibles are popular among teen marijuana users, especially in states that have legalized medical marijuana. Forty percent of seniors who had used marijuana in the past year in medical marijuana states reported having consumed it in an edible form, versus 26 percent in non-medical marijuana states. With edible marijuana products there is a great danger (to both adults and kids) of ingesting high doses of THC without intending to, making it very important that these products be properly regulated and labeled.

Scientists and policymakers may endlessly debate the degree of long-term harm marijuana poses, but while there is much we still do not know about the drug’s effects, all available evidence points to significant interference in brain development when marijuana is initiated early and used heavily. In 2014, 5.8 percent of 12th graders reported daily or near-daily use of marijuana, which may impact this segment of youth for the rest of their lives. (With the collaboration of other NIH institutes, NIDA is planning a major longitudinal study that will examine the effects of teen marijuana and other drug use more closely over the next decade.)

A brand-new area of concern reflected in the MTF survey is the surprisingly high use of e-cigarettes, which were included for the first time in this year’s survey (thus trend data are not available). The survey showed 17.1 percent of seniors, 16.2 percent of 10th graders, and 8.7 percent of 8th graders report past-month use of these devices, whose health effects are at this point virtually unknown.

Although e-cigarettes don’t burn tobacco and thus produce no tar, there may be other harmful chemicals in the vapor they produce, and products that deliver nicotine (which depend on the fluid used) can be addictive. Thus it will be very important in coming years to monitor e-cigarette use by young people and learn more about their health effects.

While overall the MTF data this year are encouraging, we of course cannot relax our efforts in educating teens about the dangers of the drugs they encounter now and will continue to encounter as they grow older. The message should be clear and unequivocal: For teens and young adults, whose brains are still not finished maturing and thus can be readily altered in their development by any substance exposure, there are simply no safe drugs.

Several students and visitors from Wesleyan University were hospitalized on February 22 after taking the club drug MDMA. U.S. DEA/HANDOUT VIA REUTERS/REUTERS

At least 11 people from the Wesleyan University campus in Middletown, Connecticut, were hospitalized on Sunday with symptoms consistent with drug overdoses. School officials and emergency responders are blaming MDMA, also known as Molly, a form of the drug ecstasy that medical experts say has become increasingly popular on college campuses.

Though some reports said 11 people had received medical treatment, Wesleyan President Michael S. Roth put the number at 12 in an email to students on Monday. That includes 10 students and two visitors.

“I ask all students: Please, please stay away from illegal substances, the use of which can put you in extreme danger. One mistake can change your life forever,” Roth wrote. “And please keep those still hospitalized in your hearts and minds. Please join me in supporting their recovery with your prayers, thoughts and friendship.”

In a statement on Monday, a Middletown Police Department spokeswoman, Lieutenant Heather Desmond, wrote that her department would be involved in an investigation into “the origin of the drugs taken” and to “determine the extent of the criminal involvement in the case.”

A spokeswoman for Middlesex Hospital tells Newsweek it treated 11 people, three of whom are still there and four of whom were airlifted by helicopter to Hartford Hospital. She could not comment on the conditions of the three patients there. A spokeswoman for Hartford Hospital confirmed that four people were there. She too could not speak to their conditions. The police spokeswoman wrote that two individuals are in critical condition and two are in serious condition.

Middletown Fire Chief Robert Kronenberger tells Newsweek his department made seven runs to Wesleyan related to the incident on Sunday after receiving calls between 7:30 a.m. and 1:30 p.m. It rendered aid to eight individuals, including two people in a single dorm room. “We saw the trend and we worked with the university and the police department to notify them of the trend,” Kronenberger says. “We’ve never had anything to this extent,” he says, referring to health and safety issues at Wesleyan. “A couple of them were in some serious dire straits,” he says about the students, adding that they were cooperative. “As a parent of two college-age students, this definitely concerns me and hopefully something to this extent will open eyes,” he says.

Wesleyan’s student newspaper, The Wesleyan Argus, first reported about the incident on its website on Sunday after the school’s vice president for student affairs, Michael Whaley, sent a series of emails to students.

Medical experts say MDMA use on college campuses has grown in recent years, and while there have been reports of bad reactions to the drug, it appears the Wesleyan incident is the most widespread.

In 2013, a University of Virginia sophomore collapsed at a nightclub after taking MDMA and later died. Students at Syracuse University in Syracuse, New York; Plymouth State University in Plymouth, New Hampshire; and Texas State University in San Marcos, Texas have also died after taking the drug. In 2013, organizers of the Electric Zoo music festival in New York City cut the event short after two people died while taking MDMA, including a University of New Hampshire student.

“This age group is a risk-taking group that is willing to follow their friend wherever they go, and if the person next to them is popping a pill, then they’re going to do it too,” says Dr. Mark Neavyn, director of medical toxicology at Hartford Hospital, who treats patients there for MDMA overdoses.

“I think the popular culture engine kind of made it seem safer in some way,” Neavyn says, referring to references to the drug by the singers Miley Cyrus and Madonna that made headlines.

But when it comes to MDMA, people are rarely taking what they think they’re taking, the doctor says.

According to Neavyn, symptoms of an MDMA overdose include fast heart rate, high blood pressure, delirium, elevated body temperature and alterations in consciousness. Extreme cases could involve cardiac arrhythmia and seizures.

Wesleyan, which has about 2,900 full-time undergraduate students and 200 graduate students, also apparently dealt with MDMA-related issues last semester. As the Argus reported, the school’s Health Services Department emailed students on September 16 following a series of MDMA-related hospitalizations.

One former Wesleyan student from the class of 2011, who requested anonymity when discussing drug use, says the news is not surprising, given the prevalence of drugs on campus. “Anything you can imagine…would be readily available there,” the person says. “I don’t think at Wesleyan you need [a campus event] to take drugs. If it’s sunny, there’s probably a good percentage of people that are taking something.”

The campus activities calendar did not show any major events scheduled for Saturday or Sunday.

Another former Wesleyan student from the class of 2012, who also requested anonymity, says the drug culture at Wesleyan is comparable to that at similar schools. “It’s one of those things where, much like at those schools, you kind of have an understanding of where you can go to get it and who had it,” the person says. “If there’s a will there’s a way.”

www.newsweek.com weds Feb. 2015

The family of a Tulsa man who shot himself Saturday night in Keystone is blaming his suicide on his ingestion of edible marijuana candies.

It was completely a reaction to the drugs,” Kim Goodman said about her son Luke’s Saturday night suicide.

Luke Goodman’s death is now the third death in Colorado linked to marijuana edibles.

The 23-year-old college graduate was in the midst of a two-week ski and snowboard vacation with family members. Saturday afternoon he and his cousin, Caleb Fowler, took a bus from Keystone to Silverthorne where Fowler says they bought $78 worth of edibles and marijuana.

He was excited to do them,” Fowler told CBS4.

When the young men got back to Keystone, Fowler said they began ingesting the edible pot. He said his cousin favored some peach tart candies, each piece of candy containing 10 mg of the active ingredient in marijuana, the recommended dose for an adult consuming an edible.

But when Goodman consumed several and experienced no immediate effects he kept gobbling them up. “Luke popped two simultaneously” after the first two didn’t seem to do anything, said Fowler.

Then he said Goodman took a fifth candy, five times the recommended dose. His mother says her son likely didn’t see the warning on the back of the container which says, “The intoxicating effects of this product may be delayed by two or more hours … the standardized serving size for this product includes no more than 10 mg.”

Several hours later Fowler said his cousin became “jittery” then incoherent and talking nonsensically. “He would make eye contact with us but didn’t see us, didn’t recognize our presence almost. He had never got close to this point, I had never seen him like this,” Fowler said.

Fowler says Goodman became “pretty weird and relatively incoherent. It was almost like something else was speaking through him.” When family members left the condo Goodman refused to join them. After they left he got a handgun that he typically traveled with for protection, and turned it on himself.

Summit County Coroner Regan Wood says the preliminary cause of death is a self-inflicted gunshot wound. As for the impact of the marijuana edibles, she said, “That’s what we’ve heard consistently.” She said the impact the edibles had on Goodman will be more clear when toxicology results come back in a few weeks. “It’s still under investigation,” said Wood.

While definitive answers may be weeks away, Kim Goodman, Luke Goodman’s mother, told CBS4 she knows why her son took his own life. “It was 100 percent the drugs,” she said. “It was completely because of the drugs — he had consumed so much of it.” She said her son was well adapted, well-adjusted and had no signs of depression or suicidal thoughts. “It was completely out of character for Luke … there was no depression or anything that would leave us being concerned, nothing like that.”

Caleb Fowler echoed the feeling saying he fully believed the ingestion of so much marijuana laced candy triggered the suicide. “He was the happiest guy in the world. He had everything going for him.”

A year ago a Wyoming college student jumped to his death from a Denver hotel balcony after eating a marijuana cookie. Witnesses said Levy Thamba Pongi was rambling incoherently after eating the cookie. The Denver coroner ruled “marijuana intoxication” was a significant factor in Pongi’s death.

Richard Kirk of Denver faces first-degree murder charges stemming from the fatal shooting of his wife in Denver last year. Before her death his wife called 911 and said her husband had eaten marijuana candy and taken prescription medication and was hallucinating.

Kristine Kirk and Richard Kirk (credit CBS)

Luke Goodman’s family is now planning a memorial service for Friday in Tulsa. His mother says she remembers her last interaction with her son.

We both said ‘I love you’ and I said ‘Have a great week.’ ”

Kim Goodman told CBS4 she believes marijuana edibles should be removed from store shelves.

I would love to see edibles taken off the market … I think edibles are so much more dangerous.”

Source: CBS4 26th March 2015

 Underage drinkers who consume supersized flavored alcoholic drinks – also known as alcopops – are more than six times as likely to report alcohol-related injuries as underage youth who consume other types of alcoholic beverages, according to a new study. The research, published in the Feb. 25 American Journal of Public Health, is the first to document the association between consumption of alcopops and risky drinking habits in teens.

Alcopops — alcoholic beverages blended with fruit juice, lemonade or other flavorings — appeal to underage drinkers because they taste more like sweet soda than other alcoholic drinks. These brews are typically 8 percent alcohol content by volume compared to less than 5 percent for beer.

Flavored alcoholic drinks come in malt-based beverages; spirits-based premixed, ready-to-drink cocktails; and supersized alcopops. Previous studies found that half of underage drinkers in the U.S. said they had consumed flavored alcohol beverages in the past 30 days.

“It is impossible to discuss harmful alcohol consumption among youth and not include supersized alcopops,” study co-author David Jernigan, PhD, director of the Center for Alcohol Marketing and Youth at the Johns Hopkins Bloomberg School of Public Health, said in a news release. “These low-priced and sweet-tasting beverages are associated with reports of dangerous consequences among youth.”

For their study, the researchers surveyed 1,031 underage youth ages 13 to 20 who had consumed at least one alcoholic drink during the past 30 days between December 2011 and May 2012. Using an online, self-reporting survey, respondents indicated which brands they had consumed in the past 30 days, and the typical number of drinks of each brand they had consumed on those days.

Survey results showed that heavy episodic drinking was reported by nearly 70 percent of the pre-mixed/ready-to-drink cocktail users. About 75 percent of supersized alcopop users and almost 80 percent of those who consumed more than one type of flavored alcoholic beverage engaged in the same drinking behaviors. Among the non-alcopop group, 45 percent reported heavy episodic drinking. Consumption of more than one type of alcopop was strongly associated with fighting and alcohol-related injuries.

In recent years, public health advocates have expressed concerns about the alcopops and their appeal to youth. Flavored alcoholic drinks, concluded the authors, “present an emerging public health problem among young people.”

“Public health practitioners and policy makers would be wise to consider what further steps could be taken to keep these beverages out of the hands of youth,” study author Alison Albers, PhD, an assistant professor at the Boston University School of Public Health, said in the news release.

Source: http://www.examiner.com/article/flavored-alcoholic-drinks 27th Feb. 2015

The information comes from the Indiana Youth Institute’s annual Kids Count report.

The data is worrisome to area health professionals, like Dr. Ahmed Elmaadawi, who says marijuana is mentally addictive. 

