Health

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

Louise Stanger is a speaker, educator, licensed clinician, social worker, certified daring way facilitator and interventionist who uses an invitational intervention approach to work with complicated mental health, substance abuse, chronic pain and process addiction clients.

In the mid-to-late 2000s, Red Bull, an energy drink high on energy and low on nutritional value, made its North American debut with the famous “Red Bull gives you wings” campaign. The tag line, a nod to the “pick me up” qualities it gives to drinkers of the product, set the stage for the way in which teens and young adults relate to the nascent product category.

In essence, advertising birthed energy drinks as the way to find uplift, fight fatigue, and give that extra boost. Regrettably, no one was paying attention to the drinks’ negative side effects.

Red Bull has since spawned its own grocery store aisle of knock-offs – Monster, Rockstar, Full Throttle, Amp – to name a few. In 2016, U.S. retail sales of energy drinks topped $11 billion (Red Bull generated $5.1B in revenue in 2010). By comparison, that number is roughly how much Hollywood makes on movie tickets in a year.

Paradoxically, energy drinks’ meteoric rise in popularity and consumption has coincided with major health risks and the onslaught of addiction to other harmful substances. How did a drink that tastes like cough syrup land with such a huge impact?

Long before Red Bull “gave us wings,” Chaleo Yoovidhya, a Southeast Asian pharmacist, developed energy “tonics” aimed at labourers and truck drivers in the 1960s, according to The Dragonfly Effect, a book that looks at successful branding campaigns for products like energy drinks.

Then in the 1980s, an Austrian billionaire businessman named Dietrich Mateschitz discovered the tonics and married them with innovative guerrilla marketing to launch in North America. The aim was to put cans of Red Bull, the syrupy concoction of sugar and caffeine, in the hands of their target market: young adult males and teens who are oblivious to the drinks’ ingredients. The ad campaign struck like a lightning bolt and a multibillion dollar industry took ro

The key ingredient in energy drinks that gives the consumer energizing effects is caffeine. Though caffeine, found in commonly consumed drinks like coffee, tea and sodas, isn’t outright bad for you, the serving size, frequency and consumption patterns are cause for alarm.

Most energy drinks contain 70-200 milligrams of caffeine; for example, Rockstar 2X has 250 mg per 12 ounces, a 12 ounce can of Red Bull has 111 mg, and a 5-Hour Energy shot, a variation of the energy drink craze, is a whopping 207 mg of caffeine in just 2 ounces.

To put these concentration levels into perspective, the American Academy of Paediatrics maintains adolescents must not consume more than 100 mg of caffeine per day (it’s 500 mg for adults).

And more alarming than the serving sizes are the rates at which teens consume energy drinks. When young adults and teenagers get with their friends, they’ll consume 3-4 drinks in a short period of time or even chug (i.e. “shotgun”) whole cans in an instant. Despite this binge-style consumption, teens remain oblivious to the high caffeine content and unaware of the effects energy drinks have on the body. Other studies and researchers have observed energy drinks become the chaser for alcohol consumption in certain situations.

At these high levels of consumption, the Journal of the American Medical Association (JAMA) reports serious health risks associated with energy drinks. These include:

· Increased heart rate, irregularities and palpitations

· Increased blood pressure

· Sleep disturbances, insomnia

· Diuresis or increased urine production

· Hyperglycaemia (increased blood sugar), due to the high levels of sugar content, which may be harmful for people at risk for diabetes or already diabetic

Perhaps most dangerous are the serious side effects caused when energy drinks are consumed with alcohol. According to University Health News Daily, “the dangers of energy drinks mixed with alcohol are related to reduced sensation of intoxication and impaired judgment.”

Here’s how it goes: the user gets a burst of energy and alertness (increased heart rate and dilated blood vessels) from the high content of caffeine in the energy drink, prompting the person to feel less intoxicated and therefore drinking more alcohol and putting themselves at risk for alcohol poisoning and severely impaired judgment.

Teens, young adults and college-aged students who play drinking games or drink in high-risk environments such as parties, boating, swimming, beach days, etc. put themselves at greater risk of injury and bodily harm with these combinations.

In addition to high-risk environments and dangerous situations, energy drink and alcohol mixing lowers inhibitions, making room for engaging in high-risk behaviours such as unwanted sexual encounters, driving vehicles, boats and jet skis under the influence, and other behaviours that may lead to hospitalization or encounters with law enforcement.

We need look no further than the case of Four Loko, an energy drink that comes ready made with alcohol and caffeine for proof that mixing the two is dangerous. The drink gets its name from its four signature ingredients: alcohol, caffeine, taurine and guarana.

According to a report in The Week, the company that produced Four Loko, Phusion Projects of Chicago aka Drink Four Brewing Company, came under ethical fire for marketing to adolescents under the age of 21 (as most energy drink companies do – though this was the first to pre-mix alcohol and caffeine).

Four Loko also caught fire with college students and it didn’t take long for reports of blackouts and other alcohol overdose related incidents to take hold of its users. University campuses across the nation including the University of Rhode Island, Central Washington University and Worcester State University began to ban the beverage and companies with similar beverages have since reformulated its drinks and reduced its marketing toward underage students and young adults. In 2014, the company reached a settlement to stop production and distribution of Four Loko in the United States, according to a report in The Atlantic.

Moreover, the University of Maryland’s research on the topic has found a link between high energy drink consumption and developing addiction to other harmful substances later on. Researchers looked at the health and risk-taking habits of 1,099 college students over a four year period.

Their analysis of the study found that participants who consumed highly caffeinated drinks (energy drinks, sodas, etc.) are more likely to develop an addiction to cocaine, alcohol, or other substances when compared to students who did not consume such beverages. “The results suggest that energy drink users might be at heightened risk for other substance use, particularly stimulants,” says Amelia Arria, an associate professor and lead author of the study.

New research from Purdue University found that mixing alcohol and highly caffeinated drinks could significantly change the brain activity of a teenager. Dr. Richard van Rijn, the lead researcher, says “it seems the two substances (energy drinks and alcohol) together push [teenagers] over a limit that causes changes in their behaviour and changes the neurochemistry in their brains.”

Although energy drinks are regulated by the Food and Drug Administration, little oversight is given to labelling cans and packages with the risks related to consumption. As an educator, I believe the FDA must first do a better job of labelling. Just as cigarettes and alcohol have warning labels, so too must energy drinks.

Grocery stores should move energy drink products to areas where alcohol is sold – away from wandering young eyes. Public health discussions in high schools and middle schools need to take place. Youth and young adult sports teams must reconsider energy drink sponsorships and greater oversight concerning marketing practices toward under-aged youth.

As a young adult, if you do choose to consume these beverages, be sure to read the labels for serving sizes, caffeine content, and try to avoid mixing with alcohol. Parents, teachers, sports coaches, and community leaders must communicate to teenagers and young adults the harm energy drinks may cause. Together we must work together to be educated and informed against aggressive advertising to keep our teens and young adults healthy and engaged.

To learn more about Louise Stanger and her interventions and other resources, visit her website.

Source: http://www.huffingtonpost.com/entry/red-bull-monster-four-loko-rockstar-the-downside_us_59b021cce4b0bef3378cdcee    6th Sept.2017

 

 

 

by  Elizabeth Stuyt, MD

For the past 27 years, working as an addiction psychiatrist, I have struggled with big industries that push their products more for their financial gain rather than the best interests of the clients they serve. The most disconcerting piece occurs when physicians or other treatment providers or governmental entities appear to be influenced by big industry, touting the party line and minimizing any downsides to the product. I have experienced this with the tobacco industry, the pharmaceutical industry and now with the marijuana industry.

It is clear to me that wherever it happens, the push to legalize medical marijuana is simply a back-door effort, by industry, to legalize retail marijuana. However, the lack of any regulations on the potency of THC in marijuana or marijuana products in Colorado has allowed the cannabis industry to increase the potency of THC to astronomical proportions, resulting in a burgeoning public health crisis.

The potency of THC in currently available marijuana has quadrupled since the mid-1990s. The marijuana of the 1980s had <2% THC, 4.5% in 1997, 8.5% in 2006 and by 2015 the average potency of THC in the flower was 17%, with concentrated products averaging 62% THC.

Sadly, the cannabidiol (CBD) concentrations in currently available marijuana have remained the same or decreased. CBD is the component of marijuana that appears to block or ameliorate the effects of THC. Plants that are bred to produce high concentrations of THC cannot simultaneously produce high CBD. Higher-potency THC has been achieved by genetically engineering plants to product more THC and then preventing pollination so that the plant puts more energy into producing cannabinoids rather than seeds. This type of cannabis is referred to as sinsemilla (Spanish for without seed). (It has also been referred to as “skunk” due to its strong smell.)

In my view, this is no different than when the tobacco industry increased the potency of nicotine by genetically engineering tobacco plants to produce more nicotine and then used additives like ammonia to increase the absorption of nicotine. Industry’s efforts to increase the potency of an addictive substance seem to be done purely with the idea of addicting as many people as possible to guarantee continued customers. This certainly worked for the tobacco industry. And we have increasing evidence that high potency THC cannabis use is associated with an increased severity of cannabis dependence, especially in young people.12

Although marijuana has been used for thousands of years for various medical conditions, we have no idea if the benefit comes from the THC or CBD or one of the other multiple cannabinoids present in marijuana, or a combination. And we have no idea how much is needed or how often. Most of the research indicates that it is likely the CBD that is more helpful but we obviously need research on this. There is no evidence that increasing the potency of THC has any medical benefits. In fact, a study on the benefits of smoked cannabis on pain actually demonstrated that too high a dose of THC can cause hyperalgesia – similar to what is seen with high dose opiates – meaning that the person becomes more sensitive to pain with continued use. They found that 2% THC had no effect on pain, 4% THC had some beneficial effects on chronic pain and 8% resulted in hyperalgesia.3

The discovery of the “active component” in marijuana that makes it so desirable is a fairly recent phenomenon. THC and CBD were first discovered in 1963 in Israel.4

Because cannabis was made a DEA schedule I drug in 1970, very little research has been done on cannabis in the United States and most of the indications for medical marijuana have very little good research backing up the use. The chemical that is made by the body and fits the receptor which accommodates THC was discovered in 1992.5

The researcher named the chemical anandamide which means “supreme joy” in Sanskrit.  However, it turns out that the endocannabinoid system plays a very significant role in brain development that occurs during childhood and adolescence. It controls glutamate and GABA homeostasis and plays a role in strengthening and pruning synaptic connections in the prefrontal motor cortex. The consequences of using the high potency THC products during this period, especially without the protective benefits of CBD, are multifaceted and include disturbance of the endocannabinoid system, which can result in impaired cognitive development, lower IQ and increased risk of psychosis.

There is also evidence that marijuana use contributes to anxiety and depression. A very large prospective study out of Australia tracked 1600 girls for 7 years and found that those who used marijuana every day were 5 times more likely to suffer from depression and anxiety than non-users.6

Teenage girls who used the drug a least once a week were twice as likely to develop depression as those who did not use. In this study, cannabis use prior to age 15 also increased the risk of developing schizophrenia symptoms.

While there definitely are people who can use marijuana responsibly without any untoward effects, similar to how some people can drink alcohol responsibly and not have any problems, there are people who are very sensitive to the effects of THC, and its use can precipitate psychosis. The higher the potency of THC the more likely this may happen and we have no idea how to predict who will be affected. In one of the first double blind randomized placebo controlled trials on smoked cannabis (maximum of 8% THC) for the treatment of pain, a cannabis naïve participant had a psychotic reaction to the marijuana in the study and this then required that all future study participants have some experience with smoking marijuana.7

This kind of makes it difficult to have “blind” unbiased participants.

A 2015 study out of London analyzed 780 people ages 18-65, 410 with first episode psychosis and 370 healthy controls, and found that users of high potency (“skunk-like”) cannabis (THC > 15%) are three times as likely to have a psychotic episode as people who never use cannabis, and the risk is fivefold in people who smoke this form of the drug every day.89 There was no association of psychosis with THC levels < 5%. Most of the marijuana in the U.S. is of the high-THC variety. Many retailers in Colorado sell strains of weed that contain 25 percent THC or more.

Sadly, Colorado has now joined several other states in approving PTSD as an indication for the use of medical marijuana. Marijuana does not “treat” PTSD any more than benzodiazepines or opiates “treat” PTSD. All these addictive drugs do is mask the symptoms, allowing the person to continue life unaffected by the memory of the trauma. However, the psychological trauma is never resolved and the individual has to continue to use the substance in order to cope. This sets the individual up for the development of addiction to the substance or the use of other addictive substances. There is absolutely no good research to support the use of marijuana for PTSD, and there is observational data that this would be a bad idea unless this use was supported by a lot more (and better-designed) longitudinal research.

In an excellent longitudinal, observational study from 1992 to 2011, 2,276 Veterans admitted to specialized VA treatment programs for PTSD had their symptoms evaluated at intake and four months after discharge.10

They found that those who never used marijuana or quit using while in treatment had the lowest levels of PTSD symptoms, while those who continued to use or started using marijuana after treatment had worse symptoms of PTSD. Those who started using the drug during treatment had higher levels of violent behavior too.

Those of us working in the trenches in Colorado are seeing the downsides of what our governor has called “one of the great social experiments of the 21st century.” Emergency room physicians are seeing a significant increase in people experiencing consequences from marijuana use since it was legalized. One such physician wrote a very poignant piece about his experience returning to his home town of Pueblo, Colorado where he is now practicing.11

His experiences are totally supported by the Rocky Mountain High Intensity Drug Trafficking Report, volume 4 from September 2016 which documents significant increases in marijuana related emergency department visits (49%) and hospitalizations related to marijuana (32%) compared to rates prior to retail legalization. This report also documents significant increases in the use of marijuana by youth, with Colorado youth “past month marijuana use” for 2013/2014 being 74% higher than the national average, compared with 39% higher in 2011/2012.

 

In Pueblo, Colorado, where I practice, it has developed into a perfect storm. According to the Healthy Kids Colorado Survey in 2015, we have the highest incidence of youth marijuana use in the state, with 30.1% reporting using marijuana in the last 30 days. The legalization of retail marijuana seems to be reflected in the increased abuse of opiates and heroin too. In addition to the highest rates of marijuana use by youth, Pueblo has the highest rates of heroin-related deaths in the state.

 

This is a very disturbing correlation that needs attention. I have definitely seen in my practice that marijuana acts as a gateway drug to opiates, and to relapse to opiates after treatment if the person goes back to using marijuana. The Smart Approaches to Marijuana status report, which assesses state compliance with federal marijuana enforcement policy, following what is known as the Cole memo, documents that Colorado, four years after legalization, has failed to meet the specific DOJ requirements on controlling recreational marijuana production, distribution and use. This report documents a significant increase in drugged driving crashes, youth marijuana use, a thriving illegal black market and unabated sales of alcohol, which supports the idea that people are not using marijuana instead of alcohol but rather in addition to alcohol.

In spite of all this information, powerful people in the government of Colorado have publicly minimized the consequences. Larry Wolk, MD, the Chief Medical Officer for the Colorado Department of Public Health and Environment, has reported that he has “not seen any significant problems” with the legalization of marijuana.

Governor Hickenlooper’s response to Attorney General Sessions recent questions about compliance with the Cole Memo minimized the adolescent use of marijuana by saying that youth marijuana use in Colorado has “remained stable since legalization.” This is not true for Pueblo, but in any event, any use of marijuana by youth in Colorado should not be minimized and should be a major concern for future generations.

While there are people who believe we need to enforce federal law and go back to making marijuana illegal, I am afraid the horse is already out of the barn and cannot be put back in as we already have several states with “legal” retail marijuana and multiple more with “medical marijuana.” I cannot conceive of any way this could be reversed at this point, when the majority of society supports the legalization of marijuana.

Solutions to our marijuana problems have to be realistic to our current situation/environment. The number one solution is more education. Many people seem to lack a true understanding of the drug and all the potential negative consequences of the higher-potency THC. This is why education is so important. Adults should have the right to make their own decisions but they need informed consent, just like with any drug.

The biggest concern is with adolescent use and the developing brain. This requires a lot more education and increased efforts at prevention, early intervention and treatment. I believe society would be truly served by a federal ban on all advertising of addicting drugs including alcohol, tobacco and marijuana, as well as all pharmaceutical drugs. The decision to use a pharmaceutical medication should be between the patient and the medical professional, not influenced by big industry. We clearly have the big industries— alcohol, tobacco and marijuana—doing everything they can to influence the public and convince them to use their product.

Since we only have anecdotal evidence at this point that marijuana can aid any medical condition, I recommend eliminating “medical marijuana” and just have retail marijuana with limits on THC and regulations similar to alcohol and tobacco. This could help take away the perception, which adolescents and others have, that because is it “medical” it must be “safe.” In order to be able to say it is medical, it should go through the same standards for testing the safety and efficacy of any prescription drug.

In this vein, I believe we do need more research and that marijuana should be reclassified as a schedule II drug so this can occur. Since marijuana has been used medicinally for thousands of years, I believe that the plant deserves some true research to determine if and what parts of the plant are helpful medicinally. The reports that marijuana use resulted in less than 10% becoming addicted to it were done back in the 1990s when THC levels were <5%. Since we are seeing significant increases in people developing marijuana use disorder with the higher doses of THC, perhaps the limits on THC should be <5%. Editor’s note: for more information, see the pdf of the author’s talk on this topic.     Show 11 footnotes

Source:  https://www.madinamerica.com/2017/09/unintended-consequences-colorado-social-experiment/  11th September 2017

And Addiction-Connected Carcinogenicity, Congenital Toxicity And Heritable Genotoxicity

Albert Stuart Reece, Gary Kenneth Hulse

Extracts from the above research.  Recommend readers go to source for complete study.

A B S T R A C T

The recent demonstration that massive scale chromosomal shattering or pulverization can occur abruptly due to errors induced by interference with the microtubule machinery of the mitotic spindle followed by haphazard chromosomal annealing, together with sophisticated insights from epigenetics, provide profound mechanistic insights into some of the most perplexing classical observations of addiction medicine, including cancerogenesis, the younger and aggressive onset of addiction-related carcinogenesis, the heritability of addictive neurocircuitry and cancers, and foetal malformations.

Tetrahydrocannabinol (THC) and other addictive agents have been shown to inhibit tubulin polymerization which perturbs the formation and function of the microtubules of the mitotic spindle. This disruption of the mitotic machinery perturbs proper chromosomal segregation during anaphase and causes micronucleus formation which is the primary locus and cause of the chromosomal pulverization of chromothripsis and downstream genotoxic events including oncogene induction and tumour suppressor silencing.

Moreover the complementation of multiple positive cannabis-cancer epidemiological studies, and replicated dose-response relationships with established mechanisms fulfils causal criteria. This information is also consistent with data showing acceleration of the aging process by drugs of addiction including alcohol, tobacco, cannabis, stimulants and opioids. THC shows a non-linear sigmoidal dose-response relationship in multiple pertinent in vitro and preclinical genotoxicity assays, and in this respect is similar to the serious major human mutagen thalidomide. Rising community exposure, tissue storage of cannabinoids, and increasingly potent phytocannabinoid sources, suggests that the threshold mutagenic dose for cancerogenesis will increasingly be crossed beyond the developing world, and raise transgenerational transmission of teratogenicity as an increasing concern.

CONCLUSION

As mentioned above high dose cannabis and THC test positive in many genotoxicity assays, albeit often with a highly non-linear threshold like effects above low doses. As long ago as 2004 it was said that 3–41% of all neonates born in various North American communities had been exposed to cannabis [172]. Since cannabis is addictive [187], is becoming more potent [77,83,86], quickly builds up in adipose tissues [62,82] and seems generally to becoming more widely available under fluid regulatory regimes [187,188], real concern must be expressed that the rising population level of cannabinoid exposure will increasingly intersect the toxic thresholds for major genotoxicity including chromosomal clastogenicity secondary to interference and premature aging of the mitotic apparatus.

Under such a conceptualization, it would appear that the real boon of restrictive cannabis regimes [189] is not their supposed success in any drug war, but their confinement in the populations they protect, to a low dose exposure paradigm which limits incident and transgenerational teratogenicity, ageing, mental retardation and cancerogenicity.

Source:   Mutation Research/Fundamental and Molecular Mechanisms of Mutagenesis Journal Homepage: www.elsevier.com/locate/molmut    January 2016

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

Women who inject drugs are about 39% more likely to become infected with hepatitis C virus than men who inject drugs, research suggests.

A range of factors could account for the disparity, the researchers wrote in Clinical Infectious Diseases.

“Our findings provide important evidence that sex disparities in  exist independent of selected behavioral risk and demographic factors,” researcher Kimberly Page, PhD, MPH, division chief of the department of internal medicine at the University of New Mexico Health Sciences Center, and colleagues wrote. “When considering HCV risk differential among women, multiple factors including biological, social and network factors — as well as differential access to prevention services — need to be considered.”

The researchers assessed data from seven of the 10 InC3 Collaborative studies of HIV and HCV among PWID ((people who inject drugs ), which included locations in the United States, Europe and Australia.

Page and colleagues included data from 1,868 PWID, 590 (31.58%) of whom were women. No data from participants who reported being transgender were assessed. In all, the researchers found 511 PWID with incident HCV during follow-up. Of those, 182 (31.5%) were female.

The unadjusted female-to-male HR for HCV infection was 1.38 (95% CI, 1.15-1.65). The disparity remained significant after adjustment for behavioral and demographic risk factors, the researchers said, slightly rising to 1.39 (95% CI, 1.12-1.72).

Page and colleagues cited previous studies suggesting biological and social factors that may help to explain the difference.

“All of these factors should be studied further to better understand sex-related differences in risk and to maximize prevention effects of drug treatment programs and their potential to reduce acquisition of blood-borne viruses, including HCV and HIV,” they wrote.

Disclosure: Esmaeili reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Source: https://www.healio.com/infectious-disease/hepatitis-c/news/in-the-journals/%7Be0c3d409-03c9-4d3b-a277-13edeb16b8e6%7D/women-injecting-drugs-at-higher-risk-for-hcv-than-men 2nd Sept.2017

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

St. Petersburg, FL – Thursday, August 31, 2017 – Drug Free America Foundation today introduced a first-of-its-kind Opioid Tool Kit in an effort to help address the opioid epidemic gripping the United States.

The Opioid Tool Kit was unveiled in conjunction with International Overdose Awareness Day, a global event held on August 31st each year that aims to raise the awareness of the problem of drug overdose-related deaths.

“With more than 142 people dying each day, drug overdoses are now the leading cause of death for Americans under the age of 50,” according to Calvina Fay, Executive Director of Drug Free America Foundation. “Moreover, deaths from drug overdose are an equal opportunity killer, with no regard to race, religion or economic class,” she said.

“While alcohol and marijuana still remain the most common drugs of abuse, the nonmedical use of prescription painkillers and other opioids has resulted in a crisis-level spike in drug overdose deaths,” said Fay.

The Opioid Tool Kit has been designed to educate people about the opioid epidemic and offer strategies that can be used to address this crisis. “The Tool Kit is also intended to encourage collaboration with different community sectors and stakeholders to make successful and lasting change,” Fay continued.

The Opioid Tool Kit is a comprehensive guide that defines what an opioid is, examines the scope of the problem, and addresses why opioids are a continuing health problem.  The Tool Kit also provides strategies for the prevention of prescription drug misuse and overdose deaths and includes a community advocacy and action plan, as well as additional resources.

Fay emphasized that the best way to prevent opioid and other drug addiction is not to abuse drugs in the first place.  “The chilling reality is that the long-term use and abuse of opioids and other addictive drugs rewire the brain, making recovery a difficult and often a life-long struggle,” she concluded. The Opioid Tool Kit can be found on Drug Free America Foundation’s website at https://dfaf.org/Opioid%20Toolkit.pdf.

Source:   https://dfaf.org/Opioid%20Toolkit.pdf..  August 2017

Background

On August 29, 2013, the U.S. Department of Justice (DOJ) issued guidelines to Federal prosecutors and law enforcement officials regarding where to focus their drug enforcement efforts in states that have passed laws legalizing the retail sales of marijuana. The so-called “Cole Memo” directs enforcement officials to focus resources, including prosecutions, “on persons and organizations whose conduct interferes with any one or more of [eight] priorities, regardless of state law.”

Per the memorandum, the eight DOJ priorities are:

● Preventing distribution of marijuana to minors

● Preventing marijuana revenue from funding criminal enterprises, gangs or cartels

● Preventing marijuana from moving out of states where it is legal

● Preventing use of state-legal marijuana sales as a cover for illegal activity

● Preventing violence and use of firearms in growing or distributing marijuana

● Preventing drugged driving or exacerbation of other adverse public health consequences associated with marijuana use

● Preventing growing marijuana on public lands

● Preventing marijuana possession or use on federal property

According to the Department of Justice, the Federal “hands-off” approach to marijuana enforcement enumerated in the Cole Memo is contingent on its expectation that “states and local governments that have enacted laws authorizing marijuana-related conduct will implement strong and effective regulatory and enforcement systems that will address the threat those state laws could pose to public safety, public health, and other law enforcement interests.

A system adequate to that task must not only contain robust controls and procedures on paper, it must also be effective in practice.”

Unfortunately, since Colorado and Washington became the first states to legalize the recreational sale of marijuana in 2012, evidence has emerged that regulations intended to control the sale and use of marijuana have failed to meet the promises made by advocates for legalization.

For example, states with legal marijuana are seeing an increase in drugged driving crashes and youth marijuana use. States that have legalized marijuana are also failing to shore up state budget shortfalls with marijuana taxes, continuing to see a thriving illegal black market, and are experiencing an unabated sales of alcohol, despite campaign promises from advocates promising that marijuana would be used as a “safer” alternative instead.

Moreover, state regulatory frameworks established post-legalization have failed to meet each of the specific DOJ requirements on controlling recreational marijuana production, distribution, and use.

While long-term studies and research on the public health and safety impacts of marijuana legalization are ongoing, this report provides a partial census of readily available information that demonstrates how Colorado, Oregon, and Washington State –

the jurisdictions with the most mature regulatory markets and schemes – have not fulfilled the requirements of the Cole Memo.

DOJ Guideline 1: “Preventing distribution of marijuana to minors”

● According to the nation’s largest and most comprehensive survey of drug use trends in the nation, past-month use of marijuana among 12 to 17-year-olds in Colorado increased significantly – from 9.82% to 12.56% after marijuana retail sales began (Colorado legalized marijuana in 2012 and implemented legal marijuana stores in 2014).

The same study notes that teens and adults in Colorado now use marijuana at a higher rate than the rest of the country. No other representative sample of drug users in Colorado has contradicted this sample.

● A 2017 study from the University of Colorado found that marijuana-related emergency room visits and visits to its satellite urgent care centers by teens in Colorado more than quadrupled after the state legalized marijuana.

● In Colorado, a new report from the state’s public safety agency reveals that after the state legalized the drug, marijuana-related arrests for black and Hispanic youth rose by 58% and 29% respectively, while arrest rates for white kids dropped by eight percent. School Resource Officers in Colorado have reported a substantial increase in marijuana-related offenses in Colorado schools after the state commercialized the drug.

● According to data from the State of Washington, there have been over 240 violations of legal marijuana sales to minors and of minors frequenting restricted marijuana sales areas as of July 2017. ● Youth use – among 8th and 10th graders at least – is increasing in Washington State. According to a special analysis of teenage drug use published in the peer-reviewed, highly regarded Journal of American Medical Association Pediatrics, the perceived  harmfulness of marijuana in Washington declined 14.2% and 16.1% among eighth and 10th graders, respectively, while marijuana use increased 2.0% and 4.1% from 2010-2012 to 2013-2015.

● According to the Washington State Office of the Superintendent of Public Instruction during 2013-2014, 48 percent of statewide student expulsions were for marijuana in comparison to alcohol, tobacco, and other illicit drugs. During the 2014-2015 school year, statewide student expulsions for marijuana increased to 60 percent. Marijuana related suspensions for the 2013-2014 school year reported 42 percent and for the 2014-2015 school year, suspensions increased to 49 percent.

● In Washington State, youth (12-17) accounted for 64.9% of all state marijuana seizures in 2015 as compared to 29.9% in 2010, according to data from the National Incident Based Reporting System (NIBRS).

● From 2012 to 2016, reported exposure calls for marijuana increased 105 percent in Washington. According to the 2016 Annual Cannabis Toxic Trends Report, of exposures related to children under the age of five, 73 percent occurred in those one to three years of age. The counties with the highest reported exposures for both 2015 and 2016 were: King, Spokane, Snohomish, and Pierce.

DOJ Guideline 2: “Preventing revenue of the sale of marijuana from going to criminal enterprises, gangs, and cartels”

● In June 2017, Colorado Attorney General Cynthia Coffman announced a takedown of a massive illegal marijuana trafficking ring in Colorado. The bust is the largest since legalization and indicted 62 individuals and 12 businesses in Colorado. The operation stretched into other states including Kansas, Texas, Nebraska, Ohio and Oklahoma.

● In March 2017, a leaked report from the Oregon State Police uncovered evidence from state officials that the black market for marijuana continues to thrive in the state. The 39-page report noted that, “The illicit exportation of cannabis must be stemmed as it undermines the spirit of the law and the integrity of the legal market…it steals economic power from the market, the government, and the citizens of Oregon, and furnishes it to criminals, thereby tarnishing state compliance efforts.”

Washington State Office of the Superintendent of Instruction. (2016, Jan. 26). Behavior Report. http://www.k12.wa.us/SafetyCenter/Behavior/default.aspx

Washington State Poison Center – Toxic Trends Report: 2016 Annual Cannabis Report

● In 2016, Seattle Police spokesman Sean Whitcomb noted that “large-scale illegal grow operations… are still prevalent in Seattle, and we do come across those with a degree of frequency.” DOJ Guideline 3: “Preventing the diversion of marijuana from states where it is legal under state law in some form to other states”

● In 2014, two states – Nebraska and Oklahoma – sued their neighbor state of Colorado by citing evidence of increased marijuana flowing into those states. Law enforcement officials have reported a substantial increase in marijuana flow across state borders into neighboring states.

● In 2016, there were multiple raids conducted by state law enforcement in Colorado, leading authorities to seize more than 22,0000 pounds of marijuana intended for sales outside of Colorado.

● According to the Oregon State Police, the state has an “expansive geographic footprint” on marijuana exports across the U.S. Several counties in Oregon including Jackson, Multnomah, Josephine, Lane, Deschutes and Washington “lead the way” in supplying marijuana to states where it is not legal.

● According to the Rocky Mountain High Intensity Drug Trafficking Area task force, “there were 360 seizures of marijuana in Colorado destined for other states. This is nearly a 600% increase in the number of individual stops in a decade, seizing about 3,671 pounds in 2014. Of the 360 seizures reported in 2014, 36 different states were identified as destinations, the most common being Kansas, Missouri, Illinois, Oklahoma and Florida.”

● Law enforcement officials report that since legalization in 2012, Washington State marijuana has been found to be destined for 38 different states throughout the United States. Between 2012 and 2017, 8,242.39 kilograms (18,171.35 pounds) have been seized in 733 individual seizure events across 38 states. From 2012 to 2016, 470 pounds of marijuana have been seized on Washington State highways and interstates. Since 2012, 320 pounds of Washington State-origin marijuana have been seized during attempted parcel diversions. DOJ Guideline 4: “Preventing state-authorized marijuana activity from being used as a cover or pretext for the trafficking of other illegal drugs or other illegal activity”

● According to Jorge Duque from the Colorado Department of Law, cartels operating in Colorado are now “trading drugs like heroin for marijuana,” and the trade has since opened the door to drug and human trafficking. Duque also explains that money 5 laundering is a growing problem as “cartels are often disguising their money through legally purchasing marijuana or buying houses and growing marijuana in it.”

● In June 2017, a former Colorado marijuana enforcement officer and a Denver-based marijuana entrepreneur were indicted for running a statewide marijuana trafficking ring that illegally produced and sold “millions of dollars worth of marijuana across state lines.” This trafficking organization obtained 14 marijuana licenses in order to present their activities as protected business endeavors, despite “never ma[king] a single legal sale of cannabis in their two years of operation.”

● In Oregon, State Police officials report that criminals are exploiting Oregon’s legal marijuana industry for financial crimes and fraud. In one example, according to the Oregon State Police report, “Tisha Silver of Cannacea Medical Marijuana Dispensary falsified licensing to solicit investors and worked with Green Rush Consulting to locate unwitting investors. Silver exploited the burgeoning cannabis industry in the state to entice investors to back an illegitimate company, securing a quarter of a million dollars in fraudulent gains. According to some analysts, cannabis investors fell prey to ‘pump and dump’ schemes and lost up to $23.3 billion in 2014 alone.”

● Officials in Oregon note that the U.S. Postal Service is being exploited to ship marijuana products and revenue. According to former Attorney General Eric Holder, “The Postal Service is being used to facilitate drug dealing,” a clear violation of federal law and a violation of the sanctity of the U.S. mailing system.

DOJ Guideline 5: “Preventing violence and the use of firearms in the cultivation and distribution of marijuana”

● While crime rates dropped or remained stable in many of the nation’s largest cities, Colorado’s crime rate increased. There has been an increase in rape, murder, robbery and auto thefts. While it is not possible to link legalization to a direct change in crime rates, officials in Colorado cited marijuana legalization as one of the reasons behind the rise.

● In Colorado, prosecutors are reporting an increase in marijuana-related homicides since the state legalized the drug.  This situation is detailed here: http://www.oregonlive.com/marijuana/index.ssf/2016/07/state_slaps_portland_dispensar.h tml.

Other instances of fraud have been discussed here: Sapient Investigations Newsletters (2015, Feb. 10) “High Times for Fraud,” available online at https://sapientinvestigations.com/spi-news/high-times-for-fraud/

● In Oregon, state police report that, “Cannabis is a lucrative target for robbery. As recently as December 2016, a state-licensed cannabis producer was targeted for a violent armed robbery. In the aforementioned case, a well-known cannabis grower in Jackson County was assaulted, bound, and his harvest was taken by armed assailants.”

● In Prince George’s County Maryland, Police Chief Henry Stawinski noted a significant rise in marijuana-related homicides since neighboring D.C. legalized the drug. Stawinski said 19 homicides in 2016 were related to marijuana.

DOJ Guideline 6:  “Preventing drugged driving and the exacerbation of other public health consequences associated with marijuana use”

● Drugged driving has increased in states with legal marijuana sales. According to a study published by the American Automobile Association, fatal drugged driving crashes doubled in Washington State after the state legalized marijuana. The Governors Highway Safety Association also notes a disturbing rise in drugged driving crashes even as alcohol-related crashes are declining.

● A Denver Post analysis found the number of marijuana-impaired drivers involved in fatal crashes in Colorado more than doubled since 2013, the year after the state voted to legalize recreational marijuana use. Colorado saw a 145 percent increase in the number of marijuana-impaired drivers involved in fatal crashes between 2013 and 2016. Marijuana is also figuring into more of Colorado’s fatal crashes overall: in 2013, marijuana-impaired drivers accounted for 10 percent of all fatal crashes, but by 2016 it reached 20 percent.

● According to a study published in the Annals of Emergency Medicine, poison control calls for children more than tripled after marijuana legalization. Much of this is linked to a boom in the sale of marijuana “edibles.” THC concentrate is mixed into almost any type of food or drink, including gummy candy, soda, and lollipops. Today, these edibles comprise at least half of Colorado’s marijuana market.

● In Washington State, the number of marijuana-involved DUIs are increasing with 38 percent of total cases submitted in 2016 testing above the five nanogram per milliliter of blood legal limit for those over the age of twenty-one. In addition, 10 percent of drivers involved in a fatal accident from 2010 to 2014 were THC-positive.

● A study by the Highway Loss Data Institute reveals that Colorado, Oregon, and Washington have experienced three percent more collision claims overall than would ( NWHIDTA Drug Threat Assessment For Program Year 2018)  have been expected without legalization.

Colorado witnessed the largest jump in claims. The state experienced a rate 14 percent higher than neighboring states.

● In Washington State, from 2012 to 2016, calls to poison control centers increased by 79.48%. Exposures increased 19.65% from the time of marijuana commercialization in 2014 to 2016. Of the marijuana calls answered by the Poison Center in 2016, youth under the age of 20 accounted for almost 40% of all calls.

According to the 2016 Annual Cannabis Toxic Trends Report, 42% of the calls reported were for persons aged 13 to 29. Additionally, among exposures related to children under the age of five, 73% involved children one to three years of age. The counties with the highest reported number of exposures for 2015 remained in the top four for 2016: King, Spokane, Snohomish, and Pierce.

DOJ Guideline 7: “Preventing the growing of marijuana on public lands and the attendant public safety and environmental dangers posed by marijuana on public lands”

● In Washington State, 373,778 marijuana plants were found growing illegally on public and private lands between 2012 and 2016. Of the illegal marijuana plants eradicated in 2016, 60% were being cultivated on state land, and the 58,604 illegal marijuana plants eradicated in 2016 consumed an estimated 43.2 million gallons of water over a full growing season (120-day cycle).

More than 400 pounds of fertilizers, chemicals, and pesticides were removed from illegal marijuana growing operations in 2016, and Furadan, a neurotoxin that is extremely dangerous to humans, was found in an illegal marijuana growing operation the same year.

● In June 2017, Colorado officials found more than 7,000 illegal plants on federal land in the state’s San Isabel National Forest. This was the fifth illegal grow found in that area alone since the year marijuana legalization passed, demonstrating legalization has not curbed the problem of grows exploiting public lands.

● In Oregon, the legalization of marijuana in the state has failed to eliminate illegal growing operations and public lands continue to be exploited despite a legal market. According to a report from state officials, “To date in Oregon, cannabis legalization has not had a noticeable influence on Mexican National [Drug Trafficking Organizations] illicit cannabis cultivation operations on public lands… leaving a lasting scar on Oregon’s unique ecosystems.

Illicit cannabis grows employ excessive amounts of pesticides, rodenticides, and herbicides, thereby threatening local wildlife habitats. Additionally, many illicit grow sites clear-cut timber, furthering soil erosion and water contamination. Research on the environmental impact of illicit cannabis grows indicates that grows tend to be bunched near water sources, resulting in disproportionate impacts on ecologically important areas…

Oregon is robbed of roughly 122 Olympic swimming pools 8 worth of water annually, or roughly 442,200 gallons of water daily during the growth season.”

DOJ Guideline 8: “Preventing marijuana possession or use on federal property”

● Advocates for legal marijuana frequently flout federal laws by possessing and using marijuana on federal properties purportedly in acts of civil disobedience. In January 2017, one group gave away free marijuana in Washington, D.C. to smoke on the National Mall during the inauguration of President Trump. On April 24, 2017, four activists were arrested after purposely flouting federal law and publicly using marijuana on U.S. Capitol grounds.

Conclusion and Key Recommendations

Federal resources should target the big players in the marijuana industry. Individual marijuana users should not be targeted or arrested, but large-scale marijuana businesses, several of which now boast of having raised over $100 million in capital, and their financial backers, should be a priority. These large businesses are pocketing millions by flouting federal law, deceiving Americans about the risks of their products, and targeting the most vulnerable.

They should not have access to banks, where their financial prowess would be expanded significantly, nor should they be able to advertise or commercialize marijuana.

These businesses target many of the marijuana products they sell toward kids, such as pot candies, cookies, and ice cream. And despite state regulations, these products continue to have problems with contamination. Recently, one of the largest, most sophisticated manufacturers of these pot “edibles” was forced to recall a number of products because they contained non-food-grade ingredients.

Additionally, the black market continues unabated in legalized states. A leaked report from Oregon police showed that at least 70 percent of that state’s marijuana market is illegal, despite legalization. In June 2017, Colorado Attorney General Cynthia Coffman said, “The black market for marijuana has not gone away since recreational marijuana was legalized in our state, and in fact continues to flourish.”

Further, state-legal businesses have acted as top cover for these illegal operations, as recent large-scale arrests in Colorado have shown. These large marijuana operations, which combine the tactics of Big Tobacco with black marketeering, should form the focus of federal law enforcement, not individual users.  Recalls are becoming more commonplace because of pesticides, moulds, and other issues.

See The Denver Post for news stories related to these recalls in legalized states: http://www.thecannabist.co/tag/marijuana-recall/

At the same time, the federal government along with non-government partners should implement a strong, evidence-based marijuana information campaign, similar to the truth ® campaign for tobacco, which alerts all Americans about the harms of marijuana and the deceitful practices of the marijuana industry.

Background:

Cannabis is increasingly available for the treatment of chronic pain, yet its efficacy remains uncertain.

Purpose: 

To review the benefits of plant-based cannabis preparations for treating chronic pain in adults and the harms of cannabis use in chronic pain and general adult populations.

Data Sources:

MEDLINE, Cochrane Database of Systematic Reviews, and several other sources from database inception to March 2017.

Study Selection: 

Intervention trials and observational studies, published in English, involving adults using plant-based cannabis preparations that reported pain, quality of life, or adverse effect outcomes.

Data Extraction: Two investigators independently abstracted study characteristics and assessed study quality, and the investigator group graded the overall strength of evidence using standard criteria.

Data Synthesis: From 27 chronic pain trials, there is low-strength evidence that cannabis alleviates neuropathic pain but insufficient evidence in other pain populations. According to 11 systematic reviews and 32 primary studies, harms in general population studies include increased risk for motor vehicle accidents, psychotic symptoms, and short-term cognitive impairment. Although adverse pulmonary effects were not seen in younger populations, evidence on most other long-term physical harms, in heavy or long-term cannabis users, or in older populations is insufficient.

Limitation: Few methodologically rigorous trials; the cannabis formulations studied may not reflect commercially available products; and limited applicability to older, chronically ill populations and patients who use cannabis heavily.

Conclusion: 

Limited evidence suggests that cannabis may alleviate neuropathic pain in some patients, but insufficient evidence exists for other types of chronic pain. Among general populations, limited evidence suggests that cannabis is associated with an increased risk for adverse mental health effects.

Source:  http://annals.org/aim/article/2648595/effects-cannabis-among-adults-chronic-pain-overview-general-harms-systematic#.WZXJbYbta0I.email

Key Points

Question  Are US state medical marijuana laws one of the underlying factors for increases in risk for adult cannabis use and cannabis use disorders seen since the early 1990s?

Findings  In this analysis using US national survey data collected in 1991-1992, 2001-2002, and 2012-2013 from 118 497 participants, the risk for cannabis use and cannabis use disorders increased at a significantly greater rate in states that passed medical marijuana laws than in states that did not.

Meaning  Possible adverse consequences of illicit cannabis use due to more permissive state cannabis laws should receive consideration by voters, legislators, and policy and health care professionals, with appropriate health care planning as such laws change.

Abstract

Importance  Over the last 25 years, illicit cannabis use and cannabis use disorders have increased among US adults, and 28 states have passed medical marijuana laws (MML). Little is known about MML and adult illicit cannabis use or cannabis use disorders considered over time.

Objective  To present national data on state MML and degree of change in the prevalence of cannabis use and disorders.

Design, Participants, and Setting  Differences in the degree of change between those living in MML states and other states were examined using 3 cross-sectional US adult surveys: the National Longitudinal Alcohol Epidemiologic Survey (NLAES; 1991-1992), the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; 2001-2002), and the National Epidemiologic Survey on Alcohol and Related Conditions–III (NESARC-III; 2012-2013). Early-MML states passed MML between NLAES and NESARC (“earlier period”). Late-MML states passed MML between NESARC and NESARC-III (“later period”).

Main Outcomes and Measures  Past-year illicit cannabis use and DSM-IV cannabis use disorder.

Results  Overall, from 1991-1992 to 2012-2013, illicit cannabis use increased significantly more in states that passed MML than in other states (1.4–percentage point more; SE, 0.5; P = .004), as did cannabis use disorders (0.7–percentage point more; SE, 0.3; P = .03).

In the earlier period, illicit cannabis use and disorders decreased similarly in non-MML states and in California (where prevalence was much higher to start with). In contrast, in remaining early-MML states, the prevalence of use and disorders increased.

Remaining early-MML and non-MML states differed significantly for use (by 2.5 percentage points; SE, 0.9; P = .004) and disorder (1.1 percentage points; SE, 0.5; P = .02). In the later period, illicit use increased by the following percentage points: never-MML states, 3.5 (SE, 0.5); California, 5.3 (SE, 1.0); Colorado, 7.0 (SE, 1.6); other early-MML states, 2.6 (SE, 0.9); and late-MML states, 5.1 (SE, 0.8). Compared with never-MML states, increases in use were significantly greater in late-MML states (1.6–percentage point more; SE, 0.6; P = .01), California (1.8–percentage point more; SE, 0.9; P = .04), and Colorado (3.5–percentage point more; SE, 1.5; P = .03).

Increases in cannabis use disorder, which was less prevalent, were smaller but followed similar patterns descriptively, with change greater than never-MML states in California (1.0–percentage point more; SE, 0.5; P = .06) and Colorado (1.6–percentage point more; SE, 0.8; P = .04).

Conclusions and Relevance

Medical marijuana laws appear to have contributed to increased prevalence of illicit cannabis use and cannabis use disorders. State-specific policy changes may also have played a role. While medical marijuana may help some, cannabis-related health consequences associated with changes in state marijuana laws should receive consideration by health care professionals and the public.

Source:  JAMA Psychiatry. 2017;74(6):579-588. doi:10.1001/jamapsychiatry.2017.0724

LONDON (Reuters) – People who smoke marijuana have a three times greater risk of dying from hypertension, or high blood pressure, than those who have never used the drug, scientists said on Wednesday. The risk grows with every year of use, they said.

The findings, from a study of some 1,200 people, could have implications in the United States among other countries. Several states have legalized marijuana and others are moving toward it. It is decriminalized in a number of other countries.

“Support for liberal marijuana use is partly due to claims that it is beneficial and possibly not harmful to health,” said Barbara Yankey, who co-led the research at the school of public health at Georgia State University in the United States.

“It is important to establish whether any health benefits outweigh the potential health, social and economic risks. If marijuana use is implicated in cardiovascular diseases and deaths, then it rests on the health community and policy makers to protect the public.”

Marijuana is also sometimes used for medicinal purposes, such as for glaucoma.

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

For Yankey’s study, information on marijuana use was merged with mortality data in 2011 from the U.S. National Center for Health Statistics, and adjusted for confounding factors such as tobacco smoking and variables including sex, age and ethnicity.

The average duration of use among users of marijuana, or cannabis, was 11.5 years.

The results showed marijuana users had a 3.42-times higher risk of death from hypertension than non-users, and a 1.04 greater risk for each year of use.

There was no link between marijuana use and dying from heart or cerebrovascular diseases such as strokes.

Yankey said were limitations in the way marijuana use was assessed — including that researchers could not be sure whether people had used the drug continuously since they first tried it.

But she said the results chimed with plausible risks, since marijuana is known to affect the cardiovascular system.

“Marijuana stimulates the sympathetic nervous system, leading to increases in heart rate, blood pressure and oxygen demand,” she said.

Experts not directly involved in the study said its findings would need to be replicated, but already raised concerns.

“Despite the widely held view that cannabis is benign, this research adds to previous work suggesting otherwise,” said Ian Hamilton, a lecturer in mental health at Britain’s York University. Source:  https://www.reuters.com/article/us-health-marijuana-hypertension-idUSKBN1AP0JS   9th Aug.201

A string of recent deaths in New Zealand is being attributed to the rise of so-called synthetic cannabis is made to look like normal cannabis

A man in his 20s died on Tuesday night, bringing the number of fatalities this month linked to the illegal substance to eight.  The drug consists of dried plants sprayed with synthetic drugs – it triggers effects similar to cannabis but is more powerful and dangerous.  Synthetic cannabis has already caused huge concerns in the US and Europe.

In each of the eight deaths this month, the victim was thought to have used the drug before dying or was found with the drug on them.  The actual substance in the drug responsible for the deaths is not yet known.

All eight deaths have occurred in Auckland and authorities say there is a much higher number of non-fatal cases where people had to be taken to hospital.

Earlier this month, the Auckland City District Police issued a warning on Facebook over the drug use and the apparent link to the rising number of victims.

“This is not an issue unique to Auckland,” the statement warned. “Police are also concerned at the impact of synthetic cannabis in other communities in New Zealand.”

Auckland police also took the rare step of releasing CCTV footage of a man violently ill and barely able to stand after smoking synthetic cannabis.

“We have grave concerns as users don’t know what poisonous chemicals they are potentially putting into their bodies when they’re smoking this drug,” Det Insp Lendrum said.

 

What is synthetic cannabis?

§ Actual cannabis contains an active ingredient which interacts with certain receptors in the brain.

§ Synthetic cannabis is dried plant matter sprayed with chemicals that interact with the same receptors.

§ Produced and sold illegally, the chemicals used vary a lot. That means the effect of the drug is a lot less predictable, so a lot more dangerous.

§ Effects can be extreme, including increased heart rates, seizures, psychosis, kidney failure and strokes.

Cannabis-simulating substances – or synthetic cannabinoids – were developed more than 20 years ago in the US for testing on animals as part of a brain research programme.  But in the last decade or so they’ve become widely available to the public.

In the UK, synthetic cannabis was also temporarily legal, being sold under a variety of names most prominently Spice and Black Mamba.  The drugs were banned in 2016 but continue to cause widespread problems in the country.

Synthetic cannabis has also been banned in the US but continues to be widely available as an illegal drug.

Source:   http://www.bbc.co.uk/news/world-asia-40724390      26 July 2017

MS Society says there is sufficient evidence of drug’s effectiveness to relax ban for patients with no other options

Ten thousand people with multiple sclerosis in the UK should be allowed to use cannabis legally in order to relieve their “relentless and exhausting” symptoms, experts in the disease have told ministers.

The MS Society claims the one in 10 sufferers of the condition whose pain and spasticity cannot be treated by medication available on the NHS should be able to take the drug without fear of prosecution.

The evidence on cannabis’s effectiveness, while not conclusive, is now strong enough that the government should relax the ban on the drug for MS patients who have no other treatment options, the society says in a report.

Doctors who treat MS patients have backed the society’s call, as have the Liberal Democrats and the Green party. Legalisation would ease “the extremely difficult situation in which many people with MS find themselves”, the charity said.

The society is calling for the first time for the 10,000 patients – one in 10 of the 100,000 people in Britain with MS – to be able to access cannabis without fear of arrest. It has changed its position after reviewing the evidence, consulting its medical advisers and seeking the views of 3,994 people who have the condition.

“We think cannabis should be legalised for medicinal use for people with MS to relieve their pain and muscle spasms when other treatments haven’t worked,” said Genevieve Edwards, the MS Society’s director of external affairs.

“The level of clinical evidence to support cannabis’s use for medicinal purposes is not conclusive. But there is sufficient evidence for our medical advisers to say that on the balance of probability, cannabis could benefit many people with MS experiencing pain and muscle spasms.” The charity is also urging NHS bosses to make Sativex, a cannabis-based drug used by some people with MS, available on prescription across the UK so that patients who can afford it no longer have to acquire it privately, at a cost of about £2,000 a year. Wales is the only home nation to provide the mouth spray through the NHS.

Patients’ inability to access Sativex on the NHS in England, Scotland and Northern Ireland “has resulted in many people with MS turning to illegal forms of cannabis as an alternative. It’s simply not right that some people are being driven to break the law to relieve their pain and spasticity. It’s also really risky when you’re not sure about the quality or dosage of what you’re buying,” Edwards said.

Norman Lamb, the Lib Dem health spokesman, said: “This is the strongest proof yet that the existing law on cannabis is a huge injustice that makes criminals of people whose only crime is to be in acute pain. This draconian law is potentially opening anything up to 10,000 MS sufferers to prosecution, and underlines why the Liberal Democrats have braved a tabloid backlash to campaign for the legalisation of cannabis. It is about time the government listened to the science.”

One in five (22%) MS patients who took part in a survey by the society said they had used cannabis to help manage their symptoms, but only 7% were still doing so. A quarter (26%) of those who had stopped taking it said they had done so out of fear of

prosecution. Another 26% of respondents had considered trying cannabis but had not done so for the same reason and also because they were concerned about the drug’s safety.

Doctors are divided over cannabis’s potential role in treating MS. Some are supportive while others are anxious about endorsing the use of a drug that can cause psychiatric problems. The Royal College of GPs said it was currently drawing up policy on the issue and could not comment. The Royal College of Physicians, which represents hospital doctors, said it had no policy on the issue.

Dr Willy Notcutt, a pain management specialist at the James Paget hospital in Norfolk, who has been treating MS patients for more than 20 years, said: “Every week I come across patients wishing to use cannabis to control their symptoms but who are unable to get proven drugs like Sativex from the NHS. Many patients seek illegal cannabis to get help. They can’t be sure of its origin but are being forced to commit a criminal act in order to obtain relief.”

Dr Waqar Rashid, a consultant neurologist at Brighton and Sussex University Hospitals NHS trust, said: “[Cannabis is] not a cure-all, and there are other treatments that should be tried first. But it makes sense for criminality not be a barrier to a treatment which could reduce the debilitating impact of symptoms and transform someone’s quality of life.”

Caroline Lucas, the Green party co-leader and its sole MP, said: “The MS Society’s new position is a big step forward, and recognises the fact that thousands of people with MS could benefit from the the use of medicinal cannabis. By rigidly sticking to criminalising cannabis the government drives MS sufferers to illegally acquire the drugs, thus putting themselves as risk of prosecution simply for searching for pain relief.” The National Institute for Health and Clinical Excellence (Nice), which advises the government, has told the NHS not to prescribe Sativex for spasticity because it is not cost-effective. The Home Office said: “This government has no plans to legalise cannabis. Cannabis is controlled as a Class B drug under the Misuse of Drugs Act 1971 and, in its raw form, currently has no recognised medicinal benefits in the UK.”

Case study: Steven Colborn, 55, from Seaham, County Durham

Imagine running a marathon while sharp pain darts up and down your legs. This is what multiple sclerosis feel like for me. When muscle spasticity kicks in my legs just twist and turn and bend back on themselves and it’s excruciatingly painful.

But three years ago I was offered a treatment that could help. During a regular appointment, a specialist nurse said they had managed to get a month’s supply of Sativex, a drug derived from cannabis, from the manufacturer.

The results were incredible. My muscle tension eased and I started to feel my legs moving better. I was able to get a good night’s sleep. I could exercise without getting as tired as quickly. For the first time in a long time I felt that I was managing my condition.

My month’s supply ran out and the drug wasn’t available free on the NHS. I was offered a muscle relaxer called Baclofen which hadn’t worked for me in the past.

I have been forced to pay for this drug myself. I can’t work any more so I rely on disability benefits. I have to save up a lot of money to be able to afford it – it costs £412 a month. Over the past four years I’ve only managed to buy about seven months’ worth.

I take Sativex but other people get similar relief from cannabis in its pure form. I don’t like taking this myself because of the narcotic effect, which you don’t get with Sativex. But for those it helps, it should be made legal.

I have had this illness for 36 years and every day I wake up and think ‘maybe there has been a breakthrough’. I know there will never be a cure, but I am just looking for a way to make things easier. Now I have been presented with something that offers me hope and the NHS say they cannot afford it. My question is: can you afford people like me getting worse?

Source:  https://www.theguardian.com/society/2017/jul/27/legalise-cannabis-as-treatment-of-last-resort-for-multiple-sclerosis-says-charity

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Comments by  NDPA:

UK  is 1st world nation with 1st world medicine approval system, even then we get things wrong e.g Thalidomide.

Cannabis based medicine is no problem if it goes through that system.

Sadly, ill people have been and are being exploited by the drug legalisation lobby, in furtherance of their nirvana of recreational cannabis for all.

Cannabis is a very harmful psychoactive drug, it induces dependency in around 1 in 9 or 10 users. It has numerous bad effects.

Smoking is obviously not a sensible delivery system for medication, yet a lot of those complaining want to smoke cannabis.

Cannabis based drugs like Sativex are in the pharmacopeia thanks to the wise licensing of the research on them by successive UK governments.

The mechanisms by which those cannabis based drugs are made available to  specific MS sufferers are a matter for the relevant authorities who deal with all pharmaceutical drugs. They must show efficacy and they must satisfy NICE.

There are no grounds at all for making cannabis any sort of special case, in fact the recreational user base and the legalisation lobby distort the arguments and would be better remaining silent.

In his last article for Pro Talk, Renaming and Rethinking Drug Treatment, psychologist Robert Schwebel, Ph.D., author and developer of The Seven Challenges program, expressed his views about problems in typical drug and alcohol treatment. In this interview, he focuses on changes that he thinks would better meet the needs of individuals with substance problems.

The Seven Challenges Program

The Seven Challenges is described as “a comprehensive counselling program for teens and young adults that incorporates work on alcohol and other drug problems.” The program addresses much more than substance issues because it also helps young people develop better life skills, as well as manage their situational and psychological problems. Although there is an established structure for each session and a framework for decision-making (see website for the youth version of “The Seven Challenges”), it is not pre-scripted as in many traditional programs. Rather it is “exceptionally flexible, in response to the immediate needs of the clients.”

Independent studies funded by The Center for Substance Abuse Treatment and published in peer-reviewed journals have provided evidence that The Seven Challenges significantly decreases substance use of adolescents and greatly improves their overall mental health status. The program has been shown to be especially effective for the many young people with drug problems who also have trauma issues.

Just recently, a new version of The Seven Challenges program was introduced for adults and is being piloted in a research project. Soon, a book geared toward the general public by Dr. Schwebel that incorporates much of the philosophy of the program, as well as many of the decision-making and behavior change strategies, will be available.

Q&A: What Should Treatment Look Like?

Q: In your last article for Pro Talk, you argued strongly against the word “treatment” and suggested that we use the word “counselling” instead. Will you reiterate why you prefer using “counselling” when talking about professional help for people with substance problems?

Dr. S.: Counselling is an active and interactive process that’s responsive to the needs of individuals. It may include education, but it’s more than that because the information is personalized and offered in the context of a discussion about what’s happening in a person’s life. Effective counsellors help clients become aware of their options, expand those options, and make their own informed choices.

Treatment, on the other hand, sounds like something imposed and passive that an authority (say a doctor) does to someone else or tells them to do. It also implies recipients receive a standardized protocol or regime with a preconceived goal, usually abstinence when we’re talking about addiction. It doesn’t suggest autonomy of choice or collaboration.

 

Q: You stress the importance of choice and collaboration, suggesting both are important in addiction counselling. Please tell us more.

Dr. S.: In collaborative counselling that allows choices, clients get to identify the issues they want to work on. They make the decisions. We make it clear that we’re not there to make them quit using drugs…and couldn’t even if we tried. We tell them, “We’re here to support you in working on your issues, things that are important to you; things that are not going well in your life or as well you would like them to be going.”

We also support clients in decision-making about drugs. They set their own goals about using. One person might want to quit using, while another might want to set new limits. For those who want to change their drug use behavior, we check in with them about how they’re doing regarding their decision on a session-by-session basis. If they have setbacks, we’ll provide individualized support to help them figure out why, We’re not doubting them or trying to “catch” them. Rather, we’re helping them succeed with their own decisions to change. This type of check-in would not apply to individuals who have not yet decided to make changes.

 

Q: Many addiction programs feel that dealing with addiction should be the first priority and that other issues are secondary. What are your thoughts about this?

Dr. S.: I’ll start by saying that they have equal importance. Drug problems have everything to do with what is going on in a person’s life. And, a person’s life is very much affected by drug problems. I do want to say, however, that not everyone who winds up in an addiction program has an addiction. That’s a ridiculous generalization. They may be having problems with binge drinking, issues with family or jobs because of substance misuse, or legal problems because they were unlucky and got caught. (For instance they got arrested for another crime and tested positive for drugs.) They often wind up in places that require abstinence and wonder, “What am I doing here?” Then they’re told they’re “in denial.”

Traditional treatment tends to focus narrowly on drug problems, usually pushing an agenda of immediate abstinence. However, drug problems – whether or not they qualify as “addiction,” are very much connected to the rest of life. Therefore, clients need comprehensive counselling that addresses what’s happening in their overall lives and helps clients make their lives better. So it’s not all about use of substances and making the individual quit. The goal is to support clients and to help them make their own decisions about life and substance use.

We use the term “issues” – not “problems.” Whatever is most important to the individual that day is what we work on. A client might say, “I have an issue with my mother.” We don’t just want to have a discussion about the issue; we want to set a session goal so that a client gets practical help with an issue each time. Ideally we try to facilitate a next step, some sort of action that can be taken between sessions. We want to support our clients in making their own lives better. We like to reassure clients that we won’t be harping on drugs all the time: At least half of what we do is about everything else besides drugs. This means that counsellors need to know how to help people with their other problems. Unfortunately, many have a narrow background in drug treatment and don’t yet know how to do that.

