National Drug Prevention Alliance & PPP

Today’s more potent marijuana can be addictive

ndpa — Tue, 15 May 2012 12:43:07 +0000

As professionals in the business of preventing and treating substance abuse, we at Trinity County Behavioral Health Services spend a good deal of our time researching and reading current science based literature and studies on the addictive nature of substances in order to better treat clients. For us, it is important to dispel the myth that marijuana is not addictive.

Research on marijuana use and addiction has been ongoing for many years and it has been proven that marijuana is an addictive drug. It is classified as a Schedule 1 controlled substance. Marijuana is the most commonly abused illicit drug used in the United States and addiction to this drug is listed under the Diagnostic and Statistical Manual of Mental Disorders as Cannabis Dependence (304.30). The main active chemical of marijuana causing dependence is delta-9-tetrahydrocannabinol, otherwise known as THC.

A favorite DVD we use here at Behavioral Health Services in treating our marijuana addicted clients is “Marijuana Neurochemistry and Physiology” produced by CNS Production. In this DVD, Haight- Ashbury Free Clinic (HAFC) Fellow and Doctor of Pharmacy Darryl Inaba discusses the addictive nature of marijuana. According to Dr. Inaba, in the late 1960s and through the ‘70s, the HAFC rarely (if at all) treated clients for marijuana addiction. But this changed in the late 80s and into the 90s as THC levels in marijuana began to climb sharply (a 151 percent increase in potency between 1992 and 2002). According to Dr. Inaba, in 2005 HAFC saw about 100 people per month seeking treatment for marijuana addiction alone and aside from any other drug use.

Dr. Inaba’s observation confirms what research is telling us about both psychological and tissue dependence caused by today’s “new,” more potent hybridized marijuana strains. These new marijuana strains have had some of the biggest impacts on our youth. Substance Abuse and Mental Health Services Administration treatment episodes data show that between 1992 and 2002 treatment for marijuana cannabis dependence among adolescents increased from 23 percent to 64 percent respectively — increasing right along with average THC levels over that time period. Parents need to know that today’s marijuana is very different than when they were teens. In many ways it is no longer a “gateway drug,” but the drug of choice and with the increased potency come increased addiction rates.

Should marijuana one day be legalized, we hope that the marijuana industry will have a better social consciousness than society has experienced with the alcohol and tobacco industries, the two industries marijuana proponents most compare in justifying legalization of marijuana. Alcohol and tobacco have never been taxed at a rate high enough to compensate for the tremendous harm they have caused. It has been our experience that when such industries profit by more consumption, they rarely educate the end users about the true negative consequences of using their products, something we see happening now with the promotion of marijuana as a “benign and harmless natural herb.”

Source: http://www.trinityjournal.com/news/2010-02-17/Opinion/Todays_more_potent_marijuana_can_be_addictive.html

Tweens Might Say No to Drugs, Alcohol and Cigarettes, Study Says

ndpa — Tue, 15 May 2012 11:13:40 +0000

When it comes to prevention of substance use in our “tween” population, turning kids on to ‘thought control’ may just be the answer to getting them to say no, Medical News Today reports.

New research published in the Journal of Studies on Alcohol and Drugs, co-led by professors Roisin O’Connor of Concordia University and Craig Colder of State University of New York at Buffalo, has found that around the” tween-age” years, youth are decidedly ambivalent toward cigarettes and alcohol. It seems that the youngsters have both positive and negative associations with these harmful substances and have yet to decide one way or the other. Because they are especially susceptible to social influences, media portrayals of drug use and peer pressure become strong allies of substance use around these formative years.

“Initiation and escalation of alcohol and cigarette use occurring during late childhood and adolescence makes this an important developmental period to examine precursors of substance use,” O’Connor said. “We conducted this study to have a better understanding of what puts this group at risk for initiating substance use so we can be more proactive with prevention.”

The study showed that at the impulsive, automatic level, these kids thought these substances were bad but they were easily able to overcome these biases and think of them as good when asked to place them with positive words. O’Connor explains that “this suggests that this age group may be somewhat ambivalent about drinking and smoking. We need to be concerned when kids are ambivalent because this is when they may be more easily swayed by social influences.”

According to O’Connor, drinking and smoking among this age group is influenced by both impulsive (acting without thinking), and controlled (weighing the pros against the cons) decisional processes. With this study, both processes were therefore examined to best understand the risk for initiating substance use.

To do this, close to 400 children between the ages of 10 and 12 participated in a computer-based test that involved targeted tasks. The tweens were asked to place pictures of cigarettes and alcohol with negative or positive words. The correct categorization of some trials, for example, involved placing pictures of alcohol with a positive word in one category and placing pictures of alcohol with negative words in another category.

The next step in the study is to look at kids over a longer period of time. The hypothesis from the research is that as tweens begin to use these substances there will be an apparent weakening in their negative biases toward drinking and smoking. The desire will eventually outweigh the costs. It is also expected that they will continue to easily outweigh the pros relative to the cons related to substance use.

O’Connor said researchers would like to continue to track the youth, who, he said, know that drugs are inherently bad.

“The problem is the likelihood of external pressures that are pushing them past their ambivalence so that they use. In a school curriculum format I see helping kids deal with their ambivalence in the moment when faced with the choice to use or not use substances,” O’Connor concluded.

Source:www.cadca.org 15th March 2012

Why teenagers should steer clear of cannabis

ndpa — Tue, 15 May 2012 11:06:44 +0000

Adolescents’ use of marijuana may increase the risk of heroin addiction later in life, a new study suggests. Researchers say the work adds to “overwhelming” evidence that people under 21 should not use marijuana because of the risk of damaging the developing brain.

The idea that smoking cannabis increases the user’s chance of going on to take harder drugs such as heroin is highly contentious. Some dub cannabis a “gateway” drug, arguing that peer pressure and exposure to drug dealers will tempt users to escalate their drug use. Others insist that smoking cannabis is unrelated to further drug use.

Now research in rats suggests that using marijuana reduces future sensitivity to opioids, which makes people more vulnerable to heroin addiction later in life. It does so by altering the brain chemistry of marijuana users, say the researchers.

“Adolescents in particular should never take cannabis – it’s far too risky because the brain areas essential for behaviour and cognitive functioning are still developing and are very sensitive to drug exposure,” says Jasmin Hurd, who led the study at the Karolinska Institute in Sweden.
But Hurd acknowledges that most people who use cannabis begin in their teens. A recent survey reported that as many as 20% of 16-year-olds in the US and Europe had illegally used cannabis in the previous month.

“Teenage” rats

In order to explore how the adolescent use of cannabis affects later drug use, Hurd and colleagues set up an experiment in rats aimed to mirror human use as closely as possible.

In the first part of the trial, six “teenage” rats were given a small dose of THC – the active chemical in cannabis – every three days between the ages of 28 and 49 days, which is the equivalent of human ages 12 to 18. The amount of THC given was roughly equivalent to a human smoking one joint every three days, Hurd explains. A control group of six rats did not receive THC.

One week after the first part was completed, catheters were inserted in all 12 of the adult rats and they were able to self-administer heroin by pushing a lever.
“At first, all the rats behaved the same and began to self-administer heroin frequently,” says Hurd. “But after a while, they stabilised their daily intake at a certain level. We saw that the ones that had been on THC as teenagers stabilised their intake at a much higher level than the others – they appeared to be less sensitive to the effects of heroin. And this continued throughout their lives.”

Hurd says reduced sensitivity to the heroin means the rats take larger doses, which has been shown to increase the risk of addiction.

Drug memory

The researchers then examined specific brain cells in the rats, including the opioid and cannabinoid receptors. They found that the rats that had been given THC during adolescence had a significantly altered opioid system in the area associated with reward and positive emotions. This is also the area linked to addiction.

“These are very specific changes and they are long-lasting, so the brain may ‘remember’ past cannabis experimentation and be vulnerable to harder drugs later in life,” Hurd says.
Neurologist Jim van Os, a cannabis expert at the University of Maastricht in the Netherlands told New Scientist the research was a welcome addition to our understanding of how cannabis affects the adolescent brain.

“The issue of cross-sensitisation of cannabis/opioid receptors has been a controversial one, but these findings show the drug’s damaging effects on the reward structures of the brain,” van Oshe says. “There is now overwhelming evidence that nobody in the brain’s developmental stage – under the age of 21 – should use cannabis.”

Source: On line edition of Neuropsychopharmacology. Reported in NewScientist.com July 2006

Young People and Alcohol

ndpa — Tue, 15 May 2012 10:59:21 +0000

• Young people in the UK have by far the most positive expectations of alcohol in Europe and are least likely to feel that it might cause them harm.
• Exposure to alcohol marketing increases the likelihood that young people will start to use alcohol and the amount they consume.
• The alcohol industry spends £800 million on marketing in the UK annually
• A spends £153 encouraging drinking per £1 contributed to Drinkaware – the industry led alcohol information organisation charged with promoting sensible drinking.
• Underage drinkers consume approximately the equivalent of 6.9 million pints of beer or 1.7 million bottles each week
• 630,000 11- to 17-year-olds drink twice or more each week.
• Between 2002 and 2009 – 92,220 under-18s were admitted to hospital in England for alcohol-related conditions- over 36 children or young people each day.
• Under-18s alcohol-related hospital admissions increased by 32% between 2002 and 2007.
• The latest European School Survey Project on Alcohol and Other Drugs reported that in the UK 26% of 11-15 year-olds reported suffering an accident or injury because of their drinking, the highest percentage in Europe.
• Although cases of dependence amongst underage drinkers are rare, in 2008/9 – 8,799 younger people accessed treatment for alcohol up from 4,886 in 2005/6.

Source:www.alcoholconcern.org.uk Nov.2011

Drug Legalisation: An Evaluation of the Impacts on Global Society

ndpa — Mon, 14 May 2012 12:15:17 +0000

Position Statement – December 2011

The flawed proposition of drug legalisation

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

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

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

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

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

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

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

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

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

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

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

Types of drug legalisation

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

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

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

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

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

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

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

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

The problem is with the drugs and not the drug policies

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Drug advisers told no chance of decriminalising possession laws

ndpa — Mon, 14 May 2012 11:53:41 +0000

Theresa May, the Home Secretary, issued a humiliating rebuke to her drug advisers after they called for the possession of drugs to be decriminalised.

The Home Office said there was no intention to give people a “green light” to use drugs because they “destroy lives and cause untold misery”.

The Advisory Council on the Misuse of Drugs (ACMD) risked a fresh row with the Home Office after suggesting those who possess any drug, including cocaine or heroin, for personal use should be taken out of the criminal justice system.

The Government issued a blunt statement insisting drug laws would not be liberalised and “decriminalisation is not the answer”. It is the latest in a series of run-ins between Whitehall’s official drug advisory body and the Home Office.

In 2009, the then Home Secretary Alan Johnson, sacked the ACMD chairman Professor David Nutt after he openly criticised the Government’s stance on cannabis. He had also previously said taking Ecstasy was no more dangerous than riding a horse.

The ACMD called for a review on how those caught in possession of drugs are handled in a submission to the Sentencing Council, which is consulting on guidelines for courts on drug offences.
However, it is not in the remit of the Sentencing Council to consider what would effectively decriminalisation and the ACMD only included its comments in the final section asking for any further comments. It wrote: “There is an opportunity to be more creative in dealing with those who have committed an offence by possession of drugs.

“For people found to be in possession of drugs (any) for personal use (and involved in no other criminal offences), they should not be processed through the criminal justice system but instead be diverted into drug education/awareness courses.”

The courses “would be the equivalent of the apparently successful ‘speed awareness’ courses to which drivers can be referred as a diversion”, the council added. It also suggested that those accused of possessing drugs could also face “more creative civil punishments”, such as the loss of a driving licence or passport.

A spokesman for the Home Office said: “We have no intention of liberalising our drugs laws. Drugs are illegal because they are harmful – they destroy lives and cause untold misery to families and communities. “Those caught in the cycle of dependency must be supported to live drug free lives, but giving people a green light to possess drugs through decriminalisation is clearly not the answer.”

Source: www.telegraph.co.uk 18th Oct 2011

Dedicated drug court pilots: a process report

ndpa — Mon, 14 May 2012 11:24:38 +0000

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

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

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

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

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

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

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

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

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

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

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

Source: www.findings.org.uk March 2009

Cannabis – a cause for Concern ?

ndpa — Mon, 14 May 2012 11:16:36 +0000

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

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

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

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

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

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

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

A Drug Policy for the 21st Century

ndpa — Mon, 14 May 2012 10:42:06 +0000

Illegal drugs not only harm a user’s mind and body, they devastate families, communities, and neighborhoods. They jeopardize public safety, prevent too many Americans from reaching their full potential, and place obstacles in the way of raising a healthy generation of young people.

To address these challenges, today we are releasing the 2012 National Drug Control Strategy — the Obama Administration’s primary policy blueprint for reducing drug use and its consequences in America. The President’s inaugural National Drug Control Strategy, published in 2010, charted a new direction in our approach to drug policy. Today’s strategy builds upon that approach, which is based on science, evidence, and research. Most important, it is based on the premise that drug addiction is a chronic disease of the brain that can be prevented and treated. Simply put, we are not powerless against the challenge of substance abuse — people can recover, and millions are in recovery. These individuals are our neighbors, friends and family members. They contribute to our communities, our workforce, our economy, and help make America stronger.

Our emphasis on addressing the drug problem through a public health approach is grounded in decades of research and scientific study. There is overwhelming evidence that drug prevention and treatment programs achieve meaningful results with significant long-term cost savings. In fact, recent research has shown that each dollar invested in an evidence-based prevention program can reduce costs related to substance use disorders by an average of $18.

But reducing the burden of our nation’s drug problem stretches beyond prevention and treatment. We need an all of the above approach. To address this problem in a comprehensive way, the President’s new strategy also applies the principles of public health to reforming the criminal justice system, which continues to play a vital role in drug policy. It outlines ways to break the cycle of drug use, crime, incarceration, and arrest by diverting non-violent drug offenders into treatment, bolstering support for reentry programs that help offenders rejoin their communities, and advancing support for innovative enforcement programs proven to improve public health while protecting public safety.

Together, we have achieved significant reform in the way we address substance abuse. And the Affordable Care Act will — for the first time — require insurers to cover treatment for drug addiction the same way they would other chronic diseases. This is a revolutionary shift in how we address drug policy in America.
Over the past three decades, we have reduced illegal drug use in America. Over the long term, rates of drug use among young people today are far lower than they were 30 years ago. More recently cocaine use has dropped nearly 40 percent and meth use has dropped by half. And we can do more. As President Obama has noted, we have successfully changed attitudes regarding rates of smoking and drunk driving, and with your help we can do the same with our illegal drug problem.

Source: R. Gil Kerlikowske
Director, White House Office of National Drug Control Policy 18th April 2012

Mephedrone users told they are playing Russian roulette

ndpa — Mon, 14 May 2012 10:08:14 +0000

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

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

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

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

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

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

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

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

Source: The Independent 26th October

Parents and parents of friends can influence drug use

ndpa — Sun, 06 May 2012 14:32:30 +0000

Parents of teenagers’ friends can have as much effect on the teens’ substance use as their own parents, according to a new study.

“Among friendship groups with ‘good parents’ there’s a synergistic effect - if your parents are consistent and aware of your whereabouts, and your friends’ parents are also consistent and aware of their (children’s) whereabouts, then you are less likely to use substances,” said Michael J. Cleveland, research assistant professor at the Prevention Research Centre and the Methodology Centre, Penn State.

In the study, 9,417 ninth-grade students were surveyed during the spring semester, and then again the following spring semester. The subjects came from 27 different rural school districts in Pennsylvania and Iowa, all participating in the Promoting School-university-community Partnerships to Enhance Resilience (PROSPER) study.

In ninth grade, the students were asked to name five of their closest friends. The researchers then identified social networks within the schools by matching up the mutually exclusive friendships. Overall, the team identified 897 different friendship groups, with an average of 10 to 11 students in each group.

At that time students also responded to questions about their perceptions of how much their parents knew about where they were and who they were with. They were also asked about the consistency of their parents’ discipline.

In the tenth-grade follow-up, participants answered questions about their substance use habits, specifically their use of alcohol, cigarettes and marijuana.

Researchers found parenting behaviours and adolescents’ substance-use behaviours to be significantly correlated that higher levels of parental knowledge and disciplinary consistency leading to a lower likelihood of substance use, whereas lower levels lead to a higher likelihood of substance use.

It was also found that behaviours of friends’ parents influenced substance use even when taking into account the effects of the teens’ own parents’ behaviours and their friends’ substance use, demonstrating the powerful effect of peers on adolescent behaviour

For example, if adolescents’ parents are consistent and generally aware of their children’s activities, but the parents of the children’s friends are inconsistent and generally unaware of their own children’s activities, the adolescents are more likely to use substances than if their friends’ parents were more similar to their own parents.

“The peer context is a very powerful influence,” said Cleveland. “We’ve found in other studies that the peer aspect can overwhelm your upbringing.”

According to the authors, this to be the first study where parenting at the peer level proved to have a concrete and statistically significant impact on child outcomes.

“I think that it empowers parents to know that not only can they have an influence on their own children, but they can also have a positive influence on their children’s friends as well,” said Cleveland. “And that by acting together the notion of ‘it takes a village’ can actually result in better outcomes for adolescents.”

The study was published in this month’s issue of the Journal of Studies on Alcohol and Drugs.

Deaths from Prescription Drugs – USA

ndpa — Sun, 06 May 2012 14:27:03 +0000

“While prescription drug abuse has been a major public health concern for several years, the public health and public safety consequences of prescription drug abuse continue to mount. National data show that in 2009 the 39,147 drug-induced deaths exceeded deaths from motor vehicle crashes (36,216). In 2008, the latest year for which national data are available, there were 20,044 unintentional prescription drug overdose deaths. The problem of prescription drug abuse is particularly acute in the southern United States and the Appalachian region. Prescription drugs caused an average of seven deaths per day in Florida in 2010, according to the Florida Medical Examiners Commission Drug Report.”

Source: http://www.whitehouse.gov/ondcp/2012-national-drug-control-strategy)

While it’s important for all of us to maintain our focus on illicit drugs of abuse, it’s also important to recognize that diverted prescription drugs, principally opioids, are estimated to cause more overdose deaths each year in the US than heroin, cocaine, and methamphetamine – combined! Moreover, the figure of 20,044 “unintentional prescription drug overdose deaths” mentioned in the recent ONDCP Strategy Report (supra) in all likelihood represents an undercount. This death tally is computed by the Centers for Disease Control and Prevention (CDC) from death certificates filed by state medical examiners. Researchers, however, have criticized this dataset for its limitations. Wysowski (2007), for example, conducted a surveillance study of 25,031 deaths attributed to prescription drugs in 2003 and compared this with a total of 16,135 similar deaths reported for 1999. She used the aforementioned CDC data base that transfers data from death certificates to categories known as the ICD-10 codes, designed in accordance with the International Classification of Diseases (10th revision). Wysowski commented on the limitations of these data:

“Drug names also are absent from death certificates because of certifiers’ under-attribution of drug-related deaths. Certifiers of death may not recognize a drug as a cause or, or as contributing to, a patient’s death, and when they do, they sometimes write ‘adverse drug reaction’ without providing the name of the drug on the death certificate. Furthermore, toxicological data are often unavailable at the time of death certification although death certificates can be amended to include subsequent information.”

Source: (Ref: Wysowski DK. Surveillance of prescription drug-related mortality using death certificate data. Drug Saf. 2007;30(6):533-540

New party high peril: 50p “coma in a bottle” danger drug kills two friends

ndpa — Sun, 06 May 2012 14:19:46 +0000

The two pals are believed to have taken deadly GBL, a solvent found in paint strippers and chillingly known on the club scene as “coma in a bottle”

A heartbroken mum yesterday warned that Britain faces a new epidemic after banned party drug GBL was blamed for killing two friends within hours.

Carl Fearon, 24, was found dead at his flat at about 1pm on Saturday afternoon.

Just eight hours later, mum-of-one Lynette Nock, 28, died at a memorial wake held by his friends.

The two pals are believed to have taken deadly GBL, a solvent found in paint strippers and chillingly known on the club scene as “coma in a bottle”.

The tragedy comes exactly three years after medical student Hester Stewart, 21, was found dead at a house in Brighton after a party.

Police found a bottle of GBL next to her body.

Hester’s mum Maryon Stewart, who went on to launch drug awareness charity the Angelus Foundation, said yesterday: “They are not drugs, they are chemicals and when you take them you’re playing Russian Roulette with your life.

“But you can’t control something like paint stripper because it has legitimate uses. When you ban one of these things probably a dozen others pop up to replace it.

“Last year 49 new substances appeared and no one really knows what’s in them. This is a major epidemic.

“The Home Office should be taking responsibility to protect young people and raise awareness. There were directives from Europe 18 months before Hester died but nothing was done.’

“Sadly, the message has still not filtered through and the same thing has happened and I’m deeply saddened.”

Electrical engineer Carl was found dead at his flat in Birmingham . Friends said he collapsed after taking GBL the previous night.

When word of his death spread, pals hosted a wake at a house in the city on Saturday night at which accountant Lynette collapsed.

Neighbour Emma Heath, 24, said: “I heard they put it in a Fanta bottle and several of them ended up being taken to hospital.” Lynette’s heartbroken father Dave, 69, yesterday paid tribute to his daughter and called for something to be done about GBL, describing it as “a lethal drug, a killer”. He says he fears Lynette’s drink may have been spiked, adding: “If Lynette had GBL in her system, did she and the others at that party ingest it without knowing what they were taking? Was it that their drink was spiked? From what I’ve read, this GBL has no taste and no smell.”

Det Insp Andy Hawkins said: “We believe the controlled substance Gamma-Butyrolactone, or GBL, may have been used as a drug at the gathering.” A spokesman for drugs charity FRANK said: “GBL is a dangerous drug with sedative and anaesthetic effects that can produce feelings of euphoria and can cause drowsiness. “It can kill.”

“It can do almost anything”: Analysis by drugs policy expert Dr Jonathan Cave

THE body converts GBL to date rape drug GHB, and because of how it is converted, GBL takes effect more quickly. It’s often advertised as a nutritional supplement but is harmful. GBL is unpredictable because it can do almost anything. It can have a mild effect, give people a headache or in some cases do a lot worse. It’s not directly toxic but the people to whom it is toxic won’t know until they take it. Some get addicted and take it 24 hours a day.

GBL, or Gamma-Butyrolactone, is known as “coma in a bottle”. It is used as paint stripper and was banned for consumption in 2009.

GBL is odourless and tasteless when diluted and is sold online for as little as 50p a shot.

The effect is similar to ecstasy but there is a high risk of overdosing. Some users say it feels as if their muscles are being torn apart. Medics say it kills six a year, damages organs and leads to psychosis. It is related to banned date rape drug GHB.

Source: www.Mirror.co.uk 2 May 2012

Increase in Cannabis Farms in UK

ndpa — Sun, 06 May 2012 12:35:37 +0000

More than 20 cannabis farms and factories were discovered by police every day last year as they seized drugs which could sell for £100 million on the streets, figures showed today.

Senior police chiefs said the size and scale of the farms were reducing as criminals producing cannabis were spreading the risk and minimising losses by employing a large number of so-called gardeners to manage small sites across multiple residential areas.

Over the two years since the last report by the Association of Chief Police Officers (Acpo), some 1.1 million plants have been seized with a street value of £207.4 million.

A total of 7,865 farms were found across the UK in 2011/12, up 15% from 6,866 in 2009/10 and more than a 150% increase from the 3,032 identified four years ago, the study by the Association of Chief Police Officers (Acpo) found.

There has been a “move back to the use of residential property” and dismantling factories was seen as “a short term solution, with missed opportunities for further investigation into potentially linked factories”, the police chiefs said.

The number of offences related to cannabis production is also increasing, up from 14,982 in 2010/11 to 16,464 last year.

Scotland Yard Commander Allan Gibson, the lead on cannabis cultivation for the police chiefs, said: “Commercial cannabis cultivation continues to pose a significant risk to the UK .

“Increasing numbers of organised crime groups are diverting into this area of criminality but we are determined to continue to disrupt such networks and reduce the harm caused by drugs.

“This profile provides a detailed analysis of the current threat from commercial cultivation of cannabis and the work undertaken by law enforcement agencies to combat the threat.”

The highest number of farms (936) were found in the West Yorkshire force area, equivalent to 42 factories per 100,000 people, the Acpo figures showed.

But South Yorkshire had 64 farms per 100,000 people, the highest ratio in the UK , with 851 farms.