“Cannabis, in general, works in an area of the brain that’s responsible for judgment and well-being. We actually know if you use marijuana for a long period of time, it affects your judgment [and] self-esteem. And longtime use of cannabis can actually cause psychosis,” said Dr. Elmaadawi, a child and adolescent psychiatrist.

Dr. Elmaadawi is concerned mainly for teen use. He says there is proven research marijuana can be healing to cancer patients and others suffering from chronic pain, but use for teens is dangerous. He says those who try the drug before age 18 are 67% more likely to continue using. The number drops to 27% for adults who try it for the first time.

“The pleasurable response is there. They want to have more to get that same feeling from the first time they used marijuana,” said Dr. Elmaadawi.

While health professionals are standing strong in the dangers, there is an overwhelming support for legalization at the national level. According to a Pew Research Poll, millennials are setting aside partisan politics with 77% of Democrats between ages 18-34 and 63% of Republicans agreeing laws that prohibit pot are outdated.

But, not all young people agree, including one local teen who struggled with abuse at an early age. The teen, called “John” for the purpose of this story, went to rehab at age 16. He started using pot at 13. His legal trouble started when he was caught on camera stealing from parked cars with a friend. Both were high and had a history of theft.

“There was an adrenaline part that didn’t make me worry about it. The money part is what made me do it, but the thrill is what didn’t make me afraid of it,” said John.

After his first arrest, John went to the Juvenile Justice Center (JJC) for 10 days. After his release, he started using synthetic marijuana. His mom caught him sometime later, called his parole officer, and he was again arrested. This time, John went to JJC for a month and rehab for 6 months.

“I stopped mainly because it was hurting a lot of the relationships I had, and I wanted to do stuff for myself. I knew if I wanted to go as far as I wanted to, I was going to get backtracked all the time if I smoked weed,” said John.

An arrest record and rehab aren’t enough for everyone. The Indiana Youth Institute (IYI) says while overall substance abuse is declining in terms of alcohol and cigarettes, marijuana use is increasing in teens.

“A big key to being successful to keeping our kids away from any illicit substance is open communication with their parents and other caring adults in their lives,” said Bill Stanczykiewicz, the President and CEO at IYI.

Dr. Elmaadawi and Stanczykiewicz agree there are mixed messages about marijuana legalization and the longtime effects. They agree open communication and community resources are key in helping teens make tough choices. Dr. Elmaadawi says there needs to be more education in schools in addition to collaboration between the resources in the community. Stanczykiewicz says teens are most influenced in their personal decision making by people they know directly.

“Kids benefit when they hear consistent messages about right and wrong from all of the caring adults in their lives. There’s no 100% guarantee that kids are going to make good choices, but what we are trying to do is increase the odds,” said Stanczykiewicz.

To read the Kids Count Data, click here.

Source: www.wndu.com  9th March 2015

Charities warn against drug legalisation on eve of Clegg announcement. 

 A new poll of over 100 charities by the think-tank, the Centre for Social Justice (CSJ) found that:

69 per cent would be concerned if the Government decriminalised cannabis;

73 per cent were concerned of the effects that cannabis had on their clients and families.

Charities on the front-line of the battle against poverty are opposed to liberalising cannabis laws, a new think-tank survey finds. A new CSJ poll of over 100 charities – many of them are working directly to combat addiction or are supporting those with addictions back into education and work – has found over two-thirds (69 per cent) would be concerned if the Government decriminalised cannabis because they say it would lead to greater drug abuse. The poll comes on the eve of the Lib Dem leader Nick Clegg’s announcement that the Liberal Democrats want to decriminalise cannabis.  

Nearly three-quarters (73 per cent) of the charities surveyed by the CSJ were concerned about the effect cannabis use had on their clients and families. Over half (56 per cent) felt the decriminalisation of cannabis would lead to an increase in its use. Less than a quarter (23 per cent) thought it would not. 

Commenting on the findings, Christian Guy, Director of the CSJ said: “Drug addiction is ripping Britain’s poorest communities apart. Our network of 300 front-line charities sees this on a daily basis. Many are right to be worried that liberalising cannabis laws will lead to more people taking drugs and developing harder use.” Politicians need to listen to these experts. They are the people who witness the devastating impact of drugs in our poorest neighbourhoods day in, day out.”

While the survey was anonymous, a number of charities wanted to make their voice heard publically on this crucial issue. Andy Cook, CEO of Twenty Twenty, who work with disadvantaged young-people, said: “We are scared by the idea of liberalising cannabis laws. We work tirelessly to get the most disadvantaged and disengaged young people back into learning and to hold down jobs. If they are taking cannabis it makes it almost impossible to succeed – sapping their motivation and effectively tying our hands in the support we can give. Cannabis is ruining the life opportunities of those we work with, so the idea that society would be better off if this stuff was decriminalised is crazy. Making it more easily available and more culturally acceptable will mean that more of our young people would take it. The result will be that more of our young people would fail to make the most of their potential.”  

Data shows that cannabis addiction is a growing problem. In 2005-6, nine per cent of those presenting to treatment for the first time were doing so for a cannabis addiction. Data for 2013-14 show this has almost doubled to 17 per cent. Figures also suggest there is a particular issue with young people – 43 per cent of those aged 18-24 who were presenting to treatment for the first time were doing so due to a cannabis addiction. This report also comes weeks after an academic study found 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”.

Source:  http://www.centreforsocialjustice.org.uk/

It started with a wine cooler, said Paige Cederna, describing that first sweet, easy-to-down drink she experienced as a “magic elixir.” 

“I had no inhibitions with alcohol,” said Ms. Cederna, 24. “I could talk to guys and not worry about anyone judging me. I remember being really proud the day I learned to chug a beer. I couldn’t get that feeling fast enough.” But before long, to get over “that feeling,” she was taking Adderall to get through the days.

But it was now more than three years since she drank her last drop of alcohol and used a drug for nonmedical reasons. Her “sober date,” she told the group, many nodding their heads encouragingly, was July 8, 2011.

Ms. Cederna’s story of addiction and recovery, told in a clear, strong voice, was not being shared at a 12-step meeting or in a treatment center. Instead, it was presented on a cool autumn day, in a classroom on the campus of the University of Michigan in Ann Arbor, to a group of 30 undergraduate students in their teens and early 20s.

On the panel with Ms. Cederna were two other Michigan graduate students. Hannah Miller, 27, declared her “sober date” as Oct. 5, 2010, while Ariel Britt, 29, announced hers as Nov. 6, 2011. Like Ms. Cederna’s, Ms. Britt’s problems with drugs and alcohol started in her freshman year at Michigan, while Ms. Miller’s began in high school. All three are participants in a university initiative, now two years old, called the Collegiate Recovery Program.

Staying sober in college is no easy feat. “Pregaming,” as it is called on campus (drinking before social or sporting events), is rampant, and at Michigan it can start as early as 8 a.m. on a football Saturday. The parties take place on the porches and lawns of fraternities, the roofs and balconies of student houses, and clandestinely in dormitories — everywhere but inside the academic buildings.

For this reason — because the culture of college and drinking are so synonymous — in September 2012 the University of Michigan joined what are now 135 Collegiate Recovery communities on campuses all over the country. While they vary in size from small student-run organizations to large embedded university programs, the aim is the same: to help students stay sober while also thriving in college.

“It shouldn’t be that a young person has to choose to either be sober or go to college,” said Mary Jo Desprez, who started Michigan’s Collegiate Recovery Program as the director of Michigan’s Wolverine Wellness department. “These kids, who have the courage to see their problem early on, have the right to an education, too, but need support,” she said, calling it a “social justice, diversity issue.” Matthew Statman, the full-time clinical social worker who has run Michigan’s program since it began in 2012, added, “We want them to feel proud, not embarrassed, by their recovery.”

At the panel presentation, Ms. Britt, who temporarily dropped out of Michigan as an undergraduate, shared with the students her anxiety when she finally sobered up and decided to return to campus. “I had so many memories of throwing up in bushes here,” she said. “I wanted to have fun, but I also had no idea how to perform without partying.”

Ms. Cederna also remembers what it felt like to return to Michigan sober her senior year. Not only did she lose most of her friends (“Everyone I knew on campus drank,” she said), but she also dropped out of her sorority (“I was only in it to drink,” she said). “I ended up alone in the library a lot watching Netflix,” she said. Molly Payton, 24 (now a senior who once fell off an eight-foot ledge, drunk and high at a party), said, “I read all the Harry Potter books alone in my room my first months clean.”

Everything changed, however, when these students learned there were other students facing the same issues. Ms. Cederna first found Students for Recovery, a small student-run organization that, until the Collegiate Recovery Program began, was the only available support group on Michigan’s campus besides local 12-step meetings, most of which tend toward an older demographic.

“Through S.F.R., I ended up having five new friends,” she said of the organization, which still exists but is now run by the 25 to 30 Collegiate Recovery Program students; both groups meet every other week in the health center. The main difference between the two is that students in the Collegiate Recovery Program have to already be sober and sign a “commitment contract” that they will stay clean throughout college through a well-outlined plan of structure. Students for Recovery is aimed at those who are still seeking recovery, may be further into their recovery or want to support others in recovery.

When a young student incredulously asked the panel, “How do you possibly socialize in college without alcohol?” Ms. Britt, Collegiate Recovery Program’s social chairwoman, rattled off a list of its activities — sober tailgates, a pumpkin-carving night, volleyball games, dance parties, study groups, community service projects and even a film screening of “The Anonymous People” that attracted some 600 students. “But we also just hang out together a lot,” she said.

Indeed, looking around the organization’s lounge just before the holidays (a small, cordoned-off corner on the fourth floor of the health center, minimally decorated with ratty couches, a table and a small bookshelf stocking titles like “Wishful Drinking” and “Smashed”), it was hard to believe some of these young adults were once heroin addicts who had spent time in jail. On the contrary, they looked like model students, socializing over soft drinks and snacks as they celebrated one student who had earned back his suspended license.

“By far the biggest benefit to our students in the recovery program is the social component,” said Mr. Statman, who is hoping a current development campaign may provide more funding. (The program is currently supported by a mandatory student health tuition fee.) “Let’s just say, we all wish we could be Texas Tech,” he said.

The Collegiate Recovery Program was established at Texas Tech decades ago, and it is now one of the largest, with 120 recovery students enrolled (along with Rutgers University and Augsburg College in Minneapolis). Thanks to a $3 million endowment, the Texas Tech program now offers scholarships as well as substance-free trips abroad. The students there have access to an exclusive lounge outfitted with flat-screen TVs, a pool table and a Ping-Pong table, kitchen, study carrels and a seminar room. Entering freshmen in recovery even have their own dormitory.

“We found that simply putting them on the substance-free halls didn’t work,” said Kitty Harris, who, until recently, was the director for more than a decade of Texas Tech’s program (she remains on the faculty). “Most of the kids on substance-free floors are just there to make their parents happy.” (The Michigan students in the recovery program mostly live off campus for the same reason; they do not have their own housing.)

“Most students begin experimenting innocently in college with drugs and alcohol,” said Mr. Statman, who just celebrated his 13th year in recovery. “Then there are the ones who react differently. They are not immoral, pleasure-seeking hedonists, they are simply vulnerable, and for their whole life.”

Rates of substance-use disorders triple from 5.2 percent in adolescence to 17.3 percent in early adulthood, according to 2013 data from the Substance Abuse and Mental Health Services Administration. It thus makes this developmental stage critical to young people’s future.

It is at the drop-in Students for Recovery meetings where one often sees nervous new faces. At the beginning of one meeting at Michigan last semester, a young woman introduced herself as, “One day sober.” Shortly afterward, a young man spoke up, “I am five days sober.” Danny (who asked that his last name not be published), a graduating recovery program senior applying to medical schools, later explained an important tenet all of them know from their various 12-step programs. “The most important person in the room is the new person,” he said, adding that after the Students for Recovery meetings, members try to approach any new participants, directing them to the C.R.P. website and to Mr. Statman, who is always on call for worried students.

“In the same way a diabetic might not always get their sugar levels right, part of addiction is relapsing, and we really don’t want our students to see that as a failure if it happens,” said Mr. Statman, adding that it is often the other students in the program who tell him if they suspect a student is using again.