 

Q: How do you address the issue of “powerlessness” which a number of young people have told me they struggled with in12-step treatment programs they’ve attended? Don’t adolescents by nature resist anything that threatens to take away their autonomy?

Dr. S.: One of our main messages is “You are powerful; people do take control over their drug use. You have that power within you.” We also say, “You don’t need to do it alone. You are entitled to support. We’re behind you. We’re not saying it’s easy and

there won’t be setbacks along the way. If there are, we’ll help you figure out why and how to handle it differently the next time. At the same time we’ll help you with other issues in your life so you’ll have less need for drugs.”

I think there is great harm in the all-or-nothing approach to drug and alcohol problems and that more people would come for help if they were not told that they’re powerless. Also, many more would come if they felt they could make a choice about drugs and did not expect to be coerced.

 

A New Version of The Seven Challenges

Following is the new adult version of Dr. Schwebel’s The Seven Challenges program:

· Challenging Yourself to Make Thoughtful Decisions About Your Life, Including Your Use of Alcohol and Other Drugs

· Challenging Yourself to Look at Your Responsibility and the Responsibility of Others for Your Problems

· Challenging Yourself to Look at What You Like About Alcohol and Other Drugs, and Why You Use Them

· Challenging Yourself to Honestly Look at Your Life, Including Your Use of Alcohol and Other Drugs

· Challenging Yourself to Look at Harm That Has Happened or Could Happen From Your Use of Alcohol and Other Drugs

· Challenging Yourself to Look at Where You Are Headed, Where You Would Like to Go, and What You Would Like to Accomplish

· Challenging Yourself to Take Action and Succeed With Your Decisions About Your Life and Use of Alcohol and Other Drugs

Source:  http://www.rehabs.com/pro-talk-articles/what-drug-and-alcohol-treatment-should-look-like-an-interview-with-dr-robert-schwebel/     17th July 2017

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

Cannabis is the most widely used illicit drug in the United States, and trends show increasing use in the general population. As cannabis consumption rises, there has been significant emerging evidence for cannabis-related risks to health.1

Numerous lines of evidence suggest a correlation between cannabis consumption and a variety of psychiatric conditions, including cannabis-induced psychosis (CIP). While it can be difficult to differentiate CIP from other psychoses, CIP holds distinguishing characteristics, which may aid in its diagnosis. Given the increasing push toward cannabis legalization, assessing CIP and employing timely treatments is critical.

Specifically in youth, there is a direct relationship between cannabis use and its risks. The lack of knowledge surrounding its detrimental effects, combined with misunderstandings related to its therapeutic effects, has potential for catastrophic results.

CASE VIGNETTE

Ms. J, a 19-year-old college sophomore, was admitted to the Early Psychosis Unit at the Centre for Addiction and Mental Health (CAMH) displaying signs of agitation and acute psychosis. Her roommates had noted that her behavior had become increasingly bizarre, and she had isolated herself over the past month. She began smoking marijuana at the age of 17 and since starting college used it daily.

Ms. J exhibited signs of paranoia, believing other students in her dorm were stealing from her and trying to poison her. She remained adamant that all her problems were rooted in the competitive environment of the university and that smoking marijuana aided in keeping her sanity. In a sense, she was self-medicating. Her clinical presentation was consistent with a diagnosis of CIP.

After the hospitalization, she received outpatient case management services in the Early Psychosis Program at CAMH, which included motivational interviewing to raise her awareness about the importance of abstaining from cannabis use. She has been abstinent from cannabis for more than a year with no evidence of psychosis; she recently returned to school to finish her degree.

Epidemiology of CIP

Reports have shown a staggering increase in cannabis-related emergency department (ED) visits in recent years. In 2011, the Substance Abuse and Mental Health Services Administration (SAMHSA) and Drug Abuse Warning Network (DAWN) estimated a total of 1.25 million illicit-drug–related ED visits across the US, of which 455,668 were marijuana related.2 A similar report published in 2015 by the Washington Poison Center Toxic Trends Report showed a dramatic increase in cannabis-related ED visits.3 In states with recent legalization of recreational cannabis, similar trends were seen.4

States with medicinal marijuana have also shown a dramatic rise in cannabis-related ED visits. Moreover, states where marijuana is still illegal also showed increases.5 This widespread increase is postulated to be in part due to the easy accessibility of the drug, which contributes to over-intoxication and subsequent symptoms. Overall, from 2005 to 2011, there has been a dramatic rise in cannabis-related ED visits among all age groups and genders.

Neurobiology of CIP

Cannabis is considered an environmental risk factor that increases the odds of psychotic episodes, and longer exposure is associated with greater risk of psychosis in a dose-

dependent fashion. The drug acts as a stressor that leads to the emergence and persistence of psychosis. While a number of factors play a role in the mechanism by which consumption produces psychosis, the primary psychoactive ingredient is considered to be delta 9-tetrahydrocannabinol (delta9-THC). Properties of delta9-THC include a long half-life (up to 30 days to eliminate the long-acting THC metabolite carboxy-THC from urine) and high lipophilicity, which may contribute to CIP.

During acute consumption, cannabis causes an increase in the synthesis and release of dopamine as well as increased reuptake inhibition, similar to the process that occurs during stimulant use. Consequently, patients with CIP are found to have elevated peripheral dopamine metabolite products.

Findings from a study that examined presynaptic dopaminergic function in patients who have experienced CIP indicate that dopamine synthesis in the striatum has an inverse relationship with cannabis use. Long-term users had reduced dopamine synthesis, although no association was seen between dopaminergic function and CIP.6 This observation may provide insight into a future treatment hypothesis for CIP because it implies a different mechanism of psychosis compared with schizophrenia. As cannabis may not induce the same dopaminergic alterations seen in schizophrenia, CIP may require alternative approaches—most notably addressing associated cannabis use disorder.

Polymorphisms at several genes linked to dopamine metabolism may moderate the effects of CIP. The catechol-o-methyltransferase (COMT Val 158Met) genotype has been linked to increased hallucinations in cannabis users.7Homozygous and heterozygous genetic compositions (Met/Met, Val/Met, Val/Val) for COMT Val 158Met have been studied in patients with CIP and suggest that the presence of Val/Val and Val/Met genotypes produces a substantial increase in psychosis in relation to cannabis use. This suggests that carriers of the Val allele are most vulnerable to CIP attacks.

There has been much controversy surrounding the validity of a CIP diagnosis and whether it is a distinct clinical entity or an early manifestation of schizophrenia. In patients being treated for schizophrenia, those with a history of CIP had an earlier onset of schizophrenia than patients who never used cannabis.8Evidence suggests an association between patients who have received treatment for CIP and later development of schizophrenia spectrum disorder. However, it has been difficult to distinguish whether CIP is an early manifestation of schizophrenia or a catalyst. Nonetheless, there is a clear association between the 2 disorders.

Assessment of CIP

DSM-5 categorizes cannabis-induced psychotic disorder as a substance-induced psychotic disorder. However, there are distinguishing characteristics of CIP that differentiate it from other psychotic disorders such as schizophrenia. Clear features of CIP are sudden onset of mood lability and paranoid symptoms, within 1 week of use but as early as 24 hours after use. CIP is commonly precipitated by a sudden increase in potency (eg, percent of THC content or quantity of cannabis consumption; typically, heavy users of cannabis consume more than 2 g/d). Criteria for CIP must exclude primary psychosis, and symptoms should be in excess of expected intoxication and withdrawal effects. A comparison of the clinical features of idiopathic psychosis versus CIP is provided in the Table.

When assessing for CIP, careful history taking is critical. Time of last drug ingestion will indicate if a patient’s psychotic symptoms are closely related to cannabis intoxication/withdrawal effects. While acute cannabis intoxication presents with a range of transient positive symptoms (paranoia, grandiosity, perceptual alterations), mood symptoms (anxiety), and cognitive deficits (working memory, verbal recall, attention), symptoms that persist beyond the effects of intoxication and withdrawal are better categorized as CIP, regardless of the route of administration (smoke inhalation, oral, intravenous). CIP has historically been associated with fewer negative symptoms than schizophrenia; however, without a clear timeline of use, distinguishing schizophrenia from CIP may prove difficult.

A diagnosis of primary psychosis (eg, schizophrenia) is warranted in the absence of heavy cannabis use or withdrawal (for at least 4 weeks), or if symptoms preceded onset of heavy use. The age at which psychotic symptoms emerge has not proved to be a helpful indicator; different studies show a conflicting median age of onset.

Clinical features of schizophrenia and CIP share many overlapping characteristics. However, compared with primary psychoses with concurrent cannabis abuse, CIP has been established to show more mood symptoms than primary psychosis. The mood symptom profile includes obsessive ideation, interpersonal sensitivity, depression, and anxiety. Of significance is the presence of social phobia: 20% of patients with CIP demonstrate phobic anxiety compared with only 3.8% of patients with primary psychosis with cannabis abuse.

Hypomania and agitation have also been found to be more pronounced in cases of CIP.9 Visual hallucinations are more common and more distinct in CIP than in other psychoses such as schizophrenia. Perhaps the most discriminating characteristic of CIP is awareness of the clinical condition, greater disease insight, and the ability to identify symptoms as a manifestation of a mental disorder or substance use. The presence of much more rapidly declining positive symptoms is another distinctive factor of CIP.

Finally, family history may help distinguish CIP from primary psychosis. Primary psychosis has a strong association with schizophrenia and other psychotic disorders in first- or second-degree relatives, whereas CIP has a weaker family association with psychosis.

Treatment of CIP

As with all substance-induced psychotic states, abstinence from cannabis may be the definitive measure to prevent recurrence. With limited research surrounding CIP, achieving symptomatic treatment during acute phases of CIP has proved to be difficult. The Figure suggests possible treatment progression for CIP.

Pharmacotherapeutic interventions include the second-generation antipsychotic drug olanzapine and haloperidol. While both are equally effective, their different adverse- effect profiles should be taken into consideration when treating a patient; olanzapine is associated with significantly fewer extrapyramidal adverse effects.

One report indicates that antipsychotics worsened the condition in some patients.10 Conventional antipsychotics failed to abate the symptoms of CIP in one 20-year old man. Trials of olanzapine, lithium, and haloperidol had little to no effect on his psychosis. Risperidone was tried but elicited temporal lobe epilepsy with auditory, somatic, and olfactory hallucinations. However, the use of valproate sodium markedly improved his symptoms and cognition, returning him to baseline.

Carbamazepine has also been shown to have rapid effects when used as an adjunct to antipsychotics.11 Use of anti-seizure medication in CIP treatment has been hypothesized to reduce neuroleptic adverse effects, resulting in better tolerance of antipsychotics.10,11 These results suggest the use of adjunctive anti-epileptics should be considered in CIP treatment strategies, although further studies in a broad range of patients with CIP are needed.

Abstaining from cannabis is the most beneficial and effective measure for preventing future CIP events; however, it is likely to be the most difficult to implement.

Psychosocial intervention has a significant impact on early-phase psychosis, and when the intervention is initiated plays a role in disease outcomes. A delay in providing intensive psychosocial treatment has been associated with more negative symptoms compared with a delay in administrating antipsychotic medication.12 Employing cannabis- focused interventions with dependent patients who present with first-episode psychosis can decrease use in a clinically meaningful way and subjectively improve patient quality of life.

Compared with the standard of care, motivational interviewing significantly increases number of days abstinent from cannabis and aids in decreasing short-term consumption.13 Patients who are treated with motivational interviewing in addition to standard of care (combination of antipsychotic medication, regular office-based psychiatric contact, psychoeducation) are reported to also have more confidence and willingness to reduce cannabis use.

Patients with CIP who are unwilling or unable to decrease cannabis consumption may be protected from psychotic relapse with aripiprazole (10 mg/d). Its use suppresses the re-emergence of psychosis without altering cannabis levels. However, no direct comparison has been made with aripiprazole and other antipsychotics in treating CIP. Clearly, well-controlled large studies of putative treatments for CIP are needed.

Conclusions

As more countries and states approve legalization, and marijuana becomes more accessible, CIP and other cannabis-related disorders are expected to increase. Efforts should be made by physicians to educate patients and discourage cannabis use. Just as there was an era of ignorance concerning the damaging effects of tobacco, today’s conceptions about cannabis may in fact be judged similarly in the future. The onus is on psychiatrists to take an evidence-based approach to this increasing problem.

Source:  http://www.psychiatrictimes.com/substance-use-disorder/cannabis-induced-psychosis-review  14th July

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.

 

A study by researchers from the Murdoch Children’s Research Institute (MCRI) that followed a sample of almost 2000 Victorian school children from the age of 14 until the age of 35 found that social disadvantage, anxiety, and licit and illicit substance use (in particular cannabis), were all more common in participants who had reported self-harm during adolescence.

The longitudinal study, the Victorian Adolescent Health Cohort Study, was the first in the world to document health-related outcomes in people in their 30s who had self-harmed during their adolescence. Until now, very little has been known about the longer-term health and social outcomes of adolescents who self-harm.

Published in the new Lancet Child and Adolescent Health journal, the study found the following common elements:

· People who self-harmed as teenagers were more than twice as likely to be weekly cannabis users at age 35

· Anxiety, drug use, and social disadvantage were more common at age 35 among participants who had self-harmed during their teenage years. While most of these associations can be explained by things like mental health problems during adolescence and substance use during adolescence, adolescent self-harm was strongly and independently associated with using cannabis on a weekly basis at age 35 years

· Self-harm during the adolescent years is a marker for distress and not just a ‘passing phase’

The findings suggest that adolescents who self-harm are more likely to experience a wide range of psychosocial problems later in life, said the study’s lead author, Dr Rohan Borschmann from MCRI. “Adolescent self-harm should be viewed as a conspicuous marker of emotional and behavioural problems that are associated with poor life outcomes,” Dr Borschmann said.

The study found that anxiety, drug use, and social disadvantage were more common at age 35 among participants who had self-harmed during their teenage years. “While most of this can be explained partly by things like mental healthduring adolescence and substance use during adolescence, adolescent self-harm was strongly and independently associated with using cannabis on a weekly basis at age 35 years,” Dr Borschmann said.

Interventions during adolescence which address multiple risk-taking behaviours are likely to be more successful in helping this vulnerable group adjust to adult life.

More information: Rohan Borschmann et al. 20-year outcomes in adolescents who self-harm: a population-based cohort study, The Lancet Child & Adolescent Health (2017). DOI: 10.1016/S2352-4642(17)30007-X

Source:  https://medicalxpress.com/news/2017-07-twenty-year-outcomes-adolescents-self-harm-substance.htm

Residential treatment has received a lot of criticism and scepticism over the last several years, especially for opioid use disorders. (Some of it is deserved. Too many providers are hustlers and others provide little more than detox with inadequate follow-up. Of course, many of the same criticisms have been directed at medication-assisted treatment. But, that’s not what this post is about.)

At any rate, the Recovery Research Institute recently posted about a study looking at completion rates for outpatient and residential treatment.   The study looked at A LOT of treatment admissions, 318,924.  Residential completion rates appear to have surprised a lot of people:

Results: Residential programs reported a 65% completion rate compared to 52% for outpatient settings. After controlling for other confounding factors, clients in residential treatment were nearly three times as likely as clients in outpatient treatment to complete treatment.

But, what really surprised some readers was this:

Compared to clients with a primary alcohol use disorder:
Clients with marijuana use disorder were only 74% as likely to complete residential treatment.
Clients with an opioid use disorder were 1.29x MORE likely to complete residential treatment.

So opioid users were much more likely to benefit from residential treatment compared to alcohol users. . . .

We speculate that for opioid abusers, the increased structure and cloistering of residential treatment provide some protection from the environmental and social triggers for relapse or that otherwise lead to the termination of treatment that outpatient treatment settings do not afford. Indeed, environmental risk characteristics in drug abusers’ residential neighbourhoods, such as the presence of liquor stores and indicators of concentrated disadvantage at the neighbourhood level, have been found to be associated with treatment non-continuity and relapse.

Such environmental triggers may play a particularly substantial role for those addicted to opioids compared to those seeking treatment for marijuana abuse. Since opioid users have the lowest raw completion rates in general, this finding that residential treatment makes a greater positive difference for opioid users than it does for any of the other substances represents an important result that merits further investigation. Given the current epidemic of opioid-related overdoses in the U.S., our results suggest that greater use of residential treatment should be explored for opioid users in particular.

For the differences between residential and outpatient, they say the following:

In general, residential treatment completion rates are usually higher compared to outpatient settings, but what is particularly noteworthy is that even after controlling for various client characteristics and state level variations, the likelihood of treatment completion for residential programs was still nearly three times as great as for outpatient settings. Given the more highly structured nature and intensity of services of residential programs compared to outpatient treatment, it is understandable that residential treatment completion rates would be higher. It requires far less effort to end treatment prematurely in outpatient settings com-pared to residential treatment.

Given the strong association between treatment completion and positive post-treatment outcomes such as long term abstinence, the large magnitude of difference between outpatient and residential treatment represents a potentially important consideration for the choice of treatment setting for clients.

Source:  https://addictionandrecoverynews.wordpress.com/2017/07/13/opioid-users-complete-residential-at-higher-rates

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

Today’s Reality

Even if you smoked pot 20+ years ago without harm, today’s situation is different.  We want our children to avoid marijuana because they care about the risks in marijuana itself.

Here’s the facts for raising your children today:

* Marijuana has been modified since 1994. The THC, which gives the high, is 3-10x stronger in the plants of today.  If a child begins using today’s pot , it’s like to learning to drink with grain alcohol, instead of beer or wine.  Also, youth today frequently use the potent “dabs” “wax” and “budder.”  These are extractions can have 40-80% THC.

* Marijuana is addictive, contrary to a popular myth, particularly with today’s stronger strains of pot.

* In states with medical marijuana, teen usage is much higher than in other states, and many teens who use pot get it from some marijuana cardholders.

* Those who begin in adolescence or their teens, have an addiction rate of 17 percent, as opposed to 9 percent for those who begin using marijuana as an adult. *Emergency Department hospitalizations from marijuana rose from 281,000 to 455,000 between 2004 and 2011, making it 2nd amongst the illegal drugs causing ER treatment.

* Individuals responses to marijuana can be vary greatly, and the potential for paranoia and psychotic reactions are real side effects, omitted in the pot propaganda.

* Marijuana is fat soluble and stays in the body for weeks, which is why some people have flashbacks.

* The  brain, which is 1/3 fat, isn’t fully developed until age 25 or later, and until it is, marijuana can cause irreversible damage.

* Marijuana is not as widely used as alcohol,  6-7% of the adult population, vs.  66% who drink, one reason the comparison doesn’t work. * Marijuana usage causes traffic deaths and it is not safe to combine with driving.

* More teens seek substance abuse treatment for pot than any other legal or illegal substance. * Marijuana is a gateway drug,  because nearly every young person who develops a drug addiction begins with marijuana.  Early pot users such as Robert Downey, Jr. (age 9), and Cameron Douglas  (age 13), prove that the stranglehold of drug addiction lasts for years.

* A multi-year study out of New Zealand, tracking marijuana users and through their mid-30s showed IQs decrease an 6-8 percentage points over time.  Again, we point to the medical studies summarized on this webpage.

* In a recent study, schizophrenics who have used marijuana had an onset of the disease 2-1/2 years earlier than those who did not use marijuana. * Marijuana can trigger psychotic symptoms and/or mental illness, and cognitive decline in youth, more quickly than alcohol, while tobacco does not.

* Since marijuana usage increases the odds of developing a mental illness, expansion of pot will expand mental health treatment needs.

* Efforts to legalize for age 21+  hide the motivation to attract young users and build big profits.  Legal pot mean more young users.

* Marijuana usage is associated with greater risk for testicular cancer in males.

* With universal health care, all of us will pay for the increase in medical care for those needing help from pot abuse.

* The number of pot-related hospitalizations in Colorado accelerated in 2009 and went out of control in the first half of 2014.

* Existing mental health issues, such as ADHD, anxiety and depression, greatly increase the use of drugs for self-medication.

Mental Health, Physical Health Alike

“We cannot promote a comprehensive system of mental health treatment and marijuana legalization, which increases permissiveness for a drug that directly contributes to mental illness,”  states former Congressman Patrick Kennedy, who fought tirelessly on behalf of parity for mental health treatment. Kennedy and policy expert Kevin Sabet promote  Smart Approaches to Marijuana.

* The National Alliance for Mental Illness lists four illegal drugs which cause psychosis: cannabis, LSD, methamphetamine and heroin and two classes of legal drugs, amphetamines and steroids. Pharmaceutical drugs are sold with warnings, while marijuana isn’t.

Sharon Levy, Chairwoman of the American Academy of Paediatrics committee on substance abuse, said “We’re losing the public health battle” and policy is being made by legalization advocates who might be misinformed about marijuana’s dangers.”

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

In The Lancet Psychiatry, Schoeler and colleagues present a study1 describing the mediating effect of medication adherence on the association between continued cannabis use and relapse risk in patients with first-episode psychosis.

They have previously reported a relapse rate of 36% in this patient group over a 2-year period.2 Acknowledging the potential risk of psychosis relapse related to the high proportion of patients continuing cannabis use after the onset of psychosis, the current study1 investigates the same patient group consisting of 245 patients, obtaining retrospective data on active cannabis use and medication adherence shortly after illness onset, as well as risk of relapse at 2-year follow-up. The authors find that relapse of psychosis associated with continued cannabis use is partly mediated through non-adherence to prescribed antipsychotic medication.

It is well established that cannabis use increases the risk of schizophrenia, not only from the early Swedish conscript studies3 but also from studies on people who use sinsemilla in London, UK, showing that high potency cannabis increases the risk of schizophrenia.4

Twin studies from Norway have shown that cannabis increases the risk of psychosis, even when controlling for genetic factors.5There has been discussion on the direction of the association, as none of these studies can rule out reverse causality, but it seems reasonable to conclude that cannabis is one of many stressors that can precipitate schizophrenia, at least in susceptible individuals.

The association between cannabis use and psychosis continues to interest clinicians and researchers. Cannabis does not precipitate psychosis in most users.3 What are the risk factors in the pathway from cannabis use to psychosis?

The use of cannabis in patients with psychosis can be divided into three groups: those not using cannabis, those using cannabis with few negative consequences, and those in whom cannabis use is followed by relapse and worsening of the disease. Too little effort has been put into studying people with psychosis who can use cannabis without many negative consequences.

Further research should also be put into different variants of cannabis. Strains cultured to produce high content of D-9 tetrahydrocannabinol (THC) are probably associated with higher risk for psychosis than those strains with less THC.4 In healthy participants, cannabidiol has been shown to inhibit THC-elicited paranoid symptoms and hippocampal-dependent memory impairment.6 The use of more balanced forms of cannabis could possibly be less detrimental to mental health.

Genetic predisposition is one factor that is related to the development of psychosis after the use of cannabis.5 However, there is still a long way to go in clarifying the interplay between genes and environmental factors in the cannabis–psychosis association. Therefore, we support the request for doing more studies to investigate the possible interaction between polygenic risk score for schizophrenia and cannabis use in causing psychosis.7

Furthermore, there is a need to examine the use of antipsychotic medication and investigate if some medications are particularly useful for patients with psychotic disorders who intend to continue to use cannabis. In a randomised trial comparing the effects of different antipsychotics,8 clozapine seemed to stand out in reducing craving for cannabis, a finding that is in need of replication.

Previous research has shown that stopping cannabis use after a first episode of psychosis has beneficial outcomes compared with continued use.9 A meta-analysis of observational studies published in 201710 compared adherence to antipsychotic medication between cannabis users and non-users, and found that cannabis use increases the risk of non-adherence to anti-psychotic medication and quitting cannabis may help adherence to antipsychotics. In the current study by Schoeler and colleagues,1 the authors found that adherence to medication was a possible mediator in the association between cannabis use and risk of psychosis relapse when taking potential confounders into account. They found that medication adherence partly mediated the effect of continued cannabis use on outcome, including risk of relapse (proportion mediated=26%, pindirecteffects=0·040, 95% CI 0·004–0·16), number of relapses (36%, pindirect effects=0·040, 0·003–0·14), time to relapse (28%, pindirect effects=0·051, −0·53 to 0·001), and care intensity (20%, pindirect effects=0·035, 0·004–0·11), but not length of relapse (6%, pindirect effects=0·35, −0·030 to 0·09).

Acknowledging the complexity of psychosis relapse prevention, the current findings point to reduction in cannabis use as an intervention target to improve medication adherence, thereby preventing psychosis relapse. The understanding of a triangular association of ongoing cannabis use with medication adherence and psychosis relapse may be a step forward in counteracting further psychotic episodes in some patients.

Source:   DOI: http://dx.doi.org/10.1016/S2215-0366(17)30254-7   Published: 10/7/17

Investigating the proposition that cannabis is worth bothering with, this hot topic looks at reports that stronger cannabis on the market is increasing harms to users, prospects of recovery from disorders and dependence, and the emerging response to synthetic forms of cannabis like ‘spice’.

CANNABIS IN THE LAW

A controlled ‘Class B’ substance, cannabis carries legal penalties for possession, supply, and production. Between 2004–2009 cannabis was reclassified as a ‘Class C’ substance, meaning for a brief period of time it carried lesser penalties for possession. In 2009, the Association of Chief Police Officers issued new guidance, advising officers to take an escalating approach to the policing of cannabis possession for personal use: • A warning • A penalty notice for disorder (PND) • Arrest

This three-tiered approach was designed to be “ethical and non-discriminatory”, but also reinforce the “national message that cannabis is harmful and remains illegal”.

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.’ The typically calming use of the drug by adults was seen as preferable to the main alternative – alcohol and its associated violence and disorder. 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, and exposing the hypocrisy of alcohol-drinking adults. In 1997 the Independent on Sunday launched a campaign to decriminalise cannabis, culminating in a mass ‘roll-up’, and 16,000-strong pro-cannabis march from Hyde Park to Trafalgar Square. Its Editor Rosie Boycott wrote in the paper about her own coming-of-age experience smoking cannabis, telling readers:

“I Rolled my first joint on a hot June day in Hyde Park. Summer of ’68. Just 17. Desperate to be grown-up. … My first smoke, a mildly giggly intoxication, was wholly anti-climatic. The soggy joint fell apart. I didn’t feel changed. But that act turned me – literally – into an outlaw. I was on the other side of the fence from the police – or the fuzz, as we used to call them. So were a great many of my generation.”

The campaign was explosive, but short-lived, apparently subsiding when Boycott left to take up her role as Editor of the Daily Express. A decade later, the Independent issued an apology for the campaign. ‘If only they had known then, what they knew now’, was the message of the article, referring to the reportedly damaging impact of the more potent strains of cannabis and its links to “mental health problems and psychosis for thousands of teenagers”.

Are stronger strains creating more problems?

There has been a long-standing, but controversial, association between cannabis strength and harm. Reading newspaper articles on the subject, it wouldn’t be unusual to see a headline drawing a straight line between ‘super-strength skunk’ and addiction, violence, deaths, or psychosis. In 2008, then Prime Minister Gordon Brown spoke in a similar vein, telling a breakfast-television viewing audience:

I have always been worried about cannabis, with this new skunk, this more lethal part of cannabis.

I don’t think that the previous studies took into account that so much of the cannabis on the streets is now of a lethal quality and we really have got to send out a message to young people – this is not acceptable.

Brown was warning of a dangerous new strain of cannabis on the market, that caused very severe harms to users – contrasting starkly with the common perception of cannabis as a ‘low harm’ or ‘no harm’ drug. The strength or potency of cannabis is determined by the amount of ‘THC’ it contains. THC produces the ‘high’ associated with cannabis, and another major component ‘CBD’ produces the sedative and anti-anxiety effects. As well as potency, the relative amounts of THC and CBD are important for understanding the effects of cannabis – something explored in a University College London study during the programme Drugs Live: Cannabis on Trial. The research team compared two different types of cannabis: the first had high levels of THC (approx. 13%) but virtually no CBD; and the second had a lower level of THC (approx. 6.5%) and substantial amounts of CBD (approx. 8%). They found that CBD had a moderating or protective effect on some of the negative effects of THC, and that “many of the effects that people enjoy are still present in low-potency varieties without some of the harms associated with the high-potency varieties”. At least in the US over the last two decades (between 1995–2014), potency has increased from around 4% to 12%, and the protective CBD content of cannabis has decreased, from around 28% to less than 15%, significantly affecting the ratio of THC to CBD, and with it, the nature and strength of the psychoactive effect of cannabis. Until the 1990s, herbal cannabis sold in the UK was predominantly imported from the Caribbean, West Africa, and Asia. After this time, it was increasingly produced in the UK, being grown indoors using intensive means (artificial lighting, heating, and control of day-length). A study funded by the Home Office analysed samples of cannabis confiscated by 23 police forces in England and Wales in 2008, and found that over 97% of herbal cannabis had been grown by intensive methods; its average potency of 16% compared with just 8% for traditional imported herbal cannabis. This matched other reports of home-grown cannabis being consistently (around 2–3 times) stronger than imported herbal cannabis and cannabis resin.

In 2015, observing a decrease in the use of cannabis in England and Wales, but parallel increase in demand for treatment, a UK study examined whether the trend could be explained by an increase in the availability of higher-potency cannabis. Over 2500 adults were surveyed about their use of different types of cannabis, severity of dependence, and cannabis-related concerns. The researchers found that higher potency cannabis was associated with a greater severity of dependence, especially in young people, and was rated by participants as causing more memory impairment and paranoia than lower potency types. However at the same time, it was reported to produce the best ‘high’, and to be the preferred type.

By definition cannabis is a psychoactive substance, which means it can change people’s perceptions, mood, and behaviour. Higher potency cannabis contains more of the psychoactive component, so it makes sense that higher potency cannabis could increase the risk of temporary or longer-term (adverse) problems with perceptions, mood, and behaviour. However, there is a particular concern that cannabis use could be linked to ‘psychosis’, a term describing a mental illness where a person perceives or interprets reality in a very different way to those around them, which can include hallucinations or delusions.

Whether cannabis causes psychosis, precipitates an existing predisposition, aggravates an existing condition, or has no impact at all on psychotic symptoms, has for decades been hotly contested. With our focus on evaluations of interventions, Drug and Alcohol Findings is in no position to pronounce on this issue, nor on the possibility that the drug might sometimes improve mental health, but some examples of research informing this debate are included below. A 2009 UK study examined whether daily use of high-potency cannabis was linked to an elevated risk of psychosis, comparing 280 patients in London presenting with a first episode of psychosis with a healthy control group. The patients were found to be more likely to smoke cannabis on a daily basis than the control group, and to have smoked for more than five years. Among those who used cannabis, 78% of the patients who had experienced psychosis used higher-potency cannabis, compared with 37% of those in the control group. The findings indicated that the risk of psychosis was indeed greater among the people who were using high potency cannabis on a frequent basis, but couldn’t show that the cannabis use caused the psychosis, or even that the cannabis use made the group more susceptible to psychosis. The wider literature on mental health and substance use would suggest that the association is more complex than this. A recently published paper from the University of York has demonstrated the complications of attributing any association between cannabis use and psychosis to a causal effect of cannabis use rather than other factors or a reverse causal effect. A calculation based on data from England and Wales helped to put this into perspective, indicating that even if cannabis did cause psychosis more than 20,000 people would need to be stopped using cannabis to prevent just one case of psychosis. The apparent steady increase in cannabis potency in the UK since the 1990s is important context for further research. Where higher potency cannabis is increasingly becoming the norm, and is the preference for cannabis users, it would be relevant to generate more evidence of the health-related problems with high potency cannabis, and the treatment and harm reduction solutions based around these health-related problems.

Cannabis accounts for half of all new drug treatment patients

The most widely used illegal drug in Europe, many seemingly enjoy cannabis without it leading to any significant negative social or health effects. However, numbers entering treatment for cannabis use problems have been on the rise (both in the UK, and the rest of Europe), while heroin treatment numbers have fallen  chart. According to Public Health England, this is not because more people are using cannabis, 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 of emerging issues with stronger strains of the drug. 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 22% in 2011/12. With the caveat that data from 2013 onwards is not directly comparabledue to changes in methodology, in 2014 and 2015 the proportion of patients who entered treatment primarily because of a cannabis issue hovered above previous years at 26% (25,278 and 26,295 respectively). Among first ever treatment presentations, the increase from 2003/04 was more pronounced, from 19% to 37%. By 2013, cannabis use had become the main prompt for half the patients who sought treatment for the first time (at 49%), and stayed relatively constant at 47% in 2014, and 48% in 2015.

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 they had used cannabis in the past year fell from about 11% to 7% in 2013/14, then stayed at that level in 2014/15 and 2015/16. The treatment figures largely reflect trends in England, where in 2013/14 the number of patients starting treatment with cannabis use problems had risen to 30,422, 21% of all treatment starters, up from 23,018 and 19% in 2005/06. Subsequently the number dropped to 27,965 in 2015/16, still around a fifth of all treatment starters. Among the total treatment population – starting or continuing in treatment – cannabis numbers rose from 40,240 in 2005/06 to peak at 64,407 in 2013/14 before falling back to 59,918 in 2015/16; corresponding proportions again hovered around a fifth. As a primary problem substance among under-18s cannabis dominated, accounting for three-quarters of all patients in treatment in 2015/16 and in numbers, 12,863. The dominance of cannabis increased from 2008/09 as numbers primarily in treatment for drinking problems fell.

‘All treatments appear to work’

According to the two main diagnostic manuals used in Europe and the USA, problem cannabis use can develop into a cannabis use disorder or cannabis dependence, identifiable by a cluster of symptoms including: loss of control; inability to cut down or stop; preoccupation with use; neglecting activities unrelated to use; continued use despite experiencing problems; and the development of tolerance and withdrawal. This level of clinical appreciation for cannabis use problems didn’t exist when researcher and writer William L. White entered the addictions field half a century ago:

“When I first entered the rising addiction treatment system in the United States nearly half a century ago, there existed no clinical concept of cannabis dependence and thus no concept of recovery from this condition. In early treatment settings, cannabis was not consider[ed] a “real” drug, the idea of cannabis addiction was scoffed at as remnants of “Reefer Madness,” and casual cannabis use was not uncommon among early staff working in addiction treatment programs of the 1960s. Many in the field remain sceptical of the idea of cannabis dependence, specifically whether problem users at the severe end experience physiological withdrawal. However, reviewing what they believe is mounting evidence, these authors suggest there can be confidence in the existence of a “true withdrawal syndrome” – albeit one that differs qualitatively from the “significant medical or psychiatric problems as observed in some cases of opioid, alcohol, or benzodiazepine withdrawals”. In the case of cannabis, the main symptoms are primarily emotional and behavioural, although appetite change, weight loss, and some physical discomfort are reported. A brief review aimed at practitioners in UK primary care provides guidance on how to manage symptoms of withdrawal among patients trying to stop or reduce their cannabis use.

Research has come a long way, says William L. White, with now “clear data supporting the dependency producing properties of cannabis, a clear conceptualization of cannabis use disorders (CUD) and cannabis dependence (CD)”, but until recently, very little evidence about the prospects of long-term recovery. Yet, key papers – found here and here – indicate that:

• Full remission from cannabis use disorders is not only possible, but probable.

• Stable remission takes time – an average of 33 months.

• Abstinence may not be initially realistic for heavy cannabis users – but those in  remission are usually able to reduce the intensity of their use and its  consequences.

At least in the United States, it seems dependence is more quickly overcome from cannabis than the main legal drugs. 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. 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.

Specialised treatment programmes for cannabis users in European countries

Generally for people with cannabis use problems, the European Monitoring Centre for Drugs and Drug Addiction concluded in 2015, and before that in 2008, that “all treatments appear to work”. For adults, effective treatments include motivational interviewing, motivational enhancement therapy and cognitive-behavioural therapy, and for younger people, family-based therapies seem most beneficial. Less important than the type of treatment is the treatment context and the individual’s determination to overcome their problems through treatment. And there is “no firm basis for a conclusion” that cannabis-specific interventions (designed around the risks and harms associated with cannabis) are more effective than general substance use treatment tailored to the individual needs of the cannabis user seeking treatment chart. 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. 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.

The relative persistence of opiate use problems versus the 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, the last time this particular analysis was published. 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, 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 30% of opiate users and 42% 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.

Enjoyable and trouble-free for many, but not without harms Harm reduction – the “set of practical strategies and ideas aimed at reducing negative consequences associated with drug use” – is mostly associated with ‘harder’ drugs like heroin, for which blood-borne viruses and drug-related deaths are clear and severe risks. Yet while “many people experience cannabis as enjoyable and trouble free”, there are also varying degrees of harm with this drug depending on the characteristics of the person using, the type of the cannabis, and the way they consume it. Many formal cannabis harm reduction programmes borrow from the fields of alcohol and tobacco. Advice includes:

• safer modes of administration (eg, on the use of vaporisers, on rolling safer joints, on less risky modes of inhaling) Many people experience cannabis as enjoyable and trouble free … some people require help to reduce or stop

• skills to prevent confrontation with those who disapprove of use

• encouraging users to moderate their use

 

• discouraging mixing cannabis with other drugs

• drug driving prevention and controls

• reducing third-party exposure to second-hand smoke

• education about spotting signs of problematic use

• self-screening for problematic use

In some parts of the UK, National Health Service tobacco smoking cessation services incorporated cannabis into their interventions with adults; and Health Scotland, also addressing the risks of tobacco and cannabis smoking, published a booklet for young people titled Fags ‘n’ Hash: the essential guide to cutting down the risks of using tobacco and cannabis.

Vaporising or swallowing cannabis offers a way to avoid respiratory risks, but only a minority of cannabis do this, most choosing to smoke cannabis joints (or cannabis and tobacco joints). While not all will know about the different health risks, cannabis users may choose against safer consumption methods anyway for a range of reasons (including their own thoughts about safe use):

• Users may find it easier to control the effects (eg, severity, length of effect) of cannabis when inhaling in the form of a joint or spliff

• Preparing and sharing joints can be an enjoyable part of the routine, or part of a person’s social activities

• Alternative methods of smoking (eg, bongs and vaporisers) may be inconvenient to use, or expensive to buy

 

Most harm reduction advice is delivered informally long before users come into contact with drugs professionals – for example through cannabis magazines, websites, and headshops – highlighting the importance of official sources engaging with non-official sources to promote the delivery of accurate, evidence-based harm reduction messages.

A new high

In May 2016 the Psychoactive Substances Act placed a ‘blanket ban’ on new psychoactive substances (previously known as ‘legal highs’), including synthetic cannabinoids (synthetic forms of cannabis). Prior to this, in 2014, there had been 163 reported deaths from new psychoactive substances in the UK, and 204 the year after. The average age was around 28, younger than the average age for other drug misuse deaths of around 38. The fact that these psychoactive substances – which produced similar effects to illicit drugs like cannabis, cocaine, and ecstasy – could be bought so easily online or on the high street, appeared inconsistent; and each fatality prompted “an outcry for something to be done to prevent further tragedies”. This was the context (and arguably the political trigger) for the introduction of the Psychoactive Substances Act. While possession of a psychoactive substance as such wasn’t criminalised;, production, supply, offer to supply, possession with intent to supply, import or export were – with a maximum penalty of seven years’ imprisonment.

Just seven months after the Act came into effect, the Home Office labelled it a success, with a press release stating that nearly 500 people had been arrested, 332 shops around the UK had been stopped from selling the substances, and four people had been sent to prison. But did the Psychoactive Substances Act have the presumably desired effect of limiting access to psychoactive substances (and reducing deaths), or did it just push the drugs the way of dealers? It is perhaps too early to tell, but former chair of the Advisory Council on the Misuse of Drugs Professor Nutt had warned before the Act came into effect that the ‘blanket ban’ would make it harder (not easier) to control drugs. And while Chief executive of DrugWise Harry Shapiro had said the new law would make new psychoactive substances harder to obtain, he also agreed that sale of the drugs would not cease, but merely be diverted to the illicit market: “The same people selling heroin and crack will simply add this to their repertoire.” The paper “From niche to stigma” examined the changing face of the new psychoactive substance user between 2009 and 2016, focusing on people using the synthetic cannabis known as ‘spice’. It looked at the transition of (then) ‘legal highs’ from an “experimental and recreational” scene associated with a “niche middle class demographic”, to “those with degrees of stigma”, especially homeless, prison, and socially vulnerable youth populations (including looked after children, those involved in or at risk of offending, and those excluded or at risk of exclusion from mainstream education). In 2014, the DrugScope Street Drug Survey also observed a problem among these particular groups, recording a “rapid rise in the use of synthetic cannabinoids such as Black Mamba and Exodus Damnation by opiate users, the street homeless, socially excluded teenagers and by people in prison”.

‘SPICE’ AND OTHER SYNTHETICS

Cannabis contains two key components:

• ‘THC’ (tetrahydrocannabinol), which produces the ‘high’

• ‘CBD’ (cannabidiol), which produces the sedative and anti-anxiety effects

Synthetic forms of cannabis contain chemicals that aim to copy the effects of ‘THC’ in cannabis. But the effects of synthetic cannabis can be quite different (and often stronger): firstly, because synthetic production makes it easier to manipulate the amount of the THC-like chemical; and secondly, because of the absence of the moderating equivalent of ‘CBD’. Some synthetics are purposely designed to resemble herbal cannabis, and can be consumed in the same ways (eg, smoked or inhaled). The names also often have deliberate cannabis connotations. The risk of this is that people wishing to take cannabis may be initially unaware that they have been sold the synthetic form, or may believe from the look of it that it will produce similar sought-after effects. The greater intensity of synthetic cannabis at lower dose levels ( box) ensures that it has an appeal in terms of potency and affordability, but may put those with fewer resources at greater harm.

In 2014, the prison inspectorate for England and Wales raised concerns about the rise in the use of psychoactive substances in prisons, in particular synthetic cannabis. A study set in an English adult male prison found that the nature of the market was posing significant challenges to the management of offenders. There, the primary motivation for consumption was being able to take a substance without it being detected. Given this motivation, and the greater likelihood of harms from synthetic versus natural cannabis, the researchers concluded that it was imperative for mandatory drug-testing policies to be revised, and instead rooted in harm reduction – something which would also apply to people on probation subject to mandatory drug-testing.

Cannabis throws up a range of issues rather different from those associated with the drugs treatment in the UK has normally focused on. If current trends continue, understanding the findings will become yet more important to British treatment services.

Source:   http://findings.org.uk/PHP/dl.php?file=cannabis_treat.    Last revised 10 July 2017. 

Cannabis has recently been legalised in many US states

Cannabis itself is harmful to cardiovascular health and increases the chance of early death regardless of related factors such as smoking tobacco, new research reveals.

Data taken from more than 1,000 US hospitals found that people who used the drug had a 26 per cent higher chance of suffering a stroke than those who did not, and a 10 per cent higher chance of having a heart attack.

The findings held true after taking into account unhealthy factors known to affect many cannabis smokers, such as obesity, alcohol misuse and smoking.

‘This leads us to believe that there is something else going on besides just obesity or diet-related cardiovascular side effects’ Dr Aditi Kalla, Einstein Medical Center, Philadelphia

They indicate there is something intrinsic about cannabis which can damage the proper functioning of the human heart.

“Even when we corrected for known risk factors, we still found a higher rate of both stroke and heart failure in these patients, so that leads us to believe that there is something else going on besides just obesity or diet-related cardiovascular side effects,” said Dr Aditi Kalla, Cardiology Fellow at the Einstein Medical Center in Philadelphia and the study’s lead author.

“It’s important for physicians to know these effects so we can better educate patients.”

Previous research in cell cultures has shown that heart muscle cells have cannabis receptors relevant to contractility, or squeezing ability, suggesting that those receptors might be one mechanism through which marijuana use could affect the cardiovascular system.

The research team analysed more than 20 million records of young and middle-aged patients aged between 18 and 55 who were discharged from 1,000 hospitals in 2009 and 2010, when marijuana use was illegal in most states.

It identified 316,000 patients – 1.5 per cent – where marijuana use was diagnosed in the notes.  Their cardiovascular disease rates were compared to those who shunned the drug.

The research was published yesterday at a meeting of the American College of Cardiology in Washington DC.

Source:  http://www.telegraph.co.uk/science/2017/03/09/cannabis-boosts-risk-stroke-heart-attack-independent-tobacco/  

Ketamine Continues to Impress and Confound Researchers

A novel glutamatergic hypothesis of depression, using a 50-year-old anaesthesia medicine, has had a remarkable run as of late. First an anaesthetic, then a popular club drug in the 90s known as “Special K” (and currently still popular in Hong Kong as a “Rave Drug”), and now a novel, fast acting antidepressant, ketamine is a N-Methyl D-Aspartame (NMDA) receptor antagonist. Ketamine was FDA-approved in the U.S. as an anaesthetic nearly 50 years ago. It is used primarily by anaesthesiologists in both hospital and surgical settings. As an N-Methyl D-Aspartame (NMDA) receptor antagonist with dissociative properties, NMDA receptors possess high calcium permeability, which allows ketamine to reach its target quickly. Increasing clinical evidence has shown that a single sub-anaesthetic dose (0.5 mg/kg) of IV-infused ketamine exerts impressive antidepressant effects within hours of administration. These effects have stabilized suicidality in severely depressed, treatment-resistant individuals. The effects of low-dose ketamine infusion therapy can last up to seven days, although the dosing and patient characteristics regarding its optimal effectiveness have not been established.

In my book, “The Good News About Depression: Cures And Treatments In The New Age of Psychiatry”–Revised (1996), I said there was never a better time to be depressed, due in part to recent breakthroughs in understanding of the underlying biology of depression, plus the discovery of novel therapeutics e.g., the SSRIs. Today that book might be called the “Better News About Depression” as a result of the effectiveness of novel treatments such as Transcranial Magnetic Stimulation (TMS) and now ketamine, which has illuminated and broadened our understanding and view of treating depression.

Why Is This Better News?

New clinical and preclinical studies suggest that dysfunction of the glutamatergic system is perhaps more relevant and important than the current catecholamine hypothesis and therapy that targets serotonin, norepinephrine and sometimes dopamine. These medications often take four to six weeks to exert any therapeutic benefit, whereas rapid reductions in depressive symptoms have been observed in response to a single dose of ketamine. This is a vast departure from the SSRIs and SSNRIs that have occupied the mainstream of pharmacological therapy for depression and anxiety disorders for more than 30 years.

Lastly, the mechanism of action of NDMA antagonists are comparatively underexplored but vitally important to our understanding of depression, reversal of suicidality, as well as the debilitating, depressive symptoms induced by abuse of alcohol and other drugs. This review highlights the current evidence supporting the antidepressant effects of ketamine as well as other glutamatergic modulators, such as D-cycloserine, riluzole, CP-101,606, CERC-301 (previously known as MK-0657), basimglurant, JNJ-40411813, dextromethorphan, nitrous oxide, GLYX-13, and esketamine. This all adds up to some very good news for depressed persons and especially those who do not respond to previous SSRI or SSNRI treatments.

Source: http://www.rivermendhealth.com/resources/ketamine-fast-acting-antidepressant/  June2017

 

It comes as no surprise that the prevalence of marijuana use has significantly increased over the last decade. With marijuana legal for recreational use in four states and the District of Columbia and for medical use in an additional 31 states, the public perception about marijuana has shifted, with more people reporting that they support legalization. However, there is little public awareness, and close to zero media attention, to the near-doubling of past year marijuana use nationally among adults age 18 and older and the corresponding increase in problems related to its use. Because the addiction rate for marijuana remains stable—with about one in three past year marijuana users experiencing a marijuana use disorder—the total number of Americans with marijuana use disorders also has significantly increased. It is particularly disturbing that the public is unaware of the fact that of all Americans with substance use disorders due to drugs other than alcohol; nearly 60 percent are due to marijuana. That means that more Americans are addicted to marijuana than any other drug, including heroin, cocaine, methamphetamine, and the nonmedical use of prescription drugs.

Stores in Colorado and Washington with commercialized marijuana sell innovative marijuana products offering users record-high levels of THC potency. Enticing forms of marijuana, including hash oil used in discreet vaporizer pens and edibles like cookies, candy and soda are attractive to users of all ages, particularly those underage. The legal marijuana producers are creatively and avidly embracing these new trends in marijuana product development, all of which encourage not only more users but also more intense marijuana use.

Yet despite the expansion of state legal marijuana markets, the illegal market for marijuana remains robust, leaving state regulators two uncomfortable choices: either a ban can be placed on the highest potency—and most enticing—marijuana products which will push the legal market back to products with more moderate levels of THC, or the current evolution to ever-more potent and more attractive products can be considered acceptable despite its considerable negative health and safety consequences. If tighter regulations are the chosen option, the illegal market will continue to exploit the desire of marijuana users to consume more potent and attractive products. If state governments let the market have its way, there will be no limit to the potency of legally marketed addicting marijuana products.

The illegal marijuana market thrives in competition with the legal market by offering products at considerably lower prices because it neither complies with regulations on growth and sale, nor pays taxes on sales or their profits. Unsurprisingly, much of the illegal marijuana in the states with legalized marijuana is diverted from the local legal marijuana supply. It is troubling that in response to the decline in demand for Mexican marijuana, Mexican cartels are increasing the production of heroin, a more lucrative drug.

When alcohol prohibition ended in 1933, bootlegged alcohol gradually and almost completely disappeared. Those who favour drug legalization are confident that the same will occur in the market for drugs; they argue that legalizing drugs will eliminate the illegal market with all its negative characteristics including violence and corruption. The initial experience with marijuana legalization shows that this is dangerous, wishful thinking. Why doesn’t legalization now work for marijuana as it did for alcohol 80 years ago? One obvious reason is that there is little similarity between the bootleg industry of alcohol production that existed during prohibition and contemporary drug trafficking organizations. Today’s illegal drug production and distribution system is deeply entrenched, highly sophisticated, and powerfully globalized. Traffickers are resourceful and able to rapidly to adjust to changes in the market, including competing with legal drugs.

The legalization of marijuana or any other drug is making a bargain with the devil. All drugs of abuse, legal and illegal, including marijuana, produce intense brain reward that users value highly—so highly that they are willing to pay high prices and suffer serious negative consequences for their use. Marijuana users’ brains do not know the difference between legal and illegal marijuana, but, as with other drugs, the brain prefers higher potency products. Drug suppliers, legal and illegal, are eager to provide the drugs that users prefer.

The challenge of drug policy today is to find better ways to reduce drug use by using strategies that are cost-effective and compatible with modern values. Legalization fails this test because it encourages drug use. Most of the costs of drug use are the result of the drug use itself and not from efforts to curb that use. It is hard to imagine a drug user who would be better off with having more drugs available at cheaper prices. Supply matters. More supply means more use. Drug legalization enhances drug supply and reduces social disapproval of drugs.

Our nation must prepare itself for the serious negative consequences both to public health and safety from the growth of marijuana use fuelled by both the legal and the illegal marijuana markets.

Source: http://www.rivermendhealth.com/resources/marijuana-legalization-led-use-addiction-illegal-market-continues-thrive/    June 2017  Author: Robert L. DuPont, M.D.

Author: Mark Gold, MD

Mortality resulting from opioid use (over 33,000 in 2015) is now epidemic in the U.S., exceeding drug-related deaths from all other intoxicants. Dr. Ted Cicero of Washington University, Dr. William Jacobs, Medical Director of Bluff Plantation, and I discussed the opioid over-prescribing and switch to heroin at DEA Headquarters on November 17, 2015. Things have gone from bad to worse. In a recent JAMA article (March 2017), Dr. Bertha Madras, Professor in the Department of Psychiatry at Harvard Medical School, offers compelling analysis and recommendations to rein in this crisis.

Physicians have increasingly prescribed opioids for pain since the AMA added pain as the “fifth vital sign,” which, like blood pressure, mandated assessment during each patient encounter. As a result of this and acceptance of low-quality evidence touting opioids as a relatively benign remedy for managing both acute and chronic pain, prescriptions for opioids have risen threefold over the past two decades.

Addiction, overdose and mortality resulting directly from opioid misuse increased rapidly. In addition, the influx of cheap heroin, often combined with homemade fentanyl analogues, became increasingly popular as prescription opioids became harder to attain and cost prohibitive on the streets. Consequently, a proportion of prescription opioid misusers transitioned to cheaper, stronger and more dangerous illicit opioids.

Opioid Mortality

The breakdown in mortality was confirmed by surveys (2015) revealing a disproportionate rise in deaths specifically attributable to: fentanyl/analogs (72.2%) and heroin (20.6%) compared with only prescription opioids, at less than eight percent. The unprecedented rise in overdose deaths and association with the heroin trade catalyzed the formation of federal and state policies to reduce supply and increase the availability of treatment and of a life saving opioid antagonist overdose medication Naloxone, a short-acting, mu 1, opioid receptor antagonist. Naloxone quickly reverses the effect of opioids and acute respiratory failure provoked by overdose.

Yet, according to Dr. Madras, the current federal and state response is woefully inadequate. She writes: “Of more than 14,000 drug treatment programs in the United States, some funded by federal block grants to states, many are not staffed with licensed medical practitioners. An integrated medical and behavioral treatment system, under the supervision of a physician and substance abuse specialist, would foster comprehensive services, provide expedient access to prescription medicines, and bring care into alignment with current medical standards of care.”

Why Does This Matter?

As baby boomers age and live longer, chronic non-cancer pain is highly prevalent. Opioids for legitimate non-cancer pain are not misused or abused by most patients under proper medical supervision. Yet there is no effective, practical means in this managed care climate whereby Primary Care Physicians (PCPs) can determine who is at risk for abuse and addiction and who is not. And frankly, addicts lie to their doctors to get opioids. Without proper training, physicians, who genuinely want to help their patients, get in over their heads and don’t know how to respond.

Further complicating the issue is that many of the affordable treatment programs do not employ medical providers who are trained and Board Certified in Addiction and Pain

Medicine, not to mention addiction psychiatry, or addiction medicine physicians. Thus the outcomes are dismal, which fosters doubt and mistrust of treatment.

Lastly, the lack of well-trained providers is due, in part, to the lack of training for medical doctors in addiction and behavioral medicine. At the University of Florida, we developed a mandatory rotation for all medical students in “the Division of Addiction Medicine.” We also started Addiction as a sub-specialty within psychiatry, where residents and post-doctoral fellows were immersed in both classroom and clinical training.

Since 1990, many other similar fellowship programs have started, yet few are training all medical students in the hands-on, two-week clerkship experience in Addiction Medicine like they have in obstetrics. We took this a step further when we developed a jointly run Pain and Addiction Medicine evaluation and treatment program which focused on prevention and non-opioid treatments. Many more are needed, as well as increased CME in addictive disease for physicians in any specialty.

Source:   http://www.rivermendhealth.com/resources/chronic-pain-opioid-use-consequences   June 2017

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

Marijuana sales have created an economic boom in U.S. states that have fully or partially relaxed their cannabis laws, but is the increased cultivation and sale of this crop also creating escalating environmental damage and a threat to public health?

In an opinion piece published by the journal Environmental Science and Technology, researchers from the University of North Carolina at Chapel Hill and Lancaster University in the U.K. have called on U.S. federal agencies to fund studies that will gather essential environmental data from the legal cultivation farms and facilities.

This information could then be used to help U.S. states minimize any environmental and public health damage caused by this burgeoning industry and aid legal marijuana growers in making their business environmentally sustainable.

State-by-state legalization is effectively creating a new industry in U.S., one that looks set to rival all but the largest of current businesses. In Colorado alone, sales revenues have reached $1 billion, roughly equal to that from grain farming in the state. By 2020 it is estimated that country-wide legal marijuana sales will generate more annual revenue than the National Football League.

But the article, titled “High Time to Assess the Environmental Impacts of Cannabis Cultivation” co-authored by William Vizuete, associate professor of environment sciences and engineering at UNC’s Gillings School of Global Public health and Kirsti Ashworth, research fellow at Lancaster University’s Lancaster Environment Centre say that this expanded cultivation carries with it serious environmental effects.

Their article points out that cannabis is an especially needy crop requiring high temperatures (25-30 °C for indoor operations), strong light, highly fertile soil and large volumes of water — around twice that of wine grapes. In addition, the authors state that the few available studies of marijuana cultivation have uncovered potentially significant environmental impacts due to excessive water and energy demands and local contamination of water, air, and soil.

For example, a study of illegal outdoor grow operations in northern California found that rates of water extraction from streams threatened aquatic ecosystems. High levels of growth nutrients, as well as pesticides, herbicides and fungicides, also found their way back into the local environment, further damaging aquatic wildlife.

Controlling the indoor growing environment requires considerable energy with power requirements estimated to be similar to that of Google’s massive data centers. No significant data has been collected on the air pollution impacts on worker’s public health inside these growing facilities or the degradation of outdoor air quality due to emissions produced by the industrial scale production of marijuana.

The authors emphasize, however, much of the data on marijuana cultivation to date has come from monitoring illegal cannabis growing operations.

Dr Ashworth of Lancaster Environment Centre said: “The illegal status of marijuana has prevented us from understanding the detrimental impacts that this industrial scale operation has on the environment and public health.”

“This is an industry undergoing a historic transition, presenting an historic opportunity to be identified as a progressive, world-leading example of good practice and environmental stewardship.”

The continued expansion of legalization by the states does offer significant opportunities for the US Department of Agriculture, Environmental Protection Agency (EPA), National

Institutes of Health (NIH, and Occupational Safety and Health Administration (OSHA) to fund research into legal cannabis cultivation to protect the environment.

“Generating accurate data in all the areas we discussed offers significant potential to reduce energy consumption and environmental harm, protect public health and ultimately, improve cultivation methods,” said Dr Vizuete . “There are also significant potential public health issues caused by emissions from the plants themselves rather than smoking it. These emissions cause both indoor and outdoor air pollution.”

Story Source: Materials provided by Lancaster University. Note: Content may be edited for style and length.

Journal Reference:

K. Ashworth, W. Vizuete. High Time to Assess the Environmental Impacts of Cannabis Cultivation. Environmental Science & Technology, 2017; 10.1021/acs.est.6b06343DOI:

Source:   ScienceDaily, 21 February 2017. <www.sciencedaily.com/releases/2017/02/170221081736.htm>.

Warfarin. A single published case report describes an interaction with a patient taking warfarin who also regularly smoked tobacco and marijuana. The patient had multiple comorbidities and was taking at least 10 other medications. On at least two occasions, the patient’s international normalized ratio (INR) increased to values over 10 with episodes of bleeding. The only change reported for both occasions was an increase in the amount and frequency of marijuana smoking.[24] Patients who take warfarin and use marijuana regularly should receive close INR monitoring for any potential interaction.

Antiepileptic drugs (AEDs). A recent study examined baseline serum AED levels to identify drug-drug interactions between CBD and 19 AEDs during an open-label safety study in 81 patients (39 adults, 42 children) with refractory epilepsy.[25] As doses of CBD were increased, the researchers noted an increase in the serum levels of topiramate (P<.01), rufinamide (P<.01), and desmethylclobazam (P<.01) and a decrease in the levels of clobazam (P<.01) in both adult and pediatric patients. In adult patients, a significant increase in the serum levels of zonisamide (P=.02) and eslicarbazepine (P=.04) was observed with increasing CBD dose. No other drug interactions among the 19 AEDs were noted.   The authors recommended monitoring serum AED levels in patients receiving CBD, as drug-drug interactions may be correlated with adverse events and laboratory abnormalities.

Patients using marijuana should be educated to avoid drugs that affect associated CYP450 enzymes. When these drugs cannot be avoided, and marijuana use is expected to continue, the patient should be monitored closely for potential drug interactions.   Be Aware and Educate Patients

Smoking more than two joints weekly is likely to increase the risk for drug-related interactions.[5,10] No data exist monitoring large-scale marijuana use in the United States. However, in Washington, a state in which marijuana use is legal, the average user is estimated to smoke two to three joints per week.[26]  With growing legalization and use throughout the nation, healthcare professionals must exercise heightened caution in the situation of concomitant use of medications and marijuana.

Source:: Stirring the Pot: Potential Drug Interactions With Marijuana – Medscape – Jun 08, 2017.  http://www.medscape.com/viewarticle/881059#vp

Deputy Attorney General Rod Rosenstein said on Tuesday morning. Rosenstein, along with acting head of the Drug Enforcement Agency, Chuck Rosenberg, and other prominent officials in law enforcement addressed the media at the DEA’s headquarters in Arlington, VA to discuss the ongoing response to the nation’s staggering opioid epidemic.