The two forces were followed by other heavily-populated force areas, including West Midlands (663 farms, or 25 per 100,000 people), the Metropolitan Police (608 farms, or eight per 100,000 people) and Avon and Somerset (653 farms, or 40 per 100,000 people).

But the Devon and Cornwall force recorded the highest rise in the number of farms since the last report in 2009/10, with the number of farms identified rising 1,664% from 11 to 183 (11 farms per 100,000 people)

Source: www.Independent.co.uk 30th April 2012

ADDICTION

ndpa — Sun, 06 May 2012 12:28:01 +0000

In human populations, cigarettes and alcohol generally serve as gateway drugs, which people use first before progressing to marijuana, cocaine, or other illicit substances. To understand the biological basis of the gateway sequence of drug use, we developed an animal model in mice and used it to study the effects of nicotine on subsequent responses to cocaine. We found that pretreatment of mice with nicotine increased the response to cocaine, as assessed by addiction-related behaviors and synaptic plasticity in the striatum, a brain region critical for addiction-related reward. Locomotor sensitization was increased by 98%, conditioned place preference was increased by 78%, and cocaine-induced reduction in long-term potentiation (LTP) was enhanced by 24%. The responses to cocaine were altered only when nicotine was administered first, and nicotine and cocaine were then administered concurrently. Reversing the order of drug administration was ineffective; cocaine had no effect on nicotine-induced behaviors and synaptic plasticity. Nicotine primed the response to cocaine by enhancing its ability to induce transcriptional activation of the FosB gene through inhibition of histone deacetylase, which caused global histone acetylation in the striatum. We tested this conclusion further and found that a histone deacetylase inhibitor simulated the actions of nicotine by priming the response to cocaine and enhancing FosB gene expression and LTP depression in the nucleus accumbens. Conversely, in a genetic mouse model characterized by reduced histone acetylation, the effects of cocaine on LTP were diminished. We achieved a similar effect by infusing a low dose of theophylline, an activator of histone deacetylase, into the nucleus accumbens. These results from mice prompted an analysis of epidemiological data, which indicated that most cocaine users initiate cocaine use after the onset of smoking and while actively still smoking, and that initiating cocaine use after smoking increases the risk of becoming dependent on cocaine, consistent with our data from mice. If our findings in mice apply to humans, a decrease in smoking rates in young people would be expected to lead to a decrease in cocaine addiction.

Source: Science Translational Medicine 2 November 2011:
Vol. 3, Issue 107, p. 107ra109

Placebo-Controlled Trial of Cytisine for Smoking Cessation.

ndpa — Sun, 06 May 2012 12:18:21 +0000

West, R., et al. (2011)

This important study assessed the effectiveness of the drug cytisine in smoking cessation programs, and a potential star was born. In a single-center, randomized, double-blind, placebo-controlled trial, the journal paper concluded that “cytisine was more effective than placebo for smoking cessation. The lower price of cytisine as compared with that of other pharmacotherapies for smoking cessation may make it an affordable treatment to advance smoking cessation globally.”

Source: New England Journal of Medicine 365: 1193-1200. 2011

Legalized Drugs: Dumber Than You May Think

ndpa — Sun, 06 May 2012 12:08:43 +0000

Even smart people make mistakes, sometimes surprisingly large ones. A current example is drug legalization, which way too many smart people consider a good idea. They offer three bad arguments.

First, they contend, “the drug war has failed”, despite years of effort we have been unable to reduce the drug problem. Actually, as imperfect as surveys may be, they present overwhelming evidence that the drug problem is growing smaller and has fallen in response to known, effective measures. Americans use illegal drugs at substantially lower rates than when systematic measurement began in 1979, down almost 40 percent. Marijuana use is down by almost half since its peak in the late 1970s, and cocaine use is down by 80 percent since its peak in the mid-1980s. Serious challenges with crack, meth, and prescription drug abuse have not changed the broad overall trend: Drug use has declined for the last 40 years, as has drug crime.

The decades of decline coincide with tougher laws, popular disapproval of drug use, and powerful demand reduction measures such as drug treatment in the criminal justice system and drug testing. The drop also tracks successful attacks on supply, as in the reduction of cocaine production in Colombia and the successful attack on meth production in the United States. Compared with most areas of public policy, drug control measures are quite effective when properly designed and sustained.

Drug enforcement keeps the price of illegal drugs at hundreds of times the simple cost of producing them. To destroy the criminal market, legalization would have to include a massive price cut, dramatically stimulating use and addiction. Legalization advocates typically ignore the science. Risk varies a bit, but all of us and a variety of other living things, monkeys, rats, and mice, can become addicted if exposed to addictive substances in sufficient concentrations, frequently enough, and over a sufficient amount of time. It is beyond question that more people using drugs, more frequently, will result in more addiction.

About a third of illegal drug users are thought to be addicted (or close enough to it to need treatment), and the actual number is probably higher. There are now at least 21 million drug users, and at least 7 million need treatment. How much could that rise? Well, there are now almost 60 million cigarette smokers and over 130 million who use alcohol each month. It is irrational to believe that legalization would not increase addiction by millions.

We can learn from experience. Legalization has been tried in various forms, and every nation that has tried it has reversed course sooner or later. America’s first cocaine epidemic occurred in the late 19th century, when there were no laws restricting the sale or use of the drug. That epidemic led to some of the first drug laws, and the epidemic subsided. Over a decade ago the Netherlands was the model for legalization. However, the Dutch have reversed course, as have Sweden and Britain (twice). The newest example for legalization advocates is Portugal, but as time passes the evidence there grows of rising crime, blood-borne disease, and drug usage.

The lessons of history are the lessons of the street. Sections of our cities have tolerated or accepted the sale and use of drugs. We can see for ourselves that life is not the same or better in these places, it is much worse. If they can, people move away and stay away. Every instance of legalization confirms that once you increase the number of drug users and the addicted, it is difficult to undo your mistake.

The most recent form of legalization, pretending smoked marijuana is medicine, is following precisely the pattern of past failure. The majority of the states and localities that have tried it are moving to correct their mistake, from California to Michigan. Unfortunately, Washington, D.C., is about to start down this paths. It will end badly.

The second false argument for legalization is that drug laws have filled our prisons with low-level, non-violent offenders. The prison population has increased substantially over the past 30 years, but the population on probation is much larger and has grown almost as fast. The portion of the prison population associated with drug offences has been declining, not growing. The number of diversion programs for substance abusers who commit crimes has grown to such an extent that the criminal justice system is now the single largest reason Americans enter drug treatment.

Despite constant misrepresentation of who is in prison and why, the criminal justice system has steadily and effectively focused on violent and repeat offenders. The unfortunate fact is that there are too many people in prison because there are too many criminals. With the rare exceptions that can be expected from human institutions, the criminal justice system is not convicting the innocent.

Most recently, crime and violence in Central America and Mexico have become the third bad reason to legalize drugs. Even some foreign leaders have joined in claiming that violent groups in Latin America would be substantially weakened or eliminated if drugs were legal.

Many factors have driven this misguided argument. First, while President Álvaro Uribe in Colombia and President Felipe Calderón in Mexico demonstrated brave and consequential leadership against crime and terror, such leadership is rare. For both the less competent and the corrupt, the classic response in politics is to blame someone else for your failure.

The real challenge is to establish the rule of law in places that have weak, corrupt, or utterly inadequate institutions of justice. Yes, the cartels and violent gangs gain money from the drug trade, but they engage in the full range of criminal activities, murder for hire, human trafficking, bank robbery, protection rackets, car theft, and kidnapping, among others. They seek to control areas and rule with organized criminal force. This is not a new phenomenon, and legalizing drugs will not stop it. In fact, U.S. drug laws are a powerful means of working with foreign partners to attack violent groups and bring their leaders to justice.

Legalization advocates usually claim that alcohol prohibition caused organized crime in the United States and its repeal ended the threat. This is widely believed and utterly false. Criminal organizations existed before and after prohibition. Violent criminal organizations exist until they are destroyed by institutions of justice, by each other, or by authoritarian measures fueled by popular fear. No honest criminal justice official or family in this hemisphere will be safer tomorrow if drugs are legalized, and the serious among them know it.

Are the calls for legalization merely superficial, silly background noise in the context of more fundamental problems? Does this talk make any difference? Well, suppose someone you know said, “Crack and heroin and meth are great, and I am going to give them to my brothers and sisters, my children and my grandchildren.” If you find that statement absurd, irresponsible, or obscene, then at some level you appreciate that drugs cannot be accepted in civilized society. Those who talk of legalization do not speak about giving drugs to their families, of course; they seem to expect drugs to victimize someone else’s family.

Irresponsible talk of legalization weakens public resolve against use and addiction. It attacks the moral clarity that supports responsible behavior and the strength of key institutions. Talk of legalization today has a real cost to our families and families in other places. The best remedy would be some thoughtful reflection on the drug problem and what we say about it.

Source: http://www.weeklystandard.com/author/john-p.-walters 7th May 2012

Teens’ ‘cinnamon challenge’ is dangerous

ndpa — Tue, 01 May 2012 20:16:16 +0000

A word of warning to parents of adolescents, from the nation’s poison centers: Yes, you’ve secured your medicine chest and your liquor cabinet, but a new thrill-seeking activity among teens might make you consider locking away the cinnamon shaker as well.

In the first three months of 2012, the nation’s poison centers have had 139 calls—close to three times as many as were received in all of 2011—seeking help and information about the intentional misuse of cinnamon. At least 122 of these calls arose from something called the “cinnamon challenge”—a game growing in popularity among teens in which a child is dared to swallow a spoonful of ground or powdered cinnamon without drinking any water.

As cinnamon coats and dries the mouth and throat, coughing, gagging, vomiting and inhaling of cinnamon ensures, leading to throat irritation, breathing difficulties and risk of pneumonia, says Dr. Alvin C. Bronstein, medical and managing director of Rocky Mountain Poison and Drug Center. For teens who suffer from asthma, the “cinnamon challenge” can be particularly risky, because they can develop shortness of breath.

Of the 139 calls received so far this year by poison control centers, 30 required medical evaluation. What started kids abusing the contents of the kitchen’s little bear shaker? Look no further than the internet: Videos posted there are helping spread word of the cinnamon challenge.

”We urge parents and caregivers to talk to their teens about the cinnamon challenge, explaining to their teens that what may seem like a silly game can have serious health consequences,” said Bronstein.

The latest warning comes out of the American Association of Poison Control Centers’ National Poison Data System, which collects data on some 2 million calls made to poison control lines across the country each year, providing early warning of dangerous trends.

Source: ErieTimes News - USA 2^nd April 2012

Failure of Portuguese Drugs Experiment

ndpa — Tue, 01 May 2012 20:07:47 +0000

Congratulations to our colleague Manuel Pinto Coelho in Portugal. This is an enormous victory! The very liberal drug policy of Portugal is crumbling.

———————————————

Dear colleagues,

As you can see, although in Portuguese, it is official – Portuguese IDT and all its staff including the president Goulão has been abolished.

The mask fell down and there is no more “magnificent Portuguese model – an example to the world”. I hope Portuguese authorities decision may arrive in time to dissuade the rest of the world don’t follow countries like Mexico, Argentina and Czech Republic – as you know unfortunately they did bite the hook and decriminalized drugs already.

The magnificent Health Minister Paulo Macedo (ex-responsible by the treasure and finances) is now trying to understand how it was possible the existence of so many holes of so many millions of euros, opening the eyes FINALY to some personal and/or corporate interests some years ago installed… and as you can imagine there is a (very) few people very worried about…!

Now there is the SICAD with the competencies of…

”…planeamento e acompanhamento de programas de redução do consumo de substâncias psicoactivas, na prevenção dos comportamentos aditivos e na diminuição das dependências num novo serviço criado no âmbito da administração directa do Ministério da Saúde”

that means, the”… planning and following up of programs to reduce the consumption of psychoactive substances, prevention of addictive behaviours and diminishing of dependencies in a new service born in Health Ministry direct administration.”

Treatment and harm reduction structures are since today within the responsibility of the several structures in the ground of National Health Service untied to central services… So the licences to internments and other services became responsibility of each and every ARS – Health Regional Administration accordingly its needs in the ground.

This is a big victory of good sense and REASON and very good news to everyone who suffer with drug dependence, giving to all of us more wings to believe that our efforts must go on moving always forward a drug free society

Manuel Pinto Coelho, International Task Force on Strategic Drug Policy. Dec. 2011

The Factual Picture of Portuguese Drug Policy

ndpa — Tue, 01 May 2012 20:02:40 +0000

This letter is from Dr. Pinto Coelho from Portugal – his English is not perfect but the gist of the paper is very clear .. i.e. the media claims that decriminalisation in Portugal has been successful are simply not true.

The factual picture of Portuguese drug policy
Reaching out English Parliament and David Cameron

The Executive Office of the President Barak Obama Drug Control Policy, Director Gil Kerlikowske, in a letter to a member of the International Task Force on Strategic Drug Policy and Drug Watch International, is peremptory: “Our analysts found that claims that decriminalization has reduced drug use and had no detrimental impact in Portugal significantly exceed the existing scientific basis. Because this conclusion largely contradicts prevailing media coverage and several policy analyses in Portugaland the United States, my staff has heavily documented the sources of the data and information contained in this working paper. Please feel free to use this document in part or in whole to help strengthen your own efforts to advance a more honest discussion of decriminalization in Portugal and of the drug policy choices with nations are grappling today.”

This report is a consequence of a complete absurd campaign of an unacceptable manipulation of Portuguese drug policy facts and numbers, rose on the 33 pages of a so original as misleading book written by a writer/lawyer, Glenn Greenwald, fluent in Portuguese (on the eve of two important elections in Portugal), for the American “libertarian” think-tank Cato Institute - a long time advocate of drug legalization.

That book, underestimating the readers’ understanding and suggesting the contrary to what the numbers show clearly and unequivocally, has been carried out unconscientiously and naively by some usually responsible national and international press all over the world that boosting the proliferation of the Portuguese “good news” are dangerously distorting the projection of the reality: “The Guardian” -“Britain looks at Portugal´s success story over decriminalizing personal drug use” (September 5th 2010), “The Economist” – “The evidence from Portugal since 2001 is that decriminalization of drug use and possession has benefits and no harmful side-effects” (August 27th 2009) and the Portuguese magazine “Visão” – “Portugal inspira Obama” (Maio 7, 2009) are just a few of the publications that mimicked the phenomena.

It was so effective that irreparable damages are already there – Czech Republic, Mexico and Argentina copied the Portuguese “good example” and did decriminalize drugs too…

That is the razing power of an attractive fallacy!

But lets go to the data (and his sources) and to that high representative USA official above letter: “Drug-induced deaths in Portugal that decreased from 369 in 1999 to 152 in 2003, climbed to 314 in 2007 – significantly more than the 280 deaths recorded when decriminalization started in 2001”. (EMCDDS, Statistical Bulletin 2009, Table DRD-2.)

“…the report´s claims of Portuguese drug legalization success, however it trumpets a decline in the lifetime prevalence rate for the 15-19 age group from 2001 to 2007, while discounting a larger lifetime prevalence increase in the 15-24 age group and ignoring the substantially larger lifetime prevalence increase in the 20-24 age group over the same period. (Greenwald, p.14.) Furthermore, the report emphasizes decreases in lifetime prevalence rates for the 13-18 age group from 2001 to 2006 and for heroin use in the 16-18 age group from 1999 to 2005, but once again downplays increases in the lifetime prevalence rates for the 15-24 age group between 2001 and 2006, and for the 16-18 age group between 1999 and 2005”. (Greenwald, pp. 12-14.)

“… despite an assertion in the Cato Institute report that increases in lifetime prevalence rates for a general population are “virtually inevitable in every nation”, EMCDDA data indicate that countries have been able to achieve decreases in lifetime prevalence rates, including Spain, for cannabis and ecstasy use between 2003 and 2008.” (EMCDDA, Statistical Bulletin 2009, Table GPS-1.)

To this painful data we must add:

“There is a notorious growing consumption of cocaine in Portugal, although not as severe as that which is verifiable in Spain. The increase in consumption of cocaine is extremely problematic”. (EMCDDA Executive Director, Wolfgang Gotz, Lisbon, May 2009.)

“While amphetamines and cocaine consumption rates doubled in Portugal, cocaine drug seizures have increased sevenfold between 2001 and 2006, rating Portugal the sixth highest in the world.” (World Drug Report, June 2009.)

“Behind Luxembourg, Portugal is the European country with the highest rate of consistent drug users and IV heroin dependents”. (Portuguese Drug Situation Annual Report, 2006)

“Portugal keeps on being the country with the most cases of injected drug related AIDS (85 new cases per one million of citizens in 2005, while the majority of other EU countries do not exceed 5 cases per million) and the only one registering a recent increase. 36 more cases per one million of citizens were estimated in 2005 comparatively to 2004, when only 30 were referred. It is the only country recording a recent increase. 703 newly diagnosed infections, followed from a distance by Estonia with 191 and Latvia with 108 reported cases.” (EMCDDA, November 2007.)

“The highest HIV/AIDS mortality rates among drug users are reported for Portugal, followed by Estonia, Spain, Latvia and Italy; in most other countries the rates are low” (EMCDDA – November 2010).

“In Portugal, since decriminalization has been implemented in July 2001, the number of drug related homicides has increased by 40%. It was the only European country with a significant increase between 2001 and 2006.” (World Drug Report, June 2009.)

This is the factual picture of Portuguese drug policy.
Unfortunately for drug dependent’ and their extended families and friends, a lie, as convenient as it could be, no matter how many times affirmed, no matter how insistently repeated, would never become the truth. So, “resounding success” seems a gross overestimate. It is rather simple and easy to grasp the reality of the facts, with one look at the real figures, the official figures.
Extraordinarily Mr. Greenwald managed to picture it otherwise and most of the world press bought it. Subsequently some governments disgracefully did too (USA fortunately didn’t) and others are pathetically wondering to “experiment the potential benefits of innovations like Portugal’s.” (“The Observer” Sunday 5 September 2010.) …

Manuel Pinto Coelho
Medical Doctor, Chairman of the Association for a Drug Free Portugal – member of World Family Organization and World Federation Against Drugs
Member of International Task Force on Strategic Drug Policy
Portugal Delegate of Drug Watch International
Portugal representative of European Cities Against Drugs

P.S. I am political independent – I am not enrolled to any political party.
I do not practice or have any links to any drug dependence facilities.

Adopted kids’ drug abuse risk affected by biological family

ndpa — Tue, 01 May 2012 10:59:05 +0000

Adopted children are twice as likely to abuse drugs if their biological parents did too, suggesting that genetics do indeed play a role in the development of substance abuse problems.However, trouble or substance abuse in the adoptive family is also a risk factor, according to a study of more than 18,000 adopted children inSweden.

This suggests that both environment and biological family history can influence a child’s likelihood of future drug use.”For someone at low genetic risk, being in a bad environment conveys only a modestly increased risk of drug abuse,” says lead study author Dr. Kenneth S. Kendler, professor of psychiatry and human genetics at Virginia Commonwealth University in Richmond. “But if you are at high genetic risk, this can put your risk for drug abuse much higher.”

The findings should be reassuring to adoptive parents, and to people who are thinking about adopting, because they show the importance of a positive environment, experts say. “A child who is adopted, just like a child who is biological, does carry a certain genetic risk, but this shows that the environment they’re being raised in and how their genetic risk interacts with that is probably much more important for the potential development of any disease, including substance abuse and dependence,” says Dr. Lukshmi Puttanniah, director of child and adolescent psychiatry at Lenox Hill Hospital in New York, who was not involved with the study.

The study, published this week in the Archives of General Psychiatry, included 18,115 children born inSwedenbetween 1950 and 1993 and later adopted. Overall, 4.5% of adopted individuals had drug-abuse problems as identified by Swedish medical, legal and pharmacy records, versus 2.9% of people in the general population.

But 8.6% of those who had at least one biological parent who abused drugs had their own abuse problems versus 4.2% of adoptees whose biological parents did not have a history of drug abuse.

Adopted children had roughly double the risk of drug abuse if their biological full- or half-sibling had similar issues. But the risk was about the same if their adoptive siblings — those who had no biological connection to them — had abused drugs.

In general, trouble in the adoptive family, such as parental divorce, death, criminal activity, and alcohol problems was linked to a higher risk of drug abuse in the adopted child. There are a number of things adoptive parents — and biological parents for that matter — can do to minimize the risk of their children experimenting with drugs and alcohol, say experts.

“If parents are responsible, are monitoring their children’s behavior, paying attention to them, spending time with them, that’s going to have a positive effect and protect them from going down the path of alcohol and drug abuse,” says Maria M. Wong, Ph.D., associate professor of psychology at Idaho State University in Pocatello.

”Knowing the medical history of children who will be adopted is always a good idea, however . . . genes are not destiny,” adds Dr. Wilson Compton, director of the division of epidemiology, services, and prevention research at the National Institute on Drug Abuse, which helped fund the study. “This study shows that in a healthy, safe, and secure environment with little exposure to drug abuse and other problems in the adoptive relatives, even children with multiple drug abusing biological relatives do much better than those whose adoptive families don’t provide such advantages.”

But the current study omitted some factors, some of which might be important to current and future adoptive parents.For instance, the researchers didn’t know when the adopted child joined his or her new family.

“Children who are adopted at age 5 are in a different risk category from newborns,” says Dr. Lisa Albers, director of the Adoption Program at Children’s Hospital Boston.

And the study probably underestimates the number of drug users given that drug abuse was identified only if a person had had a brushwith the law, had been hospitalized or had a certain prescription history. That sets a “relatively high bar,” Albers says. In any event, rates of drug abuse in theU.S.tend to be higher than inSwedenor other Scandinavian countries, says Kendler. Also, researchers didn’t take into account changes in adoption in the last 50 years.

For instance, many more children placed for adoption today have birth parents with a history of substance abuse compared with 50 years ago, says Albers.

On the other hand, the medical community has moved forward “light years” in its understanding and ability to handle other risk factors for substance abuse, such as ADHD, impulse control challenges, mental health concerns like anxiety or significant trauma, which may have occurred prior to the child coming into the family — all of which are risk factors for substance abuse, says Albers.

“If we have parents with a history of drug abuse, we can probably do better . . .. if we address the early signs that put the child at risk for drug abuse,” says Albers.

“Joining an adoptive family that is supportive even if you’re genetically at high risk is a very positive thing,” she adds.

Source: www.health.com 5th March 2012

19 percent of teens admit to driving while under influence of marijuana, more than drunk driving

ndpa — Tue, 01 May 2012 10:48:26 +0000

RANCHO CUCAMONGA, CA - In new survey, 19 percent of teens admit to driving while under influence of marijuana, more than drunk driving. The survey, conducted by Liberty Mutual Insurance and Students Against Destructive Decisions (SADD), found that more teens are driving after smoking weed than after drinking alcohol. Only 13 percent of teens said they have driven after drinking. Read news release, click here.

Source: paul@drugfreecalifornia.org Feb.201

Dutch marijuana advocates face off with Cabinet

ndpa — Mon, 23 Apr 2012 09:33:21 +0000

Dutch coffee shop owners went to court Wednesday in a last ditch bid to block a government plan to stop foreigners from buying marijuana in the Netherlands.

Lawyers representing the coffee shops oppose what would be the most significant change in decades to the country’s famed soft drug tolerance: turning marijuana cafes into “members only” clubs open solely to Dutch residents. Members would only be able to get into the coffee shops by registering for a “weed pass” and the shops would only be allowed a maximum of 2,000 members.

The move comes into force in the south of the country May 1 and is scheduled to roll out nationwide on Jan. 1, 2013. Whether it will be enforced in Amsterdam, whose coffee shops are a major tourist draw card, remains to be seen.

The city has strongly opposed the pass idea and mayor Eberhard van der Laan says he wants to negotiate a workable compromise with the country’s Justice Minister Ivo Opstelten. Lawyers for the cafe owners told a judge at The Hague District Court that the move — aimed at reining in problems caused by foreign “drug tourists” who buy marijuana in the Netherlands and resell it in neighboring countries — is “clearly discriminatory.”

Lawyer Ilonka Kamans argued that Dutch drugs policy gives citizens “the fundamental right to the stimulant of their choosing” and should not deprive visiting foreigners of the same right.

Another of the coffee shop lawyers, Maurice Veldman, told The Associated Press outside the court that the problem of drug tourism is confined to southern provinces close to the Dutch border with Germany and Belgium and should be tackled with local measures, not nationwide legislation.

But government lawyer Eric Daalder defended the measures.