Jake Goldberg, 22, now a junior, arrived at Michigan three years ago as a freshman already in recovery. “I did really well the first five months,” he said. “I was sober. I was loud and proud on panels, but I had internal reservations. I had few friends and felt like I wanted to be more a part of the school.” He recalled that in the spring of his freshman year, he suddenly found himself trying heroin for the first time. “I should have died,” he said, remembering how he woke up 14 hours later, dazed and bruised.

After straightening up, Mr. Goldberg relapsed again his sophomore year when he thought he might be able to have just one drink. “That drink led to drugs and to more drinking,” he said, remembering how Mr. Statman and Ms. Desprez called him into their office one day. “They told me this is not going to end well,” he said. Now sober two years, Mr. Goldberg said: “I now live recovery with all the structure, but I also am in a prelaw fraternity. When they drink a beer, I drink a Red Bull.”

Ms. Miller echoed Mr. Goldberg’s feelings over coffee one day on the Michigan campus. “Most of us did not get sober just to go to meetings all the time,” she said. “We want to live life too.” She also said that socializing with nonrecovery students is still challenging. “I went to a small party recently where everyone was eating pot edibles and drinking top-shelf liquor,” she said. “I got a bit squirrely in my head and had to leave.”

But now students in the Collegiate Recovery Program have a new place in Ann Arbor they can frequent: Brillig Dry Bar, a pop-up, alcohol-free spot that serves up spiced pear sodas and cranberry sours and features live jazz. And in March, four of the students in the program are joining dozens of recovery students from other colleges on a six-day, five-night, “Clean Break” in Florida, arranged by Blue Community, an organization that hosts events and vacations for young adults in recovery. (The vacation package includes music, guest speakers, beach sports and daily transport to local 12-step meetings.)

“My hope is that we continue to get more students who need a safe zone to our social events,” said Ms. Britt, who is about to publicize a “sober skating night” in March at the university ice rink. “They would see you can have a lot of fun in college without drinking.

“And honestly, we really do have fun.”

  source: http://mobile.nytimes.com/2015/03/01/style/not-the-usual-college-party-

The main points are that it seems to target teens and college students and could easily be abused by underage persons. Powdered alcohol comes in packets and can be hidden from parents and  teachers, and sneaked into homes, schools, parties, bars, etc. The product may be abused by making it with less liquid (concentrating the alcohol), possibly snorting it. Underage drinking prevention is the main concern. Senator Flores is sponsoring senate bill 536 which would ban Palcohol/ powdered alcohol. Several other states have already banned it. AG Pam Bondi wants it banned. 

The makers of powdered alcohol, Palcohol, say it will be available for sale soon, but several states are already moving to ban the product. So far, Alaska, Delaware, Louisiana, South Carolina and Vermont have banned Palcohol – even though it is not yet available – and Florida, New York, Virginia and several other states are also considering a ban. Florida Attorney General Pam Bondi publicly announced that prohibiting the product is one of her legislative priorities this year. Bondi said, “We want to flat-out ban it in our state.” 

Palcohol is powdered alcohol, developed by Mark Phillips. Phillips said he wanted a “refreshing adult beverage” after engaging in activities such as biking or kayaking, where carrying large bottles of alcohol was not possible. He then spearheaded the creation of powdered alcohol. The product is available either in V powder, which is quadruple-distilled vodka, or R powder, which is premium Puerto Rican rum. Simply add water to the powder and you have an alcoholic beverage.

According to the Palcohol website, Palcohol will be sold in one ounce packages that contain the equivalent of one shot of alcohol each. Each bag is about 80 calories and is gluten-free. The website also notes that Palcohol is “for the legitimate and responsible enjoyment by lawful consumers.” The website explains it can be used by “outdoors enthusiasts such as campers, hikers and others who wanted to enjoy adult beverages responsibly without having the undue burden of carrying heavy bottles of liquid.” Or “adult travlers journeying to destinations far from home could conveniently and lawfully carry their favorite cocktail in powder format.”

Phillips is known in the wine community for producing and hosting the television show, “Enjoying Wine with Mark Phillips” and his book, “Swallow This: The Progressive Approach to Wine.” He also served as a wine expert to the Smithsonian.
However, Palcohol has faced difficulty almost from the beginning. Last April, the Alcohol and Tobacco Tax and Trade Bureau approved the product. However, 13 days later, it rescinded its approval and said it had issued the approval “in error.” The TTB announced, “Those label approvals were issued in error and have since been surrendered.”

As soon as the product hit the media headlines, criticism exploded over the possibility of minors gaining access to the product and users snorting the powdered alcohol. Palcohol dismisses these concerns and counters them on its web site. It notes that snorting the product is “painful” and “impractical…It takes approximately 60 minutes to snort the equivalent of one shot of vodka. Why would anyone do that when they can do a shot of liquid vodka in two seconds?”

The company also says it is not easier to “sneak into venues” and because it does not dissolve instantly, it can’t be used to spike a drink. Finally, the company says kids will not have easier access to powdered alcohol than to regular alcohol.
Unfortunately, however, early versions of the Palcohol web site did not help its cause. SB Nation reported that Palcohol’s website originally included the following wording:
Let’s talk about the elephant in the room….snorting Palcohol. Yes, you can snort it. And you’ll get drunk almost instantly because the alcohol will be absorbed so quickly in your nose. Good idea? No. It will mess you up. Use Palcohol responsibly.
Palcohol subsequently removed that wording and explained, “There was a page visible on this site where we were experimenting with some humorous and edgy verbiage about Palcohol. It was not meant to be our final presentation of Palcohol.”
Despite the controversy, the company says it will be available this Spring. It also is planning to introduce powdered cocktails, including Cosmopolitan, Mojito, and “Powderita,” which it says takes like a Margarita, and Lemon Drop.
However, so far, it is unclear where exactly you will be able to buy it.

 Source:  http://www.commdiginews.com/life/controversy-brews-over-powdered-alcohol-34291/   January 31, 2015 

In 1990s Britain a common reaction to allocating resources to treating cannabis users was, ‘Why bother? We have more than enough patients with problems with serious drugs like heroin.’ Calls for a treatment response were seen as pathologising what in many societies is both normal and in some ways desirable youth development: trying new experiences, challenging conventions, exposing the hypocrisy of alcohol-drinking adults. The typically calming use of the drug by adults was seen as preferable to the main alternative, alcohol and its associated violence and disorder. 

Those views retain some validity for the vast majority of cannabis users, but this has become, and/or become seen more clearly as, a drug with a problem tail which justifies therapeutic intervention. As heroin use and treatment numbers fall way, cannabis treatment numbers are on the rise – not, according to Public Health England, because more people are using the drug, but perhaps because services relieved of some of the recent pressure of opiate user numbers are giving more priority to cannabis, because they are making themselves more amenable to cannabis users, and because stronger strains of the drug are creating more problems.

Cannabis accounts for half of all new drug treatment patients

Whatever the causes, across the UK figures submitted to the European drug misuse monitoring centre show that the proportion of patients starting treatment for drug problems who did so primarily due to their cannabis use rose steadily from 11% in 2003/04 to 27% in 2013, that year amounting to about 27,270 individuals. Among first ever treatment presentations, the increase was more pronounced, from 19% to 49%, meaning that by 2013 their cannabis use had became the main prompt for half the patients who sought treatment for the first time  chart right. Showing that more users was not the reason for more starting treatment, over about the same period, in England and Wales the proportion of 16–59-year-olds who in a survey said that had used cannabis in the past year fell from about 11% to about 7% in 2013/14, having hovered at 6–7% since 2009/10.

The treatment figures largely reflect trends in England, where in 2013/14 the number of patients starting treatment due primarily to their cannabis use had continued to rise to 11,821, 17% of all treatment starters, up from around 7,500 and 9% just seven years before. The greater ‘stickiness’ of opiate use meant that in the total treatment population – new and continuing – the proportionate trends were less steep, cannabis numbers rising from around 11,000 in 2005/06 to 17,229 in 2013/14, and in proportion from 6% to 9%. Among younger adults, cannabis dominates; in 2013/14, far more 18–24s started treatment for cannabis than for opiate use problems – 5,039 versus 3,142 – and they constituted 43% of all treatment starters.

Further down the age range, among under-18s in treatment in England, cannabis is even more dominant. In 2013/14, of the 19,126 young people who received help for alcohol or drug problems, 13,659 or 71% did so mainly in relation to cannabis, continuing the generally upward trend since 2005/06.

Though the crime reduction justification for treating adult heroin and crack users is not so clear among young cannabis users, still immediate impacts plus the longer term benefits of forestalling further problems has been calculated to more than justify the costs of treating under-18 patients, among whom cannabis is the major player.

Cannabis users rarely stay in long-term treatment

Relative to the main legal drugs, at least in the USA dependence on cannabis is more quickly overcome. A survey of the US general adult population found that within a year of first becoming dependent, 3% each of smokers and drinkers were in remission and remained so until they were surveyed. For cannabis the figure was nearly 5% and for cocaine, nearly 9%. After ten years the proportions in remission had risen to 18% for nicotine, 37% for alcohol, 66% for cannabis and 76% for cocaine  chart right. About 26 years after first becoming dependent, half the people at some time dependent on nicotine were in remission, a milestone reached for alcohol after 14 years, for cannabis six years, and for cocaine, five.

Unlike heroin users, regular users of cannabis have been seen as sufficiently amenable to intervention to warrant trying brief interventions along the lines established for risky but not dependent drinkers, and sufficiently numerous in some countries to make routine screening in general medical and other settings a worthwhile way of identifying problem users. When the World Health Organization trialled its ASSIST substance use screening and brief advice programme in Australia, India, the United States and Brazil, just over half the identified patients (all had to be at moderate risk of harm but probably not dependent) were primarily problem cannabis users. Among these, risk reduction in relation to this drug was significantly greater among patients allocated to a brief advice session than among those placed on a three-month waiting list for advice. In each country too, risk reduction was greater among intervention patients, except for the USA, where the order was reversed. Suggesting that severity of use was not a barrier to reacting well to brief intervention, only patients at the higher end of the moderate risk spectrum further reduced their cannabis use/risk scores following intervention. The ASSIST study was confined to adults, but young people in secondary schools in the USA whose problem substance use focused mainly on cannabis also reacted well to brief advice.

In some studies brief interventions have been found to work just as well as more intensive treatment, but when the patients are heavily dependent, and the most difficult cases are not filtered out by the research, longer and more individualised therapies can have the advantage. These studies on adults might not translate to adolescents, for whom approaches which address family, school and other factors in the child’s environment are considered most appropriate for what are often multiply troubled youngsters.

The relative persistence of opiate use problems and transitory nature of those primarily related to cannabis seemed reflected in an analysis of treatment entrants in England from 1 April 2005 to the end of 2013/14. At the end of this period just 7% of primary cannabis users were still in or back in treatment compared to the 30% overall figure and 36% for primary opiate users. The figure peaked at 43% for users of opiates and crack. Over half – 53% – of primary cannabis users had left treatment as planned, apparently having overcome their cannabis problems, compared to 27% of primary opiate users and just 20% with dual opiates and crack use problems. Another 40% of cannabis users had left treatment in an unplanned manner not having overcome their dependence, a slightly higher proportion than among opiate users. The figures tell a tale of relatively high level of success which enables cannabis users to leave treatment, though even in the absence of recorded success, few stay long-term.

However, the forms patients in England complete with their keyworkers while in treatment seem to tell a different story. Compared to how they started treatment, around six months later 45% of primary cannabis users were assessed as using just as often (including a few using more), compared to 29% of opiate users and 38% whose main problem drugs were both opiates and crack, suggesting more rapid and/or more complete remission for opiate users than for cannabis users. One interpretation is that the widespread use of substitute drugs like methadone more reliably reduced the illegal opiate use of opiate users and also helped retain them in treatment, while cannabis users tended quickly to leave treatment, having done well or not. However, these figures relate only to patients who completed the forms at their six-month review, which in practice could have happened anywhere from about one to six months after their assessment for treatment. What proportion of primary cannabis users were still in treatment at that point and available to complete the forms is not clear, but they may have been the patients whose problems were deep seated enough to require extended treatment.