“We’re not talking about a slight increase. There’s a horrifying surge of drug overdoses in the United States of America. Some people say we should be more permissive, more tolerant, more understanding about drug use. I say we should be more honest and forthcoming with the American people on the clear and present danger that we know face,” opened Rosenstein.

“Fentanyl is especially dangerous. It is 40 to 50 times more deadly than heroin. Just two milligrams, a few grains of salt, an amount you could fit on the tip of your finger, can be lethal. Fentanyl exposure can injure or kill innocent law enforcement officers and first responders. Inhaling a few airborne particles can have dramatic effects,” he continued.

Rosenstein, Rosenberg, and their colleagues used the event to roll out new precautions for first responders in dealing with fentanyl. Such measures predominately featured hazmat suits as a means of avoiding airborne inhalation.

“Fentanyl’s everywhere and it’s killing people,” Rosenberg solemnly remarked.

Despite such a bleak update, Rosenberg claimed reasons for careful optimism in the midst of this epidemic. He has spoken extensively with his Chinese counterparts in law enforcement, given that China is the major source of Fentanyl that enters America. According to Rosenberg, the Chinese government banned 116 synthetic opioids for export and 4 more after his trip to China this March. Additional synthetics are scheduled to be banned as well.

“I do not want to understate such gains, nor do I want to overstate them,” he cautioned. More progress in international cooperation, he said, still has to be made in cutting off fentanyl shipments from China.

Rosenberg and other law enforcement officials such as Jonathan Thompson of the National Sheriffs’ Association assessed the difficulty associated with training first responders in such new duties and admitted that such efforts would strain already stretched resources in fighting what is an overwhelming epidemic.

Rosenberg’s daunting assessment of fentanyl put in perspective the existential danger of the ongoing opioid crisis that, according to Rosenstein, has contributed to the largest yearly increase in overdose deaths on record in America.

Rosenberg pointed out that such statistics tend to “wash over you.” To grasp the enormity of the epidemic he claimed that if three mass-shootings as deadly as the Pulse Nightclub Attack occurred three times every day for 365 days, then the death toll would roughly reach that of drug overdoses in 2015.

Source:   http://www.breitbart.com/big-government/2017/06/07/doj-drug-overdose-now-leading-cause-of-death-for-americans-under-50/

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

 

DATE: June 1, 2017

DISTRIBUTION: All First Responders

ANALYST: Ralph Little/904-256-5940

SUBJECT: Grey Death compound in Jacksonville & Florida

NARRATIVE:  The compound opioid known as Grey Death has been detected for the first time in North Florida. Although Purchased in March in St. Augustine, the basic drugs were from Jacksonville and may have been purchased pre-mixed.  Other  samples have occurred from March through May. Delays are due to testing requirements.  Grey Death has been detected in Florida since November 2016 in four counties south of NFHIDTA. Palm Beach reported a related death on May 19th.  Grey Death has been reported in the Southeast, with overdoses and at least  two deaths in Alabama and Georgia. It has  also been found in Ohio, Pennsylvania and Indiana. The compound is  a mixture of U-47700, heroin and fentanyl. Overall, different fentanyls, including carfentanil, have been detected and the amount of each ingredient varies.  The substance’s appearance is similar to concrete mixing powder with a varied texture from fine powder to rock-like. While grey is most common and is the color seen in St. Augustine, pictures indicate tan as well. The potency is much higher than heroin and can be administered via injection, ingestion, insufflation and smoking.

DANGER: Grey Death ingredients and their concentrations are unknown to users, making it particularly lethal. Because these strong drugs can be absorbed through the skin, touching or the accidental inhalation of these drugs  can result in absorption. Adverse effects, such as disorientation, sedation, coughing, respiratory distress or cardiac  arrest can occur very rapidly, potentially within minutes of exposure. Any concoction containing U-47700 may not respond to Narcan, depending on its relative strength in the mix.   Light grey powder in a test tube.

CONCLUSION: Responders are advised to employ protective gear to prevent skin absorption or inhalation. Miniscule (grains) of this substance are dangerous. Treat any particles in the vicinity of scene or potentially adhering to your or victim outer clothing or equipment as hazardous.

Source:  HIDTA Intelligence brief.   1st 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 new study suggests smoking high-potency marijuana may cause damage to nerve fibers responsible for communication between the brain’s two hemispheres.

The study included MRI scans of 99 people, including some who were diagnosed with psychosis, HealthDay reports.  The researchers found an association between frequent use of high-potency marijuana and damage to the corpus callosum, which is responsible for communication between the brain’s left and right hemispheres.

The corpus callosum is especially rich in cannabinoid receptors. THC, the psychoactive ingredient in marijuana, acts on these receptors.

Today’s high-potency marijuana has been shown to contain higher proportions of THC compared with a decade ago. Scientists have known that the use of marijuana with higher THC content has been associated with greater risk and earlier onset of psychosis, the researchers noted. This study is the first to examine the effect of marijuana potency on brain structure, according to a news release from Kings’s College London.

Frequent use of high-potency marijuana significantly affected the structure of the corpus callosum in patients with or without psychosis, the researchers report in Psychological Medicine.    The more high-potency marijuana a person smoked, the greater the damage.

“There is an urgent need to educate health professionals, the public and policymakers about the risks involved with cannabis use,” said senior researcher Dr. Paola Dazzan of the Institute of Psychiatry, Psychology & Neuroscience at King’s College London. “As we have suggested previously, when assessing cannabis use it is extremely important to gather information on how often and what type of cannabis is being used.

These details can help quantify the risk of mental health problems and increase awareness on the type of damage these substances can do to the brain.’

Source:  https://www.ncadd.org/about-addiction   Dec. 2015

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

As Cpl. Kevin Phillips pulled up to investigate a suspected opioid overdose, paramedics were already at the Maryland home giving a man a life-saving dose of the overdose reversal drug Narcan.

Drugs were easy to find:  a package of heroin on the railing leading to a basement; another batch on a shelf above a nightstand.

The deputy already had put on gloves and grabbed evidence baggies, his usual routine for canvassing a house.  He swept the first package from the railing into a bag and sealed it; then a torn Crayola crayon box went from the nightstand into a bag of its own.  Inside that basement nightstand:  even more bags, but nothing that looked like drugs.

Then—moments after the man being treated by paramedics come to—the overdose hit.

“My face felt like it was burning.  I felt extremely lightheaded.  I felt like I was getting dizzy,” he said.  “I stood there for two seconds and thought, ‘Oh my God, I didn’t just get exposed to something.’ I just kept thinking about the carfentanil.”

Carfentanil came to mind because just hours earlier, Phillips’ boss, Harford County Sheriff Jeffrey Gahler, sent an e-mail to deputies saying the synthetic opioid so powerful that it’s used to tranquilize elephants had, for the first time ever, showed up in a toxicology report from a fatal overdose in the county.  The sheriff had urged everyone to use extra caution when responding to drug scenes.

Carfentanil and fentanyl are driving forces in the most deadly drug epidemic the United States has ever seen.  Because of their potency, it’s not just addicts who are increasingly at risk—it’s those tasked with saving lives and investigating the illegal trade.  Police departments across the U.S. are arming officers with the opioid antidote Narcan.  Now, some first responders have had to use it on colleagues, or themselves.

The paramedic who administered Phillips’ Narcan on May 19 started feeling sick herself soon after;  she didn’t need Narcan but was treated for exposure to the drugs.

Earlier this month, an Ohio officer overdosed in a police station after bushing off with a bare hand a trace of white powder left from a drug scene.  Like Phillips, he was revived after several doses of Narcan.  Last fall, SWAT officers in Hartford, Connecticut, were sickened after a flash-bang grenade sent particles of heroin and fentanyl airborne.

Phillips’ overdose was eye-opening for his department, Gahler said.  Before then, deputies didn’t have a protocol for overdose scenes; many showed up without any protective gear.

Gahler has since spent $5,000 for 100 kits that include a protective suit, booties, gloves, and face masks.  Carfentanil can be absorbed through the skin and easily inhaled. and a single particle is so powerful that simply touching it can cause an overdose, Gahler said.  Additional gear will be distributed to investigators tasked with cataloguing overdose scenes—heavy-duty gloves and more robust suits.

Gahler said 37 people have died so far this year from overdoses in his county, which is between Baltimore and Philadelphia.  The county has received toxicology reports on 19 of those cases, and each showed signs of synthetic opioids.

“This is all a game-changer for us in law enforcement,” Gahler said.  “We are going to have to re-evaluate daily what we’re doing.  We are feeling our way through this every single day . . . we’re dealing with something that’s out of our realm.  I don’t want to lose a deputy ever, but especially not to something the size of a grain of salt.”

Source:  – Erie Times-News, Erie, Pa. – May 28, 2017 – www.goerie.com  The Associated Press

Ohio had the most overdose fatalities in the United States in 2014 and 2015.

A newspaper’s survey of county coroners has painted a grim picture of fatal overdoses in Ohio: more than 4,000 people died from drug overdoses in 2016 in the state badly hit by a heroin and opioid epidemic.

At least 4,149 died from unintentional overdoses last year, a 36 percent climb from the previous year, or a time when Ohio had the most overdose fatalities in the United States so far.

“They died in restaurants, theaters, libraries, convenience stores, parks, cars, on the streets and at home,” wrote The Columbus Dispatch in its report revealing the findings.

Survey Findings

It’s likely getting worse, too, as coroners warned that overdose deaths this year are fast outpacing these figures brought on by overdoses from heroin, synthetic opioids fentanyl and carfentanil, and other drugs.

The Dispatch obtained the number by getting in touch with coroners’ offices in all 88 Ohio counties. Coroners in six smaller counties, according to the paper, did not provide the requested figures.

Leading the counties in rapid drug overdose rises are counties such as Cuyahoga, where there were 666 deaths in 2016, as well as Franklin, Hamilton, Lucas, Montgomery, and Summit.

The devastation, added the survey, did not discriminate against big or small cities and towns, urban or rural areas, and rich and poor enclaves.

“It’s a growing, breathing animal, this epidemic,” said Medina County coroner and ER physician Dr. Lisa Deranek, who has sometimes revived the same overdose patients a few times each week.

Fentanyl Overdoses

Cuyahoga County, which covers Cleveland, had its death toll largely blamed on fentanyl use. Heroin remains a leading killer, but the autopsy reports reflected the major role of fentanyl, a synthetic opiate 50 times stronger than morphine, and animal tranquilizer carfentanil.

“We’ve done so much, but the numbers are going the other way. I don’t see the improvement,” said William Denihan, outgoing CEO of Cuyahoga County Alcohol, Drug Addiction and Mental Health Services Board.

Cuyahoga County had 400 fentanyl-linked deaths from Nov. 21 in 2015 to Dec. 31 last year, more than double related deaths of all previous years in combination. The opioid crisis, too, no longer just affected mostly white drug users, but also minority communities.

Dr. Thomas Gilson, medical examiner of Cuyahoga County, warned that cocaine is now getting mixed into the fentanyl distribution and fentanyl analogs in order to bring the drugs closer to the African-American groups.

Plans And Prospects

The state’s Department of Mental Health and Addiction Services stated that the overdose death toll back in 2015 would have been higher if not for the role of naloxone, an antidote use for opioid overdose cases. It has been administered by family members, other drug users, and friends to revive dying individuals.

State legislature moved to make naloxone accessible in pharmacies without a prescription. Ohio topped the nation’s drug overdose death numbers in 2014 and 2015. In the latter year, it was followed by New York, according to an analysis by the Kaiser Family Foundation using statistics from the U.S. Centers for Disease Control and Prevention.

Experts are pushing for expanding drug prevention as well as education initiatives from schoolkids to young and middle-aged adults, which also make up the bulk of dying people.

And while the state pioneered in crushing “pill mills” that issue prescription painkillers, health officials warned that this sent addicts to heroin and other stronger substances.

Naloxone, too, is merely an overdose treatment and not a cure for the growing addiction. Last May 22 in Pennsylvania, two drug counselors working to help others battle their drug addiction were found dead from opioid overdose at the addiction facility in West Brandywine, Chester County.

Source:  http://www.techtimes.com/articles/208540/20170529/ohio-leads-in-nations-fatal-drug-overdoses-with-4-000-dead-in-2016-survey.htm  29.05.17

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

 A New Agenda to  Turn Back the Drug Epidemic

Robert L. DuPont, MD, President , Institute for Behavior and Health, Inc.

A. Thomas McLellan, PhD, Senior Strategy Advisor , Institute for Behavior and Health, Inc.  May 2017

Institute for Behavior and Health, Inc. , 6191 Executive Blvd , Rockville, MD 20852 , www.IBHinc.org 1

Background 

The Institute for Behavior and Health, Inc. (IBH) is a 501(c)3 non-profit substance use policy and research organization that was founded in 1978. Non-partisan and non-political, IBH develops new ideas and serves as a force for change.

Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs and Health was published in November 2016. Four months later, in March 2017, IBH held a meeting of 25 leaders in addiction treatment, health care, insurance, government and research to discuss the scope and implications of this historic document. The US Surgeon General, VADM Vivek H. Murthy, MD, was an active participant in the meeting. The significance of this new Surgeon General’s Report is analogous to the historic 1964 Surgeon General’s report, Smoking and Health, a document that inspired an extraordinarily successful public health response in the United States that has reduced the rates of cigarette smoking by over 64% and continues its impact even today, more than 50 years following its release.

The following is a summary of the discussion at the March 2017 meeting and the conclusions and recommendations that were developed.

Introduction: The 2016 Surgeon General’s Report 

The two primary objectives of the US Surgeon General’s Report of 2016 are first to provide scientific evidence that shows that in addition to nicotine, other substance misuse and addiction issues (e.g., alcohol, opioids, marijuana, etc.) also are best understood and addressed as public health problems; and second to encourage the inclusion of addiction – its prevention, early recognition and intervention, treatment and active long-term recovery management – into the mainstream of American health care. At present these elements are not integrated either as a stand-alone continuum or within the general medical system. As is true for other widespread illnesses, addiction to nicotine, alcohol, marijuana, opioids, cocaine and other substances is a serious chronic illness. This perspective is contrary to the common perception that addiction reflects a moral failing, a personal weakness or poor parenting. Such opinions have stigmatized individuals who are suffering from these often deadly substance use disorders and have led to expensive and ineffective public policies that segregate prevention and treatment outside of mainstream medical care. A better public health approach encourages afflicted individuals and their family members to seek and receive help within the current health care system for these serious health problems.

An informed public health approach to reducing the prevalence and the harms associated with substance use disorders requires more than the brief treatment of serious cases. Particularly important are substance use prevention programs in schools, healthcare and in all other parts of the community to protect adolescents (ages 12 – 21), the group most at risk for the initiation of substance-related harms and substance use disorders.  Importantly, abundant tragic experience and accumulating science show that substance use disorders are not effectively treated with only short-term care. Because substance use disorders produce 2 significant long-lasting changes in the brain circuits responsible for memory, motivation, inhibition, reward sensitivity and stress tolerance, addicted individuals remain vulnerable to relapse years following specialized treatment.1, 2, 3 Thus, as is true for all other chronic illnesses, long periods of personalized treatment and monitoring are necessary to assure compliance with care, continued sobriety, and improved health and social function. In combination, science-based prevention, early intervention, continuing care and monitoring comprise a modern continuum of public health care. The overall goals of this continuum comport well with those of other chronic illnesses:

1 US Department of Health and Human Services (HHS), Office of the Surgeon General. (2016). Chapter 2. The Neurobiology of Substance Use, Misuse, and Addiction. In: Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS. Available: https://addiction.surgeongeneral.gov/

2 US Department of Health and Human Services (HHS), Office of the Surgeon General. (2016). Chapter 5. Recovery: The Many Paths to Wellness. In: Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS. Available: https://addiction.surgeongeneral.gov/

3 Betty Ford Institute Consensus Panel. (2007). What is recovery? A working definition from the Betty Ford Institute. Journal of Substance Abuse Treatment, 33(3), 221-228.

4 White, W. L. (2012). Recovery/remission from substance use disorders: An analysis of reported outcomes in 415 scientific reports, 1868-2011. Philadelphia, PA: Philadelphia Department of Behavioral Health and Intellectual Disability Services.

· sustained reduction of the cardinal symptom of the illness, i.e., substance use;

· improved general health and function; and,

· education and training of the patient and the family to self-manage the illness and avoid relapses.

In the addiction field achieving these goals is called “recovery.” This word is used to describe abstention from the use of alcohol, marijuana and other non-prescribed drugs as well as improved personal health and social responsibility.3,4 Over 25 million formerly addicted Americans are in stable, long-term recovery of a year or longer.4 Understanding how to consistently accomplish the life-saving goal of recovery must inform health care decisions.

The 2016 Surgeon General’s Report offers a science-informed vision and path to recovery in response to the nation’s serious addiction problem, including specifically the opioid overdose epidemic. Research shows that it is possible to prevent or delay most cases of substance misuse; and to effectively treat even the most serious substance use disorders with recovery as an expectable result of comprehensive, continuous care and sustained monitoring. To do this, substance use disorders must be recognized as serious, chronic health conditions that are both preventable and treatable. The nation must integrate the short-term siloed episodes of specialty treatment that now are isolated from mainstream healthcare into a fully integrated continuum of care comparable to that currently available to those with other chronic illnesses such as diabetes, hypertension, asthma and chronic pain.

Meeting Discussion and Conclusions 

The Surgeon General’s Report and the meeting convened by the Institute for Behavior and Health, Inc. (IBH) to promote its recommendations are significant responses to the expanding epidemic of opioid 3 and other substance use disorders, an epidemic that struck nearly 21 million Americans aged 12 and older in 2015 alone.5 That year saw more than 52,000 overdose deaths.6 This drug epidemic has devastated countless families and communities throughout the US. Unlike earlier and smaller drug epidemics, the current opioid epidemic is not limited to a few regions or communities or a narrow range of ethnicities or incomes in the United States. Instead it afflicts all communities and all socioeconomic groups; its impacts include smaller communities and rural areas as well as suburban areas and inner cities. Fuelled by the suffering of countless grieving families, the nation is in the early stages of confronting the new epidemic. A growing national determination to turn back this deadly epidemic has opened the door to innovation that is sustained by strong bipartisan political support for new and improved efforts in both prevention and treatment of substance use disorders.

5 Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series H-50). Available: http://www.samhsa.gov/data/

6 Rudd, R. A., Seth, P., David, F., & Scholl, L. (2016, December 30). Increases in drug and opioid-involved overdose deaths – United States. Morbidity and Mortality Weekly Report, 65(50-51), 1445-1452. Available: https://www.cdc.gov/mmwr/volumes/65/wr/mm655051e1.htm

7 Levy, S. J., Williams, J. F., & AAP Committee on Substance Use and Prevention. (2016). Substance use screening, brief intervention, and referral to treatment. Pediatrics, 138(1), e20161211. Available: http://pediatrics.aappublications.org/content/138/1/e20161211

8 US Department of Health and Human Services (HHS), Office of the Surgeon General. (2016). Chapter 3. Prevention Programs and Policies. In: Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS. Available: https://addiction.surgeongeneral.gov/

Abstinence is an Achievable Goal, both for Prevention and for Treatment 

Embracing and synthesizing the 30 years of science supporting the findings of the 2016 Surgeon General’s Report, the group discussed a single goal for the prevention of addiction: no use of alcohol, nicotine, marijuana or other non-prescribed drugs by youth for reasons of health. This goal should be the core prevention message to all children from a very young age. Health care professionals, educators and parents should understand the importance of this simple, clear health message. They should continue to reinforce this message of no-use for health as children grow to adulthood. Even when prevention fails, it is possible for parents, other family members, friends, primary care clinicians, educators and others to identify and to intervene quickly to stop youth substance use from becoming addiction.7

The science behind this ambitious but attainable prevention goal is clear. Alcohol, nicotine products, marijuana and other non-prescribed drug use is uniquely harmful to the still-developing brains of adolescents. Thus any substance “use” among youth must be considered “misuse” – use that may harm self or others. The goal of no substance use is not just for the purpose of preventing addiction, though that is one clear and important by product of successful prevention. Addiction is a biological process that can take years to develop. In contrast, even a single episode of high-dose use of alcohol or other substance could immediately produce an injury, accident or even death. While it is true that most episodes of substance misuse among adults do not produce serious problems, it is also true that substance misuse is associated with 70% or more of the injuries, disabilities and deaths of young people.8 These figures are even higher for minority youth. Many adolescent deaths are preventable 4 because most are related to substance use – including substance-related motor vehicle crashes and overdose.9

9 Subramaniam, G. A., & Volkow, N. D. (2014). Substance misuse among adolescents. To screen or not to screen? JAMA Pediatrics, 168(9), 798-799. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4827336/

10 Data analyzed by the Center for Behavioral Health Statistics and Quality. CBHS. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15- 4927, NSDUH Series H-50).

11 2014 data obtained by IBH from the Monitoring the Future study. For discussion of data through 2013 see DuPont, R. L. (2015, July 1). It’s time to re-think prevention; increasing percentages of adolescents understand they should not use any addicting substances. Rockville, MD: Institute for Behavior and Health, Inc. Available: https://www.ibhinc.org/s/IBH_Commentary_Adolescents_No_Use_of_Substances_7-1-15.pdf

Youth who use any one of the three most common “gateway” substances, i.e., alcohol, nicotine and marijuana, are many times more likely than those who do not use that single drug to use the other two substances as well as other illegal drugs.10 The use of any drug opens the door to an endless series of highly risky decisions about which drugs to use, how much to use, and when to use them. This perspective validates the public health goal for youth of no use of any drug.

Complete abstinence from the use of alcohol or any other drug among adolescents is not simply an idealistic goal – it is a goal that can be achieved. Data were presented at the meeting from the nationally representative Monitoring the Future study showing that 26% of American high school seniors in 2014 reported no use of alcohol, cigarettes, marijuana or other non-prescribed drugs in their lifetimes. 11 This is a remarkable increase from only 3% reported by American high school seniors in 1983. Moreover, in the same survey, 50% of high school seniors had not used any alcohol, cigarettes, marijuana or other non-prescribed substance in the past 30 days, up from 16% in 1982. These largely overlooked and important findings show that youth abstinence from any substance use is already widespread and steadily increasing.

In parallel with the goal of abstinence for prevention, the recommended goal for the treatment of those who are addicted is sustained abstinence from the use of alcohol and other drugs, with the caveat, explicitly acknowledged by the group, that individuals who are taking medications as-prescribed in the treatment of substance use disorders (e.g., buprenorphine, methadone and naltrexone) and who do not use alcohol or other non-prescribed addictive substances – are considered to be abstinent and ”in recovery.” Abstinence from all non-prescribed substance use is the scientifically-informed goal for individuals in addiction treatment. This treatment goal is widely accepted in the large national recovery community. The long-lasting effects of addiction to drugs are easily seen among cigarette smokers: smoking only a single cigarette is a serious threat to the former smoker, even decades after smoking the last cigarette. There is incontrovertible evidence from brain and genetic research showing the long-term effects of substance misuse on critical brain regions.2 It is unknown when or if these brain changes will return to being entirely normal following cessation of substance use; however, it is known that the recovering brain is particularly vulnerable to the effects of return to any substance use, often leading to overdose or rapid re-addiction. 5

Participants in the IBH meeting supported the idea that abstinence is the high-value outcome in addiction treatment; and that while any duration of abstinence is valuable, longer-term, stable abstinence of 5 years is analogous to the widely-used standard in cancer treatment of 5-year survival. The scientific basis for the value of sustained recovery is validated by the experience of the estimated 25 million Americans now in recovery. This increasingly visible recovery community is a remarkable and very positive new force in the country.

Measuring and Attaining these Goals 

The mantra from the IBH meeting was, if you don’t measure it, it won’t happen. The group of leaders recognized the paucity of current models for systematic integration of addiction treatment and general healthcare. The group encouraged the identification of promising models and the promotion of innovation to achieve the goal of sustained recovery. Even programs that include fully integrated care of other diseases, managed care and other comprehensive health programs do not reliably achieve the goal of sustained or even temporary recovery for substance use disorders. The meeting participants noted the absence of long-term outcome studies of the treatment of substance use disorders and encouraged all treatment programs not only to extend the care of discharged patients but also to systematically study the trajectories of discharged patients to improve their long-term treatment outcomes. The increasing range of recovery support services after treatment is an important and promising new trend that is now actively promoting sustained recovery.

Meeting participants noted one particularly promising model of public health goal measurement and attainment – the 90-90-90 goals for the treatment of HIV/AIDS: 90% of people with HIV will be screened to know their infection status; 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy; and 90% of all patients receiving antiretroviral therapy will have viral suppression (i.e., zero viral load).12 These measurable goals provide an operational definition of public health success for the country, states and individual healthcare organizations.

12 UNAIDS. (2014). 90-90-90: An Ambitious Treatment Target to Help End the AIDS epidemic. Geneva, Switzerland: Joint United Nations Programme on HIV/AIDS. Available: http://www.unaids.org/sites/default/files/media_asset/90-90-90_en_0.pdf

With this model as background, the IBH group concluded that a similar public health approach and similarly specific numeric goals should be established for preventing and treating substance use disorders. Examples of parallel national prevention goals could include 90% rates of screening for substance misuse among adolescents; 90% provision of interventions and follow-up for those screening positive; and 90% total abstinence rates among youth aged 12-21. While these are admittedly ambitious prevention goals, adoption of them could incentivize families, schools and communities to increase the percentage of youth who do not use any alcohol, nicotine, marijuana or other drugs every year.

A similar approach was adopted by the IBH group to improve the impact of addiction treatment. Again, there would be significant public health value if the US adopted the following goals: 90% of individuals aged 12 or older receive annual screening for substance misuse and substance use disorders; 90% of those who receive a diagnosis of a substance use disorder are referred and meaningfully engaged (at 6 least three sessions) in some form of addiction treatment; and 90% of those engaged in treatment achieve sustained abstinence as measured by drug testing, during and for six months following treatment.

Source:  IBH-Report-A-New-Agenda-to-Turn-Back-the-Drug-Epidemic  May 2017

Carfentanil. If there was ever a drug designed to wreak havoc – this is it!

5 milligrams (about 1/16th the size of a baby aspirin) is strong enough to take down a one-ton Buffalo, actually make that 7 one-ton Buffalos, and it’s readily available through illicit sales on street corners throughout the US. It is also now one of the leading causes of opioid related death, which claimed over 33,000 lives (out of 52,000+ drug related overdose deaths) in 2015, the most recent year for which statistics are available.  Carfentanil first showed up in the Ohio area in mid-2016 and has been advancing it’s destructive power across the nation with a vengeance. If it came in a bottle, it would need to have a warning label that is longer than the Great Wall of China, stating something to the effect of “If you take this drug, you are committing suicide. Avoid it at all costs.” In fact, its only legal use is for the sedation of large animals, like “elephants”. Addicts generally work their way up to Carfentanil. The typical gateway is by medical prescription for something like Oxycontin, with the user then graduating to cheaper heroin once the prescriptions run out. In fact, the majority of heroin users admit they started with prescription opioids. They beckon you like the sirens from Greek mythology, tempting you past your breaking point. It eventually gets to a level that heroin is no longer nearly enough, so you start taking fentanyl, many multiple times stronger than morphine which sucked so many war veterans into addiction during the Vietnam era. Your tolerance builds as your habit expands from a few days a week to every day.  Eventually fentanyl too is not enough. What else is there? Carfentanil. ‘Do I risk it?’ is what an addict should now ask himself, but they rarely listen to their voice of reason. They jump ‘all in’ without any thought or concern of consequences, they just want to get high. Then again, oftentimes they don’t even get to make that choice, it’s made for them. Carfentanil is so cheap that it’s used as an additive on the street.

I read an article the other day where someone bought street Xanax. It was laced with Carfentanil; he was dead within minutes. This same scenario has repeated itself throughout the country, as drug dealers seek to convert a small amount of Carfentanil, into a large amount of sale-able product, mixing it with ‘whatever is available’, solely to line their pockets with addicts’ money. Carfentanil is also a concern for first responders. It is odorless, colorless and can be absorbed via skin contact, inhalation, oral exposure or ingestion. EMS crews typically wear protective gloves and masks because a dose as small as a grain of salt could kill a person even if just absorbed through the skin, much like Anthrax. The increases in opioid-related emergencies are overwhelming the country on a state-by-state and city-by-city basis. Incidents are up 13.3 percent in Minnesota, over 20 percent throughout Ohio and the numbers are even worse in Kentucky, New Hampshire, New Mexico and West Virginia. The growth in Native American communities is by far the worst at 32.7 percent. 50 people recently overdosed in one day alone in Philadelphia, which experienced 35 overdose related deaths over five days. Cincinnati had 174 overdoses in six days, Cleveland 46 in one day and tiny Akron 236 over 20 consecutive days. In Maryland, Gov. Larry Hogan declared a state of emergency after opioids killed nearly 1,500 residents in the first nine months of 2016. The US represents just 4.6 percent of the world’s population, yet we consume 80 percent of its opioids. So, where’s all this Carfentanil coming from?  The usual suspects. China and India were the largest suppliers for the illegal online pharmacies during the early 2000s.

Distributors located in the Caribbean and Central American countries, typically run by American ex-pats, bought knock-offs of everything from Viagra to Xanax to Oxycontin for pennies a pill, sending shipments ‘directly to your door’ without the need of a pesky prescription. Those same large suppliers simply shifted to the next hot product and now sell to Mexican cartels distributing it street-by-street. After recent pressure from the US Drug Enforcement Agency (DEA), China clamped down on bootleg opioid operations to curb the flow of illicit drugs into the US. Yet, the Mexican drug-lords are resourceful. I fear it won’t take too much time for them to find other suppliers to fill the gap. There’s already evidence of them trying to produce substantial quantities on their own, to eliminate the need for an outside source. According to the DEA, 144 people now die each day from a drug overdose. As recently as 10 years ago, gun related deaths outnumbered drug overdose deaths by a factor of 5-to-1. Today more people die from opioids than guns and traffic accidents combined. It is estimated that 600 people try heroin for the first time each and every day. The issue is now mission critical. President Trump has appointed a SWAT Team of business executives to tackle the opioid crisis, led by his son-in-law Jared Kushner, a leading businessman and near billionaire in his own right. They are already working with a ‘Who’s Who’ of Fortune 500 Company leaders including such luminaries as Apple’s Tim Cook and Microsoft’s Bill Gates, just to name a few. Kipu and our sister company, InRecovery Magazine, have reached out to this Team to offer our unique experience, knowledge, perspective and support. We are hopeful that this is a key step toward helping to start to turn the tide in this life-or-death struggle against addiction.

Source: http://campaign.r20.constantcontact.com/render?m=1125801102133&ca=c086bc62-9760-47b5-8dad-385b0609ab8d   May 2017

COLUMBUS, Ohio — It’s being called “gray death” — a new and dangerous opioid combo that underscores the ever-changing nature of the U.S. addiction crisis.

Investigators who nicknamed the mixture have detected it or recorded overdoses blamed on it in Alabama, Georgia and Ohio. The drug looks like concrete mix and varies in consistency from a hard, chunky material to a fine powder.

The substance is a combination of several opioids blamed for thousands of fatal overdoses nationally, including heroin, fentanyl, carfentanil – sometimes used to tranquilize large animals like elephants – and a synthetic opioid called U-47700.

“Gray death is one of the scariest combinations that I have ever seen in nearly 20 years of forensic chemistry drug analysis,” Deneen Kilcrease, manager of the chemistry section at the Georgia Bureau of Investigation, said.  Gray death ingredients and their concentrations are unknown to users, making it particularly lethal, Kilcrease said. In addition, because these strong drugs can be absorbed through the skin, simply touching the powder puts users at risk, she said.

Last year, the U.S. Drug Enforcement Administration listed U-47700 in the category of the most dangerous drugs it regulates, saying it was associated with dozens of fatalities, mostly in New York and North Carolina. Some of the pills taken from Prince’s estate after the musician’s overdose death last year contained U-47700.

Gray death has a much higher potency than heroin, according to a bulletin issued by the Gulf Coast High Intensity Drug Trafficking Area. Users inject, swallow, smoke or snort it.

Georgia’s investigation bureau has received 50 overdose cases in the past three months involving gray death, most from the Atlanta area, said spokeswoman Nelly Miles.

In Ohio, the coroner’s office serving the Cincinnati area says a similar compound has been coming in for months. The Ohio attorney general ‘s office has analyzed eight samples matching the gray death mixture from around the state.

The combo is just the latest in the trend of heroin mixed with other opioids, such as fentanyl, that has been around for a few years.  Fentanyl-related deaths spiked so high in Ohio in 2015 that state health officials asked the federal Centers for Disease Control and Prevention to send scientists to help address the problem.

The mixing poses a deadly risk to users and also challenges investigators trying to figure out what they’re dealing with this time around, said Ohio Attorney General Mike DeWine, a Republican.

“Normally, we would be able to walk by one of our scientists, and say ‘What are you testing?’ and they’ll tell you heroin or ‘We’re testing fentanyl,’” DeWine said. “Now, sometimes they’re looking at it, at least initially, and say, ‘Well, we don’t know.’”

Some communities also are seeing fentanyl mixed with non-opioids, such as cocaine. In Rhode Island, the state has recommended that individuals with a history of cocaine use receive supplies of the anti-overdose drug naloxone.

These deadly combinations are becoming a hallmark of the heroin and opioid epidemic, which the government says resulted in 33,000 fatal overdoses nationally in 2015. In Ohio, a record 3,050 people died of drug overdoses last year, most the result of opioid painkillers or their relative, heroin.

Most people with addictions buy heroin in the belief that’s exactly what they’re getting, overdose survivor Richie Webber said.  But that’s often not the case, as he found out in 2014 when he overdosed on fentanyl-laced heroin. It took two doses of naloxone to revive him. He’s now sober and runs a treatment organization, Fight for Recovery, in Clyde, about 45 miles (72 kilometers) southeast of Toledo.

A typical new combination he’s seeing is heroin combined with 3-methylfentanyl, a more powerful version of fentanyl, said Webber, 25. It’s one of the reasons he tells users never to take drugs alone.

“You don’t know what you’re getting with these things,” Webber said. “Every time you shoot up you’re literally playing Russian roulette with your life.”

Source:  https://www.statnews.com/2017/05/04/opioid-gray-death-overdoses/  4th May 2017

The opioid epidemic has led to the deadliest drug crisis in US history – even deadlier than the crack epidemic of the 1980s and 1990s.

Drug overdoses now cause more deaths than gun violence and car crashes. They even caused more deaths in 2015 than HIV/AIDS did at the height of the epidemic in 1995.

A new study suggests that we may be underestimating the death toll of the opioid epidemic and current drug crisis. The study, conducted by researchers at the Centers for Disease Control and Prevention (CDC), looked at 1,676 deaths in Minnesota’s Unexplained Death surveillance system (UNEX) from 2006 – 2015. The system is meant to refer cases with no clear cause of death to further testing and analysis. In total, 59 of the UNEX deaths, or about 3.5 percent, were linked to opioids. But more than half of these opioid-linked deaths didn’t show up in Minnesota’s official total for opioid related deaths.

It is unclear how widespread of a problem this is in other death surveillance systems and other states, but the study’s findings suggest that the numbers we have so far for opioid deaths are at best a minimum. Typically, deaths are marked by local coroners or medical examiners through a system; if the medical examiner marks a death as immediately caused by an opioid overdose, the death is eventually added to the US’s total for opioid overdose deaths. But there is no national standard for what counts as an opioid overdose, so it’s left to local medical officials to decide whether a death was caused by an overdose or not. This can get surprisingly tricky – particularly in cases involving multiple conditions or for cases in which someone’s death seemed to be immediately caused by one condition, but that condition had a separate underlying medical issue behind it.

For example, opioids are believed to increase the risk of pneumonia. But if a medical examiner sees that a person died of pneumonia, they might mark the death as caused by pneumonia, even if the opioids were the underlying cause for the death. “In early spring, the Minnesota Department of Health was notified of an unexplained death: a middle-aged man who died suddenly at home. He was on long-term opioid therapy for some back pain, and his family was a little bit concerned that he was abusing his medication,” said Victoria Hall, one of the study’s authors.

“After the autopsy, the medical examiner was quite concerned about pneumonia in this case, and that’s how the case was referred to the Minnesota Department of Health unexplained deaths program. Further testing diagnosed an influenza pneumonia, but also detected a toxic level of opioids in his system. However, on the death certificate, it only listed the pneumonia and made no mention of opioids.”

Since this is just one study of one surveillance system in one state, it’s unclear just how widespread this kind of underreporting is in the United States. But the data suggests that there is at least some undercounting going on – which is especially worrying, as this is already the deadliest drug overdose crisis in US history. “It does seem like it is almost an iceberg of an epidemic,” said Hall. “We already know that it’s bad. And while my research can’t speak to what percent we’re underestimating, we know we are missing some cases.” In 2015, more Americans died of drug overdoses than any other year on record – more than 52,000 deaths in just one year. That’s higher than the more than

38,000 who died in car crashes, the more than 36,000 who died from gun violence, and the more than 43,000 who died due to HIV/AIDS during that epidemic’s peak in 1995.

See more: • The Changing Face of Heroin Use in the US study • Today’s Heroin Epidemic – CDC

Source:  Prevention Weekly. news@cadca.org  May 2017

Alzheimer’s and Marijuana ?

An estimated 200,000 people in the United States under age 65 are living with younger-onset Alzheimer’s disease. And hundreds of thousands more are coping with mild cognitive impairment, a precursor to Alzheimer’s and other dementias.

“It’s beyond epidemic proportions. There truly is a tidal wave of Alzheimer’s disease,” said Dr. Vincent Fortanasce, a clinical professor of neurology in Southern California who is also a renowned Catholic bioethicist, author and radio host.

Fortanasce, a member of Legatus’ San Juan Capistrano Chapter, for several years has studied Alzheimer’s disease, its underlying causes and treatments. Through his research, he believes there may be a link between chronic use of marijuana — especially when started at a young age — and Alzheimer’s.

Finding the link

Fortanasce notes that medical research shows chronic users of marijuana, in particular the kind with high quantities of THC, have reduced volume in the hippocampus, the region of the brain responsible for memory and learning. In Alzheimer’s disease, Fortanasce said, medical researchers have also noticed reduced hippocampus volume with increased B-amyloid plaques and neurofibrillary tangles.

Taking into account other factors, such as skyrocketing obesity rates and lack of exercise, Fortanasce argues that chronically smoking marijuana and consuming products laced with cannabis are harming the long-term mental health of millions of young Americans. He is trying to convince the American Academy of Neurology to conduct a major survey to see if people diagnosed with dementia have also smoked marijuana.

Source: :  http://legatus.org/kicking-pot-curb/  April 9th 2017

Misleadingly marketed as a legal and safe alternative to marijuana, synthetic cannabinoids have a variety of adverse health effects. A new review summarizes the clinical cases that have so far been linked to the use of the synthetic substances.

A new review warns that so-called synthetic marijuana is actually very different from cannabis and is potentially unsafe. Synthetic cannabinoids (SCBs) are a type of psychotropic chemical increasingly marketed as a safe and legal alternative to marijuana.

They are either sprayed onto dried plants so that they can be smoked, or they are sold as vaporizable and inhalable liquids.

A new review from the University of Arkansas for Medical Sciences (UAMS) warns against the dangerous side effects of the compounds popularly (and misleadingly) referred to as “synthetic marijuana.”

Referring to the SCBs currently sold as “K2” and “Spice,” Paul L. Prather, a cellular and molecular pharmacologist at UAMS and corresponding author of the review, explains the motivation behind it:

“In the United States, in 2007 or so, we started seeing all kinds of people coming into emergency rooms saying they smoked marijuana, but they had these really bizarre symptoms that did not correspond with the effects you see with marijuana.”

The report, therefore, set out to give an overview of the existing literature on SCBs, and to show that not only are they different from marijuana, but also that they do not constitute an appropriate substitute for cannabis. On the contrary, SCBs are drugs in their own right, with many toxic – and sometimes even fatal – effects. The review has been published in the journal Trends in Pharmacological Sciences.

SCBs are different from marijuana

SBCs are known to create psychotropic effects in much the same way as marijuana – by activating the CB1 cannabinoid receptor, which is found primarily in the brain and the central nervous system. Additionally, in the case of marijuana, its main active ingredient is tetrahydrocannabinol (THC), which also activates the CB2 receptor (found mainly in the immune system).

However, as the authors warn, SCBs activate the CB1 receptor to a much higher intensity than THC does.

William E. Fantegrossi, a behavioral pharmacologist at UAMS and co-author of the review, notes that SCBs “are highly efficacious drugs; they tend to activate the CB1 receptor to a greater degree than we can ever get to with THC from marijuana.”

Additionally, the authors caution that because SCBs are chemically different from THC, they may activate other receptors aside from CB1. These cellular receptors, so far unknown, may be causing the negative health effects noticed in SCB users.

SCBs linked to serious adverse health effects and even death

As reported in the review, some of these effects suggest that SCBs cause much more toxicity than marijuana. Toxicity has been reported across a wide range of systems, including the gastrointestinal, neurological, cardiovascular, and renal systems.

The clinical cases documented in the review include acute and long-term symptoms, such as:

  •  Seizures
  •  Convulsions
  •  Catatonia
  • Kidney injury § Hypertension
  •  Chest pain
  •  Myocardial toxicity
  •  Ischemic stroke

Common adverse effects include prolonged and severe vomiting, anxiety, panic attacks, and irritability. Additionally, SCBs reportedly caused extreme psychosis in susceptible individuals, whereas marijuana only causes mild psychosis in those predisposed.

Furthermore, 20 deaths have been linked to SCBs between 2011 and 2014, whereas no deaths were reported among marijuana users during that time.

Finally, SCBs are likely to result in tolerance, dependence, and withdrawal.

SCBs are not safe, authors warn

Because SCBs cannot be detected by standard drug screening, they are particularly popular among users who want to avoid detection, such as teenagers and army personnel. These users often purchase the drugs online, but as Prather and colleagues warn, customers often do not know what they are purchasing because they get something different each time.

“Not only does the amount of the active pharmacological agent change with different batches of drugs, made by different labs, but the active compound itself can change,” says Fantegrossi. Prather adds that “there are usually a minimum of three, if not five, different synthetic cannabinoids in a single product.”

However, the potential therapeutic benefits of cannabinoids should not be dismissed entirely, write the authors. As with opioids in general, misuse or abuse can have severely adverse or even fatal consequences, but proper use may offer significant benefits.

Overall, though, SCBs should be viewed with suspicion and treated with caution.

“The public sees anything with the marijuana label as potentially safe, but these synthetic compounds are not marijuana […] You never know what they are, and they are not safe.”

Source:  http://www.medicalnewstoday.com/articles/315634.php?mc_cid=4a0d722034&mc_eid=46cee4286 0  Feb 2017

In 2014, recreational cannabis use was legalized in Colorado, and seven other states have since followed suit. With an ever-expanding part of the population using marijuana to cure a number of ailments, researchers at Colorado State University have investigated its effects on mood. The researchers – led by Lucy Troup, assistant professor in the university’s Department of Psychology – publish their findings in the journal PeerJ.

They note that the “relationship between cannabis use and symptomatology of mood and anxiety disorders is complex,” adding that although “a great deal of research exists and continues to grow, the evidence remains contradictory.” Troup and colleagues point to a large international survey published in 2013, in which 5.2 percent of respondents reported that they used cannabis to alleviate depressive symptoms. Meanwhile, a survey of medical marijuana users in California revealed that 26.1 percent of participants reported therapeutic benefits for depression, and 37.8 percent reported benefits for anxiety.

“This trend of self-medication for conditions other than the one prescribed is too large to ignore when investigating the associations between cannabis use and mood disorders,” write the Colorado State University researchers.

They add that this increases “the need to include recreational users for research, especially when the casual user group are most likely recreational users and seem to sustain the greatest deficits in mood.”

Is cannabis used correctly for self-medication? For their study, Troup and colleagues wanted to focus on Colorado, which was the first state to legalize recreational marijuana.

As such, they conducted an in-depth, questionnaire-based study of 178 legal cannabis users who were aged 18-22.

They divided their participants into three groups based on self-reported use: a control group who never used cannabis, a casual user group, and a group of chronic users.

Interestingly, the participants who were categorized with subclinical depression, and who also used cannabis to treat their depressive symptoms, scored lower on anxiety symptoms than on their depressive symptoms. In short, they were more depressed than anxious.

The researchers also say that the self-reported anxiety sufferers were found to be more anxious than depressed.

Study co-author Jacob Braunwalder, a researcher in Troup’s laboratory, says that “if they were using cannabis for self-medication, it wasn’t doing what they thought it was doing.”

The questionnaire used in the study was developed by co-author Jeremy Andrzejewski. Called the Recreational Cannabis Use Evaluation, the questionnaire delved into users’ habits, including whether they smoked cannabis or used stronger products such as hash oils or edibles.

The researchers say that inconsistencies in previous studies are better understood when considering how cannabis use is reported. “Phytocannabinoid type and strength is not consistent between studies,” they say, “and there have been significant changes in the strength of these products post-legalization.”

‘Infrequent users have stronger relationship with negative mood’

Troup and colleagues say that it is important to point out that they looked at the residual effects of cannabis use, not administration of specific doses.

However, they do note that their results “suggested that cannabis use had an effect on measurements of mood disorder symptomatology. In particular, those who used cannabis less frequently, the casual user group, had the strongest correlations with overall score and negative effect on the CES-D [Center for Epidemiological Studies depression scale].”

Interestingly, the researchers did not observe a relationship with pre-anxiety symptoms in the cannabis user groups, compared with controls.

The researchers emphasize that their study does not conclude that cannabis causes depression or anxiety. It also does not show that cannabis cures these conditions. However, they add that their analysis displays a need for further study regarding how cannabis affects the brain.

Andrzejewski adds that “there is a common perception that cannabis relieves anxiety,” but this has not been fully backed by research.

“It is important not to demonize cannabis, but also not to glorify it,” adds Troup. “What we want to do is study it, and understand what it does. That’s what drives us.”

Concluding their study, the researchers write:

“Our data indicate that infrequent users have a stronger relationship with negative mood. Our data suggested that those that use cannabis casually scored higher on the CES-D scale for depression, and consequently could be at greater risk for developing pre-depression symptomology compared to both chronic users and controls.”

It is important to note that the study has limitations, including:

  •  Sample size
  •  Control for phytocannabinoids in terms of strength and type
  •  Confounding variables such as multiple drug use and alcohol consumption
  •  The self-report design
  • A limited interpretation of depression due to lack of clinical evaluation.

Still, the researchers say that their study “provides a starting point from which to design controlled experiments to further investigate the relationship between mood and cannabis use in a unique population.”

Source:  http://www.medicalnewstoday.com/articles/314823.php   Dec. 2014

As Manchester police report a spike in spice related incidents, homeless people say the highly addictive drug is causing deaths.

When Alex first tried spice in 2014, he thought it was cannabis. The 23-year-old had been sleeping on the streets in Manchester after his mum had lost her council house. He was just looking to take his mind off his problems, but at lightning speed he became addicted, buying increasing quantities of the drug to feed his habit.

“I was waking up, buying it, smoking it, going to sleep, waking up, buying it, smoking it, going to sleep again,” he says.

Alex spent about a year addicted to spice, while he was living in tents in the city centre, before kicking the habit near the start of 2016. At the peak of his addiction, he was spending around £200 a week on the drug. “It was horrible,” he says. “Every morning I was waking up being physically sick. I was worn out and tired. I couldn’t eat. I couldn’t drink. My bones kept on aching.”

Spice, one of the names used for a group of substances known as synthetic cannabinoids, has been in the UK for more than a decade and was initially marketed as having effects similar to those of cannabis. The highly addictive psychoactive substance, an illegal class B drug since December, induces an inactive state and in recent years has become commonly used among the UK’s homeless population.

Although charities in other big UK cities report spice addiction as an issue among their homeless communities, Manchester’s problem is particularly visible. Between the city’s main train station and Piccadilly Gardens, a transport and shopping hub, it is common to see figures slumped in doorways apparently passed out after smoking the drug.

Earlier this week, Greater Manchester police released figures showing the burden the drug has placed on the city’s emergency services. The force attended 58 spice-related incidents in the city centre on Friday, Saturday and Sunday last week. There were also 23 incidents to which an ambulance was called, and 18 dispersal orders or directions to leave were issued.

Researchers estimate that 90-95% of homeless people in Manchester smoke the drug. And while there is very little research into the effects of spice on the body, there are scores of reports of people dying after smoking it. “We try and keep our outreach teams away from Piccadilly Gardens,” says Yvonne Hope, operations and resources director at the Manchester-based homelessness charity Barnabus. “It’s so unsafe there now.”

The release of police figures prompted a flurry of media interest in the problem. A series of photographs of homeless spice users in Manchester city centre, some covered in vomit and being helped by emergency services, were published by local and national newspapers. Local charities were critical of the coverage, describing it as dehumanising and sensationalist.

Spice’s main attractions are that it is cheap and strong. It is thought to be imported from China in liquid form, then sprayed on an inert plant such as marshmallow before being sold to be smoked. Only the tiniest amount of the chemical is needed to have an effect.

Alex, who has been helped into supported accommodation by the homelessness charity Depaul UK, is due to start a new job next month. He realised he needed to kick the habit when his former partner refused him access to his daughter. “I went cold turkey,” he says. “I got my cousin to lock me in the back of a van and just leave me there to sweat it out.” The withdrawal symptoms include sweating, vomiting, stomach cramps and headaches, he says.

Standing outside Barnabus’s Beacon drop-in centre – which provides showers, cooked breakfasts and cups of tea to Manchester’s rough sleepers – John and Steve, 52 and 35, agree spice has largely replaced heroin, crack and even alcohol as the drug of choice.

“You can go get a fiver, buy half a gram and it’ll knock you out for a few hours,” says John, who has been homeless since 2014. “It’s better than buying a bottle of White Ace [cider].”

“I have tried heroin and it’s worse than that,” says Steve, adding that friends of his have died after taking spice. The last time he smoked a joint of spice he woke up in a hospital bed, he says. “I don’t touch the stuff any more, it doesn’t agree with me.”

Hope says there has been a rise in crime associated with the drug since it was banned in May last year, with fights breaking out among people who visit the drop-in centre. “Up until about 2015, we had people who were mostly a community and people who respected each other, and spice just seems to have killed that,” she says. The use of spice has also reached crisis point in Britain’s prisons, helped by the fact that it does not show up in routine drugs tests. Dr Robert Ralphs, a senior lecturer in criminology at Manchester Metropolitan University, who has conducted research into the use of spice in the city, says the drug is used partly because of its ability to make hours pass in what feels like a few minutes. “People have told me they’ve used [spice] for the last two or three years, but that it seems like a couple of months,” he says.

Dr Oliver Sutcliffe, a senior lecturer in psychopharmaceutical chemistry at Manchester Metropolitan University, says the strength of the drug can vary wildly, which poses serious health risks. Tests on samples of the drug provided by police show the most recent batch to hit the streets in Manchester was 10 times stronger than is usual.

Sutcliffe says that although the packets look the same, they can contain a range of different cannabinoids at varying strengths. “You’re playing Russian roulette,” he adds. The chemicals found in spice in Manchester have been linked to 10 deaths in Japan.

Peter Morgan, a support worker with Depaul UK who is helping Alex in his transition back to work, says there is a need for rehabilitation programmes like those provided for heroin addicts. “Spice is clearly the strongest drug in the country right now,” he says.

Alex agrees with Morgan and swears he will not touch the drug again. He wants to rebuild his life with his girlfriend and hold down his new job. He says he has seen homeless friends in tears because they want to stop using spice. “But they can’t,” he continues. “Because no one’s going to help them do it.”

Some names in this article have been changed.

What is spice?

Spice, or synthetic cannabis, is not a single drug, but a range of laboratory-made chemicals designed to mimic the effects of the main psychoactive compound in cannabis, tetrahydrocannabinol (THC).

The active substance in spice is mass-produced in underground labs, often in China, and sent to Europe in powder form where suppliers typically spray the chemical on to mixes of herbal leaves that are then sold on. The precise chemical formulation of the drug is constantly shifting, meaning there are potentially hundreds or even thousands of variations available.

The THC in natural cannabis works by travelling through the blood to the brain, where it binds to cannabinoid receptors. The synthetic version does the same thing, but can be 100 times more potent, binding to the receptors more efficiently and in some cases for far longer. This has led to anecdotal reports of people remaining under the “high” of the drug for more than a day.

The precise effects are likely to depend on the chemical formula and, probably more importantly, on the concentration of the substance in the product. Since the drug is sprayed on, even within a single bag of the product there can be highly concentrated “hot spots”. This has made it difficult for scientists to come up with a typical profile of the effects of the drug and associated risks.

The positive short-term effects of spice appear to be approximately similar to that of herbal cannabis: users report feeling warm, happy and relaxed, and sometimes report confusion, paranoia and anxiety. But the adverse effects appear to be more severe and wide-ranging. A characteristic side-effect of smoking cannabis is an increased heart rate and there is some evidence that the cardiovascular effects of synthetic cannabis can be more extreme, with case reports of people having heart attacks and strokes after taking the drug. Cases have also been reported of kidney and liver damage and psychosis.

Little is known about the long-term effects of synthetic cannabis, since these products have only been in widespread recreational use since around 2008.

Source:  https://www.theguardian.com/society/2017/apr/15/its-worse-than-heroin-how-spice-is-ravaging-homeless-communities

Abstract

Cannabis use remains a critical issue in the United States.  In 2014, an estimated 22 million US residents used cannabis,1 double the number from 10 years age.

As of December 2016, 28 states and the District of Columbia have implemented or have voted to authorize medical cannabis programs, and 8 states and the District of Columbia have legalized recreational cannabis.

Health care professionals often are concerned about whether cannabis use will lead to psychiatric illnesses such as substance use disorders, anxiety disorders, or mood disorders among their patients. Many stakeholders are concerned that an association between cannabis use and psychiatric illnesses will lead to a steady increase in these illnesses as more states implement medical or recreational cannabis legalization policies. Given these trends and concerns, it has become increasingly important to obtain longitudinal data to clarify the relationship between cannabis use and subsequent psychiatric disorders.

Source:  JAMA. 2017;317(10):1070-1071. doi:10.1001/jama.2016.19706

The Centers for Disease Control and Prevention (CDC) stated that 33,091 people died from opioid overdoses in 2015, which accounts for 63 percent of all drug overdose deaths in the same year. A recent report from the CDC found that drug deaths from fentanyl and other synthetic opioids, other than methadone, rose 72 percent in just one year, from 2014 to 2015. Last year, the death of music icon Prince was linked to fentanyl and the prescription drug has become a source of concern for government agencies and law enforcement officials alike, as death rates from fentanyl-related overdoses and seizures have risen across the country.

What exactly is fentanyl?

According to the National Institute on Drug Abuse, fentanyl is a powerful synthetic opioid analgesic that is similar to morphine – but is 50 to 100 times more potent. It is a schedule II prescription drug, and it is typically used to treat patients with severe pain or to manage pain after surgery. It is also sometimes used to treat patients with chronic pain who are physically tolerant to other opioids. In its prescription form, fentanyl is known by such names as Actiq®, Duragesic® and Sublimaze®. Like heroin, morphine and other opioid drugs, fentanyl works by binding to the body’s opioid receptors, which are found in areas of the brain that control pain and emotions.

When opioid drugs bind to these receptors, they can drive up dopamine levels in the brain’s reward areas, producing a state of euphoria and relaxation. But fentanyl’s effects resemble those of heroin and include drowsiness, nausea, confusion, constipation, sedation, tolerance, addiction, respiratory depression and arrest, unconsciousness, coma and death.

So why is abuse and misuse of fentanyl so dangerous?

When prescribed by a physician, fentanyl is often administered via injection, transdermal patch or in lozenges. However, the fentanyl and fentanyl analogs associated with recent overdoses are produced in clandestine laboratories.

This non-pharmaceutical fentanyl is sold in the following forms: as a powder; spiked on blotter paper; mixed with or substituted for heroin; or as tablets that mimic other, less potent opioids. Fentanyl sold on the street can be mixed with heroin or cocaine, which markedly amplifies its potency and potential dangers.

Users of this form of fentanyl can swallow, snort or inject it, or they can put blotter paper in their mouths so that the synthetic opioid is absorbed through the mucous membrane. Street names for fentanyl or for fentanyl-laced heroin include Apache, China Girl, China White, Dance Fever, Friend, Goodfella, Jackpot, Murder 8, TNT, and Tango and Cash.

Can misuse of fentanyl lead to death?

Opioid receptors are also found in the areas of the brain that control breathing rate. High doses of opioids, especially potent opioids such as fentanyl, can cause breathing to stop completely, which can lead to death. The high potency of fentanyl greatly increases risk of overdose, especially if a person who uses drugs is unaware that a powder or pill contains fentanyl.

The United States Drug Enforcement Administration issued a nationwide alert in 2015 about the dangers of fentanyl and fentanyl analogues/compounds. Fentanyl-laced heroin is causing significant problems across the country, particularly as heroin use has increased in recent years.

Source: http://drugfree.org/newsroom/news-item/overdose-deaths-fentanyl-rise-know/   Jan 18th 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

Utah, more than other area of the nation, is suffering from a silent epidemic.  From 2000 to 2014, Utah has experienced a nearly 400% increase in deaths from the misuse and abuse of prescription drugs. Each month there are 24 individuals who die from prescription drug overdoses.

What can we do to help alleviate this growing epidemic? Constant education of the public is essential to prevent drug and alcohol abuse. There is great danger in legal prescription medications and illicit drugs.

What is addiction? As defined by the American Society of Addiction Medicine: “Addiction is a biological, psychological, social and spiritual illness.”   We are learning more and more that opioids now kill more young adults than alcohol. Yet, these deaths are preventable.

Addictionologist, Dr. Sean A. Ponce, M.D., at Salt Lake Behavioral Health Hospital is an advocate of prevention and clinical expert in the treatment of addiction.    Dr. Ponce relates having cancer to that of drug or alcohol addiction. “For cancer, we want to know the prognosis, how far it’s spread… we want to hear the word remission.  Do we talk about that with addiction?”

He goes onto say, “Addiction is a disease that can also spread.  It is a disease that can be mild, moderate or severe.  We want to put it into remission. When cancer reoccurs everyone rallies around that patient to help. When addiction reoccurs what happens?  We send a mixed message.  It is also a disease and we need to be able to help.”

Dr. Ponce also tells us that, “Surviving isn’t really a way to live.  Thriving is.”

Intermountain Health Care recently kicked off a prescription opioid misuse awareness campaign with new artwork in the main lobby of McKay-Dee Hospital including a chandelier built entirely of pill bottles.

This artwork highlights the hospital’s efforts to raise awareness about prescription opioid misuse and represents the 7,000 opioid prescriptions filled each day in Utah. It’s aim: to inform visitors that the risk of opioid addiction “hangs over everyone.”

The campaign’s partners include: Bonneville Communities That Care, Weber Human Services, Use Only as Directed, and Intermountain’s Community Benefit team.

There are also several elevator doors, in McKay Dee Hospital, covered with warnings against opioid use. It definitely sends a strong message to stop and think about the dangers involved.

As previously mentioned, Salt Lake Behavioral Health is a private, freestanding psychiatric hospital specializing in mental health and substance abuse treatment.

You may use this link to learn more about how to help prevent the spread of this deadly epidemic.   www.saltlakebehavioralhealth.com

Source:  http://www.sentinelnews.net/article/3-3-2017/education-key-prevention-alcohol-and-drug-abuse

(Comment by NDPA:  Some shocking figures from the USA in this article)

In 1964 the Surgeon General’s report on smoking and health began a movement to shine the bright light on cigarette smoking and dramatically change individual and societal views. Today, most states ban smoking in public spaces.

Most of us avoid private smoky places and sadly watch as the die-hard huddle 15 feet from the entrance on rainy, snowy or frigid coffee breaks. Employers often charge higher health insurance premiums to employees who smoke, and taxes on cigarettes are nearly triple a gallon of gas. Yet, some heralded progressive states have passed referendums to legalize the recreational use of a different smoked drug.

Now, more than 50 years later, another very profound statement has been made in the introduction to the recent report, “Substance misuse is one of the critical public health problems of our time.”

“Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health,” was released in November 2016 and is considered to hold the same landmark status as that report from 1964. And maybe, just maybe, it will have the same impact.

Many key findings are included that are critical to garnering support in the health care and substance abuse treatment fields. But the facts are just as important for the general public to know:

— In 2015, substance use disorders affected 20.8 million Americans — almost 8 percent of the adolescent and adult population. That number is similar to the number of people who suffer from diabetes, and more than 1.5 times the annual prevalence of all cancers combined (14 million).