“Fighting criminality and drug tourism is a reasonable justification” for the crackdown, Daalder told the court. He said the government wants to bring coffee shops back to what they were originally intended to be: “small local stores selling to local people.”

Marc Josemans of the Easy Going coffee shop in Maastricht said he expects the government will lose because it hasn’t thought through consequences or tried other ways of achieving its aims.

“We understand that this topic is something that’s of interest to tourists, but it’s equally important to our Dutch customers, which is most of them,” he told the AP ahead of Wednesday’s hearing.

“The limits on membership are going to lead to immediate problems in cities that don’t have enough coffee shops.”

Josemans said that if the court’s April 27 ruling goes against them, the Maastricht coffee shops plan to disregard the ruling, forcing the government to prosecute one of them in a test case.

Though the weed pass policy was designed to resolve traffic problems facing southern cities, later studies have predicted that the result of the system would be a return to street dealing and an increase in petty crime — which was the reason for the tolerance policy came into being in the 1970s in the first place.

The cities of Tilburg, Breda and Maastricht have now said they oppose the pass system, though Eindhoven plans to move ahead with it and the eastern city of Dordrecht wants to adopt it in anticipation of an influx of foreign buyers — even though it is not yet required to do so.

Marijuana cafes are a major tourist draw for Amsterdam, with some estimates saying a third of visitors try the drug, perhaps in between visiting the Van Gogh Museum and other major attractions.

Mayor Van der Laan says the Dutch capital doesn’t suffer major problems from pot smokers, and it doesn’t make sense to apply the same policy developed for the border cities here. According to U.N. data, the use of marijuana by Dutch nationals is in the mid-range of norms for developed countries — higher than in Sweden or Japan but lower than in Britain, France or the United States.

In the face of growing evidence linking marijuana smoking with mental illness, the Dutch government has been placing new restrictions on coffee shops for a decade. It has set limits on the amount of active chemicals that can be contained in weed and hash; refused to renew licenses for shops that cause problems or are located too close to schools; and banned tobacco smoking at coffee shops in 2008.

Source:http://www.sfgate.com/cgi-bin/article.cgi?f=/n/a/2012/04/18/international/i063025D58.DTL

April 18th 2012

How does cognitive behaviour therapy work with opioid-dependent clients? Results of the UKCBTMM study.

ndpa — Fri, 20 Apr 2012 10:46:02 +0000

Kouimtsidis C., Reynolds M., Coulton S. et al.
Drugs: Education, Prevention and Policy: 2011, early online publication.
Request reprint using your default e-mail program or write to Dr Kouimtsidis at drckouimtsidis@hotmail.com

Compromised by an inability to interest enough patients, the only randomised UK trial of cognitive-behavioural therapy for methadone patients was unable to be definitive but did find some signs of benefit and that the therapy had pulled some of the intended psychological levers.

Summary Cognitive approaches to treating substance misuse problems are still relatively new and it is important to understand how they work. Relevant treatment models emphasise the role of: self-efficacy to cope with situations associated with drug use without using; developing skills to cope with these situations as well as skills to generate broader lifestyle changes; and changing patients’ expectations of the positives and negatives of using the substance. Successful treatment is theorised to result from a reduction in the extent to which patients expect positive outcomes from substance use, an increase in their negative expectations, and enhanced self-efficacy and coping skills.

The featured study was the first study to directly test this model in the context of substitution treatment for opiate dependence. The findings derive from the UKCBTMM United Kingdom Cognitive Behaviour Therapy Study In Methadone Maintenance Treatment. study, which investigated the effectiveness and cost-effectiveness of cognitive-behavioural therapy for patients in opiate substitute prescribing programmes, itself the first randomised controlled trial of a psychosocial intervention in this setting in the UK.

At several UK treatment centres, the study randomly allocated substitute prescribing patients to keyworking only or keyworking plus cognitive-behavioural therapy, and assessed whether the additional therapy improved outcomes six and 12 months later. Additional therapy was offered weekly for 24 weeks but typically patients attended only four sessions. Therapists and keyworkers were recruited from existing staff and the therapists were trained and supervised in the therapy.

Perhaps because so few patients were eligible for and prepared to join the trial (just 60 did so of 369 who were eligible), though there were outcome gains from the extra therapy, none were statistically significant. Nevertheless, as measured by their effect sizes, A standard way of expressing the magnitude of a difference (eg, between outcomes in control and intervention groups) applicable to most quantitative data. Enables different measures taken in different studies to be compared or (in meta-analyses) combined. Based on expressing the difference in the average outcomes between control and experimental groups as a proportion of how much the outcome varies across both groups. The most common statistic used to quantify this difference is called Cohen’s d. Conventionally this is considered to indicate a small effect when no greater than 0.2, a medium effect when around 0.5, and a large effect when at least 0.8. In the featured study effect sizes were expected to be about 0.3. the gains were as large as expected in terms of reductions in the severity of addiction and heroin use, and improved compliance with prescribed methadone use. The cost of the extra therapy was more than outweighed by savings in health, social, economic, work, and criminal justice costs. Perhaps because patients had already been in methadone treatment for on average five months, these savings were less than in some other studies, and the difference in cost savings between therapy and non-therapy groups was not statistically significant.

Main findings

However, the featured report was less concerned with whether extra cognitive-behavioural therapy improved the end result of methadone treatment, than with how it might have done so. One way was expected to be by improving how well patients coped with life’s problems, a concept measured by a standard questionnaire which assessed different aspects of this ability. Relative to keyworking only, as expected, at six months the therapy was followed by a significant improvement in the degree to which patients positively reappraised problems, and a non-significant improvement in problem solving. Other domains where additional improvements were expected (logical analysis, seeking guidance and seeking alternatives) improved to roughly the same degree regardless of the extra therapy. Six months later (and 12 months after therapy had started) a similar analysis revealed that nearly all the expected mechanisms had improved after cognitive-behavioural therapy but deteriorated without it. The exception was logical analysis, where the reverse pattern was seen. Despite these trends, none of differences between patients who had or had not been offered cognitive-behavioural therapy were statistically significant, so chance variation could not be ruled out.

As expected, the degree to which patients felt confident that they could resist the urge to use drugs (‘self-efficacy’) increased after cognitive-behavioural therapy but decreased (at six months) or increased less (at 12 months) without this therapy. Patients were also asked about the good and bad consequences they expected from cutting down their heroin use. These measures changed in the opposite to what was expected; patients offered the therapy became relatively less positive and more negative about cutting down. Again, none of these differences between the two groups of patients were statistically significant.

Further analyses not reported here assessed changes among only patients who attended at least one session of their intended psychosocial intervention and related changes to the number of therapy sessions attended.

The authors’ conclusions

Though no definite conclusions can be taken from this study, there are indications that the therapy may be effective through at least some of the intended mechanisms, but also that methadone-maintained patients at services as configured in England in the 2000s generally reject the chance for this form of extra therapy.

The fact that few patients were prepared to join the study and that those who did attended few therapy sessions suggest there could be major barriers to implementing cognitive-behavioural therapy in routine practice in the British drug treatment system, perhaps associated with a culture of limited psychological therapy and relatively low expectations of clients’ engagement and compliance with treatment.

With such a small sample there is a heightened possibility that real differences made by the therapy will fail to meet conventional criteria for statistical significance and be mistakenly dismissed as chance variation. That this might have happened is suggested by the fact that the relative increase in days free of heroin use after six months was as great as expected. With a larger sample, it might well have also proved statistically significant. Economic analyses also found non-significant but appreciable net social cost-savings. The featured analysis supplements these outcome findings with indications that cognitive-behavioural therapy may have fostered some but not all of the crucial problem-solving skills.

The main seemingly counter-productive finding related to expectations about the pros and cons of reducing heroin use as measured by a scale yet to be validated. Also, more sessions of therapy did not further enhance the presumed psychological mechanisms through which the therapy worked. Nor were these mechanisms significantly related to substance use and other outcomes – again, perhaps due to the small sample size.

While appreciating the limits set by sample size, the non-significant trends suggesting that the therapy worked though the intended mechanisms were generally small in size. Of 22 comparisons between the two sets of patients, in only one had a mechanism (positively reappraising life’s problems) changed to a statistically significant degree in the expected direction – a result to be expected purely by chance. Together with a few counterproductive trends, these minor changes in the mechanisms thought to be specific to cognitive-behavioural therapy do not suggest it has a special role (that is, over and above other forms of psychological therapy) as a supplement to routine keyworking in the circumstances of the trial. At the same time the findings suggest that extra therapeutic contact did help stabilise patients who were prepared to accept it. Whether this needed to be cognitive-behavioural or a recognised therapy of any kind is impossible to tell from the study. Broader research offers little support for a distinctive role in addiction treatment for cognitive-behavioural approaches, results from which are generally equivalent to other approaches. It also seems that, at least in the mid 2000s, a steep hill remained to be climbed before formal psychological interventions of any kind were routinely and expertly implemented inBritain’s methadone clinics. How far that has changed is unclear. Details below.

CBT in methadone treatment

Guidelines from Britain’s National Institute for Health and Clinical Excellence (NICE) recommend cognitive-behavioural therapy not as a routine means of further stabilising patients, but to help with lingering anxiety and/or depression among those already stabilised in maintenance treatment. However, the analyses which led NICE to counsel against routine use did not show that cognitive-behavioural therapy was ineffective, just that it was not convincingly more effective than other well structured therapies.

Published in 2007, these guidelines did not have available to them the latest update of an authoritative meta-analytic A study which uses recognised procedures to combine quantitative results from several studies of the same or similar interventions to arrive at composite outcome scores. Usually undertaken to allow the intervention’s effectiveness to be assessed with greater confidence than on the basis of the studies taken individually. review conducted for the Cochrane collaboration which combined results from studies comparing structured psychosocial interventions against normal counselling among methadone and other opiate substitution patients. Taking in new studies available up to 2011, it found that overall such interventions had improved neither retention nor outcomes (including opiate use) to a statistically significant degree. In particular, the same was true of the family of behavioural interventions including cognitive-behavioural therapy. Contrary to expectations, this update found contingency management conferred no significant benefits, contradicting both its earlier findings and the NICE guidelines referred to above.

In the Cochrane review, verdicts in respect of cognitive-behavioural therapy rested on three studies, one of which does not appear to have reported substance use outcomes but did find greater improvements in psychological health. Relative to drug counselling alone, so too did a study of male US ex-military personnel starting methadone treatment. A year later, in this study cognitive-behavioural patients had improved more on a much wider range of psychological, social and crime measures, but not in respect of substance use. From methadone plus routine drug counselling only, so complete were the reductions in opiate use that little space was left for additional therapy to further improve outcomes. These two US studies are supplemented by a German study which found that group cognitive-behavioural therapy led to significantly greater post-therapy reductions (at the six-month follow-up) in drug use than routine methadone maintenance alone. The effect was largely due to changes in cocaine use, but there were also minor extra improvements in abstinence from opiate-type drugs and benzodiazepines. What these three studies suggest is that offering extra psychotherapy (not necessarily cognitive-behavioural therapy in particular) improves psychological and social adjustment and perhaps too helps reduce non-opiate substance use, but that methadone maintenance itself as implemented in these studies was such a powerful anti-opiate use intervention that further gains on this front were harder to engineer.

CBT in substance use treatment generally

If in terms of core substance use outcomes, cognitive-behavioural therapy in methadone maintenance does little to improve on routine counselling, this will simply be in line with findings in respect of the therapy’s role in treating drug and alcohol problems in general. A review combining results from relevant studies suggested that it remains to be shown that cognitive-behavioural therapies are more effective than other similarly extensive and coherent approaches. Studies which directly tested this proposition often found little or no difference, even when the competing therapy amounted simply to well structured medical care.

The implication is that choice of therapy can be made on the basis of what makes most sense to patient and therapist, availability, cost, and the therapist’s training. In respect of cost and availability, cognitive-behavioural therapy may (more evidence is needed) prove to have two important advantages. The first is that effects may persist and even amplify without having to continue in therapy. The second is that it lends itself to manualisation to the point where it can be packaged as an interactive computer program and made available in services lacking trained therapists – potentially a crucial advantage for widespread implementation.

Will CBT help methadone patients leave treatment?

Beyond core substance use outcomes is what in Britain is now a priority issue – whether more intensive therapy, even if it seems to add little to the powerful opiate use reduction effect of methadone treatment, might help people gain sufficient psychological and social stability to leave this treatment, and leave it sooner. In respect of psychotherapy in general and cognitive-behavioural therapy in particular, this remains a live possibility with some support from studies of during and post-treatment changes, though none have directly tested whether these enable patients to more safely leave the shelter of substitute prescribing programmes.

However, from the starting point revealed by the featured study, there seems a long way to go before structured psychosocial interventions of any kind are routine in Britain’s methadone services. An earlier report from the study commented that services were overstretched and understaffed and suffered from high staff turnover. Very few staff had been trained in psychological interventions and sometimes even basic individual client keyworking was extremely limited. Difficulties in engaging clients in the study were attributed partly to a low level of psychological interventions in services, which in turn led to low expectations of clients engaging with these interventions. Perhaps too, the authors speculated, some clients were reluctant to become involved in more intensive treatment or to address psychological issues not previously identified in usual clinical care. Most tellingly, the researchers observed “a nihilistic view of psychological intervention and clients’ capacity for change among some staff”.

In this climate, and with the added burden of research procedures, the small proportion of patients prepared to accept therapy and attend more than a few sessions is likely to be an underestimate of the possible caseload if cognitive-behavioural therapy were well promoted as a part of usual care, especially if elements of the approach were incorporated in keyworking rather than offered as an optional add-on.

In a different set of services probably sampled in the mid-2000s, perfunctory brief encounters focused on dose, prescribing and dispensing arrangements, attendance records, and regulatory and disciplinary issues characterised the keyworking service offered by some British criminal justice teams to offenders on opiate substitute prescribing programmes. However, ‘relapse prevention’ was the most common therapeutic activity in the sessions, featuring in 44% of the last sessions recalled by the staff, a term often taken to imply cognitive-behavioural approaches. What staff included under this heading was unclear, and the time given to it averaged just seven minutes, but is does suggest that there is a platform which could be built on. Unfortunately the need to do this building to foster recovery and treatment exit has coincided with resource constraints which make widespread training in and implementation of fully fledged therapy programmes seem unlikely.

Thanks for their comments on this entry in draft to Christos Kouimtsidis of the Herts Partnership NHS Foundation Trust in England. Commentators bear no responsibility for the text including the interpretations and any remaining errors.

Last revised 16 December 2011

Source: www.findings.org.uk

Adaptive programming improves outcomes in drug court: an experimental trial.

ndpa — Fri, 20 Apr 2012 10:15:41 +0000

Latest in an impressively coherent and persistent series of studies of how US courts specialising in supervision and treatment of drug-related offenders can do more to reduce drug use and crime. Triaging offenders to more or less intensive programmes and then adjusting based on actual progress made significant differences.

Summary Drug courts specialise in closely supervising (through regular urine tests and court appearances) and ordering the treatment of drug-related offenders to improve compliance with treatment as an alternative to prosecution or imprisonment. Judges impose sanctions or offer praise or more tangible rewards and adjust treatment depending on progress. However, in the USA this intensive process is available to only a small minority of potentially suitable offenders. Extending the reach of drug courts may be more feasible if intensive supervision and treatment are reserved for offenders who need them in order to do well, and if these decisions can to a degree be routinised rather than made on an individual basis.

Background to the study

One step towards this is to match intensity to the risk that the offender will fail to meet the requirements of the court, imposing stricter supervision on offenders assessed as high risk before the start of their sentences. As described by Findings, this has been trialled by the research group responsible for the featured study. They found that high risk (antisocial personality disorder or a history of treatment for drug abuse problems) offenders were more likely to test negative for drugs and to complete their court orders when they had been randomly assigned to fortnightly court progress hearings rather than hearings ‘as needed’ in response to infractions. A further trial implemented this matching procedure and again found better outcomes among high risk offenders matched to fortnightly hearings.

However, predicting in advance how offenders will react to different drug court requirements is an imperfect science. Another step forward is to adapt these to how offenders actually do respond, if possible based on pre-set criteria derived from research findings. For example, if a participant misses a set number of counselling sessions, an ‘adaptive’ regimen might stipulate a motivational enhancement intervention. Treatment staff retain authority to override or alter an adaptation, but typically have to explain their decisions. The featured study was the first major test of adaptive programming in a drug court.

Deciding who needs more supervision or treatment

The criteria for adapting the drug court regimen and the adaptations were developed by the drug court team and research staff with a view to being feasible as well as effective. As in earlier studies in the series, first offenders were categorised as high or low risk and assigned on this basis to fortnightly or as-needed hearings. Monthly assessments identified those who did not comply with the court’s requirements, indicated by two or more unexcused missed counselling sessions or failures to provide a valid urine specimen. In these instances it was assumed that judicial supervision was inadequate and it was stepped up to fortnightly or, if already fortnightly, further infractions would result in conviction for the original offence.

At other times offenders might attend treatment and comply with tests, but still carry on using illegal drugs, indicated by two or more positive urine tests. In these instances it was assumed that the treatment A minimum of four months (approximately 18 weeks) of weekly group psychoeducational counselling sessions covering the pharmacology of drug and alcohol use, progression from substance use to dependence, the impact of addiction on the family, treatment options, HIV/AIDS risk reduction, and relapse prevention strategies. Participants could also attend group or individual treatment sessions based on clinical need. was inadequate and its intensity was stepped up to include clinical case management entailing an additional two therapeutic group sessions per week and one individual session per month focused on motivational enhancement and relapse-prevention techniques.

A pilot study demonstrated the feasibility and promise of this approach, paving the way for the featured study.

About the study

Essentially the featured study tested whether in addition to triaging based on starting risk levels, adjusting treatment and supervision based on the offender’s actual progress improved outcomes. Both the pilot and the featured study were conducted in a drug court in the city of Wilmington, the largest in the USstate of Delaware. It accepted adult local residents charged with a misdemeanour Less serious offences such as possession or use of cannabis or possession of equipment related to drug use. without a history of a serious violent offending, and who drug court treatment staff assessed as meeting criteria for substance abuse or dependence. Defendants plead guilty but will be absolved if they satisfactorily complete Minimum requirements are attending at least 12 weekly group counselling sessions, providing at least 14 consecutive weekly drug-negative urine specimens, remaining arrest free, obeying programme rules and procedures, and paying a $200 court fee. the drug court programme and are not arrested for the next six months. Failing this they are convicted, have a criminal record, stand to lose their driving licences, and to be sentenced to a period on probation.

In 2009 and 2010 researchers approached 335 consecutive drug court defendants of whom 130 agreed to join the study (risking allocation to more intensive supervision and treatment than usual) and 125 actually started the programmes it tested. All were triaged based on their risk levels As in previous studies, antisocial personality disorder or prior treatment for drug problems indicated high risk and fortnightly hearings. to fortnightly or as-needed hearings and their progress was monitored monthly by researchers and reported back to the drug court.

Using the criteria outlined above, for a randomly selected 62 offenders, these monthly assessments determined Unless the drug court team or judge decided otherwise. whether those failing to comply with attendance and testing requirements were subject to more frequent or stricter supervision, and whether those still using drugs were directed in to more intensive treatment. Remaining offenders were subject to the court’s usual procedures.

Primarily at issue was whether adapting treatment/supervision to progress reduced drug use, as indicated by weekly urine tests over the first 18 weeks of the drug court sentence, the minimum needed to complete it.

Main findings

The key finding was that offenders subject to the predetermined adaptations were less likely to use illegal drugs. Of the urine tests they took, 68% indicated they were drug free compared to 49% of comparison offenders. Assuming missed tests would have indicated drug use, the figures were 61% and 46%. Under either assumption, offenders whose supervision and treatment were adapted to their progress were over twice as likely as other offenders to submit a urine test negative for illegal drugs, a statistically significant difference, and one which was apparent over the entire 18 weeks.

In contrast, the proportions of offenders who satisfactorily completed the drug court programme within 18 weeks (31% in the adaptive regimen, 23% of the remainder) or within a year (68% and 67% respectively) did not significantly differ.

Just over a third of both sets of offenders at some time failed to meet criteria for complying with attendance or urine test requirements. These infractions were much more likely (64% v. 30%) to be responded to by the court when offenders were subject to the adaptive regimen and the court had been alerted to the infraction by the researchers. Also, roughly the same proportions (a fifth to a quarter) of offenders continued to use illegal drugs, though in this case the court was no more likely impose consequences on offenders in the adaptive programme.

There was a (not statistically significant) tendency for more offenders in the adaptive programme to see the drug court’s procedures as fair, but otherwise no differences in perceptions of how effectively these acted as deterrents, attitudes to the judge, and satisfaction with drug court services, all of which were generally positive.

The authors’ conclusions

Findings confirmed that adaptive programming can promote abstinence from illegal drugs among misdemeanour offenders sentenced by a drug court. This improvement in drug abstinence rates appears to have been attributable to more intensive supervision of offenders who failed to comply with attendance and testing requirements, rather than to more intensive and individualised treatment in response to continued drug use.

As intended, the criteria set for adapting the regimen, alerts to when these were breached, and the clear structure for how the court should respond, seem to have helped staff identify and rectify mismatches between offenders and the supervision schedule they had been assigned to on the basis of their anticipated risk of failure. In theory, drug court staff could have made these adjustments on their own initiatives, but were much less likely to do so without the guidance and assistance of the adaptive structure. Lacking this, they imposed consequences in respect of less than one in three of the times when offenders failed to show up for treatment or testing, a ratio unlikely to optimally promote compliance with supervision requirements. The adaptive regimen meant fewer offenders ‘slipped through the cracks’ to continue noncompliant behaviour with relative impunity. There was no indication (if anything, the reverse) that this greater strictness jaundiced offenders’ views of the court or its procedures.

Strangely, while offenders whose programmes were adapted were more likely to test abstinent, they were no more likely to satisfactorily complete the drug court programme, despite the fact that a run of 14 ‘clean’ urine tests was perhaps the primary requirement. It could be that the adaptive regimen failed to affect the other criteria offenders had to meet to satisfy the court and expunge their offence, or that the court took other factors in to account in making these decisions.

One methodological concern is that under 4 in 10 of the offenders asked to join the study did so, reducing the degree to which the findings can be assumed to be representative of what would happen if such procedures were applied across the board. It seems likely that refusers were less motivated to comply with the court’s requirements or felt (perhaps due to their addiction) that they would be unable to satisfy the court if more intensively supervised. Also, rather than persisting impacts, these findings reflected periods when many offenders had recently ended or were still on drug court sentences.

There may be scope to improve criteria used to adapt supervision and treatment. For example, the assumption that non-attendance for counselling or testing does not require more intensive treatment may be false if offenders who have lapsed try to hide this by not turning up. And while supervision and treatment could be intensified in response to poor progress, there was no mechanism for good progress to trigger the reverse.

Marlowe D.B., Festinger D.S., Dugosh K.L. et al.
Criminal Justice and Behavior: 2012, 39(4), p. 514–532.

This is the latest in an impressively coherent and persistent attempt to evidence howUSdrug courts can do more to reduce drug use and crime, including ways to conserve resources by reserving intensive intervention for offenders who need it. These studies have shown that triaging on the basis of initial risk and then adjusting in the light of experience, based on simple and clear criteria and feasible treatment and supervision enhancements, are both possible for US drug courts and effective in promoting abstinence from illegal drugs. In turn this finding confirms that some kind of courts are more effective than others. Generally drug court sentences are associated with lower crime and drug use rates than comparison sentencing options, but there are not enough rigorous and convincing studies to be sure that this is due to drug court procedures as opposed to the type of offenders seen by drug courts or some other factor. Feeling more the weight than the quality of the evidence, generally reviewers have cautiously concluded that drug courts are more effective then conventional sentencing, but this largely US evidence is of doubtful relevance to the UK, where negative findings from Scotland may have contributed to a waning in enthusiasm at a national level for extending the drug court model to more offenders. Details below.

About the study

While the strategies tested by the featured study and its predecessors may seem obvious, deciding on the criteria for risk, the dividing line between poor versus good progress, and corresponding adjustments to supervision and treatment, is not straightforward. In the US context, and particularly in the context of a court trying less serious offences, triaging on the basis of antisocial tendencies and prior drug treatment and then adjusting on the basis of two missed appointments or urine tests had in some respects the desired impact. As the authors pondered, the puzzle is why this impact did not extend to what for the offender is probably the critical outcome – successfully completing the sentence.