These are some of the issues thrown up by a set of patients and a set of interventions rather different from those associated with the drugs treatment in the UK has normally focused on. If current trends continue, understanding the findings of these and other studies will become yet more important to British treatment services.

Source:  www.findings.org.uk     03 March 2015

Image

Painkiller addicted baby

 Doctors in the United States are seeing more infants born addicted to narcotic painkillers — a problem highlighted by a new Florida-based report.

These infants experience what’s called neonatal abstinence syndrome as they undergo withdrawal from the addictive drugs their mothers took during pregnancy. Most often these are narcotic painkillers, such as oxycodone, morphine or hydrocodone, according to the report from the U.S. Centers for Disease Control and Prevention.  Since 1995, the number of such newborns jumped 10-fold in Florida while tripling nationwide, the researchers said.

“These infants can experience severe symptoms that usually appear within the first two weeks of life,” said lead researcher Jennifer Lind, a CDC epidemiologist.    The symptoms can include seizures, fever, excessive crying, tremors, vomiting and diarrhea, she said. And withdrawal can take a few weeks to a month.

Dr. David Mendez is a neonatologist at Miami Children’s Hospital. He said, “Being in Florida, I can tell you there’s been an explosion in the number of babies going through neonatal abstinence syndrome. It’s clearly related to the exposure moms have to all narcotic painkillers.”

Mendez said the infants go through a difficult time, but they do recover.  Sometimes it’s enough to keep these babies in a quiet environment, but almost four out of five need treatment with morphine or the anticonvulsant phenobarbital to quell seizures and other withdrawal symptoms, Lind said.

The report — which used data from three Florida hospitals — cites a need for improved counseling and treatment of drug-abusing and drug-dependent women earlier in pregnancy.   Previous studies have found that addiction to narcotic painkillers can increase the risk for premature births, low birth weight and birth defects, Lind said. “Some of the birth defects are heart defects and defects of the brain and the spine,” she said.  “More studies are needed to look at long-term outcomes,” she added.

In 2009, the national incidence of neonatal abstinence syndrome was 3.4 per 1,000 births, less than Florida’s total of 4.4 per 1,000 births, according to background information in the report. Florida officials, alarmed by the increase, last year asked the CDC for help in assessing the problem.  According to the report, 242 infants with neonatal abstinence syndrome were identified in three Florida hospitals in the two-year period from 2010 to 2011.

The researchers found that 99.6 percent of these babies had been exposed to narcotic painkillers and had serious medical complications, according to the March 6 issue of the CDC’s Morbidity and Mortality Weekly Report.   Nearly all of the addicted infants required admission to the neonatal intensive care unit, and average length of stay was 26 days, the investigators found.  The condition is very expensive to treat, Lind said.

Mendez added that lengthy hospital stays aren’t just for treatment. “Some of it is due to the social issues that affect these babies,” he said.  The mothers are often incapable of caring for their babies, Mendez explained. “Hospitals become the babysitter while social services arrange for a new home for the baby,” he said.  Lind said that only about 10 percent of the babies’ mothers had been referred for drug counseling or rehabilitation during pregnancy, even though many tested positive for drugs in urine tests.

Neonatal abstinence syndrome is preventable simply by not taking drugs or by getting treatment for addiction, she said.  From conception on, a pregnant woman is responsible for another human being, Mendez stressed. “Anything a woman does to herself she does to her baby. So if you are engaged in high-risk behavior, if you are taking drugs, they are going to impact the baby,” he said.

Source:  health.usnews.com   6th March 2015

A lot of times, a simple “no thanks” may be enough. But sometimes it’s not. It can get intense, especially if the people who want you to join in on a bad idea feel judged. If you’re all being “stupid” together, then they feel less self-conscious and don’t need to take all the responsibility. 

But knowing they are just trying to save face doesn’t end the pressure, so here are a few tips that may come in handy.

1. Offer to be the designated driver. Get your friends home safely, and everyone will be glad you didn’t drink or take drugs.

2. If you’re on a sports team, you can say you are staying healthy to maximize your athletic performance—besides, no one would argue that a hangover would help you play your best.

3. “I have to [study for a big test / go to a concert / visit my grandmother / babysit / march in a parade, etc.]. I can’t do that after a night of drinking/drugs.”

4. Keep a bottled drink like a soda or iced tea with you to drink at parties. People will be less likely to pressure you to drink alcohol if you’re already drinking something. If they still offer you something, just say “I’m covered.”

5. Find something to do so that you look busy. Get up and dance. Offer to DJ.

6. When all else fails…blame your parents. They won’t mind! Explain that your parents are really strict, or that they will check up on you when you get home.

If your friends aren’t having it—then it’s a good time to find the door. Nobody wants to leave the party or their friends, but if your friends won’t let you party without drugs, then it’s not going to be fun for you.

Sometimes these situations totally surprise us. But sometimes we know that the party we are going to has alcohol or that people plan to do drugs at a concert. These are the times when asking yourself what you could do differently is key to not having to go through this weekend after weekend.

Source:   www.teens.drugabuse.gov      March  9th 2015

Teens Affected by Addiction is a project aimed at raising awareness about the impact of alcoholism on families – here, they share some personal stories. 

Here, four people who grew up with an alcoholic parent share their stories.  These stories have been collected by ‘Teens Affected by Addiction’, a Young Social Innovators project from Mount Mercy College in Cork, Ireland,  with the aim of raising awareness about how addiction impacts children.

“I will never get my childhood back”

“My life as a child of an alcoholic parent was frightening and lonely. My dad was a chronic alcoholic. I had a different childhood to all my friends: no birthday parties, couldn’t invite friends over to the house, and Christmas was a nightmare.

There was no one I could talk to and no one could help me, I just had to put up with it.

When I was 17 I had no choice but to leave home. I had to live my own life. My mother was heartbroken but she knew I had to go.

When I was 18, I was able to get counselling which was a great help to me. I was able to understand that alcoholism was an illness. A few months after leaving home my dad turned his life around and stopped drinking.

I will never get my childhood back but I now have a great relationship with my father and my mother now has the life she deserves. I hope this story can give other children some hope and let them know that there is a light at the end of the tunnel.”

*******

“Missing you”

The following is a short poem a woman sent to us about her father’s alcoholism.

I don’t miss the sense of invisibility to you, 

I don’t miss listening constantly for the front door,
I don’t miss watching your face to decipher your mood,
I don’t miss dodging your verbal assaults,
I don’t miss the sense of being so small,
I don’t miss the enormity of you and your drink,
I don’t miss the deep shame,
I don’t miss everyone covering up for you,
I don’t miss everyone knowing but me,
I don’t miss the smell of drink,
I don’t miss the fear of drink,
I don’t miss my friends knowing,
I don’t miss no-one caring about me,
I don’t miss fear,
I don’t miss loving you,
I don’t miss hating you,
I don’t miss you.

******* 

 “We had food in the house but it wasn’t for us – it was for the social worker to see.”

“My alcoholic parent was my mother. She always drank. She started when she was young. When she was a child her father abused her and her brothers. They were battered by their father constantly. They locked their doors every night to keep their father out. She was beaten badly and was always expected to act like a lady. She started drinking to forget the pain she had to go through. This doesn’t make what she did to her children any bit forgivable.

When I was a child my uncle and aunts tried to take me away from my home by taking me on day trips with my sister. Back then I thought my mother would heal. My sister and I used to beg my uncle and aunts to bring us home so we could mind our mother. We didn’t want to upset her by being away for too long. One of my uncles was like a father to me. His oldest daughter and I look like brother and sister. We are just as close too. They tried to help me and give me a better life but they couldn’t.

My mom had a lot of ‘boyfriends’. They never really stayed too long. A small few used to beat me. These men were constantly in our house so we never really questioned a strange man in our house. It was normal for us.

At 15 years old I would come home from school and meet up with my mother and grandmother in the pub. My mother would buy me beer and I would sit in the pub with my drunken mother and help her get home. My home was filthy. There used to be dogs running through the house constantly and the house was never cleaned. We had food but it wasn’t for us. The food was perfect but we were not allowed eat it as it was only for when the social workers called so it would look like she was feeding us. In reality we were starving.

I started hanging out with a very rough group where I lived. They were drinking constantly and doing drugs. Eventually, I got away from them and my mother. I ran from Ireland at 16 to the States to my father. My sister was so upset with me for leaving her with my mother back in Ireland.

Now I’m living in America with a beautiful wife and three amazing children. Sometimes what happened still affects me but I try to block it out and ignore it and carry on. I’m honestly not recommending running away. I am planning on coming back to Ireland soon to sort out a few things with my mother.

*******

“I’ve never not known Mum to have her cans by her chair and her vodka stashed away under the bed”

Well to begin with there’s a common misconception that men are generally the alcoholics in a family but when it’s the mother, the nucleus of the family is destroyed and everything falling apart becomes an inevitable fate. I come from a small family with it just being my mum, dad and my brother and I. We’ve been battling with my mother’s alcoholism for as long as I remember, I’ve never not know her to have her cans by her chair and her vodka stashed away under the bed. It wasn’t that I always saw it as the norm but when you don’t know any different it does tend to be a bit more difficult to imagine the situation differently. I’m actually very happy to see the back of 2014 as from December 2013 my whole family spiralled out of control and I spent more times in hospital than anywhere else. My parents split in December 2013 after 21 years married (I am 20 years old) my mum’s alcoholism was at its peak. Having been in and out of hospital for the past six years due to liver failure, she was on a path to destruction. In those months, mum had fallen whilst drunk and tried to hit my father with a golf club and broke her femur. She had several serious operations and she nearly died as her blood is extremely thin due to medication and alcoholism. Mum came out of hospital and continued to drink and began running around saying that she was fine and could walk. She fell hundreds of times and it became so bad she now can’t walk properly. I live with my grandmother, having left school at 17 as I suffered from depression and I went back to do my Leaving Cert and moved out of my home. Within months a series of events led to both my father and brother leaving and moving into an apartment and my mum was left wallowing in her drunken states ringing and abusing everybody (she still does this).I contacted the HSE in January 2014 with several emails sent to all organisations that support victims of alcoholism, I got a lot of reaction. I was furious that I spent years sitting in my mothers’ doctor’s surgery with my dad begging for ways out. They would always look at us helplessly and say “move out”. I felt embarrassed and as if there were no light at the end of the tunnel. My grandmother who I live with and who’s been a mother to me all my life has had a nervous breakdown and right now I spend my days working eight hour shifts as a photographer in a studio and then I go home to this mess. 

My mum has been in hospital about eight times since February 2014 when a stomach ulcer burst and she was found in a pool of blood by my grandmother. I soon lost faith but I always tried to get help; my letter to the HSE got me six months with a councillor but I was so busy with my Leaving Cert and everything I just couldn’t find time to go.

Now I am still living with this situation but I try my very best to overcome it every day and I refuse any kind of medication such as an “anti depressant” as I believe it’s just a easy way for doctors to dose people up and make money. I wish to study politics and history and possibly then business in university in the future and I hope that one day I can actually help people.

These stories are shared by ‘Teens Affected by Addiction’, a Young Social Innovators project from Mount Mercy College in Cork. The students have recently received funding from the YSI Den to publish a book with the stories of adults who grew up with an addict in the home. 

 Please see www.teensaffectedbyaddiction.com or email:  affectedbyaddictionysi@gmail.com if you would like to share your story.

Follow Teens Affected by Addiction on Twitter: @affbyaddiction

Source:   www.thejournal.ie    March 2015

Though many young people seem to perceive marijuana as harmless, its use may pose serious risk for adverse behaviors and health consequences.

An extensive research review published June 5 in the New England Journal of Medicineconcluded that marijuana use is linked to multiple adverse effects—particularly in youth.

“Despite some contentious discussions regarding the addictiveness of marijuana, the evidence clearly indicates that long-term marijuana use can lead to addiction,” said lead author Nora Volkow, M.D., director of the National Institute on Drug Abuse (NIDA), and three of NIDA’s top officials.