— 12.5 million Americans reported misusing prescription pain relievers in the past year.

— 78 people die every day in the United States from an opioid overdose, nearly quadruple the number in 1999.

— We have treatments we know are effective, yet only 1 in 5 people who currently need treatment for opioid use disorders is actually receiving it.

— It is estimated that the yearly economic impact of misuse and substance use disorders is $249 billion for alcohol misuse and alcohol use disorders and $193 billion for illicit drug use and drug use disorders ($442 billion total).

— Many more people now die from alcohol and drug overdoses each year than are killed in automobile accidents.

— The opioid crisis is fuelling this trend with nearly 30,000 people dying due to an overdose on heroin or prescription opioids in 2014. An additional roughly 20,000 people died as a result of an unintentional overdose of alcohol, cocaine or non-opioid prescription drugs.

Our community has witnessed many of these issues first hand, specifically the impact of the heroin epidemic. The recent Winnebago County Coroner’s report indicated that of 96

overdose deaths in 2016, 42 were a result of heroin, and 23 from a combination of heroin and cocaine.

We know that addiction is a complex brain disease, and that treatment is effective. It can manage symptoms of substance use disorders and prevent relapse. More than 25 million individuals are in recovery and living healthy, productive lives. I, myself, know many. Most of us do.

Locally, the disease of addiction hits very close to many of us. I’ve had the privilege of being part of Rosecrance for over four decades, and I have seen the struggle for individuals and families — the triumphs and the tragedies. Seldom does a client come to us voluntarily and without others who are suffering with them. Through research and evidence-based practices at Rosecrance, I have witnessed the miracle of recovery on a daily basis. Treatment works!

If you believe you need help, or know someone who does, seek help.  Now. Source: http://www.rrstar.com/opinion/20170304/my-view-addiction-is-public-health-issue-treatment-works.  4th March 2017

(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

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

Once again, the echo chamber nature of press releases serves to promote misleading science and health clickbait.  This time it is with headlines like “Tobacco, but not pot, boosts early stroke risk.”

First, it is an imprecise conclusion based on the newly published study.  Second, the research it refers to downplays the significant flaws and limitations of its own work.

Let’s break down the findings for you to draw accurate (and your own) conclusions.  The goal of the work was to determine whether there is an “association between cannabis use and early-onset stroke, when accounting for the use of tobacco and alcohol.”

Who was studied and how was the data acquired? (1)

* Population-based cohort study comprised of 49,321 Swedish men (born between 1949 and 1951) aged 18-20 years old during 1969/70 when conscripted into military service

* All men— at time of conscription— underwent 2-day screening procedure inclusive of a health examination and completion of 2 questionnaires: 1) substance use, 2) social and behavioral factors

* In 1969/70, the conscripts were asked about cannabis, alcohol and tobacco smoking habits.  Vital signs and a physician assessment were performed then and those with Diabetes Mellitus and Migraines were documented.  The researchers linked their data with parental records to assess parental history of death by cardiovascular disease (CVD) and socioeconomic status in childhood based on the father’s occupation.

* Information on stroke events up to around 60 years of age was obtained from national databases; this includes strokes experienced before 45 years of age

* Participants were followed to assess the initial occurrence of strokes (fatal or nonfatal) from 1971-2009 (between roughly ages 20-59) by collecting information through national public hospital and death record databases.

How was the data analyzed?

* After computation of crude models, the authors estimated a model adjusting for body mass index, systolic and diastolic blood pressure along with the other original (from 1969/70) parameters, additionally adjusting for indicators of socioeconomic status until young adulthood, and additionally adjusting for tobacco smoking and alcohol consumption What does Cannabis, Tobacco, Alcohol Use, and the Risk of Early Stroke:  A Population-Based Cohort Study of 45,000 Swedish Men in the journal STROKE claim?

* We found no evident association between cannabis use in young adulthood and stroke, including strokes before 45 years of age.  Tobacco smoking, however, showed a clear, dose-response shaped association with stroke.  In multivariate-adjusted models, the elevated hazards were attenuated both in relation to heavy cannabis use and high alcohol consumption

CONTRADICTION:  “Cannabis use showed no association with stroke before 45 years of age” “Crude models demonstrated that the hazard of ischemic stroke until 59 years of age was almost 2 times higher among men who were heavy cannabis users in young adulthood than among nonusers.”

* Although an almost doubled risk of ischemic stroke (2) was observed in those with cannabis use >50 times, this risk was attenuated when adjusted for tobacco usage.

*

* Smoking more than or equal to 20 cigarettes per day was clearly associated both with strokes before 45 years of age (more than 6 times higher than nonsmokers) and with strokes throughout the follow-up.

*

* 1037 first-time strokes occurred during the follow-up period until 59 years of age, before age 45 specifically there were 192.  Ischemic strokes were significantly more common than hemorrhagic in all categories.

*

* Most common factors of men with stroke before age 60:  parental history of CVD, overweight, poor cardiorespiratory fitness, low socioeconomic position in childhood, short schooling, heavy smoking, high alcohol consumption (in those before 45 risk 4 times higher than nondrinkers).

*

* High blood pressure and heavy cannabis use seemed to be more prevalent among men having a stroke before 45 years of age but did not differ to the same extent between men with and without stroke when followed until age 60

The many FLAWS in this study…

* The researchers lacked the knowledge of adulthood levels of abuse or use of cannabis, tobacco and alcohol (or other drugs) along with environmental exposures during the military service and after in their respective occupations and lifestyles.

*

* No life long or adult disease diagnoses or medication use were included or known (migraine and diabetes were “estimated”

* )

* Basically, there was no follow-up data to the baseline 1969/70 figures.

*

* Such statistics are vital to understanding contributions to strokes in later life outside of adolescence.

*

* Their early data required substance abuse self-reporting which is traditionally under-reported and demonstrated lower norms than the previous and subsequent year anonymous data they had from other conscript surveys.

*

* This report makes no reference to the varying ingredients and changes in modern day cannabis or tobacco and so on to those of that era or the intervening time period

* Only military young men were studied.  The data may not be able to be generalized to other populations.

*

* MAIN PROBLEM:  The cannabis users were routinely tobacco and alcohol users as well— sometimes tobacco is added to cannabis cigarettes (aka joints).  The authors used “crude modeling” to eliminate those confounding factors which reflects math magic more than actual reality.  Multi-drug use is a challenge to the attainment of sufficient data to interpret.  The ideal study would compare full-on abstainers as a control group to only cannabis users to only tobacco users to only alcohol abusers by quantifying their varying degrees of use.

Take Home Messages…

Epidemiological studies are routinely flawed as associations can be mathematically fit into the desired framework.  Otherwise stated, when we look for something we tend to find it.  The notion that the method used to eliminate for tobacco or alcohol use, for example, in assessing the cannabis issue as an effective strategy is not one to which I subscribe. Even an author of the study, Dr. Anna-Karin Danielsson of Karolinska Institute in Stockholm, revealed to Reuter’s Health:

“The almost doubled risk of ischemic stroke following heavy cannabis use that was observed in our study disappeared when we controlled for tobacco smoking.”  But, she added, the fact that almost all the pot smokers were also tobacco smokers makes it hard “to rule out possible associations between cannabis and stroke.”

There is no doubt —which the authors of this study appreciate— that more research needs to be done on the health effects of cannabis.  There is a growing existing body of literature linking cannabis use to stroke especially in young adults. (3)  Typically, these are in current or heavy users who also are tobacco smokers.  A United States study deemed “cannabis use was associated with a 17% increase in the risk of hospitalization because of acute ischemic stroke, even if both tobacco and amphetamine use constituted bigger risks” while another found its abuse or dependence was linked to ischemic, not hemorrhagic stroke.  (4)  The National Institute on Drug Abuse is a valuable resource, click here.

Once again, exercising, eating and sleeping well, maintaining an optimal weight, pursuing education, and avoiding such substances as marijuana, tobacco smoking along with heavy and binge alcohol consumption will likely best serve all of us and our well-being.  As the laws begin changing with respect to marijuana legality and accessibility, the necessary work needs to be done to determine the genuine risks of its use and abuse so as to most aptly inform the public.

NOTES: (1)  The bullet point answers are direct or paraphrased quotes from the study itself.

(2)  This paper explored ischemic and hemorrhagic strokes, more so the former.  Ischemic ones occur when something blocks the flow of blood to the brain like a clot, for example, so that that region of the brain gets deprived of proper nourishment

and oxygen and is injured as a result.  Hemorrhagic is when too much blood or a massive bleed injures the brain tissue.

Source:  National Families in Action’s The Marijuana Report <srusche=nationalfamilies.org@mail116.atl11.rsgsv.net>; 11th January 2017

Researchers who tested marijuana sold in Northern California found multiple bacterial and fungal pathogens that can cause serious infections. The study was published this month in the journal Clinical Microbiology and Infection.

The mould and bacteria was so widespread and potentially dangerous that the UC Davis academics concluded that they cannot recommend smoking raw or dried weed. “We cannot recommend inhaling it,” says George Thompson III, an associate professor of clinical medicine at the university who helped conduct the cannabis research.

The findings might also apply to indoor, hydroponic marijuana popular at Southern California collectives, according to Thompson. Using pot in baked goods such as brownies might be “theoretically” safer because the products could be heated enough to kill bacteria and fungus, he says.

Asked if concentrates such as wax, honey oil, dabs and shatter would be safe because heat is involved in the production process of “butane extraction,” Thompson says he isn’t sure.

The key finding of the research  is that patients with weak immune systems, such as those with HIV or cancer, should avoid smoking raw and dried pot. Though Thompson told the Sacramento Bee that “for the vast majority of cannabis users, this is not of great concern,” he stresses that there really isn’t a safe way to smoke marijuana buds, even for those who are healthy.

He says it’s possible that filters used with tobacco cigarettes could help with marijuana: Tobacco and all natural plant products have these kinds of bacterial and fungal issues. Irradiated marijuana, though unappealing, also could be an answer, he adds.

Researchers sampled weed samples from Northern California dispensaries and found they tested positive for the fungi Cryptococcus, Mucor and Aspergillus, and for the bacteria E. coli, Klebsiella pneumoniae and Acinetobacter baumannii. The academics said these can lead to serious and lethal illness, noting that smoking the mould and bacteria can embed them directly where they can do the most damage — the lungs.

“Infection with the pathogens we found in medical marijuana could lead to serious illness and even death,” Joseph Tuscano, a professor of internal medicine at UC Davis, said in a statement. “Inhaling marijuana in any form provides a direct portal of entry deep into the lungs, where infection can easily take hold.” The state Department of Public Health is working on guidelines for marijuana testing with the goal that both medical and recreational pot sold next year at permitted dispensaries would be labelled as safe. It’s not clear how this research will affect those guidelines. Thompson says he has reached out to state officials to share his findings.

“We are aware of the study, and while it’s certainly concerning, this is exactly why we need regulation,” Alex Traverso, spokesman for the state Bureau of Medical Cannabis Regulation, said via email. “The Bureau is working with the Department of Public Health to develop strong standards for testing because patient safety is extremely important to us all.”

Source: http://www.laweekly.com/news/marijuana-is-not-safe-to-smoke-researchers-say-7927826 Wednesday, Feb. 14, 2017

Abstract

Background Amphetamine abuse is becoming more widespread internationally. The possibility that its many cardiovascular complications are associated with a prematurely aged cardiovascular system, and indeed biological organism systemically, has not been addressed.

Methods

Radial arterial pulse tonometry was performed using the SphygmoCor system (Sydney). 55 amphetamine exposed patients were compared with 107 tobacco smokers, 483 non-smokers and 68 methadone patients (total=713 patients) from 2006 to 2011. A cardiovascular-biological age (VA) was determined.

Results

The age of the patient groups was 30.03±0.51–40.45±1.15 years. This was controlled for with linear regression. The sex ratio was the same in all groups. 94% of amphetamine exposed patients had used amphetamine in the previous week. When the (log) VA was regressed against the chronological age (CA) and a substance-type group in both cross-sectional and longitudinal models, models quadratic in CA were superior to linear models (both p<0.02). When log VA/CA was regressed in a mixed effects model against time, body mass index, CA and drug type, the cubic model was superior to the linear model (p=0.001). Interactions between CA, (CA)2 and (CA)3 on the one hand and exposure type were significant from p=0.0120. The effects of amphetamine exposure persisted after adjustment for all known cardiovascular risk factors (p<0.0001).

Conclusions

These results show that subacute exposure to amphetamines is associated with an advancement of cardiovascular-organismal age both over age and over time, and is robust to adjustment. That this is associated with power functions of age implies a feed-forward positively reinforcing exacerbation of the underlying ageing process.

To read the whole research study log on to:

Source:    http://dx.doi.org/10.1136/heartasia-2016-010832

SACRAMENTO (KPIX 5) – Did the medicine contribute to the patient’s death? That was the question facing doctors when a California man died from a relatively rare fungal infection.

“It started with a couple patients that were undergoing very intensive chemotherapy and a stem cell therapy, and those patients were very immune compromised,” explained Dr. Joseph Tuscano of the University of California, Davis Cancer Center.  Those patients were already in a very serious cancer fight when that fight suddenly became much more complicated with a relatively rare but particularly lethal fungal infection.

“We thought it was strange to have cases of such a bad fungal disease in such a short amount of time,” said Dr. George Thompson, a fungal infection expert with UC Davis Medical Center.

The patients were relatively young, in winnable cancer battles. For one of them, it was the fungal infection that proved deadly. So the doctors set out to find that killer, and right away, they had a suspect.

“What struck me is both of these gentlemen were at least medicinal marijuana users, that helped them with nausea and appetite issues that come with the treatment,” said Tuscano, who joined with Thompson to investigate further.  Only problem, federal law prohibited them from doing that research at UC Davis, so they joined forces with Steep Hill Laboratories in Berkeley.

“We kind of go on the credo of  ‘do no harm,’” said Dr. Donald Land, who has been analyzing contaminated marijuana for over a decade.

“We sometimes see 20 or 30 percent of our samples coming through the lab significantly contaminated with molds,” said Land, who had plenty of experience finding mold and fungus strains, but this time, he and his team went deeper.

They gathered 20 samples of medical marijuana from across California and took them apart, pulling out a range of dangerous bacteria and fungi which they analyzed right down to their DNA.  Even Land was surprised by the results. “We were a little bit startled that ninety percent of those samples had something on them. Some DNA of some pathogen,” he told KPIX 5.

These weren’t just any pathogens, they were looking at the very fingerprints of a killer. “The cannabis was contaminated with many bacteria and fungi, some of which was compatible with the infections that I saw in my patients,” Tuscano said.

“Klebsiella, E.coli, Pseudomonas, Acinetobacter, these are all very serious infections for anybody in the hospital. But particularly in that population, the cancer population,” Thompson.

One of questions this raises is whether the risk is made worse by smoking, which could send pathogens directly into the lungs, which are particularly vulnerable.  Truth is, there’s really isn’t much research on any of this.  “But we think now,” Thompson says, “with some of these patients, it’s really unknowingly self-inflicted form cannabis use.”

Cannabis, labelled medicinal, that could pose a lethal threat to already vulnerable patients.

When this research is published it will suggest more warnings for patients with weakened immune systems, because, as Dr. Tuscano explains, “the problem in my opinion is that there’s this misconception that these dispensaries produce products that have been tested to be safe for patients, and that’s not necessarily the case.”

Source: sanfrancisco.cbslocal.com/2017/02/06/medical-marijuana-fungus-death-uc-davis-medical-center/  6th Feb. 2017

UC Davis researcher Dr. George Thompson advises cancer patients and others with weakened immune systems to avoid vaping or smoking marijuana.

In uneasy news for medical marijuana users, UC Davis researchers have identified potentially lethal bacteria and mold on samples from 20 Northern California pot growers and dispensaries, leading the doctors to warn patients with weakened immune systems to avoid smoking, vaping or inhaling aerosolized cannabis.

“For the vast majority of cannabis users, this is not of great concern,” said Dr. George Thompson, professor in the UC Davis Department of Medical Microbiology and Immunology. But those with weakened immune systems – such as from leukemia, lymphoma, AIDS or cancer treatments – could unwittingly be exposing themselves to serious lung infections when they smoke or vape medical marijuana.

“We strongly advise them to avoid it,” Thompson said.

The study’s findings were published online in a research letter in the journal Clinical Microbiology and Infection.  It comes as California and a majority of states have eased laws on medical and recreational marijuana use, and a majority of U.S. doctors support the use of medical marijuana to relieve patients’ symptoms, such as pain, nausea and loss of appetite during chemotherapy and other treatments.

Typically, patients with lower-functioning immune systems are advised to avoid unwashed fruits or vegetables and cut flowers because they may harbor potentially harmful bacteria and mold, or fungi. Marijuana belongs in that same risk category, according to Thompson.

“Cannabis is not on that list and it’s a big oversight, in our opinion,” Thompson said. “It’s basically dead vegetative material and always covered in fungi.”

The study began several years ago after Dr. Joseph Tuscano, a UC Davis blood cancer specialist, began seeing leukemia patients who were developing rare, very severe lung infections. One patient died.

Suspecting there might be a link between the infections and his patients’ use of medical marijuana, Tuscano teamed with Thompson to study whether soil-borne pathogens might be hiding in medical marijuana samples.

The marijuana was gathered from 20 Northern California growers and dispensaries by Steep Hill Labs, a cannabis testing company in Berkeley. It was distilled into DNA samples and sent to UC Davis for analysis, which found multiple kinds of bacteria and fungi, some of which are linked to serious lung infections.

There was a “surprisingly” large number of bacteria and mold, said Donald Land, a UC Davis chemistry professor who is chief scientific consultant for Steep Hill Labs. The analysis found numerous types of bacteria and fungi, including organic pathogens that can lead to a particularly deadly infection known as Mucor.

“There’s a misconception by people who think that because it’s from a dispensary, then it must be safe. That’s not the case,” said UC Davis’ Tuscano. “This is potentially a direct

inoculation into the lungs of these contaminated organisms, especially if you use a bong or vaporization technique.”

Patients with compromised immune systems are especially susceptible to infections, usually acquired in their environment or in the hospital. But given the testing results, Tuscano said, it’s possible that even some of the more common infections, such as aspergillus, could also be attributed to contaminated medical marijuana.   Tuscano emphasized that until more research is done, he can’t be 100 percent assured that contaminated cannabis caused the infections, but “it’s highly suspicious.” Under California’s Proposition 64, the voter-approved initiative that eased restrictions on personal marijuana use, the state is expected to have cannabis testing regulations in place for medical marijuana by Jan. 1.

“Patient safety is one of our chief concerns in this process,” said Alex Traverso, spokesman for the state Bureau of Medical Cannabis Regulation, in an email. He said the state’s new medical-marijuana testing standards will soon be available for public review. “We welcome everyone’s input to ensure that testing standards are as strong as we need them to be.”

Until then, consumers are largely on their own.  The vast majority of cannabis sold in California is not tested, according to Land.

“You can’t tell what’s in (a marijuana product) by looking at it, smelling it, feeling it, or a person in a dispensary telling you it’s safe or clean,” he said. “The only way to ensure you have a safe, clean product is to test it and be sure it’s handled according to good manufacturing practices.”

Some medical marijuana clinics already do voluntary testing of their products. Kimberly Cargile, director of A Therapeutic Alternative, a medical marijuana clinic in Sacramento, said a sample from every incoming pound of pot is sent to a local, independent testing lab.

“It’s for consumer protection. It’s a healthy first step,” Cargile said.

To avoid the risk of exposure to severe lung infections, Thompson and Tuscano advise cancer patients and others with hampered immune systems to avoid smoking, vaping or inhaling aerosolized cannabis altogether. Cannabis edibles, such as baked cookies or brownies, could be a safer alternative.  Theoretically, Thompson said, the consumption of cooked edibles seems safer than smoking or vaping, but it’s not scientifically proven.

“I give that advice with a caveat: We don’t know it’s safer; we think it probably is,” he said.

For patients heeding the UC Davis advice to avoid smoking or vaping medical marijuana, “it’s always better to err on the side of caution,” said medical marijuana advocate Cargile. There are plenty of alternatives, she noted, including cannabis salves, lotions, sprays, tinctures and suppositories.

Source:  http://www.sacbee.com/news/local/health-and-medicine/article131391629.html Feb.2017

Since the state legalized marijuana for recreational use, the Colorado Department of Public Health and Environment has issued a report on marijuana and health every two years. Colorado legalized recreational pot in 2012 to go into effect in 2014. This is the second health report. The report contains a huge amount of data. An executive summary appears on pages 1-6. The most startling data about the consequences of legalization are the number of marijuana-related hospitalizations that have occurred from 2000, the year Colorado legalized marijuana for medical use to September 2015, 21 months after recreational legalization began. A graph showing rates of these hospitalizations by age is pictured below. They are rates per 100,000 and have nearly doubled among adolescents and quintupled among young adults. A graph of the data broken down by race on page 291 of the report are equally stunning. Read report here.

Source:  http://themarijuanareport.org/  Feb.2017

More than 900 people died in British Columbia last year from illicit drug overdoses, but the provincial health minister says the toll could have been far higher and he warned the federal government Wednesday the epidemic is spreading across Canada.

The arrival of the powerful opioid fentanyl pushed the provincial death toll to a new peak of 914 overdose deaths in 2016. The BC Coroners Service reported the figure is almost 80 per cent higher than the 510 deaths due to illicit drugs in 2015.

Chief coroner Lisa Lapointe said December was the worst month at 142 deaths, the highest monthly death total ever.

“The introduction of fentanyl to our province is a game-changer,” Lapointe told a news conference. “We’ve now got this contaminant in the illicit drug system that is not manageable.”

Health Minister Terry Lake said B.C.’s death toll would have been much higher if it had not been for overdose prevention measures undertaken by the province and the often heroic efforts by first-responders and others who rushed to provide aid to victims.

“The evidence suggests many, many more lives would have been lost had we not done what we have done,” he said.

Lake said he has records of 96 overdose reversals at community overdose prevention sites where addicts can use drugs under supervision of health officials. There were no overdose deaths at the Insite safe-injection site in Vancouver’s Downtown Eastside, he said.   “We’ve seen the mobile medical unit, over 600 overdoses treated,” he said.

The B.C. government declared a public health emergency last spring in an attempt to reduce the rising numbers of drug overdose deaths.  The B.C. Centre For Disease Control also launched a take-home naloxone program for residents to reverse the effects of opioids.

The government also announced late last year that overdose prevention sites would be established in communities across the province where people could take illicit drugs while being monitored by trained professionals equipped with naloxone.

Lake said the federal government should declare a nationwide public health emergency, saying the problem is spreading across the country.

“It would focus, from a national perspective, action on this epidemic,” he said. “We haven’t had any additional funding from Ottawa to help us with this. Declaring a national public health emergency would focus all Canadians on an issue that is wracking B.C. at the moment.”

Lapointe couldn’t forecast an end, saying it will require long-term vigilance and programs on the part of governments, health providers, first-responders, families and drug users themselves.

She said she recognizes that those who are dependent on illicit drugs aren’t going to be able to abstain, but she urged them to take the drugs in front of someone who has medical expertise or at least with a sober friend.

An average of nine people died every two days from overdoses last month, she said.

“We know that this represents suffering and devastation in communities across our province.”

The coroner’s service said fatalities aren’t just happening among those who use opioid drugs, such as heroin.

“Cocaine and methamphetamines are also being found in a higher percentages of fentanyl-detected deaths in 2016,” Lapointe said.

People aged 30 to 49 accounted for the largest percentage of overdose deaths last year, and males accounted for more than 80 per cent of the overall toll.  Dr. Perry Kendall, the province’s chief medical health officer, said the number of deaths is difficult to confront.

“This was unexpected and disheartening,” he said. “We still have not as yet been able to reverse the trend. This is frankly a North America-wide problem.”

He said he will review European drug treatment programs that prescribe heroin-like medicines to addicts.

Source:  THE CANADIAN PRESS Published on: January 18, 2017 |

A medical marijuana patient in Lower Sackville, N.S., said he’s worried after the marijuana he consumed for nearly a year was recalled by Health Canada because it was grown with two pesticides that, if heated, can emit hydrogen cyanide.

John Percy, 67, smokes, vapes and bakes his cannabis to control pain in his hip caused by osteoarthritis. The former Green Party leader had been ordering his medical marijuana from OrganiGram in Moncton, N.B., the only licensed producer in Atlantic Canada.

He said his pain was an “eight out of 10.”

“I was shocked,” said Percy, when he first learned of the voluntary recall in late December. The letter said the marijuana he consumed “tested positive for bifenazate and/or myclobutanil, both unapproved pesticides and not registered for use on marijuana.”

“I assumed like most patients that the product would be organic,” he said.

According to Health Canada hydrogen cyanide interferes with how oxygen is used in the body and may cause headaches, dizziness, nausea, and vomiting. Larger concentrations may cause gasping, irregular heartbeats, seizures, fainting, and even death.

‘I got angry’

He said he was willing to take a wait-and-see approach. But less than two weeks later, there was another, higher-level recall notice from OrganiGram saying all products manufactured since February had been recalled.

“That’s when I got angry and I started to consider what the effects on me have been,” said Percy, who also sits on the board of Maritimers Unite for Medical Marijuana.

He said he plans to talk to his doctor about whether the recalled medical marijuana he’d been consuming, about three grams a day, has adversely affected his health.

‘Patient safety at risk’

Percy said he’s upset that Health Canada did not issue a mandatory recall. Health Canada said no cases of adverse reactions have been reported.

“Putting patient safety at risk is unacceptable, and for a government department that is supposed to take care of people’s safety, I think they’ve fallen down on the job,” said Percy.

He said he’s written to the health minister and to members of Parliament. He believes Health Canada should test marijuana for more than 13 compounds to ensure it’s safe for consumption.

Percy said he and other licensed medical marijuana patients have discussed starting a class-action lawsuit.

Without a licensed producer, he’s going to an illegal dispensary — and paying 30 per cent more for his medication. There’s no compassionate pricing at the illegal spot, so his monthly marijuana budget has shot up to about $850 from $600. “It hurts, it hurts,” he said.

He said getting a prescription filled for another one of the 30-plus licensed producers in Canada would take months, but didn’t want to wait in pain.

Source:  https://ca.news.yahoo.com/medical-marijuana-user-shocked-recall-120500202.html

Abstract

The objective of the present research was to examine the association between lifetime cannabis use disorder (CUD), current suicidal ideation, and lifetime history of suicide attempts in a large and diverse sample of Iraq/Afghanistan-era veterans (N = 3233) using a battery of well-validated instruments.

As expected, CUD was associated with both current suicidal ideation (OR = 1.683, p = 0.008) and lifetime suicide attempts (OR = 2.306, p < 0.0001), even after accounting for the effects of sex, posttraumatic stress disorder, depression, alcohol use disorder, non-cannabis drug use disorder, history of childhood sexual abuse, and combat exposure.

Thus, the findings from the present study suggest that CUD may be a unique predictor of suicide attempts among Iraq/Afghanistan-era veterans; however, a significant limitation of the present study was its cross-sectional design. Prospective research aimed at understanding the complex relationship between CUD, mental health problems, and suicidal behavior among veterans is clearly needed at the present time.

Source:  https://www.ncbi.nlm.nih.gov/pubmed/28129565 J Psychiatr Res. 2017 Jan 5;89:1-5. doi: 10.1016/j.jpsychires.2017.01.002. [Epub ahead of print]

Abstract

Cannabis use is observationally associated with an increased risk of schizophrenia, but whether the relationship is causal is not known.

Using a genetic approach, we took 10 independent genetic variants previously identified to associate with cannabis use in 32,330 individuals to determine the nature of the association between cannabis use and risk of schizophrenia. Genetic variants were employed as instruments to recapitulate a randomized controlled trial involving two groups (cannabis users vs nonusers) to estimate the causal effect of cannabis use on risk of schizophrenia in 34 241 cases and 45 604 controls from predominantly European descent.

Genetically-derived estimates were compared with a meta-analysis of observational studies reporting ever use of cannabis and risk of schizophrenia or related disorders. Based on the genetic approach, use of cannabis was associated with increased risk of schizophrenia (odds ratio (OR) of schizophrenia for users vs nonusers of cannabis: 1.37; 95% confidence interval (CI), 1.09-1.67; P-value=0.007). The corresponding estimate from observational analysis was 1.43 (95% CI, 1.19-1.67; P-value for heterogeneity =0.76).

The genetic markers did not show evidence of pleiotropic effects and accounting for tobacco exposure did not alter the association (OR of schizophrenia for users vs nonusers of cannabis, adjusted for ever vs never smoker: 1.41; 95% CI, 1.09-1.83). This adds to the substantial evidence base that has previously identified cannabis use to associate with increased risk of schizophrenia, by suggesting that the relationship is causal. Such robust evidence may inform public health messages about cannabis use, especially regarding its potential mental health consequences.

Source:Molecular Psychiatry advance online publication, 24 January 2017; doi:10.1038/mp.2016.252.

The letter below speaks of the heroin epidemic in the USA.  The figure of heroin and opioid addiction that has destroyed countless families and killed more than 50,000 Americans in 2015 alone is salutary.

A chronicle of President Barack Obama’s tenure must include the heroin epidemic that he leaves us with. Our nation is plagued with a systemic heroin and opioid addiction that has destroyed countless families and killed more than 50,000 Americans in 2015 alone. This one-year death toll is greater than the total number of Americans killed in action during the Vietnam War.

The opioid casualty count only tells part of the story. More than half a million Americans admit to being addicted to heroin, and each of them has a very difficult, if not impossible, road to recovery. Yet, heroin flows into our nation every day and is readily available for $5 a bag 24/7 on street corners throughout the cities and suburbs of America.

How was this level of accessibility not reason enough for President Obama to make slowing our porous borders a priority?  Obama, in his final days as president is now becoming more vocal about the epidemic he leaves behind. However, this is too little, too late in the extreme. His record-setting pardoning and lessening of drug dealer sentences, which have included heroin dealers, further erodes his record on the heroin epidemic. Classifying a heroin dealer as a nonviolent criminal in the face of the American opioid death toll is nonsense.

Perhaps Obama was one of the lucky ones that didn’t have a close friend or relative addicted or taken by heroin and he just didn’t notice the plague that took root under his watch.

Robert Cochran Stafford

Source:  http://www.app.com/story/opinion/readers/2017/01/14/letter-obama-legacy-includes-drug-addiction-epidemic/96557686/

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

Regularly smoking cannabis may damage users’ eyesight by triggering an abnormality in the retina, a new study has found.   Researchers in France tested 28 cannabis smokers and 24 people who did not use the drug to see how well their retinal cells responded to electrical signals.

A small but significant delay was found in the time taken for the signals to be processed by the retina of the marijuana users by comparison with the control group.  “This finding provides evidence for a delay of approximately 10 milliseconds in the transmission of action potentials evoked by the retinal ganglion cells,” the researchers wrote in the JAMA Ophthalmology.

“As this signal is transmitted along the visual pathway … to the visual cortex, this anomaly might account for altered vision in regular cannabis users. Our findings may be important from a public health perspective since they could highlight the neurotoxic effects of cannabis use on the central nervous system as a result of how it affects retinal processing.”

A statement issued by the Journal of the American Medical Association described the study as “small” and “preliminary”.  But the researchers, led by Dr Vincent Laprevote, of the Pole Hospitalo-Universitaire de Psychiatrie du Grand Nancy, added: “Independent of debates about its legalisation, it is necessary to gain more knowledge about the different effects of cannabis so that the public can be informed.   “Future studies may shed light on the potential consequences of these retinal dysfunctions for visual cortical processing and whether these dysfunctions are permanent or disappear after cannabis withdrawal.”

In a related article commenting on the research, Dr Christopher Lyons, of the University of British Columbia in Vancouver, and Dr Anthony Robson, of Moorfields Eye Hospital, London, wrote that it dealt with “an important and neglected issue, namely the possible toxic effects of cannabis, with all its implications for the many users of this ubiquitous drug”.

“Addressing this issue through the visual system, as the authors have done, is an elegant concept. Any deleterious effect on the visual system would also have implications for driving, work and other activities and thus warrants further study,” they added.

“Electrophysiology can provide reliable and reproducible measurements of retinal and visual pathway function and is useful in the investigation and localisation of dysfunction, including that caused by toxicity.

“However, the conclusion that cannabis causes retinal ganglion cell dysfunction cannot be made with any degree of certainty based on the evidence provided in the current study.

Source:  http://www.independent.co.uk/news/science/cannabis-eyesight-vision-damage-toxic-effects-study-a7463331.html

THE level of people being hospitalised after taking cannabis and related ‘legal highs’ has reached a 10-year peak, according to official figures from the Scottish Government.  More than 900 acute stays in general hospitals – as opposed to psychiatric admissions – involved the drug last year.

The Scottish Tories said the data showed cannabis was not the benign drug some claimed.

The latest figures show that in 2015-16 there were 7537 hospital stays in Scotland with a diagnosis of drug misuse, involving 5922 people, some admitted more than once.

Of these stays, 913 or 12 per cent, involved “cannabinoids”, which include synthetic highs such as Spice as well as the plant form of cannabis.   This was the highest percentage involving cannabinoids since 13 per cent in 2005-06.

Cannabinoids were the most common cause of drug stays among children – accounting for 45 per cent of cases involving under-15s.

The health boards with the most stays were NHS Greater Glasgow and Clyde (306), NHS Lothian (165) and NHS Lanarkshire (106).  Although still sometimes called a legal high, synthetic cannabis was criminalised last May, with its production and sale made punishable by up to seven years in prison.

Hospital admissions associated with cannabis were almost double those linked to cocaine.

Acute stays involving cocaine were at their highest since 2008-09 last year, but involved 553 admissions, or 7 per cent of all general drug-related cases.

The drugs most associated with hospital admissions were opioids, such as heroin, morphine, oxycodone and fentanyl.

Last year, opioids were behind 4656 stays, or 62 per cent of the drug-related total.  The number and prevalence of opioid admissions has increased hugely in the last 20 years.  In 1996-97, opioids accounted for just 791 stays, then equal to 34 per cent of drug admissions.

Scottish Tory justice spokesman Douglas Ross criticised campaigns to decriminalise cannabis and Police Scotland taking a soft touch approach to its use.  The force said in 2015 it might give people caught with cannabis on-the-spot recorded warnings as an alternative to prosecution.   Mr Ross said: “It’s quite alarming that quite so many people are being hospitalised through using cannabis, a drug many people feel authorities are going soft on.

“Not only is it dangerous in its own right, as these statistics prove, but it’s a gateway drug to even more harmful substances.

“We have a massive fight on our hands in Scotland both with illegal drugs and so-called legal highs.   “Now is not the time to give in and wave the white flag.  “We need to crack down on those circulating drugs of all kinds on our streets, and reinforce the message about just how damaging taking these substances can be.”

Scottish LibDem health spokesman Alex Cole-Hamilton said it was a concern that the figures were rising, but said the Conservatives’ solution was “completely wrong and regressive”.  He said: “If anything these figures show that the LibDems have been right in calling for this dark market to be brought out of the shadows.  “If the Tories had their way then they would drive the market further underground exposing people to more dangerous drugs and endangering more lives leading to more hospitalisations.

“The answer is to educate and regulate not to punish as the Tories want to do.”

Health Secretary Shona Robison said drug use continued to fall in the general population.  She said: “We have greatly reduced drug and alcohol waiting times with 94 per cent of people now being seen within three weeks of being referred.

“We have also invested over £630m to tackle problem alcohol and drug use since 2008 and over £150m over five years to improve mental health services in Scotland.”

Source: http://www.heraldscotland.com/news/15005884.Hospital_stays_linked_to_cannabis_at_10_year_high/   Jan,2017

Since marijuana is currently illegal in all but physician-approved circumstances, there have been no properly constructed clinical trials of smoking this drug in Canada, writes Lawrie McFarlane of the Victoria Times .

The greatest public-health disaster our species ever brought upon itself began in Europe 400 years ago — the introduction and use of tobacco.

In the 20th century alone, 100 million people died from cigarette smoking worldwide. And while the incidence rate has fallen in western countries, it remains high in Third World nations. Six million tobacco users still die each year. The cause of smoking deaths is not, primarily, the active ingredient in tobacco — nicotine. Rather it is the chemicals that comprise tobacco smoke — among them various tars, ammonia, hydrogen cyanide and formaldehyde.  Collectively, these chemicals cause a host of fatal maladies, including cancer, heart disease and emphysema. In short, a perfect horror show.

Now at this point, you’re probably saying: Tell me something I didn’t know. Well, here it is: Many of those same chemicals form marijuana smoke, and we are about to legalize the consumption of this drug. It’s not clear yet which forms of use might be authorized. If smoking is not among them, we might yet avoid another public-health calamity.

True, there are worrisome effects that come with consuming marijuana by other means, among them elevated pulse rates and memory loss. But these are minor matters, by comparison.

However, if smoking marijuana is blessed for general use, we might have an entirely different situation on our hands. For here is what is currently known with medical certainty about the health impacts of lighting up a joint: Nothing.  Since marijuana is currently illegal in all but physician-approved circumstances, there have been no properly constructed clinical trials of smoking this drug.

For the same reason, there have been no robust after-market research projects, in which users are tracked down years later, and their health status compared with that of non-users. Yet this is an essential process in revealing whether drugs that appear safe at first blush turn out to have serious side-effects downstream.  There have been suggestions that marijuana might act as a gateway drug to such potent narcotics as heroin and fentanyl. But whether these are anecdotal or fact-based, no one really knows.

There is also the matter of what is called the dose effect. Cigarettes have a high dose effect, meaning the risk of illness increases exponentially the more you consume. Hence the toxicology maxim: “The dose is the poison.”  So what is the dose effect of smoking marijuana? Again, we simply do not know and this is no small concern.

Generally speaking, it seems fair to assume that making an addictive substance more readily available will increase consumption rates. So what happens if people begin smoking 20 marijuana joints a day?  What happens if manufacturers find ways to strengthen the active ingredient — THC — while making their product less harsh? That’s what cigarette companies did.

In short, we are on the brink of approving a form of drug use, the medical consequences of which remain uncertain, but which might involve inhaling carcinogens. You would think the history of tobacco might have taught us something about fooling with addictive substances before we know the facts. In particular, you might think we would have learned how difficult, if not impossible, it is to close a Pandora’s box like this after it has been opened.

Once a government-sanctioned infrastructure of production, marketing and distribution is erected around marijuana, and millions of additional users are recruited, there will be no going back, regardless of whatever medical verdict is finally rendered. That’s principally why we continue to license tobacco production, despite its many ills.

I recognize we already turn a blind eye to occasional or “recreational” use of marijuana. But between turning a blind eye and conferring on this drug an official stamp of approval lies a world of unknown harm.

— Lawrie McFarlane is a columnist for the Victoria Times Colonist

Source:   http://theprovince.com/opinion/little-research-on-marijuanas-dangers  2nd Jan 2017

A most detailed and valuable research study printed as a letter in the journal Nature, Vol. 539 – available online.

This study demonstrates that at least one G-protein-coupled receptor present on mitochondrial membranes modulates high brain functions such as memory formation through the modulation of intra-mitochondrial G-protein signalling. Considering that G proteins play a central role in the brain, the present data will probably pave the way for a new field of research that deals with the acute effects of mitochondrial activity on brain functioning.

Cannabinoid drugs have several therapeutic potentials30, unfortunately limited by important side effects, such as impairment of memory5,6. The present data suggest that selective targeting of specific subcellular populations of CB1 receptors in the brain might assist in development of safer therapeutics against several brain disorders.

Source: 2 4 November 2 0 1 6 | VO L 5 3 9 | N AT U RE | 5 5 5

Fentanyl is a painkiller that is 50 times stronger than heroin. It has already killed thousands, including Prince. Chris McGreal reveals why so many are playing Russian roulette with this lethal drug Natasha Butler had never heard of fentanyl until a doctor told her that a single pill had pushed her eldest son to the brink of death – and he wasn’t coming back. “The doctor said fentanyl is 100 times more potent than morphine and 50 times more potent than heroin. I know morphine is really, really powerful. I’m trying to understand. All that in one pill? How did Jerome get that pill?” she asked, her voice dropping to a whisper as the tears came. “Jerome was on a respirator and he was pretty much unresponsive. The doctor told me all his organs had shut down. His brain was swelling, putting pressure on to the spine. They said if he makes it he’ll be a vegetable.”

Painkiller addiction claims more lives in the US than guns, cutting across class, race and region

The last picture of Jerome shows him propped immobile in a hospital bed, eyes closed, sustained only by a clutch of tubes and wires. Natasha took the near impossible decision to let him die.  “I had to remove him from life support. That’s the hardest thing to ever do. I had him at 15 so we grew together. He was 28 when he died,” she said. “I had to let him die but after that I needed some answers. What is fentanyl and how did he get it?” That was a question asked across Sacramento after Jerome and 52 other people in and around California’s capital overdosed on the extremely powerful synthetic opioid, usually only used by hospitals to treat patients in the later stages of cancer, over a few days in late March and early April 2016. Twelve died.

Less than a month later, this mysterious drug – largely unheard of by most Americans – killed the musician Prince and burst on to the national consciousness. Fentanyl, it turned out, was the latest and most disturbing twist in the epidemic of opioid addiction that has crept across the United States over the past two decades, claiming close to 200,000 lives. But Prince, like almost all fentanyl’s victims, probably never even knew he was taking the drug.

“The number of people overdosing is staggering,” said Lieutenant Tracy Morris, commander of special investigations who manages the narcotics task force in Orange County, which has seen a flood of the drug across the Mexican border. “It is truly scary. They don’t even know what they’re taking.” The epidemic of addiction to prescription opioid painkillers, a largely American crisis, sprung from the power of big pharmaceutical companies to influence medical policy. Two decades ago, a small family-owned drug manufacturer, Purdue Pharma, unleashed the most powerful prescription painkiller yet sold over the pharmacist’s counter. Even though it was several times stronger than anything else on the market, and bore a close relation to heroin, Purdue claimed that OxyContin was not addictive and was safe to treat even relatively minor pain. That turned out not to be true.

It spawned an epidemic that in the US claims more lives than guns, cutting across class, race and geographic lines as it ravages communities from white rural Appalachia and Mormon Utah to black and Latino neighbourhoods of southern California. The prescription of OxyContin and other painkillers with the same active drug, oxycodone, became so widespread that entire families were hooked. Labourers who wrenched a back at work, teenagers with a sports injury, just about anyone who said they were in pain

was put on oxycodone. The famous names who ended up as addicts show how indiscriminate the drug’s reach was; everyone from politician John McCain’s wife Cindy to Eminem became addicted.

Clinics staffed by unscrupulous doctors, known as “pill mills”, sprung up churning out prescriptions for cash payments. They made millions of dollars a year. By the time the epidemic finally started to get public and political attention, more than two million Americans were addicted to opioid painkillers. Those who finally managed to shake off the drug often did so only at the cost of jobs, relationships and homes.

After the government finally began to curb painkiller prescriptions, making it more difficult for addicts to find the pills and forcing up black market prices, Mexican drug cartels stepped in to flood the US with the real thing – heroin – in quantities not seen since the 1970s. But, as profitable as the resurgence of heroin is to the cartels, it is labour intensive and time-consuming to grow and harvest poppies. Then there are the risks of smuggling bulky quantities of the drug into the US.

The ingredients for fentanyl, on the other hand, are openly available in China and easily imported ready for manufacture. The drug was originally concocted in Belgium in 1960, developed as an anaesthetic. It is so much more powerful than heroin that only small quantities are needed to reach the same high. That has meant easy profits for the cartels. The Drug Enforcement Administration (DEA) has said that 1kg of heroin earns a return of around $50,000. A kilo of fentanyl brings in $1m.

At first the cartels laced the fentanyl into heroin to increase the potency of low-quality supplies. But prescription opioid painkillers command a premium because they are trusted and have become increasingly difficult to find on the black market. So cartels moved into pressing counterfeit tablets.  But making pills with a drug like fentanyl is a fairly exact science. A few grammes too much can kill. “It’s very lethal in very small doses,” said Morris. “Even as little as 0.25mg can be fatal. One of our labs had a dime next to 0.25mg and you could barely see it. It’s about the size of the head of a pin. Potentially that could kill you.”

The authorities liken buying black market pills to playing Russian roulette. “These pills sold on the street, nobody knows what’s in them and nobody knows how strong they are,” said Barbara Carreno of the DEA.

After Prince died, investigators found pills labelled as prescription hydrocodone, but made of fentanyl, in his home, suggesting he bought them on the black market. The police concluded he died from a fatal mix of the opioid and benzodiazepine pills, a particularly dangerous combination. It is likely Prince did not even know he was taking fentanyl.  Others knowingly take the risk. In his long battle with addiction, Michael Jackson, used a prescription patch releasing fentanyl into his skin among the arsenal of drugs he was fed by compliant doctors. Although it was two non-opioids that killed him, adding fentanyl into the mix was hazardous.

Jerome Butler, a former driver for Budweiser beer who was training to be a security guard, thought he was taking a prescription pill called Norco. His mother’s voice breaks as she recounts what she knows of her son’s last hours. Natasha said she was aware he used cannabis, but had no idea he was hooked on opioid painkillers. She said her son at one time had a legitimate prescription and may have become addicted that way. She has since discovered he was paying a doctor, well known for freely prescribing opioids, to provide pills.  “I didn’t even know,” she said. “You find stuff out after. It’s killing me because they’re saying, ‘Well, yeah, Jerome was taking them pills all the time.’ And I’m like, ‘He was doing what?’”

Jerome may have had a prescription, but like many addicts he will have needed more and more. The pill that killed him was stamped M367, a marking used on Norco pills made of an opioid, hydrocodone. It was a fake with a high dosage of fentanyl.   This is fentanyl. The first time you take it you’re not coming back. You’re gone

“If Jerome had known it was fentanyl he would never have took that,” said Natasha. “This ain’t like crack or a recreational drug that people been doing for so many years and survived it but at 60 or 70 die from a drug overdose because their heart can’t take it no more. This is fentanyl. The first time you take it you’re not coming back. You’re gone.”

That wasn’t strictly true of the batch that hit Sacramento. It claimed 11 other lives. The youngest victim was 18-year-old George Berry from El Dorado Hills, a mostly white upscale neighbourhood. The eldest was 59. But others survived. Some were saved by quick reactions; doctors were able to hit them with an antidote before lasting damage was done. Others swallowed only enough fentanyl to leave them seriously ill but short of death.

It was a matter of luck. When investigators sent counterfeit pills seized after the Sacramento poisonings for testing at the University of California, they found a wide disparity in the amount of fentanyl each contained. Some pills had as little as 0.6mg. Others were stuffed with 6.9mg of the drug, which would almost certainly be fatal. The DEA thinks the difference was probably the result of failing to mix the ingredients properly with other powders, which resulted in the fentanyl being distributed unevenly within a single batch of counterfeit pills.

That probably explains the unpredictable mass overdosing popping up in cities across the US. In August, 174 people overdosed on heroin in six days in Cincinnati, which has one of the fastest-growing economies in the Midwest. Investigators suspect fentanyl because the victims needed several doses of an antidote, Naloxone, where one or two will usually suffice with heroin. The same month, 26 people overdosed on fentanyl-laced heroin in a four-hour period in Huntington, a mostly white city in one of the poorest areas of West Virginia. In September seven people died from fentanyl or heroin overdoses in a single day in Cuyahoga County, Ohio.

The US authorities don’t know for sure how many people fentanyl kills because of the frequency with which it is mixed with heroin, which is then registered as the cause of death. The DEA reported 700 fatalities from fentanyl in 2014 but said it is an underestimate, and rising. In 2012, the agency’s laboratory carried out 644 tests confirming the presence of fentanyl in drug seizures. By 2015, the number of positive tests escalated to 13,002.

The police did not have to look far for the source of the drug that killed Jerome. He and his girlfriend were staying at the house of her aunt, Mildred Dossman, while they waited for their own place to live. Jerome was smoking cannabis and drinking beer with Dossman’s son, William. Shortly before 1am, William went to his mother’s bedroom and came back with the fake Norco pill. Jerome took it and said he was going to bed.  Jerome’s girlfriend was in jail after being arrested for an unpaid traffic fine and so he was alone with their 18 month-old daughter, Success, lying next to him.

“The doctors explained to me that within a matter of minutes he went into cardiac arrest,” said his mother. “Then as he lay there that’s when time progressed for the organs to be poisoned by fentanyl. He was dying with his daughter next to him.” Natasha said other people in the house heard her son in distress, complaining his heart was hurting. But they did nothing because they were afraid that calling an ambulance would also bring the police.

It was not until 10 hours later that the Dossmans finally sought help from a neighbour who knew Jerome. He tried CPR and then called the medics. The police came, too, and in time Mildred Dossman, 50, was charged with distributing fentanyl and black market opioid painkillers. She was the local dealer.

The DEA is tightlipped about the investigation into the Sacramento deaths as its agents work on persuading Dossman to lead them to her suppliers. But it is likely she was getting the pills from Mexican cartels using ingredients from labs in China where production of fentanyl’s ingredients is legal.  Carreno said some Mexican cartels have long relationships with legitimate Chinese firms which for years supplied precursor chemicals to make meth amphetamine.

Packages of fentanyl are often moved between multiple freight handlers so their origins are hard to trace. Larger shipments are smuggled in shipping containers. Last year, six Chinese customs officials fell ill, one of them into a coma, after seizing 72kg of various types of fentanyl from a container destined for Mexico. American police officers have faced similar dangers. In June, the DEA put out a video warning law enforcement officers across the US that fentanyl was different to anything they have previously encountered and they should refrain from carting seizures back to the office.   “A very small amount ingested, or absorbed through the skin, can kill you,” it said.   A New Jersey detective appears in the video after accidentally inhaling “just a little bit of fentanyl puffed into the air” during an arrest: “It felt like my body was shutting down… I thought that was it. I thought I was dying.”

Along with the Mexican connection, a home-grown manufacturing industry has sprung up in the US. Weeks after Jerome died, agents arrested a married couple pressing fentanyl tablets in their San Francisco flat.

Candelaria Vazquez and Kia Zolfaghari made the drug to look like oxycodone pills. They sold them across the country via the darknet using Bitcoin for payment – on one occasion Zolfaghari cashed in $230,000. The couple shipped the drugs through the local post office. Customers traced by the DEA thought they were buying real painkiller pills. The couple ran the pill press in their kitchen. According to a DEA warrant, a dealer said Zolfaghari made large numbers of tablets: “He could press 100 out fast as fuck.”

The pair made so much money that agents searching their flat found luxury watches worth $70,000, more than $44,000 in cash and hundreds of “customer order slips” which included names, amounts and tracking numbers. The flat was stuffed with designer goods. The seizure warrant described Vazquez’s shoe collection as “stacked virtually from floor to ceiling”. Some still had the $1,000 price tags on them. Zolfaghari was arrested carrying a 9mm semi-automatic gun and about 500 pills he was preparing to post. The dealers made so much money that their flat was stuffed with luxury goods and cash.

Even as Americans are getting their heads around fentanyl, it is being eclipsed. In September, the DEA issued a warning about the rise of a fentanyl variant that is 100 times more powerful – carfentanil, a drug used to tranquilise elephants.

“Carfentanil is surfacing in more and more communities,” said the DEA’s acting administrator, Chuck Rosenberg. “We see it on the streets, often disguised as heroin. It is crazy dangerous.”

The drug has already been linked to 19 deaths in Michigan. Investigators say that with its use spreading, it is almost certainly claiming other lives. Dealers are also getting it from China, where carfentanil is not a controlled drug and can be sold to anyone.

Natasha Butler is still trying to understand the drug that killed her son. She wants to know why it is that it took Jerome’s death for her to even hear of it. She accuses the authorities of failing to warn people of the danger, and politicians of shirking their responsibilities.   A bill working its way through California’s legislature stiffening sentences for fentanyl dealing died in the face of opposition from the state’s governor, Jerry Brown, because it would put pressure on the already badly crowded prisons.

“I’m so dumbfounded. How does that happen?” says Natasha. Her tears come frequently as she sits at a tiny black table barely big enough to seat three people. She talks about Jerome and the tragedy for his three children, including Success, who she is now raising.

But some of the tears are to mourn the devastating impact on her own life. “Look where I’m at. I was in Louisiana. I had a house. I had a job. I had a car. I had a life. I worked every day. I was a manager for a major company. I came here, I became homeless. I had to move into this apartment to help out my granddaughter,” she said. “You see me. This is what my kitchen table is. My son is dead. He had three kids and those two mothers of those kids are depending on me to be strong. I want answers and help. I say, you got the little fish. Where did they get it from? How did they get it here? You are my government. You are supposed to protect us.”

Source:  https://www.theguardian.com/global/2016/dec/11/pills-that-kill-why-are-thousands-dying-from-fentanyl-abuse–

After three tours in Iraq and Afghanistan, C. J. Hardin wound up hiding from the world in a backwoods cabin in North Carolina. Divorced, alcoholic and at times suicidal, he had tried almost all the accepted treatments for post-traumatic stress disorder: psychotherapy, group therapy and nearly a dozen different medications. “Nothing worked for me, so I put aside the idea that I could get better,” said Mr. Hardin, 37. “I just pretty much became a hermit in my cabin and never went out.”

Then, in 2013, he joined a small drug trial testing whether PTSD could be treated with MDMA, the illegal party drug better known as Ecstasy.  “It changed my life,” he said in a recent interview in the bright, airy living room of the suburban ranch house here, where he now lives while going to college and working as an airplane mechanic. “It allowed me to see my trauma without fear or hesitation and finally process things and move forward.”

Based on promising results like Mr. Hardin’s, the Food and Drug Administration gave permission Tuesday for large-scale, Phase 3 clinical trials of the drug — a final step before the possible approval of Ecstasy as a prescription drug.   If successful, the trials could turn an illicit street substance into a potent treatment for PTSD.   Through a spokeswoman, the F.D.A. declined to comment, citing regulations that prohibit disclosing information about drugs that are being developed.

“I’m cautious but hopeful,” said Dr. Charles R. Marmar, the head of psychiatry at New York University’s Langone School of Medicine, a leading PTSD researcher who was not involved in the study. “If they can keep getting good results, it will be of great use. PTSD can be very hard to treat. Our best therapies right now don’t help 30 to 40 percent of people. So we need more options.”  But he expressed concern about the potential for abuse. “It’s a feel-good drug, and we know people are prone to abuse it,” he said. “Prolonged use can lead to serious damage to the brain.”

The Multidisciplinary Association for Psychedelic Studies, a small non-profit created in 1985 to advocate the legal medical use of MDMA, LSD, marijuana and other banned drugs, sponsored six Phase 2 studies treating a total of 130 PTSD patients with the stimulant. It will also fund the Phase 3 research, which will include at least 230 patients.

Two trials here in Charleston focused on treating combat veterans, sexual assault victims, and police and firefighters with PTSD who had not responded to traditional prescription drugs or psychotherapy. Patients had, on average, struggled with symptoms for 17 years.

After three doses of MDMA administered under a psychiatrist’s guidance, the patients reported a 56 percent decrease of severity of symptoms on average, one study found. By the end of the study, two-thirds no longer met the criteria for having PTSD. Follow-up examinations found that improvements lasted more than a year after therapy.

“We can sometimes see this kind of remarkable improvement in traditional psychotherapy, but it can take years, if it happens at all,” said Dr. Michael C. Mithoefer, the psychiatrist who conducted the trials here.   “We think it works as a catalyst that speeds the natural healing process.”  The researchers are so optimistic that they have applied for so-called breakthrough therapy status with the Food and Drug Administration, which would speed the approval process. If approved, the drug could be available by 2021.

Under the researchers’ proposal for approval, the drug would be used a limited number of times in the presence of trained psychotherapists as part of a broader course of therapy. But even in those controlled circumstances, some scientists worry that approval as a therapy could encourage more illegal recreational use.

“It sends the message that this drug will help you solve your problems, when often it just creates problems,” said Andrew Parrott, a psychologist at Swansea University in Wales who has studied the brains of chronic Ecstasy users. “This is a messy drug we know can do damage.”

Allowing doctors to administer the drug to treat a disorder, he warned, could inadvertently lead to a wave of abuse similar to the current opioid crisis.  During initial studies, patients went through 12 weeks of psychotherapy, including three eight-hour sessions in which they took MDMA. During the sessions, they lay on a futon amid candles and fresh flowers, listening to soothing music.

Dr. Mithoefer and his wife, Ann Mithoefer, and often their portly terrier mix, Flynn, sat with each patient, guiding them through traumatic memories.  “The medicine allows them to look at things from a different place and reclassify them,” said Ms. Mithoefer, a psychiatric nurse. “Honestly, we don’t have to do much. Each person has an innate ability to heal. We just create the right conditions.”

Research has shown that the drug causes the brain to release a flood of hormones and neurotransmitters that evoke feelings of trust, love and well-being, while also muting fear and negative emotional memories that can be overpowering in patients with post-traumatic stress disorder. Patients say the drug gave them heightened clarity and ability to address their problems.

For years after his combat deployments, Mr. Hardin said he was sleepless and on edge. His dreams were marked with explosions and death. The Army gave him sleeping pills and antidepressants. When they didn’t work, he turned to alcohol and began withdrawing from the world.

Ed Thompson, a former firefighter, took part in a study of Ecstasy as a treatment for PTSD. Without the drug, “he’d be dead,” his wife said.  “I just felt hopeless and in the dark,” he said. “But the MDMA sessions showed me a light I could move toward. Now I’m out of the darkness and the world is all around me.”  Since the trial, he has gone back to school and remarried.

The chemist Alexander Shulgin first realized the euphoria-inducing traits of MDMA in the 1970s, and introduced it to psychologists he knew. Under the nickname Adam, thousands of psychologists began to use it as an aid for therapy sessions. Some researchers at the time thought the drug could be helpful for anxiety disorders, including PTSD, but before formal clinical trails could start, Adam spread to dance clubs and college campuses under the name Ecstasy, and in 1985, the Drug Enforcement Administration made it a Schedule 1 drug, barring all legal use.

Since then, the number of people seeking treatment for PTSD has exploded and psychiatry has struggled to keep pace. Two drugs approved for treating the disorder worked only mildly better than placebos in trials. Current psychotherapy approaches are often slow and many patients drop out when they don’t see results. Studies have shown combat veterans are particularly hard to treat.

In interviews, study participants said MDMA therapy had not only helped them with painful memories, but also had helped them stop abusing alcohol and other drugs and put their lives back together.

On a recent evening, Edward Thompson, a former firefighter, tucked his twin 4-year-old girls into bed, turned on their night light, then joined his wife at a backyard fire. “If it weren’t for MDMA …” he said   “He’d be dead,” his wife, Laura, finished.   They both nodded.

Years of responding to gory accidents left Mr. Thompson, 30, in a near constant state of panic that he had tried to numb with alcohol and prescription opiates and benzodiazepines.  By 2015, efforts at therapy had failed, and so had several family interventions. His wife had left with their children, and he was considering jumping in front of a bus.

A member of a conservative Anglican church, Mr. Thompson had never used illegal drugs. But he was struggling with addiction from his prescription drugs, so he at first rejected a suggestion by his therapist that he enter the study. “In the end, I was out of choices,” he said.

Three sessions with the drug gave him the clarity, he said, to identify his problems and begin to work through them. He does not wish to take the drug again.  “It gave me my life back, but it wasn’t a party drug,” he said. “It was a lot of work.”

Correction: November 29, 2016

An earlier version of this article misstated the year that the Multidisciplinary Association for Psychedelic Studies was founded. It was 1985, not 1986. A picture caption misspelled the surname of a psychiatrist and his wife, a psychiatric nurse, who studied the use of Ecstasy. They are Dr. Michael C. Mithoefer and Ann Mithoefer, not Mitheofer.

Source:  http://www.nytimes.com/2016/11/29/us/ptsd-mdma-ecstasy.html

Hippocampus, the brain’s key memory and learning center, has the lowest blood flow in marijuana users suggesting higher vulnerability to Alzheimer’s. As the U.S. races to legalize marijuana for medicinal and recreational use, a new, large scale brain imaging study gives reason for caution. Published in the Journal of Alzheimer’s Disease, researchers using single photon emission computed tomography (SPECT), a sophisticated imaging study that evaluates blood flow and activity patterns, demonstrated abnormally low blood flow in virtually every area of the brain studies in nearly 1,000 marijuana compared to healthy controls, including areas known to be affected by Alzheimer’s pathology such as the hippocampus.