For society and Britainin particular, crime-reduction is probably the critical outcome. Whether the full adaptive regimen reduced criminal recidivism is as yet unreported, but a prior study found that the first step – triaging high-riskUS misdemeanour offenders to fortnightly supervision – did not do so to a statistically significant degree. According to their confidential accounts to researchers, among high-risk offenders in this study the reduction in the proportion who offended was greater (down by 23% v. 7%) when they had been left to the court’s usual (roughly monthly) hearings.

The authors of the featured study suggest that rather than intensified treatment, imposing tighter supervision and more certain sanctions was how the adaptive regimen helped offenders avoid illegal drug use. This raises the issue of whether for these types of offenders, treatment can be dispensed with altogether and supervision and sanctions relied on to enforce compliance. For what seems to have been a mainly methamphetamine using caseload, this was essentially the proposition tested in Hawaii. Where the featured study reserved more intensive treatment for offenders with positive urine tests, inHawaii they took this a step further by reserving treatment as such. There intensive urine testing allied with swift and certain but not severe sanctions for non-compliance dramatically curbed drug use, prison time and re-arrest rates among a high risk group of drug using offenders. Treatment was available for offenders who wanted it or whose repeat positive drug tests suggested it was needed, but few did want or need it – perhaps 1 in 10.

British policy and experience

In the featured study’s drug court it seems that most offenders confined their regular illegal drug use to cannabis. In Hawaii, a stimulant was the main problem drug and opiate use was rare. These caseloads are very different from the dependent heroin users who have committed serious and/or repeated offences who constitute the major part of the caseload in drug courts in England and Scotland. It seems unlikely that many in the UK would be considered at low risk of reoffending, that fortnightly classes would be considered an adequate treatment for their addictions, or that many could sustain four months without registering some form of illegal drug use in at least two weekly urine tests. Generally they would be considered to warrant at least the intensity of treatment reserved for the minority of poor responders in the featured study. Though this means that in the British context, risk criteria and adaptive responses would have to be different, the principle of establishing these, and doing so on the basis of evidence rather than intuition, is likely to be applicable. If costly sentence failure and imprisonment are to be avoided, it seems critical that such adjustments are made before offenders get to the point where their breaches lead the court to revoke the drug court order and re-sentence for the original offence.

Drug courts have operated in Englandand Scotlandfor several years but are not widespread. In six pilot English courts, involved offenders and professionals felt the courts were a useful addition to the range of initiatives aimed at reducing drug use and offending. They set concrete goals for offenders to meet, raised self-esteem, and imposed a degree of accountability for their actions on offenders. They were also seen as facilitating partnership working between agencies. However, Scottish courts too were seen as useful and effective, yet there was no reliable evidence that (despite costing substantially more per order and per successfully completed order) their sentences were any more effective than similar orders made by other courts, as assessed by the proportions of offenders reconvicted and the frequency of convictions.

The 2010 English drug strategy made no specific mention of drug courts. For more details on criminal justice policy it referred to a Ministry of Justice green paper, which warned that drug courts “will only be continued if they genuinely make a difference and are cost effective”. Evidence gathered for the paper was equivocal about the applicability of international evidence to England and Wales and did not list drug courts among its “promising approaches”. The applicability of reasonably promising evidence from overseas (primarily the USA) was also questioned by the UK Drug Policy Commission in its review of programmes for problem drug-using offenders.

Scotland’s drug strategy published in 2008 looked forward to the assessment of the country’s pilot drug courts cited above, which found no reliable crime-reduction impact but increased cost. A review of interventions for drug using offenders produced for the Scottish Government accepted these findings, and warned that the most rigorous international trials which randomly allocated offenders to drug courts or other judicial options found only weak crime reduction impacts which fell short of statistical significance.

Given the negative crime reduction findings in Scotland, the lack of evidence in the rest of Britain, and doubts about the validity and applicability of mainly USinternational evidence, the national-level impetus apparent a few years ago for trying drug courts in Britainmay have waned. Treatment allied with urine or other biological tests for drug use remain high on the UKagenda, but drug courts no longer appear to be seen as a prime means of ensuring and supervising such programmes. Nevertheless, such courts could be seen as one way to ensure offenders enter and comply with the treatment programmes (and specifically addiction treatment) the Ministry of Justice saw as effective in reducing the costs of crime, or one way local areas may choose to pursue the crime reductions which it suggested could attract financial rewards in ‘payment by results’ schemes.

Recent reviews

Reservations in the Scottish review cited above over the evidence for drug courts from randomised trials were echoed in a review conducted by British experts for the Swedish Council for Crime Prevention. It was able to synthesise crime-reduction results from just two high quality trials. Together these registered an advantage for drug courts versus comparison judicial options, but not one which was statistically significant. According to this analysis, treatment in general had been shown to reduce drug-related crime, but the same could not yet be said of treatment delivered via a drug court.

Mandated by USlaw, in 2011 the USGeneral Accounting Office investigated how well US adult drug courts have reduced crime and substance use and their associated costs and benefits. They reported that compared to alternative dispositions, generally studies found drug courts were associated with lower rates of criminal recidivism and relapse to drug use, but few studies were free of possible bias arising from non-random selection of drug court versus comparison offenders. Due mainly to reduced future victimisation and justice system expenditures, benefits to society expressed in financial terms usually but not always outweighed costs. This balance was partly dependent on the expense of the alternative disposal; if community sentences supervised by a drug court replaced prison, the cost savings were likely to be positive and substantial.

In hedging its cost-benefit findings, the General Accounting Office touched on a fundamental criticism of US drug courts – that most exclude violent or drug dealing offenders or those with extensive criminal histories and serious mental health issues. The upshot is often a caseload of low-level drug offenders who are otherwise generally law-abiding, many of whom might have been more cheaply and appropriately diverted out of the criminal justice system altogether. The report also echoed a general finding in other research syntheses – that the more sound the study, the less likely it is to find any substantial recidivism reductions due to drug courts.

How far most studies fall short of the gold standard randomised controlled trial was commented on by (at the time of writing) the latest synthesis of drug court studies. Among this “methodologically weak” body of work, just three of 92 studies of courts Other than those dealing with traffic-related offences. trying adults had randomly allocated offenders to these versus alternative judicial procedures. Across these three, recidivism was lower among drug court offenders, but the finding was not statistically significant. The next most sound studies typically attempted instead to match drug court and comparison offenders on key variables, or to adjust the findings for their relative risks of offending. Across these 20 studies, recidivism was modestly and significantly lower among drug court offenders, but such research designs have limited power to iron out the most important differences between offenders who are or are not referred to (or choose to be processed by) drug courts. Presumably crucial variables – like how committed the offenders is to succeed, their social and family support, or professional assessments of how well suited they are to a drug court regimen – are rarely available to researchers. Echoing the featured study, this synthesis found that drug use was lowest in courts which supervised offenders frequently and which – like the court in the study – could hold out the prospect that success would expunge the original offence. These too were among the effective ingredients identified in a major study funded by the US Department of Justice of 23 drug courts.

For Findings drug court analysis run this search. In particular see these background notes with a detailed consideration of one of the most methodologically rigorous studies to date, conducted in Baltimore with a caseload unusually relevant to the UK because it consisted mainly of heroin addicts with extensive criminal records. Though methodological concerns remained, it found that over the three years after offenders had been allocated to the court or to normal proceedings, the average numbers of new arrests and charges were significantly fewer among drug court offenders and drug use was lower.

Source www.findings.org.uk 30 March 2012

A Comparison of Jamaican Male Adolescent Cannabis Users’ and Non-Users’ Performance on Tests of Memory.

ndpa — Fri, 20 Apr 2012 10:07:25 +0000

W De La Haye (1), K Powell-Booth (2). (1) The University of the West Indies, Mona Campus, Jamaica, (2) The University of the West Indies, Mona Campus & University of Technology, Jamaica.

Background: Cannabis is a popular drug mainly among adolescent males in Jamaica. The aim of this study was to assess whether there is a difference in performance of male cannabis users and non-users on tests of learning, memory, attention and intelligence.

Methods: Psychological tests of intelligence, learning and memory were administered for all participants. Tests included Wechsler Intelligence Scales for Children, fourth edition (WISC-IV) Wide Range Assessment of Memory and Learning, third edition (WRAML. 3). The sample size (N = 62), with an age range of 13 and 17 years, comprised 2 groups: adolescent users of cannabis (n = 30), the experimental group, and non-users of canabis (n = 32), the control group. Both groups’ performance was compared on each test. Independent t-tests were used to analyze the data, with alpha = .05.

Results: There is a significant difference in performance between the groups, as non-users had higher scores on all tests of memory than users of cannabis. The largest mean difference was for Verbal Intelligence Quotient (VIQ), 6.65, followed by Digit Span Forward 6.47, and 6.60 for Digit Span Backward, while the smallest mean difference was for the Picture Memory sub – test. The mean age was 14.97 years, (SD = 1.36).

Conclusion: Users of cannabis displayed cognitive deficits on all tests of memory.

Findings lend support to research that suggests that cannabis use may impair learning and memory.

Source: Winston De La Haye, M.D., M.P.H., D.M.

Lecturer and Consultant Psychiatrist . Dep. of Community Health & Psychiatry

The University of the West Indies, Mona Campus,JAMAICA

Crystal Meth Detected In Newborns’ Hair

ndpa — Mon, 02 Apr 2012 16:53:58 +0000

TORONTO, Nov. 2 — Methamphetamine can be detected in the hair of newborns whose mothers used the drug during pregnancy, researchers here have found.

Action Points

Note that this study shows that methamphetamine used during pregnancy can be found in the hair of neonates, suggesting it crosses the placental barrier with effects that are not completely understood.

Advise patients who ask that drug abuse during pregnancy can be detrimental to the fetus, with a range of physical and intellectual sequelae, as well as hazardous to the mother.

It represents the first direct evidence in humans that crystal meth, which is a growing drug-abuse problem in North America, can cross the placenta and affect the growing fetus, according to Facundo Garcia-Bournissen, M.D., of the Motherisk program at the Hospital for Sick Children.
Researchers at the program have been testing hair samples from parents and adults across Canada for several years, usually when there is clinical suspicion of drug abuse on the part of parents, Dr. Garcia-Bournissen and colleagues reported in the online issue of Archives of Disease in Childhood.
From June 1997 through December 2005, the database accumulated results of 34,278 tests for drugs in hair, representing 8,270 people. Nearly 60% (or 4,926) of these people were positive for at least one drug of abuse, the researchers said.
In a retrospective analysis, Dr. Garcia-Bournissen and colleagues examined the incidence of methamphetamine in hair samples:
• The first methamphetamine was found in hair in 2003, when six samples tested positive, with a slight increase in 2004, with eight cases.
• There were 372 cases in 2005 and the researchers said preliminary data for 2006 indicates that the surge has not stopped.
• The study identified 11 mother-neonate pairs in which each was positive for methamphetamine.
• Also, one newborn was negative, although the mother was positive.
The median methamphetamine values in the mother-baby pairs were 1.75 ng/mg for the mothers and 1.63 ng/mg for the newborns. Dr. Garcia-Bournissen and colleagues said.
The median concentrations were not significantly different, “suggesting that the transplacental transfer of methamphetamine is extensive,” the researchers said. On an individual level, maternal and neonatal drug levels correlated significantly (at P=0.003, using Spearman’s rho test, with r=0.8).
Interestingly, among the 171 subjects who were positive for methamphetamine and whose hair was tested for other drugs, 83.5% were positive for at least one other drug, usually cocaine, Dr. Garcia-Bournissen and colleagues found.
In contrast, among the 1,053 subjects negative for methamphetamine but positive for some other drug, only 38% were positive for more than one drug, they said.
“Positive exposure to methamphetamine strongly suggests that the person is a polydrug user, which may have important implications for fetal safety,” the researchers said.
The effects of the drug on the exposed child remain unclear, Dr. Garcia-Bournissen and colleagues noted, although there is some evidence that “children exposed in utero to methamphetamine are at risk of developmental problems, because of either the effect of direct exposure to the drug during pregnancy or growing in the environment associated with parental methamphetamine misuse, or probably both.”
Because the study was retrospective and anonymous, clinical information on the exposed infants is not available, the researchers said.

Source: www.medpage.today.com 2nd Nov. 2006

Nonmedical Use of Prescription Pain Relievers and Tranquilizers More Prevalent in U.S. Than Use of All Types of Illicit Drugs Except Marijuana

ndpa — Mon, 02 Apr 2012 16:51:52 +0000

U.S. residents continue to be more likely to report the nonmedical use of prescription drugs† than the use of almost all types of illicit drugs, according to recently released data from the 2010 National Survey on Drug Use and Health (NSDUH). Approximately 5% of persons ages 12 or older reported using prescription pain relievers nonmedically in the past year and 2% reported the nonmedical use of prescription tranquilizers—more than any type of illicit drug with the exception of marijuana. The nonmedical use of prescription stimulants was slightly less prevalent at 1.1%. All other substances, including ecstasy and prescription sedatives used nonmedically, were used by 1% or less of U.S. residents. These rankings have remained relatively unchanged over the past five years (see CESAR FAX, Volume 15, Issue 36).

Percentage of U.S. Residents (Age 12 or Older) Reporting Past Year Substance Use, 2010

†Nonmedical use of prescription drugs refers to using a prescription pain reliever, tranquilizer, stimulant, or sedative without a personal prescription or only for the experience or feeling it causes. It also include drugs within these groupings that originally were prescription medications but currently may be manufactured and distributed illegally, such as methamphetamine, which is included under stimulants.

NOTE: NSDUH is representative of the civilian, noninstitutionalized population aged 12 and older living in the U.S., which represents approximately 98% of the population. The survey excludes homeless persons who do not use shelters, military personnel on active duty, and residents of institutional group quarters, such as jails, hospitals, and residential drug treatment centers.

SOURCE: Adapted by CESAR from Substance Abuse and Mental Health Services Administration (SAMHSA), Results from the 2010 National Household Survey on Drug Use and Health: Detailed Tables, 2011. Available online at http://oas.samhsa.gov/NSDUH/2k10NSDUH/tabs/Cover.pdf.

Alcohol Hospital Admissions Double in a Decade

ndpa — Mon, 02 Apr 2012 16:48:30 +0000

Some 1,173,386 people in England were admitted to casualty for injuries or illnesses caused by drinking in 2010/11, compared with just 510,780 in 2002/3, according to the data. The figures for last year represent an 11 per cent increase on the previous 12 months, when alcohol-related admissions stood at 1,056,962.

Separate information published by Anne Milton, the public health minister, showed that since January an estimated 7,074 under-18s have been admitted to hospital due to alcohol.

Diane Abbott, the shadow public health minister, said the Government should take notice of the statistics and “get a grip” on binge drinking. She accused ministers of “rapidly pushing us towards a binge drinking crisis”, despite similar annual increases in recent years.

She said: “The alarm bells should be ringing with the publication of these figures. A recent report predicted that binge-drinking will cost the NHS £3.8 billion by 2015, with 1.5 million A&E admissions a year.”

Andrew Lansley, the Health Secretary, blamed Labour’s 24-hour drinking policy and accused the last government of “taking their eye of the ball” on the issue of binge drinking.

He said: “These figures are disturbing evidence that, despite total consumption of alcohol not increasing recently, we have serious problems with both binge-drinking and long-term excessive alcohol abuse in a minority of people. Our alcohol strategy, which we will set out in the new year, will outline what further steps we are taking to tackle this growing problem.”

Today’s Local Alcohol Profiles for England figures also show that the number of hospital admissions for conditions attributable to alcohol are rising at a similar rate. The number of admissions has more than doubled since 2002/03 and increased by nine per cent last year.

In 2002/03 there were 926 admissions per 100,000 people for conditions caused by alcohol, rising to 1,743 per 100,000 in 2009/10 and 1,898 last year.

The biggest increase over the past 12 months was inLondon, with a jump in admissions of 14 per cent, followed by the East of England with 10 per cent.

From The Telegraph Dec. 2011

Pat Robertson is wrong about marijuana

ndpa — Wed, 21 Mar 2012 16:22:20 +0000

Evangelical patriarch Rev. Pat Robertson has long been a leader in the conservative movement advocating for a better civil and moral society. But his recent support of marijuana legalization couldn’t be more wrongheaded.

“I really believe we should treat marijuana the way we treat beverage alcohol,” Robertson said last week in an interview with The New York Times. “I’ve never used marijuana and I don’t intend to, but it’s just one of those things that I think: this war on drugs just hasn’t succeeded.”

“It’s completely out of control,” Robertson added. “Prisons are being overcrowded with juvenile offenders having to do with drugs. And the penalties, the maximums, some of them could get 10 years for possession of a joint of marijuana. It makes no sense at all.”

Robertson’s arguments are wrong on each and every fact. First, regulating marijuana like the way we regulate alcohol (or cigarettes) will only result in the increased use and abuse of marijuana, particularly among youths. As the late, great political scientist, James Q. Wilson, put it, “The central problem with legalizing drugs is that it will increase drug consumption.” Arguing that adding a dangerous substance to the legal marketplace will reduce its usage is to renounce all common sense. Does Robertson truly believe that addicts and first-time users will be curtailed once the substance they seek becomes easier to obtain?

To stay on alcohol for a moment: There are about 79,000 alcohol-related deaths each year. The Center for Disease Control calculated that excessive drinking cost the United States $223.5 billion annually and the government pays more than 60 percent of these health care costs. Is that really the model that Robertson would recommend for the betterment of society?

The Household Survey of Substance Abuse tells us that alcohol, more than tobacco and illegal drugs, is the most used and abused drug among youth. Why is that? Because alcohol is legal; drugs are not. Alcohol is easily available; drugs are less so. Alcohol is culturally acceptable; drugs are, for the most part, stigmatized, in large part because they are illegal. Robertson has long respected the importance of the law and the culture. It is a grave error for him to abandon that now.

As for his other claims, the 2011 World Drug Report paints a detailed picture of marijuana abusers. Among cannabis users in treatment in the United States, 80.5% are not married, 90% have obtained an education of 12 years or less; 25% are unemployed and 46% are not in the labor force (of which 55% are students). Of the cannabis users who entered treatment services from 2000 to 2008, nearly a quarter report psychiatric problems. In addition, new research suggests that driving under the influence of marijuana could double a person’s risk of getting in a serious or fatal car crash.

Why should we promote the legalization of a substance that can irretrievably harm our children’s brains and makes our citizens less intelligent, less productive and less safe? Open and unrestricted drug use cannot coexist with a free, safe and productive society.

Moreover, Robertson’s claim that our prisons are overflowing with marijuana users are wildly exaggerated. The U.S. criminal justice system is the largest referral source for drug treatment programs. And, the large majority of inmates in state and federal prison for marijuana have been found guilty of much more than simple possession. The Office of National Drug Control Policy, for example, recently reported that of all the inmates in state prisons, 0.3% are arrested for offenses involving only marijuana possession.

Contrary to Robertson’s view, we have had successes in the fight against drugs. According to the Drug Enforcement Administration, 700,000 fewer teenagers used illicit drugs in 2010 than a decade earlier, a 16% decline. From 2000 to 2010, current marijuana use by teens has dropped 9%, methamphetamine use by teens has plummeted 60%, LSD use has dropped 50%, and current cocaine use among high school seniors has dropped 38%.

There have been other important victories, too. In the late 1980s and early 1990s, with the help of the Partnership for a Drug Free America, America’s policymakers and opinion shapers got tough on drugs. Through movies, television, mass media, and, yes, sermons, America sent a message: Drug use is not culturally or morally acceptable and it will not be tolerated. The nation was committed to defeating the cocaine epidemic, and it did.

We have much work left in our own fight against drugs. We need more drug education and prevention classes in schools, more rehabilitation and treatment centers, and more resources for law enforcement officials. But all this is for naught if our nation’s leaders, including its religious leaders, undermine and abandon the cause.

During a recent trip to Mexico, Vice President Joe Biden was right to reject the idea of legalization. “There is no possibility the Obama-Biden administration will change its policy on legalization,” he said. It’s time for a new bipartisan coalition committed to defending our children and our future from the dangers of drug abuse and addiction. Surrendering, like Robertson suggests, is not an option.

Editor’s note: William J. Bennett, a CNN contributor, is the author of “The Book of Man: Readings on the Path to Manhood.” He was U.S. secretary of education from 1985 to 1988 and director of the Office of National Drug Control Policy under President George H.W. Bush.

Source: William Bennett CNN 14th March 2012

Drug-addicted teenagers should seek help, GP warns

ndpa — Wed, 21 Mar 2012 16:21:10 +0000

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

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

Mexican drug cartels ‘operating in the UK, France and Netherlands’

ndpa — Wed, 21 Mar 2012 16:19:49 +0000

Mexico’s violent drug cartels have reached the streets of Britain, France and the Netherlands, according to US immigration officials, with undercover British agents undergoing training in El Paso to combat the problem.

Three members of Britain’s Serious Organised Crime Agency (SOCA) met US agents on the Texas-Mexico border this week in a bid to put a stop to cartels taking hold on Britain and Europe. The British agents spoke about surveillance tactics, special operations teams and cybercrime units, according to a US immigration officials.

On Thursday, they watched how ICE investigators tore apart a car where a cargo of marijuana was found at the Paso del Norte Bridge in this West Texas city. The agents are expected to head to Miami next week to learn about port operations in the US.

“The most important lesson that we have shared with SOCA, is that if they are not prepared to deal with the Mexican cartels, they will spread like a cancer and will entrench themselves in the economy and community in an attempt to ‘legitimise’ their illicit profits.” Oscar Hagelsieb, an agent at the US Immigration and Customs Enforcement’s Homeland Security Investigations office, said. “They must also be aware of the violence that will undoubtedly follow.”

US authorities believe Mexico’s Sinaloa cartel has drug distribution networks in England and has established footholds in France and the Netherlands, among other places in Europe, he said.

Mexican crime groups have previously made attempts to establish a presence in Europe, Mr Hagelsieb added, “but not to the scope we are seeing now. The Sinaloa is the first cartel that can have an impact worldwide.”

SOCA was created in 2006 and is responsible for investigating drug trafficking, criminal organisations, cybercrime, counterfeiting, the use of firearms and serious robberies. In a statement read by one of the British undercover agents, the agency said it wanted its agents to come to El Paso as “it’s always better to be exposed to the problems and the environment first hand.”

“We want to learn from the special agents about the local, regional and international impact of the widely reported scale of drug trafficking that takes place across this border,” the statement said.

The British agents were also interested in how El Paso has managed to remain one of the safest cities in the US even though it’s across the Rio Grande from Ciudad Juarez, a city afflicted by one of the highest murder rates in the hemisphere.

US Immigration and Customs Enforcement’s Homeland Security Investigations collaborates with local agencies, targeting specific criminal groups and gathering intelligence on them, Mr Hagelsieb said. “We are able to intercept them at points of entry before they cross back and forth.”

Source: The Telegraph March 2012

Drug developed to make people drink less alcohol

ndpa — Wed, 21 Mar 2012 16:18:10 +0000

A pill that makes alcoholics want to drink less has been developed by scientists for the first time, a conference has been told.

The drug is thought to work by blocking mechanisms in the brain that give alcoholics enjoyment from drink and so helps them fight the urge to drink too much. It only needed to be taken when people were going out where they might be tempted to drink alcohol. Alcoholics taking the drug and having counselling more than halved the amount of alcohol they drank per day and binged on fewer days. The findings were presented at the European Psychiatric Association (EPA) congress in Prague.

The drug, developed by Lundbeck pharmaceutical company, called nalmefene is not licensed yet and is currently going through clinical trials. There are other drugs on the market that make addicts ill if they drink any alcohol at all but this is thought to be the first aimed at reducing the amount of alcohol consumed. Side effects included dizziness, nausea, fatigue, sleep disorder or insomnia, vomiting, cold-like symptoms or excessive sweating.

Dr David Collier, of Barts and The London School of Medicine, Queen Mary University of London and an investigator in a nalmefene study, said: “The people volunteering for these trials had real problems with alcohol dependence, most had never sought help before, and others had tried and failed with abstinence strategies – stopping drinking for good.”

“Abstinence is the right option for many people, but not everyone wants to do that, and in those that do try, it helps only about half of them. From our experience in these trials, reducing alcohol consumption to safer levels can be a realistic and practical treatment goal for people who are dependent on alcohol, that can bring many short- and longer-term benefits to health.”

“These trial results suggest that the combination of medication and counselling could offer a new option for people in the UK not currently treated for their alcohol dependence.” There are thought to be 1.6m people addicted to alcohol who are not currently being treated.

Andrew Langford, Chief Executive of The British Liver Trust said: “We are genuinely worried about the increasing numbers of people from all walks of life with alcohol problems who are functioning seemingly well with their lives yet have built up a need for alcohol. Many feel that they need to drink just to feel normal, increasing potential negative effects on their physical and emotional health, including liver disease such as cirrhosis and liver cancer.”