Stanimir G.Stoev/Shutterstock

According to the 2012 National Survey on Drug Use and Health, marijuana is the most commonly used “illicit” drug in the United States, with an estimated 12 percent of people aged 12 or older reporting its use in the prior year. The 2013 Monitoring the Future Survey—supported by NIDA—found that 6.5 percent of 12th graders report daily or near-daily marijuana use, with 60 percent perceiving regular use of marijuana not to be harmful (Psychiatric News, February 6). Volkow and colleagues suggested that as more states move toward policies that legalize cannabis for medical or recreational purposes, rates for marijuana use among teenagers and young adults will increase, as will the negative health consequences associated with its use.

“The regular use of marijuana during adolescence is of particular concern, since use by this age group is associated with an increased likelihood of deleterious consequences,” Volkow and colleagues cautioned.

The review, “Adverse Health Effects of Marijuana Use,” provided science-based reasoning to explain the onset of marijuana addiction and gave an overview of the adverse health consequences associated with marijuana use from data of 77 studies and literature reviews.

From animal studies, the authors concluded that exposure to tetrahydrocannabinol (THC)—the primary psychoactive chemical in cannabis—in early life can recalibrate the dopaminergic system, the reward system of the brain, to become more sensitive to stimulation with drugs. The authors speculated that the findings may help to explain the increased vulnerability to abuse of marijuana and other substances in later life, which have been reported by adults who initiated cannabis use during adolescence.

The review also highlighted studies showing an association between marijuana use and impaired regions of the human brain, including the precuneas, a key node that is involved in alertness and self-conscious awareness, and the hippocampus, which is important in learning and memory. Other adverse consequences of cannabis use included impaired driving, lowered IQ scores into adulthood, and a potential risk to exacerbate psychotic symptoms in those with mental disorders. The review suggested that risks for adverse effects increase when the drug is used along with alcohol.

“Some physicians continue to prescribe marijuana for medicinal purposes despite limited evidence of a benefit,” noted Volkow and colleagues. “Because older studies are based on the effects of marijuana containing lower levels of THC, stronger adverse health effects may occur with the use of today’s more-potent marijuana.”

The authors emphasized that more research must be done on the potential health consequences of second hand marijuana smoke, the long-term impact of prenatal cannabis exposure, and the effects of marijuana legalization policies on public health.

“It is important to alert the public that using marijuana in the teen years brings health, social, and academic risk,” said Volkow. “Physicians in particular can play a role in conveying to families that early marijuana use can interfere with crucial social and developmental milestones and can impair cognitive development.”

Source: http://psychnews.psychiatryonline.org/ June 26, 2014

On Nov. 4, Alaskans will consider Ballot Measure 2, an initiative to legalize the sale and use of marijuana for recreational purposes. And those who support that commercial trade are investing heavily in hoping you will vote “yes.” Make no mistake about it, marijuana — like tobacco and alcohol — is big business.

Like alcohol and tobacco, the costs of marijuana to public health, public safety, our youth and lost productivity, are similarly high. It’s not surprising that Outside investors would regard Alaska as fertile territory for unconditional legalization.

In 1975, our Supreme Court found a right for Alaskans to consume small amounts of marijuana in their homes in the privacy provisions of the Alaska Constitution. And in 1998, Alaskans voted to legalize marijuana for medical purposes with 58 percent support. But Ballot Measure 2 is not about “medical marijuana,” nor is it necessary in order to protect adult Alaskans who consume marijuana in their homes from police intrusion. The measure is less about freedom than it is about profit at the expense of public health. That’s why I plan to vote “no” on Ballot Measure 2.

I came to this decision after careful consideration of the medical evidence. My guide through the scientific literature was Dr. Nora Volkow, the director of the National Institute on Drug Abuse (NIDA). Earlier this year, Dr. Volkow published a peer-reviewed paper about the health effects of marijuana in the New England Journal of Medicine, one of the nation’s most eminent medical publications. Volkow directs a component of our National Institutes of Health which is, of course, neutral on state level policy initiatives. Fortunately for all of us, NIH does not prohibit its scientists from entering the discussion by objectively sharing the science with policymakers and the public.

Here’s what Volkow has to say about the state of the evidence: “The popular notion seems to be that marijuana is a harmless pleasure, access to which should not be regulated or considered illegal.”

However popular notions are not always correct. One of the detrimental effects is addiction. “The evidence clearly indicates that long term marijuana usage can lead to addiction,” Volkow states. “About 16 (percent) of those who begin marijuana usage as teenagers will become addicted. And there seems to be a strong association between repeated use and addiction. About a quarter to a half of those who use marijuana everyday are addicted. …Marijuana use by adolescents is particularly troublesome.”

Those who begin using marijuana as teenagers, when the brain is still developing, are two to four times more likely to demonstrate dependence symptoms within two years of first use than those who first use marijuana as adults. And since marijuana use “impairs critical cognitive functions … for days after use many students could be functioning at a cognitive level that is below their natural capability for considerable period of times,” according to Volkow.

These effects could be even longer lasting. Adults who smoked marijuana during adolescence have fewer fibers in specific brain regions that are important to things like alertness, self-consciousness, learning and memory.

NIDA-funded research provides some support for long standing fears that use of marijuana may be a gateway to use of other drugs with even greater known adverse health effects. Truthfully, the same may be said of alcohol and tobacco. Whether the mechanism is chemical, cultural or some combination of the two, is less well known. No evidence is cited to suggest that marijuana use keeps young people away from other drugs.

The prevalence of impaired driving in Alaska is well known and deeply troublesome. On this, Volkow observes that “both immediate and long term exposure to marijuana impair driving ability; marijuana is the illicit drug most frequently reported in connection with impaired driving and accidents, including fatal accidents.” Moreover, the mixing of marijuana and alcohol can further exacerbate the dangers to public safety.

Perhaps the most startling revelation of Volkow’s research is that all marijuana is not alike. The potency of marijuana is determined by its Tetrahydrocannabinol, or THC, content. Analysis of seized marijuana for sale on the street demonstrates that THC concentrations have been rising from about 3 percent in 1980 to about 12 percent today. Volkow suggests that this may be the reason for increased emergency room visits associated with marijuana and a higher level of fatal crashes. Also, the initiative specifically defines marijuana to include concentrates, which can contain 80-90 percent THC. Marijuana edibles would also be legalized and commercialized under the initiative. In Colorado, child-attractive edibles like lollipops, flavored drinks and gummy bears, with multiple doses of THC, are being sold.

Marijuana is a drug and with all drugs there are risks and benefits. Research suggests that use of marijuana or some of its component chemicals can be beneficial for the alleviation of a variety of medical conditions. But patients with these conditions benefit from discussions with their healthcare providers about the risks and benefits.

The state should examine the most appropriate access for this class of users. That said, the evidence that marijuana is harmful for non-medical use is growing. That should give Alaskans pause as we enter the voting booth.

I believe strongly in working for the health, safety, educational achievement, productivity and community welfare of Alaskans. That is why I am voting “no” on Ballot Measure 2.

Lisa Murkowski is a Republican U.S. Senator representing Alaska.

Source: www.juneauempire.com/opinion/2014-10-22

Young men who use cannabis may be putting their fertility at risk by inadvertently affecting the size and shape of their sperm, according to new research. In the world’s largest study to investigate how common lifestyle factors influence the size and shape of sperm, a research team found that sperm size and shape was worse in samples ejaculated in the summer months, but was better in men who had abstained from sexual activity for more than six days.

(Stock image) Credit: © milkovasa / Fotolia

In the world’s largest study to investigate how common lifestyle factors influence the size and shape of sperm (referred to as sperm morphology), a research team from the Universities of Sheffield and Manchester also found that sperm size and shape was worse in samples ejaculated in the summer months but was better in men who had abstained from sexual activity for more than six days.

However, other common lifestyle factors reported by men, including smoking cigarettes or drinking alcohol, appeared to have little effect.

The study, published in the medical journal Human Reproduction, recruited 2,249 men from 14 fertility clinics around the UK and asked them to fill out detailed questionnaires about their medical history and their lifestyle. Reliable data about sperm morphology was only available for 1,970 men and so the researchers compared the information collected for 318 men who produced sperm of which less than four per cent was the correct size and shape and a control group of 1,652 men where this was above four per cent and therefore considered ‘normal’ by current medical definitions.

Men who produced ejaculates with less than four percent normal sperm were nearly twice as likely to have produced a sample in the summer months (June to August), or if they were younger than 30 years old, to have used cannabis in the three month period prior to ejaculation.

Lead author Dr Allan Pacey, Senior Lecturer in Andrology at the University of Sheffield, said: “Our knowledge of factors that influence sperm size and shape is very limited, yet faced with a diagnosis of poor sperm morphology, many men are concerned to try and identify any factors in their lifestyle that could be causing this. It is therefore reassuring to find that there are very few identifiable risks, although our data suggests that cannabis users might be advised to stop using the drug if they are planning to try and start a family.”

Previous research has suggested that only sperm with good sperm morphology are able to pass into the woman’s body following sex and make their way to the egg and fertilize it. Studies in the laboratory also suggest that sperm with poor morphology also swim less well because their abnormal shape makes them less efficient. Dr Andrew Povey, from the University of Manchester’s Institute of Population Health, said: “This research builds on our study of two years ago which looked at the risk factors associated with the number of swimming sperm (motile concentration) in men’s ejaculates.

“This previous study also found that there were relatively few risk factors that men could change in order to improve their fertility. We therefore have to conclude again that there is little evidence that delaying fertility treatment to make adjustments to a man’s lifestyle will improve their chances of a conception.”

Although the study failed to find any association between sperm morphology and other common lifestyle factors, such as cigarette smoking or alcohol consumption, it remains possible that they could correlate with other aspects of sperm that were not measured, such as the quality of the DNA contained in the sperm head.

Professor Nicola Cherry, originally from the University of Manchester but now at the University of Alberta, commented on a recent companion paper published by the group in the Journal of Occupational and Environmental Medicine: “In addition to cannabis exposure shown in this paper, we also know that men exposed to paint strippers and lead are also at risk of having sperm with poor morphology.”

Source:

University of Sheffield. “Sperm size, shape in young men affected by cannabis use.” ScienceDaily. ScienceDaily, 4 June 2014. <www.sciencedaily.com/releases/2014/06/140604202946.htm>.

Moderate alcohol intake of at least 5 units every week is linked to poorer sperm quality in otherwise healthy young men, suggests research. And the higher the weekly tally of units, the worse the sperm quality seems to be, the findings indicate, prompting the researchers to suggest that young men should be advised to steer clear of habitual drinking.

They base their findings on 1221 Danish men between the ages of 18 and 28, all of whom underwent a medical examination to assess their fitness for military service, which is compulsory in Denmark, between 2008 and 2012.

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As part of their assessment, the military recruits were asked how much alcohol they drank in the week before their medical exam (recent drinking); whether this was typical (habitual); and how often they binge drank, defined as more than 5 units in one sitting, and had been drunk in the preceding month.

They were also invited to provide a semen sample to check on the quality of their sperm, and a blood sample to check on their levels of reproductive hormones.

The average number of units drunk in the preceding week was 11. Almost two thirds (64%) had binge drunk, while around six out of 10 (59%) said they had been drunk more than twice, during the preceding month.

The analysis showed that after taking account of various influential factors, there was no strong link between sperm quality and either recent alcohol consumption or binge drinking in the preceding month. But drinking alcohol in the preceding week was linked to changes in reproductive hormone levels, with the effects increasingly more noticeable the higher the tally of units.

Testosterone levels rose, while sex hormone binding globulin (SHBG) fell; similar associations were also evident for the number of times an individual had been drunk or had binge drunk in the preceding month. Almost half (45%, 553) of the men said that the quantity of alcohol they drank in the preceding week was typical of their weekly consumption.

And in this group the higher the tally of weekly units, the lower was the sperm quality, in terms of total sperm count and the proportion of sperm that were of normal size and shape, after taking account of influential factors. The effects were evident from 5+ units a week upwards, but most apparent among those who drank 25 or more units every week. And total sperm counts were 33% lower, and the proportion of normal-looking sperm 51% lower, among those knocking back 40 units a week compared with those drinking 1-5. Habitual drinking was associated with changes in reproductive hormone levels, although not as strongly as recent drinking, while abstinence was also linked to poorer sperm quality.