All data were obtained for analysis from a large multisite database, involving 26,268 patients who came for evaluation of complex, treatment resistant issues to one of nine outpatient neuropsychiatric clinics across the United States (Newport Beach, Costa Mesa, Fairfield, and Brisbane, CA, Tacoma and Bellevue, WA, Reston, VA, Atlanta, GA and New York, NY) between 1995-2015. Of these, 982 current or former marijuana users had brain SPECT at rest and during a mental concentration task compared to almost 100 healthy controls.

Predictive analytics with discriminant analysis was done to determine if brain SPECT regions can distinguish marijuana user brains from controls brain. Low blood flow in the hippocampus in marijuana users reliably distinguished marijuana users from controls.

The right hippocampus during a concentration task was the single most predictive region in distinguishing marijuana users from their normal counterparts. Marijuana use is thought to interfere with memory formation by inhibiting activity in this part of the brain.

According to one of the co-authors on the study Elisabeth Jorandby, M.D., “As a physician who routinely sees marijuana users,  what struck me was not only the global reduction in blood flow in the marijuana users brains, but that the hippocampus was the most affected region due to its role in memory and Alzheimer’s disease.

Our research has proven that marijuana users have lower cerebral blood flow than non-users. Second, the most predictive region separating these two groups is low blood flow in the hippocampus on concentration brain SPECT imaging.

This work suggests that marijuana use has damaging influences in the brain – particularly regions important in memory and learning and known to be affected by Alzheimer’s.”

Dr. George Perry, Editor in Chief of the Journal of Alzheimer’s Disease said, “Open use of marijuana, through legalization, will reveal the wide range of marijuana’s benefits and threats to human health.  This study indicates troubling effects on the hippocampus that may be the harbingers of brain damage.”

According to Daniel Amen, M.D., Founder of Amen Clinics, “Our research demonstrates that marijuana can have significant negative effects on brain function. The media has given the general impression that marijuana is a safe recreational drug, this research directly challenges that notion.  In another new study just released, researchers showed that marijuana use tripled the risk of psychosis. Caution is clearly in order.”

Source: Press http://content.iospress.com/articles/journal-of-alzheimers-disease/jad160833 – DOI: 10.3233/JAD-160833

 

A man holds a sheet of THC concentrate known as “shatter,” in Denver, Colorado. (Brennan Linsley/Associated Press)

An emergency psychiatrist in Victoria warns that a dramatic increase in severe mental illness cases may be connected to use of a powerful, relatively new drug called “shatter.” Dr, Kiri Simms told On the Island host Gregor Craigie she treated 10 patients needing hospitalization in the past year after using shatter or other highly concentrated marijuana-based products made from butane hash oil.

“They’re coming in with symptoms of depression, anxiety and sometimes psychosis, which for a psychiatrist means a break from reality, hallucinations, delusions,” Simms said.

Marijuana psychosis previously rare

In the past, when most marijuana use involved smoking dried leaves and buds, she said the infrequent cases of marijuana-related psychosis usually were patients with a family history of schizophrenia.  “Most people did not become psychotic from marijuana alone.” Simms said.

Several medical marijuana stores in Victoria openly advertise shatter and related marijuana products which an emergency psychologist links to an increasing number of cases of severe psychosis. (CBC)

That has changed. Now, most of the patients she currently sees are regular users of different marijuana products, often what she calls butane hash oil products. Those include shatter, wax and a gooey substance called honey or butter or oil, she said.

Simms said she has personally seen 10 people in the past year, “very, very ill and with the kind of psychotic experience that requires a stay in our psychiatric intensive care or on one of our in-patient wards.”    She said it’s not like the ‘old days’ when symptoms of psychosis would pass in a few hours or days.  “Now, sometimes it’s taking weeks before there is a clearing and occasionally it’s taking months and the patients are not cleared yet,” Simms said.   “Almost all of our patients, even our young patients tell us they can easily obtain these products in the local dispensaries.”

Shatter is openly advertised online by a number of medical marijuana storefront businesses in Victoria.Dana Larsen, the director of the Vancouver Dispensary Society, acknowledged that products such as shatter are too strong for inexperienced users but he does not support new rules or regulations for selling it.

“I think perhaps there should be better labelling and warnings on how to use cannabis products,” Larsen said. “I don’t think this is inherently more dangerous than other cannabis products.”

Source:  http://www.cbc.ca/news/canada/british-columbia/illicit-drugs-shatter-victoria-mental-illness-1.3862535    22nd  Nov. 2016

If Marijuana is Medicine, How Come it Makes People So Sick?

There’s a great irony that comes from the pot industry’s claims that marijuana is medical and it’s supposed to help with nausea.   It’s called Cannabis Hyperemesis, and it hits with a vengeance.

This past week a parent wrote to PopPot, saying: “Parents should watch for red flags of pot use in their children including frequent, long hot showers; weight loss; unexplained nausea and vomiting.”

“I took my teen to the doctor assuming the stress of a rigorous course load combined with the demands of an after school sport were taking a physical toll on my child, ” the mom wrote.  “In hindsight, these were the signs of escalating pot use as described in this Pub Med article about cannabinoid hyperemesis. Unfortunately many in the medical community are ignorant of the detrimental effects of pot use on our young people —  ranging from psychotic breaks to debilitating gastrointestinal symptoms.”

From another mother in Pueblo, Colorado who also wrote this past week:  “Last week I met a 14-year-old girl suffering from Cannabis Hyperemesis Syndrome.  When I met her, at first I thought she had an addiction to meth because she was so very thin and malnourished.  She was asking me how can she return to live with her parents who are marijuana users when marijuana is so toxic for her.”

Incidences of this severe illness appear to be on the rise since the rollout of legal weed.  The high THC content of today’s weed — 5x the amount in the 1980s — seems to be involved also.  Because of misdiagnosis or denial of drug use by patients, this syndrome is going undetected.  Furthermore, users self-medicate and exacerbate this severe illness, as a medical marijuana patient was doing for more than eight months.

From veterans hospitals to addiction specialists as well as gastroenterologists, there’s suddenly an increased interest in and diagnoses of this condition.  Further research into this mysterious illness turns up numerous medical journal articles on the link between excessive and/or long-term cannabis use and hyperemesis.

Cannabis Hyperemesis: How to Know if You or Someone You Love is Afflicted

This syndrome is still largely unknown throughout the medical profession and even among cannabis users. The most prominent cases are among long-term users that started using the drug at a very early age and have used daily for over 10 years, according to the MedScape article, Emerging Role of Chronic Cannabis Use and Hyperemesis Syndrome. The article goes on to say that it can also effect newer users and even non-daily users.

In Practical Gastroenterology, there’s a case of a 19 year old Hispanic man who contracted the problem within only two years of marijuana use.  Symptoms reported in a Current Psychiatry article include cyclic vomiting, abdominal pain, nausea, gastric pain and compulsive hot bathing or showers to ease pain.  Frequent bathing and vomiting can also lead to dehydration and excessive thirst. Mild fever, weight loss, and a drop in blood pressure upon standing are other symptoms.

Sufferers find they need to take many showers or baths a day just to get relief from the chronic nausea and vomiting. The bouts of illness are so severe and frightening they lead to frequent trips to the emergency room. And finally, this debilitating illness can be very disruptive to life and relationships. The many absences from work lead to job loss and the inability to hold down a job.

Parents may mistake this situation as bulimia, particularly if the teens hide the vomiting.  Another common way this disease is misdiagnosed as cyclic vomiting syndrome. According to the Current Psychiatry article, 50% of those diagnosed with CVS are daily cannabis users.  Another common misreading by doctors of the compulsive habit of frequent hot baths is as Obsessive Compulsive Disorder.

Further complicating matters, doctors find that even when cannabis use is consistent, the bouts of hyperemesis come and go, which further serves to keep the patient in denial about the connection to their drug use.

In Spite of Cannabis Hyperemesis, Addiction is a Stronghold

Complete cessation of marijuana use is the only known cure for Cannabis Hyperemesis Syndrome.

Sadly, even those who have greatly suffered over a long period of time, still want to be able to consume marijuana. The claim by the industry that marijuana is not addictive is easily disproved when you see the comments to a High Times article, What is Cannabinoid Hyperemesis Syndrome?  Not only do many commenters admit they suffer from this detrimental effect of this drug, they confess they still love marijuana. The commenters lament having to give up their stoner lifestyle even after years of disabling illness! A number of them state that once they are well, they plan to return to the habit, albeit to a lesser degree.

Source:  http://www.poppot.org/2016/11/19/cannabis-hyperemesis-toxic-side-effect-of-dangerous-drug/   19th Nov. 2016

The surgeon general’s recent report is a much-needed call to arms around a public health crisis.

On Nov. 17, Dr. Vivek Murthy, a vice admiral of the U.S. Public Health Service Commissioned Corps and U.S. surgeon general, issued a timely and much-needed report on what has become a public health crisis and menace in this country – namely, misuse and addiction to legal and illegal psychoactive drugs.

In the report preface, Murthy remarks that before starting his current job he stopped by the hospital where he had practiced. It was the nurses who said to him, he writes, “please do something about the addiction crisis in America.” He knew they were right, and he took their wise counsel.

Why are they right? Substance use disorders, where a person is functionally impaired and often physically dependent on a drug, affect nearly 21 million Americans annually – the same number of people who have diabetes and 150 percent of those with a cancer diagnosis, of any type.

In 2015, about 67 million people reported binge drinking in the past month, and 48 million were using illegal drugs or misusing prescribed drugs. In the past year, 12.5 million Americans reported misusing prescription pain relievers. In 2014, 47,055 people died from a drug overdose, with more than half of those using an opioid (like OxyContin, Percodan, Vicodin, methadone and heroin).

The numbers chill the mind, and yet with the widespread use, abuse and potentially deadly consequences, only 1 in 10 of those with a substance use disorder obtain any treatment. The nurses to whom Murthy spoke were surely seeing the consequences of drug misuse in their emergency rooms, clinics and inpatient units. They also were likely seeing the consequences among their family, friends and co-workers. (Health professionals are prone to misuse alcohol and drugs.)

What distinguishes the surgeon general’s report is its call for a long overdue shift in alcohol and drug policy – away from a criminal justice approach to a clinical or public health approach. What also distinguishes every cover note and chapter is a spirit of hope, that substance use can be prevented, detected early, effectively treated and its manifold adverse impacts mitigated.

To start, the surgeon general urges that we begin by “improving public awareness of substance misuse and related problems.” Negative attitudes, critical judgments and moral invective towards people with addiction not only interfere with delivering good care they deter people who need services from getting them.

But the report also makes clear that there is no single solution or path, nor should we expect one with problems this broad and deep. The heart of the report then, chapter by chapter, speaks to comprehensive policy action: prevention, early intervention, ongoing treatment, so-called wellness activities, identifying and reaching out to high-risk populations and supporting research efforts.

Central to the report is that we must integrate health care services with substance use treatment: not by referral from one to the other but by embedding screening and basic forms of treatment into primary care and family practice. We screen for hypertension, lipids, diabetes and much more; why aren’t we screening for problem alcohol and drug use where these problems are most likely to appear? Screening, Brief Intervention and Referral for Treatment, or SBIRT, is perhaps the best-known and most effective means of extending substance screening and management into the general health system.

Of course, all these efforts must be financed. A powerful argument can be made that it costs more to not treat these conditions than to treat them. Substance use disorders cost the U.S. more than $400 billion every year on health care expenses, criminal justice costs, social welfare consequences and lost workplace productivity. However, our health, social welfare and criminal justice systems are simply too siloed, (separated) and we pay the human and financial price of not reaching across the ersatz boundaries of government and community agencies.

Still, some laws are making inroads to improve care. The Affordable Care Act requires treatment for substance use disorders to be an “essential benefit,” no different from any other illness. The 2008 Federal Parity Act, now finally with regulations, also requires insurers to not discriminate against people with addictions. The policy and legislative pillars are there, and we need to keep using them.

The surgeon general ends his report with a vision for the future. He is deeply sanguine that we can disrupt the addiction epidemic that has seized our country. The path is a public health one, as I have illustrated above, but the report talks also of what individuals and families can do: reach out to those we see in trouble, withhold judgment, support those in recovery, and, for parents, talk to your child about alcohol and drugs. “Making [these changes] will require a major cultural shift in the way Americans think about, talk about, look at, and act toward people with substance use disorder,” the report reads. “For example, cancer and HIV used to be surrounded by fear and judgment, but they are now regarded by most Americans as medical conditions like many others.”

We owe a great thanks to the surgeon general and the many experts and advocates who put together this call for how we can respond to what is now a public health crisis. We can do that. It will be hard, but the alternative of not taking collective action will be far harder to bear.

Source: http://www.usnews.com/opinion/policy-dose/articles/2016-11-21/surgeon-general-is-right-to-target-the-public-health-crisis-of-addiction

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

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.

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

To many people, a glass of wine with dinner or a nightcap before bed is enjoyable. But a recent study conducted by UC San Francisco shows that even moderate alcohol drinking may change the structure of the heart and increase risk of heart chamber damage.

The finding is published in Journal of the American Heart Association.  Previous research has shown that moderate alcohol drinking may be a risk factor for abnormal heart rhythm (atrial fibrillation), but the mechanism by which alcohol may lead to atrial fibrillation is unknown.

Abnormal heart rhythm is a risk factor for stroke. The irregular pumping of blood can lead to blood clots, which may travel to the brain and cause stroke.  In the study, researchers looked at damage to the left heart chamber (atrium) of the heart as a possible pathway between alcohol and abnormal heart rhythm.

They evaluated data from more than 5,000 adults collected over several years in the Framingham Heart Study, including heart tests, medical history and self-reported alcohol intake.   Most of the participants were white and in their 40s to 60s, reported on average just over one drink per day.

The overall rate of abnormal heart rhythm in the group was 8.4 cases per 1,000 people per year – meaning over a 10-year period, 8 out of 100 people were likely to develop abnormal heart rhythm.

The result also showed that every additional drink per day was associated with a 5% increase in the yearly risk.

Every additional drink per day also was associated with a statistically significant 0.16 mm enlargement of the left heart chamber, which highlighted a possible site of physical damage caused by drinking.

Researchers suggest that the new finding shed light on the complex relationship between alcohol and heart health.  Patients who drink moderately are more likely to have abnormal heart rhythm but less likely to have heart attacks and congestive heart failure.

Alcohol’s abilities to protect and harm the heart likely operate through different mechanisms and vary from person to person.   Future work will try to figure out these mechanisms and inform therapies for heart conditions. Ultimately, the findings will enable physicians to give personalized advice to patients.

Source: McManus DD, et al. (2016). Alcohol Consumption, Left Atrial Diameter, and Atrial Fibrillation.Journal of the American Heart Association, published online. DOI:10.1161/JAHA.116.004060. 20thOct 2016

Filed under: Alcohol,Health :

A research team from the University of Edinburgh examined data from 284 adults who attended primary care centers in the United Kingdom between 2011 and 2013.  Some 170 were marijuana users, 114 smoked cigarettes but did not use marijuana. Heavy users had smoked marijuana 47,000 times in their lifetime; occasional users averaged about 1,000 times. Using a special x-ray process, researchers examined study participants’ bone density and found the heavy marijuana users had a 5 percent lower bone density than nonusers.  “We have known for a while that the components of cannabis can affect bone cell function, but we had no idea up until now of what this might mean to people who use cannabis on a regular basis. Our research has shown that heavy users of cannabis have quite a large reduction in bone density compared with nonusers, and there is a real concern that this may put them at increased risk of developing osteoporosis and fractures later in life,” said the team’s leader, Professor Stuart Ralston. The team says more research is needed to confirm this association.

Source:  National Families in Action’s The Marijuana Report srusche=nationalfamilies.org@mail145.atl121.mcsv.net   19th Oct 2016

This November, several states will vote on whether to legalize marijuana for recreational use, and the proponents of legalization have seized on a seemingly clever argument: marijuana is safer than alcohol.  The Campaign to Regulate Marijuana Like Alcohol, an effort of the Marijuana Policy Project (or MPP), has taken this argument across the country.  Their latest strategy is labelled Marijuana vs. Alcohol.  It is a very misleading, even dangerous, message, based on bad social science and sophistic public deception. Citing out-of-date studies that go back ten years and more, even using that well-known scientific journal, Wikipedia, the MPP never references current research on the harms of today’s high potency and edible marijuana, studies that come out monthly if not more frequently.  Indeed, their Marijuana vs. Alcohol page concludes with a 1988 statement about the negligible harms of marijuana—but that is a marijuana that simply does not exist anymore, neither in mode nor potency.  Today’s marijuana is at least five times more potent, and sold in much different form.  And the science of marijuana and its effects on the brain have come some distance since 1988 as well.

So out-of-date is the science and knowledge of marijuana from thirty years ago, it would be malpractice in any other field to suggest that kind of information about a drug having any contemporary relevance at all.  One almost wonders if the MPP thinks public health professors still instruct their students on how to use microfiche to perform their research as they prepare to write their papers on 5k memory typewriters.

It is simply misleading in a public health campaign to cite dated research while at the same time ignore a larger body of current evidence that points in the opposite direction of a desired outcome.  At great potential peril to our public health, political science (in the hands of the marijuana industry) is far outrunning medical science.  But the danger is clear: with the further promotion, marketing, and use of an increasingly known dangerous substance, public health and safety will pay the price.

Consider three basic problems with the industry’s latest campaign:

I.  Comparisons of relative dangers of various drugs are simply impossible and can often lead to paradoxical conclusions.  It is impossible to compare a glass of chardonnay and its effects on various adults of various weights and tolerance levels with the inhalation or consumption of a high-potency marijuana joint or edible.  Is the joint from the 5 percent THC level or the 25 percent level?  How about a 30 mg—or stronger—gummy bear?  A glass of wine with dinner processes through the body in about an hour and has little remaining effect.  A marijuana brownie or candy can take up to 90 minutes to even begin to take effect.

Consider a consumer of a glass of wine who ate a full meal and waited an hour or more before driving and a consumer of a marijuana edible taking the wheel of a plane, train, automobile, or anything else.  The wine drinker would likely be sober, the marijuana consumer would just be getting high, and, given the dose, possibly very high at that.

True, marijuana consumption rarely causes death, but its use is not benign.  Last year, an ASU professor took a standard dose of edible marijuana, just two marijuana coffee beans. The effect?  “Episodes of convulsive twitching and jerking and passing out” before the paramedics were called.  Such episodes are rare for alcohol, but they are increasingly happening with marijuana.

Beyond acute effects, the chronic impact of marijuana is also damaging.  Approximately twice the percentage of regular marijuana users will experience Marijuana Use Disorder than will alcohol users experience Alcohol Use Disorder—both disorders categorized by the Diagnostic Statistics Manual (DSM).[1]   Marijuana is also the number one substance of abuse for teens admitted to treatment, far higher than the percentage who present with alcohol problems.  In fact, the most recent data out of Colorado shows 20 percent of teens admitted for treatment have marijuana listed as their primary substance of abuse compared to less than one percent for alcohol.

Still, the Campaign persists in its deceptions—as if they have not even read their own literature.  One online marketing tool it recently deployed was the “Consume Responsibly” campaign.  Delve into that site and you will find this warning: “[Smoked marijuana] varies from person to person, you should wait at least three to four hours before driving a vehicle.”  And: “Edible marijuana products and some other infused products remain in your system several hours longer, so you should not operate a vehicle for the rest of the day after consuming them.”  Who has ever been told that they should not operate a vehicle for four hours, much less for the rest of the day, if they had a glass of wine or beer?  Safer than alcohol?  This is not even true according to the MPP’s own advice.

Beyond unscientific dose and effect comparisons, there is a growing list of problems where marijuana use does, indeed, appear to be more harmful than alcohol.  According to Carnegie Mellon’s Jonathan Caulkins: “Marijuana is significantly more likely to interfere with life functioning” than alcohol and “it is moderately more likely to create challenges of self-control and to be associated with social and mental health problems.” Additionally, a recent study out of UC Davis revealed that marijuana dependence was more strongly linked to financial difficulties than alcohol dependence and had the same impacts on downward mobility, antisocial behavior in the workplace, and relationship conflict as alcohol.

II.  The marijuana industry pushes and promotes the use of a smoked or vaped substance, but never compares marijuana to tobacco.  Indeed, the two substances have much more in common than marijuana and alcohol, especially with regard to the products themselves and the method of consumption (though we are also seeing increasing sales of child-attractive marijuana candies).  But why is the comparison never made?  The answer lies in the clear impossibility.

Consider: Almost every claim about marijuana’s harms in relation to alcohol has to do with the deaths associated with alcohol.  But, hundreds of thousands more people die from tobacco than alcohol.  Based on their measures of mortality, which is safer: alcohol or tobacco?  Can one safely drink and drive?  No.  Can one smoke as many cigarettes as one wants while driving?  Of course. So, what’s the more dangerous substance?  Mortality does not answer that question.

Alcohol consumption can create acute problems, while tobacco consumption can create chronic problems.  And those chronic problems particularly affect organs like the lungs, throat, and heart.  But what of the chronic impact on the brain?  That’s the marijuana risk, and, seemingly, society is being told that brains are less important than lungs.  Nobody can seriously believe that, which is why these comparisons simply fail scrutiny.

This illustrates but one of the problems in comparing dangerous substances. As Professor Caulkins recently wrote:

The real trouble is not that marijuana is more or less dangerous than alcohol; the problem is that they are altogether different….The country is not considering whether to switch the legal statuses of alcohol and marijuana. Unfortunately, our society does not get to choose either to have alcohol’s dangers or to have marijuana’s dangers. Rather, it gets to have alcohol’s dangers…and also marijuana’s dangers. Further, marijuana problems are associated with alcohol problems.  New research out of Columbia University reveals that marijuana users are five times more likely to have an alcohol abuse disorder.  Society doesn’t just switch alcohol for marijuana—too often, one ends up with use of both, compounding both problems.

The larger point for voters to understand:  The marijuana legalization movement is not trying to ban or end alcohol sales or consumption; rather, it wants to add marijuana to the dangerous substances already available, including alcohol.  This is not about marijuana or alcohol, after all.  It’s about marijuana and alcohol. We can see this effect in states like Colorado, with headlines such as “Alcohol sales get higher after weed legalization.”  And, according to the most recent federal data [2], alcohol use by teens, as well as adults, has increased in Colorado since 2012 (the year of legalization). If alcohol is the problem for the MPP, in their model state–Colorado–alcohol consumption has increased with marijuana legalization.  Legalizing marijuana will, in the end, only make alcohol problems worse. III.  The legalization movement regularly cites to one study in the Journal of Scientific Reports to “prove” that marijuana is safer than alcohol.  But this study leads to odd conclusions in what the authors, themselves, call a “novel risk assessment methodology.”  For instance, the researchers find that every drug, from cocaine to meth to MDMA to LSD, is found to be safer than alcohol. (See this graph).  By the MPP standard, we should thereby make these substances legal as well.  But, seeing such data in its full light, we all know this would be nonsensical.

Further, the authors specifically write that they only looked at acute effects and did not analyze “chronic toxicity,” and cannot judge marijuana and “long term effects.”  Indeed, they specifically write in their study the toxicity of marijuana“may therefore be underestimated” given the limitations of their examination.  Yet legalizers ignore these statements.  Always.  It simply does not fit their narrative. What long-term effects are we talking about?  To cite the New England Journal of Medicine: “addiction, altered brain development, poor educational outcomes, cognitive impairment,” and “increased risk of chronic psychosis disorders.”  Now think about what it will mean to make a drug with those adverse effects more available, and for recreational use.

Finally, the very authors of the much-cited Journal of Scientific Reports study specifically warn their research should be “treated carefully particularly in regard to dissemination to lay people….especially considering the differences of risks between individuals and the whole population.”  But this is precisely what commercialization is about—not individual adult use but making a dangerous drug more available to “the whole population.”

Given what we know in states like Colorado, we clearly see that legalization creates more availability which translates into more use, affecting whole populations—Colorado college-age use, for example, is now 62 percent higher than the national average. [See FN2, below]. And the science is coming in, regularly.  Indeed, the same journal the MPP points to in its two-year old “novel” study, just this year published another study and found:

Neurocognitive function of daily or near daily cannabis users can be substantially impaired from repeated cannabis use, during and beyond the initial phase of intoxication. As a consequence, frequent cannabis use and intoxication can be expected to interfere with neurocognitive performance in many daily environments such as school, work or traffic.

That is why these comparisons of safety and harm are—in the end—absurd and dangerous.  In asking what is safer, the true answer is “neither.”  And for a variety of reasons.  But where one option is impossible to eliminate (as in alcohol), society should not add to the threat that exists:  One doesn’t say because a playground is near train tracks you should also put a highway there.  You fence off the playground.

That, however, is not the choice the MPP has given us.  They are not sponsoring legislation to reduce the harms of alcohol, they are, instead, saying that with all the harms of alcohol, we should now add marijuana.  But looking at all the problems society now has with substance abuse, the task of the serious is to reduce the problems with what already exists, not advance additional dangers.

If the MPP and its Campaigns to Regulate Marijuana Like Alcohol are serious about working on substance abuse problems, we invite them to join those of us who have labored in these fields for years.  One thing we do know: adding to the problems with faulty arguments, sloppy reasoning, and questionable science, will not reduce the problems they point to.  It will increase them.  And that, beyond faulty argument and sloppy reasoning, is public policy malfeasance. [1] See http://archpsyc.jamanetwork.com/article.aspx?articleid=2464591 compared to http://archpsyc.jamanetwork.com/article.aspx?articleid=2300494

Source:  http://amgreatness.com/2016/09/25/lie-travels-comparing-alcohol-marijuana/  Sept 25th 2016

There are many reports of drug use leading to mental health problems, and we all know of someone having a few too many drinks to cope with a bad day. Many people who are diagnosed with a mental health disorder indulge in drugs, and vice versa. As severity of both increase, problems arise and they become more difficult to treat. But why substance involvement and psychiatric disorders often co-occur is not well understood.

In addition to environmental factors, such as stress and social relationships, a person’s genetic make-up can also contribute to their vulnerability to drug use and misuse as well as mental health problems. So could genetic risk for mental illness be linked to a person’s liability to use drugs?

This question has been addressed in a new study, published in the open-access journal Frontiers in Genetics.

“Our research shows that if someone is genetically predisposed towards having mental illness, they are also prone to use licit and illicit substances and develop problematic usage patterns,” says Caitlin E. Carey, a PhD student in the BRAINLab at Washington University in St. Louis and lead author of this new study. “This is important because if a mental illness, like depression, runs in your family, you are presumed at risk of that disorder. But we find that having a genetic predisposition to mental illness also places that person at risk for substance use and addiction.”

This is the first study to compare genetic risk for mental illness with levels of substance involvement across a large sample of unrelated individuals. Rather than analysing family history, Carey and her co-authors used information across each person’s genetic code to calculate their genetic risk for psychiatric disorders.

“Previous research on the genetic overlap of mental illness and drug use has been limited to family studies. This has made it difficult to examine some of the less common disorders,” says Carey. “For example, it’s hard to find families where some members have schizophrenia and others abuse cocaine. With this method we were able to compare people with various levels of substance involvement to determine whether they were also at relatively higher genetic risk for psychiatric disorders.” As well as finding an overall genetic relationship between mental health and substance involvement, the study revealed links between specific mental illnesses and drugs. Dr. Ryan Bogdan, senior author of the study and Director of the BRAINLab, notes, “We were fortunate to work with data from individuals recruited for various forms of substance dependence. In addition to evaluating the full spectrum of substance use and misuse, from never-using and non-problem use to severe dependence, this also allowed us to evaluate specific psychiatric disorder-substance relationships”. He continues, “For example, we found that genetic risk for both schizophrenia and depression are associated with cannabis and cocaine involvement.”

The study opens up new avenues for research evaluating the predictive power of genetic risk. For example, could genetic risk of schizophrenia predict its onset, severity and prognosis in youth that experiment with cannabis and other drugs?

Dr. Bogdan concludes, “It will now be important to incorporate the influence of environmental factors, such as peer groups, neighborhood, and stress, into this research. This will help us better understand how interplay between the environment and genetic risk may increase or reduce the risk of co-occurring psychiatric disorders and substance involvement. Further, it will be important to isolate specific genetic pathways shared with both substance involvement and psychiatric illness. Ultimately, such knowledge may help guide the development of more effective prevention and treatment efforts decades in the future.”

Source:  Caitlin E. Carey et al, Associations between Polygenic Risk for Psychiatric Disorders and Substance Involvement, Frontiers in Genetics (2016). DOI: 10.3389/fgene.2016.00149 

Since many drug dependent individuals are known to be depressed and sometimes suicidal this research is encouraging. NDPA

Suicide is the cause of more than 42,000 deaths in the United States every year, making it the 10th leading cause of death in the country. Now, a new study paves the way for a drug to avert suicidal behavior, after identifying an enzyme related to brain inflammation that has the potential to predict and prevent suicide.

Researchers say their findings may bring us closer to a drug that can prevent suicidal behavior.

In the journal Translational Psychiatry, researchers reveal how a certain variant of the enzyme ACMSD leads to abnormal levels of two acids in the brain, which may encourage suicidal behavior.

The research team – including senior author Dr. Lena Brundin of the Center for Neurodegenerative Science at Van Andel Research Institute in Grand Rapids, MI – say their findings could bring us closer to a blood test that can identify patients at high risk of suicide.

What is more, the study suggests ACMSD could be a promising drug target for suicide prevention.

According to Dr. Brundin and colleagues, previous research has suggested the immune system plays a role in depression and suicidal behavior, primarily by responding to stress with inflammation.

However, the underlying mechanisms of this association have been unclear, which has hampered the discovery of clinical strategies to prevent suicide. The new study aimed to shed some light.

Past studies have shown patients with suicidal behavior experience persistent inflammation in their blood and cerebrospinal fluid (CSF).

With this in mind, the researchers assessed the blood and CSF samples of more than 300 individuals from Sweden, some of whom had attempted suicide.

ACMSD enzyme variant more prevalent in people with suicidal behavior

On comparing samples, the team found that individuals who had attempted suicide had abnormal levels of both picolinic acid and quinolinic acid. These irregular acid levels were identifiable in samples taken straight after a suicidal attempt and at various points over the subsequent 2 years.

Among subjects with suicidal behavior, levels of picolinic acid – known to have neuroprotective effects – were too low, while their levels of quinolinic acid – a known neurotoxin – were too high.

These abnormal levels were most prominent in CSF, the team reports, though they could still be identified in blood samples.

Since previous research had shown that both picolinic and quinolinic acid are regulated by the enzyme ACMSD – known to regulate brain inflammation – the researchers conducted a genetic analysis of individuals with suicidal behavior, as well as healthy controls.

From this, they found that individuals who had attempted suicide were more likely to possess a specific variant of ACMSD, and this variant was associated with increased levels of quinolinic acid.

While the study is unable to demonstrate that ACMSD activity is directly linked to suicide risk, the researchers say their findings suggest the enzyme could be a potential drug target for suicide prevention. “We now want to find out if these changes are only seen in individuals with suicidal thoughts or if patients with severe depression also exhibit this. We also want to develop drugs that might activate the enzyme ACMSD and thus restore balance between quinolinic and picolinic acid.”

Co-study leader Dr. Sophie Erhardt, Karolinska Institutet, Sweden

Additionally, since the results show that abnormal levels of picolinic and quinolinic acid can be identified in the blood, the team says they may bring us closer to a blood test that can identify patients at high risk of suicidal behavior.

Source:  http://www.medicalnewstoday.com/articles/313287.php  4th Oct.2016

Avoiding a New Tobacco Industry

SummaryPoints

• The US states that have legalized retail marijuana are using US alcohol policies as a model for regulating retail marijuana, which prioritizes business interests over public health.

• The history of major multinational corporations using aggressive marketing strategies to increase and sustain tobacco and alcohol use illustrates the risks of corporate domination of a legalized marijuana market.

• To protect public health, marijuana should be treated like tobacco, not as the US treats alcohol: legal but subject to a robust demand reduction program modelled on successful evidence-based tobacco control programs.

• Because marijuana is illegal in most places, jurisdictions worldwide (including other US states) considering legalization can learn from the US experience to shape regulations that prioritize public health over profits.

Introduction

While illegal in the United States, marijuana use has been increasing since 2007 [1]. In response to political campaigns to legalize retail sales, by 2016 four US states (Colorado, Washington, Alaska, and Oregon) had enacted citizen initiatives to implement regulatory frameworks for marijuana, modelled on US alcohol policies [2], where state agencies issue licenses to and regulate private marijuana businesses [2,3,4]. Arguments for legalization have stressed the negative impact marijuana criminalization has had on social justice, public safety, and the economy [5].

Uruguay, an international leader in tobacco control [6], became the first country to legalize the sale of marijuana in 2014, and, as of July 2016, was implementing a state monopoly for marijuana production and distribution [7]. None of the US laws [2], or pending proposals in other states [8], prioritize public health. Because marijuana is illegal in most places, jurisdictions worldwide (including other US states) considering legalization can learn from the US experience to shape regulations that favor public health over profits.

PLOS Medicine | DOI:10.1371/journal.pmed.1002131 September 27, 2016 1 / 9a11111

OPEN ACCESS

Citation: Barry RA, Glantz S (2016) A Public Health

Framework for Legalized Retail Marijuana Based on

the US Experience: Avoiding a New Tobacco

Industry. PLoS Med 13(9): e1002131. doi:10.1371/

journal.pmed.1002131

Published: September 27, 2016

Copyright: © 2016 Barry, Glantz. This is an open

access article distributed under the terms of the

Creative Commons Attribution License, which permits

unrestricted use, distribution, and reproduction in any

medium, provided the original author and source are

credited.

Funding: This work was supported in part by

National Cancer Institute grant CA-061021 and UCSF

funds from SG’s Truth Initiative Distinguished Professorship. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests: The authors have declared that no competing interests exist.

Provenance: Not commissioned; externally peer reviewed

In contrast, while legal, US tobacco use has been declining [1]. To protect public health,

marijuana should be treated like tobacco, legal but subject to a robust demand reduction program modelledon evidence-based tobacco control programs [9] before a large industry (akin to tobacco [10]) develops and takes control of the market and regulatory environment [11].

Likely Effect of Marijuana Commercialization on Public Health.

While the harms of marijuana do not currently approach those of tobacco [12], the extent to which legal restrictions on marijuana may have functioned to limit these harms is unknown. Currently, regular heavy marijuana use is uncommon, and few users become life time marijuana smokers [13]. However, marijuana use is not without risk. The risk for developing marijuana dependence (25%) is lower than for nicotine addiction (67%) and higher than for alcohol dependence (16%) [14], but is still substantial, with rising numbers of marijuana users in high income countries seeking treatment [15]. Reversing the historic pattern, in some places, marijuana has become a gateway to tobacco and nicotine addiction [15]. This situation will likely change as legal barriers that have kept major corporations out of the market [10] are removed. Unlike small-scale growers and marijuana retailers, large corporations seek profits through consolidation, market expansion, product engineering, international branding, and promotion of heavy use to maximize sales, and use lobbying, campaign contributions, and public relations to create a favorable regulatory environment [2,11,16,17,18,19]. By 2016, US marijuana companies had developed highly potent products [15] and were advertising via the Internet [11] and developing marketing strategies to rebrand marijuana for a more sophisticated audience [20].Without effective controls in place, it is likely that a large marijuana industry, akin to tobacco and alcohol, will quickly emerge and work to manipulate regulatory frameworks and use aggressive marketing strategies to increase and sustain marijuana use [10,11] with a corresponding increase in social and health costs.

Public perception of the low risk of marijuana [21] is discordant with available evidence.

Marijuana smoke has a similar toxicity profile as tobacco smoke [22] and, regardless of whether marijuana is more or less dangerous than tobacco, it is not harmless [2]. The California Environmental Protection Agency has identified marijuana smoke as a cause of cancer [23], and marijuana smokers are at increased risk of respiratory disease [24,25]. Epidemiological studies in Europe have found associations between smokingmarijuana and increased risk of cardiovascular disease, heart attack, and stroke in young adults [15,26]. One minute of exposure to marijuana smoke significantly impairs vascular function in a rat model [27]. In humans, impaired vascular function is associated with adverse cardiovascular outcomes including atherosclerosis and myocardial infarction [27,28,29].

Acute risks associated with highly potent marijuana products (i.e., cannabinoid concentrates, edibles) include anxiety, panic attacks, and hallucinations [15]. Other health risks associated with use include long-lasting detrimental changes in cognitive function [13,15], poor educational outcomes, accidental childhood ingestion and adult intoxication [26], and auto fatalities [30,31]. US Alcohol Policy Is Not a Good Model for Regulating Marijuana The fact that US marijuana legalization is modelled on US alcohol policies is not reassuring. In 2014, 61% of US college students (age 18–25) reported using alcohol in the past 30 days, compared to 19% for marijuana and 13% for tobacco

[32]. Binge drinking is a serious problem, with 41% of young Americans reporting heavy episodic drinking in the past year [33].

Aggressive alcohol marketing likely contributes to this pattern [34]. Even though the alcohol industry’s voluntary rules prohibit advertising on broadcast, cable, radio, print, and digital communications if more than 30% of the audience is under age 21, this standard permits them to advertise in media outlets with substantial youth audiences [35], including Sports Illustrated and Rolling Stone, resulting in American youth (ages 12–20) being exposed to 45% more beer

and 27% more spirits advertisements than legal drinking-aged adults [36]. If such alcohol marketing regulations were applied universally to marijuana, consumption would likely be higher, not lower, than it is now [26].

Using a Public Health Framework from Evidence-Based Tobacco Control to Regulate Retail Marijuana

Table 1 compares the situation in the four US states that have legalized retail marijuana to a public health standard based on successes and failures in tobacco and alcohol control. A public health framework for marijuana legalization would designate the health department as the lead agency with, like tobacco, a mandate to protect the public by minimizing all (not just youth) use. The health department would implement policies to protect nonusers, prevent initiation, and encourage users to quit, as well as regulate the manufacturing, marketing, and distribution of marijuana products, with other agencies (such as tax authorities) playing supporting roles.

Because public health regulations are often in direct conflict with the interests of profit driven corporations [19], it is important to protect the policy process from industry influence. In contrast to what states that have legalized retail marijuana have done to date, a public health framework would require that expert advisory committees involved in regulatory oversight and public education policymaking processes consist solely of public health officials and experts and limit the marijuana industry’s role in decision-making to participation as a member of the “public.” Including the tobacco industry on advisory committees when developing tobacco regulations blocks, delays, and weakens public health policies [37].

TheWorld Health Organization Framework Convention on Tobacco Control, a global public health treaty ratified by 180 parties as of April 2016, recognizes the need to protect the policymaking process from industry interference:

“[Governments] should not allow any person employed by the tobacco industry or any entity working to further its interests to be a member of any government body, committee or advisory group that sets or implements tobacco control or public health policy.” [37, Article 5.3]”

A marijuana regulatory framework that prioritizes public health would have similar provisions. A public health framework would avoid regulatory complexity that favors corporations with financial resources to hire lawyers and lobbyists to create and manipulate weak or unenforceable policies [11]. To simplify regulatory efforts, including licensing enforcement, implementation of underage access laws, prevention and education programs, and taxation, a public health framework would create a unitary market, in which all legal sales, regardless of whether use is intended for recreational or medical purposes, follow the same rules [38]. Unlike Colorado, Oregon, and Alaska, in 2015,Washington State accomplished this public health goal when it merged its retail and medical markets [39].

Earmarked funds to support comprehensive prevention and control programs over time,  hich are not included in the four US states’ regulatory regimes, will be critical to reduce marijuana prevalence, marijuana-related diseases, and costs arising from marijuana use. A public health framework would set taxes high enough to discourage use and cover the full cost of legalization, including a broad-based marijuana prevention and control program. Using a public health approach, the prevention program would implement social norm change strategies, modelled on evidence-based tobacco control programs, aimed at the population as a whole—not just users or youth [9].

Key: ✓ Required by law or regulation; X Not required by law or regulation; –Pending legislative approval or rulemaking process Demand reduction strategies applied to marijuana would include:

1) countering pro-marijuana business influence in the community;

2) reducing exposure to secondhand marijuana smoke and aerosol and other marijuana products (including protecting workers vulnerable to these exposures);

3) controlling availability of marijuana and marijuana products;

4) promoting services to help marijuana users quit.

A public health framework would protect the public from second hand smoke exposure by including marijuana in existing national and local smoke free laws for tobacco products, including e-cigarettes. Local governments would have authority to adopt stronger regulations than the state or nation. There would be no exemptions for indoor use in hospitality venues, marijuana retail stores, or lounges, including for “vaped” marijuana. To protect the public from industry strategies to increase and sustain marijuana use, a public health framework would prohibit or severely restrict (within constitutional limitations) marketing and advertising, including prohibitions on free or discounted samples, the use of cartoon characters, event sponsorship, product placement in popular media, cobranded-merchandise, and therapeutic claims (unless approved by the government agency that regulates such claims).Marketing would be prohibited on television, radio, billboards, and public transit and restricted in print and digital communications (e.g., internet and social media) with the percentage of youth between ages 12 and 20 as the maximum underage audience composition for permitted advertising (roughly 15% in the US) [35]. These advertising restrictions are justified and would likely pass US Constitutional muster because they are implemented for important public health purposes, are evidence-based[35], and have worked to promote similar goals in other contexts. Legal sellers of the newly legal  marijuana products would be permitted to communicate relevant product information to their legal adult customers.

A scenario in which a public health regulatory framework is applied to marijuana would require licensees to pay for strong licensing provisions for retailers, with active enforcement and license revocation for underage sales. As has been done in the four US states (Table 1), outlets would be limited to the sale of marijuana only to avoid the proliferation and normalization of sales in convenience stores or “big box” retailers. No retailer that sold tobacco or alcohol would be granted a license to sell marijuana products. Based on best public health practices for tobacco retailers [40], marijuana retail stores would be prohibited within 1,000 feet of underage- sensitive areas including postsecondary schools, with limits on new licenses in areas that already have a significant number of retail outlets. Electronic commerce, including internet, mail order, text messaging, and social media sales, would be prohibited because these forms of non traditional sales are difficult to regulate, age-verification is practically impossible [41], and they can easily avoid taxation [42].

Central to a public health framework would be assigning the health department with the authority to enact strong potency limits, dosage, serving size, and product quality testing for marijuana and marijuana products (e.g., edibles, tinctures, oils), with a clear mission to protect public health. Additives that could increase potency, toxicity, or addictive potential, or that would create unsafe combinations with other psychoactive substances, including nicotine and alcohol, would be illegal. Unlike US restrictions on marijuana products, flavors (that largely appeal to children), would be prohibited.

A public health model applied to marijuana would include health warning labels that follow state-of-the-art tobacco requirements implemented in several countries outside of the United States, including Uruguay, Brazil, Canada, and Australia [43]. Public health-oriented labels would:

1) be large, (at least 50% of packaging) on front and back and not limited to the sides,

prominently featured, and contain dissuasive imagery in addition to text;

2) be clear and direct and communicate accurate information to the user regarding health risks associated with marijuana use and secondhand exposure; and

3) use language appropriate for low-literacy adults.

Health messages would include risk of dependence [2], cardiovascular [2,44,45], respiratory [25], and neurological disease [46], and cancer [23], and would warn against driving a vehicle or operating equipment, as well as the risks of co-use with tobacco or alcohol. While there is already adequate scientific evidence to raise concern about a wide range of adverse health effects, there is more to learn. Earmarked funds from marijuana taxes would also provide an ongoing revenue stream for research that would guide marijuana prevention and control efforts and mitigate the human and economic costs of marijuana use, as well as better define medical uses as the basis for proper regulation of marijuana for therapeutic purposes.

Avoiding a Private Market

Privatizing tobacco and alcohol sales leads to intensified marketing efforts, lower prices, more effective distribution, and an industry that will aggressively oppose any public health effort to control use [47,48]. Avoiding a privatized marijuana market and the associated pressures to increase consumption in order to maximize profits would likely lead to lower consumer demand, consumption, and prevalence, even among youth, and would reduce the associated public health harm [49].

Governments may avoid marijuana commercialization by implementing a state monopoly over its production and distribution, similar to Uruguay’s regulatory structure for marijuana [3,50] and to the Nordic countries’ alcohol control systems [51], which are designed to protect public health over maximizing government revenue. The state would have more control over access, price, and product characteristics (including youth-appealing products or packaging, potency, and additives) and would refrain from marketing that promotes increased use [3,52].

In cases where national laws cause concern about local authority’s ability to adopt government monopolies, a public health authority could be used as an alternative [53].

It is important to avoid intrinsic conflicts of interest created by state ownership. As is the case with state-ownership of tobacco, without specific policies to prioritize public health, a state’s desire to increase revenue often supersedes public health goals to minimize use [51,52]. Beyond mitigating potential conflicts of interest inherent in state monopolies, a public health framework for marijuana would instruct the government agency that manages the monopoly to minimize individual consumption in order to maximize public health at the population level. (Similar public health goals are explicit in Nordic alcohol monopolies [51].)

While a state monopoly is an effective approach to protect public health [51,54], in practice, however, even the strongest government monopolies for alcohol (i.e., Nordic Countries) have been eroded over time by multinational companies that argue such controls are illegal protectionism under international and regional trade agreements [4,51].While trade agreements have been used to threaten tobacco control and other public health policies [55], clearly identifying protection of public health as the goal of the state monopoly would make it more difficult to challenge these controls, especially if sales revenues were used to help fund evidence-based demand reduction policies [49] (Table 1).

Conclusion

It is important that jurisdictions worldwide learn from the US experience and implement, concurrently with full legalization, a public health framework for marijuana that minimizes consumption to maximize public health (Table 1). A key goal of the public health framework would be to make it harder for a new, wealthy, and powerful marijuana industry to manipulate the policy environment and thwart public health efforts to minimize use and associated health problems.

Acknowledgments

This paper is based on an invited presentation at the Marijuana and Cannabinoids: A Neuroscience Research Summit held at the National Institutes of Health onMarch 22–23, 2016.

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PLOS Medicine | DOI:10.1371/journal.pmed.1002131 September 27, 2016 9 / 9

Source:  http://journals.plos.org/plosmedicine/article?id=10.1371%2Fjournal.pmed.1002131

Chelsea Clinton recently suggested that marijuana might be deadly when taken with other drugs. But is this really true?

Although marijuana can interact with other drugs, there do not appear to be any reports of deaths that directly resulted from taking marijuana in combination with other drugs.

While speaking in Ohio on Sept. 24, Clinton was asked whether her mother, Hillary Clinton, supports changing the way marijuana is categorized by the Drug Enforcement Administration so that it would be easier for researchers to conduct studies on the drug. Chelsea Clinton replied that her mother does support research on marijuana. Then, she added, “But we also have anecdotal evidence now from Colorado, where some of the people who were taking marijuana for those purposes, the coroner believes, after they died, there was drug interactions with other things they were taking.”

A spokesperson for Clinton later said Clinton “misspoke about marijuana’s interaction with other drugs contributing to specific deaths,” according to The Huffington Post.

By itself, marijuana is not known to have direct lethal effects. According to the U.S. Drug Enforcement Administration, no overdose deaths from marijuana have been reported in the United States.

In addition, the evidence that marijuana may interact with other drugs is limited, according to a 2007 review paper in the American Journal of Health-System Pharmacy.

Still, marijuana does appear to interact with a number of drugs, the review said. If marijuana is taken with alcohol, benzodiazepines (drugs that treat anxiety) or muscle relaxants, the combination can result in “central nervous system depression,” the review said, which means that people can experience decreased breathing and heart rate, and loss of consciousness. [How 8 Common Medications Interact with Alcohol]

There also have been reports of people experiencing a rapid heart rate and delirium after using marijuana while taking older forms of antidepressants (known as tricyclic antidepressants), the review said.

Marijuana may also interact with drugs that are broken down by enzymes in the liver known as cytochrome P450 enzymes, according to the Mayo Clinic. That’s because a compound in marijuana called cannabidiol can inhibit these enzymes. Therefore, marijuana may prevent other drugs from being broken down properly, and as a result,

levels of these other drugs may be increased in the blood, which “may cause increased effects or potentially serious adverse reactions,” the Mayo Clinic says.

One example is the drug sildenafil, commonly known by the brand name Viagra, which is broken down by cytochrome P450 enzymes. In 2002, researchers in the United Kingdom reported that a 41-year-old man had a heart attack after taking marijuana and Viagra together. This report could not prove that the marijuana-Viagra combination was definitely the cause of the man’s heart attack. However, the researchers said that doctors “should be aware” of the effects of inhibiting cytochrome P450 enzymes when prescribing Viagra.

Still, Live Science could not find any scientific or news reports of people who have died as a result of marijuana interacting with another drug.

But that doesn’t mean marijuana is harmless — the drug can impair coordination and slow down reaction time, and it has been linked with fatal car crashes, according to the National Institute on Drug Abuse (NIDA). A 2011 study found that people who reported driving within 3 hours of using marijuana, or drivers who tested positive for the drug, were more than twice as likely to be involved in a car crash compared with other drivers.

The Mayo Clinic says marijuana can increase the drowsiness caused by some drugs, including diazepam (Valium), codeine, antidepressants and alcohol, and so people need to be cautious if they drive or operate machinery after using these drugs with marijuana.

People who take high doses of marijuana may experience anxiety attacks or hallucinations, according to the NIDA. In some rare cases, intoxication with marijuana has been linked with suicide. In 2014, researchers from Germany reported that two men died from heart problems that were brought on by smoking cannabis. But marijuana may have a benefit in terms of reducing deaths from opioid painkillers. A 2014 study found that rates of overdose death from opioids were lower in states where medical marijuana is legal. Another study, published earlier this month, found that rates of opioid use decreased among younger adults in states that had legalized medical marijuana. It’s possible that people are substituting medical marijuana for opioids to treat chronic pain, the researchers said.

Source:http://www.livescience.com/56356-marijuana-drug-interactions.html

3rd Oct.2016

Latest statistics show 305 admissions were diagnosed as drugs misuse in the year 2011/12 — compared to 97 in 2007/08.

Across NHS Tayside as a whole the number has more than doubled, with an increase from 244 five years ago to 512 last year.  Doctors have warned there is now a “constant background level of recreational drug use” in the region’s Accident and Emergency departments.

A&E consultant Dr Julie Ronald said people come in with drugs-related problems most weekends.  She said: “We deal with a lot of drugs-related admissions. It can be very time consuming — especially if patients cause disruption to the rest of the department.

“It’s something we see most weekends of some variety. The vast majority are brought in by ambulance.  Usually someone has been with the patient or found them and decided they require medical attention.”

Across Tayside, opioids — such as heroin — were the cause for more than 80% of admissions over the period.  Of these, 60 were categorised as resulting from multiple drugs or other less common drugs.

And 468 — more than 90% — were classed as emergency admissions. Also last year, 28 of the admissions were for cannabis-type drugs, nine were for cocaine, eight for sedatives or hypnotics and seven were for other sedatives.

Dr Ronald, who works in the A&E departments at Ninewells Hospital and Perth Royal Infirmary, said there has been a noticeable increase in younger patients for drugs misuse .She said: “There is a constant background level of recreational drug use. We’re always coming into contact with it. We do see heroin misuse. What we have certainly seen is more recreational legal high-type drugs.   A lot of teens and people in the younger age groups are coming in who have taken party drugs, such as bubbles or MCAT.”

Some 89 of the admissions for 2011/12 had to stay in hospital for a week or longer. Dr Ronald said: “A&E look after the vast majority of people coming in with recreational drug misuse. We tend to keep them in for a few hours for observation, or overnight if they need to be monitored for longer.”

Source:  www.eveningtelegraph.co.uk   15th June 2013

6-suprising-ways-alcohol-affects-your-health

Some of the ways alcohol affects our health are well known, but others may surpriseyou. Here are six less-known effects that alcohol has on your body, according to gastroenterologist Ibrahim Hanouneh, MD:

  1. Drinking gives your body work to do that keeps it from other processes. Once you take a drink, your body makes metabolizing it a priority — above processing anything else. Unlike proteins, carbohydrates and fats, your body doesn’t have a way to store alcohol, so it has to move to the front of the metabolizing line. This is why it affects your liver, as it’s your liver’s job to detoxify and remove alcohol from your blood.

  2. Abusing alcohol causes bacteria to grow in your gut, which can eventually migrate through the intestinal wall and into the liver, leading to liver damage.

  3. Too much is bad for your heart. It can cause the heart to become weak (cardiomyopathy) and have an irregular beat pattern (arrhythmias). It also puts people at higher risk for developing high blood pressure.

  4. People can develop pancreatitis, or inflammation of the pancreas, from alcohol abuse.

  5. Drinking too much puts you at risk for some cancers, such as cancer of the mouth, esophagus, throat, liver and breast.

  6. It can affect your immune system. If you drink every day, or almost every day, you might notice that you catch colds, flu or other illnesses more frequently than people who don’t drink. This is because alcohol can weaken the immune system and make the body more susceptible to infections.

Your liver heads up alcohol breakdown process. When you drink, here’s what happens in your liver, where alcohol metabolism takes place.

Your liver detoxifies and removes alcohol from the blood through a process known as oxidation. Once the liver finishes the process, alcohol becomes water and carbon dioxide. If alcohol accumulates in the system, it can destroy cells and, eventually, organs. Oxidative metabolism prevents this.

But when you’ve ingested too much alcohol for your liver to process in a timely manner, the toxic substance begins to take its toll on your body, starting with your liver. “The oxidative metabolism of alcohol generates molecules that inhibit fat oxidation in the liver and, subsequently, can lead to a condition known as fatty liver,” says Dr. Hanouneh.

Fatty liver, early stage alcoholic liver disease, develops in about 90 percent of people who drink more than one and a half to two ounces of alcohol per day. So, if you drink that much or more on most days of the week, you probably have fatty liver. Continued alcohol use leads to liver fibrosis and, finally, cirrhosis.

The good news is that fatty liver is usually completely reversible in about four to six weeks if you completely abstain from drinking alcohol. Cirrhosis, on the other hand, is irreversible and likely to lead to liver failure despite abstinence from alcohol, according to Dr. Hanouneh. If you drink heavily, see your doctor immediately if you notice a yellow tinge to your skin, feel pain in the upper right portion of your abdomen or experience unexplained weight loss.

Healthy people can drink — a little

If you’re healthy, Dr. Hanouneh says you don’t have to avoid alcohol altogether, but you should not drink every day, or even most days of the week. And, when you drink, men should not drink more than two or three ounces and women should not consume over one or two ounces. If you have liver disease, or some other health issue, you should not drink alcohol at all.

This article was written by Digestive Health Team from Cleveland Clinic and was legally licensed through the NewsCred publisher network.

Source: http://www.msn.com/en-us/health 17th March 2015

“Many studies have linked marijuana use with early onset of psychosis. The question is, does smoking marijuana cause earlier psychosis? A new review of 83 studies involving more than 22,000 participants seeks an answer.

The meta-analysis found that people who smoked marijuana developed psychotic disorders an average 2.7 years earlier than people who did not use cannabis.

 
Context

A number of studies have found that the use of cannabis and other psychoactive substances is associated with an earlier onset of psychotic illness.
Objective

To establish the extent to which use of cannabis, alcohol, and other psychoactive substances affects the age at onset of psychosis by meta-analysis.

 
Data Sources

Peer-reviewed publications in English reporting age at onset of psychotic illness in substance-using and non–substance-using groups were located using searches of CINAHL, EMBASE, MEDLINE, PsycINFO, and ISI Web of Science.

 
Study Selection

Studies in English comparing the age at onset of psychosis in cohorts of patients who use substances with age at onset of psychosis in non–substance-using patients. The searches yielded 443 articles, from which 83 studies met the inclusion criteria.

 
Data Extraction

Information on study design, study population, and effect size were extracted independently by 2 of us.

 
Data Synthesis

Meta-analysis found that the age at onset of psychosis for cannabis users was 2.70 years younger (standardized mean difference = –0.414) than for nonusers; for those with broadly defined substance use, the age at onset of psychosis was 2.00 years younger (standardized mean difference = –0.315) than for nonusers. Alcohol use was not associated with a significantly earlier age at onset of psychosis. Differences in the proportion of cannabis users in the substance-using group made a significant contribution to the heterogeneity in the effect sizes between studies, confirming an association between cannabis use and earlier mean age at onset of psychotic illness.

 
Conclusions.

The results of meta-analysis provide evidence for a relationship between cannabis use and earlier onset of psychotic illness, and they support the hypothesis that cannabis use plays a causal role in the development of psychosis in some patients. The results suggest the need for renewed warnings about the potentially harmful effects of cannabis.

 

 
Matthew Large, BSc(Med), MBBS, FRANZCP; Swapnil Sharma, MBBS, FRANZCP; Michael T. Compton, MD, MPH; Tim Slade, PhD; Olav Nielssen, MBBS, MCrim, FRANZCP

 
Source: Arch Gen Psychiatry. Published online February 7, 2011. doi:10.1001/archgenpsychiatry.2011.5

Filed under: Cannabis/Marijuana,Health :

Dublin city coroner Dr Brian Farrell is to write to the Department of Health to highlight a link between methadone use and heart failure following an inquest into the death of a 30-year-old man.   Philip Wright of Celbridge, Co Kildare, died on December 13th, 2011, having collapsed after taking heroin.

He had discharged himself on December 12th from Connolly Hospital Blanchardstown where he had been taken off methadone, a heroin replacement drug, because of the dangerous effect it was having on his heart. Mr Wright had attended the hospital on December 9th after collapsing at home. He was also on antibiotics for a chest infection.

Dr Joseph Galvin, consultant cardiologist at the hospital, told the coroner an electrocardiogram (ECG) carried out on Mr Wright picked up a problem with his heart and his methadone was stopped on December 11th. He said the drug could put the heart out of rhythm by changing its electrical properties “in a dangerous way”.

Mr Wright’s heart returned to normal after he was taken off methadone, he said. Recent studies had shown up to 18 per cent of people on methadone had experienced the same heart problems, he said.   The doctor recommended that anyone who collapsed while using methadone should have an ECG carried out. “It is not as benign a drug as was first thought,” Dr Galvin said.

He also said he had recommended an alternative drug for Mr Wright to replace the methadone: buprenorphine.  By lunchtime on Monday, December 12th, Mr Wright had not received the drug. His father, James Wright, told the coroner his son feared he would go into severe withdrawal without it.  He discharged himself from hospital against medical advice and obtained heroin. He died of respiratory failure in the bathroom of his parents’ home the following day having injected the heroin.

Evidence was also given that the pharmacy in the hospital did not receive a request for buprenorphine for Mr Wright and there were issues around access to the drug.

There was also a recommendation that there should be an interval between the time methadone is stopped and buprenorphine is given.  Returning a verdict of death by misadventure, Dr Farrell said he would write to the department and to methadone maintenance authorities and clinics about the potential cardiac effects of methadone.

He would also raise the issue of availability of buprenorphine.

Source: www.irishtimes.com Sat. 5th Jan

A study by doctors from the National Institute of Drug Abuse found that people who smoked marijuana had changes in the blood flow in their brains even after a month of not smoking. The marijuana users had PI (pulsatility index) values somewhat higher than people with chronic high blood pressure and diabetes, which suggests that marijuana use leads to abnormalities in the small blood vessels in the brain. These findings could explain in part the problems with thinking and remembering found in other studies of marijuana users.

According to two studies, marijuana use narrows arteries in the brain, similar to patients with high blood pressure and dementia, and may explain why memory tests are difficult for marijuana users. In addition, chronic consumers of cannabis lose molecules called CB1 receptors in the brain‘s arteries, leading to blood flow problems in the brain which can cause memory loss, attention deficits, and impaired learning ability.

Source: drugabuse.gov

More than 200 people in Colorado who smoked synthetic marijuana during a 1-month period last summer developed altered mental status severe enough to require emergency care, according to a state public health investigation.

 

The investigation was prompted by several hospitals that contacted the Colorado Department of Public Health and Environment (CDPHE). Increasing numbers of patients had come to their emergency departments with aggression, agitation, confusion, and other symptoms after smoking the synthetic drug. The CDPHE asked all Colorado emergency departments to report through a Web-based system any patients treated with altered mental status who used synthetic marijuana between August 21 and September 18.

Source:   JAMA. 2014;311(5):457. doi:10.1001/jama.2014.47.

leonard-nimoy-5774458356-1-bynimoy

Photo:Gage Skidmore/Wikimedia Commons*

 “Live long and prosper.” The Vulcan salute is immediately identifiable with the actor Leonard Nimoy  and his most famous character, Mr. Spock. The  beloved cultural icon was admired for his sterling character on Star Trek and off-screen as well. In  recent years and up until his last few months, while  suffering the debilitating effects of a respiratory illness, he took steps to ensure that others would indeed “live long and prosper” by speaking clearly about the role that smoking played in the illness that caused his death.