In the study, nalmefene was used as needed by the patients, who took one tablet only when they perceived that there was a risk of drinking alcohol. Both the nalmefene and placebo groups of the study received counselling to maximise their motivation to reduce their alcohol intake, and ensure they continued to take the medicine.

Over six months in the trial the average amount of alcohol consumed per day reduced from 84g per day – the equivalent to a bottle of wine – to 30g per day or a large glass of wine. The number of days they drank heavily reduced from 19 to seven in those taking the drug alongside counselling.

The large study was conducted with 604 patients in Austria, Finland, Germany and Sweden.

Source: www. WiredIn.org.uk 6th March 2012

Marijuana Legislation’s Unintended Consequences

ndpa — Wed, 21 Mar 2012 16:16:43 +0000

Next November, Californians will ballot on allowing people 21 years and older to possess, cultivate and transport cannabis for personal use, as well as enable its commercial production and sale. Professor Keith Humphreys of Stanford University School of Medicine’s psychiatry and behavioural sciences departments, discusses the potential consequences.
He recently returned to Stanford after a one-year stint in the White House as a senior adviser on national drug control policy – and was a key speaker at the UK/European Symposium on Addictive Disorders in London last May.
Click here for related facts, also CannabisSkunk Support.
Q: There are estimates that, with legalisation, marijuana use could rise 50-100 percent%. Are those projections reasonable?
Humphreys: We know very well from other commodities that if you make something illegal, the price of it goes up. And when you make it legal, it becomes much cheaper. So the findings are credible. Why they’re scary is that big drops in price tend to affect mainly people with less disposable income… teenagers, the unemployed, other people who have just a small amount of extra money. This will drop marijuana to something they could easily afford to do on a daily basis.
It is not just legalising consumption; it is legalising production. That means you’re going to have an industry, like the tobacco industry, that will have lobbyists and marketers and lots of money. In fact, I wonder if tobacco companies might go into this business. They are well-positioned. They have the outlets and the pricing power. It will become a mass-produced, very cheap product.
Q: But the proposition also allows people to grow their own marijuana…
Humphreys: For the vast majority of people, if there’s a refined product in a nice package down at the store that costs 1/10th as much, and you don’t have to water or worry about sunlight, then they will buy it.
Q: What about the argument that taxing marijuana will provide much-needed revenue?
Humphreys: We should be legalising child pornography and human trafficking? There’s lots of awful things that raise money, and that doesn’t make them right. The second point is that taxes never recoup the harm from substances. If you look at all estimates of alcohol and tobacco taxation, it never even touched a fifth of the amount of health damage. So you get a little money in the short term, but in the long term, someone’s got to pay for car accidents and kids flunking out of school and things like that.
Q: What about the notion that by legalising it you take it out of clandestine operations?
Humphreys: You will probably get rid of some gun violence, for example. But look at the example of a tobacco company. You could have substantially more death. There’s lots of ways to do violence in this world. You can weaken government regulations in a way that results in thousands of people dying.

In terms of its medical use, I have compassion for patients; I was a hospice worker for many years. But I don’t feel that’s the typical person getting medical marijuana. A paper in the Harm Reduction Journal that profiled about 4,000 such people said the prototypical patient was a 30-year-old male who had been smoking pot for about 15 years and wasn’t seriously ill – that group is riding on our compassion for the people who have Aids, MS or cancer.
To me, it’s a pretty big jump to go from saying that this plant has some medical value, to saying that its consumption — and also its production and advertising — should be legalised.

Source: Addiction Today August 6th 2010

Deaths from ‘safe ketamine drug’ – – Mexxy

ndpa — Wed, 21 Mar 2012 16:14:34 +0000

The Government’s Advisory Council on the Misuse of Drugs has got an application to ban Methoxetamine (Mexxy) as two people in Leicestershire lost their lives due to the drug. The police and health advisors have advised that the people should not take the drug.

A woman, who was 59 years old from Leicester and a man, 32, from Melton Mowbray were found to be dead in February. The drug was said to be the safe alternative to the class C drug ketamine. However, it did not stand up to its expected levels. It is a form of legal high, which is taken as a party drug.

It is said that the drug will be taken off from the shelves in a few days and till then people should not take the drug. The drug is even available for £17 a gram on the net, so there are chances that people start ordering the drug from there.

Families, who have lost their loved ones due to the drug, were of the view that the drug should be banned straight away. Campaigner Maryon Stewart has also lost his teenage daughter Hester, due to the drug called GBL. It was then banned and then it was said that Mexxy is a safe drug. However, the drug has found to be on the same lines of GBL.

The Advisory Council on the Misuse of Drugs said that they have passed an application under which a temporary ban will be issued for a year. It is said that there are more than 40 legal highs available in Britain. The count has gone up from 13 to 40 in few years, informed experts.

After repeated incidents, it is expected that all new committed should be formed to check the efficacy of drugs. Home Office Minister Lord Henley said, “We have become increasingly concerned at the potential harms of Methoxetamine, and continue to work with our drug experts on the ACMD to decide on the best way to protect public health”.

Source: www.topnews/us 7th March 2012

Association Between Marijuana Exposure and Pulmonary Function Over 20 Years

ndpa — Fri, 24 Feb 2012 17:50:13 +0000

Context Marijuana smoke contains many of the same constituents as tobacco smoke, but whether it has similar adverse effects on pulmonary function is unclear.

Objective To analyze associations between marijuana (both current and lifetime exposure)and pulmonary function.

Design, Setting, and Participants The Coronary Artery Risk Development in Young Adults (CARDIA) study, a longitudinal study collecting repeated measurements of pulmonary function and smoking over 20 years (March 26, 1985-August 19, 2006) in a cohort of 5115 men and women in 4 US cities. Mixed linear modelling was used to account for individual age-based trajectories of pulmonary function and other covariates including tobacco use, which was analyzed in parallel as a positive control. Lifetime exposure to marijuana joints was expressed in joint-years, with 1 joint-year of exposure equivalent to smoking 365 joints or filled pipe bowls.

Main Outcome Measures Forced expiratory volume in the first second of expiration (FEV1) and forced vital capacity (FVC).

Results Marijuana exposure was nearly as common as tobacco exposure but was mostly light (median, 2-3 episodes per month). Tobacco exposure, both current and lifetime, was linearly associated with lower FEV1 and FVC. In contrast, the association between marijuana exposure and pulmonary function was nonlinear (P_.001): at low levels of exposure, FEV1 increased by 13 mL/joint-year (95% CI, 6.4 to 20; P_.001) and FVC by 20 mL/joint-year (95% CI, 12 to 27; P_.001), but at higher levels of exposure, these associations levelled or even reversed. The slope for FEV1 was −2.2 mL/joint-year (95% CI, −4.6 to 0.3; P=.08) at more than 10 joint-years and −3.2 mL per marijuana smoking episode/mo (95% CI, −5.8 to −0.6; P=.02) at more than 20 episodes/mo. With very heavy marijuana use, the net association with FEV1 was not significantly different from baseline, and the net association with FVC remained significantly greater than baseline

(eg, at 20 joint-years, 76 mL [95% CI, 34 to 117]; P_.001).

Conclusion Occasional and low cumulative marijuana use was not associated with adverse effects on pulmonary function.

JAMA. 2012;307(2):173-181 www.jama.com

RESPONSE TO ASSOCIATION BETWEEN MARIJUANA EXPOSURE AND PULMONARY FUNCTION OVER 20 YEARS STUDY

1. Research validity

The study appears well designed and there is no reason to think it was not done according to description. But they only look at limited lung function parameters FeV1 and FVC. No microscopic analysis of tissue was done and certainly other areas of potential damage were not addressed.

The investigators also admit that there were limitations in the study. A significant problem is that cannabis use is often difficult to quantify precisely due to smokers sharing joints, different inhalation techniques and different ways of smoking cannabis including joints, pipes and bongs. By comparison, the average amount of tobacco in a commercial cigarette of standard length is 1 gram. Therefore, the comparison between nicotine smokers and marijuana smokers is moot because the amount of smoke exposure in the two groups was vastly different and a comparable marijuana cohort was not recruited.

Clearly there was a reduction in lung function between 7-10 joint-years, but significant reductions at more than 20 joints per month.

The increased function was found with under 10 joint-years – that could be 1 joint per day for 10 years or 2 joints per week for 30 years. Numerous other studies have demonstrated damage- I am including some that are attached.

What is telling is that they did not have heavy users but still found evidence to suggest that heavy use causes lung damage. There is no accounting for changing patterns of use over the life time and lung recovery potential, which is great.

A key sentence is occasional and low cumulative marijuana use is not associated with adverse effects on pulmonary function. Occasional and low tobacco use is also not associated with adverse consequences. They did not have enough heavy marijuana users to draw conclusions of detrimental effects on pulmonary function. If nicotine smokers are using about 8-9 cigarettes/day and marijuana users 2-3 episodes in past 30 days, this is not really a valid comparison.

The authors note that “some investigators have proposed that the deep inspiratory manoeuvers practiced by marijuana smokers could stretch the lungs resulting in larger lung volumes.” It is true that cannabis smokers inhale more deeply, hold their breath for longer, and perform Valsalva manoeuvre at maximal breath hold which could result in a stretching of the lungs. However, it is important to note that cannabis is usually smoked without a filter and to a shorter butt length, and the smoke is a higher temperature than tobacco, thus exposing the cannabis smoker to greater levels of carboxyhaemoglobin and tar inhaled when compared with a tobacco cigarette of the same size. (Tashkin)

Another speculative possibility they note is “strengthening of chest wall musculature or another ‘training’ effect that allows marijuana users to inspire more fully (closer to total lung capacity) on spirometry testing.” The functional effects of this association on lung health or respiratory function in daily life are unclear. “Hypothetically speaking, a positive effect from marijuana in the short term (the stretch/training effect) and a negative effect in the long term (damage from smoke exposure) should result in a nonlinear association as observed. According to this explanation, the predominant effect for FEV1 at very high exposure (more than 40 joint-years) reflects cumulative damage

Their findings suggest an accelerated decline in pulmonary function with heavy use and a resulting need for caution and moderation when marijuana use is considered. Additionally, marijuana potency has increased dramatically in recent years and this study was initiated 20 years ago. The authors conclude that they did find an association with calendar time, but this assumption is questionable because the people were recruited a long time ago and their smoking habits (dose/unit) may or may not remain stable.

2. What this study lacked

This study did not compare light cigarette smokers (2-3 cigarettes in past 30 days) with light marijuana smokers (2-3 episodes in past 30 days) (or heavy with heavy). They provide no comforting conclusions. Lung capacity (how much air you can force your lungs to exhale) was the only measure presented. Deep inhalation may have increased the ability of lungs to store more air and enable exhalation. But studies have shown that marijuana smoking is associated with large airway inflammation, symptoms of bronchitis, increased airway resistance and lung hyperinflation. They should have availed themselves of more lung tests than simply “blowing out air.”

There are many other studies that have demonstrated health concerns about smoking marijuana. (Below are summaries of some studies. A fuller report of these and other studies are available upon request.)

S Aldington, et al. 2007. Effects of cannabis on pulmonary structure, function and symptoms. Thorax Online First.

METHODS: 339 adults from the Greater Wellington region. Their respiratory status was assessed using high-resolution CT (HRCT) scanning, pulmonary function tests and a respiratory and smoking questionnaire. Associations between respiratory status and cannabis use were examined by analysis of covariance and logistic regression.

RESULTS: A dose-response relationship was found between cannabis smoking and reduced force expiratory volume in 1 s to forced vital capacity ratio and specific airways conductance, and increased total lung capacity. Cannabis smoking was associated with decreased lung density on HRCT scans.

CONCLUSIONS: Smoking cannabis was associated with a dose-related impairment of large airways function resulting in airflow obstruction and hyperinflation. In contrast, cannabis smoking was seldom associated with macroscopic emphysema. The most important finding was that one joint of cannabis was similar to 2.5-5 tobacco cigarettes in terms of causing airflow obstruction. This dose equivalence is consistent with the reported 3-5 fold greater levels of carboxyhaemoglobin and tar inhaled when smoking a cannabis joint compared with a tobacco cigarette of the same size. The findings suggest that the predominant effects of cannabis on pulmonary structure, function and symptoms are in causing the symptoms of wheezing, cough, chest tightness and sputum production, large airways obstruction and hyperinflation, but not emphysema.

S Aldington, et al. 2008. Cannabis use and risk of lung cancer: a case-control study. European Respiratory Journal.

METHODS: A case-control study of lung cancer in adults greater than ≤0 years of age was conducted in eight district health boards inNew Zealand. In total, 79 cases of lung cancer and 324 controls were included in the study. The aim of the study was to determine the risk of lung cancer associated with cannabis smoking.

RESULTS: The risk of lung cancer increased 8% for each joint-year of cannabis smoking, after adjustment for confounding variables included cigarette smoking, and 7% for each pack-year of cigarette smoking, after adjustment for confounding variables including cannabis smoking. The highest percentile of cannabis use was associated with an increased risk of lung cancer, after adjustment for confounding variables including cigarette smoking.

CONCLUSION: The result indicated that long-term cannabis use increases the risk of lung cancer in young adults. The results also provided a quantification of the effect of cannabis smoking: the increased risk for each joint-year of cannabis smoking was similar to that for each pack-year of cigarettes. In other words, the risk of lung cancer increased by 8% for each joint-year of cannabis exposure after adjustment for confounding variables, including tobacco smoking.

D Moir, et al. 2008. A Comparison of Mainstream and Sidestream Marijuana and Tobacco Cigarette Smoke Produced under Two Machine Smoking Conditions. American Chemical Society.

METHODS: In this study a systematic comparison of the smoke composition of both mainstream and side stream smoke from marijuana and tobacco cigarettes prepared in the same way and consumed under two sets of smoking conditions was undertaken. The study examined the suite of chemicals routinely analyzed in tobacco smoke.

RESULTS: As expected, the results showed qualitative similarities with some quantitative differences. Ammonia was found in mainstream marijuana smoke at levels up to 20-fold greater than that found in tobacco. Hydrogen cyanide, and some aromatic amines were found in marijuana smoke at concentrations 3-5 times those found in tobacco smoke. Mainstream marijuana smoke contained selected poly7chclic aromatic hydrocarbons (PAHs) at concentrations lower than those found in mainstream tobacco smoke, while the reverse was the case for side stream smoke, with PAHs present at higher concentrations in marijuana.

CONCLUSION: The presence, in both mainstream and side stream smoke of marijuana cigarettes, of known carcinogens and other chemicals implicated in respiratory diseases was confirmed.

BMoore. 2004. Respiratory Effects of Marijuana and Tobacco Use in aU.S.Sample. JGIM.

METHODS: This study examined respiratory effects of marijuana and tobacco use in a nationally representative sample while controlling for age, gender, and current asthma. The Design was analysis of the nationally representative third National Health and Nutrition Examination Survey (NHANES III) and the Setting wasU.S.households. Participants were a total of 6,728 adults age 20-59 who completed the drug, tobacco, and health sections of the NHANES III questionnaire in 1988 and 1994. Current marijuana use was defined as self-reported 100+ lifetime use and at least 1 day of use in the past month.

RESULTS: Self-reported respiratory symptoms included chronic bronchitis, frequent phlegm, shortness of breath, frequent wheezing, chest sounds without a cold, and pneumonia. A medical exam also provided an overall chest finding and measure of reduced pulmonary functioning. Marijuana use was associated with respiratory symptoms of chronic bronchitis, coughing on most days, phlegm production, wheezing, and chest sounds without a cold.

CONCLUSION: The impact of marijuana smoking on respiratory health has some significant similarities to that of tobacco smoking.

SW Hii, et al. 2007. Bullous lung disease due to marijuana. Asian Pacific Society of Respirology.

METHODS: A report on a series of 10 patients (mean age 41 ± 9 years, eight male, two female), who presented over a period of 12 months with new respiratory symptoms and who admitted to regular chronic marijuana smoking (≥ 1 year continuously). Symptoms on presentation were dyspnoea, pneumothorax, and chest infection.

RESULTS: High-resolution CT revealed symmetrical, variably sized, emphysematous bullae in the upper and mid zones. However, the CXR was normal in four patients and lung function was normal in five.

CONCLUSION: Marijuana smoking leads to asymmetrical bullous disease, often in the setting of normal CXR and lung function. In subjects who smoke marijuana, these pathological changes occur at a younger age (approximately 20 years earlier) than in tobacco smokers.

Another example: Ann Epidemiol. 2010 Apr;20(4):289-97. Associations between duration of illicit drug use and health conditions: results from the 2005-2007 national surveys on drug use and health. Han B, Gfroerer JC, Colliver JD.

METHODS: Data from respondents aged 35 to 49 (N = 29,195) from the 2005-2007 National Surveys on Drug Use and Health (NSDUH) were analyzed.

RESULTS: The prevalence rates of a broad range of health conditions by duration of use of specific illicit drug among persons 35 to 49 years of age in the United States were estimated and compared: Positive associations between duration of marijuana use and anxiety, depression, sexually transmitted disease (STD), bronchitis, and lung cancer were found.

3. Impact on the debate over medical marijuana

The use of marijuana daily for “chronic medical conditions” or for psychoactive purposes is not captured by this study and therefore cannot inform the public about the ongoing “medical marijuana” effects and effects of heavy marijuana use.

Marijuana is being used by many individuals on a daily (and several times a day) as a so-called medicine for prolonged and indefinite periods of time. The authors’ own conclusions were that they did not have enough people who were heavy users (e.g. daily) to draw any conclusions and the trend towards accelerated decline in lung capacity was seen in heavy users (but not statistically because not enough users). Sadly, because it is a longitudinal study they did not start with current trends of high dose marijuana and increased number of heavy users, especially those using for purported medical purposes.

Until such time that specific substances have proven effects there is no place for marijuana in modern medicine. Medications have side effects that have to be managed and risks weighed against benefit; but, for most of evidence-based medical practitioners, there is no place for a smoked medicine without proven efficacy.

4. Additional thoughts

This will fuel the debate among those already committed to marijuana but it will not advance public health.

It is important to not forget the numerous other serious consequences of marijuana use: cognitive, learning, psychosis, addiction, criminal behaviour, impaired drivers on the highway and in workplaces, etc. – none of which were considered in this study.

Source: Document written byCalvinaFay, Bertha Madras, Andrea Barthwell, and Eric Voth International Task Force on Global Drug Policy January 2012

Marijuana Use and Adolescents: What clinicians need to know

ndpa — Fri, 24 Feb 2012 17:07:29 +0000

As marijuana use among teenagers increases and its perceived danger among this age group decreases, clinicians need to know the latest science about the harmful effects of the drug on the adolescent brain, according to a researcher at theUniversityofColorado,Denver.

Paula Riggs, PhD, Professor of Psychiatry, notes the most recent Monitoring the Future Survey shows a significant increase in marijuana use, including daily marijuana use among U. S. high school students and a decrease in perceived risk of use. “There are a number of indicators, including the increasing number of states that have passed ‘medical marijuana’ legislation, and that society as a whole tends to view marijuana as a relatively benign, recreational drug. However, scientific research does not support this.”

A growing body of research shows that adolescent marijuana use can be detrimental to the brain development and may produce long-lasting neurocognitive deficits and increased risk of mental health problems including psychosis, said Dr. Riggs, who spoke about this topic at the recent California Society of Addiction Medicine meeting.

Marijuana is the most commonly used illicit drug in the United States. Although some have questioned whether marijuana is an addictive drug, scientific research shows that one in 10 people overall, and one in six adolescents, who use marijuana develop dependence or addiction, Dr. Riggs says. Research shows that marijuana can cause structural damage, neuronal loss and impair brain function on a number of levels, from basic motor coordination to more complex tasks, such as the ability to plan, organize, solve problems, remember, make decisions and control behavior and emotions.

Dr. Riggs also cited recent studies indicating that adolescents may be more vulnerable to addiction, in part due to rapid brain development. “Emerging research suggests that individuals who start using marijuana during their teenage years may have longer-lasting cognitive impairments in executive functioning than those who start later,” she says. “Animal studies also suggest that exposure to marijuana during adolescence compared to adulthood may increase the vulnerability or risk of developing addiction to other substances of abuse such as cocaine and methamphetamine.”

She adds, “It is important for pediatricians, psychiatrists and other mental health clinicians to be aware of current research because they are on the front line to identify teens when they first start to experiment. They need to be able to effectively screen adolescents for marijuana use, and be armed with the scientific facts to educate teens and families about associated risks.”

Source www.partnershipatdrugfree.org Nov. 2011

Alcoholic hospital admissions double in a decade

ndpa — Sun, 19 Feb 2012 18:54:34 +0000

Separate information published by Anne Milton, the public health minister, showed that since January an estimated 7,074 under-18s have been admitted to hospital due to alcohol.

Diane Abbott, the shadow public health minister, said the Government should take notice of the statistics and “get a grip” on binge drinking. She accused ministers of “rapidly pushing us towards a binge drinking crisis”, despite similar annual increases in recent years.

She said: “The alarm bells should be ringing with the publication of these figures. A recent report predicted that binge-drinking will cost the NHS £3.8 billion by 2015, with 1.5 million A&E admissions a year.”

Andrew Lansley, the Health Secretary, blamed Labour’s 24-hour drinking policy and accused the last government of “taking their eye of the ball” on the issue of binge drinking.

He said: “These figures are disturbing evidence that, despite total consumption of alcohol not increasing recently, we have serious problems with both binge-drinking and long-term excessive alcohol abuse in a minority of people. Our alcohol strategy, which we will set out in the new year, will outline what further steps we are taking to tackle this growing problem.”

Today’s Local Alcohol Profiles for England figures also show that the number of hospital admissions for conditions attributable to alcohol are rising at a similar rate. The number of admissions has more than doubled since 2002/03 and increased by nine per cent last year.

In 2002/03 there were 926 admissions per 100,000 people for conditions caused by alcohol, rising to 1,743 per 100,000 in 2009/10 and 1,898 last year.

The biggest increase over the past 12 months was inLondon, with a jump in admissions of 14 per cent, followed by the East of England with 10 per cent.

Source: The Telegraph Dec. 2011

£570 Million – But Not For Drug Strategy Goal

ndpa — Sun, 19 Feb 2012 18:43:37 +0000

“The longer he is in Downing Street, the more aware the prime minister is becoming of the forces that can thwart progress… every attempt at reform has to fight its way past vested interests and the forces of bureaucratic inertia,” James Forsyth of The Spectator and Daily Mail recently noted. This coalition government’s humane goal of getting addicts off drugs in its first Drug Strategy is no exception.

On Friday, the National Treatment Agency for Substance Abuse sent a press release to treatment commissioners, saying how much they will get in 2011-12 from a £570million budget for community and prison drug treatment services – but throughout the press release and accompanying three-page letter from NTA CEO Paul Hayes, there was not one recommendation that they use the funds for the coalition government’s reasonable goal of getting addicts drug-free.

There is mention of “recovery”, but the NTA does not define recovery, leaving it meaningless for those commissioners spending the pot of money.

It does mention people leaving treatment successfully – but how is that defined? Does it mean those classified this way in NTA annual reports who actually died? Does it mean patients who have been years on methadone must vomit blood, break their clavicles and limbs or have a stroke before they “successfully exit” their substitute drugs and are sent to rehab?

“I believe the sum is sufficient to enable the field to deliver the transformative change set out in the Drug Strategy and ensure that 2011-12 is the year of transition to a recovery-focused treatment system.” said Hayes. We agree that the sum is sufficient – but again note no mention of the government’s goal.

“”The fact that the prime minister has to devote such attention to checking his instructions are followed acrossWhitehalldoes suggest that parts of the Civil Service are forgetting that its role is to implement government policy,” Forsyth concludes.

Source: Addiction Today Feb. 14^th 2011

Addicts’ Brains May Be Wired At Birth For Less Self-Control

ndpa — Sun, 12 Feb 2012 14:53:44 +0000

February 3, 2012

Simon Jones/Science/AAAS

The red areas show gray matter that
is abnormally increased in drug users. Blue shows gray matter that is
abnormally decreased in drug users. Yellow shows white matter tracts, called
fractional anisotropy or FA. FA is significantly reduced in both the drug users
and in their siblings, which suggests that the white matter tracts work less
efficiently.

Many addicts inherit a brain that has trouble just saying
no to drugs.

A study
in Science finds that cocaine addicts have abnormalities in
areas of the brain involved in self-control. And these abnormalities appear to predate
any drug abuse.