This is an observational study, so no definitive conclusions can be drawn about cause and effect. And the researchers point out that the findings could be the result of reverse causation — whereby men with poor quality sperm have an unhealthier lifestyle and behaviours to start with. But animal studies suggest that alcohol may have a direct impact on sperm quality, they say.

“This is, to our knowledge, the first study among healthy young men with detailed information on alcohol intake, and given the fact that young men in the western world [drink a lot], this is of public health concern, and could be a contributing factor to the low sperm count reported among [them],” they suggest.

And they conclude: “It remains to be seen whether semen quality is restored if alcohol intake is reduced, but young men should be advised that high habitual alcohol intake may affect not only their general health, but also their reproductive health.”

Source:

BMJ-British Medical Journal. “Moderate weekly alcohol intake linked to poorer sperm quality in healthy young men”ScienceDaily,2October2014.      <www.sciencedaily.com/releases/2014/10/141002221232.htm>.

Feb. 24, 2015 8:30am

Jennifer Kerns is a branded contributor to The Blaze and other publications where she writes about the 2nd Amendment, religious liberty, the future of the GOP, limited government battles and other political hot topics. She served as Spokeswoman for the historic Colorado recalls, as Spokeswoman for the California Republican Party, twice as an Appointee of Governor Arnold Schwarzenegger, and as Spokeswoman for Prop. 8 which went all the way to the U.S. Supreme Court.

During her career as a GOP strategist, she has been described as one of “the most relevant Press Secretaries in the West” — winning every major newspaper endorsement for her candidates. Proud of her ability to win over tough liberal reporters and coalitions, she made her mark by being the first known Press Secretary in history (Republican or Democrat) to win 52 unanimous endorsements from such liberal publications as the Los Angeles Times, San Francisco Chronicle and the Spanish-language La Opinion – arguably among the toughest Press Corps, in the most populous State in the nation.

What a long, strange trip it’s been for pot legalization in Colorado. First, the law came under fire last year for not protecting youth as scores of children were taken to emergency rooms after ingesting their parents’ pot edibles.

Just a few days ago, nine former heads of the Drug Enforcement Administration — both Republican and Democrat — signed onto an amicus brief urging the U.S. Supreme Court to overturn Colorado’s legalization of marijuana citing numerous public safety concerns.

Now, Colorado health professionals are coming forward to report an emerging trend: expectant mothers who are addicted to pot.

The emerging health crisis is creating what is undoubtedly our generation’s version of 1980s “crack babies.” Health practitioners specializing in the field of Obstetrics & Gynecology spoke to me on condition of anonymity to report an alarming rise in pregnant patients showing up in emergency rooms and doctors’ offices and presenting mysterious complications including abdominal pains, cold sweats, shakiness, insomnia, weight loss and a host of psychological problems. According to the physicians, as routine pot smokers cease consumption of marijuana upon learning they are pregnant, it can lead to violent or painful withdrawal from tetrahydrocannabinol — also known as THC — the addictive substance found in marijuana.

The emerging situation is not unlike babies who are addicted to crack.

Physicians say the exact cause and treatment of symptoms are initially difficult to pinpoint as patients either don’t admit to prior pot use, or aren’t aware that weeks-old or even months-old marijuana consumption can remain in the body and cause such withdrawals, thus affecting children in the womb.

While the physicians in Colorado commend pot users for refraining from the use of marijuana during pregnancy, they regret to inform the patient that it is the first step in a potentially long battle.

According to the Cleveland Clinic, the presence of THC in foetuses can lead to impairment of foetus growth and low birth weight.

The March of Dimes reports that the presence of marijuana can lead to premature birth. It can also create problems with brain development which may later affect a child’s “behavior, memory, problem-solving skills and ability to pay attention.” It can also create neonatal abstinence syndrome, in which a baby gets addicted to a drug before birth “then goes through withdrawal after birth.”

In order to treat symptoms as well as help alleviate the pain of the withdrawal process, the physicians in Colorado report they have had to reintroduce doses of THC to expectant mothers, which of course leaves their babies susceptible to addiction and the complications above which often must be treated in neonatal units. The emerging situation is not unlike babies who are addicted to crack.

Cases of THC addictions during pregnancy are so much on the rise that Colorado’s health professionals have begun to bone up on the subject matter of THC and other complications from pot.

At a recent three-day nursing conference, Colorado OB-GYN nurses spent the entire final day of the conference covering THC-related topics. All of this presents new challenges for Colorado which is already struggling to keep up with demands placed upon the state by Obamacare.

And now that another state has legalized pot, these cases could become an epidemic.

These gestations, which I call “pot pregnancies,” are yet another chapter in a legalization experiment that has gone horribly awry at an expense to public health and to children — both born and unborn — who have no say in the matter.

While the Colorado legislature rushes to fix many side effects of legalization one has to ask, “Does the benefit of legalizing this substance outweigh the risk to public health?”

Those who suggest it does are simply blowing smoke.

Source: http://www.theblaze.com/ 24th Feb. 2015

International Narcotics Control Board report says US and Uruguay are breaking drug treaties and warns of huge rise in abuse of ADHD treatment Ritalin

The United Nations has renewed its warnings to Uruguay and the US states of Colorado and Washington that their cannabis legalisation policies fail to comply with international drug treaties.

The annual report from the UN’s International Narcotics Control Board, which is responsible for policing the drug treaties, said it would send a high-level mission to Uruguay, which became the first country to legalise the production, distribution, sale and consumption of cannabis for recreational purposes.

The UN drug experts said they would also continue their dialogue with the US government over the commercial sale and distribution of cannabis in Colorado and Washington state.

The possession and cultivation of cannabis became legal on 26 February inWashington DC. Voters in Oregon and Alaska have also approved initiatives to legalise the commercial trade in cannabis for non-medicinal purposes.

The INCB said it “continues to engage in a constructive dialogue” with the US government on cannabis developments and it is clear the UN is putting strong pressure on the US government to ensure that the drug remains illegal at a federal level.

The US government has issued new guidance to banks on their provision of services to marijuana-related businesses and all state attorneys have been reminded of the need to investigate and prosecute cannabis cases in all states.

The INCB said it was aware that the US government intended to monitor the impact on public health of legalising cannabis and has again reminded the Obama administration that the position in Colorado and Washington meant the states were failing to comply with the treaties.

Lochan Naidoo, the INCB president, said the limitation of use of narcotic drugs and psychotropic substances to medical and scientific purposes was one of the fundamental principles underpinning the international drug control framework. “This legal obligation is absolute and leaves no room for interpretation,” he said.

The UN body also renewed its call for the abolition of the death penalty for drug-related offences and voiced concern that Oman was proposing to make use of the death penalty for drug-trafficking offences.

The INCB’s annual report records a further rise in the number of new “legal highs” or psychoactive substances that have been identified. The number has risen from 348 to 388 in the past year – an increase of more than 11%. More than 100 countries are taking action against “legal highs” and the INCB has welcomed moves by China, considered by many to be one of the main sources, to start banning these synthetic substances that imitate the effects of traditional drugs such as cannabis and ecstasy.

The UN drug board also warns of a 66% increase in the global consumption of a stimulant, methylphenidate, which is primarily used in the treatment of ADHD or attention deficit hyperactivity disorder and is better known by one of its trade names, Ritalin. The rise has been seen in its use by teenagers and young adults in the US, Iceland, Norway, Sweden and Australia.

It also highlights the lack of access for 5.5 billion people to medicines containing drugs such as codeine and morphine, which means that 75% of the world’s population do not have access to proper pain-relief treatment.

Source: http://www.theguardian.com/society 3rd March 2015

An ITV documentary will take a look at the impact of drinking alcohol in pregnancy as one in 100 babies are born in Britain each year brain-damaged with Foetal Alcohol Spectrum Disorder (FASD).

These babies will go through life with a range of developmental, social and learning difficulties. A few will have tell-tale facial features which will make it easier to get a diagnosis and access support, but the majority will battle with an invisible disability.

What is FASD?

Foetal Alcohol Spectrum Disorder is a series of preventable birth defects caused entirely by a woman drinking alcohol at any time during her pregnancy, often even before she knows that she is pregnant.

The term ‘spectrum’ is used because each individual with FASD may have some or all of a spectrum of mental and physical challenges. In addition each individual with FASD may have these challenges to a degree or ‘spectrum’ from mild to very severe.

These defects of both the brain and the body exist only because of prenatal exposure to alcohol.

What are the guidelines?

The Government’s current guidelines advise that those who are pregnant or trying to get pregnant should avoid alcohol altogether – but then adds: “If women do choose to drink, to minimise the risk to the baby, we recommend they should not drink more than one to two units once or twice a week and they should not get drunk.”

The Royal College of Obstetricians and Gynaecologists had taken a similar view, although they referred to one or two units a week as a safe amount.

Spokesman Dr Pat O’Brien said: “If nobody drank any alcohol in pregnancy there would be no Foetal Alcohol Syndrome and no Foetal Alcohol Spectrum Disorder. But on the other hand if you look at all of the evidence there appears to be a safe level of alcohol intake in pregnancy.”

However earlier this month they updated their advice, recommending that pregnant women do not drink alcohol during the first three months of pregnancy. The advice does say that drinking small amounts of alcohol after this time does not appear to be harmful for the unborn baby, but that pregnant women should not drink more than one or two units, and then not more than once or twice a week.

Professor Sir Al Aynsley-Green, former Children’s Commissioner for England, said: “Exposure to alcohol before birth is the single most important preventable cause of incurable brain damage. And it’s an issue which affects all of us in society.”

Source: http://www.liverpoolecho.co.uk/ 3rd March 2015

Nearly five young people are being admitted to hospital every day in NSW because of alcohol, exclusive data from NSW Health shows.

The figures show the huge toll alcohol is taking on children and young people in NSW, with a child aged between zero and four admitted to hospital almost every week because of injuries linked to their parents’ drinking. 

In total, nearly 1800 children aged between zero and 19 were so injured by their own drinking or that of others they were admitted to hospital in the 2012-13 financial year.

Experts say the government needs to urgently crack down on alcohol sales to children by introducing undercover stings, while parents need to heed the message that providing alcohol to their kids is dangerous.

The director of the McCusker Centre for Action on Alcohol and Youth, Mike Daube, said the hospital admissions were just the tip of the iceberg.

“This is only injuries so severe they need hospitalisation, and even then it is five a day in NSW alone,” he said. “This comes in a week when research has shown more than half of kids say it’s easy to buy alcohol.

“How many more wake-up calls do we need … state governments need to crack down on this issue.”

In the 2012-13 financial year, the last for which information is available, 1565 teenagers aged 15 to 19 year were admitted to hospital because of problems linked to alcohol. The overwhelming majority were male.

The injuries could involve problems directly caused by alcohol consumption, or injuries linked to alcohol, NSW Health said. Last month a 19-year-old student, Carl Salomon, died after falling from a crane into water in Balmain after a night out drinking.

And the harm doesn’t stop with teenagers. More than 50 children aged between zero and four and 70 aged five to nine were treated in hospital because of injuries linked to alcohol. Even more would have suffered from problems linked to foetal alcohol syndrome, which occurs in a baby whose mother drinks heavily while pregnant, that are not included in the data.

The chief executive of the Foundation for Alcohol Research and Education, Michael Thorn, said cheap, two-for-one and similar alcohol deals encouraged young people to binge drink. “Kids are very price-sensitive,” he said. “And they don’t take it home if they haven’t drunk it all”.

This week the foundation released a report into alcohol’s impact on children and families that found up to a quarter of people could be experiencing harm from the drinking of family members.

“Being raised in a harmful environment is very deleterious to a child, it affects their education, their development, their wellbeing, and it certainly increases their likelihood of health problems later,” he said.

Jo Mitchell, the director of the centre for population health in NSW Health, said dangerous drinking did not just occur among young people. “This is a serious public health issue across all age groups,” she said. “Often people think there’s a specific problem for young people … whereas the data shows that across the board there are high levels of risky drinking among adults as well.”

A new NSW Health data snapshot shows the rate of alcohol hospitalisations in NSW increased by 35 per cent from 1998-99, with nearly 52,000 hospital cases linked to alcohol in 2012-13.