Nimoy started smoking, like many, when he was young. He managed to quit more than 30 years before his death, but not early enough to prevent the respiratory disease that took his life late February. Nimoy took great pains to show us that cigarettes are a deadly addiction – encouraging followers on Twitter to quit or never start. While he was just one of the 480,000 people in the U.S. who will die prematurely from tobacco-related diseases in 2015, he will surely be among the most well-known and widely missed by an admiring public. That makes the steps took to tell his story so vital.

Tobacco is one of the toughest addictions to overcome and by far the most deadly product available. About 14 million major medical conditions in the U.S. can be blamed on smoking. Yet, despite that inescapable fact, more than 42 million Americans still smoke.

And it isn’t just smoking. Smokeless tobacco products, like those used by sports legend,Tony Gwynn, and other professional baseball players, are linked to oral cancer and other illnesses. Like Nimoy, Gwynn was outspoken before his death last year in naming chewing tobacco as the cause of his cancer. His efforts to speak the truth give meaning to the efforts of a coalition working to eliminate tobacco consumption on and around American baseball fields. Knock Tobacco Out of the Park will succeed, in part, because icons like Gwynn and Nimoy shared their stories and demonstrated the painful cost of tobacco-related illness.

The glamour and appeal of smoking and the power of nicotine addiction are forces that we work to counter every day at Legacy. Even that first cigarette does damage to your body and can spur a life-long addiction and struggle. Nimoy could not imagine what would happen to him five decades after he smoked his first cigarette. By sharing his story, he may help other smokers comprehend the illness and death that lie in wait for them.

As fans remember Leonard Nimoy and Tony Gwynn for cherished memories and contributions to our shared culture, we celebrate them as ambassadors of truth and of knowledge in the fight to build a future where illness and death, caused by the use of tobacco, are things of the past.

Source: www.drugfree.org 18th March 2015

Highlights

* •People arrested multiple times for drug-related offences have shorter life expectancy.

* •Accidental overdosing with drugs was a common manner of death in repeat offenders.

* •In 44% of poisoning deaths four or more drugs were identified in autopsy blood samples.

* •Illicit recreational drugs, such as heroin, cannabis and amphetamine were common findings.

* •The major prescription drugs identified in blood were opioid analgesics and sedative-hypnotics.

Abstract

Background

Multiple arrests for use of illicit drugs and/or impaired driving strongly suggests the existence of a personality disorder and/or a substance abuse problem.

Methods

This retrospective study (1993–2010) used a national forensic toxicology database (TOXBASE), and we identified 3943 individuals with two or more arrests for use of illicit drugs and/or impaired driving. These individuals had subsequently died from a fatal drug poisoning or some other cause of death, such as trauma.

Results

Of the 3943 repeat offenders 1807 (46%) died from a fatal drug overdose and 2136 (54%) died from other causes (p < 0.001). The repeat offenders were predominantly male (90% vs 10%) and mean age of drug poisoning deaths was 5 y younger (mean 35 y) than other causes of death (mean 40 y). Significantly more repeat offenders (46%) died from drug overdose compared with all other forensic autopsies (14%) (p < 0.001). Four or more drugs were identified in femoral blood in 44% of deaths from poisoning (drug overdose) compared with 18% of deaths by other causes (p < 0.001). The manner of death was considered accidental in 54% of deaths among repeat offenders compared with 28% for other suspicious deaths (p < 0.001). The psychoactive substances most commonly identified in autopsy blood from repeat offenders were ethanol, morphine (from heroin), diazepam, amphetamines, cannabis, and various opioids.

Conclusions

This study shows that people arrested multiple times for use of illicit drugs and/or impaired driving are more likely to die by accidentally overdosing with drugs. Lives might be saved if repeat offenders were sentenced to treatment and rehabilitation for their drug abuse problem instead of conventional penalties for drug-related crimes.

Source:  www.fsijournal.org. August 2016  Volume 265, Pages 138–143  DOI: http://dx.doi.org/10.1016/j.forsciint.2016.01.036

Dr. Raj Waghmare says Cannabinoid Hyperemesis syndrome is stomach pain and nausea that can be helped by hot baths or stopping cannabis use.

Marijuana is having a moment. The once recreational-use-only drug is now considered by many as a medicine, an anti-nauseant and pain reliever, even an epilepsy medication.

But some long-term “pot heads” are finding the drug they once loved can suddenly turn on them and become almost toxic.   These users are developing a little-understood condition called cannabinoid hyperemesis syndrome that brings on unrelenting vomiting, nausea and stomach pain.

Standard medications do not relieve it, smoking more marijuana only seems to worsen it, and some doctors say they are seeing a lot more cases of it.

It was intense stomach pains that brought Dave to his doctors four months ago. The 45-year-old from southern Ontario (who’d prefer not to use his full name) knew he needed help when intense cramping left him balled up on the sofa, unable to work.  “I really wasn’t able to function much at all. I was constantly having to lie down with a constant pain,” he told CTVNews.ca by phone.

Even after Dave’s doctor ordered reams of ultrasounds, CT scans, and colonoscopies, no one could find anything wrong with him, leaving Dave frustrated.  “It was starting to take a toll on me after a few months. I was doing all these tests and not knowing what was wrong with me or who to turn to,” he says.  Dave finally turned to the internet, where he stumbled on discussions about cannabinoid hyperemisis, a condition he had never heard of.

History of hyperemesis

The first mention of the syndrome appeared in 2004, when a doctor in Australia published an article in the journal Gut describing several patients with a “cyclical vomiting illness” (or hyperemesis). All the patients had a history of “chronic cannabis abuse” and all seemed to find relief from their symptoms by taking multiple hot showers or baths a day.

“Everything I read about this CHS fit the picture,” Dave says.

“The only thing I didn’t have was the vomiting. But I had nausea and constant stomach pain and I was getting relief with hot baths and showers,” he said.

Dave also had a 25-year history of daily pot smoking. He had recently switched to smoking “shatter,” a marijuana concentrate high in THC, that he believes made things worse. Though Dave had told his doctor about his drug use, he connect his symptoms to

CHS. In fact, the physician may have never seen another patient with CHS. Emergency room doctors such as Dr. Raj Waghmare are seeing them, however. Waghmare recently wrote a blog post about the first time hediagnosed a patient with CHS, just under two years ago.

The well-dressed man had come into his ER with non-stop vomiting and abdominal pain. Like Dave, this man’s blood and urine test came out normal, yet no matter what drug Waghmare offered him, nothing seemed to quell his nausea.

Then the man mentioned that hot baths helped to dull the pain. That’s when Waghmare recognized CHS from an article he had read about in a Canadian medical journal.

It’s a condition that can’t be easily diagnosed, since there is no one test that can spot it. It’s only after everything else has been ruled out and a history of pot use has been established that doctors are left with CHS.

Waghmare says he’s since seen dozens more patients with CHS come through the doors of Southlake Regional Health Centre where he works.

“I probably see this every week in the ER,” he says. “if we were to go through all the charts from a full week, I’m sure we’d see at least a case of day among all the doctors.”

Most of the patients Waghmare sees had no idea that the drug they used every day could suddenly become toxic to them.  “People don’t know that this exists,” he says.

What actually causes CHS remains a mystery. The THC (tetrahydrocannabinol) in marijuana causes the drug’s high by stimulating the brain’s cannabinoid receptors, but one theory is that in some patients, those receptors eventually become overloaded.

“So it will work for nausea in the beginning, but then it will totally desensitize the receptors so that people will just feel nauseated all the time,” says Waghmare.

Why some patients develop the syndrome and others don’t remains a mystery; the condition hasn’t been the subject of rigorous scientific study. It appears to develop in those who smoke weed several times a day for a decade or so. But there is some evidence that people who begin daily pot use at a young age are more at risk.

The majority of CHS patients coming to see Waghmare are young men who have been smoking marijuana since high school. By the time they reach their mid-20s, they have a decade of use under their belts.

And yet many refuse to believe the pot is the problem.

When Waghmare tells young pot users the only thing that will end their vomiting and pain is to quit smoking weed for good, they often stop listening.  “A lot of these patients who come in are ‘frequent flyers,’ They’ve heard it before and they refuse to believe it. They refuse to give it up,” he says.

But older patients often take his advice and quit cold turkey, as the patient who Waghmare wrote about promised he would do. As an ER doc, however, he has no way of following up. At least one Facebook group has also been formed in which users discuss their symptoms and experiences.

As for Dave, he says has stopped smoking both marijuana and shatter. In fact, he wishes he never tried shatter at all, since he suspects that is what triggered his symptoms. Now, after three months of pain, he’s finally beginning to feel better. He’s also found a new doctor and has begun a new drug regimen for his Type 2 diabetes, which is also helping him feel better.

But doctors like Waghmare says there needs to be more awareness that this syndrome can develop in some pot users.

With all the recent discussions about the medicinal uses for marijuana, and the ongoing discussion about legalization, Waghmare says many pot users assumes the drug is benign, that it relieves pain and nausea, that there’s no way it could cause it.

“There’s this belief that (marijuana) is totally safe, a miracle drug, Not true,” he says.

Source:  http://www.ctvnews.ca/health/pot-pains-why-marijuana-can-become-toxic-for-some-1.2984756     13th July 2016

NEW YORK — More than two dozen people were sickened in an apparent mass drug overdose on a New York City street corner, sparking warnings from police and health officials about the dangers of using K2, also known as synthetic marijuana.

Calls started coming in Tuesday morning that numerous people appeared to be overdosing in the Bedford-Stuyvesant neighbourhood of Brooklyn. Witnesses reported seeing victims lying on the sidewalk, shaking and leaning against trees and fire hydrants.

Thirty-three people were taken to area hospitals with non-life-threatening injuries, police said. It was not immediately clear what drugs the victims had ingested, but police said some of the victims had been smoking K2.

Dennis Gonzalez of Bushwick told WNBC-TV that K2 use in that part of Brooklyn is out of control.

“It’s gotten out of hand,” Gonzalez said. “They even sleep in the street, we have to walk around them. It’s just too much to keep under control.”

The Health Department issued a statement Tuesday saying it “recorded a spike in K2-related emergency room visits” connected to the incident in Brooklyn. The department said it’s investigating and monitoring emergency rooms across the city.

“We remind New Yorkers that K2 is extremely dangerous,” the Health Department said in its statement. “The city’s public awareness efforts and aggressive enforcement actions over the past year have contributed to a significant decline in ER visits related to K2.”

Though K2 affects the same area of the brain as marijuana, it contains chemicals made in laboratories and sprayed onto dry leaves. These chemicals are not derived from the marijuana plant, according to the Health Department.

K2 can cause extreme anxiety, confusion, paranoia, hallucinations, rapid heart rate, vomiting, fainting, kidney failure and reduced blood supply to the heart.

The production and sale of the drug was outlawed in New York City in October 2015.

Source: http://www.ctvnews.ca/health/33-sick-after-apparent-mass-drug-overdose-in-new-york-city-1.2984643    13th July 2016

Filed under: Health,Synthetics,USA :

A backlash is growing in a state where marijuana has quickly become a $1 billion legal business. For months, Paula McPheeters and a handful of like-minded volunteers have spent their weekends in grocery-store parking lots, even in 95° F heat. Sitting around a folding table draped with an American flag, they asked passing shoppers to sign a petition. Inevitably a few sign-wielding young protesters would show up to argue that McPheeters’s group was dead wrong. With the two sides often just yards away from each other, shouting matches erupted. “We’re peaceful people,” one woman yelled. “You’re drugged out,” countered an angry man. Threats and phone calls to police became the norm.  The wedge dividing the people of this small blue-collar city of Pueblo, Colo.?   Legal marijuana.

Colorado gave the green light to recreational marijuana back in 2012, when it passed a law to make nonmedical pot sales legal starting Jan. 1, 2014. But now opposition is rising in communities across the state. Colorado has become a great social experiment, the results of which are still not clear. “The jury is still out as to whether this was a good idea,” says Colorado attorney general Cynthia Coffman.

What’s undeniable is this: Legal marijuana is in high demand in Colorado. Only three other states—Alaska, Washington, and Oregon—plus the District of Columbia currently permit recreational adult use of cannabis. (It’s legal for medical use in another 19 states.) Of that group, Colorado led the way in 2015 with $996.5 million in licensed pot sales—a 41.7% jump over 2014 and nearly three times the figure in Washington State. Recreational sales made up nearly two-thirds of the total.

Now, as citizen groups attempt to put the brakes on the growing industry, a heated debate has emerged about the drug’s societal impact. Doctors report a spike in pot-related emergency room visits—mostly due to people accidentally consuming too much of potent edible pot products. Police face new cartel-related drug operations. Parents worry about marijuana being sold near their homes and schools. And less affluent communities like Pueblo struggle with the unintended consequences of becoming home to this emerging and controversial industry.

Amendment 64 decriminalized marijuana statewide, but Colorado’s cities and counties still decide if the drug can be grown and sold locally. At least 70% of the municipalities in the state have banned commercial operations, either by popular vote or board decisions.

Many other communities have begun pushing back. Last fall, controversy arose in the small western Colorado town of Parachute when an antipot group attempted to recall members of the town council who had welcomed pot shops. (Voters defeated the recall 3 to 1.) Debate has since emerged in Aspen, Carbondale, Glenwood Springs, Grand Junction, Littleton, and Rifle over the number, location, smell, and mere existence of retail and cultivation facilities. Citizens in the San Luis Valley, in the southern part of the state, say their schools and social services have been overwhelmed by a flood of newcomers coming to grow cannabis on cheap land, despite limited water. And just this spring officials in Colorado Springs and Englewood opted to ban pot social clubs, which are akin to lounges in which people can legally smoke weed in public.

“I’m getting calls now from people who voted for legalization thinking it wouldn’t affect them,” says Kevin Sabet, co-founder of national antimarijuana legalization group Smart Approaches to Marijuana. “They’re surprised to see these are sophisticated businesses opening up next to their schools selling things like marijuana gummy bears. And they’re angry.”

Officials in Denver, which is home to one-third of the state’s cannabis market, moved this spring to rein in pot capitalism. The city passed an ordinance capping the number of dispensaries and grow facilities at the present level. But discontent continues to fester in poorer communities, where many of these operations inevitably land. “We were told that legalization would take drugs out of our community,” says Candi CdeBaca, a community activist who grew up in the mostly Latino and poor Denver neighborhood of Elyria-Swansea. “The drugs stayed—and the drug dealers changed.”

CdeBaca points to, for example, an increase in school suspensions related to marijuana. And unlike the meatpacking plants and refineries that once dotted the area, CdeBaca says, this new industry hasn’t brought her neighbors jobs. Instead, the money is flowing to outsiders.

“It’s the Wild West, and the well-funded marijuana industry has dominated the regulatory process, and people are finally speaking up,” says Frank McNulty, a lawyer for Healthy Colorado, which plans to put a measure on the November state ballot—an easier task in Colorado than in many other states—that would limit the active drug ingredient THC in cannabis candy and concentrates and require health warnings on packaging. The marijuana industry has objected to the proposal, and the issue is now before the Colorado Supreme Court.

Cannabis backers bristle at the pushback, calling it a back-door effort by prohibitionists who simply disagree with the legalization of the drug. Mason Tvert, director of the Marijuana Policy Project, which leads legalization efforts nationwide, cites studies showing minimal impact on society and no harm to Colorado’s growing economy. Says Tvert: “Anyone who says it’s caused an increase in this or that [problem] is full of shit.”

What plays out in Colorado may influence what happens across the nation. Pot remains illegal under federal law. But legalization of recreational marijuana for adult use will be on the November ballot in California, Massachusetts, and Nevada, and likely in Arizona and Maine too. Voters in Arkansas, Florida, and Missouri will be voting on whether to approve it for medical use. The growth of the cannabis industry has begun to attract the interest of big companies. Microsoft announced in mid-June that it has developed a software product to help states track marijuana growth and sales.

In a recent appearance on CNBC, Colorado Gov. John Hickenlooper offered this advice to other states considering legalization: “I would suggest wait a year or two and see how it goes.”

Nowhere has the impact of legalization in Colorado been felt more powerfully than in the small community of Pueblo, located 114 miles south of Denver. At least 20 dispensaries and 100 growing facilities with 4 million square feet of cultivation now dot the highways near this town of 160,000, which has aggressively embraced the budding industry, making it the top cultivation spot in the state. “We’re sort of like the Napa Valley of cannabis,” says Pueblo County commissioner Sal Pace.

Pueblo has struggled for decades, ever since the 1983 recession, when most of the jobs at the local CF&I steel mill disappeared. Today the community is dealing with failingschools, rising gang activity, and increased crime. With a total of 26 homicides in 2014 and 2015, Pueblo earned the highest per capita murder rate in the state.

When the county’s three commissioners approved licenses for marijuana operations in 2014, Pueblo’s problems got worse, argues McPheeters, a Pueblo mom and community-college budget manager who is the driving force behind a group called Citizens for a Healthy Pueblo. “The promises of marijuana have not come true,” she argues. After weeks of contentious petition drives, McPheeters’s group believes it has gathered enough signatures to put a measure on the November ballot to revoke all the recreational marijuana licenses in the county. Marijuana industry groups, however, have sued, arguing that the number of signatures falls short under a new state law. A judge is set to decide in July.

Groups serving the poor in Pueblo report a flood of homeless people arriving from other states. Local homeless shelter Posada, for instance, has witnessed a 47% jump in demand since 2014, including 1,200 people who reported to shelter workers that they came to smoke pot or get jobs in the industry, says Posada’s director, Anne Stattelman. She says her funding is tapped out. “It’s changed the culture of our community,” she says.

The city’s three hospitals officially threw their support behind the antipot ballot measure after reporting a 50% spike in marijuana-related ER visits among youth under age 18 and more newborns with marijuana in their system. A number of local businesses are also backing the ban after struggling to find sober employees.

Commissioner Pace, in particular, has emerged as a target of criticism for citizens hoping to rid Pueblo of legal marijuana.  As a state legislator he drafted early pot regulations and then as commissioner led local efforts to launch the industry in Pueblo County after 56% of voters in the city approved Amendment 64. “It will take time to change some people’s opinions that pot is bad,” he says.

The pro-marijuana contingent in Pueblo say critics are misplacing blame for the area’s problems. They argue that the pot business has generated jobs and taxes as well as a college scholarship and a local playground. Revoking the licenses of cannabis shops, they say, will only fuel the black market. Says Chris Jones, an employee at a local dispensary clad in a Bob Marley T-shirt: “We already voted on this one time. Let it stand.”

Both antipot groups and marijuana advocates tend to cherry-pick data to support their claims. However, Larry Wolk, chief medical officer for the state department of health, says it’s too early to draw conclusions about the true social and health impacts on Colorado.

Marijuana-related hospitalizations have tripled in Colorado since legalization, and emergency room visits have climbed 30%, according to a state report released this spring. And pot-related calls to poison control have jumped from 20 to 100 a year, says Wolk. Drug-related school suspensions have also climbed. Yet teen usage hasn’t shot up dramatically, and crime has remained fairly stable. Marijuana-related DUIs increased 3%, and traffic fatalities involving THC increased 44%—but the absolute numbers were small in comparison to those that involved alcohol, according to the report.

The data is tricky, Wolk says, because Colorado didn’t track these numbers the same way prior to legalization. Are there more suspensions, he asks, because teachers are more aware? Are doctors now asking about marijuana at hospitals when they didn’t previously? “It may be a year or two before we’ll really have good answers,” says Wolk.

Marijuana legalization has delivered some surprises statewide to regulators, police, and citizens alike. For instance, many people thought legalization would quash the black market for the drug. “That’s been a fallacy,” says Coffman, Colorado’s attorney general. Legalization of cannabis stores and grow operations has drawn more drug-related crime, she says, including cartels that grow the plant in Colorado and then illegally move it and sell it out of state. “They use the law,” she says, “to break the law.”

Since 2013, law officials say, they have busted 88 drug cartel operations across the state, and just last year law-enforcement made a bust that recovered $12 million in illegal marijuana. Adds Coffman: “That’s crime we hadn’t previously had in Colorado.”

The state legislature is trying to play catch-up. Last year it passed 81 bills enacting changes to drug laws, prompting state law-enforcement groups to request a two-year moratorium on new laws so that they could have time to adjust. Lawsuits are also flying—including one from Colorado’s neighbors. Nebraska and Oklahoma have sued Colorado, claiming that it is violating federal drug statutes and contributing to the illegal drug trade in their states.

Another surprise to many Coloradans is that a promised huge tax windfall to benefit schools hasn’t materialized. Of the $135 million generated in 2015, for example, $20 million goes to regulatory and public-safety efforts related to cannabis, $40 million funds small rural school construction projects, and the rest goes to youth drug prevention and abuse programs. That’s a drop in the bucket for a $6.2 billion education budget.

A third revelation to parents in particular is the potency of today’s pot, says Diane Carlson, a mother of five who started Smart Colorado to protect teens from the drug. The weed, edibles, and concentrates sold in stores have THC levels that average 62% and sometimes as high as 95%, according to a 2015 state report. That compares with levels of 2% to 8% in the 1990s. “We passed this thinking it was benign, that it was the stuff from college,” says Carlson. “The industry is just moving too fast, and we’re playing catch-up while the industry is innovating.”

Sitting in a Denver café, Carlson compares marketing by the marijuana industry to that of Big Tobacco in the 1950s, portraying the product as a harmless cure-all for everything from ADHD to anxiety. Yet research shows that marijuana is harmful to the developing brain. She supports Healthy Colorado’s ballot initiative to limit the active drug ingredient in THC in marijuana edibles, candy, and concentrates to 17%.

The backlash worries Mike Stettler, the founder of Marisol, one of Pueblo County’s largest dispensaries, which has been endorsed by comedian and weed smokers’ icon Tommy Chong. The onetime construction worker fears that Pueblo’s pushback against pot will shut down his entire recreational dispensary and its 10-acre grow operation,

which generated $4.5 million in revenue last year. “I’m hoping and praying this thing doesn’t go through, but you don’t know,” he says.

He says he has invested millions in his business and has more plans for growth. In May he flew to Las Vegas to discuss a partnership with famed guitarist Carlos Santana to create a Santana brand of weed called Smooth, named after the artist’s hit song.

Inside, Marisol is a veritable wonderland for cannabis enthusiasts. Customers can consult a “budtender” for advice on the right weed for energy, sleep, or relaxation. They can also choose from a seemingly boundless variety of marijuana merchandise—from vegan “dabbing” concentrates for water pipes to pot-infused bottled beverages to peanut-butter-and-jelly-flavored THC candies. There are even liquid products designed to alleviate marijuana overdoses.

Giving a tour of the store, employee Santana O’Dell, clad in green tights with tiny marijuana leaves on them, sighs as a beatific smile appears on her face. “This is freedom,” she says.

For a growing number of her neighbors, however, legalized marijuana is starting to feel like a really bad high.

Source:  a version of this article appears in the July 1, 2016 issue of Fortune.

 

Abstract

The recent demonstration that massive scale chromosomal shattering or pulverization can occur abruptly due to errors induced by interference with the microtubule machinery of the mitotic spindle followed by haphazard chromosomal annealing, together with sophisticated insights from epigenetics, provide profound mechanistic insights into some of the most perplexing classical observations of addiction medicine, including cancerogenesis, the younger and aggressive onset of addiction-related carcinogenesis, the heritability of addictive neurocircuitry and cancers, and foetal malformations.

Tetrahydrocannabinol (THC) and other addictive agents have been shown to inhibit tubulin polymerization which perturbs the formation and function of the microtubules of the mitotic spindle. This disruption of the mitotic machinery perturbs proper chromosomal segregation during anaphase and causes micronucleus formation which is the primary locus and cause of the chromosomal pulverization of chromothripsis and downstream genotoxic events including oncogene induction and tumour suppressor silencing.

Moreover the complementation of multiple positive cannabis-cancer epidemiological studies, and replicated dose-response relationships with established mechanisms fulfils causal criteria. This information is also consistent with data showing acceleration of the aging process by drugs of addiction including alcohol, tobacco, cannabis, stimulants and opioids. THC shows a non-linear sigmoidal dose-response relationship in multiple pertinent in vitro and preclinical genotoxicity assays, and in this respect is similar to the serious major human mutagen thalidomide.

Rising community exposure, tissue storage of cannabinoids, and increasingly potent phytocannabinoid sources, suggests that the threshold mutagenic dose for cancerogenesis will increasingly be crossed beyond the developing world, and raise transgenerational transmission of teratogenicity as an increasing concern.

Copyright © 2016 Elsevier B.V. All rights reserved.

KEYWORDS:

Cannabis; Chromothripsis; Dose-response relationship; Epigenetics; Foetal malformations; Heritable; Interdisciplinary; Microtubules; Oncogenesis; Population effects; Threshold dose; Transgenerational; Tubulin

Source:      Reece AS1, Hulse GK2.   Mutat Res. 2016 Jul;789:15-25. doi: 10.1016/j.mrfmmm.2016.05.002. Epub 2016 May 4.PMID: 27208973    10.1016/j.mrfmmm.2016.05.002   DOI: [PubMed – in process] 

Filed under: Cannabis/Marijuana,Health :

When The Baltimore Sun ran an editorial about the Maryland mall shooter, who killed two people and then himself, the newspaper said that mental health problems need to be identified sooner. But it failed to breathe a word about killer Darion Aguilar’s admitted marijuana use. Dr. Christine Miller, a semi-retired molecular neuroscientist living in Maryland, was not too surprised by the omission. She says the liberal media tend to ignore the relationship between marijuana and mental illness.

 

“I know that the editors are aware of the marijuana-psychosis connection because I have corresponded in the past with one of their journalists who was unable to get them interested in a story on the topic,” she told Accuracy in Media. “They did publish one letter I wrote to their local Towson Times affiliate.”

Miller has researched the cause of schizophrenia for many years, and is working to stave off marijuana legalization in Maryland. “Though none of my work involved the study of marijuana use, I became aware of the growing body of literature showing its association with the onset of schizophrenia, and I now regard those numerous reports as the most well-replicated finding in schizophrenia research,” she says.

In a case in Colorado, where marijuana has been legalized, the national news media recently aired a video of a man stealing an SUV with a 4-year-old boy inside, but did not emphasize his history of drug abuse, including marijuana. The Denver Post reported that a pickup truck he had stolen earlier was found with drug paraphernalia, including empty syringes, five pipes containing residues believed to be of methamphetamine and marijuana, as well as 2.1 grams of pot.

 

In another sensational case, in Tennessee, a woman who said she smoked marijuana all day and all night drove her car into a church and stabbed her husband. Church Hill Police Department Chief Mark Johnson told The Kingsport Times News that the woman stated that God had told her to stab her husband for “worshipping” NASCAR. The woman said, “I smoke a bunch of weed. I love to smoke it. Sometimes when I do, I start seeing things that others don’t. Isn’t God good? He told me that this would happen, and just look, I am okay.”

 

In the Washington, D.C. area, The Baltimore Sun isn’t the only paper reluctant to examine the marijuana link to mental illnesses, including schizophrenia and psychosis. After Dr. Miller testified to the Maryland House Judiciary Committee about the marijuana-psychosis connection, she was contacted by Frederick Krunkel of The Washington Post, asking for a phone interview. She said, “I replied, along with my phone number and a time to call, but they never called.”

“It turns out that 15 percent of marijuana users experience psychosis, half of whom will go on to become schizophrenic if they don’t stop using,” she told AIM. “Fortunately, many do stop if they aren’t addicted already, because paranoia is no fun.” She says some people are under the misimpression that if someone is psychotic due to marijuana, it comes from what the marijuana is laced with. “In fact,” she says, “the converse is true—a large study out of Finland last year shows that in acute substance-induced psychosis cases, the cannabis users convert to schizophrenia spectrum disorder at the highest rate.”

Incredibly, however, the Maryland House of Delegates passed Del. Cheryl Glenn and Del. Dan Morhaim’s medical marijuana bill in a 127-9 vote. The dope lobby, known as the Marijuana Policy Project, is saying, “Maryland may finally become the 21st state with an effective medical marijuana law!”   In attempting to explain the media’s failure to cover both sides of this debate, Miller said, “I think we are losing our journalistic standards.” She believes that papers like the Post no longer have the “depth of talent” from reporters who understand how to cover scientific evidence in controversies like this.

 

Another factor, she said, is that there’s a “giddy rush” by the media to jump on the “progressive bandwagon,” which views the marijuana movement as fashionable. In this regard, she singled out CNN’s Dr. Sanjay Gupta, who has been promoting “medical marijuana” without taking into account the serious mental health problems associated with its use. She said liberal reporters are also influenced by the perception that too many members of minority groups are being punished for drug use.

 

Despite the rush to legalize marijuana for various purposes, Miller said the media will eventually be forced to cover the link between marijuana use and mental illness because of the growing number and severity of violent incidents involving schizophrenic individuals using the drug. Those whose schizophrenia manifests in the context of drug use are much more likely to be violent. She also says that in the wake of its legalization in Colorado, data is coming out of that state about impaired driving associated with the increasing use of marijuana.

Source:   http://www.aim.org/aim-column/media-continue-cover-up-of-marijuana-induced-mental-illness/   27th March 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

Objective: Adolescent marijuana use continues to increase in prevalence as harm perception declines. Better understanding of marijuana’s impact on neurodevelopment is crucial. This prospective study aimed to investigate cortical thickness and neurocognitive performance before and after 28 days of monitored abstinence in adolescent marijuana and alcohol users. 

Method: Subjects (N = 54; >70% male) were adolescent marijuana users (ages 15–18 years) with regular alcohol use (MJ + ALC; n = 24) and non-using controls (CON; n = 30) who were compared before and after 4 weeks of sequential urine toxicology to confirm abstinence. Participants underwent magnetic resonance imaging, neuropsychological assessment, and substance use assessment at both time points. Repeated-measures analysis of covariance was used to look at the main effects of group, time, and Group × Time interactions on cortical thickness and neurocognitive functioning. Bivariate correlations estimated associations between cortical thickness, substance use severity, and cognitive performance.

Results: Marijuana users showed thicker cortices than controls in the left entorhinal cortex (ps < .03) before and after monitored abstinence, after adjusting for lifetime alcohol use. More lifetime marijuana use was linked to thinner cortices in temporal and frontal regions, whereas more lifetime alcohol use and heavy episodic drinking episodes was linked to thicker cortices in all four lobes (ps < .05). Age of onset of regular marijuana use was positively related to cortical thickness (ps < .03).

Conclusions: Adolescent alcohol and marijuana use may be linked to altered longer-term neurodevelopmental trajectories and compromised neural health. Cortical thickness alterations and dose-dependent associations with thickness estimates were observed both before and after monitored abstinence and suggest neural differences continue to persist 28 days after cessation of marijuana use. Neural recovery may be identified with longer follow-up periods; however, observed changes related to use severity could have implications for future psychosocial outcomes.  

Joanna Jacobus, Lindsay M. Squeglia, Scott F. Sorg, Tam T. Nguyen-Louie, Susan F. Tapert

Source:  www.jsad.com  (J. Stud. Alcohol Drugs, 75, 729–743, 2014) 

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

An analysis has found moderate-quality evidence supporting the use of cannabinoids for certain types of pain, but not for other conditions such as nausea and sleep disorders. This review of nearly 80 randomized controlled trials has been published in JAMA.

Penny F. Whiting, PhD, of the University of Bristol, Bristol, United Kingdom, and colleagues collected data from 79 randomized controlled clinical trials with 6,462 patients on the use of cannabinoids for nausea and vomiting due to chemotherapy, appetite stimulation in HIV/AIDS, chronic pain, spasticity due to multiple sclerosis or paraplegia, depression, anxiety disorder,sleep disorder, psychosis, glaucoma, or Tourette syndrome. Study quality was determined using the Cochrane risk of bias tool.

Improvements in symptoms with use of cannabinoids were not statistically significant in most studies. Only two trials evaluated cannabis and there was no evidence of differential effects between cannabis and other cannabinoids. There was moderate-quality evidence suggesting that cannabinoids could be beneficial for the treatment of chronic neuropathic or cancer pain, along with spasticity due to multiple sclerosis but low-quality evidence for nausea and vomiting due to chemotherapy, weight gain in HIV, sleep disorders, and Tourette’s syndrome. For cannabinoids in the treatment of anxiety, there was very low-quality evidence; in addition, there was low-quality evidence for no effect on psychosis and very low-level evidence for no effect on depression. No clear evidence for benefits or risks with specific types of cannabinoids or modes of administration was noted. An increased risk of short-term adverse events including dizziness, dry mouth, nausea, fatigue, somnolence, euphoria, vomiting, disorientation, drowsiness, confusion, loss of balance, and hallucination was also found.

In an accompanying editorial, Deepak Cyril D’Souza, MBBS, MD, and Mohini Ranganathan, MD, of the Yale University School of Medicine noted that large double-blind randomized clinical trials are needed to test the short- and long-term safety and efficacy of medical marijuana for various medical conditions. They also added that “since medical marijuana is not a life-saving intervention, it may be prudent to wait before widely adopting its use until high-quality evidence is available to guide the development of a rational approval process.” Currently 23 states and the District of Columbia have introduced laws permitting the use of medical marijuana. For more information visit JAMANetwork.c

Source:  http://www.empr.com/   3rd June 2016

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

 

Summary

This annual statistical report presents information on drug misuse among both adults and children. The topics covered include:

  • Prevalence of drug misuse, including the types of drugs used;
  • Trends in drug misuse over recent years;
  • Patterns of drug misuse among different groups of the population;
  • Health outcomes related to drug misuse including hospital admissions, drug treatment and number of deaths.

The report also summarises Government plans and targets in this area, as well as providing sources of further information and links to relevant documents.

The report draws together data from a variety of different sources and presents it in a user-friendly format. Most of the data contained in the bulletin have been published previously by the Health and Social Care Information Centre, the Home Office, the Office for National Statistics or the National Treatment Agency for Substance Misuse. Previously unpublished figures on drug-related admissions to hospital are presented using data from the Health and Social Care Information Centre’s Hospital Episode Statistics (HES).

Key facts

Drug misuse related hospital admissions (England)

  • In 2014/15, there were 8,149 hospital admissions with a primary diagnosis of drug-related mental health and behavioural disorders. This is 14 per cent more than 2013/14 but only 4 per cent higher than 2004/05.
  • There were 14,279 hospital admissions with a primary diagnosis of poisoning by illicit drugs. This is 2 per cent more than 2013/14 and 57 per cent more than 2004/05.

Deaths related to drug misuse (England and Wales)

  • In 2014 there were 2,248 deaths which were related to drug misuse. This is an increase of 15 per cent on 2013 and 44 per cent higher than 2004.
  • Deaths related to drug misuse are at their highest level since comparable records began in 1993.

Drug use among adults (England and Wales)

  • In 2015/16, around 1 in 12 (8.4 per cent) adults aged 16 to 59 had taken an illicit drug in the last year. This equates to around 2.7 million people.
  • This level of drug use was similar to the 2014/15 survey (8.6 per cent), but is significantly lower than a decade ago (10.5 per cent in the 2005/06 survey).

Drug use among children (England)

  • In 2014, 15 per cent of pupils had ever taken drugs, 10 per cent had taken drugs in the last year and 6 per cent had taken drugs in the last month.
  • The prevalence of drug use increased with age. For example, 6 per cent of 11 year olds said they had tried drugs at least once, compared with 24 per cent of 15 year olds.

Resources

Statistics on Drug Misuse: England, 2016 – Report [.pdf](Opens in a new window)

Statistics on Drug Misuse: England, 2016 – Appendices [.pdf](Opens in a new window)

Statistics on Drug Misuse: England, 2016 – Data Quality Statement [.pdf](Opens in a new window)

Statistics on Drug Misuse: England, 2016 – Tables [.xlsx](Opens in a new window)

Statistics on Drug Misuse: England, 2016 – CSV data pack [.zip](Opens in a new window)

Statistics on Drugs Misuse: England, 2016: Pre-release access list [.pdf]

 

Source:  http://digital.nhs.uk/catalogue/PUB21159    28th July 2016

 

 

Filed under: 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

One in four deaths of young men aged from 15 to 39 in Ireland is due to alcohol and drink is a factor in half of all suicides, according to the Health Research Board.

Alcohol is also involved in more than one third of cases of deliberate self-harm, peaking around weekends and public holidays.

Those grim statistics are among the challenges for the medical professional nationwide and yesterday the first regional Alcohol Strategy to tackle the damage caused by alcohol in counties Cork and Kerry was launched at Cork County Hall.

“Our overarching principle in terms of strategy is to reduce the harm caused by alcohol in Cork and Kerry,” said David Lane, co-ordinator of Drug & Alcohol Services at HSE South.

While welcoming the new Public Health (Alcohol) Bill, Mr Lane said its slow progress through the legislature was frustrating.  “We need this new legislation as a matter of urgency,” he said.

“In fact, the minimum unit pricing which is a central plank of the Bill should have been put in place years ago. In the meantime, more than one person every week in this country dies of alcohol poisoning. They just consume alcohol and no other drug and die from it. That is quite shocking.”

Among the HRB findings: n Alcohol consumption in Ireland almost trebled between 1960 (4.9 litres) and 2001 (14.3 litres); n Almost two thirds (63.9%) of males started drinking alcohol before the age of 18; n Four in five (80.3%) male drinkers consumed six or more standard drinks on occasion.

Those attending the launch of the strategy heard that liver disease rates are increasing rapidly in Ireland and the greatest level of increase is among 15- to 34-year-olds, who historically had the lowest rates of liver disease.

As well as that, 900 people are diagnosed with alcohol-related cancers with around 500 people dying from these diseases every year. Drink driving is also factor in one third of all deaths on Irish roads.

The bill aims to reduce alcohol consumption in Ireland to 9.1 litres per person per annum by 2020 and to reduce the harms associated with alcohol. It consists of 29 sections and includes five main provisions.

These are: Minimum unit pricing; health labelling of alcohol products; the regulation of advertising and sponsorship of alcohol products; structural separation of alcohol products in mixed trading outlets; and the regulation of the sale and supply of alcohol in certain circumstances.

However, Mr Lane lamented the absence in the proposed legislation of any attempt to tackle seriously the marketing of alcohol, particularly in its association with sporting events.

“We might be turning a corner,” said Mr Lane.

“The Public Health (Alcohol) Bill outlines some positive steps to tackle the issue for the first time in a meaningful way.

“It might be the first step in introducing minimum unit pricing which we, as an Alcohol Strategy Group for Cork and Kerry, will fully support. But Ireland needs to strengthen its resolve to tackle the availability and marketing of alcohol in a meaningful way too.

“Finally, we must include alcohol as part of our response to substance misuse and when our National Drugs Strategy runs out at the end of 2016 we must include alcohol in a new National Substance Misuse Strategy from the start of 2017.”

Source: http://www.irishexaminer.com/ireland/25-of-males-age-15-39-die-due-to-alcohol-404928.html

Filed under: Alcohol,Health :

VANCOUVER, BRITISH COLUMBIA–(Marketwired – May 31, 2016)

Researchers at the University of Western Australia have identified the causal links between marijuana use and the development of serious diseases, cancers, birth defects, and the inheritance of traits that can cause such problems in children and grandchildren including the development of Down’s Syndrome. Parental use of marijuana is a children’s rights issue.

Associate Professor Stuart Reece and Professor Gary Hulse from UWA’s School of Psychiatry and Clinical Sciences found illnesses are likely caused by cell mutations resulting from cannabis properties having a chemical interaction with a person’s DNA. Even if a mother has never used cannabis, the mutations passed on by a father’s sperm can cause serious and fatal illnesses in offspring. The parents DNA carrying these mutations can lie dormant and may only affect generations down the road. The study was published in the Mutation Research — Fundamental and Molecular Mechanisms of Mutagenesis.

Source: http://www.sciencedirect.com/science/article/pii/S0027510716300574

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

Introduction

This essay is about the drug problem in society, particularly in the United States. By “drug” I mean alcohol, tobacco, and illegal drugs such as marijuana, hallucinogens, stimulants, depressants, and opiates. In regard to youth, inhalants (household chemicals inhaled to get a “high”) are also included.

This is not about the struggles faced by individuals who are addicted, or who struggle with any of the many life problems that can arise from drug use. Others are well addressing those issues in the treatment programs they offer and the publications they write. That society should be more diligent in ensuring availability of treatment for all who need it has been well stated by others. This essay is not about people’s drug problems so much as society’s drug problem.

The problem is that drugs are significantly decreasing our collective quality of life: decreasing our capacity to solve the problems that we collectively face in living. Whether you turn to issues of economics, health, social justice, family life, or the strength of the work force, the magnitude of the damage done by drugs is striking:

  • The number of deaths due to drugs in the United States alone each year exceeds 400,000 from tobacco, 100,000 from alcohol, and 35,000 from other drugs.
  • The most recent estimate of cost to U.S. society (not to users) of alcohol and other drug abuse was 246 billion dollars: 148 billion from alcohol abuse and 98 billion from other drug abuse.
  • A large percentage of health problems and health care costs are due to alcohol or other drugs.
  • Substance abuse in a single year costs American businesses 37 billion dollars due to premature deaths and another 44.6 billion dollars due to employee illness. Drug dependence and alcohol together cost businesses 200 billion dollars. A majority of the alcohol problems are caused by light and moderate drinkers, rather than alcoholics.
  • A high percentage of child abuse and neglect is associated with parental AOD (alcohol or other drug) abuse.
  • A recent study of teen marijuana users found they were 4 times more likely than non-users to attack someone, 3 times more likely to destroy others’ property, and 5 times more likely to have stolen things.
  • The combination of alcohol-related accidents, assaults, and suicides makes alcohol the leading risk factor for adolescent death and injury.

Whether or not you have directly experienced a drug problem in your life, society’s drug problem is shared by all of us. Most of the people who are aware of the impact of drugs on families and other relationships would argue forcefully one person’s drug use hurts more than just that person. The issue may be debatable in the case of any single individual, but collectively there can be no doubt: the drug problem is a problem for all of us.

In the twelve years I have worked in drug prevention, I have learned a lot about how drug use develops, and how it can be prevented. I have discovered that there is tremendous energy and potential in drug prevention, but progress has sometimes been slow, for good reason. The reason is that the general public, and in some cases even prevention professionals, hold some core assumptions about the drug problem that are actually incorrect. As a result, much of the effort put into prevention strays slightly, but significantly, from what is needed.

This essay is an attempt to identify, describe, and correct those faulty assumptions. This is not a “how to” book on prevention. I have written such a book (Best Practices in ATOD Prevention, 1997), with much help. But having the right tools are not enough to become a builder. To be successful with “how to,” you have to start with, “what’s that?” This essay is about understanding the drug problem: what causes it and what is needed to stop it. The application of this knowledge is up to each reader. I hope you find some valuable insights here, or perhaps find support for some of your own observations.

I am convinced that if we stop going down dead-end streets, we can really get places in prevention. Thanks for letting me share the results of my explorations in drug prevention.

Fallacy #1: The primary target of drug prevention should be hard-core drug abuse.

This fallacy has three main parts: (a.) which drugs are the problem, (b.) which drug users are the problem, and (c.) the relation of addiction to drug abuse.

a. “Shouldn’t crack, speed, and heroin be our number one concern?”

No. Ounce for ounce these drugs are certainly among the most potent, but they are (or should be) of secondary concern to drug prevention because of the developmental nature of drug abuse, the limitations of prevention, and the greater amount of societal problems associated with other drugs.

Development of Drug Abuse

It is exceedingly rare for an adult who has never used any drug to use drugs like cocaine or heroin. Nearly as rare is a youth or adult who uses one of these drugs without a history of use of at least one, and often all three, “gateway” drugs: alcohol, tobacco, and marijuana.

Don’t misunderstand the gateway drug phenomenon: obviously not all people who use alcohol, tobacco, or marijuana progress to other drug use. But, the odds of other drug use depend on gateway use because those who don’t use gateway drugs are so extremely unlikely to use other drugs.

The gateway phenomenon includes two other notable features in addition to the issue of whether or not gateway drugs are used. One is that the younger a person is when they begin gateway use, the greater their likelihood of drug problems (with gateway and other drugs) later in life. The other is that people who use two or three gateway drugs are more likely to progress to other drugs than people who use one (use of all three is most significant).

So alcohol, tobacco, and marijuana are truly “gateways” to other drug use. Although most of the people who go through the gate don’t do on to other drug use, nearly everyone who goes on to other drugs passes first through the threshold of gateway use. This alone doesn’t conclude the case for where to direct drug prevention, but sets the stage for two other two facts.

Limitations of Prevention

Prevention is just one of the major strands of anti-drug efforts. The other two are treatment and legal restrictions (regarding use, possession, and sale of drugs). To a great extent the target population for prevention and the target for treatment are opposite. By the time people go through gateway use and begin using other drugs, they have become (due to some combination of self-selection and the results of earlier gateway use) fairly habituated to drugs. In many cases they are already addicted. The habit formed from regular drug use is hard to break. When addiction is also present, the strong forces involved are not only psychological but also bio-chemical. We like to think our minds are in control, but addiction can rule behavior at a level so deep and powerful that rational thought pales in comparison.

As a result, prevention efforts that may be appropriate for youth who are non-users or experimenters with drugs are simply not effective with more committed users, and certainly not with addicts. Addiction calls for drug treatment: prevention is inadequate for those trying to back away from heavy drug use.

On the other hand, treatment is not appropriate for first-time experimenters. The treatment process is not designed for that population, and the cost of providing such intensive services is neither justified for the individual drug experimenter nor remotely available for the whole population of experimenters. For them and for those who are yet to experiment, prevention is the key.

Of those who use gateway drugs, some require treatment (or cessation aid, in the case of tobacco), but most do not. Of those who use other drugs, a large proportion requires treatment, and few would benefit from prevention. This strengthens the case for targeting gateway drugs in prevention, and leads to the third point.

Societal Cost of Gateway Drug Problems

Recall that ounce per ounce, gateway drugs are not as destructive as crack, crank, and heroin. But the scope of any one drug’s impact on society depends on the amount of use (including number of users and degree of use by each) as well as the drug’s dangers. Unlike crack and heroin, gateway drugs are used by a large portion of the population. And, though gateway drugs seem less dangerous than so called “hard” drugs, research and bitter experience have shown that the gateway drugs are dangerous enough:

  • Tobacco kills four times as many Americans as does alcohol, and alcohol kills three times as many as all illegal drugs combined.
  • Alcohol seems to be the leading cause of teen deaths, based on the high percent of instances in which alcohol is a major factor in car crashes, suicides, homicides, drownings, and other unintended injuries.
  • Marijuana combines the cancer potential of tobacco with the cognitive impairment of alcohol, except that impaired thought lasts longer after each marijuana use than after each alcohol use.

As a result, the benefit to society of cutting gateway drug use in half would be much greater than cutting other drug use in half. Combine this point with the point about prevention’s limits and the point about the development of drug abuse, and you get a strong case for making gateway drug use (particularly by youth) the prime target of prevention.

b. Shouldn’t prevention always target “high risk” youth?

No. Although it may be appropriate to devote extra preventive effort to some groups of youth, conceiving ATOD prevention in only those terms is problematic for reasons that include the breadth of risk, the importance of environmental risk, and the need for different approaches according to the nature of different risk conditions.

Breadth of Risk

While some characteristics act as “risk factors” for youth ATOD use, the absence of those risk factors doesn’t guarantee a drug-free youth. To some extent, everyone is at risk. The older a persons gets without using, the lower the risk that they will use. Furthermore, while the primary aim of ATOD prevention is to prevent use, an important secondary function is to help prepare all youth for addressing the drug problem in society: as family members, co-workers, or citizens. We are currently a society at risk.

This is not to say that community risk conditions shouldn’t be considered, nor that “selective” ATOD prevention efforts can’t be done for groups of medium risk youth or families. I use the term “medium risk” to refer to youth who haven’t begun ATOD use, but whose family or personal characteristics include some risk factors (e.g., poverty, low academic achievement, parental drug use or addiction, etc.) for youth ATOD use. But these efforts are a supplement to prevention efforts for all youth, rather than a replacement.

Environmental Risk

Preoccupation with risk profiles of individual youths, or even groups of youths, diverts attention away from the strongest influences of whether most youth will try drugs or avoid drugs. The combination of youths’ peer social environment, family environment, school environment, media environment, and their community’s adult social environment account for the vast majority of variation in youth drug behavior. A “low risk” youth who enters a “high risk” environment (e.g., a “no-use” youth who moves to a school where drinking is the norm) is no longer low risk.

Prevention planners who only look at what’s “inside” youth can miss the environmental factors (including media influences) that shape youths’ attitudes. If not directly addressed, these environmental factors can misdirect youths’ attitudes and behaviors as fast or faster than youth-focused programs can positively affect them.

Different Risks – Different Approaches

The risk factor that is most important to the largest number of youth in regard to initiation of gateway drug use is their perception of peer attitudes about drugs, as will be discussed in regard to “Fallacy #3.” However, for a smaller number of youth other factors play a major role. For example, children raised in households with parental violence, neglect, or addiction are more likely than average to develop their own problems with alcohol or other drugs. The number of children in this kind of situation, though much larger than it should be, is small compared to the overall number of children and families.

For a child in a household with parental violence (domestic violence and/or child abuse), what happens to that violence may be the most important “risk factor” for their future mental health, including their relation to drugs. Their greatest need may have little to do with drug prevention, and everything to do with appropriate resolution of the violence.

For a youth failing school, the greatest need may be assistance with whatever is interfering with school achievement.

In each case, the most effective form of drug prevention may be to resolve the problem(s) that increase risk for drug use, rather than to directly address the issue of drugs. On the other hand, a youth who has started to experiment with drugs may need intervention services, sometimes called “indicated prevention”, but actually more closely akin to some forms of substance abuse treatment counseling. In all these instances, the kinds of programs that constitute “universal” drug prevention programs may be less relevant. So, these kinds of “high risk” youth need more focused and intensive assistance than is available through what I am calling drug prevention, i.e. programs designed to impact the gateway drug attitudes and behaviors of large groups of youth. They may be helped somewhat by such programs, and so should not be excluded, but to limit participation in prevention programs only to such “high risk” youths is probably not appropriate, particularly given the risk of a norm of gateway drug use arising among program participants if all are “high risk.”

c. Isn’t addiction prevention the main goal of substance abuse prevention?

No. Addiction is one major outcome of drug use, but the impairment of rational thought, the plethora of anti-social and injurious behaviors caused or heightened by that impairment, and the direct toxic effects of drugs are all substantial societal problems worthy of prevention. Addiction increases these other problems, but a person need not be addicted in order to seriously injure of kill themselves or others while impaired, typically due to negligence (as in DUI crashes) rather than violent intent.

Further, since the number of alcohol or other drug users at any given point in time far exceeds the number of addicts (including alcoholics), the societal damage done by non-addicted persons can cumulatively exceed the damage done by addicts. Even though individual addicted persons are more problematic to society than individual non-addicted AOD (alcohol and other drug) users, the much larger number of non-addicted users makes them a major part of societal AOD problems.

Efforts to make the public more aware of realities of addiction should continue, but preventing addiction is one main goal of drug prevention: not the main goal.

Fallacy # 2: Alcohol and other drug problems are mainly a result of other problems, and drug prevention can best be accomplished by addressing those other problems.

Drug abuse has multiple causative factors: this has become an oft stated truism. Unfortunately, people tend to notice and magnify the causative strand that is most evident in their personal or professional experience. Their observations are strengthened by studies which demonstrate the connection between each of a variety of “risk factors” and drug abuse, but which fail to consider the larger context of the societal drug problem, including which of the many risk factors play the most important roles within the largest numbers of people. Rather than starting with convergence on the most prevalent and powerful risks, people therefore tend to diverge into various less central issues:

  • Persons who focus on poverty see poverty as the main root of drug problems.
  • Persons concerned with stimulating positive youth development see their work as the best form of drug prevention.
  • Persons familiar with dysfunctional family systems see family dysfunction as the main root of drug problems.

Attention to this whole range of negative factors may be appropriate, but mistaking any one of these for the “main” cause of drug problems is not. One person or subgroup may be profoundly influenced by one of these factors, but the prevalence of each factor in the population is far less than the prevalence of drug problems.

Family Dysfunction: Major dysfunction (such as family violence) greatly heightens the chance of youth drug problems, but the majority of youth AOD users (and hence, most of the future AOD abusers) do not come from dysfunctional families. Dysfunctional family life is a potent risk factor but not a prevalent one, in comparison to the scope of youth AOD problems.

Poverty: Poverty makes drug problems more likely, but only slightly more likely: a large number of well-to-do people are among those who children use and abuse alcohol and other drugs.

Positive Youth Development: Policies that empower youth development are a good idea, but aren’t sufficient to prevent youth drug use. The notion that positive youth development can substitute for specific attention to drug prevention is similar to the 1970’s notion that good self-esteem is the key to drug prevention. Unfortunately, ignoring drug prevention in favor of self-esteem tends to produce drug users with high self-esteem. Self-esteem doesn’t protect from the destructive effects of drugs. Youth development programs can be an important aid for youths who lack key developmental assets, but will only impact drug use if:

  1. anti-drug norms are already present in the lives of those youth, or
  2. the youth development program includes building anti-drug norms as part of its mission.

Two kinds of problems arise from the mis-attribution of heightened importance of these factors as causes of substance abuse:

  1. More global causes of ATOD problems, such as youths’ and parents’ attitudes about drug use, may be glossed over in the design of prevention strategies. In other words, potentially efficacious approaches to prevention may be ignored in favor of less broadly effective approaches.
  2. Parents may believe that avoiding family dysfunction is sufficient to prevent youth drug problems.

The worst instances of this fallacy in action have parents or other adults allowing and enabling youth alcohol or other drug use under the misguided notion that only troubled individuals abuse substances. Statements like, “It’s no big deal,” or “They’re just going through a phase,” or “It’s part of growing up” tend to be evidence of this. While it’s true that troubled youth are more likely to develop a drug problem, also true is that alcohol or other drug use can cause a person to become troubled – especially if addiction is involved.

Youth alcohol and other drug use is a bad idea no matter how positive an individual’s circumstances. Youth with substantial personal or family problems are more likely to experience significant problems with drugs, but the initial absence of personal disturbance is no insurance policy against addiction or other ATOD problems. And, although family problems constitute a risk factor for youth ATOD use, family wellness is not a sufficient protective factor to counter other negative influences on youth ATOD decisions. Parents who don’t have general problems with family management can take steps (particularly in regard to monitoring youth activities) to decrease their children’s likelihood of ATOD use, but just being a “good” parent isn’t a cure-all. Drug prevention needs to go beyond the foundation of healthy families and positive youth development, to build attitudes and behaviors that especially counter ATOD influences in society.

Fallacy #3: The main essence of successful drug prevention is communication about the dangers of drugs.

This very common misperception probably sidetracks more prevention efforts than any other single error. Actually the essence of success in preventing youth use of gateway drugs is making drug use unpopular: destroying the myth that peers approve of drug use. This can be supplemented by fact-based approaches and parent programs, but the most basic reason youth as a whole start gateway drug use is because they believe their peers approve of it. No matter how dangerous they are told drug use may be, if they think many others are doing it they will tend to do the same, unless they consistently see very negative effects on those believed to be using.

There are two reasons I see for the continuing strength of Fallacy #3 in spite of evidence to the contrary. The first is our nature as human beings. We like to think we are logical, sensible beings. To some extent we are, but most of us, and especially children and youth, base our actions first on what we observe from those around us, and only secondly on what we believe.

Remember that we are talking about society as a whole here: there are certainly some people who are less prone to be influenced by others (psychology calls them “field independent” as opposed to field dependent), and all of us vary in our susceptibility. But as a whole, we’re just not as logical as we like to think. To be human is to be influenced by our observations of others.

The second reason for the fallacy is a more complex one having to do with the nature of scientific studies of youth alcohol and other drug use. Common scientific method in the social sciences involves looking for things that go together in large populations. The question is what “factors” tend to go with, and particularly to predict, youth ATOD use. A basic premise is that correlation does not necessarily equate to causation, especially in cross-sectional one-time studies. However, when a factor such as “perception of harm” is closely matched with drug use over a period of years, as has been the case in the national “Monitoring the Future” study, observers are hard pressed to ignore the likely conclusion that changing perception of harm is the key to prevention.

The problem is, how does one change perception of harm? The common assumption is that you do this by communicating drug dangers. Often overlooked is that there is an equally strong association with perceived peer approval or disapproval for use of drugs: what youth believe their peers think of drugs. I think that, contrary to common assumptions, the perception of peer attitude drives youths’ own attitudes about drugs (both perceived harmfulness and intent to use). Perception of harm then ends up being a strong indicator of whether a youth will use a drug, especially because it is probably also affected by other risk factors. But the route to turning around perception of harm usually has to go through perceptions of peer approval/ disapproval. When we present logical facts about drug dangers to youth, if they think most of their peers approve of drug use, and indeed use drugs, then the warnings seem ungrounded and are easily ignored.

I base this point on a variety of research, but some of the most striking and easiest to communicate is research about what works in prevention. Of all the things that have been tried in prevention curricula for young teens, the most powerful is simply to correct their typically exaggerated assumptions about how many peers use drugs. When they are shown that far fewer than thought peers use, their attitudes change to a degree not seen with mere truth about drugs.

This is not to say that education about drug dangers is not important for youth: it is! These facts back up the facts about peer attitudes, and may be especially important for some youth who are able to base their behavior on rational truth about drug dangers. Even if this weren’t the case, it would simply not be right to let youth grow up in this society without exposing them to the truth about drugs. But to assume that exposure is the key element of prevention is to severely limit the effectiveness of one’s prevention efforts.

One of the important implications of this is that the images presented by mass media, especially in regard to images of youth attitudes and behaviors, should be a vital concern of prevention. We all like to think that we are too sophisticated to be influenced by the images of television and other media, but it’s just not so. We are influenced. That’s why advertising works. While any one youth may be more influenced by their parents than by the media, youth as a whole are dramatically influenced (as has been demonstrated by studies showing that youth smoke those cigarette brands that are most heavily advertised to youth). Media plays the role of a “super-peer,” playing directly into the heart of youth decisions by telling them what is cool and what isn’t. Prevention cannot afford to ignore this. Luckily, the same principles currently used by alcohol and tobacco advertisers to snare youth users can also be used in prevention. But, first we have to get past this fallacy that drug facts are the key.

Fallacy # 4: Making and enforcing laws against the use of drugs, and against underage use of alcohol and tobacco, is contrary to prevention and treatment of drug use.

This premise has been advanced by legalization groups, claiming all would be well if we did away with laws against drug use and relied solely on prevention and treatment. But the truth is that prevention, treatment, and legal barriers to use all depend on each other for effectiveness. The kind of “prevention” touted by legalization groups is not prevention of use but facilitation of “safe” use, called “harm reduction.” The role of prevention in this scenario is to teach people how to use drugs safely. The problem with this is that the laws against each particular drug are enacted because its use is inherently unsafe. An analogy would be explosives manufacturers lobbying to take the funds used to enforce laws against possessing bombs and instead just teaching youth how to use them “safely,” and of course not until they were 18 or 21. Would the public stand for that? Would even the most avid libertarians be crazy enough to support it? Legalizers suggest that drugs hurt only the user, but impacts of our society’s drug problem go far beyond the circle of users, as was discussed earlier.

Even if, after legalization, the current drug-free message of prevention were maintained, a country that tolerates drug use would be giving a strange message that would undercut any such “no-use” message. “Drugs are dangerous and hurt society, but you can go ahead and do them if you want.” Use would soon rise, not so much from drug-free adults starting use but from every new generation of teens becoming more and more enmeshed in drug use, in spite of any legal age restrictions. This is what has happened when legalization has been tried. Similarly, the number of people entering treatment, cooperating with treatment, and avoiding relapse would be far less without the force of law to compel users to quit.

High quality drug prevention and treatment are currently vital to our society, but their success would be lessened, not increased, if legal sanctions against use were eliminated. The specific workings of the legal and criminal justice system in regard to drug use can always be examined for improvement, but most groups who currently call for drug law “reform” are using the term as a euphemism for legalization.

Fallacy # 5: Marijuana is not dangerous.