The study, done by a team at the University
of Cambridge in the U.K., looked at
50 pairs of siblings. One member of each pair was a cocaine addict. The other
had no history of drug abuse.

But brain scans showed that both siblings had brains
unlike those of typical people, says Karen Ersche,
the study’s lead author.

“The fibers that connect the different parts of the
brain were less efficient in both,” she says.

These fibers connect areas involved in emotion with areas
that tell us when to stop doing something, Ersche says. When the fibers aren’t
working efficiently, she says, it takes longer for a “stop” message
to get through.

And sure enough, another experiment done by Ersche’s team
showed that both siblings took longer than a typical person to respond to a
signal telling them to stop performing a task. In other words, they had less
self-control.

That’s what you’d expect to find in addicts, Ersche says.

“We know that in people who are addicted to drugs
like cocaine, that self-control is completely impaired,” she says.
“These people use drugs and lose control on how much they use. They put
everything at risk, even their lives.”

But the fact that siblings without drug problems also had
impaired self-control offers strong evidence that these brain abnormalities are
inherited, Ersche says.

And she says the finding also raises a big question about
the siblings who aren’t addicts: “How do they manage with an abnormal
brain without taking drugs?”

Ersche hopes to conduct another study of the sibling
pairs that will answer that question.

In the meantime, the findings about self-control have
implications that go far beyond drug addiction, says Nora Volkow,
director of the National Institute on Drug Abuse.

“Self-control and the ability to regulate your
emotions really is an indispensable aspect of the function of the brain that
allows us to succeed,” she says.

That’s because the part of the brain that decides whether
to take a drug is also the part that helps us decide whether to speed through a
yellow light or drop out of school, she says.

And this brain circuit seems to be involved in a lot of
common disorders, she says.

“One of the ones that attracts the most attention is
ADHD [attention
deficit hyperactivity disorder], where kids are unable to control
their response to stimuli that distract them,” Volkow says.

Impulse control is also central to behaviors like
compulsive gambling and compulsive eating, she says.

The new study shows it’s possible to identify people who
have inherited a susceptibility to these sorts of problems, Volkow says. And it
should help researchers figure out how to help susceptible people strengthen
their self-control, she says.

“Predetermination is not predestination,”
Volkow says.

Source:

http://www.npr.org/blogs/health/2012/02/03/146307907/addicts-brains-may-be-wired-at-birth-for-less-self-control

Marijuana 2.0 – It is a Different Drug Now

ndpa — Sun, 22 Jan 2012 21:53:32 +0000

After alcohol, marijuana is the drug most abused by teens. In fact,
marijuana is the most widely used illicit substance in the United
States and recent data show an uptrend in teen marijuana use
during 2009. Unfortunately, it is still viewed today by many as being the
same drug it was 45 years ago, despite significant changes.

Prevalence of Use by
Teens in the past 30 ays (2008)
monitoringthefuture.org
Marijuana:
8th grade – 5.8%,
10th grade- 13.8%,
12th grade – 19.4%

It is a Stronger Drug Today. Delta9-tetrahydrocannabinol, A.K.A. “THC” is
the active ingredient in marijuana that creates the intoxication. From the
1960’s – 1970’s marijuana was around 1/2 % – 3% THC. For 35 years following the 70‘s, the potency of
marijuana slowly increased to 4% by 1995.

2. Average Age of First Use is Younger Today.
Replicated studies since 1997 have provided a convergence of data suggesting that “early onset of first
intoxication,” as an independent variable, significantly increases the probability of developing addiction. 4
Today the average age of first intoxication is 12 years old. This compares to the 1960’s when marijuana
was primarily used by college students.
One study by (1997) Grant & Dawson, shows the probability of a person developing addiction based
on age of first intoxication in the chart below. In addition to age as a variable if the drug-user has a
genetic family history of addiction then the risk factor is increased by 15 percent. See chart below.

3. Marijuana Then vs. Today – A Picture is Worth a Thousand Words:

Marijuana Then:

Paraphernalia Then:

Marijuana Today:

20 – 25% THC)

Paraphernalia Today

Vaporizer, Grinder, Blunt Wrap

Clearly this is not the same marijuana used 40 years ago or certainly prior to 1995. For many, this grade of
marijuana has only been accessible from “cannabis clubs.” At the same time, because the cost of the marijuana
in the clubs was so expensive, many card holders still purchased marijuana from dealers on the street.
However, with the economic contraction high grade marijuana prices have fallen in many of the cannabis clubs
and access is now easier. Moreover, seeds to grow highly potent marijuana are easily purchased via the internet.
Clients in our program state that “the weed is so sticky I need to use a weed grinder to break it up if I want to
roll a blunt.”

4. Withdrawal From the Drug Can Occur Today:

t the 2009 medical doctor’s CSAM conference in San Francisco, a focus was on how to manage marijuana
withdrawal with Gabapentin. Withdrawal symptoms include loss of appetite, problems sleeping and anxiety.
Clearly people did not experience withdrawal 40 years ago and medicines weren’t being explored to manage
withdrawal symptoms. Finally, with regard to teens, any drug being abused inhibits normal neural, emotional
and social development, which can create a pathological relationship to intoxication resulting in negative
consequences with school, family, money, friendships, romantic attachments, health, mental health, sports,
employment, etc.

Final Thoughts: Evaluations, Education
&Treatment

Marijuana is not the innocuous drug that some believe it to be.
Too often parents and professionals base their understanding of
the drug from their own personal use 20 years ago. One of the
biggest challenges facing professionals
who specialize in the treatment of teen
and young adult addictive disorders is
that the intervention is not only with the
individual, but it is also with the family,
other health care professionals, schools,
and legal system, who might “minimize”
or discount the severity of marijuana
abuse. Statements such as “It is only
marijuana,” “at least it isn’t oxycontin,
meth, etc” are examples of the type of
denial described as “minimizing.” These messages from
various systems support denial for the individual who is having
consequences in different areas of their life because of the drug.
For this reason, intervention must occur with the individual,
family and community in order to be effective. It is also
important that if families are seeking help for their child who is
abusing drugs, they should seek professionals who are specially
trained in adolescent and young adult addiction. If you are a
parent or a professional working with teens and it is discovered
that they have used, regardless of the frequency, an evaluation
by a specialist is warranted. The individual needs to become
educated, explore their relationship to intoxication and examine
how it has already impacted different areas of their life in
addition to learning new affect regulation and relational skills to
move beyond this in their life. In addition, the family needs
education on teen addiction, an understanding on how the brain,
emotional, and social development are thwarted by drug use.
An examination of parental denial & enabling is needed as well
as help with developing and implementing a good home
contract, drug testing and education regarding how to be both a
supportive resource for their child meanwhile maintaining a
zero tolerance of drug use.

Sources:
1. Janet E. Joy, Stanley J. Watson, Jr., and John A Benson, Jr., “Marijuana and Medicine:
Assessing the Science Base,” Division of Neuroscience and Behavioral Research, Institute of
Medicine (Washington, DC: National Academy Press, 1999).
2. http://www.monitoringthefuture.org/data/09data.html#2009data-drugs
3. http://www.justice.gov/ndic/pubs37/37035/national.html
4. (1997) Grant & Dawson, Journal of Substance Abuse, Vol. 9
5. http://www.oas.samhsa.gov/newUsers.html
6. (1997) Grant & Dawson, Journal of Substance Abuse

Failure of Portugal’s drug legalisation experiment

ndpa — Sat, 10 Dec 2011 18:23:44 +0000

Congratulations to our colleague Manuel Pinto Coelho in Portugal. This is an enormous victory! The very liberal drug policy of Portugal is crumbling.

———————————————

Dear colleagues,

As you can see, although in Portuguese, it is official – Portuguese IDT and all its staff including the president Goulão has been abolished.

Now there is the SICAD with the competencies of…”…planeamento e acompanhamento de programas de redução do consumo de substâncias psicoactivas, na prevenção dos comportamentos aditivos e na diminuição das dependências num novo serviço criado no âmbito da administração directa do Ministério da Saúde”

Manuel Pinto Coelho, International Task Force on Strategic Drug Policy. Dec. 2011

Marijuana Impaired Driving: A serious safety problem

ndpa — Sat, 10 Dec 2011 18:10:44 +0000

While “medical marijuana” and marijuana legalization are common topics in the news, little attention is given to a large and growing body of research showing that marijuana impaired driving is a major cause of crashes, injuries and deaths.

The overall number of traffic fatalities has continued to decrease nationally over the past 40 years,1 reaching its lowest level in decades of 33,808 deaths in 2009.2 While reductions in alcohol-related fatalities have led this favorable trend, over the past five years the number of drug-positive drivers, including those positive for marijuana, has increased.3 Of all drug-positive fatally injured drivers in 2009, 28% were positive for marijuana. This accounts for 9% of all fatally injured drivers who had confirmed drug test results. Because many states do not conduct routine – or in some instances any – drug testing of fatally injured drivers, the prevalence of drugs, and in particular of marijuana, among fatally injured drivers is likely to be higher.

Marijuana is a Schedule I drug of abuse that has serious impairing psychological and physiological effects.4 A recent meta-analysis of nine epidemiological studies concluded that drivers who test positive for marijuana or report driving within three hours of marijuana use are more than twice as likely as other drivers to be involved in a crash.5 Studies of drivers involved in motor vehicle crashes support this conclusion. A study of seriously injured drivers admitted to a Maryland Level-1 shock trauma center showed that 26.9% of all seriously injured drivers tested positive for marijuana.6 A study of fatally injured drivers inWashingtonStateshowed

12.7% tested positive for marijuana and that among alcohol-positive drivers, 17.3% also tested positive for marijuana. The combination of marijuana use and alcohol is of great concern as evidence shows that low doses of marijuana combined with low doses of alcohol causes severe impairment.7 These data also show that combining alcohol and marijuana is common among seriously injured and dead drivers.

Efforts to reduce drunk driving have included strong legislation, effective enforcement and massive national education campaigns, yielding impressive results. The number of fatally injured drivers with illegal blood alcohol concentrations (BAC) of 0.08 g/dL has decreased 49% from 21,113 deaths in 1982 to 10,839 deaths in 2009.8 Similar actions must be taken to reduce drugged driving, including marijuana-specific initiatives since marijuana is by far the leading cause of drugged driving crashes, injuries and deaths. The problem of drugged driving received national attention for the first time in 2010, when the White House Office of National Drug Control Policy (ONDCP) identified reducing drugged driving a national priority in the National Drug Control Strategy.9 In 2011, ONDCP renewed its commitment to work to reduce drugged driving by 10% over the next 5 years in the 2011

Commentary December 8, 2011

The national rate of illicit drug use has increased in recent years after a long-term decline, largely due to increases in marijuana use, particularly among young adults.11 Increased marijuana use poses a heightened risk on the nation’s roads and highways. As perceived risk of marijuana use has decreased, particularly among youth, the rate of marijuana use has increased.12

The emergence of “medical marijuana” in 16 states and the District of Columbia have made national headlines, sending a strong, misleading message to the public that marijuana use is safe and that marijuana is a “medicine”, leading to increases in marijuana use. Adding to the more permissive state laws and to the changing perceptions of risk of marijuana use, a discussion paper released by the Institute for the Study of Labor recently has received significant international press attention for its conclusions that “medical marijuana” laws cause decreased traffic fatalities and decreased alcohol consumption.13 Analyzing three states which permit “medical marijuana” (Vermont, Rhode Island and Montana), the authors conclude that

“medical marijuana” increases adult marijuana use and not youth marijuana use; that increased adult marijuana use is associated with decreased alcohol use; and that the decrease in adult alcohol use in these states after their approval of “medical marijuana” led to fewer motor vehicle crashes and fatalities.

As stated by General Arthur Dean, Chairman and CEO of the Community Anti-Drug Coalitions of America (CADCA), there are three significant problems with this non-peer-reviewed discussion paper:

“(1) the study methodology is greatly flawed; and,

(2) the study’s authors disregard a large body of evidence showing that marijuana and alcohol are compliments; and,

(3) The study’s authors disregard mounting evidence that marijuana use is linked with impaired driving.”14

Former White House Drug Policy Advisor Kevin Sabet, Ph.D. points out that this paper’s authors “clearly dismiss or ignore research about the effects of medical marijuana that happen to be inconsistent with their conclusions.”15 In particular, a recent peer-reviewed study showed that rates of youth marijuana use are higher in states with “medical marijuana” than in states without “medical marijuana,” noting need for further research.16

Marijuana is not a substitute for alcohol; rather, the use of marijuana and alcohol is complementary. People use both marijuana and alcohol, though not necessarily at the same time. The larger point is however, how could the introduction of “medical marijuana” laws have resulted in such large reductions on the states’ alcohol consumption and highway deaths when only tiny percentages of the states’ populations are “medical marijuana” users?Vermonthas 349 registered “medical marijuana” users, or 0.05% of the state population.Rhode Islandhas an estimated 3,000 users, less than 1% of the state population.Montanahas over 27,000 registered users, accounting for nearly 3% of the state population. These small percentages of the states’ populations could not conceivably account for the large reductions in alcohol use and traffic fatalities reported in this study. What is most noteworthy about this discussion paper is the media coverage it has received. There is a strong contrast between the widespread media coverage of this non-peer-reviewed, obviously misleading, paper and the virtual absence of media attention to the many scientifically 3 sophisticated, peer-reviewed studies showing the significant highway safety threat posed by marijuana use. The large and ever-growing evidence that marijuana use is a significant contributor to highway crashes and deaths should be highlighted in any discussion of “medical marijuana” laws which by all accounts, including the proponents of “medical marijuana,” increase this drug’s availability and use.

“Medical marijuana” states are not immune to the consequences of marijuana impaired driving.Montana, which had the second-highest rate of alcohol impaired fatalities in the nation in 2009, is no exception to the problems of marijuana and drugged driving.17 Like other states, among drivers arrested for Driving Under the Influence (DUI) inMontana, marijuana is the most widely detected drug. From 2007-2010, the presence of marijuana among DUI suspects inMontanaincreased over 100%.18 In addition, during this period of time, the number of DUI suspects who

tested positive for both marijuana and alcohol increased by over 180%. Among fatally injury crashes in 2010, 38% involved drugs, 33% involved alcohol, and 14% involved drugs and alcohol.

Two important and related national improvements are cause for celebration: a decreased number of fatal crashes and a decreased number of alcohol-related motor vehicle fatalities. Despite these notable public health and public safety achievements, fatal crashes remain a significant problem, with clear evidence that drug use, and in particular marijuana use, is causing a large proportion of these preventable deaths. While nationally alcohol use has remained stable in recent years, marijuana use has increased,19 particularly among young adults.20 Contrary to the conclusions of the recent discussion paper, increasing marijuana use increases highway fatalities. It does not decrease them.

Robert L. DuPont, M.D. President, Institute for Behavior and Health, Inc. First Director, National Institute on Drug Abuse (NIDA) 1973 to 1978

Source: www.ibhinc.org. Dec 2011

References

1 National HighwayTraffic Safety Administration. (2009). 2008 Traffic Safety Annual Assessment. Traffic Safety

Facts. Washington,DC:NHTSANationalCenter for Statistics and Analysis. Retrieved December 8, 2011 from

http://www-nrd.nhtsa.dot.gov/pubs/811172.pdf

2 National HighwayTraffic Safety Administration. (n.d.). Fatality Analysis Reporting System (FARS)

Encyclopedia. Retrieved December 8, 2011 from http://www-fars.nhtsa.dot.gov/Main/index.aspx

3 National HighwayTraffic Safety Administration. (2010). Drug involvement of fatally injured drivers. Traffic

Safety Facts. DOT HS 811 415.

4Couper, F.J., &Logan, B.K. (2004). Drugs and human performance fact sheets.Washington,DC: National

Highway Traffic Safety Administration. DOT HS 809 725. Retrieved December 8, 2011 from:

http://www.nhtsa.gov/people/injury/research/job185drugs/drugs_web.pdf

5 Li, M., Brady, J.E., DiMaggio, C.J., Lusardi, A.R., Tzong, K.Y., & Li, G. (2011). Marijuana use and motor vehicle

crashes. Epidemiological Reviews. doi: 10.1093/epirev/mxr017

6 Walsh, M., Flegel, R., Atkins, R., Cangianelli,L.A., Cooper, C., Welsh, C., & Kerns., T.J. (2005). Drug and

alcohol use among drivers admitted to a Level-1 Trauma Center. Accident Analysis and Prevention, 37(5), 894-901.

7 Ramaekers, J.G., Robbe, H.W., O’Hanlon, J.F. (2000). Marijuana, alcohol and actual driving performance. Human

Psychopharmacology, 15(7), 551-558.

8 The Century Council. (2010). State ofDrunkDriving Fatalities in America 2009.Arlington,VA: The Century

Council. Retrieved December 8, 2011 from: http://www.centurycouncil.org/files/material/files/SODDFIA.pdf

9 Office of National Drug Control Policy. (2010). National drug control strategy, 2010.Washington,DC: Office of

National Drug Control Policy. Retrieved December 8, 2011 from

http://www.whitehouse.gov/sites/default/files/ondcp/policy-and-research/ndcs2010_0.pdf

10 Office of National Drug Control Policy. (2011). National drug control strategy, 2011.Washington,DC: Office of

National Drug Control Policy. Retrieved December 8, 2011 from

http://www.whitehouse.gov/sites/default/files/ondcp/ndcs2011.pdf

11 Substance Abuse and Mental Health Services Administration. (2011, September 8). National survey shows a rise

in illicit drug use from 2008 to 2010. SAMHSA News Release. Retrieved December 8, 2011 from

http://www.samhsa.gov/newsroom/advisories/1109075503.aspx

12 Center for Substance Abuse Research. (2011). Marijuana use continues to increase as perceived risk of use

decreases among U.S.high school seniors. CESAR FAX, 20(3). Retrieved December 8, 2011 from

http://www.cesar.umd.edu/cesar/cesarfax/vol20/20-03.pdf

13Anderson, D.M., & Rees, D.I. (2011). Medical marijuana laws, traffic fatalities, and alcohol consumption.

Discussion paper series IZA DP No. 6112.Germany: Institute for the Study of Labor.

14Dean, A. (2011, December 5). Why “study” linking medical marijuana and driving reductions is flawed.

Community Anti-Drug Coalitions ofAmerica. Retrieved December 6, 2011 from:

http://www.cadca.org/blogs/detail/why-%E2%80%9Cstudy%E2%80%9D-linking-medical-marijuana-drivingfatality-

reductions-flawed

15 Sabet, K.A. (2011, December 5). Does medical marijuana really reduce alcohol crash fatalities? Huffington Post.

Retrieved December 8, 2011 from http://www.huffingtonpost.com/kevin-a-sabet-phd/media-report-medicalmarijuana_

b_1129654.html?ref=politics

16 Wall, M.M., Poh, E., Cerda, M., Keyes, K.M., Galea, S., & Hasin, D.S. (2011). Adolescent marijuana user from

2002 to 2008: higher in states with medical marijuana laws, cause still unclear. Annals of Epidemiology, 21(9):714-

716.

17MontanaDepartment of Transportation. (2011, August). Overview ofMontana’s Impaired Driving Problem.

Retrieved December 8, 2011 from: http://www.mdt.mt.gov/safety/docs/impaired_driving_prob_overview_2011.pdf

18MontanaDepartment of Transportation. (2011, August). Overview ofMontana’s Impaired Driving Problem.

Retrieved December 8, 2011 from: http://www.mdt.mt.gov/safety/docs/impaired_driving_prob_overview_2011.pdf

19 Substance Abuse and Mental Health Services Administration. (2011). Results from the 2010 National Survey on

Drug Use and Health: Summary of National Findings, NSDUH Series H-41, HHS Publication No. (SMA) 11-4658.

Rockville,MD: Substance Abuse and Mental Health Services Administration. Retrieved December 8, 2011 from:

http://www.samhsa.gov/data/NSDUH/2k10Results/Web/HTML/2k10Results.htm

20 Substance Abuse and Mental Health Services Administration. (2011, September 8). National survey shows a rise

in illicit drug use from 2008 to 2010. SAMHSA News Release. Retrieved December 8, 2011 from

http://www.samhsa.gov/newsroom/advisories/1109075503.aspx

Smoking and Binge Drinking Raises Oral-Cancer Risk

ndpa — Sun, 27 Nov 2011 16:01:45 +0000

New research suggests that people who smoke and drink heavily are more at risk for oral cancer, the Researchers from King’s College in London, England, found an increase in oral cancer among men and women in their 20s and 30s who smoke and binge drink.

The researchers said that when tobacco smoke combines with alcohol, it produces dangerous levels of cancer-causing chemicals that attack the lining of the mouth.

“Our data show that smoking, drinking and poor diet are major risk factors, and that the younger people start smoking and drinking, the higher the risk,” said Newell Johnson, a professor of oral pathology at King’s College

Source: Daily Telegraph, London reported Nov. 9.2004

Skunk and Mental Illness

ndpa — Sun, 27 Nov 2011 15:47:42 +0000

Record numbers of teenagers are requiring drug treatment as a result of smoking skunk, the highly potent cannabis strain that is 25 times stronger than resin sold a decade ago.

More than 22,000 people were treated in 2007 for cannabis addiction – and almost half of those affected were under 18. With doctors and drugs experts are warning that skunk can be as damaging as cocaine and heroin, leading to mental health problems and psychosis for thousands – an IoS editorial states that there is growing proof that skunk causes mental illness and psychosis.

The decision comes as statistics from the NHS National Treatment Agency show that the number of young people in treatment almost doubled from about 5,000 in 2005 to 9,600 in 2006, and that 13,000 adults also needed treatment.

The skunk smoked by the majority of young Britons bears no relation to traditional cannabis resin – with a 25-fold increase in the amount of the main psychoactive ingredient, tetrahydrocannabidinol (THC), typically found in the early 1990s. New research being published in this week’s Lancet (2008) will show how cannabis is more dangerous than LSD and ecstasy. Experts analysed 20 substances for addictiveness, social harm and physical damage. The results will increase the pressure on the Government to have a full debate on drugs, and a new independent UK drug policy commission being launched next month will call for a rethink on the issue.

The findings last night reignited the debate about cannabis use, with a growing number of specialists saying that the drug bears no relation to the substance most law-makers would recognise. Professor Colin Blakemore, chief of the Medical Research Council, who backed the original Independent campaign for cannabis to be decriminalised, has also changed his mind.

He said: “The link between cannabis and psychosis is quite clear now; it wasn’t 10 years ago.”

Many medical specialists agree that the debate has changed. Robin Murray, professor of psychiatry at London’s Institute of Psychiatry, estimates that at least 25,000 of the 250,000 schizophrenics in the UK could have avoided the illness if they had not used cannabis. “The number of people taking cannabis may not be rising, but what people are taking is much more powerful, so there is a question of whether a few years on we may see more people getting ill as a consequence of that.”

“Society has seriously underestimated how dangerous cannabis really is,” said Professor Neil McKeganey, from Glasgow University’s Centre for Drug Misuse Research. “We could well see over the next 10 years increasing numbers of young people in serious difficulties.”

Politicians have also hardened their stance. David Cameron, the Conservative leader, has changed his mind over the classification of cannabis, after backing successful calls to downgrade the drug from B to C in 2002. He abandoned that position last year, before the IoS revealed that he had smoked cannabis as a teenager, and now wants the drug’s original classification to be restored.

Source IoS Dec. 2008

Separate Genes Responsible for Drinking, Alcoholism

ndpa — Sun, 27 Nov 2011 15:41:41 +0000

New research finds there are some genes that affect one but not the other

WEDNESDAY, Aug. 18 (HealthDayNews) — Some people can drink a lot of alcohol without becoming addicted, and specific genes may help explain why, researchers say.

In a new study of Australian twins, scientists found that separate genes appear to be responsible, to some degree, for dependence on alcohol — addiction — and how much people drink. Understanding how these genetic factors work together should give researchers more insight into treatment of alcoholism in its various forms, said study co-author John B. Whitfield, a researcher at Royal Prince Alfred Hospital in Australia.

Alcoholism and alcohol consumption may appear to be similar, but researchers are increasingly studying them separately. Consumption refers to the amount of alcohol that someone drinks, while addiction refers to a person’s inability to go without a drink.

“The transition from social alcohol consumption to alcohol dependence is a gradual process, and it is often hard to notice it,” said Dr. Alexei B. Kampov-Polevoi, an assistant professor of psychiatry at Mount Sinai School of Medicine. “As a result, many alcoholics and their family members continue to think that a person ‘just drinks too much’ while this person already developed alcohol dependence and requires treatment.”