But she said there had been some good successes in recent years in decreasing drinking rates. The department was also focused on delaying the age at which young people drank, and raising awareness among parents about the dangers of alcohol supply.

One such program, called “Stop the Supply“, has been run by the Northern Beaches Community Drug Action Team.

Team chairwoman Susan Watson said many parents were not aware of the dangers of youth drinking.

“We know that alcohol causes damage to [a growing] brain, and we didn’t know that years ago … so it’s really about starting conversations with parents about that,” she said. “It can be really difficult for parents to make these decisions when there is all this pressure out there, not just from themselves but from other parents.”

Source: http://www.smh.com.au/nsw/children-admitted-to-hospital-because-of-alcohol 1st March 2015

STATEN ISLAND, N.Y. — As the prescription drug and heroin epidemic continues to worsen on Staten Island and elsewhere, Borough President James Oddo plans on combating that by impressing on kids the importance of staying away from drugs.

He outlined an initiative recently during an editorial board meeting with the Advance, beginning with fifth-graders and imparting on them why they are “Too Good For Drugs.”

The aptly named program will either pair classroom teachers with police officers during the school day or pair after-school leaders with officers to teach students “an evidence-based program that has proven to work,” Oddo said.

The program will be piloted in the spring in one public school in each Staten Island police precinct and later broadened to other public and private schools.

In the 120th Precinct, PS 16 will pilot the program; PS 44 in the 121st Precinct; PS 8 in the 122nd Precinct; and PS 3 in the 123rd Precinct.

STATEN ISLAND’S EPIDEMIC

Statistics show that alcohol and substance abuse among high school students is higher on Staten Island than the city average. That applies to all categories of use, including for alcohol, marijuana, heroin, cocaine, opioids and other prescription drugs.

Oddo’s director of education, Rose Kerr, said the NYPD, Department of Education and the Roman Catholic Archdiocese of New York reviewed the curriculum and found “that it will be one that can be adapted to the police officer in the classroom.”

There will be a mechanism, she said, to monitor behavioral changes or use feedback forms to determine effectiveness of the curriculum and then decide how to spread it to other schools.

Oddo said of the initiative, “to a certain degree, it’s the same approach” as the D.A.R.E program, which is no longer implemented in NYC schools.

Ms. Kerr said, “The curriculum is contact-based on specifically ways in which abuses can be combatted: Decision-making skills and other content and life skills.”

She added, “We are hoping that this will be an ounce of prevention as opposed to a cure. We need the prevention piece, we need young ones to think differently and make different choices.”

‘IT’S THE BEGINNING’

Oddo said it became clear that high school and even middle school is too late to begin talking to kids about substance abuse.

He hopes to “start at the fifth grade and then grow this curriculum so that at each grade, in multiple steps along the way, these kids have the right message to kind of counter the pressures.”

Oddo added, “Is this the panacea? No. But it’s the beginning of getting a much larger presence in our schools, to get much more aggressive with this captive audience to fight this. Because this is life and death and there’s been, frankly, too much death.”

Source: http://www.silive.com/news 27th Feb.2015

I K Lyoo, S Yoon, T S Kim, S M Lim, Y Choi, J E Kim, J Hwang, H S Jeong, H B Cho, Y A Chung and P F Renshaw

Abstract

Adolescence is a period of heightened vulnerability both to addictive behaviors and drug-induced brain damage. Yet, only limited information exists on the brain mechanisms underlying these adolescent-specific characteristics. Moreover, distinctions in brain correlates between predisposition to drug use and effects of drugs in adolescents are unclear.

Using cortical thickness and diffusion tensor image analyses, we found greater and more widespread gray and white matter alterations, particularly affecting the frontostriatal system, in adolescent methamphetamine (MA) users compared with adult users.

Among adolescent-specific gray matter alterations related to MA use, smaller cortical thickness in the orbitofrontal cortex was associated with family history of drug use. Our findings highlight that the adolescent brain, which undergoes active myelination and maturation, is more vulnerable to MA-related alterations than the adult brain.

Furthermore, MA-use-related executive dysfunction was greater in adolescent MA users than in adult users. These findings may provide explanation for the severe behavioral complications and relapses that are common in adolescent-onset drug addiction. Additionally, these results may provide insights into distinguishing the neural mechanisms that underlie the predisposition to drug addiction from effects of drugs in adolescents.

Source:  Molecular Psychiatry , (10 February 2015) | doi:10.1038/mp.2014.191

The 50 states are sometimes called “laboratories of democracy”. Although the expression is intended to highlight in flattering terms how innovative they can be, it also suggests that the states’ political experiments can and do fail. In the event of failure, the hope must be that damage can be stopped at the state line. Today, the experiment of state-by-state marijuana legalization is failing before our eyes—and failing most signally where the experiment has been tried most boldly. The failure is accelerating even as the forces pushing legalization are on what appears to be an inexorable march.

In November 2012, the states of Colorado and Washington voted to legalize the sale of marijuana to any adult consumer. Advocates of legalization carried the vote with a substantial campaign budget, a few million dollars, and a brilliant slogan: “Drug dealers don’t ask for ID.” The implied promise: Marijuana legalization would be joined to tough enforcement to keep marijuana away from minors. After all, persistent and heavy marijuana use among adolescents has been shown to reduce their IQ as adults by 6 to 8 points. An Australian study of identical twins found that a twin who started using cannabis before age 17 was 3 times more likely to attempt suicide than the twin who did not. People in Colorado had good reason to worry about teen drug use. Colorado voters had approved a limited experiment with medical marijuana in 2000. A complex series of judicial and administrative decisions in the mid-2000s overthrew most restrictions on the dispensing of marijuana. Between 2009 and 2012, the number of dispensaries jumped past 500, and the number of medical cardholders multiplied from roughly 1,000 to more than 108,000. 

With so many medical-marijuana card-holders walking about, it was simply inevitable that some would re-sell their marijuana to underage users. A 2013 study of Colorado teens in drug treatment found that 74 percent had shared somebody else’s medical marijuana. The number of occasions on which they had shared averaged over 50 times. According to a report by the Rocky Mountain High-Intense Drug Trafficking Area, Colorado teens, by 2012, were 50 percent more likely to use marijuana than their peers in the rest of the country.

Debates about marijuana tend to travel pretty fast into the domain of libertarian ideology: I’m a consenting adult, why can’t I do what I want? Yet the best customers for the marijuana industry are not adults at all. The majority of people who try marijuana quit by age 30. Adults in their twenties are significantly less likely than high school students to smoke; 14 percent of twenty-somethings say they smoke marijuana, while 22.7 percent of 12th-graders smoke at least once a month, and 6.5 percent say they smoke every day. 

Why do people quit using marijuana as they mature? Your guess is as good as anybody else’s, but whatever the reason, the trend presents marijuana sellers with a marketing problem. Yet there is promising news from the emerging marijuana industry’s point of view: People who start smoking in their teens are significantly more likely to become dependent than people who start smoking later: about 1 in 6, as opposed to 1 in 10. Start them young; keep them longer. Very rationally, then, the marijuana industry is rolling out products designed to appeal to the youngest consumers: cannabis-infused soda, cannabis-infused chocolate taffy, cannabis-infused jujubes.

The promise that legalization will actually protect teenagers from marijuana is false. So, too, are the other promises of the legalizers. It is false to claim that marijuana legalization will break drug cartels. Those cartels will continue to traffic in harder and more lucrative drugs, such as heroin, cocaine, and methamphetamine. Criminal cartels may well stay in the marijuana business, too, marketing directly to underage users. Public policy is about trade-offs, and marijuana users need to face up to the trade-off they are urging on American society. Legal marijuana use means more marijuana use, and more marijuana use means above all more teen marijuana use.

Proponents of marijuana legalization often question why the law bans marijuana but not alcohol or tobacco. One important difference is that alcohol and tobacco are drugs on the decline. Since 1980, per capita consumption of alcohol has dropped almost 20 percent. One-third of Americans smoked tobacco in 1980; fewer than one-fifth smoke today. The progress against drunk driving is even more remarkable: Fatalities caused by drunk drivers have decreased by more than half since 1982.

The reduction in tobacco and alcohol use has been hastened by increasingly restrictive laws that govern where and how these products may be consumed. Tobacco-smoking has been banned on planes, in restaurants, and in almost all public places. The drinking age, reduced in the 1970s from 21 to 18 in most states, was restored to 21 by federal action in the 1980s. Tobacco taxes have been steeply hiked. Bars that served intoxicated patrons face rising tort risk.

With marijuana, however, the law is heading in the opposite direction, and has been for some time. Since 1996, 20 states and the District of Columbiahave approved “medical marijuana” laws, whereby people who obtain a prescription from a doctor can legally use or purchase marijuana. As in Colorado, many of these supposed medical regimes are degenerating into legalization by another name. Oregon, for example: At the end of 2012, it was home to 56,531 medical-marijuana patients. The majority of these 56,000-plus permissions were approved by only nine doctors. One doctor—an 80-year-old retired heart surgeon in Yakima—approved 4,180 medical-marijuana applications in a span of 12 months. Only 4 percent of Oregon’s medical-marijuana patients, as of the end of 2012, suffered from cancer. Only 1 percent were diagnosed with HIV/AIDS. The large majority, 57 percent, cited unspecified “pain” as the ailment for which treatment was sought. Yet none of the nine doctors who wrote the majority of the marijuana prescriptions was a pain specialist.

Fewer than 2 percent of California card holders have HIV, glaucoma, multiple sclerosis, or cancer: One survey found that the typical California medical-marijuana patient was a healthy 32-year-old man with a history of drug and alcohol abuse. Here, too, some doctors are signing thousands of recommendations after only the scantiest examination—or none at all. An NBC news investigator in Los Angeles visited one dispensary, was examined by a man who later proved to be an acupuncturist and massage therapist, and then received a prescription signed by a doctor who lived 67 miles away.

In the words of Los Angeles police chief Charlie Beck, most dispensaries are “for-profit businesses engaged in the sale of recreational marijuana to healthy young adults.” By early 2012, Los Angeles contained almost eight times as many dispensaries as Starbucks coffee shops. The city became alarmed that the customers who congregated at these dispensaries were active in crimes from robbery to murder. By July, the City Council voted unanimously to shut down all of the nearly 800 known dispensaries in the city. The marijuana lobby succeeded in preventing that ban from going into effect, so the next year, the city government tried a different approach: a local referendum called Proposition D to cap the number of dispensaries at 135, raise taxes on marijuana sales, and forbid dispensaries to locate near primary, middle, and high schools. 

The proposition was approved, but this approach also proved ineffective. In the words of Medical Marijuana Business Daily (yes, it exists): 

Officials have actually only forced about 70 dispensaries to close so far. While some other dispensaries shut down on their own to avoid legal troubles, most did not. That means at least 700—possibly more—illegal shops are still open.

“What happened is that we’re really trying to put a Band-Aid on some crazy open wound, and it’s not big enough to stop the bleeding,” said Adam Bierman, who runs the consultancy MedMen. “Prop D as a concept is half decent, but there’s really no way to enforce it.”

Marijuana does possess certain medicinal properties. So does opium. But we don’t allow unscrupulous quacks to write raw opium prescriptions for anyone willing to pay $65. And if we did, would anybody be surprised that the vast majority of opium buyers were not recovering from surgery—and that many of them shared or resold some of their opium to underage users?

Some older adults have a hard time crediting the dangers of marijuana use because they imagine the marijuana on sale today is the same low-grade stuff they smoked in college. The marijuana sold in the 1980s averaged between 3 and 4 percent THC, the psychoactive ingredient. Today’s selectively bred marijuana averages over 12 percent THC, with some strains reaching 30 percent. Hundreds of YouTube videos will show you how to combust a marijuana wax with butane, to boost the THC content to 90 percent. As marijuana consumers shift from smoking to ingesting marijuana, they can ingest larger and larger doses of THC at a time. Since 2006, Colorado emergency rooms have seen a steep rise in the number of patients arriving panicked and disoriented from excess THC, including a near doubling of patients ages 13 and 14.  