We tend to think of drugs as poisons to the body, and measure the potency of a drug by how fast and how completely it can interfere with physical health. We are less quick to recognize that the most crucial characteristics of drugs are their “psychoactive” effect: their alteration of thought, feelings, and behavior. Measured by physical effects only, marijuana is not as dangerous as many other drugs (though it has the potential to kill as many people as tobacco does, if it were as popular as tobacco). But, examined for its behavioral effect, marijuana is quite potent. The subtlety with which it alters behavior, typically over a period of weeks or months, makes it all the more effective as a behavioral change agent. The data that has begun to emerge as younger teens and pre-teens smoke more potent marijuana shows a devastating effect on the social functioning of many users. Some users may have been self-centered when they began use, but marijuana heightens that characteristic, killing the empathy and capacity for altruism that embody the best qualities of society. What is left is a person addicted to marijuana and concerned about marijuana, but not so much about relationships, achievement, or even obeying the law. People sometimes discount the effects of marijuana because many users do not seem to be greatly impaired, but the luck of some in warding off clear impairment is a poor balance to the studies and accumulated life experiences of those who have been severely changed by marijuana use.

Fallacy # 6: Anti-drug laws and anti-drug law enforcement is driven by national bureaucracy and the zealousness of federal officials.

People who travel in a sub-culture of drug tolerance tend to perceive the government’s anti-drug actions as being out of touch with the populace, but polls show that a large majority of the American (and other) public opposes drug legalization. The greatest passion in favor of enforcing drug laws comes not from any government but from families that have seen the worst that drugs do. The proper balance between society’s interest in stopping drugs and the freedom of individuals becomes clear when one has witnessed a family or community ravaged by drug use and addiction. The social value of drugs is far below zero. Any loosening of restrictions on drug use has tended to lead to a cycle of increased use, increased damage to society, and a resulting determination to toughen enforcement of laws against drug use. Ultimately, the source of calls for strict enforcement of laws against drugs come not from any one group but from the power of drugs to damage people, and damage society.

Alan Markwood is the Prevention Projects Coordinator at Chestnut Health Systems, Inc. in Bloomington, Illinois. Responsibilities include:

  • Participating in prevention research, development, and training projects as a contractor to the Illinois Department of Human Services.
  • Directing prevention coalitions in three counties, funded by the federal Center for Substance Abuse Prevention and the Illinois Department of Human Services under grants he wrote.

Mr. Markwood is the principal author of the Best Practices in ATOD Prevention Handbook (1997), and has managed a series of statewide studies on youth substance use in Illinois. He served as InTouch Area 14 Prevention Coordinator at Chestnut Health Systems from 1987 until promoted to his current position in 1995. Prior to his work in prevention, he worked as a School Psychologist for seven years in Illinois and Massachusetts. He has a Master of Arts degree in Psychology from Alfred University and a Certificate of Advanced Graduate Study in Education from Boston University.

Source: www.drugwatch.org Sept.1999

 

USE of illicit drugs in the country is increasing at an alarming rate, with cannabis and heroin being the most commonly used, hence the need for the government to embark on immediate strategies to tackle the problem.

A study conducted in 12 regions has shown an increase in illicit drug use, especially along major transport corridors. The trend poses a serious danger to future generations who are being lured into the vice.

The study was conducted by 14 experts from the Drug Control Commission (DCC), the University of California, San Francisco and the US Centre for Disease Control and Prevention in Tanzania, who presented the findings yesterday in Dar es Salaam.

Among recommendations presented by the researchers include provision of a range of services including advocacy and sensitisation activities, provision of primary drug use and HIV risk prevention strategies for all groups.

The services also envisage strengthening coordination and governance of community and government resources for drug-use interventions, carrying out additional studies to measure HIV prevalence and associated behaviour among PWUD and provision of more education on types of drugs as well as their effects and consequences.

The study; ‘ mapping of people who use drugs (PWUD) and people who inject drugs (PWID) in the selected regions of Tanzania’, sought to understand the scope and magnitude of non-injection and injection use of illicit drugs among the two groups.

The study was conducted between July 2013 and August 2014 in 12 regions which are Mtwara, Dodoma, Morogoro, Coast, Kilimanjaro, Tanga, Arusha, Mwanza, Mbeya, Shinyanga, Geita and Kigoma. The majority of the PWUD engage in smoking a ‘cocktail,’ which is a combination of cannabis dust, tobacco and heroin, while those identified as PWID appeared to inject heroin.

One of the researchers, Ms Moza Makumbuli, noted that within all 12 regions, several primary and secondary key informants could not distinguish heroin from cocaine by name but instead use a local term ‘unga’. “In all regions needle sharing was high among the small number who engaged in injection drug use.

Risky sexual behaviour also appeared high among people who use drugs,” she explained. In Tanga the findings shows that drug use has spread to small towns and villages outside the regional capital along the Tanga-Segera highway, with drug pushers supplying from Tanga City.

Of the regions studied Tanga appeared to have the most drug pushers, with PWUD moving from one hotspot to another depending on where drugs or quality drugs were available.

Mtwara had the lowest estimated number of PWUD with drug use concentrated in Mtwara Municipality, but was also reportedly present in Masasi town as well, according to the study.

Generally the study estimates that the number of PWUD across the regions were 5,190 in Tanga, 3,300 in Mwanza, 2,700 in Arusha, 1,539 in Coast, 1,500 in Morogoro, 1,096 in Dodoma, 820 in Mbeya, 563 in Kilimanjaro, 319 in Shinyanga, 108 in Geita, 100 in Kigoma and 65 in Mtwara.

The PWID was 540 in Tanga, 300 in Mwanza, 297 in Morogoro, 230 in Arusha, 164 in Coast, 133 in Dodoma, 107 in Kilimanjaro, 64 in Mbeya, 25 in Shinyanga, 7 in Mtwara, 3 in Geita and 0 in Kigoma.

In his opening remarks, the DCC Commissioner, Mr Kenneth Kaseke, said there is very little data about injection drug use in the rest of the country, apart from Zanzibar and Dar es Salaam, which prompted the qualitative study.

Although the study is not representative, meaning it does not reflect the real situation in the whole country, Mr Kaseke said this gives a clear picture of the extent of the problem and calls for the need for in-depth research to represent the whole country.

“Despite limited resources, Tanzania is determined to combat the growing problem of drug abuse and HIV transmission by providing a comprehensive package services for IDUs and their injecting or sexual partners,” he explained.

The Zanzibar Executive Director, Anti-Drug Commission, Ms Kheriyangu Khamis, said the study shows that the situation on the ground is alarming and that illicit drug abuse is spreading rapidly in the region.

“We must use the research findings in our development plans, so we can come up with the right strategies that are needed on the ground,” she explained.

Source:  http://www.dailynews.co.tz/   1st August 2015

Few states where marijuana use is legal restrict its use around children

A new study to be presented at the Pediatric Academic Societies 2016 Meeting found that one in six infants and toddlers admitted to a Colorado hospital with coughing, wheezing and other symptoms of bronchiolitis tested positive for marijuana exposure.

The study, “Marijuana Exposure in Children Hospitalized for Bronchiolitis,” recruited parents of previously healthy children between one month of age and two years old who were admitted to Children’s Hospital Colorado (CHC) between January 2013 and April 2014 with bronchiolitis, an inflammation of the smallest air passages in the lung. The parents completed a questionnaire about their child’s health, demographics, exposure to tobacco smoke, and as of October 2014, whether anyone in the home used marijuana. Marijuana became legal in Colorado on January 1, 2014.

Of the children who were identified as having been exposed to marijuana smokers, urine samples showed traces of a metabolite of tetrahydrocannabinol (THC), the psychoactive component of marijuana, in 16 percent of them. The results also showed that more of the children were THC positive after legalization (21 percent, compared with 10 percent before), and non-white children were more likely to be exposed than white children.

The findings suggest that secondhand marijuana smoke, which contains carcinogenic and psychoactive chemicals, may be a rising child health concern as marijuana increasingly becomes legal for medical and recreational use in the United States, said lead researcher Karen M. Wilson, MD, MPH, FAAP, an associate professor of pediatrics at the University of Colorado School of Medicine and section head at CHC. Most states with legal marijuana do not restrict its combustion around children, she said.

“Our study demonstrates that, as with secondhand tobacco smoke, children can be exposed to the chemicals in marijuana when it is smoked by someone nearby,” Dr. Wilson said. “Especially as marijuana becomes more available and acceptable, we need to learn more about how this may affect children’s health and development.” In the meantime, she said, “marijuana should never be smoked in the presence of children.”

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

 

 

Filed under: Cannabis/Marijuana,Health :

Most of us who drink alcohol won’t die from liver disease – but it still kills more of us than diabetes and road deaths combined The recent report into life on the liver ward makes sobering reading. John has alcohol-induced dementia (Korsakoff’s syndrome) and doesn’t know where he is. Rita has cirrhosis of the liver and is homeless. Her life has spiralled downwards as a wine habit segued into damaging dependence. It’s easy to feel sorry for the Johns and Ritas, though most of us think it’ll never happen to us. But will it? Are we becoming a nation of drinkers and drunks? The UK death rate from liver disease has increased fourfold in the past 30 years as cheap alcohol has flooded our shores and our gullets. Alcohol-related emergencies resulted in over a quarter of a million admissions in 2013/14, most of whom were 45-64-year-olds, who see themselves as regular rather than binge drinkers. Jackie Ballard, the chief executive of Alcohol Concern, says “Alcohol is linked to over 60 medical conditions including cancer, diabetes and high blood pressure.” And the chief medical officer, Sally Davies is so concerned that she has published new and controversial guidelines on safe drinking. The good news is that the tide seems to be turning against alcohol use in the UK. The percentage of men drinking alcohol in a typical week fell from 72% in 2005 to 64% in 2012 (in women the fall was from 57% to 52%). Frequent drinking has also been reported to be in decline.  Most of us who drink alcohol won’t die of liver disease, just as many smokers don’t die of lung cancer. It’s a question of weighing the risks against the benefit that alcohol gives us. It’s my drug of choice but I wouldn’t pretend that it’s harmless.   The great British booze problem: how a few glasses a day has led to an epidemic for the NHS

How much alcohol is too much? Some can probably safely drink more than others; your size, genetics, lifestyle and state of your liver make a difference. But in general, less than 14 units, spread over at least three days a week should be OK. That’s just under a bottle-and-a-half of wine (ABV 13.5%), or an average of one 175ml glass per day. For beer drinkers, that’s less than five pints of higher strength beer (ABV 5.2%) a week.

The liver is a resilient and vital organ. With the kidneys, it acts as a waste-disposal system, filtering our blood of toxins. The liver plays a key role in digestion and also produces hormones, bile to digest fats and proteins for blood clotting. We have two kidneys, which is handy if one fails, but only one liver. Luckily, it can withstand a tremendous battering and still recover. We can survive on a liver that is only 30% operational; after that it gets critical.

Viruses, drugs, chemicals, toxins and some genetic conditions can take their toll on even the youngest and meatiest of livers. At first, these irritants cause inflammation, which is reversible. But long-standing damage causes cirrhosis, which is irreversible thickening (fibrosis) that stops the liver from functioning. We can’t live without a liver, so a transplant becomes the only option. Liver disease kills more of us than diabetes and road deaths combined and is the fifth-biggest killer now after heart attacks, cancer, strokes and lung diseases. It is the only major cause of death in the UK that is still increasing year on year. The hope is that as awareness rises and alcohol intake falls, the crowded NHS liver wards will become a thing of the past.

Source:  http://www.theguardian.com/society/shortcuts/2016/jan/25

Cannabis in First-Episode Psychosis Linked to Poor Outcomes * Early, Intensive Treatment for Psychosis Justifies Cost * High-Potency Cannabis Linked to Brain Damage, Experts Warn * Teen Marijuana Use Linked to Earlier Psychosis Onset

Cannabis use by patients with first-episode psychosis (FEP) is associated with significantly worse clinical outcomes over time, a large, retrospective study shows.

Investigators from King’s College London, in the United Kingdom, found that cannabis users were 50% more likely to be admitted to hospital in the 5 years after initial FEP treatment and that length of stays in hospital were longer for these patients.

“We also found that the poor outcomes associated with cannabis use may be linked to antipsychotic treatment failure,” study investigator Rashmi Patel, BMBCh, told Medscape Medical News.

“The findings of this study are important, as they highlight a need for greater emphasis to reduce the risks of cannabis use among people with FEP and to determine how to optimize treatment in this group of patients,” Dr Patel said.

Contributor to Treatment Failure?

Previous research has suggested that cannabis use is associated with an increased risk of developing a psychotic disorder, but until now, little was known about the effects of cannabis on individuals with an established psychotic disorder, said Dr Patel.

The researchers analyzed de-identified electronic health records for 2026 adults treated for FEP at a large mental health care service provider in Europe between 2006 and 2013. Patients were followed for up to 5 years.

At presentation for FEP, cannabis use was noted in the records of 939 individuals (46.3%), consistent with the high levels of lifetime cannabis use seen in other FEP studies, the authors note. In this sample, cannabis use was particularly common in young, single men.

Cannabis use was associated with increased frequency of hospital admission (incidence rate ratio, 1.50; 95% confidence interval [CI], 1.25 – 1.80) and increased odds of a compulsory admission (odds ratio, 1.55; 95% CI, 1.16 – 2.08). Cannabis use was also associated with a greater number of days spent in the hospital. During follow-up, length of stay progressively increased for cannabis users, from an average of 21 extra days within 3 years to 35 additional days within 5 years.

The records also showed that at initial presentation for FEP, cannabis users were more apt to be treated with clozapine (multiple brands), an antipsychotic used for difficult-to-treat schizophrenia, and to receive a higher number of individual antipsychotics (up to 11), which is a proxy marker for treatment failure, the investigators note.

To their knowledge, this is the first published study to “demonstrate the potential mediation of cannabis use with poorer outcomes by a failure of antipsychotic treatment,” they write.

Owing to the observational nature of the study, no firm conclusions can be drawn about cause and effect, they point out. However, they say their findings “highlight the importance of ascertaining cannabis use in people receiving care for psychotic disorders.” The findings should also “prompt further study to investigate the mechanisms underlying poor clinical outcomes in people who use cannabis and strategies to reduce associated harms.”

Teasing Out Confounders

Commenting on the findings for Medscape Medical News, Subroto Ghose, MD, PhD, University of Texas Southwestern Medical Center, in Dallas, said the study is interesting and demonstrates associations between initial cannabis use and poorer outcomes.

“There are, however, certain potential confounders that need to be teased out. The major ones are whether the subjects continued to use cannabis after the index admission. Are there differences between those who stopped using compared to those who continue to use cannabis? Many subjects who use cannabis also use other illicit drugs. How did other substance use impact the results of the study?” he asked.

Dr Ghose also noted that although the greater number of medications prescribed to cannabis users “could reflect non-responsiveness, there are several other reasons why a person could have been prescribed different medications. These include medication tolerability, side effects (as mentioned by the authors), and compliance. These data suggest the need for carefully designed prospective studies in this population,” Dr Ghose concluded.

The study received no specific funding. Several investigators have received funding from pharmaceutical companies, which are listed in the original article.

Source:  BMJ Open. Published online March 3, 2016. 

Survey shows marijuana use disorder linked to substance use/mental disorders and disability.

Marijuana use disorder is common in the United States, is often associated with other substance use disorders, behavioral problems, and disability, and goes largely untreated, according to a new study conducted by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health. The analysis found that 2.5 percent of adults — nearly 6 million people — experienced marijuana use disorder in the past year, while 6.3 percent had met the diagnostic criteria for the disorder at some point in their lives. A report of the study, led by Bridget Grant, Ph.D., of the NIAAA Laboratory of Epidemiology and Biometry, appears online today in the American Journal of Psychiatry.

“…Marijuana use can lead to harmful consequences for individuals and society.”

—George F. Koob, Ph.D., Director, NIAAA

“The new analysis complements previous population-level studies by Dr. Grant’s group that show that marijuana use can lead to harmful consequences for individuals and society,” said George F. Koob, Ph.D., director of NIAAA. In a recent report, Dr. Grant and her team found that the percentage of Americans who reported using marijuana in the past year more than doubled between 2001-2002 and 2012-2013, and the increase in marijuana use disorders during that time was nearly as large. The new study analyzed data about marijuana use that were collected in the 2012-2013 wave of NIAAA’s National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), the largest study ever conducted on the co-occurrence of alcohol use, drug use, and related psychiatric conditions.

The researchers interviewed more than 36,000 U.S. adults about alcohol use, drug use, and related psychiatric conditions. Notably, the current study applies diagnostic criteria for marijuana use disorder from Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to the NESARC data. In DSM-5, marijuana dependence and abuse are combined into a single disorder. To be diagnosed with the disorder, individuals must meet at least two of 11 symptoms that assess craving, withdrawal, lack of control, and negative effects on personal and professional responsibilities. Severity of the disorder is rated as mild, moderate, or severe depending on the number of symptoms met.

Consistent with previous findings, the new data showed that marijuana use disorder is about twice as common among men than women, and that younger age groups are much more likely to experience the disorder than people age 45 and over. The risk for onset of the disorder was found to peak during late adolescence and among people in their early 20s, with remission occurring within 3 to 4 years. Also in keeping with previous findings, the new study found that past-year and lifetime marijuana use disorders were strongly and consistently associated with other substance use and mental health disorders.

Dr. Grant and her colleagues also reported that people with marijuana use disorder, particularly those with severe forms of the disorder, experience considerable mental disability. They note that previous studies have found that such disabilities persist even after remission of marijuana use disorder. The researchers also report that only about 7 percent of people with past-year marijuana use disorder receive any marijuana-specific treatment, compared with slightly less than 14 percent of people with lifetime marijuana use disorder.

“These findings demonstrate that people with marijuana use disorder are vulnerable to other mental health disorders,” said Nora D. Volkow, M.D., director of NIDA, which contributed funding to the study. “The study emphasizes the need for such individuals to receive help through evidence-based treatments that address these co-occurring conditions.”

The study authors note the urgency of identifying and implementing effective prevention and treatment for marijuana use disorder. And with ongoing changes in the drug’s legal status at the state level and a shift in beliefs about the risks associated with its use, they also note that public education about the dangers associated with marijuana use will be increasingly important to address public beliefs that marijuana use is harmless.

As marijuana and alcohol are frequently used together, more research is also needed to understand the effects of combined use. Studies suggest that using marijuana and alcohol together impairs driving more than either substance alone and that alcohol use may increase the absorption of THC, the psychoactive chemical found in marijuana.

In June 2015, NIAAA published a study based on NESARC data showing that alcohol use disorder (AUD) was on the rise in the U.S. over the last decade. The results showed that nearly one-third of adults in the United States have an AUD at some time in their lives, but only about 20 percent seek AUD treatment.

About the National Institute on Alcohol Abuse and Alcoholism (NIAAA): The National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health, is the primary U.S. agency for conducting and supporting research on the causes, consequences, prevention, and treatment of alcohol abuse, alcoholism, and alcohol problems. NIAAA funds the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA) to determine the effects of problematic alcohol use on the developing adolescent brain and examine brain characteristics that predict alcohol use disorder. NIAAA also disseminates research findings to general, professional, and academic audiences. Additional alcohol research information and publications are available at

 Source: www.niaaa.nih.gov. March 2016

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

Nora D. Volkowa,b,1, Gene-Jack Wanga, Frank Telanga, Joanna S. Fowlerc,1, David Alexoffc, Jean Logand, Millard Jaynea, Christopher Wonga, and Dardo Tomasia

Laboratory of Neuroimaging, National Institute on Alcohol Abuse and Alcoholism, Rockville, MD 20857; National Institute on Drug Abuse, Rockville, MD  20857; Biosciences Department, Brookhaven National Laboratory, Upton, NY 11973; and Department of Radiology, New York University Langone Medical Center, New York, NY 10016

Contributed by Joanna S. Fowler, June 20, 2014 (sent for review April 9, 2014; reviewed by Bertha Madras, Harvard University Medical School, and Karen Berman, National Institute of Mental Health)

Moves to legalize marijuana highlight the urgency to investigate effects of chronic marijuana in the human brain. Here, we challenged  48 participants (24 controls and 24 marijuana abusers) with methylphenidate (MP), a drug that elevates extracellular dopamine (DA) as a surrogate for probing the reactivity of the brain to DA stimulation. We compared the subjective, cardiovascular, and brain  DA responses (measured with PET and [11Craclopride) to MP between controls and marijuana abusers.

Although baseline (placebo) measures of striatal DA D2 receptor availability did not differ between groups, the marijuana abusers showed markedly blunted responses when challenged with MP. Specifically, compared with controls, marijuana abusers had significantly attenuated behavioural (“self-reports” for high, drug effects, anxiety, and restlessness), cardiovascular (pulse rate and diastolic blood pressure), and brain DA [reduced decreases in distribution volumes (DVs) of [11Craclopride, although normal reductions in striatal nondis placeable binding potential  (BPND)] responses to MP. In ventral striatum (key brain reward region),M P-induced reductions in DVs and BPND (reflecting DA increases) were inversely correlated with scores of negative emotionality, which were significantly higher for marijuana abusers than controls. In marijuana abusers, DA responses in ventral striatum were also inversely correlated with addiction severity and craving.

The attenuated responses to MP, including reduced decreases in striatal DVs, are consistent with decreased brain reactivity to the DA stimulation in marijuana abusers that might contribute to their negative emotionality (increased stress reactivity and irritability) and addictive behaviors.

Despite the high prevalence of marijuana consumption, the effects of marijuana abuse in the human brain are not well understood. Marijuana, like other drugs of abuse, stimulates brain dopamine (DA) signalling in the nucleus accumbens (1, 2), which is a mechanism believed to underlie the rewarding effects of drugs (3–5) and to trigger the neuroadaptations that result in addiction (reviewed in ref. 6). Indeed, in humans, imaging studies have shown that drugs of abuse increase DA release in striatum (including the nucleus accumbens), and these increases have been associated with the subjective experience of reward (7–9).

However, for marijuana, the results have been inconsistent: One study reported striatal DA increases during intoxication (10); two studies showed no effects (11, 12); and one study reported DA increases in individuals with a psychotic disorder and in their relatives, but not in controls (13). Imaging studies of the brain DA system in marijuana abusers have also shown different findings from those reported for other types of substance abusers. Specifically, substance abusers (cocaine, methamphetamine, alcohol, heroin, and nicotine), but not marijuana abusers (14–16), show reduced baseline availability of DA D2 receptors in striatum (reviewed ref. 6). Similarly, cocaine abusers (17, 18) and alcoholics (19, 20),but not marijuana abusers (16), show attenuated DA increases instriatum when challenged with a stimulant drug, although marijuana abusers with comorbid schizophrenia or risk for schizophrenia showed blunted DA increases to stimulants (21) and to stress (22). However, prior studies are limited by their small sample sizes (ranging from six to 16 subjects). Also, prior studies did not control for the potential confounds that the changes in cerebral vascular resistance associated with marijuana abuse (23– 25) could have on the delivery of the radiotracer to the brain when using a stimulant drug as pharmacological challenge, because stimulants decrease cerebral blood flow (26). Thus, the extent to which there are changes in brain DA signalling in marijuana abusers is still unclear. Here, we compared brain DA reactivity in healthy controls and marijuana abusers on a larger sample than that in prior studies and measured arterial concentration of non metabolized radiotracer to control for differences in radiotracer delivery to brain. We used PET and [11Craclopride (radioligand that binds to D2/D3 receptors not occupied by DA) to assess the effects of methylphenidate (MP) on the nondisplaceable binding potential [BPND; ratio of the distribution volume (DV) in striatum to that in cerebellum], which is the most frequent model parameter used to estimate DA changes (27), in 24 healthy controls and 24 marijuana abusers.We also quantified the DV,  which corresponds to the equilibrium measurement of the ratio of the concentration of the radiotracer in tissue to that in  arterial plasma, to control for potential changes in radiotracer delivery that could confound group comparisons of stimulant-induced changes in BPND. We used MP, which is a stimulant drug that blocks DA transporters, because it induces robust and reproducible DA increases in the human brain (28, 29). We predicted that MP’s behavioral effects in marijuana abusers would be attenuated, consistent with preclinical findings (30), and that decreased DA reactivity in ventral striatum would be associated with higher scores in negative emotionality (neuroticism), which mediates genetic risk for marijuana dependence (31), and with addiction severity.

Results

Participant Characteristics.

Tobacco smoking was more prevalent in marijuana abusers than controls; otherwise, there were no differences in demographics between groups (Table 1). However, the groups differed significantly in personality measures; marijuana abusers had significantly lower scores in positive emotionality (P = 0.05) and higher scores in negative emotionality (P = 0.002) than controls (Table 1).

Correlation analysis between scores in negative emotionality and history of marijuana abuse showed a negative correlation between age of I  the scores. The correlations with reported daily doses of marijuana and negative emotionality were not correlations with positive emotionality and history of marijuana abuse were not significant.

Plasma Concentrations of MP and Behavioral and Cardiovascular Effects. 

MP concentrations in plasma (nanograms per milliliter) did not differ between groups at 10 min (controls, 195 ± 51; abusers, 194 ± 45), 25 min (controls, 125 ± 24; abusers, 121 ± 19), or 40 min (controls, 102 ± 25; abusers, 94 ± 15). MP had significant behavioral effects, and these effects were attenuated in marijuana abusers compared with controls (Fig. 1A). Specifically, MP significantly increased scores on self-reports (averaged measures), and the effects differed between groups, with controls reporting a more robust “high” (drug effect: F = 92, P = 0.0001; interaction: F = 6.2, P = 0.02), “restlessness” (F = 35, P = 0.0001; interaction: F = 5.8, P = 0.02), “anxiety” (F = 7, P = 0.01; interaction: F = 5.8, P = 0.02), and “drug effects” (F = 100, P = 0.0001; interaction F = 4, P = 0.05) than marijuana abusers.

Also, comparisons of “peak” behavioral effects to MP were significantly stronger for controls for high (P = 0.01), restlessness (P = 0.003), anxiety (P=0.03),and drug effects

(P=0.02), than for the marijuana abusers. The potency of MP was also reported to be stronger by the controls than by the marijuana abusers (8.3 ± 2 vs. 5.8 ± 3; t = 3.4, P = 0.002). In marijuana abusers, MP increased self-reports of marijuana craving (Placebo: 4.0 ± 3–MP: 6.3 ± 3; P = 0.006) and tobacco craving (Placebo: 2.4 ± 2–MP: 3.8 ± 4; P = 0.05).

PLUS

MP increased heart rate

(F = 98, P = 0.0001) and systolic (F = 153, P = 0.0001) and diastolic (F = 65, P = 0.0001) blood pressure in both groups, and MP’s effects differed between groups for heart rate (interaction effect; F = 4.6, P = 0.04) and diastolic blood pressure (interaction effect: F = 4.0, P = 0.05), but not for systolic blood pressure (Fig. 1B). Post hoc t tests revealed that MP-induced increases in heart rate and diastolic pressure were significantly stronger (P < 0.05) in controls than in marijuana abusers.

Effects of MP on the DVs of [11Craclopride.

The SPM analysis showed no group differences in baseline measures of DV. It also showed that MP significantly decreased DV in brain and that the effects were significantly larger in controls than in marijuana abusers (Fig. 2). Individual plotting of MP-induced changes in DV showed that MP-induced changes in cerebellum were decreased in controls but not in marijuana abusers and that there were larger decreases of MP-induced changes in striatum in controls than in marijuana abusers (Fig. 2). The ROI analysis corroborated that MP decreased the DV in cerebellum and striatum and that the effects were larger for controls than abusers.

For cerebellum, the drug (F = 15, P = 0.0004) and drug × group interaction (F = 8.2, P = 0.007) were significant; post hoc t tests showed larger decreases in controls (13 ± 11%) than abusers (1.4 ± 16%) (P = 0.01). For caudate, the drug (F = 41, P = 0.0001) and interaction (F = 4.8, P = 0.04) were significant; post hoc t tests revealed larger decreases in controls (22 ± 18%) than abusers (9 ± 22%) (P = 0.05).

For putamen, drug (F = 93, P = 0.0001) and interaction (F = 6.9, P = 0.02) were significant; post hoc t tests showed larger decreases in controls (30 ± 16) than abusers (16 ± 21%) (P = 0.02). For ventral striatum, drug (F = 56, P = 0.0001) and interaction (F = 7.3, P = 0.01) were significant; post hoc t tests showed greater decreases in controls (25 ± 18%) than abusers (11 ± 25%) (P = 0.02). A group (controls vs. abusers) by region (delta DV in caudate, putamen, ventral striatum, and cerebellum) comparison revealed that group differences differed between regions (F = 3.5, P = 0.02); post hoc analysis showed that group differences in cerebellum were larger than in putamen (P = 0.02) and ventral striatum (P = 0.02), and showed a trend in caudate (P = 0.07).

This finding is significant; it confounds group comparisons of BPND because the latter measure is normalized to the DV in cerebellum. Note that attenuated decreases in cerebellar DV with MP in the marijuana abusers could result in an overestimation of their DA increases, reflecting an apparent lower striatal-DV/cerebellar-DV ratio (BPND) with MP (see below).

Correlations Between MP-Induced Changes in DV and Clinical Measures.

Correlation analysis revealed that MP-induced decreases in DV in ventral striatum were negatively associated with scores in negative emotionality (r = 0.51, P = 0004), and weaker correlations were observed in putamen (r = 0.37, P = 0.02) and caudate

(r = 0.35, P = 0.02) such that the larger the DV decreases, the lower were the scores of negative emotionality. Correlation with positive emotionality and constraint were not significant. MP-induced craving for marijuana in the marijuana abusers was negatively associated with DV decreases in putamen (r = 0.46, P = 0.03) and ventral striatum (r = 0.51, P = 0.01) such that participants with the smallest decreases had the most intense craving.

Baseline Measures of D2/D3 Receptor Availability (BPND).

For the baseline (placebo) measures, the SPM analysis revealed no group differences in BPND (D2/D3 receptor availability). When we decreased the threshold of significance to uncorrected P < 0.05, SPM showed lower values in marijuana abusers than in controls in ventral striatum (0, −2, −8; statistical t values = 2.59, P uncorrected = 0.007). The ROI analysis also showed a nonsignificant trend toward lower baseline BPND in marijuana abusers than in controls in ventral striatum (controls, 3.20 ± 0.3; abusers, 2.97 ± 0.59; P = 0.11) and no differences in caudate (controls, 2.80 ± 0.36; abusers 2.76 ± 0.57) or putamen (controls, 3.42 ± 0.41; abusers, 3.35 ± 0.57).

Effects of MP on BPND. 

The SPM analysis revealed significant decreases in BPND with MP compared with placebo (interpreted as reflecting DA increases) in striatum in both controls and marijuana abusers (Fig. 3 and Table 2). The SPM analysis revealed no group differences in MP-induced decreases in BPND in striatum but unexpectedly revealed larger BPND decreases in marijuana abusers than in controls in midbrain (region centered in susbtantia nigra that also encompassed sub thalamic nucleus; center of cluster left: 12, −14, −10, and 132 voxels, t = 3.1; center of cluster right: 14, −18, −8, and 27 voxels; t = 2.9; PFWE < 0.05; SVC = 10 voxels) (Fig. 3 and Table 2). The ROI analysis corroborated a significant group × drug interaction in midbrain (F = 14, P = 0.0006), and post hoc t test analyses showed that whereas in marijuana abusers, MP decreased BPND in midbrain (−3.5 ± 8%; F = 5.4, P = 0.03), MP increased BPND in controls (4 ± 6%; F = 9.2, P = 0.006).

Correlations Between MP-Induced Changes on BPND and Clinical Measures.

Voxel-wise correlation analysis revealed that MP-induced decreases in BPND in ventral striatum were inversely associated with scores in negative emotionality (Fig. 3 B and C) such that the larger the BPND decreases, the lower the scores. The striatal correlations with positive emotionality and constraint were not significant. Because the SPM revealed a significant group difference in MP-induced changes in midbrain BPND, we also performed correlations with this brain region and showed a significant correlation with positive emotionality (r = 0.42, P = 0.003) such that the greater the BPND decreases, the lower the scores. In the marijuana abusers, MP-induced decreases in BPND in midbrain were correlated with increases in marijuana (r = 0.40, P = 0.05) and tobacco (r = 0.45, P = 0.03) craving, as well as with the dependency scores (r = 0.43, P = 0.04), such that the greater the decreases in BPND, the higher was the craving triggered by MP and the higher were the dependency scores.

Discussion

Here, we show that marijuana abusers had attenuated behavioural and cardiovascular responses and blunted reductions in striatal DV (although normal reductions in BPND) when challenged with MP compared with controls, which is consistent with decreased brain reactivity to DA stimulation. We also corroborate prior findings (14–16) of no significant differences in baseline striatal D2/D3 receptor availability between controls and marijuana abusers and provide preliminary evidence of abnormal midbrain

DA reactivity in marijuana abusers. DA D2/D3 Receptor Availability in Striatum.

Only four brain imaging studies (totalling 42 marijuana abusers) have measured DA D2/ D3 receptors (14–16, 42). These studies showed no differences in striatal D2/D3 receptors between marijuana abusers and controls, but their generalizability is limited by the small sample sizes (samples ranged from n = 6 to n = 16). Thus, our results showing no differences in D2/D3 receptor availability (except for a trend in ventral striatum), using a larger sample (24 marijuana abusers) than that used for studies that identified reductions in striatal D2/D3 receptors in alcoholics and cocaine abusers, indicate that marijuana abusers, different from other drug abusers, do not show significant striatal D2/D3 receptor reductions. This difference could reflect marijuana’s agonist properties at cannabinoid 1 (CB1) receptors, which heteromerize with D2 receptors, antagonizing their effects (43). Both CB1 and D2 receptors couple to Gi-o proteins and inhibit adenylyl-cyclase, whereas their co-stimulation results in Gs protein-dependent activation of adenylylcyclase (44, 45).

Moreover, CB1 receptor agonists and antagonists counteract and potentiate, respectively, D2 receptor agonist effects (46–49), although D2 and CB1 receptor interactions might differ between rodents and primates (50, 51). It is therefore possible that in marijuana abusers, chronic CB1 receptor stimulation prevented the striatal D2/D3 receptor down-regulation observed < 0.005) and group comparisons for the effects of MP (ΔBPND) (P < 0.01, cluster size of 10 voxels). The contrast MA > HC indicates that MP induced with repeated drug use (reviewed in ref. 6). However, it should be noted that the marijuana abusers studied in the present and prior studies have been at least 10 y younger than the cocaine abusers and alcoholics studied by prior PET studies, which is relevant because striatal D2/D3 receptors decrease with age (52), and it is hypothesized that drugs accelerate the effects of brain aging (53). Thus, studies in older marijuana abusers are needed to clarify this.

MP-Induced Changes in DV.

In controls but not in marijuana abusers, MP reduced cerebellar DV. To ensure that the DV responses in the controls were consistent with prior findings, we performed a secondary analysis on the effects of MP on the cerebellar DV in an independent cohort of controls, which showed a 12% reduction, and in a sample of adults with attention deficit hyperactivity disorder (ADHD), which also showed an 11% reduction (for controls of the current cohort, the cerebellar DV decrease was 13 ± 11%). The mechanism underlying the lack of an effect of MP in cerebellar DV in abusers is unclear but could reflect the effects of chronic marijuana on cerebrovascular reactivity (increased cerebral vascular resistance) (23–25), which might have prevented MP-induced vasoconstriction and associated reductions in radiotracer delivery to the brain.

The attenuated decreases in DV with MP in the marijuana abusers were observed throughout the brain but were most accentuated in cerebellum. The higher sensitivity of the cerebellum to what we interpret to reflect changes in vascular reactivity with marijuana abuse is consistent with clinical findings that report strokes associated with marijuana abuse are more frequently localized in the posterior circulation and ischemia is most frequently observed in cerebellum (25, 54–56). Cerebellar arteries express CB1 receptors in the smooth muscle layer (57), but because comparisons with arteries in other brain regions have not been done, it is not possible to determine if higher levels of CB1 receptors in cerebellar arteries underlie their higher sensitivity to vascular effects from marijuana.

However, CB1 receptors in cerebellum are also expressed in neurons and glia (58), and the cerebellum is a region that is affected in marijuana abusers (59–61); thus, we cannot rule out the possibility that other factors contribute to the lack of an effect of MP on the cerebellar DV in the marijuana abusers. MP also decreased the DV in striatum to a greater extent in controls than in abusers (Fig. 2). In ventral striatum, these decreases were associated with negative emotionality and with marijuana craving such that the lower the response, the higher the negative emotionality and the craving. This would suggest that these attenuated responses might reflect reduced striatal DA reactivity in marijuana abusers compared with controls even though there were no group differences in MP-induced decreases in BPND (see below). This is consistent with findings from an imaging study with [18F]-dopa that reported lower than normal DA synthesis capacity in the striatum of marijuana abusers (62).

MP-Induced Changes in BPND.

We showed no group differences in MP-induced changes in BPND in striatum, which is the standard measure for assessing DA changes. Similarly, a prior study reported no differences in amphetamine-induced decreases in BPND between marijuana abusers and controls (16). However, the significant group differences in MP’s effects on the DV in cerebellum confound the findings because BPND uses the cerebellum as a reference region to normalize for nonspecific binding. Because the DV in cerebellum was not decreased by MP in marijuana abusers but was decreased in controls, this would result in an overestimation of the decrease in BPND with MP (cerebellar denominator would have a relatively larger value) and an overestimation of DA increases in marijuana abusers compared with controls.

Interestingly, an imaging study comparing DA increases using BPND and 4-propyl-9-hydroxynaphthoxazine ([11C]PHNO)

(radiotracer with >20-fold higher affinity for D3 over D2 receptors, and presumably more sensitive to competition with endogenous DA) (63, 64) in response to a stressor in individuals at high risk for schizophrenia showed that those who abused marijuana had a blunted response, consistent with decreased DA signalling (22). Because the study used cognitive stress as a challenge, it was not confounded by potential group differences in stimulant-induced changes in cerebellar radiotracer delivery.  Unexpectedly, SPM revealed that MP decreased BPND in midbrain (centered in substantia nigra) in marijuana abusers but not in controls. Although the mechanism(s) underlying this group difference is unclear, we speculate that because the midbrain has a high concentration of D3 receptors (65), which are more sensitive to endogenous DA than D2 receptors (66), it could reflect up-regulation of D3 receptors in marijuana abusers.

Indeed, in rodents, chronic Δ (9)-tetrahydrocannabinol (THC; the main psychoactive ingredient of marijuana) increased D3 receptors in midbrain (30). In the marijuana abusers, an MP-induced decrease in midbrain BPND correlated with craving and with dependency scores. A similar finding was reported in methamphetamine abusers, in whom up-regulation of D3 receptors in midbrain (assessed with [11C]PHNO) correlated with amphetamine-induced craving (30, 67). This, along with preclinical studies showing that D3 receptor antagonists interfere with drug seeking and cue- and receptor signalling in midbrain might contribute to drug craving and to decreased sensitivity to reward in marijuana abusers (see below).

However, because the midbrain finding was unexpected, we report it as a preliminary finding in need of replication.

Blunted Behavioral and Cardiovascular Responses to MP in Marijuana Abusers.

Behavioral and cardiovascular effects of MP have been associated with MP-induced DA increases in striatum (9, 69), so the blunted responses in the marijuana abusers are also consistent with decreased striatal reactivity to DA signaling. Although, to our  knowledge, this is the first clinical report of an attenuation of the effects of MP in marijuana abusers, a preclinical study had reported that rats treated chronically with THC exhibited attenuated locomotor responses to amphetamine (2.5 mg/kg

administered i.p.) (30). Such blunted responses to MP could reflect neuroadaptations from repeated marijuana abuse, such as downregulation of DA transporters (70). The attenuation of MP’s effects could also reflect abnormal D2 receptor function, as was previously suggested to explain findings in marijuana-abusing schizophrenic patients, who, despite displaying low DA release, showed increases in psychotic symptoms when challenged with amphetamine (21). Finally, it is also possible that the attenuated responses reflect blunting of MP’s noradrenergic effects because MP blocks both DA and norepinephrine transporters. Our findings of blunted responses to MP in marijuana abusers have clinical implications because they suggest that individuals with ADHD who abuse marijuana might be less responsive to the therapeutic benefits derived from stimulant medications.

Reduced Positive Emotionality and Increased Negative Emotionality in Marijuana Abusers.

Marijuana abusers showed lower scores on positive emotionality and higher scores on negative emotionality than controls, consistent, on the one hand, with lower reward sensitivity and motivation and, on the other hand, with increased stress reactivity and irritability. These characteristics overlap with the amotivational syndrome (71) and with the enhanced sensitivity to stress associated with marijuana abuse and other addictions (72, 73). Positive emotionality was inversely associated with MP induced increases in midbrain DA, which could reflect the fact that in midbrain, D2 and D3 are autoreceptors; therefore, their stimulation would result in decreased DA release in striatum (including accumbens) (74), leading to decreased sensitivity to reward and amotivation (75). In contrast, MP-induced DA increases in ventral striatum were negatively associated with scores on negative emotionality, which is consistent with the protective role of DA signalling in negative emotions (76). The association between negative emotionality and age of initiation of marijuana abuse is consistent with prior findings of worse outcomes with earlier initiation of marijuana abuse (77).

Study Limitations.

The main limitation of this study was the inadequacy of BPND for comparing the DA increases between controls and marijuana abusers due to the group differences on  the effects of MP on cerebellar DV. Also, [11Craclopride cannot distinguish between D2 and D3 receptors, so studies with D3 receptor ligands are needed to determine if the increased midbrain DA response in marijuana abusers reflects D3 receptor upregulation. The relatively poor spatial resolution of PET limits accuracy in the quantification of small brain regions, such as midbrain. Our study cannot ascertain if group differences reflect chronic use of marijuana rather than premorbid differences, and whether marijuana abusers will recover with detoxification. Although attenuation of the effects of MP could reflect interference from CB1 receptor stimulation by marijuana, this is unlikely because marijuana abusers reported that their last use of marijuana was 1–7 d before the study when cannabinoids in plasma are still detectable but at concentrations unlikely to have pharmacological effects (78). However, future studies done after longer periods of withdrawal are needed to control for potential confounds from THC and its metabolites in plasma and to determine if the blunted responses recover.

We did not obtain MRI scans on the participants. However, this is unlikely to have affected the results because measures of [11Craclopride binding are equivalent when using a region extracted from an MRI scan or from the [11Craclopride scan

(79), and there is no evidence that marijuana abusers have striatal or cerebellar atrophy (reviewed in ref. 80). Finally, the groups differed in smoking status, but this is unlikely to account for the group differences because CO levels were used as a covariate in the analysis and there were no differences in the effects of MP between marijuana abusers who smoked cigarettes and those who did not.

Conclusions

The significantly attenuated behavioral and striatal DV response to MP in marijuana abusers compared with controls, indicates reduced brain reactivity to DA stimulation that in the ventral striatum might contribute to negative emotionality and drug craving.

Source:  http://www.pnas.org/content/111/30/E3149

Study Highlights:

* Secondhand marijuana smoke may have similar cardiovascular effects as tobacco smoke.

* Lab rats exposed to secondhand marijuana smoke had a 70 percent drop in blood vessel function.

*  Breathing secondhand marijuana smoke could damage your heart and blood vessels as much as secondhand cigarette smoke, according to preliminary research presented at the American Heart Association’s Scientific Sessions 2014.  In the study, blood vessel function in lab rats dropped 70 percent after 30 minutes of exposure to secondhand marijuana smoke. Even when the marijuana contained no tetrahydrocannabinol (THC) — a compound in marijuana that produces intoxication — blood vessel function was still impaired.  Reduced blood vessel function may raise the chances of developing atherosclerosis and could lead to a heart attack. Atherosclerosis is the disease process that causes plaque build-up in the arteries which narrows them and restricts blood flow.  “Most people know secondhand cigarette smoke is bad for you, but many don’t realize that secondhand marijuana smoke may also be harmful,” said Matthew Springer, Ph.D., senior author of the study and cardiovascular researcher and associate professor of Medicine at the University of California, San Francisco’s Cardiology Division.  Marijuana and tobacco smoke are chemically and physically alike, aside from their active ingredients.  The drop in blood vessel function from THC-free marijuana suggests that the compound isn’t responsible for the effect. Similarly, this study confirms that nicotine is not required for smoke to interfere with blood vessel function.  In the study, researchers used a modified cigarette smoking machine to expose rats to marijuana smoke. A high-resolution ultrasound machine measured how well the main leg artery functioned. Researchers recorded blood vessel dilation before smoke exposure and 10 minutes and 40 minutes after smoke exposure.  They also conducted separate tests with THC-free marijuana and plain air. There was no difference in blood vessel function when the rats were exposed to plain air.  In previous tobacco studies, blood vessel function tended to go back to normal within 30 minutes of exposure. However, in the marijuana study, blood vessel function didn’t return to normal when measured 40 minutes after exposure.  Now that marijuana is becoming increasingly legalized in the United States, its effect on others is a growing public health concern, Springer said.  “If you’re hanging out in a room where people are smoking a lot of marijuana, you may be harming your blood vessels,” he said. “There’s no reason to think marijuana smoke is better than tobacco smoke. Avoid them both.”  Secondhand tobacco smoke causes about 34,000 premature deaths from heart disease each year in the United States among non-smokers according to the U.S. Surgeon General’s 2014 report on the consequences of smoking.  More research is needed to determine if secondhand marijuana smoke has other

similar effects to secondhand cigarette smoke in humans.  The National Institute on Drug Abuse and the Elfenworks Foundation funded the study.  Here is the abstract:

* Brief Exposure to Marijuana Secondhand Smoke Impairs Vascular Endothelial Function

Xiaoyin Wang, Ronak Derakhshandeh, Shilpa Narayan, Emmy Luu, Stephenie Le, Olivia M. Danforth, Hilda J. Rodriguez, Richard E. Sievers, Suzaynn F. Schick, Stanton A. Glantz, Matthew L. Springer, Univ of California, San Francisco, San Francisco, CA Objectives: Despite general public awareness that tobacco secondhand smoke (SHS) is harmful, much of the public still regards marijuana SHS as benign. Because marijuana smoke and tobacco smoke are chemically and physically similar (other than nicotine and tetrahydrocannabinol (THC)), we tested this assumption by asking whether short exposure to marijuana SHS causes acute vascular endothelial dysfunction similar to that caused by tobacco SHS. Exposure to tobacco SHS impairs arterial flow-mediated dilation (FMD) in humans and rats.

Methods: We used a rat model to test the effects of secondhand marijuana smoke on FMD. We exposed anesthetized rats to marijuana SHS using a modified cigarette smoking machine, and measured FMD three times: before 30-min exposure (“pre”), 10 min after end of exposure (“post10”), and 40 min after end of exposure (“post40”). FMD was measured by micro-ultrasound measurements of femoral artery diameter before and after transient (5 min) surgical ligation of the common iliac artery. Concentrations of respirable suspended particles <2.5 μm (RSP) fell during exposure; exposure conditions are denoted by starting concentrations.

Results: Marijuana SHS starting at 667±62 μg/m3 RSP (n=8) caused FMD to fall from 7.5±0.94% (SEM) pre to 2.3±0.50% at post10 and 2.2±0.80 at post40 (P<0.01 for both post10 and post40 vs. pre, adjusted for multiple comparisons). SHS from placebo marijuana lacking THC starting at 671±49 μg/m3 RSP (n=7) similarly impaired FMD (9.9±1.4% pre, 4.3±0.64% post10 (p<0.01), 5.5±1.3% post40 (P<0.05)), confirming that impairment did not depend on the THC. In contrast, air in the exposure chamber (1.8±0.7 μg/m3RSP; n=8) did not alter FMD (11.0±0.64% pre, 11.4±0.72% post10, 11.7±0.86% post40, P>0.70).

Conclusions: Marijuana and tobacco SHS impair endothelial function similarly under comparable exposure conditions. Public exposure to SHS should be avoided whether the source is tobacco or marijuana.

Source:  https://tobacco.ucsf.edu/secondhand-marijuana-smoke-may-damage-blood-vessels-much-tobacco-smoke  2014-11-16

In the winter issue of National Affairs, Jon Caulkins seeks to answer the question, “is marijuana dangerous?” While acknowledging some of the known harms of the drug, he ultimately undersells marijuana’s health risks, calling them “minor.” He characterizes the drug as a “performance degrader” and “more dangerously, a temptation commodity with habituating tendencies.”

Caulkins’ evidence regarding respective drug dangers, such as comparison to alcohol, turns on damage to organs (excluding, notably, the brain) and lethality. One wishes that he was more familiar with the 1974 testimony before a Senate Committee that also examined alcohol and marijuana in comparative fashion:

Brain activities in relationship to [alcohol and marijuana] are drastically different. Alcohol does not … directly and profoundly affect brain function as the cannabis preparations do…. You can use alcohol for a long period of time without producing any sort of persistent damage. But with marihuana … it seems as though you have to use it only for a relatively short time … before (it) produces distinctive and irreversible changes in the brain.

Since the time of that over-forty-year-old testimony, the evidence for marijuana’s brain-altering damage has only grown, as has the average potency, dramatically, something Caulkins’ analysis critically leaves out. There are also changes to the “habituating tendency” of the developmentally-adolescent to use the drug on a daily basis.

The drug is increasingly ingested in additional forms beyond smoked leaves (Caulkins notices the pulmonary consequences of smoking). Today, youth are consuming edibles with high doses of THC (the intoxicating and damaging component), and drinks, and “vaped” combustible concentrates, while at the same time often combining the drug with continued use of alcohol.

The impact of increased potency is still unknown, but will not be inconsequential. Forms of the drug now contain 70-80 percent THC, in contrast to the more familiar THC potencies found in smoked leaves of earlier years, which only rarely exceeded 5-10 percent.

Two things immediately follow from these chemical facts. First, most longitudinal studies of the risks of marijuana for producing cognitive effects and chemical dependency tracked youth using low-potency marijuana. The future for today’s adolescents is simply an unknown, but all signs indicate that the damage will escalate.

Second, the realization of potency renders somewhat irrelevant one of Caulkins’ key policy points, which follows his careful calculation of the volumes of the drug being consumed by users with different use profiles. Because Caulkins analyzes only the amount of (largely) self-reported leaf consumption by either slight or heavy users, he misses the critical variable, which is the amount of THC actually being consumed. As potency has escalated and is not factored in to his equations, his calculations are not as meaningful as he supposes.

A single candy bar purchased today in Colorado, for instance, can contain ten times the amount of THC as a single, premium quality marijuana “joint” of recent years. Psychotic episodes related to the consumption of these edibles are escalating in both emergency room episode reports as well as mortality toxicology reports. Caulkins needs to re-do his analysis with this factor considered.

There is also the matter of his reliance on the National Household Survey on Drug Use and Health (NSDUH) as input for his analysis. The survey, consisting of self-reports of use, also depends upon self-reports of problems in relation to DSM-established criteria for dependency. But these self-reports depend upon (no matter whether they are understated or not) a person’s sense of their behavior as it is affected by the drug.

The problem lies here: a drug that can be shown to alter brain structure and function (albeit in subtle ways, in some instances, and the permanency of such changes is today largely unknown) does not necessarily produce an impact that rises to the level of self-apprehension. That is, the user likely has a blind-spot about the actual impact, which can occur without noticeable manifestations for the person or his friends, until the impact becomes pronounced.

Rather than behavior alone, we should attend to, in addition to clinical judgments, the results of brain analysis, such as MRI analyses, of brain changes. Such a literature exists, and it is not comforting. Even casual use, a profile that Caulkins is inclined to treat as non-threatening in his policy recommendations, has been linked to “neural noise” as well as structural brain changes, even at relatively low exposure – that is, “youthful recreational use” or even “half-a-joint.”

Caulkins also appeals to relatively standard policy postures adopted by libertarians who count on market forces to shape drug behavior futures. It remains an open question whether such market forces are appropriate regulators for adolescents who are, says the medical literature, doing major but unwitting damage to themselves. And under legalization youth exposure increases considerably.

But more importantly, it’s hard to reconcile the pure public health impact of expanding drug use by adults (or semi-adults) with the recent literature showing detrimental effects of maternal use on offspring, including (in animal studies) permanent impairment of the brains of embryos exposed through maternal use. Recent findings are troubling, and call into question the conventional wisdom that drug use “harms only the user him/her self.” Should not drug policy concern itself with these effects?

There is also the question of Caulkins’ use of the literature regarding the ratios of users to those who become dependent users for various forms of drug use, including alcohol, as a means of evaluating respective dangers. The research has been interpreted to rank-order relative dangers from drugs and alcohol by calculating the respective number of users who become dependent users, seeing the outcomes as a reflection of the drug’s impact. Somewhat carelessly, this literature is cited to argue that marijuana is actually “less dangerous” than other drugs, particularly alcohol and tobacco. The most common citation is to research (Antony, 1994) that found roughly one in nine marijuana users become dependent. Caulkins wisely notes that the ratio is likely higher than that (in fact, NIDA has indicated that for daily users, the ratio is about one-in-two). Very likely the potency issue will render those early ratio assumptions to be even farther off than we today experience.

But more importantly, Caulkins misses the clear policy caveats contained in the original research, which, when grasped, weaken his main theme—that we can accommodate by a new legal “architecture” some “permissible” level of non-dependent use and only suffer public health consequences consistent with what the past literature suggests.

What the Antony research actually demonstrates is that we have fixed on the wrong interpretation of the study’s findings. One cannot conclude from Antony’s ratios anything reliable about the respective “dangers” of the substances themselves, taken in isolation, as potentially dependency-producing drugs. Nor does the original research make that claim. In fact, the researchers are well aware of the potential limitations of these results, and explicitly discuss the complexities they present.

As they write:

The array of interrelated factors includes relative drug availability, and opportunities for use of different drugs as well as their costs; patterns and frequencies of drug use that differ across drugs; different profiles of vulnerabilities of individuals … as well as both formal and informal social controls and sanctions against drug use or in its favor…. Considered all together … the transition from drug use to drug dependence runs a span from the microscopic (e.g. the dopamine receptor) through the macroscopic (e.g. social norms for or against drug use; international drug control policies).

When this position is understood, we see that, if anything, it is an argument cutting against the policy of marijuana legalization under any liberalized architecture. Both tobacco and alcohol are legal substances, and have use rates multiple times in excess of (illicit) marijuana. Moreover, they are used in patterns that make exposure to them considerably in excess of exposure to marijuana. Those who smoke tobacco do so multiple times a day, commonly every day; in relative fashion the same holds true for alcohol use.

And this research specifically notes that it is just such patterns of access, frequency, and persistence of use that contribute to the overall dependency-producing potential, in conjunction with the biology of the substance itself in relation to the brain. Simply put, were marijuana to be legal, and subject to access and use patterns comparable to alcohol or tobacco on a daily basis, the impact on subjects as found in dependency and addiction rates, while unknown, would likely be staggering.

And then, to make the final observation, Caulkins envisions possible legal architectures for dispensing the drug, without any consideration of this overwhelming fact: wherever we today find commercial, legal marijuana, there we also find, robust and thriving, the very criminal and violent and corrupting black market. The danger is great and it is getting worse rapidly.

Source:  David Murray replies to article in National Affairs.  Quoted in email from Drugwatch International  January 2016

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-

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.

Abstract

Background and Purpose

An increasing number of case reports link cannabis consumption to cerebrovascular events. Yet these case reports have not been scrutinized using criteria for causal inference.

Methods

All case reports on cannabis and cerebrovascular events were retrieved. Four causality criteria were addressed: temporality, adequacy of stroke work-up, effects of re-challenge, and concomitant risk factors that could account for the cerebrovascular event.

Results

There were 34 case reports on 64 patients. Most cases (81%) exhibited a temporal relationship between cannabis exposure and the index event. In 70%, the evaluation was sufficiently comprehensive to exclude other sources for stroke. About a quarter (22%) of patients had another stroke after subsequent re-exposure to cannabis. Finally, half of patients (50%) had concomitant stroke risk factors, most commonly tobacco (34%) and alcohol (11%) consumption.

Conclusion

Many case reports support a causal link between cannabis and cerebrovascular events. This accords well with epidemiological and mechanistic research on the cerebrovascular effects of cannabis.

  1. Daniel G. Hackam, MD, PhD, FRCPC

+Author Affiliations

  1. From the Division of Clinical Pharmacology, Department of Medicine, Western University, London, Ontario, Canada.

  1. Correspondence to Daniel G. Hackam, MD, PhD, FRCPC, 1400 Western Rd, London, Ontario, Canada N6G 2V2. E-mail dhackam@uwo.ca

Source: http://stroke.ahajournals.org/content/early/2015/02/19

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

“Even at normal doses, taking psychiatric drugs can produce suicidal thinking, violent behavior,  aggressiveness, extreme anger,  hostility, irritability, loss of ability to control impulses, rage reactions, hallucinations, mania, acute psychotic episodes, akathisia, and bizarre, grandiose, highly elaborated destructive plans, including mass murder.

“Withdrawal from psychiatric drugs can cause agitation, severe depression, hallucinations, aggressiveness, hypomania, akathisia, fear, terror, panic, fear of insanity, failing self-confidence, restlessness, irritability, aggression, an urge to destroy and, in the worst cases, an urge to kill.” -  From “Drug Studies Connecting Psychotropic Drugs with Acts of Violence” – unpublished.

My previous article on Global Research discussed the frustration of large numbers of aware observers around the world that were certain that Andreas Lubitz, the suicidal mass murderer of 149 passengers and crewmembers of the of the Lufthansa airliner crash, was under the intoxicating influence of brain-disabling, brain-altering, psychotropic medicines that had been prescribed for him by his German psychiatrists and/or neurologists who were known to have been prescribing for him.

These inquiring folks wanted and needed to know precisely what drugs he had been taking or withdrawing from so that the event could become a teachable moment that would help explain what had really happened and then possibly prevent other “irrational” acts from happening in the future. For the first week after the crash, the “authorities” were closed mouthed about the specifics, but most folks were willing to wait a bit to find out the truth.

However, another week has gone by, and there has still been no revelations from the “authorities” as to the exact medications, exact doses, exact combinations of drugs, who were the prescribing clinics and physicians and what was the rationale for the drugs having been  prescribed. Inquiring minds want to know and they deserve to be informed.

There are probably plenty of reasons why the information is not being revealed. There are big toes that could be stepped on, especially the giant pharmaceutical industries. There are medico-legal implications for the physicians and clinics that did the prescribing and there are serious implications for the airline corporations because their industry is at high risk of losing consumer confidence in their products if the truth isn’t adequately covered up. And the loss of consumer confidence is a great concern for both the pharmaceutical industry and its indoctrinated medical providers.

It looks like heavily drugged German society is dealing with the situation the same way the heavily drugged United States has dealt with psychiatric drug-induced suicidality and drug-induced mass murders (such as have been known to be in a cause and effect relationship in the American epidemic of school shootings – see www.ssristories.net).

The Traffickers of Illicit Drugs That Cause Dangerous and Irrational Behaviors Such as Murders and Suicides are Punished. Why not Legal Drug Traffickers as Well?

But there is a myth out there that illegal brain-altering drugs are dangerous but prescribed brain-altering drugs are safe. But anyone who knows the molecular structure and understands the molecular biology of these drugs and has seen the horrific adverse effects of usage or withdrawal of legal psychotropic drugs knows that the myth is false, and that there is a double standard being applied, thanks to the cunning advertising campaigns from Big Pharma.

But there is an epidemic of legal drug-related deaths in America, so I submit a few questions that people – as well as journalists and lawyers who are representing drug-injured plaintiffs – need to have answered, if only for educational and preventive practice purposes:

1) What cocktail of 9 different VA-prescribed psych drugs was “American Sniper” Chris Kyle’s Marine Corps killer taking after he was discharged from his psychiatric hospital the week before the infamous murder?

2) What were the psych drugs that Robin Williams got from Hazelden just before he hung himself?

3) What were the myriad of psych drugs, tranquilizers, opioids, etc that caused the overdose deaths of Philip Seymour Hoffman, Michael Jackson, Whitney Houston, Heath Ledger, Anna Nicole Smith, etc, etc, etc (not to mention Jimi Hendrix, Bruce Lee, Elvis Presley and Marilyn Monroe) – and who were the “pushers” of those drugs?

4) What was the cocktail of psychiatric and neurologic brain-altering drugs that Andreas Lubitz was taking before he intentionally crashed the passenger jet in the French Alps – and who were the prescribers?

5) What are the correctly prescribed drugs that annually kill over 100,000 hospitalized Americans per year and are estimated to kill twice that number of out-patients?

(See http://www.collective-evolution.com/2013/05/07/death-by-prescription-drugs-is-a-growing-problem/)

Because the giant pharmaceutical companies want these serious matters hushed up until the news cycle blows over (so that they can get on with business as usual), and because many prescribing physicians seem to be innocently unaware that any combination of two or more brain-altering psychiatric drugs have never been tested for safety (either short or long-term), even in the rat labs, future celebrities and millions of other patient-victims will continue dying – or just be sickened from a deadly but highly preventable reality.