Whitfield and his colleagues examined statistics about alcohol use from three studies of Australian twins completed between 1980 and 1995. The number of twins in the studies declined from 8,184 in 1980 to 3,378 in 1995.
The findings appear in the August issue of Alcoholism: Clinical & Experimental Research.

The researchers found twins who were genetically similar were more likely to consume similar amounts of alcohol. According to the study, some genes affected both addiction and alcohol intake, while some just affected addiction.

“We found (as others have also found) that alcohol dependence is partly, but not entirely, due to genetic differences between people who are affected by it and those who are not,” Whitfield said. “We also found that variation in the amount of alcohol that people habitually drink is subject to genetic influence, and that there is some — but not complete — overlap between the genes affecting these two things.”

Howard J. Edenberg, professor of biochemistry and molecular biology at Indiana University, said the findings — that genes separately affect alcoholism and drinking — are “reasonable.” But “that is a long way from identifying individual genes that actually are involved,” said Edenberg, whose own research is looking into that area.

So what should ordinary folks take from this study? “There is no direct and new message for people with alcoholism in their families; they are at higher risk than average but this has been known for some time and there is only a statistical risk, not a certainty by any means,” Whitfield said. “The more positive message for such people, and the community at large, is that we are learning more about alcohol use and alcohol-related problems and their causes.”

Source By Randy Dotinga
HealthDay Reporter August 2004

Research to Look at New Treatments for Heroin Addiction

ndpa — Sun, 27 Nov 2011 15:19:38 +0000

A clinical trial to test better treatment options for chronic heroin addiction is expected to begin in Vancouver at the end of this year. Led by researchers from Providence Health Care and the University of British Columbia, it’s the only clinical trial of its kind in North America.

The Study to Assess Longer-term Opioid Medication Effectiveness (SALOME) is a carefully controlled three-year clinical trial that will test whether hydromorphone (Dilaudid(R)), a licensed pain medication, is as effective as diacetylmorphine, the active ingredient of heroin, at engaging the most vulnerable long-term street heroin users, so they will enroll in treatment programs and end their use of illicit drugs.

The intent of the SALOME project is to determine whether some participants become healthier and reduce their illicit drug use or are able to switch to other forms of treatment. SALOME also intends to test if, after stabilizing patients on injectable medications, they can transition to oral formulations without losing effectiveness.

This study builds on the North American Opiate Medication Initiative (NAOMI), which was North America’s first-ever clinical trial of prescribed heroin that took place from 2005 to 2008. NAOMI, which also was led by researchers from Providence Health Care and UBC, was a randomized trial aimed at testing whether medically prescribed heroin (diacetylmorphine) was more effective than methadone therapy for individuals with chronic heroin addiction who were not benefiting from other conventional treatments.

The results, published in the New England Journal of Medicine, showed that patients treated with the prescribed heroin were more likely to stay in treatment or quit heroin altogether and more likely to reduce their use of illegal drugs and other illegal activities than patients treated with oral methadone.

In the NAOMI study, the researchers also provided a small sample of patients with injectable hydromorphone, (Dilaudid(R)). An unexpected finding was that injection patients could not accurately discriminate whether they were receiving prescribed heroin or hydromorphone. The researchers also observed similar results and benefits with both these drugs although the small number of participants receiving hydromorphone did not permit any definite and scientifically valid conclusions to be drawn as to the efficacy of hydromorphone as a viable treatment option.

Should hydromorphone be proven to be as affective as heroin, the benefits of this form of injectable treatment may be more feasible and achievable without the emotional and regulatory barriers often presented by heroin maintenance.
SALOME, led by Dr. Michael Krausz, the Providence Health Care/UBC B.C. Leadership Chair in Addiction Research and Dr. Eugenia Oviedo-Joekes, Providence Health Care researcher and an assistant professor in UBC’s School of Population and Public Health, will enroll 322 individuals with chronic heroin dependency who currently are not sufficiently benefiting from conventional therapies, such as methadone treatment, at one site based in Vancouver, BC.

In the first stage, half of the 322 participants will receive injectable prescribed heroin, and the other half will receive injectable hydromorphone. Stage I will involve six-months of treatment. All volunteers retained in injection treatment at the end of Stage I will be eligible to enter Stage II.

In Stage II, half of the participants will then continue injection treatment exactly as in Stage I on a blinded basis while the other half will switch to the oral equivalent of the same medication (prescribed heroin or hydromorphone). Stage II will also involve six-months of treatment.

Throughout the treatment period, social workers will be assigned to both groups to assist them with reaching other addiction services and community resources such as counseling, housing and job training services.

Some 60,000 to 90,000 persons are affected by opioid addiction in Canada. This study will enroll the most chronically drug-dependent members of Vancouver’s population — those who are not benefiting from other treatments, such as methadone therapy and abstinence-based programs, and continue injecting street heroin.

The SALOME study is funded by the Canadian Institutes of Health Research, the Government of Canada’s agency responsible for funding health research in Canada, Providence Health Care and the InnerChange Foundation.

Quotes:
Dr. Perry Kendall, BC’s Provincial Health Officer -
“SALOME addresses critical social and ethical concerns dealing with addiction. Opioid-dependent people are in need of treatment options to avoid marginalization from the health care system and this study aims to answer questions that could lead to improvements in the health of persons with chronic addictions and identify new ways of reintegrating this population into society.”

“If the SALOME study shows that hydromorphone can go head-to-head with heroin as an alternative therapy for people who have failed optimally provided methadone, then I think this should be part of the treatment continuum that’s available through licensed physicians.”

Dianne Doyle, Providence Health Care President and CEO -
“Providence Health Care is supporting this research because it is so aligned with our mission, vision and values. We have a very long tradition of providing compassionate care to the most marginalized and needy in our community, including those suffering from addictions.”

“What we need to get from this research is a better understanding of what the right approaches are to treating addicted populations. In particular our hope would be that we could find a new approach for those people who are addicted and not benefiting from current approaches to care. This treatment option would be one more component of a range of services offered by Providence Health Care and Vancouver Coastal Health, all of which are intended to reduce the harm to individuals and others from drug use, and to support recovery from addiction and mental illness.”

About Providence Health Care

Providence Health Care is one of Canada’s largest faith-based health care organizations, operating 15 facilities within Vancouver Coastal Health. Guided by the principle “How you want to be treated,” PHC’s 1,200 physicians, 6,000 staff and 1,500 volunteers deliver compassionate care to patients and residents in British Columbia. Providence’s programs and services span the complete continuum of care and serve people throughout B.C. PHC operates one of two adult academic health science centres in the province, performs cutting-edge research in more than 30 clinical specialties, and focuses its services on six “populations of emphasis”: cardiopulmonary risks and illnesses, HIV/AIDS, mental health, renal risks and illness, specialized needs in aging and urban health.

About the University of British Columbia

The University of British Columbia (UBC) is one of North America’s largest public research and teaching institutions, and one of only two Canadian institutions consistently ranked among the world’s 40 best universities. Surrounded by the beauty of the Canadian West, it is a place that inspires bold, new ways of thinking that have helped make it a national leader in areas as diverse as community service learning, sustainability and research commercialization. UBC offers more than 50,000 students a range of innovative programs and attracts $550 million per year in research funding from government, non-profit organizations and industry through 7,000 grants.

To view the first video of the SALOME project, please visit the following link: http://www.youtube.com/watch?v=fFgV_bt8QAU&feature=youtu.be

To view the second video of the SALOME project, please visit the following link: http://www.youtube.com/watch?v=S8xfkkeHpdE&feature=related

Source: www.marketwatch.com 13th Oct. 2011

CAMH study suggests increased risk of schizophrenia in heavy methamphetamine users

ndpa — Sun, 27 Nov 2011 15:15:09 +0000

Canadian scientists also confirm previous research showing possible link between cannabis dependence and schizophrenia

In the first worldwide study of its kind, scientists from Toronto’s Centre for Addiction and Mental Health (CAMH) found evidence that heavy methamphetamine users might have a higher risk of developing schizophrenia. This finding was based on a large study comparing the risk among methamphetamine users not only to a group that did not use drugs, but also to heavy users of other drugs.

The report will be published online on Nov. 8, 2011, at AJP in Advance, the advance edition of the American Journal of Psychiatry, the official journal of the American Psychiatric Association.

Methamphetamine and other amphetamine-type stimulants are the second most common type of illicit drug used worldwide.

“We found that people hospitalized for methamphetamine dependence who did not have a diagnosis of schizophrenia or psychotic symptoms at the start of our study period had an approximately 1.5 to 3.0-fold risk of subsequently being diagnosed with schizophrenia, compared with groups of patients who used cocaine, alcohol or opioid drugs,” says Dr. Russ Callaghan, the CAMH scientist who led the study. Dr. Callaghan also found that the increased risk of schizophrenia in methamphetamine users was similar to that of heavy users of cannabis.

To establish this association, the researchers examined California hospital records of patients admitted between 1990 and 2000 with diagnosis of dependence or abuse for several major abused drugs: methamphetamine, cannabis, alcohol, cocaine or opioids. They also included a control group of patients with appendicitis and no drug use. The methamphetamine group had 42,412 cases, while cannabis had 23,335.

Records were excluded if patients were dependent on more than one drug or had a diagnosis of schizophrenia or drug-induced psychosis during their initial hospitalization. Readmission records within California hospitals were analyzed for up to 10 years after the initial admission. The researchers then identified patients who were readmitted with a schizophrenia diagnosis in each drug group.

There has been a longstanding debate as to whether there is a connection between methamphetamine use and schizophrenia. Many Japanese clinicians have long believed that methamphetamine might cause a schizophrenia-like illness, based on their observations of high rates of psychosis among methamphetamine users admitted to psychiatric hospitals. However, they lacked long-term follow-up studies of methamphetamine users initially free of psychosis. In North America, this link has mostly been discounted, as psychiatrists believed that the psychosis was already present and undiagnosed in these methamphetamine users.

“We really do not understand how these drugs might increase schizophrenia risk,” says Dr. Stephen Kish, senior scientist and head of CAMH’s Human Brain Laboratory. “Perhaps repeated use of methamphetamine and cannabis in some susceptible individuals can trigger latent schizophrenia by sensitizing the brain to dopamine, a brain chemical thought to be associated with psychosis.” Dr. Kish also cautions that the findings do not apply to patients who take much lower and controlled doses of amphetamines or cannabis for medical purposes.

Since this is the first such study showing this potential link, the researchers emphasize that the results need to be confirmed in additional research involving long-term follow-up studies of methamphetamine users.

“We hope that understanding the nature of the drug addiction-schizophrenia relationship will help in developing better therapies for both conditions,” says Dr. Callaghan.

In an earlier study using California hospital records, the researchers found evidence for a possible association between heavy methamphetamine use and Parkinson’s disease.

Source:www.eurekalert.org. 8th Nov. 2011

Pot Shock

ndpa — Sun, 27 Nov 2011 15:12:42 +0000

PATIENTS suffering the effects of cannabis abuse are being treated by Tasmanian public hospitals every day, says a leading health authority.

People with short-term drug-induced psychosis and longer-term mental illness, compounded by pot smoking, are seeking medical help at an increasing rate. Mental Health Services clinical statewide director Peter Norrie said the Royal Hobart Hospital was seeing many cannabis cases.

First-time pot smokers were turning up at the Royal with full-blown psychosis — delusional, confused and anxious. Other more regular pot smokers with long-term mental illness were fronting for treatment for episodes likely to have been triggered or related to using cannabis.

“These days it’s close to every day,” said Dr Norrie, who is a senior clinical consultant psychiatrist at the Royal. He said he was talking about “drug-induced psychosis or long-term mental illness associated with pot smoking”. Dr Norrie said it was “very common” for first-time users to present with “floridly psychotic” behaviour.

He said psychiatrists were increasingly concerned with the link between substance abuse and mental illness. Cannabis use had been linked with depression, anxiety and schizophrenia. International studies show modern strains of marijuana are from three to 10 times stronger than those used by previous generations.

“Clinically psychiatrists have suspected a link for many years and the latest research seems to confirm this,” Dr Norrie said.

“The chicken-and-egg debate has raged for years whether pot causes psychosis or people with a tendency to psychotic illness are predisposed to smoke pot.”

Dr Norrie said the first signs of schizophrenia were often a lack of engagement with society. But those symptoms could also be what is commonly known as “typically teenage” or a sign of the onset of depression.

Disengaged teenagers could then turn to cannabis.

If psychosis did occur it was hard to tell whether smoking pot was a cause or a symptom. Dr Norrie said some pot smokers appeared to be able to continue the habit without serious mental illness but others were prone to individual cases of psychosis or longer-term mental disease.

“There’s a certain group of people who smoke pot who are unlikely to develop mental illness but there’s certainly a significant number of the population who suffer from mental illness and pot smoking adds to the risk,” Dr Norrie said.

Drug-induced psychosis usually consists of paranoia, confusion and anxiety.

Sufferers present with memory problems and delusions. They can believe they have special powers, hear and see things that are not there and are unable to distinguish what is real.

Source: Sunday Tasmanian 30th January 2005

Oral cannabis induces psychosis at low levels

ndpa — Sun, 27 Nov 2011 15:08:34 +0000

Last Updated: 2005-04-01 9:09:08 -0400 (Reuters Health)

NEW YORK (Reuters Health) – Even in clinical situations where cannabis is administered orally at low doses, psychotic reactions can occur, Swiss researchers report the current issue of BMC Psychiatry.

Recreational cannabis use has been associated with psychotic reactions, but this is the first such report in closely monitored subjects participating in a clinical trial, note Dr. Bernard Favrat and colleagues at Institut Universitaire de Medicine Legale in Lausanne.

Favrat’s group was conducting a study to examine the effects of ingestion of THC (delta-9-tetrahydrocannabinol) on psychomotor function and driving performance in eight occasional cannabis users.

The first case of psychosis was in a 22-year-old man given 20 milligrams of dronabinol, a synthetic THC. Ninety minutes after dronabinol administration he experienced severe anxiety and symptoms of psychosis, and was unable to perform the two psychometric tests.

Levels of THC and its active metabolite 11-OH-THC in the blood at the time of the strong adverse effects were 1.8 and 5.2 nanograms per milliliter, respectively.

The second case was also a 22-year-old man who developed severe anxiety one hour after taking 16.5 milligrams of a THC compound, when his THC blood level was 6.2 nanograms per milligram and 11-OH-THC was 3.9 nanograms per milligram. For several hours he was unable to perform psychometric tests

The authors note that smoking a 3.5-percent marijuana cigarette leads to blood concentrations of THC in the range of 50 to 100 nanograms per milliliter. They believe that oral administration produces higher levels of 11-OH-THC, with slower elimination.

Alternatively, they suggest that “consuming oral cannabis may produce more potent, yet unknown psychotomimetic metabolites of THC.”

“Doctors and users should be aware of the increasing availability of oral cannabis in ‘special’ drinks or food as well as in medications under development,” which can result in “significant psychotic reactions,” Favrat’s group cautions.

SOURCE: BMC Psychiatry, April 1,2005.

Myocardial Infarction Associated With Use of the Synthetic Cannabinoid K2

ndpa — Sun, 27 Nov 2011 15:07:16 +0000

Physicians who encounter myocardial infarction in teenagers should consider the possibility that the teens may have ingested K2, a form of synthetic cannabinoid, researchers said.

“Although chest pain is a common presenting complaint of teenagers seen in emergency departments, chest pain from cardiac causes remains exceedingly rare,” Colin Kane, MD, a pediatric cardiologist at the UT Southwestern Medical Center in Dallas, and colleagues wrote in the December issue ofPediatrics. “Use of illicit drugs causing chest pain and myocardial ischemia, however, must remain part of the differential diagnosis.”

The researchers reported on three cases of myocardial infarction in teenagers following ingestion of K2. Designer drugs containing synthetic cannabinoids have become more popular among teens, but little is known about their health implications.

K2 is a collection of herbs and spices that have been treated with a synthetic cannabinoid. The effects are said to be stronger than naturally occurring cannabis.

“These types of drugs give a marijuana-like effect but do not show up on drug screens,” Kane explained to MedPage Today. Therefore, careful questioning may be needed to elicit information about K2 exposure, the authors suggested.
All three cases involved 16-year-old males with no previous health problems. Each complained of chest pains of at least three days’ duration and presented between August and November of 2010.

Initial electrocardiograms revealed ST-segment elevation and high troponin levels. There was no personal or family history of early cardiac problems. Urine drugs screens noted the presence of THC in two patients. No other drugs, including cocaine and amphetamines, were found.

“When the first patient came we initially thought it was a virus that was affecting his heart,” said Kane. “The day after he was hospitalized, the chest pain, ECG, and laboratory test all changed dramatically. We went back to the patient and were more persistent about anything else he might have done. It just isn’t normal for a 16-year-old to have a heart attack.”
Shortly thereafter, two new cases presented with similar findings. After establishing that these males also had smoked K2, Kane and colleagues became concerned because their patients were not having just chest pains, but actual heart attacks.

“I have since then seen a number of kids in my practice who have smoked K2 and complained of chest pains,” said Kane. “I haven’t seen any other frank heart attacks.”

This led them to wonder if there was something different about the K2 that was in circulation at that time. Another option is that teenagers were showing up in the emergency room, but the heart attacks were not found because it is so atypical in the age group.

“It is disconcerting and frightening that K2 is relatively easy to obtain and could have such serious health consequences,” said Kane. “Emergency and primary care doctors need to ask patients specifically about the use of K2 and synthetic marijuana. If the clinical findings fit, physicians should take the extra step and look for heart damage, even in previously healthy teenagers.”

Source: www.pediatrics.aappublications.org at University of Florida on November 14, 2011

Marijuana and Schizophrenia

ndpa — Sun, 27 Nov 2011 15:02:54 +0000

Marijuana causes disruptions in concentration and memory similar to those that occur in people with schizophrenia, according to a new study.

U.K. researchers measured the electrical activity from hundreds of neurons in the brains of rats given a drug that mimics the effects of cannabis, the psychoactive ingredient of marijuana.

The effects of the drug on individual brain regions were subtle but the drug completely disrupted the coordinated brain waves across the hippocampus and prefrontal cortex. Both of these brain structures are essential for memory and decision-making and play a key role in schizophrenia.

Due to the “decoupling” of the hippocampus and prefrontal cortex, the rats were unable to make accurate decisions while attempting to find their way through a maze, the University of Bristol researchers said.

“Marijuana abuse is common among sufferers of schizophrenia and recent studies have shown that the psychoactive ingredient of marijuana can induce some symptoms of schizophrenia in healthy volunteers. These findings are therefore important for our understanding of psychiatric diseases, which may arise as a consequence of ‘disorchestrated brains’ and could be treated by re-tuning brain activity,” lead author Matt Jones said in a university news release.

The study appears Oct. 25 in the Journal of Neuroscience.
“These results are an important step forward in our understanding of how rhythmic activity in the brain underlies thought processes in health and disease,” study first author Michal Kucewicz said

Source: www.everydayhealth.com Oct. 25, 2011

Marijuana Use and Adolescents: What Clinicians Need to Know

ndpa — Sun, 27 Nov 2011 15:00:07 +0000

Source www.partnershipatdrugfree.org Nov. 2011

CAMH study suggests increased risk of schizophrenia in heavy methamphetamine users

ndpa — Sun, 27 Nov 2011 14:56:14 +0000

Canadian scientists also confirm previous research showing possible link between cannabis dependence and schizophrenia

The report will be published online on Nov. 8, 2011, at AJP in Advance, the advance edition of the American Journal of Psychiatry, the official journal of the American Psychiatric Association.

Methamphetamine and other amphetamine-type stimulants are the second most common type of illicit drug used worldwide.

“We hope that understanding the nature of the drug addiction-schizophrenia relationship will help in developing better therapies for both conditions,” says Dr. Callaghan.

In an earlier study using California hospital records, the researchers found evidence for a possible association between heavy methamphetamine use and Parkinson’s disease.

Source:www.eurekalert.org. 8th Nov. 2011

Implementation of evidence-based substance use disorder continuing care interventions.

ndpa — Sun, 27 Nov 2011 14:53:04 +0000

As this review comments, people treated for substance use often remain precariously balanced between recovery and relapse. Widely seen as valuable if not essential, aftercare is nevertheless more the exception than the rule. How to reverse that ratio is the issue addressed by these leading US analysts.

Summary
Continuing care or aftercare is the stage of treatment following initial, more intensive, treatment. This review focused on psychosocial continuing care interventions (such as individual, telephone, couples, and group therapy; case management; home visits; and brief check-ups) and 12-step mutual aid support groups. Studies of brief continuing care interventions (up to six months) have usually involved standard programmes provided after residential treatment. In contrast, most longer interventions are adapt their frequency or nature in response to systematic assessments of how well the client is doing.

Despite a broadly supportive research record, few efforts have been made to implement and sustain these interventions, and in practice few clients who might benefit from continuing care services actually receive a sufficient dose, either because they do not complete the initial treatment, do not start continuing care, or do not remain in it for a significant time. Among other things, this review seeks to better understand this discrepancy and make recommendations for future implementation efforts.

Effectiveness of continuing care
Though this review and studies have focused on either continuing care treatment or mutual aid groups, it should be remembered that many individuals participate in both and that using both sources of support is associated with improved treatment outcomes.

Studies have shown that receiving continuing care services is generally but not always associated with improved long-term substance use outcomes. This small and varied corpus of studies precludes conclusions about which approaches work best. However, the findings support certain general principles. Among these are increasing the duration of care to at least a year, ongoing monitoring of clients, reaching out actively to engage and link clients to care, and using incentives to improve treatment outcomes. Relatively low-cost practices can dramatically improve rates of sustained engagement in continuing care such as low level incentives and active outreach following discharge or drop-out. In contrast, the theoretical orientation and intensity of the interventions appear less important.

As well as or instead of continuing care treatment services, mutual aid groups are important continuing care resources. The most prevalent like Alcoholics Anonymous and Narcotics Anonymous follow 12-step principles. Several studies have shown that attending these groups after initial treatment is associated with positive substance use outcomes, though they are unable to prove that attendance causes these gains. Additional to attendance as such, being more involved in the groups (such as getting a sponsor or reading 12-step literature) has also been associated with better substance use outcomes. In practice though, while most US patients start attending groups, most of these are no longer attending a year later.

Interventions to promote participation in 12-step mutual aid groups can be traced to the Twelve Step Facilitation therapy trialled in Project MATCH. This large US study of treatment for alcohol dependence found this approach achieved significantly higher rates of continuous abstinence (and equivalent outcomes on other drinking measures) than cognitive-behavioural therapy and a therapy based on motivational interviewing, and did so because it led more patients to engage in 12-step activities. Similar results have emerged from other studies.

Implementing continuing care
A search for studies not of the effectiveness of continuing care, but of how to implement it, uncovered 28 relevant articles and others known to the authors of the review or referenced in the literature. To organise the analysis of these studies, the reviewers used the Consolidated Framework for Implementation Research. In respect of health care innovations in general, this model identifies five implementation domains, each divided in to several sub-domains. The five main domains with relevant examples are:

• Characteristics of the intervention (in this case, continuing care) such as the strength of the evidence for its effectiveness and how far it was adapted to fit the particular circumstances in which it was being implemented.
• Outer setting, which refers to the economic, political, and social environment surrounding and influencing the organisation undertaking the implementation – in this case, typically substance use treatment services; included here might be national political drivers, availability of funding, the demand from patients, and (especially in the case of 12-step groups) the degree to which the broader society is receptive to the intervention’s philosophy.
• Inner setting is pertinent features of the implementing organisation including the degree to which its structures, internal communication mechanisms, resources, leadership, and culture facilitate the adoption of continuing care or the particular continuing care intervention being implemented.
• Characteristics of the individuals conducting the intervention – in this case, typically addiction counsellors – such as what they believe about the intervention and how enthusiastic and ready they are to implement it.
• Process of implementation – the extent and quality of the implementation effort, including the degree to which relevant staff are actively engaged, the efficiency with which the implementation is carried out, the extent to which progress is appropriately monitored against specific goals and progress news fed back to the participants, and the extent to which this feedback is used to adapt and promote implementation.

Generally the few relevant studies have not developed or supported specific packages to promote continuing care implementation. The one clear example of a specific and manualised intervention is Twelve Step Facilitation therapy, an approach which has been successfully adapted to different circumstances and populations. More general evidence-based interventions for promoting mutual aid participation typically entail active and directive efforts to engage and retain clients, including education on the benefits of the groups, orientation to involvement with these groups, and connection with group members to help motivate involvement following initial treatment.