It’s said that nobody ever died from a marijuana overdose. Nobody ever died from a tobacco overdose either, but that doesn’t prove tobacco safe. Of all the dangers connected to marijuana, the most lethal is the risk of automobile accident. Marijuana-related fatal car crashes have nearly tripled across the United States in the past decade.Marijuana legalizers may counter: Can’t we just extend laws against drunk driving to stoned driving?

Unfortunately, it’s not so easy. What exactly defines marijuana impairment remains fiercely contested by an increasingly assertive marijuana industry. It took Colorado four tries to enact a legal definition of marijuana impairment: five nanograms of THC per milliliter of blood. Yet even once enacted, the standard remains very difficult to enforce. Alcohol impairment can be detected with a Breathalyzer. Marijuana impairment is revealed only by a blood test, and long-established law requires police to obtain a search warrant before a blood test is administered.

More important than catching impaired drivers after the fact is deterring them before they get behind the wheel. In the absence of a blood-testing kit, marijuana users themselves will find it difficult to know how much is too much. Time recently quoted a spokesperson for the Colorado Department of Transportation: “It’s not like alcohol. People metabolize it differently. There are different potencies,” the official said. “So there’s really no solution in terms of saying ‘you’re now at the limit.’ I just don’t think there’s enough research that we can say, ‘Wait x amount of hours before getting on the road.’ I don’t know whether it’s five hours or 10 hours or the next day. We just don’t know.” Back in 2007, a survey by the National Highway Traffic Safety Administration found that on any given Saturday night, about 12 percent of drivers tested positive for alcohol; about 6 percent for marijuana. Since then, 10 more states and the District of Columbia have adopted medical-marijuana regimes, which surely means even more buzzed drivers on the roads. 

Yet the most pervasive harm of marijuana may be psychic rather than physical. A battery of studies have found regular marijuana use to be associated with worse outcomes at school, social life, and work. I use the cautious phrase “associated with,” because it’s far from clear whether marijuana use is a cause or an effect of other problems—or (most likely) both cause and effect. An isolated, underachieving kid starts smoking marijuana. That kid then descends deeper into isolation and underachievement. Marijuana may not have been the “cause” of the kid’s malaise, but it intensifies the malaise and may inhibit or even prevent his emergence from it.

The negative spiral of despondency leading to marijuana use, leading to deeper and more protracted despondency, makes the present moment a particularly unpropitious one for marijuana legalization. The United States is currently recovering feebly from the gravest economic crisis since the Great Depression. Prospects for young people especially have narrowed. Are we really going to say to them: “Look, we haven’t got jobs for you, your chances at marriage are dwindling, you may be 30 before you can move out of your parents’ place into a home of your own, but we’ll make it up to you with pot, video games, and online porn”? They want to start life, but they are being offered instead only narcotic dreams.

As human beings, our judgment is not only imperfect, but is prone to fail in highly predictable ways. Insert a recurring charge onto our phone bill, and we will soon cease to notice it. We evolved under conditions where sugars and salt were scarce, and so we will eat far more than we need if given the chance. We overestimate our luck and will gamble our money in ways that make no mathematical sense. Our brains are wired for addictions. If a substance can trigger that addiction, it can overthrow all the reasoning and moral faculties of the mind. 

Lucrative industries have arisen to exploit these weaknesses in ways highly harmful to their customers. And the bold irony is that when their practices are challenged, they’ll invoke the very principles of individual choice and self-mastery that their industry is based on negating and defeating. So it was with tobacco. So it is with casino gambling. So it will be with marijuana. 

Proponents of marijuana legalization do make a valid point when they worry that marijuana laws are enforced too punitively—and that this too punitive approach inflicts disparate punishment on minority users as compared with white users. Ordinary marijuana users should receive civil penalties; repeat users belong in treatment, not prison; communities should experience law enforcement as an ally and supporter of local norms, not an outside force stamping young people with indelible criminal records for mistakes that carry fewer consequences for the more affluent and the better connected. It’s also true, however, that these alternative methods can succeed only if the background rule is that marijuana is illegal. It’s very often the threat of criminal sanction that impels users to seek the treatment they need, while still young enough to turn their lives around. 

The illegal U.S. market for marijuana is already twice as big as the market for coffee. As that market is legalized, it will expand, and the industry that serves the market will be emboldened to hire lobbyists to promote its continued expansion. The vision offered by some academics of a legal but non-commercial marijuana market shows little realism about American government. American legislatures exhibit notoriously poor resistance against check-book-wielding special interests. 

The resistance will be all the weaker since the costs of marijuana legalization will be borne by people to whom American legislatures pay scant attention anyway. Marijuana retailers will be located most densely in America’s poorest neighbourhoods, just as liquor and cigarette retailing is now. Out of whose pockets will the marijuana taxes of the future be paid? Whose addiction and recovery services will be least well funded? In a society in which it is already sufficiently difficult for people to rise from the bottom, who’ll find that their rise has become harder still?

David Frum is the author, most recently, of the novel Patriots (2012) and is a commentator for CNN and the Daily Beast.

Source: http://www.commentarymagazine.com/article/dont-go-to-pot/

Abstract

Background:

There has been an increase in non-daily smoking, alternative tobacco product and marijuana use among young adults in recent years. Objectives: This study examined perceptions of health risks, addictiveness, and social acceptability of cigarettes, cigar products, smokeless tobacco, hookah, electronic cigarettes, and marijuana among young adults and correlates of such perceptions. Methods: In Spring 2013, 10,000 students at two universities in the Southeastern United States were recruited to complete an online survey (2,002 respondents), assessing personal, parental, and peer use of each product; and perceptions of health risks, addictiveness, and social acceptability of each of these products.

Results:

Marijuana was the most commonly used product in the past month (19.2%), with hookah being the second most commonly used (16.4%). The least commonly used were smokeless tobacco products (2.6%) and electronic cigarettes (4.5%). There were high rates of concurrent product use, particularly among electronic cigarette users. The most positively perceived was marijuana, with hookah and electronic cigarettes being second. While tobacco use and related social factors, related positively, influenced perceptions of marijuana, marijuana use and related social factors were not associated with perceptions of any tobacco product.

Conclusions/Importance:

Marketing efforts to promote electronic cigarettes and hookah to be safe and socially acceptable seem to be effective, while policy changes seem to be altering perceptions of marijuana and related social norms. Research is needed to document the health risks and addictive nature of emerging tobacco products and marijuana and evaluate efforts to communicate such risks to youth.

KEYWORDS:

addiction; health risk; marijuana use; social norms; tobacco use; youth

Source: http://www.ncbi.nlm.nih.gov/pubmed/25268294 14 Sept 2014

Pot smokers say marijuana is a mind-expanding drug, but a new study conducted at The University of Texas at Dallas links heavy, long-term use of marijuana with smaller volume in the orbitofrontal cortex–a brain region associated with decision-making and addiction. 

The same research shows that the brains of long-term users have greater connectivity in this region than do the brains of people who don’t use pot, although this connectivity seems to disappear over time with prolonged use. The research also shows that the earlier an individual starts using marijuana, the more pronounced the brain abnormalities.

Whether these brain abnormalities cause any mental or emotional deficits isn’t yet clear.

“The orbital frontal cortex is a key part of the brain’s reward system/network and instrumental in our motivation, decision-making and adaptive learning,” study leader Dr. Francesca Filbey, director of the university’s Center for BrainHealth and an associate professor in the university’s School of Behavioral and Brain Sciences, told The Huffington Post in an email. “As such, our finding that chronic marijuana users had smaller brain volume in the orbital frontal cortex, might manifest behaviorally making it difficult for them to change learned behavior.”

For the study, Filbey and her colleagues used MRI scanners to compare the brains of 48 adults who had smoked marijuana three times a day for 10 years, on average, to the brains of 62 non-users.  While their findings are provocative, the researchers acknowledge that they do not prove that marijuana use directly causes changes in the brain–a point of view shared by Dr. Asaf Keller, a professor of anatomy and neurobiology at the University of Maryland School of Medicine, who was not involved in the study. 

“As this is a retrospective study—and not a prospective one—it is impossible to determine whether individual differences in brain anatomy are related to genetic or environmental factors other than marijuana use,” he told HuffPost Science in an email. “In sum, there is not indication that the anatomical differences in the brains of marijuana users are caused by marijuana use.”  Keller has been critical of previous research linking casual marijuana use to changes in the brain.

Still, some researchers argue that this new study is an important step forward for marijuana research.  “This is important, well-conducted research that can serve as a reminder that marijuana use may not be without risks,” Dr. Susan F. Tapert, a psychiatry professor at the University of California, San Diego, who was not involved in the study, told HuffPost Science in an email. “These findings point to the need for definitive longitudinal studies that assess future users prior to the onset of marijuana use, then again after use has started.”

Source: Journal Proceedings of the National Academy of Sciences  10th Nov  2014

The candy bar Trish Reske’s son ate, in a similar wrapper. It’s a one-ounce bar, intended as six servings.

Just a week after leaving Boston for a summer internship in California, our 21-year-old son landed in an emergency room and was put on a suicide watch. I’m going to ruin the suspense and tell you what happened: His roommate told him to help himself to the food in the fridge, and he ate a marijuana-laced chocolate bar meant to be consumed as six servings.

From my son’s perspective, he was simply cooking dinner while eating a chocolate bar, and suddenly he found his mind and world turning inside out. Thinking he was dying, he called 911. Paramedics found him lying on the front lawn, out of his mind and without any explanation.

Terrified, he called us from the emergency room. He couldn’t remember the names of his siblings.  A team of doctors deemed him a danger to himself and sent him to a rehab facility for a planned 72-hour watch. I was asked questions over the phone like, “Has your son ever experienced episodes of depression or mania before?” I was on the first flight out to California the next morning, worried sick.

I went to his apartment to pack pyjamas and a toothbrush for his observation stay. I cleaned out his pants pocket and threw the candy-bar wrapper into the trash, where his roommate later found it and texted me, “I think I know what happened.” Fortunately, I was able to explain the situation to the doctor on duty, and my son was released that day.

Our son’s toxic trip sheds light on the alarming health dangers that marijuana-infused chocolate, candy and other snacks and drinks pose to those who might mistake them for innocuous treats. He ate a one-ounce 4:20 Bar made by the Venice Cookie Company. His was milk chocolate; the bars also come in dark chocolate, toffee and other flavors. On its website, the company advises, “Until you know the effects of this product, eat only half a segment and wait 75 minutes before consuming another portion.”

My hungry son did not do that. Would your 6- or 12-year-old? As a recent article in The Times, “Snacks Laced With Marijuana Raise Concerns”, points out, it’s tough to regulate a drug disguised as candy. We live in a society that’s used to keeping alcohol away from children, with kids who are accustomed to the idea that an unfamiliar can or bottle might contain a “grown-up drink.” Candy, though, has always represented an innocent temptation. According to a July 2013 JAMA Paediatrics article, significant toxic reactions to marijuana in children can include anxiety, hallucinations, panic episodes, respiratory distress and coma. Do we want this to happen to our kids? Because it will, as long as potent levels of tetrahydrocannabinol, or THC, take the form of enticing sweets.

I am not against medical marijuana. I voted in favor of Question 3 in Massachusetts in November 2012, which legalized the use of medical marijuana in the state. What I am against is the marketing of products that look and taste like candy, contain potent levels of THC, and are not sold in child-resistant, tamper-proof packaging. Yes, kids ingest all sorts of medication and harmful products. But those products are not designed to mimic candy. The 4:20 Bar, for example, doesn’t look like a vitamin, or medicine. It just looks tasty, and if your vocabulary doesn’t include THC or cannabis, there’s no obvious reason not to consume it.

The most frightening part of our experience was not knowing what had happened to our son. He wasn’t a young guy who thought he’d try marijuana, ate too much and freaked out from the effects. He thought he was eating a candy bar.

By allowing the production and sale of appealing THC-laced sweets, we are headed down a sticky path in protecting children from accidental drug ingestion. Experts agree that the wider availability of edible marijuana now that recreational marijuana can be sold in Colorado and Washington will escalate the problem by increasing availability. Based on my son’s experience, I can only believe that will be the case.

Source:   http://mobile.nytimes.com/blogs/parenting/2014/02/10