But what about “patient confidentiality”, a common excuse for withholding specific information about patients (even if crimes such as mass murder are involved)? It turns out that what is actually being protected by that assertion are the drug providers and manufacturers. Common sense demands that such information should not be withheld in a criminal situation.

America’s corporate controlled media makes a lot of money from its relationships with its wealthy and influential corporate sponsors, contributors, advertisers, political action committees and politicians, but, tragically, the media has been clearly abandoning its historically-important investigative journalistic responsibilities (that are guaranteed and protected by the Constitution). It is obvious that the media has allied itself with the corporate “authorities” that withhold, any way they can, the important information that forensic psychiatrists (and everybody else) needs to know.

We should be calling out and condemning the authorities that are withholding the information about the reported “plethora of drugs” that is known to have been prescribed for Lubitz by his treating “neurologists and psychiatrists”, drugs that were found in his apartment on the day of the crash and identified by those same authorities who have not revealed the information to the people who need to know. Two weeks into the story and there still has been no further information given, or as far as I can ascertain, or asked for by journalists.

So, since the facts are being withheld by the authorities, I submit some useful lists of common adverse effects of commonly prescribed crazy-making psych drugs that Lubitz may have been taking. Also included are a number of withdrawal symptoms that are routinely  and conveniently mis-diagnosed as symptoms of a mental illness of unknown cause.

And at the end of the column are some excerpts from the FAA on psych drug use for American pilots. I do not know how different are the rules in Germany, but certainly both nations have to rely on voluntary information from the pilots.

1) Common Adverse Symptoms of Antidepressant Drug Use

Agitation, akathisia (severe restlessness, often resulting in suicidality), anxiety, bizarre dreams, confusion, delusions, emotional numbing, hallucinations, headache, heart attacks  hostility, hypomania (abnormal excitement), impotence, indifference (an “I don’t give a damn attitude”), insomnia, loss of appetite, mania, memory lapses, nausea, panic attacks, paranoia, psychotic episodes, restlessness, seizures, sexual dysfunction, suicidal thoughts or behaviors, violent behavior, weight loss, withdrawal symptoms (including deeper depression)

2) Common Adverse Psychological Symptoms of Antidepressant Drug Withdrawal

Depressed mood, low energy, crying uncontrollably, anxiety, insomnia, irritability, agitation, impulsivity, hallucinations or suicidal and violent urges. The physical symptoms of antidepressant withdrawal include disabling dizziness, imbalance, nausea, vomiting, flu-like aches and pains, sweating, headaches, tremors, burning sensations or electric shock-like zaps in the brain

3) Common Symptoms of Minor Tranquilizer Drug Withdrawal

Abdominal pains and cramps, agoraphobia , anxiety, blurred vision, changes in perception (faces distorting and inanimate objects moving), depression, dizziness, extreme lethargy, fears, feelings of unreality, heavy limbs, heart palpitations, hypersensitivity to light, insomnia, irritability, lack of concentration, lack of co-ordination, loss of balance, loss of memory, nightmares, panic attacks, rapid mood changes, restlessness, severe headaches, shaking, sweating, tightness in the chest, tight-headedness

4) Common (Usually Late Onset) Adverse Psychological Symptoms From Anti-Psychotic Drug Use

Blurred vision, breast enlargement/breast milk flow,  constipation, decreased sweating, dizziness, low blood pressure, imbalance and falls, drowsiness, dry mouth, headache, hyperprolactinemia (pituitary gland dysfunction), increased skin-sensitivity to sunlight, lightheadedness, menstrual irregularity (or absence of menstruation), sexual difficulty, (decline in libido, anorgasmia, genital pain).

The lethal adverse effects of antipsychotic drugs include Catatonic decline, Neuroleptic Malignant Syndrome (NMS, a condition marked by muscle stiffness or rigidity, dark urine, fast heartbeat or irregular pulse, increased sweating, high fever, and high or low blood pressure); Torsades de Pointes (a condition that affects the heart rhythm and can lead to sudden cardiac arrest”; Sudden death

5) Late and Persistent Adverse Effects of Antipsychotic Drug Use  (Some of these symptoms may even start when tapering down or discontinuing the drug!)

Aggression, akathisia (inner restlessness, often intolerable and leading to suicidality), brain atrophy (shrinkage), caffeine or other psychostimulant addiction, cataracts, creativity decline, depression, diabetes, difficulty urinating, difficulty talking, difficulty swallowing, fatigue and tiredness, hypercholesterolemia, hypothyroidism, intellectual decline (loss of IQ points), obesity, pituitary tumors, premature death, smoking – often heavy – (nicotine addiction), tardive dyskinesia (involuntary, disfiguring movement disorder), tongue edge “snaking” (early sign of movement disorder), jerky movements of head, face, mouth or neck, muscle spasms of face, neck or back, twisting the neck muscles, restlessness – physical and mental (resulting in sleep difficulty), restless legs syndrome, drooling, seizure threshold lowered, skin rashes (itching, discoloration), sore throat, staring, stiffness of arms or legs, swelling of feet, trembling of hands, uncontrollable chewing movements, uncontrollable lip movements, puckering of the mouth, uncontrollable movements of arms and legs, unusual twisting movements of body, weight gain, liver toxicity

6) Common Symptoms of Antipsychotic Drug Withdrawal

Nausea and vomiting, diarrhea, rhinorrhea (runny nose), heavy sweating, muscle pains, odd sensations such as burning, tingling, numbness,  anxiety, hypersexuality, agitation, mania, insomnia, tremor, voice-hearing

FAA Medical Certification Requirements for Psychotropic Medications

https://www.leftseat.com/psychotropic.htm

Pilots can only take one of four antidepressant drugs – Celexa (Citalopram), Lexapro (Escitalopram), Prozac (Fluoxetine) and Zoloft (Sertraline).

Most psychiatric drugs are not approved under any circumstances.

These include but are not limited to:

  • Abilify (Aripiprazole)
  • Effexor (Venlafaxine)
  • Elavil (Amitriptyline)
  • Luvox (Fluvoxamine Maleate)
  • Monoamine Oxidase Inhibitors
  • Paxil (Paroxetine)
  • Remeron (Mirtazapine)
  • Serzone (Nefazodone)
  • Sinequan (Doxepin)
  • Tofranil (Imipramine)
  • Trazodone
  • Tricyclic Antidepressants
  • Wellbutrin (Bupropion)

To assure favorable FAA consideration, the treating physician should establish that you do not need psychotropic medication. The medication should be discontinued and the condition and circumstances should be evaluated after you have been off medication for at least 60 and in most cases 90 days.

Should your physician believe you are an ideal candidate, you may be considered by the FAA on a case by case basis only. Applicants may be considered after extensive testing and evidence of successful use for one year without adverse effects. Medications used for psychiatric conditions are rarely approved by the FAA. The FAA has approved less than fifty (50) airmen under the FAA’s SSRI protocol.

After discontinuing the medication, a detailed psychiatric evaluation should be obtained. Resolved issues and stability off the medication are usually the primary factors for approval.

Dr Kohls is a retired physician who practiced holistic mental health care for the last decade of his family practice career. He writes a weekly column on various topics for the Reader Weekly, an alternative newsweekly published in Duluth, Minnesota, USA. Many of Dr Kohls’ weekly columns are archived at http://duluthreader.com/articles/categories/200_Duty_to_Warn.

Source:  http://www.globalresearch.ca/the-connections-between-psychotropic-drugs-and-irrational-acts-of-violence/5441484  April 08, 2015

 

President Obama this week told an audience in Jamaica that U.S. efforts against illegal drugs were “counterproductive” because they relied too much on incarceration—particularly for “young people who did not engage in violence.”

In what the president termed “an experiment … to legalize marijuana” in Colorado and Washington state, he said he believed they must “show that they are not suddenly a magnet for additional crime, that they have a strong enough public health infrastructure to push against the potential of increased addiction.”

In regard to Jamaica and the entire Caribbean and Central American region, he said, “a lot of folks think … if we just legalize marijuana, then it’ll reduce the money flowing into the transnational drug trade, there are more revenues and jobs created.”

To some of us, Jamaica hardly seems an auspicious location for encouraging “experimentation” with drugs, in particular because of the challenges already faced by their deficient institutions of public health and criminal justice. The U.S. Department of State 2015 International Narcotics Control Strategy Report(INCSR) states:

Jamaica remains the largest Caribbean supplier of marijuana to the United States and local Caribbean islands. Although cocaine and synthetic drugs are not produced locally, Jamaica is a transit point for drugs trafficked from South America to North America and other international markets. In 2014, drug production and trafficking were enabled and accompanied by organized crime, domestic and international gang activity, and police and government corruption. Illicit drugs are also a means of exchange for illegally-trafficked firearms entering the country, exacerbating Jamaica’s security situation.

Drugs flow from and through Jamaica by maritime conveyance, air freight, human couriers, and to a limited degree by private aircraft. Marijuana and cocaine are trafficked from and through Jamaica into the United States, Canada, the United Kingdom, Belgium, Germany, the Netherlands, and other Caribbean nations. Jamaica is emerging as a transit point for cocaine leaving Central America and destined for the United States, and some drug trafficking organizations exchange Jamaican marijuana for cocaine. . . .

The conviction rate for murder was approximately five percent, and the courts continued to be plagued with a culture of trial postponements and delay. This lack of efficacy within the criminal courts contributed to impunity for many of the worst criminal offenders and gangs, an abnormally high rate of violent crimes, lack of cooperation by witnesses and potential jurors, frustration among police officers and the public, a significant social cost and drain on the economy, and a disincentive for tourism and international investment.

This does not seem like a place where “legal” marijuana would contribute to “reduced money flow” to the transnational drug trade, or “create jobs.”  The president apparently thinks Jamaica should consider allowing more drugs, based on a faulty understanding of what is actually happening in Jamaica and in the U.S.

His charge of high incarceration rates for non-violent offenders is not factual. For instance, data show that only a fraction of one percent of state prison inmates are low-level marijuana possession offenders, while arrests for marijuana and cocaine/heroin possession and use were no more than 7 percent of all arrests,nationwide, in 2013.

Though critics of drug laws claim that hundreds or even thousands of prisoners are low-level non-violent offenders unjustly sentenced, the reality was shown recently by the President’s inability to find more than a handful of incarcerated drug offenders who would be eligible for commutation of their sentence because they fit the mythological portrait of excessive or unjust drug sentences.

Further, since 2007, the US is currently experiencing a surge in daily marijuana use, an epidemic of heroin overdose deaths (with minorities hardest hit), while the southwest border is flooded with heroin and methamphetamine flow, as shown by skyrocketing border seizures.

Importantly, Colorado, following marijuana “legalization,” has become a black-market magnet, and is currently supplying marijuana, including ultra-high-potency “shatter” to the rest of the U.S., leading to law suits by adjacent states. Legalization has not reduced criminal activity nor the threat of financial corruption.

As for Central America, Obama’s policies have shown stunning neglect. Actual aid for counter-drug activities, and for resources for interdicting smugglers have all diminished, while the countries of Central America have become battlegrounds for Mexican cartels, with meth precursors piling up at the docks, the cocaine transiting Venezuela to Honduras is surging, and violence is at an all-time high, with families fleeing north in unprecedented numbers. The Caribbean/Central American region has become deeply threatened, as noted by the State Department report above—torn apart by drug crime.

In this context the president encourages governments in the region to make drugs more acceptable and more accessible in their communities, and with even greater legal impunity?

Moreover, these developments have been accompanied by a steady drumbeat of medical science reports increasingly showing the serious dangers of marijuana use, especially for youth.   Yet President Obama speaks in a manner increasingly disconnected from the domestic and international reality of the drug problem.

Source:  David W. Murray and John P. Walters  WEEKLY STANDARD  April 11, 2015

Lynne Featherstone accepts advisory council’s recommendation of 12-month ban on substances including most widely used alternative to cocaine

Mephedrone, also known as 4-MMC and used as an alternative to cocaine, has already been banned in the UK. Photograph: Rex

Five legal highs, including an alternative to cocaine that is one of the most common in Britain, are to be banned from midnight on Thursday, ministers have announced.

The drug minister, Lynne Featherstone, said she had accepted a recommendation from the government’s official drug advisers that the five legal highs should face a temporary ban of 12 months while a full assessment of the harm they posed was undertaken.

The Advisory Council on the Misuse of Drugs has said one of the five legal highs, ethylphenidate, which users inject and is widely marketed as a “research chemical” or as a component in branded products such as Gogaine, Nopaine, Burst and Banshee Dust, has been available over the internet in Britain for four years. They said it was one of the most commonly encountered new psychoactive substances (NPSs), as legal highs are officially known, in Britain and has emerged as an alternative to cocaine.

The ACMD recommended the ban on ethylphenidate based on evidence that it had caused serious problems, particularly in Edinburgh and Taunton, Somerset. Four related compounds are to banned at the same time to prevent users switching.

Ethylphenidate is typically sold at £15 a gram for powder, £20 a gram in crystal form and £1 for a 50mg tablet. Professor Les Iversen, the chair of ACMD, said injecting users were putting themselves at risk of blood-borne disease and infections.

Police Scotland said Burst, as it is marketed in Edinburgh, was responsible for the majority of legal-high casualties seeking emergency hospital treatment in the city last summer.

Avon and Somerset police said an epidemic of injecting legal highs in public places in Taunton last summer had led to more than 200 needles being recovered in one clean-up day. In December, the high street “head shop” selling the products was closed down.

The banned substances are closely related to methylphenidate, a licensed stimulant marketed under the brand name of Ritalin that is regularly prescribed to children for the treatment of attention deficit hyperactivity disorder.

The temporary ban means anyone caught making, supplying or importing the drugs will face up to 14 years in prison and an unlimited fine. Possession is not illegal but police and border officials are allowed to search or detain anyone they suspect of having the drugs and seize, keep or dispose of the banned substance.

Drug law reform campaigners said such bans were simply trapping authorities in an “endless game of whack-a-mole” as they tried to play catch-up with drugs chemists. They said that while the government had responded to the frenzy over legal highs, drug misuse deaths overall had risen sharply.

The decision to ban methylphenidate-related substances while continuing to use the parent chemical as a medicine might raise questions over the safety of a drug often prescribed to children.

Ethylphenidate-based products are a growing issue and their use is associated with bizarre and violent behaviour

Advisory Council on the Misuse of Drugs

“The methylphenidate-related materials being marketed as NPS have psychoactive effects so similar to the parent compound that they can be expected to present similar risks to users,” Iversen said in the letter.

Although it has been marketed as a party drug, the ACMD’s advice warns that some ethylphenidate users appear to have developed chronic problems, continually redosing the drug intravenously in binges.

The ACMD report says that in Edinburgh “there has recently been a report of an outbreak of Staphylococcus aureus and Streptococcus pyogenes infections in this area associated with NPS injecting, which is believed to involve ethylphenidate.”

It added: “Ethylphenidate-based products are a growing issue in Edinburgh and their use is associated with bizarre and violent behaviour.”

Drugs reform campaigners said the government’s use of temporary bans on new substances had authorities constantly playing catch up with drugs chemists. The only answer was wholesale reform of drug policy, they said. Danny Kushlick, head of external affairs for Transform, said: “These substances have been brought out because of the success in enforcing the ban on ecstasy and cocaine in particular. Really we have to recognise that this is a self-inflicted trade.

 

 

 

 

 

 

 

Legal high drug deaths soar in UK

“If we were to have a regulated trade in drugs these ones would not exist. You would not have ‘fake cocaine’ if you could get real cocaine. The whole NPS market is a product of prohibition.

“This is a never-ending game of whack-a-mole because even using the analogues legislation there are new analogues; they can churn these out by the hundreds. This is the opposite of control and regulation. It’s fuelling anarchy in the market and we need to look at regulating frameworks for more benign drugs.”

Niamh Eastwood, director of Release, said new bans on substances only served to push drug use further underground and spur the development of new chemicals with unknown risks to users.

She said: “Speaking more broadly, the government appears to have made NPS something of a cause célèbre in its fight against drugs, apparently in response to the media frenzy over what many unhelpfully term ‘legal highs’. While NPS are indeed a part of the modern debate on drugs, they form a comparatively small part of the market.

“At a time when the associated harms are increasing for other substances – drug misuse deaths rose 21% in 2013, 32% when focusing solely on heroin/morphine deaths – there is a real risk that the government is turning its attention away from addressing the failures of its drug policy holistically in order to pander to poorly-founded fears over this new phenomenon.”

Ethylphenidate is already banned in Denmark, Austria, Germany, Hungary, Portugal, Sweden, Jersey and Turkey. It is also classified under analogue scheduling in the US and Australia.

The other substances recommended for the temporary ban by the ACMD included 3,4-dichloromethylphenidate, methylnaphthidate, isopropylphenidate and propylphenidate. It wasn’t clear how widespread their use was.

Methylphenidate, the drug from which ethylphenidate and its related compounds is derived, is currently controlled as a class B drug in Britain but also licensed as a medicine for conditions including ADHD and narcolepsy. It has also been widely used recreationally, and as a study aid. Research has found it can offer modest improvements in working memory and episodic memory.

Source:   http://www.theguardian.com/science/2015/apr/09/

Some good news, some not-so-good news about brain recovery from alcohol use disorders

According to a recent review article on recovery of behavior and brain function after abstinence from alcohol[1], individuals in recovery can rest assured that some brain functions fully recover; but others may require more work. In this article, authors looked at 22 separate studies of recovery after alcohol dependence, and drew some interesting conclusions.

First, the good news; studies show improvement or even complete recovery to the performance level of healthy participants who had never had an alcohol use disorder in many important areas, including short-term memory, long-term memory, verbal IQ, and verbal fluency. Even more promising, not only behavior, but the structure of the brain itself may recover; an increase in the volume of the hippocampus, a brain region involved in many memory functions, was associated with memory improvement.

Another study showed that after 6 months of abstinence, alcohol-dependent participants showed a reduction in a “contextual priming task” with alcohol cues; in day to day terms, this could mean that individuals in early recovery from alcohol dependence may be less likely to resume drinking when confronted with alcohol and alcohol-related cues in their natural environment because these alcohol-related triggers are eliciting less craving.- a good thing for someone seeking recovery!

Still other studies showed that sustained abstinence was associated with tissue gain in the brain; in other words, increases in the volumes of brain regions such as the insula and cingulate cortex, areas which are important in drug craving and decision-making, were seen in abstinent alcoholics. This increase is a good thing, because more tissue means more recovery from alcohol-induced damage. A greater volume of tissue in these areas may be related to a greater ability to make better decisions.

Now, the not-so-good news: these studies reported no improvement in visuospatial skills, divided attention (e.g. doing several tasks at once), semantic memory, sustained attention, impulsivity, emotional face recognition, or planning.  This means that even after abstinence from alcohol, people in recovery may still experience problems with these neurocognitive functions, which may be important for performing some jobs that require people to pay attention for long periods of time or remember long lists of requests. These functions may also be important for daily living (i.e. assessing emotions of a spouse, planning activities, etc.).

Importantly, there were many factors that influenced the degree of brain recovery; for example, the number of prior detoxifications. Those with less than two detoxifications showed greater recovery than those with more than two detoxifications.  A strong family history of alcohol use disorder was associated with less recovery. Finally, cigarette smoking may hinder recovery, as studies have shown that heavy smoking is associated with less recovery over time.

So what does all this mean? Recovery of brain function is certainly possible after abstinence, and will naturally occur in some domains, but complete recovery may be harder in other areas. Complete recovery of some kinds of behavior (e.g. sustained attention, or paying attention over long periods of time) may take more time and effort! New interventions, such as cognitive training or medication (e.g. modafinal, which improved neurocognitive function in patients with ADHD and schizophrenia, as well as in healthy groups), may be able to improve outcomes even more, but await further testing.

[1] Recovery of neurocognitive functions following sustained abstinence after substance dependence and implications for treatment

Source:  Mieke H.J. Schulte et al., Clinical Psychology Review 34 (2014) 531–550   October 2014

 

The most obvious characteristic of marijuana-legalisation campaigners – apart from billionaire interests on the scale of Big Tobacco – is that their lobbying and promises are based on theories not facts.

Legalisers regularly use the words “science” and “evidence base” but rarely cite research references. Never has this chasm between theory and fact been so powerfully and conspicuously exposed as in the March analysis by local media in Clearing the Haze of events a year after marijuana was legalised for recreational use in Colorado.

Here in the UK, a decade-long follow up by researchers into Britain’s disastrous 2004 ‘Lambeth experiment’ of depenalisation proved that it led to more crime and hospitalisations not less. The Colorado aftermath of legalisation is on a vaster scale.

CLAIM:“We view our top priority as creating an environment where negative impacts on children from marijuana legalisation are avoided completely,” Colorado’s governor promised.

FACT:There are growing concerns over exposure, potency and availability of marijuana to children. Even before legalisation, Governor John Hickenlooper predicted the need for “a project to analyse the correlation between marijuana use during pregnancy and birth defects” (FYI, here’sa listand one on perils tochildren). Colorado hospitals have admitted more children for marijuana harms. A June 2014 survey of 100 Colorado school officers found that 89 per cent witnessed a rise in marijuana-related incidents since legalisation.

CLAIM:Legalisation will fund prevention, education.

FACT:Colorado budgeted only about $34,000 for its Office of Behavioral Health’s prevention work in the 2014-2105 fiscal year; nothingwas received. Its Department of Public Health and EnvironmentGood to Knowcampaign, crafted with marijuana business owners, tells children how to use pot. “It’s like inviting a tobacco company to help us learn how to use tobacco and develop our next anti-smoking campaign.”

CLAIM:Regulation works.

FACT:How regulation would work was described only in soundbites before voting. Hickenlooper later admitted it was “reckless” and “a bad idea”. This February, Colorado Attorney General Cynthia Coffman declared it “not worth it”. Ben Cort at the University of Colorado Hospital disclosed that “Colorado has been met by an industry that fights tooth and nail any restrictions that limit profitability. Like Big Tobacco, the marijuana industry derives profits from addiction and its survival depends on turning a percentage of kids into lifelong customers.”

CLAIM:Legalisation of marijuana will unclog prisons.

FACT:There aren’t enough offenders in prison for simple possession of pot to unclog the system if they were freed: only 103. In 2011, the federal government convicted only 48 marijuana offenders with under 5,000 grams of marijuana: almost 12,000 joints.

CLAIM:Legalisation will produce new revenue for the general fund.

FACT:Tax revenues failed to meet projections – taxpayers could even get two refunds. The Governor’s Office of Marijuana Coordination director said the first priority for tax revenue is to cover regulatory costs. Moreover, Colorado isn’t equipped to gather cost-benefit analysis to quantify costs linked with cannabis abuse. This is alongside lawsuits against the state, manufacturing hazards, pressured resources for the homeless, concerns over children’s welfare and more: “Voters didn’t understand how difficult, resource-intensive and costly the enforcement of even just marijuana driving laws would be”.

CLAIM:Legalisation of marijuana will hobble drug cartels.

FACT:Cheaper marijuana prices mean cartels turn to ‘harder’ drugs including ‘black tar’ heroin and methamphetamine, as well as cybercrime and continued people-trafficking.

CLAIM:By regulating sales of marijuana, Colorado will make money otherwise locked into the black market.

FACT:Black-market sales are booming so much that they are blamed for cannabis tax revenues falling short of claims. “Don’t buy the argument that regulating sales will eliminate the black market, reduce associated criminal activity and free up law enforcement agencies’ resources,” Coffman urged in February. Worse is that “Colorado is the black market for the rest of the US”: neighbouring Denver suffered an almost 1,000 per cent spike in marijuana seizures.

CLAIM:Legalisation and regulation will see people using lower strengths of drugs.

FACT:Colorado permits one ounce of tetrahydrocannabinol (THC), the active ingredient giving a euphoric high. Many people envision an ounce of dried marijuana plant, about 40 standard cigarettes. But one ounce of concentrated THC equals over 2,800 average-size brownies or candy; an ounce of hash oil is roughly 560 standard ‘vaping’ hits.

CLAIM:Medical marijuana works, only legalisation allows research.

FACT:Treating marijuana – sold in dispensaries without FDA approval and shown to be more carcinogenic than tobacco when combusted – as if exempt from the approval process others drugs must undergo for public safety, is seen as derailing legitimate research on specific parts of the marijuana plant for new clinically-proven medicines without addiction risks. As the prevention charity, Cannabis Skunk Sense, puts it: “it’s like getting penicillin by eating mouldy bread”. Non-legalisation has not stopped 70+ scientific studies on cannabinoids elsewhere, and the National Institutes of Health awarded over $14million for such research.

CLAIM:Marijuana is safer than alcohol.

FACT:“Not when it comes to driving – and officers are seeing people using both substances, which is worse,” revealed one police chief.In the first six months of 2014, 77 per centDUIDs (driving under influence of drugs) involved marijuana. Accident risk doubles with any measurable amount of THC in the bloodstream, rising when alcohol is added.

The tragic fact above all else is that these downsides were predicted by authoritative individuals and organisations – and ignored. The good of many people was sacrificed for the greed of a few: be it for money, power or a drugged delusion. Deirdre Boyd

Source: www.conservativewoman.co.uk 1st April 2015

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

When you smoke marijuana, there’s an almost immediate effect on your brain, sense of perception, and heart rate. There may be long-term effects as well.

 

The Effects of Marijuana on the Body

Marijuana comes from the Cannabis plant. The flowers, seeds, leaves, and stems of the plant must be shredded and dried before they can be used. Most people who use marijuana smoke it, but it can be mixed into food, brewed into tea, or even used in a vaporizer. One of the ingredients in marijuana is a mind-altering chemical called delta-9-tetrahydrocannabinol (THC).

When you inhale marijuana smoke into your lungs, it is quickly released into your bloodstream on its way to your brain and other organs. It takes a little longer to be absorbed when you eat or drink it.

The effects of marijuana on the body are immediate. Longer-term effects may depend on how you take it, how much you take, and how often you use it. Since its use has long been illegal in the United States, large-scale studies have been difficult to manage.

In recent years, the medicinal properties of marijuana are gaining acceptance in mainstream America. Medical marijuana is now legal in 23 states and the District of Columbia. THC and another ingredient called cannabidol (CBD) are the main substances of therapeutic interest. National Institutes of Health-funded research into the possible medicinal uses of THC and CBD is ongoing.

In addition to medicinal use, recent legislation has made marijuana a legal recreational drug in Colorado and Washington State. With the potential for increased recreational use, knowing the effects that marijuana can have on your body is as important as ever.

Respiratory System

 

Much like tobacco smoke, marijuana smoke is made up of a variety of toxic chemicals that can irritate your bronchial passages and lungs. If you’re a regular smoker, you’re more likely to wheeze, cough, and produce phlegm. You’re also at increased risk of bronchitis and lung infections. Marijuana may aggravate existing respiratory illnesses like asthma and cystic fibrosis.

Marijuana smoke contains carcinogens. It has the potential to elevate your risk of developing lung cancer. However, studies on the subject have had mixed results. According to the National Institute of Drug Abuse(NIDA), there is no conclusive evidence that marijuana smoke causes lung cancer. More research is needed.

Circulatory System

THC moves from your lungs into your bloodstream and throughout your body. Within minutes, your heart rate may increase by 20 to 50 beats per minute, according to the NIDA. That rapid heartbeat can continue for up to three hours. For people with heart disease, this faster heartbeat could raise the risk of heart attack.

One of the telltale signs of recent marijuana use is bloodshot eyes. They look red because marijuana causes blood vessels in the eyes to expand or dilate. Marijuana may help stop the growth of blood vessels that feed cancerous tumors.

 Central Nervous System

 

When you inhale marijuana smoke into your lungs, it doesn’t take long for THC to enter your bloodstream. From there, it is quickly transported to your brain and the rest of your organs. When you get marijuana from food or drink, it is absorbed a little more slowly.

THC triggers your brain to release large amounts of dopamine, a naturally occurring “feel good” chemical. That’s what gives you a pleasant “high.” It may heighten your sensory perception, as well as your perception of time. In the hippocampus, THC changes the way you process information, so your judgment may be impaired. It may also be difficult to form new memories when you’re high.

Changes also take place in the cerebellum and basal ganglia, upsetting your balance, coordination, and reflex response. All those changes mean that it’s not safe to drive.

Very large doses of marijuana or high concentrations of THC can cause hallucinations or delusions. According to the NIDA, there may be an association between marijuana use and some mental health problems like depression and anxiety, but more research is needed to understand the connection. In people who have schizophrenia, marijuana use can make symptoms worse.

When you come down from the high, you may be tired or feel a bit depressed. In some people, marijuana can cause anxiety. About nine percent of marijuana users develop an addiction, according to the NIDA. Symptoms of withdrawal may include irritability, insomnia, and loss of appetite.

In young people whose brains are not yet fully developed, marijuana can have a lasting impact on thinking and memory skills. If you use marijuana when pregnant, it can affect the brain of your unborn baby. Your child may be more prone to trouble with memory, concentration, and problem-solving skills.

THC can lower pressure in the eyes, which can ease symptoms of glaucoma for a few hours. According to theAmerican Academy of Ophthalmology, more research is needed to understand the active ingredients in marijuana and whether or not it’s a good treatment for glaucoma.

The pharmacologic effect of marijuana extends throughout the central nervous system. It is thought to ease pain and inflammation. It may also be of use in controlling spasms and seizures.

Digestive System

 

Smoking marijuana can cause stinging or burning in your mouth and throat. When you take oral THC, it is processed in your liver. Marijuana can ease nausea and vomiting. It can also increase appetite, which can be useful to people living with cancer or AIDS.

Immune System

Some research indicates that THC affects the immune system. Studies involving animals showed that THC might damage the immune system, making you more vulnerable to illness. Further research is needed.

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

Marijuana Use and Mania

 As the debate continues to rage over the possible risks or advantages of smoking marijuana, new research out of Britain’s Warwick University has found a “significant link” between marijuana use and mania, which can range from hyperactivity and difficulty sleeping to aggression, becoming delusional and hearing voices.

Published in the Journal of Affective Disorders, the study of more than 2,000 people suggested potentially alarming consequences for teenagers who smoke the herb. 

“Cannabis [marijuana] is the most prevalent drug used by the under-18s,” said lead researcher Dr Steven Marwaha. “During this critical period of development, services should be especially aware of and responsive to the problems cannabis use can cause for adolescent populations.”

Researchers examined the effect of marijuana on individuals who had experienced mania, a condition that can include feelings of persistent elation, heightened energy, hyperactivity and a reduced need for sleep. On the other side of the coin, mania can make people feel angry and aggressive with extreme symptoms including hearing voices or becoming delusional.

“Previously it has been unclear whether cannabis use predates manic episodes,” Dr Marwaha said. “We wanted to answer two questions:

1.      Does cannabis use lead to increased occurrence of mania symptoms or manic episodes in individuals with pre-existing bipolar disorder?

2.      “But also, does cannabis use increase the risk of onset of mania symptoms in those without pre-existing bipolar disorder?”

Dr Marwaha found that marijuana use tended to precede or coincide with episodes of mania. Representing what the lead researcher referred to as “a significant link,” there was a strong association with new symptoms of mania, suggesting that these are caused by marijuana use.

The researchers also found that marijuana significantly worsened mania symptoms in people who had previously been diagnosed with bipolar disorder. “There are limited studies addressing the association of cannabis use and manic symptoms which suggests this is a relatively neglected clinical issue,” Dr Marwaha said.

However, our review suggests cannabis use is a major clinical problem occurring early in the evolving course of bipolar disorder.   More research is needed to consider specific pathways from cannabis use to mania and how these may be effected by genetic vulnerability and environmental risk factors.”

These findings add to a body of previous studies that have linked marijuana to increased rates of mental health problems including anxiety, depression, psychosis and schizophrenia, and have suggested that the herb is addictive and opens the door to hard drugs.

A study which was published in the journal Neuroscience earlier this month nevertheless found that marijuana could be used to treat depression.

Scientists at the University of Buffalo’s Research Institute on Addictions said molecules present in marijuana could help relieve the depression resulting from long-term stress.

 Source: Journal of Affective Disorders Feb 2015

This article shows how drug use in an area can impact more than the individual and their families and friends.  The local economy and small businesses are having to cope with lower productivity due to ‘functioning’ drug dependents in the workforce.    NDPA

New Hampshire drug czar: Addiction dragging state’s economy down

Providing more treatment and recovery options for drug addicts is as much about the addicts as it is about helping spur the state’s economy, said the state’s new drug czar.

“For me, it’s all about the money,” said John G. “Jack” Wozmak, senior director for substance misuse and behavioral health.  Wozmak was appointed in January by Gov. Maggie Hassan. The position is funded by a grant from the New Hampshire Charitable Foundation. Wozmak spent nearly a decade as the administrator of the Beech Hill substance abuse treatment facility in Dublin, and since 1998 had been the Cheshire County administrator.

“With a broad range of experience dealing with substance misuse through his roles in the public sector and in private substance abuse treatment, Jack will help strengthen our efforts to improve the health and safety of Granite Staters, and I thank him for his commitment to serving the people of New Hampshire, as well the New Hampshire Charitable Foundation for making his position possible,” Hassan said in a statement.

Wozmak’s task: Get a host of agencies and organizations to work together to reduce the state’s drug abuse, particularly heroin addiction.  Wozmak takes the post at a time when heroin overdoses and deaths are at an all-time high in New Hampshire. The Centers for Disease Control reports that New Hampshire is among 28 states that saw big increases in heroin deaths.

But Wozmak said drug addiction is more than the headline-generating heroin overdoses and drug-related burglaries and robberies that dominate the news.
“Yes, the number of heroin deaths is doubling (from the previous year). But that’s just the tip of the iceberg” of the state’s drug epidemic, he said.

Functioning addicts

The underlying problem – and what the drug czar said will help him get more money for treatment and prevention efforts from state legislators – is the thousands of drug abusers who do not necessarily overdose but drive up costs for employers, he said.
“You don’t hear about the day-to-day drug exposure that companies have because it’s all below the surface, like an iceberg,” he said.

Employers see everything from diminished production to having to overstaff or pay overtime to cover for employees addicted to drugs who miss work, he said. This hurts profit and, in turn, decreases the state’s revenue from business profits taxes. He said estimates from the state’s hospitality sector indicate that as many as 20 percent of that field’s employees may have drug addiction issues.

“I want to increase jobs and this is getting in the way,” he said. “It’s just interfering with productivity. It’s interfering with the economy.”  Wozmak said the drug problem as been exacerbated by a myriad of issues, including budget cuts for treatment programs, along with insurance companies cutting or capping policy coverage for substance abuse treatment.

In the 1980s, he said, the state had more than 600 beds at six private centers providing treatment for substance abuse. After all the cuts by insurance companies, the state now has 62 beds available, he said.

Further, the state ranks second-to-last – after Texas – in providing treatment for drug addiction and has the lowest rate in the country – 6 percent – of people who get treatment for their addictions.  “We have decimated the system of treatment and recovery, and we have to rebuild it,” he said. “Imagine the outrage if diabetes were treated this way.”

More money

Hassan has proposed more than tripling the state’s spending for the Commission on Alcohol and Drug Abuse Prevention, Treatment and Recovery in her proposed two-year budget, from a total of nearly $2.9 million in the 2014-15 budget, to nearly $9.6 million in 2016-17.

The way to convince legislators that the funding is necessary is by appealing to their desire for job growth in a state that has had anemic population growth, Wozmak said.  To get population and job growth, he said, the state has to make its work force healthier and the best way to do that is to reduce drug addiction.

“If you ran on a platform of job growth, you have to deal with this issue,” he said. “If (job growth is) not going to be from people moving here, then you have to improve the work force that’s here.  “If you’re not looking to take care of this problem, then you’re falling down on your promise,” he said. “If you want to create jobs, you have to make the work force more viable.”

Wozmak said the problem can be solved. He said his role includes getting the affected parties – including law enforcement, public resources, private or nonprofit organizations, charities and treatment facilities – working together. He said a provision of the Affordable Care Act that requires insurers to cover substance abuse again should help spur private investment in treatment and recovery facilities.

“There is no easy answer, but I believe there are many opportunities to make the change now on a variety of levels and a myriad of fronts,” he said. “I think we’re going to have a lot of success.”  He said getting help from the state’s medical professionals will also be key, as most heroin addicts, he said, start with addictions to prescription painkillers. He said medical professionals are “not the sole source” of the issue, but could be involved in changing the way pain is managed to help prevent addictions.

“None of them wanted to become addicts,” he said.

– See more at: http://www.unionleader.com/article/    8th March 2015

Nick Clegg’s most recent contribution to the drugs debate has been to call for an end to imprisonment for the possession of drugs for personal use, and to move leadership of the UK drug strategy from what he sees as an enforcement obsessed Home Office to a treatment focused Department of Health. His rationale for this is that we are currently wasting resources locking up the ” victims “of the drug trade while allowing “health harm to go untreated”. 

Ending the use of imprisonment to protect people from themselves has much to commend it. The detailed legal drafting will be trickier than the deputy PM seems to realise, and it is unlikely to free up much resource, given the small numbers involved and the short periods actually served in custody. Nevertheless this reform, particularly if it were allied to amendments to the Rehabilitation of Offenders Act to prevent minor convictions having a disproportionate impact on people’s future life chances, offers a sensible measured step to correct the negative consequences of the Misuse of Drugs Act. Furthermore this could be achieved without opening the Pandora’s box of legalisation, from which may flow increased drug use, and increasing harm, reversing the trend of young people turning away from drugs we have seen over the last decade.

So three cheers for proposal number one. Proposal number two, at first glance seems like common sense. If you want to focus on treatment the Department of Health is the obvious home for policy. My view based on 12 years in Whitehall responsible for the English treatment system is that it could be a disaster. Here is why.

Drug policy and drug treatment has never been a priority for the Department of Health or the NHS. The financial crisis, the interface between health and social care, waiting times, cancer, dementia, and a host of other issues dominate the DH/NHS agenda. Even when policies focus on the wider social determinants of health in an effort to reduce the burden on scarce NHS resources the priorities are :smoking: 80,000 deaths a year, obesity 30,000 deaths a year, alcohol 6500 deaths a year, not illegal drugs: 2000 deaths a year. Drug use simply doesn’t kill enough people or cause as much ill-health as over risky behaviours, and the priority accorded to it by successive Health leaderships reflects that.

Although illegal drug use causes less health harm than either alcohol or tobacco it is neither safe nor harmless. Overall, government estimate drug misuse causes £15 billion worth of harm to society, dwarfing the 5 billion of health harm from smoking. 13 billion of this is the cost of drug-related crime. Home Office research estimates that 50% of the marked rise in crime that occurred in the 1980s and 90s is attributable to the successive waves of heroin epidemics that swept over the country during those decades. Addressing this escalation in criminality by making treatment readily available across the country was the rationale behind the government’s hugely increased investment in treatment following 2001, up from 50 million a year to 600 million. Public Health England estimate that providing rapid access to treatment for around 200,000 individuals, more than twice as many as in 2001, currently prevents almost 5 million crimes each year.

Given the Home Secretary’s responsibility for crime it is not surprising that the Home Office have a very different view of the priority of drug treatment to the Department of Health. The private view in the Department of Health is that the current level of drug spend is a misdirection of scarce health resources which are needed to respond to more pressing health priorities. The Home Office view is that the current spend on treatment is cost-effective yielding, according to the National Audit Office, £2.50 worth of value for the taxpayer from every £1 invested, largely from reduced crime.

Put simply the Home Office see drug treatment as value for money the Department of Health see it as a misallocation of resources. On a number of occasions over the last decade the Department of Health has sought to disinvest from drug treatment, only stepping back when this has been resisted by successive Home Secretaries. These different orientations are particularly important at the moment as the resources currently spent on drug treatment across England come under threat of disinvestment by hard-pressed Local Authorities(who were given responsibility for drug treatment under the Lansley NHS reforms) looking to raid their public health grants to prop up core services.

So what may appear at first sight as commonsense will be very likely to result in drug policy becoming the responsibility of a department that isn’t very interested, has a wealth of competing priorities, and a track record of seeking to disinvest from the very intervention that the proposal is designed to promote. Meanwhile a department that has a powerful rationale for championing treatment, and a track record of doing so, is sidelined. If Mr Clegg is as committed to drug policy based on evidence as he maintains, perhaps he needs to reconsider.

Source:  www.huffingtonpost.co.uk  9th March 2015

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 

Not magic at all of course, but a consequence of the fact that substance use problems are closely related to other problems which often develop at early ages when substance use is just not on the agenda. The 2010 English national drug strategy and corresponding public health plans seemed to recognise this, breaking with previous versions to focus attention on early years parenting in general, and particularly among vulnerable families. 

Though studies are few compared to approaches such as drug education in schools, this renewed emphasis on the early years has a strong theoretical rationale and some research backing. Child development and parenting programmes which do not mention substances at all (or only peripherally) have recorded some of the most substantial prevention impacts. Though mainly targeted at the early years, some extend to early teenage pupils and their families. The rationale for intervention rests partly on strong evidence that schools which develop supportive, engaging and inclusive cultures, and which offer opportunities to participate in school decision-making and extracurricular activities, create better outcomes across many domains, including non-normative substance use. As well as facilitating bonding with the school, such schools are likely to make it easier for pupils to seek and receive the support they need.

Understandably, such findings do not derive from random allocation of pupils to ‘good’ versus ‘bad’ schools, so are vulnerable to other influences the study was unable to account for. More convincing if more limited in intervention scope are studies which deliberately intervene and test what happens among young people randomly allocated to the focal intervention versus a comparator. An early example was a seminal Dutch drug education study of the early ’70s which had a profound impact in Britain. For the practitioners of the time, it was a warning about the dangers of the dominant ‘scare them’ approach, but it might as well have been a lesson about the approach which outperformed the warnings – classroom discussions which simply gave teenage pupils a structured chance to discuss the problems of adolescence, leaving it up to them whether drugs cropped up.

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Among the most prominent and promising of current approaches is the Good Behavior Game classroom management technique for the first years of primary schooling  illustration. Well and consistently implemented, by age 19–21 it was estimated that this would cut rates of alcohol use disorders from 20% to 13% and halve drug use disorders among the boys. In the Effectiveness Bank you can read about the study and read a practitioner-friendly account of the research from the researchers themselves. The same programme has been combined with parenting classes, leading to reductions in the uptake and frequency of substance use over the next three years.

Another primary school example is the Positive Action programme which focuses on improving school climate and pupil character development. In Hawaii and then the more difficult schools of Chicago, it had substantial and, in Chicago, lasting preventive impacts.

In Britain perhaps best known is the Strengthening Families Programme, a family and parenting programme which in the early 2000s impressed British alcohol prevention reviewers. It features parent-child play sessions, during which parents are coached in how to enjoy being with their children and to reinforce good behaviour. At first the accent is on building up the positives before tackling the more thorny issues of limit-setting and discipline. Though the potential seems great, later research has not been wholly positive, and the earlier results derived from the minority of families prepared or able to participate in the interventions and complete the studies.

A final example comes from Norway, where a study raised the intriguing possibility that taking measures to effectively reduce bullying in schools helps prevent some of the most worrying forms of substance use.

Isolating these and other similar studies is not possible via our normal search facilities, so we have specially identified and coded them. They may prove to be the future for drug prevention, as traditional drug education struggles for credibility as a prevention tool. See how this future is shaping up today by running this hot topic search.

Source:  www.findings.org     3rd March 2015

 Christopher Lapish, Ph.D. (left) and Alexey Kuznetsov, Ph.D. of the School of Science at Indiana University-Purdue University study how alcohol hijacks the brain’s reward system. Credit: School of Science at IUPUIWith the support of a $545,000 three-year grant from the National Institute on Alcohol Abuse and Alcoholism, researchers from the School of Science at Indiana University-Purdue University Indianapolis are conducting research on how the brain’s reward system—the circuitry that helps regulate the body’s ability to feel pleasure—is hijacked by alcohol.

Scientists have only a rudimentary understanding of how alcohol affects neurons in the brain. It is known that, as any addictive drug, alcohol directly or indirectly acts on a specific population of brain cells, called dopamine neurons. Through this action, the neurotransmitter dopamine is released, which evokes feelings of pleasure. However, the biological mechanisms of how alcohol evokes dopamine release have not been determined; exploring this question is the major goal of the grant. 

The synergistic approach of the IUPUI researchers—biomathematician Alexey Kuznetsov, Ph.D., associate professor of mathematical sciences, and neuroscientist Christopher Lapish, Ph.D., assistant professor of psychology—is novel as they marry the cutting-edge tools of mathematical modeling developed by Kuznetsov and the sophisticated experimental neuroscience experiments designed and conducted by Lapish to study the electrical properties that determine the release of the neurotransmitter dopamine in the brain. As a starting point, they are focusing on the brain’s initial exposure to alcohol. 

Kuznetsov has developed unique mathematical models as he homes in on why and how much dopamine is released when alcohol is consumed. With the same goal, Lapish is employing sophisticated tools and methods to measure and analyze electrical signals of dopamine neurons in rats. This synergy forms a two-way street with data from the recordings of the electrical impulses of the rat brains affecting how the mathematical models are constructed and the predictions generated by the mathematical models informing the study of the animal brains. 

IUPUI undergraduates and graduate students are assisting the investigators in their work.

“Our mathematical models go much further than simple logic,” Kuznetsov said. “What we are learning from experiments is critical. The direct connection of modeling and experiments enables us to test and refine our hypotheses.”

“As we begin our second year on this project we are gaining a better understanding of how the brain responds to alcohol,” Lapish said. “The cross talk between us drives this hypothesis-driven research. There are many unknowns to explore and interpret.”

The IUPUI researchers are also collaborating with French scientists. “We are working on the problem at different levels—we are modeling and studying the brains of live rodents—in vivo work—and they [the French researchers] are studying in vitro brain slices in the lab,” Kuznetsov added.

 “Alcohol addiction is among America’s largest public health concerns yet we know far less about it than most other addictions. If we are going to successfully treat alcohol addiction we need to begin with the basics and understand how alcohol directly acts on dopamine neurons in both the alcoholic and normal brain,” Lapish said. 

Provided by Indiana University-Purdue University Indianapolis School of Science

Source:  http://phys.org/wire-news/187100819     6th March  2015 

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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 study published Wednesday found that consuming large flavored alcoholic beverages can increase risk for binge drinking and related alcohol injuries for underage drinkers. PHOTO BY EMILY ZABOSKI/DAILY FREE PRESS STAFF

Super-sized flavored alcoholic beverages can increase the risk of binge drinking and alcohol-related injuries for underage drinkers, researchers from Johns Hopkins University and Boston University found in a study, a Wednesday press release stated.

The study, published in the American Journal of Public Health on Feb. 25, found that underage drinkers who reported consuming malts, premixed cocktails and alcopops drank more on average and were more likely to experience “episodic heavy drinking,” the report stated. About 1,000 people ages 13 to 20 were surveyed online.

David Jernigan, an author of the study and director of the Center on Alcohol Marketing at Johns Hopkins, said heavier drinking occurs with these flavored beverages because of the serving sizes. Most of these beverages hold the equivalent of 4 to 5 beers in one container, he said.

“We particularly found the correlations between the largest size of these drinks and negative behaviors because one of these super-sized drinks is the equivalent of four to five beers,” he said. “Even though the can may have serving size though most don’t, teens are treating them as a single serving. Some people in the field call it a binge in a can.”

Study co-author Alison Albers, a professor in BU’s School of Public Health, said the study brings up important issues and will help determine future policies.

“These findings raise important concerns about the popularity and use of flavored alcoholic beverages among young people, particularly for the supersized varieties,” she said in the release. “Public health practitioners and policymakers would be wise to consider what further steps could be taken to keep these beverages out of the hands of youth.”

Jernigan said careful packaging should be implemented in the production of super-sized beverages.

“The re-sealable top is more of a joke,” he said. “These are being treated as a single serving, and the results suggest this may be a dangerous form of packaging.”

Katharine Mooney, director of Wellness and Prevention Services at BU, said the university takes steps to prevent the overconsumption of alcohol.

“We discourage against any kind of risky behavior, and these oversized sugar sweetened beverages definitely all into the category of risky,” she said. “[It’s] just like a punch bowl at a party.”

Mooney said because the drinks do not taste entirely like alcohol, it is difficult to determine how much alcohol is in them, which often leads to over drinking. Over drinking can affect students’ physical, social and academic wellbeing.

The Boston University Police Department has noted that the number of alcohol violations and transports for the spring 2015 semester has increased compared to numbers from the spring 2014 semester, The Daily Free Press reported Thursday.

Mooney said BU Student Health Services tries to do whatever possible to inform students about the dangers of binge drinking and learn how to drink in a less dangerous way.

“One of the things we work really hard to educate students about our standard drink portion. A standard beer has the same alcohol content as one shot,” she said. “A student needs to be particularly aware of what they are consuming when drinking these so that they don’t drink more than they intend to.”

Several students said they recognize how super-sized flavored drinks can be risky.

Brock Guzman, a freshman in the College of Engineering, said the drinks are popular because of their cheap prices, and because some items contain caffeine, young drinkers find them even more appealing.

“It’s appealing because you can get really drunk and you stay awake,” he said. “They have caffeine in them and don’t really taste like alcohol.”

Sergio Araujo, a junior in Metropolitan College, said he has seen a friend in a dangerous scenario after consuming Four Loko, a popular super-sized alcoholic beverage. Though Four Loko’s contents used to include caffeine, the company chose to remove caffeine from their product in 2010.

“One guy I know drank them a lot, and he left a party alone, then he got lost in a snowstorm and was too drunk to find his way home,” he said. “He almost had to sleep in the snow.”

Jaqui Manning, a freshman in the College of General Studies, said she has seen firsthand the consequences when others drink the types of alcoholic beverages described in the study, as well as the products that contain caffeine.

“I’ve heard a lot of people have had really bad experiences with them,” she said. “Especially drinking them really fast is really dangerous because not only is there alcohol, but there is so much sugar and caffeine that goes into it, and your body sometimes can’t handle it.”

Source:  http://dailyfreepress.com/flavored-alcohol     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

More media stories of addiction being successfully treated would reduce stigma and ease social reintegration and recovery, suggests this innovative study. Reading just one such story made a national US sample more willing to work with former dependent users of illicit heroin or prescription painkillers and accept them into their families. 

SUMMARY Stigma toward people with mental illness and substance use problems is substantial and widespread. Enduring social stigma is linked to discrimination, under-treatment, and poor health and social outcomes, including difficulty finding and maintaining housing and employment. For example, studies have found that a third of the US public think people suffering from untreated major depression are likely to be violent toward others, as did 60% in respect schizophrenia and 65% and 87% in respect alcohol and cocaine dependence. Expectations that stressing a biological basis for mental illness would defuse stigma have not been realised.

Key points 

A nationally representative sample of the US public read short vignettes either neutrally portraying a woman, portraying the same woman as drug dependent or mentally ill, or as having had these disorders but now in remission through treatment.

Then they answered questions which assessed different dimensions of stigma to people with these disorders.

Vignettes of untreated, active heroin addiction or mental illness – but not untreated addiction to pain medication – heightened the desire be socially distant from addicted or mentally ill people.

In contrast, portraying the same person as in remission from addiction did not exacerbate any negative attitudes, and on some measures actually led to more positive attitudes than the neutral depiction.

For the researchers these results suggest that portraying people who have successfully been treated for mental illness or drug addiction may be a promising strategy for improving public attitudes toward these groups.

These findings are largely based on reactions to written vignettes portraying an addicted or mentally ill person. However, many for whom effective treatment has led to symptom control and recovery bear little resemblance to the untreated, symptomatic individuals portrayed in the vignettes. Such portrayals in the media may spread and intensify social stigma toward these groups. In contrast, portrayals of successfully treated patients may elicit more positive attitudes. Research on other stigmatised health conditions such as HIV infection suggests increased public recognition of their being treatable has reduced stigma and discrimination. 

The featured study was the first to examine whether levels of stigma are influenced by portrayals of untreated, symptomatic sufferers versus those who have successfully recovered through treatment. It did so for schizophrenia, major depression, addiction to prescribed painkillers, and heroin addiction, in each case portraying people whose symptoms met US diagnostic criteria. To eliminate the potentially confounding influences of race, gender, and education, each vignette ( samples) portrayed the same, college-educated, white woman – ‘Mary’. This account focuses on reactions to the addiction vignettes.

Selected from a national US panel, the 3,940 (70% of those asked to join the study) respondents were very similar to the overall US population. In 2013 they were randomly allocated to read either a neutral depiction of Mary, one of the depictions of her as actively suffering one of the untreated conditions, or one of her having recovered from a condition through treatment. Participants who had read about one of the addiction conditions were then asked a series of questions which tapped different dimensions of stigma to a “person with a drug addiction”. Participants who had read the mental illness vignettes were asked corresponding questions about a person with mental illness. Half those who had merely read the neutral depiction of Mary were asked the addiction questions, half the mental illness ones. This methodology made it possible to test the impact on stigma-related beliefs and attitudes of attributing untreated or successfully treated addiction or mental illness to Mary.

Sample vignettes

Neutral Mary is a white woman who has completed college. She has experienced the usual ups and downs of life, but managed to get through the challenges she has faced. Mary lives with her family and enjoys spending time outdoors and taking part in various activities in her community. She works at a local store.

Untreated heroin addiction Mary is a white woman who has completed college. A year after college, Mary went to a party and used heroin for the first time. After that, she started using heroin more regularly. At first she only used on weekends when she went to parties, but after a few weeks found that she increasingly felt the desire for more. Mary then began using heroin two or three times a week. She spent all of her savings and borrowed money from friends and family in order to buy more heroin. Each time she tried to cut down, she felt anxious and became sweaty and nauseated for hours on end and also could not sleep. These symptoms lasted until she resumed taking heroin. Her friends complained that she had become unreliable – making plans one day, and cancelling them the next. Her family said she had changed and that they could no longer count on her. She has been living this way for six months.

Treated heroin addiction [As above up to “…Her family said she had changed and that they could no longer count on her.”] She had been living this way for six months At that point, Mary’s family encouraged her to see a doctor. With her doctor’s help, she entered a detox program to address her problem. After completing detox, she started talking with a doctor regularly and began taking appropriate medication. After three months of treatment, she felt good enough to start searching for a job. Since then, Mary has received steady treatment and her symptoms have been under control for the past three years. She lives with her family and enjoys spending time outdoors and taking part in various activities in her community. Mary works at a local store.

The questions participants were asked were: 

• Desirability of social distance: how willing they would be to have a person with addiction or mental illness marry into their family or start working closely with them;
• Perceptions of treatment effectiveness: whether they saw the treatment options for that condition as being effective, and whether with treatment most can get well and return to productive lives;
• Willingness to discriminate: whether they agreed that discrimination against people with mental illness/drug addiction is a serious problem, that employers should be allowed to deny employment to these people, and landlords deny housing;
• Endorsement of supportive policies: whether for or against requiring insurance companies to offer benefits for treatment equivalent to those for other medical services, and whether they would support increased government spending on treatment, housing subsidies, and on programmes that help these groups find jobs and offer on-the-job support.

Main findings

Relative to the neutral depiction, vignettes of untreated, active heroin addiction or mental illness heightened the desire to be socially distant from such people, but this was not the case after reading about untreated addiction to pain medication charts. Other stigma dimensions (perceptions of treatment effectiveness; willingness to discriminate; endorsement of supportive policies) generally were not significantly affected. An exception was that respondents who read the untreated heroin addiction vignette were more willing to endorse discrimination against people with drug addiction.

 

In contrast, portraying Mary as having overcome her problems through treatment did not exacerbate any negative attitudes, and on some measures actually led to more positive attitudes than the neutral depiction. In particular, portrayals of successfully treated addiction to heroin or prescribed painkillers led fewer respondents to reject the prospect of working with someone with addiction or having them marry in to the family. Again relative to the neutral depiction, vignettes of successful treatment made respondents more likely to believe treatment can effectively control symptoms. However, in general these successful-treatment vignettes did not weaken preparedness to endorse discrimination or bolster enthusiasm for supportive policies.

Given these different and sometimes opposing effects relative to the neutral depiction, not surprisingly, the effects of portraying an untreated, active disorder differed from those of portraying the same disorder successfully treated. After reading the depiction of successful treatment, significantly fewer respondents wanted to maintain social distance ( charts), more believed in the effectiveness of treatment, and fewer were willing to endorse discrimination. However, beliefs that with treatment most sufferers can get well and return to productive lives were unaffected, as generally was endorsement of supportive polices. Of the two addictions, differences between reactions to treated and untreated vignettes were more consistent and larger after portrayal of heroin addiction than after portrayal of addiction to prescribed painkillers.

As other studies have found, even after reading a vignette portraying successful treatment, more people were willing to work with someone with addiction or mental illness than to welcome them in to the family, and respondents desired more social distance from people with drug addiction than from those with mental illness. For example, 34% and 42% of respondents who read the treated schizophrenia and depression vignettes were unwilling to work closely with a person with mental illness. In contrast, for the prescription painkiller and heroin vignettes, the corresponding figures were 70% and 64%.

The authors’ conclusions

As hypothesised, portrayals of untreated, symptomatic mental illness and drug addiction, characterised by abnormal behaviour including deterioration of personal hygiene and failure to fulfil work and family commitments, heightened desire for social distance from people with mental illness or drug addiction. In contrast, adding a paragraph depicting transition to successful treatment improved some attitudes, even relative to a neutral depiction which did not mention these conditions at all.

These results imply that portraying people who have successfully been treated for mental illness or drug addiction may be a promising strategy for improving public attitudes toward these groups. Exposure to a single, one- or two-paragraph vignette, led to significant movements in public attitudes, suggesting in turn that repeated such depictions presented through the news media, popular media, and other sources, are important influences on public attitudes. The implication is that a shift in emphasis away from portrayals of symptomatic, untreated individuals, and toward portrayals of those who have successfully been treated, could reduce public stigma and discrimination toward people with these conditions.

Rather than seeking directly to influence the media, national stigma-reduction campaigns may be a more feasible route to widespread dissemination of portrayals of successful treatment. In addition, expanding access to effective treatments and encouraging treatment entry is likely be a critical way to reduce public stigma and discrimination. Longstanding social stigma has led current and former sufferers to conceal these conditions; even family members sometimes don’t know that a loved one is an exemplar of successful treatment. Driven by stigma, concealment probably also perpetuates stigma by preventing family members, friends, and acquaintances becoming aware of the possibility of successful treatment.

The findings may help explain why emphasising an inherent biological basis for mental illness and addiction does not reduce stigma. Seeing these conditions as inherent flaws (moral or biological) is not, however, cemented into the public psyche. Portrayals of successful treatment lead to improved public attitudes, suggesting many Americans are receptive to the idea that mental illness and drug addiction are treatable conditions.

Despite other positive changes, the vignettes portraying successful treatment did not increase support for public policies which benefit people with mental illness and drug addiction. Support for increased government spending is in the USA strongly related to political ideology and party identification, affiliations which may have overpowered the influence of portrayals of successful treatment. It is also possible that the vignettes led respondents to believe that supportive policies are not needed.

The results of this study should be interpreted in the context of several limitations. Among these are that exposure to a single, one- or two-paragraph vignette portraying a person with mental illness or drug addiction is not how the public typically experience these conditions, either personally or through the media. Personal experience probably elicits a stronger emotional response, and rather than a single vignette, the news media exposes Americans to multiple, competing portrayals. The effects of the vignettes were assessed immediately after exposure; it is unclear whether these effects persisted. Results may have been different if the portrayed individual had different demographic characteristics.

Source:  Portraying mental illness and drug addiction as treatable health conditions: Effects of a randomized experiment on stigma and discrimination.

McGinty E.E., Goldman H.H., Pescosolido B. et al.
Social Science and Medicine: 2015, 126, p. 73–85.

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

Cannabis substitute smoked in a pipe appears to be a soft drug, but it is addictive and can be lethal

Spice is just the latest horror drug to hit Russia. Photograph: Boris Roessler/EPA/Corbis

Valentina sifts a flaky mixture from a purple sachet into the end of a small pipe, holds a lighter to it, and inhales. Her voice becomes tense and high-pitched for a moment, then she relaxes. A faint, almost Christmassy odour of lightly stewed fruits wafts through the room.

This is a hit of spice, the collective name given to various synthetic smoking mixtures making headlines in Russia. On the market for five years, spice has the potential to be deadly.

According to Russian authorities, in recent weeks the spice epidemic has taken 25 lives and led to 700 people seeking medical attention. Hardly a day goes by without a