In more detail and organised under the main headings of the Consolidated Framework for Implementation Research, research offers the following guidance.

Intervention Characteristics Clinicians generally know that the evidence for continuing care is strong yet often continue to use interventions and practices without empirical support. A significant number of studies suggest that many interventions can be adapted to the needs of specific sites. Twelve Step Facilitation therapy has for example been successfully adapted to a group format, to focus on individuals’ broader social networks rather than just 12-step groups, and to accommodate individuals with mental health as well as substance use problems. Similarly, treatment-based continuing care efforts have been conducted successfully using telephone and home-based visits and with different types of providers. One difficulty is the relative complexity of such interventions. Knowledge gaps include the relative advantages and cost-effectiveness of different continuing care interventions, and what are their core or essential components as opposed to those which can safely be adapted.

Outer Setting The most frequently cited factors related to successful continuing care implementation are located in the outer setting domain, especially the importance of client characteristics such as their needs and resources to support continuing care involvement. African-Americans (compared to Caucasians), and clients with more severe substance use problems, are more likely to engage in continuing care for a longer time. Psychiatric disorders seem no barrier to engagement in continuing care. Patients who see staff members as supportive and have more recovery resources are more likely to engage in treatment-based continuing care. Clients with beliefs consistent with a disease model or spiritual approach to recovery, women, and those with less prior experience with 12-step groups, may be more easily engaged in mutual aid groups, and those mandated to attend by courts may do as well as those who are not. In addition to client characteristics, the convenience of continuing care is an important facilitating factor while lack of funding is a common and significant barrier. Additionally, inviting mutual aid group members to contact patients in the initial treatment service facilitates post-treatment linkages. The role of external incentives and policies appears to be an extremely important area for future implementation efforts to address and better understand.

Inner Setting Focusing on the treatment service, those oriented to 12-step approaches facilitate linkage to 12-step mutual aid. Low rates of staff and supervisor turnover and multi-stakeholder involvement are important to sustaining continuing care treatment interventions. Goals or benchmarks that allow programmes to monitor performance and modify interventions in response are important factors in successful continuing care implementation. Mutual aid group engagement is facilitated by strong therapeutic alliances, greater supportiveness, and spirituality during initial treatment. Use of incentives with staff to promote implementation of continuing care practices appear to be a potentially powerful, but underused facilitator. Little is known about the implementation climate, including goals and benchmarks for continuing care interventions, or about the role of programme readiness for change (eg, resources and knowledge) as they relate to continuing care implementation.

Characteristics of the individual provider Treatment and mutual aid continuing care implementation are facilitated by providers and programme leaders with beliefs and attitudes supportive of the particular intervention, while a lack of knowledge about the effectiveness of interventions can be a significant barrier. Additionally, clinicians who are in recovery themselves, who have fewer concerns about religion or spirituality as a part of treatment, without allegiance to non-12-step approaches to treatment, and those who require abstinence during treatment, are more likely to facilitate 12-step mutual aid involvement following treatment. It is clear that future implementation efforts will need to address important characteristics such as the knowledge, beliefs, motivation, and self-efficacy of both providers and clients to maximise the potential for implementation success.

Implementation Process Successful continuing care implementation efforts have tended to address the important constructs of planning, engaging, executing, and reflecting and evaluating implementation efforts. These activities will be critical in the development and testing of implementation strategies.

Implication for researchers and clinicians
Having summarised continuing care implementation research, the review ended by drawing out the implications of these findings for researchers and clinicians. Though scarce, viewed through the lens of the Consolidated Framework for Implementation Research, existing research provides a starting point for closing the gap between research and clinical practice. Formative evaluations intended to develop interventions to promote continuing care should be informed by this literature, and these evaluations should address all five domains, or deploy other comprehensive implementation models. Additionally, two primary recommendations emerge from this review.

Basic Continuing Care Implementation Research Is Needed Despite its clinical importance, continuing care implementation research has been relatively neglected. Both the treatment and mutual aid continuing care implementation literature have findings relevant to all five major domains of the Consolidated Framework for Implementation Research, but all the detailed strategies and factors within each domain have yet to be addressed. One of the most striking gaps is the lack of information on the relative advantages, disadvantages, and cost-effectiveness of continuing care interventions. Little is known too about and their core elements and the impact of incentives and/or consequences related to both the inner setting and outer setting domains.

Implementation Efforts Need to Address Multiple Domains The comprehensiveness of the Consolidated Framework for Implementation Research highlights that implementation efforts typically do not consider the importance of intervening across multiple domains. For instance, as already noted, the role of incentives and consequences in the inner setting and outer setting domains and at patient, counsellor and programme level, has been neglected. This review suggests that closing the gap between knowledge about continuing care interventions and their use will require a paradigm change in which both researchers and clinicians consider intervening across multiple domains rather than within a single domain, as has been typical thus far. Research-established interventions may have too few implementation facilitators and too many barriers for them to be adopted in particular settings without attention to all the relevant domains.

People treated for substance use often remain precariously balanced between recovery and relapse following initial treatment. As currently designed, the utility of treatment is limited by high post-treatment relapse and re-admission rates, and frequently prolonged addiction and treatment careers. Assertive linkage to continuing care helps individuals transition from brief experiments in sobriety (recovery initiation) to disease management and sustainable recovery maintenance, and an enhanced quality of life. It requires close connections between the worlds of professional treatment and community recovery support resources, and implementation of continuing care promotion procedures to enhance engagement and retention with these resources.

In the UK financial constraints and the recovery agenda have brought with them potentially conflicting expectations that treatment will end as soon as the patient seems able to manage on their own and rarely extend over years, yet will do more to reintegrate patients in society. More patients exiting briefer treatments would create an increasing potential caseload for aftercare services to ensure they remain safe and can rapidly re-enter treatment if relapse occurs or is threatened. How this configuration of forces will pan out and what it will mean for extended care in the form of aftercare or continuing care is unclear. Funders seeking to contain costs and maximise drug-free treatment exits may be reluctant to fund aftercare services, especially since UK research evidence that they make a difference is lacking, probably because studies have been few. On the other hand, low-cost, check-up style aftercare allied with free mutual aid groups may make it more acceptable to cut back on intensive and expensive initial treatment. These considerations are expanded on below.

The main recent British attempt to evaluate the contribution of aftercare was an analysis of the Scottish DORIS study. On several measures, it found that the few drug dependent patients who accessed aftercare after treatment in the early 2000s did better than the majority left to (or who chose to) fend on their own. However, it was unclear whether this could this be attributed to the aftercare, or whether these patients would have done well anyway. An attempt to statistically control for differences between patients still left recently being heroin free at the last 33-month follow-up associated with having received aftercare from the initial treatment agency. Having received aftercare following methadone maintenance or residential rehabilitation made little difference to whether patients had experienced a period of being entirely drug free. But consistently at each of the three follow-ups, aftercare following non-methadone community treatment like detoxification or psychosocial therapy was associated with about double the chance of having been drug free.

Formal aftercare from the treatment agency was not the only way patients sought to sustain their abstinence. Over the 33 months of the follow-up, nearly a quarter attended mutual aid groups like NA and AA. At each of the follow-ups, patients who had accessed aftercare and mutual aid were most likely to have been drug free for a period, generally those who accessed neither were least likely, and those who accessed one but not the other were in between.
Whatever the meaning of these findings for aftercare’s effectiveness, it was clear that few patients received it, and neither was it targeted at those most at risk of relapse.

An English study of problem drinkers could more securely attribute the results to aftercare enhancements, because patients were randomly allocated to normal aftercare – up to three weekly support groups plus access to the unit’s recreational and social facilities – or to an additional 15 individual sessions modelled on an influential US approach called Early Warning Signs Relapse Prevention Training. During this, patients are helped to recognise personal warning signs of relapse by analysing their most recent attempts at recovery, and then to develop ways to manage these episodes without a return to drinking. Over the following year the benefits of more intensive aftercare were reflected in significantly fewer drinking days (22% of warning sign patients drank on a fifth or more of days compared to 40% in usual aftercare), fewer heavy drinking days (corresponding figures 18% and 28%), avoidance of any return to heavy drinking (45% v 26%), and improved mental well-being. In monetary terms, warning sign patients absorbed slightly less health service and rehabilitation resources, though slightly more if the warning sign regime was itself costed in. However, neither difference approached statistical significance.

In agreement with the featured review was a review of 11 studies which allocated patients at random or in a quasi-random manner to continuing care versus minimal or no continuing care. In terms of each study’s main substance use outcome measures, seven of the 11 found a clear and statistically significant advantage for continuing care. The review’s conclusions were endorsed by a panel of experts convened by the US Betty Ford Institute, who argued that extended and regular monitoring of the patient’s progress was the key component of continuing care and the one with the greatest evidence of effectiveness. Both review and recommendations were based largely on studies of aftercare following residential treatment.

While international and to a degree UK research is at least consistent with aftercare often being an aid to lasting remission, recommendations that it be implemented run up against a strong contrary trend in current UK policy, which emphasises not continuing care, but exit from the treatment system. Without denying the need for long-term care for some patients, the English strategy on drug misuse said services needed “to become much more ambitious for individuals to leave treatment free of their drug or alcohol dependence so they can recover fully … We will ensure that all those on a substitute prescription engage in recovery activities and build upon the 15,000 heroin and crack cocaine users who successfully leave treatment every year free of their drug(s) of dependence”. Scotland’s strategy too stressed the need for more patients to “move on from their addiction towards a drug-free life as a contributing member of society”, implying a corresponding shift away from extended and/or indefinite treatment.

Set against this drive to contain treatment, the recovery agenda has brought with it a greater emphasis on sustained and extensive life change, and an accompanying expectation that treatment services will do more for their patients than a brief treatment for their addiction. At the same time resources are no longer increasing and probably diminishing overall. One way to square this circle is to draw on the free resource of mutual aid groups which offer former patients 24-hour access to support, frequent support meetings, a new social circle, and a new way of life. It comes therefore as no surprise that they feature in recent commissioning guidance from England’s National Treatment Agency for Substance Misuse, which sees them as providing “valuable support and positive social networks for individuals who are addressing their dependency through treatment”. The advice to services is that “Details of how clients can access local recovery networks should be made available throughout their treatment journey. Services may wish to consider more active engagement with local mutual aid groups, for example making rooms within the treatment service or prisons available for meetings”. The agency now sees (see annual reports for 2009–10 and 2010–11) promoting mutual aid networks as a key way to achieve its objectives. Local service commissioners are being called on to ensure that the treatment system is better integrated with wider supportive services, among which mutual aid organisations are seen as the most prominent.

Source Psychology of Addictive Behaviors: 2011, 25(2), p. 238–251.

Drugs by Numbers

ndpa — Sun, 27 Nov 2011 14:42:18 +0000

100% Three Andean countries – Colombia, Peru and Bolivia – are responsible for virtually all global coca leaf production, the raw material for cocaine.

149,100 In 2010, coca was cultivated on 149,100 hectares in the Andean countries – an area roughly one and a half times the size of Hong Kong – down from 221,300 hectares in 2000.

6% In 2010, the global area under coca cultivation decreased by 6%, mainly due to a significant reduction in Colombia that was not entirely offset by a small increase in Peru.

732,000 The amount of cocaine seized worldwide in 2009 was 732,000kg – which refers to seizures unadjusted for purity. The United Nations Office on Drugs and Crime estimates that between 46% and 60% of cocaine produced was seized – an indication of the amount manufactured the previous year.

444,000 The best reading of data and estimates suggests that about 440,000kg of pure cocaine was consumed worldwide in 2009. This would be in line with a production estimate of about 1.1m kg and purity adjusted seizures of 615,000kg, plus agricultural and other losses of about 55,000kg (which represents 5% of production).

$85bn The value of the global cocaine market is lower than in the mid-1990s, when prices were much higher and the US market was strong. In 1995, the global market was worth about $165bn, while, in 2009, this had been reduced to just over half of that.

99% Of that $85bn income from global cocaine retail sales in 2009, traffickers are estimated to have reaped about $84bn (almost 99%). The rest went to Andean farmers.

5m The US has the highest prevalence of cocaine use (2.4% of the population, or five million people, aged 15-64), but there are indications of cocaine use declining in the last few years.

$33bn The amount of cocaine consumed in Europe has doubled in the last decade. The volume and value of the western and central European cocaine market, currently valued at $33bn, is now approaching parity with that of the US ($37bn).

80% Two thirds of European cocaine users live in three countries: the UK, Spain and Italy. With Germany and France, these countries represent 80% of European cocaine consumption.

272m Globally, the UN Office on Drugs and Crime estimates that between 149 and 272 million people – 3.3%-6.1% of the population aged 15-64 – used illicit drugs at least once in the previous year.

Source: United Nations Office on Drugs and Crime

Clever children more likely to end up on drugs

ndpa — Sun, 27 Nov 2011 14:35:40 +0000

Scientists think they do so in part as a “coping strategy” to avoid bullying from their peers, and partially because they find life boring.

The effect is more pronounced in girls than boys, with those exhibiting high IQs as children more than twice as likely to have tried cocaine or cannabis by the age of 30, as those of lower intelligence. The effect in boys with high IQs is also marked, with them being around 50 per cent more likely to have done so by that age as their less intelligent former classmates.

A team at Cardiff University analysed data from almost 8,000 people born in one week in April 1970, who were enrolled at birth in the ongoing British Cohort Study, which follows participants through life. All these children had their IQs tested between the age of five and 10. Drug use, as reported by the participants themselves, was then recorded at 16 and 30 years of age.

At 16, 7.0 per cent of boys and 6.3 per cent of girls had used cannabis. This minority had “statistically significant higher mean childhood IQ scores” than non-users, according to the authors of the report, published in the Journal of Epidemiology and Community Health. At 30, 35.4 per cent of men and 15.9 per cent of women had used cannabis, while the figures for cocaine were 8.6 and 3.6 per cent respectively.

The authors noted: “Across most drugs (except amphetamine in men), men and women who reported using in the past 12 months had a significantly higher childhood IQ score than those who reported no use.”
They concluded: “High childhood IQ may increase the risk of substance abuse in early adulthood.”
The study did not look into why this was the case, although it did not fine any relationship between the social class of the participants’ parents and future drug use.

However, the authors noted that other studies suggested “intellectually ‘gifted children’ [with an IQ higher than 130] report high levels of boredom and being stigmatised by peers, either of which could conceivably increase vulnerability to using drugs as an avoidant coping strategy”.

Dr James White of Cardiff University’s Centre for Development and Evaluation of Complex Interventions for Public Health Understanding, said: “Although it is not yet clear exactly why there should be a link between high IQ and illicit drug use, previous research has shown that people with a high IQ are more open to new experiences and keen on novelty and stimulation.”

Source: www.telegraph.co.uk 15th Nov.

Cannabis use and risk of lung cancer: a case–control study

ndpa — Sun, 27 Nov 2011 14:29:16 +0000

ABSTRACT: The aim of the present study was to determine the risk of lung cancer associated with cannabis smoking.

A case–control study of lung cancer in adults less than55 yrs of age was conducted in eight district health boards in New Zealand. Cases were identified from the New Zealand Cancer Registry and hospital databases. Controls were randomly selected from the electoral roll, with frequency matching to cases in 5-yr age groups and district health boards. Interviewer-administered questionnaires were used to assess possible risk factors, including cannabis use. The relative
risk of lung cancer associated with cannabis smoking was estimated by logistic regression.

In total, 79 cases of lung cancer and 324 controls were included in the study. The risk of lung cancer increased 8% (95% confidence interval (CI) 2–15) for each joint-yr of cannabis smoking, after adjustment for confounding variables including cigarette smoking, and 7% (95% CI 5–9) for each pack-yr of cigarette smoking, after adjustment for confounding variables including cannabis smoking. The highest tertile of cannabis use was associated with an increased risk of lung cancer (relative risk 5.7 (95% CI 1.5–21.6)), after adjustment for confounding variables including cigarette smoking.

In conclusion, the results of the present study indicate that long-term cannabis use increases the risk of lung cancer in young adults.

Source Eur Respir J 2008; 31: 280–286 2008

Marijuana as Medicine ?

ndpa — Mon, 14 Nov 2011 12:13:54 +0000

The attraction that the medical profession has for medical marihuana continues to mystify me. Many of the same physicians who will exercise exemplary caution in caring for their patients, will throw caution aside when it comes to pot. I know internists in private practice who refuse to accept new patients if they smoke tobacco. I often wonder if they would have the same reaction if the patients smoke pot! Yesterday, I entered an online discussion by a medical group on this subject and I’ve pasted my comment below
The medical profession needs to apologize for letting the public down on this one – once again. In the early 1900s, although medical organizations like the AMA were against patent medicines and refused to post ads in JAMA that did not list the ingredients of the products being promoted, there were quite a few doctors who nonetheless sold and promoted the use of patent medicines, most of which were worthless elixirs of cocaine or morphine or heroin or cannabis or combinations thereof, laced with copious amounts of alcohol, coloring agents and flavorings. They were promoted as curing everything from the common cold to cancer. Although the docs knew better, they argued that they were giving their patients what they wanted and if they didn’t, the patients would buy them on the street from sidewalk vendors who were not trained healthcare professionals. Ethical?
As best we know, any “positive” effects of these nostrums came in the form of intoxication, a normal reaction to psychotropic substances, including alcohol. Therapeutic they were not. Even during alcohol prohibition (1919-1933), the federal government issued special prescriptions to physicians –only– that allowed them to prescribe “medicinal alcohol” in the form of wine, whiskey, and beer. Overnight, pharmacies became liquor stores. And doctors did, indeed, prescribe alcohol for medicinal purposes and plenty of it during Prohibition. Ethical?
Fast-forward to the 1980s and 1990s and along comes the return of “medical marihuana.” This time, however, it’s not in the form of a tincture but, instead, promoted for use in its crude form as smoked marihuana. Not surprisingly, smoked pot today is touted as a cure-all for anything that ails one, from stress, to headache, to multiple sclerosis, to cancer pain and even cancer itself. How could a drug that’s so great be overlooked for so long by so many? Moreover, as in the case of alcohol prohibition, only doctors in certain states can prescribe (or recommend) it for medicinal purposes only. Ethical?
What these brief histories have in common is the promotion and use of intoxicants for therapeutic purposes. In all three cases, doctors promoted the use of these substances knowing that the anecdotal evidence of efficacy was weak at best, unsupported by unbiased clinical trial data, and not likely to improve the patient’s condition but only mask symptoms temporarily through intoxication. Incidentally, we could add tobacco to this list, too. A favorite ad of mine comes from a 1950s magazine that shows a photo of a physician holding a cigarette with a caption proclaiming that in a national survey of physicians, more preferred Camels over any other brand of cigarette. Ethical?
Wake up, America, and realize that whatever therapeutic molecules we might be able to squeeze out of the pot plant must be synthesized, purified, and manufactured to measured standards and dosing units before being used in medical treatment. Consider morphine and codeine. We don’t recommend that people grow opium poppies, harvest them, extract and chew the gum to get pain relief. Instead, we have synthesized and standardized pharmaceutically pure opiate medicines. Current pot research is underway to isolate and restructure the genetic pathways that provide pot’s psychic effect. This, scientists say, will be accomplished without interfering or reducing in any way the therapeutic properties of the beneficial cannabinoids in the plant. The final product will be safe and effective – far more effective as a medicine than smoking pot because dosing will be concentrated and stronger – and not controlled because there will be no psychotropic response. In effect, if pot truly has medicinal benefits independent of its intoxicating effects, they should be more readily available and useful in a finished pharmaceutical form. Also, users will be spared the toxic effects of inhaling smoke. Smoking anything — paper, tobacco, dry leaves, or pot — is not good for lung tissue of any living organism. Finally, the new pot without its psychic effect can be compared to decaffeinated coffee. It will have many of the same properties of the real thing except the kick. And, let’s face it, a good cup of Starbuck’s decaf can’t be distinguished from the regular stuff.
When all this happens in a few years, pot heads now desperately trying to promote pot for everything and anything will be left with nothing but the fact that their story of pot’s medicinal history will join the other historical artifacts described above. Someday, their kids and grand-kids will look back and say the same thing that we say now when we look at those old cigarette ads from the 1950s: What were you thinking?

Source: John Coleman Drug-Watch International Feb.2010

Methadone or Not ?

ndpa — Mon, 14 Nov 2011 12:12:37 +0000

Jay’s story has a familiar ring. The pre-teen experimentation with cannabis after his father walked out on the family, followed by flirtation with ecstasy and cocaine. He had smoked his first wrap of heroin before he was old enough to buy a pint of beer. But it was only when he was off the street, safely incarcerated in a young offender institution, that methadone was added to Jay’s palate. As the gaunt teenager with grey skin shuffled from foot to foot in the West London drizzle, uncaringly dressed in a hooded tracksuit, his pin-pricked pupils scanned the streets.
“I was running wild with a raging [heroin] habit when they got me,” he said. “They tried to detox me inside but as soon as I complained they put my dose of methadone up again. I came out needing drugs as much as when I went in.”
His six-month stretch inside passed in a methadone-induced daze with, according to Jay, little attempt by prison staff to offer him a pathway to drug-free recovery. When he was released two years ago, Jay, whose only family contact is an elder brother he occasionally stays with, swiftly returned to the messy chaos of an opiate-obsessed existence. He thinks that he will be back in prison within weeks. “Most junkies I know want to be clean but if you can’t do it when you’re inside, when can you?” he says.
Methadone, a heroin substitute that is more addictive than heroin itself, has assumed a dominant position in the State’s drug-control armoury. It is given to half the country’s estimated 300,000 heroin addicts while parliamentary answers have revealed that 65,000 prisoners were prescribed it in the past year, including nearly 20,000 on a maintenance programme which can last years — an annual rise of 57 per cent. In some patches of “broken Britain” it is responsible for more fatal overdoses than any other substance.
Supporters say it stabilises addicts and protects society by removing the need for drug-financing crime sprees. Opponents argue that the State is happy to “park” people on methadone for years, giving up hope that addicts will ever lead a productive, drug-free life.
One aspect most agree on is that drug addiction is a lucrative business. Professor Neil McKeganey, a leading opponent of mass methadone medicating, said: “There’s considerable financial incentive that drug users remain drug dependent.” Drug companies make millions from producing methadone, GPs in many parts of the country get paid in the region of £220 per methadone patient per year, pharmacists can get £200 administration fees plus about £1.50 per administered dose, while more than 150,000 people are employed in drug-action teams funded largely from the public purse.
Mark Johnson, a former drug user who founded the charity Uservoice, said that although prisons are the ideal location for rehabilitation because they are “the only place that removes some people from dysfunction and gives them a respite”, the authorities are increasingly opting for the methadone route. “All we’re doing is containing the problem, not solving it,” he said.
Several studies have shown that a residential-based abstinence programme lasting at least a month has a roughly one in four success rate, while a recent study on addicts in society showed that after three years on methadone only 3 per cent are drug-free.
Despite this, however, the Government, backed by a cadre of policy experts and health professionals, is increasing its multi-million annual spend on methadone maintenance programmes. At the same time, at least 20 residential rehabilitation centres have closed in the past two years because primary care trusts have stopped referring clients. Last month Middlegate Lodge, the only residential rehab centre specifically for teenagers, closed.
Just 850 prisoners were put on the relatively succesful 12-step abstinence programme last year. No figures are available for how many young offenders are prescribed methadone.
Inspectors’ reports into young offenders’ institutions record that while alcohol and cannabis are the biggest substance problems, the use of methadone is being encouraged and is increasing.
Kathy Gyngell, a drugs policy analyst for the Centre for Policy Studies, said that prescribing methadone to young offenders had become routine. She added: “It might appear the easier option but it leads to longer term problems. Individuals who historically used their short sentences to gain clean time now feel the necessity to carry on using methadone, as it takes no effort other than presenting themselves at the healthcare door to get it.”
David Burrowes, a Tory justice spokesman, said that drug treatment was “characterised by methadone” and that a variety of treatment options needed to be available.
Katherine, a former addict, whose descent into heroin addiction began after she was raped as a teenager, said that after a decade ricocheting between methadone in prison and heroin outside, she had finally kicked her habit after becoming one of the few prisoners to be offered a place on a RAPt (Rehabilitation for Addicted Prisoners Trust) abstinence programme.
“Methadone is not a solution,” said Katherine, who left prison drug-free in 2008. “The message it gives is, ‘You come in with a habit and we’ll keep the habit and let you back out into society with no changes whatsoever.” She said that even in prison, addicts are able to exploit the system by using cotton wool to absorb the sickly-sweet green methadone linctus, before selling it on to other inmates and buying heroin with the proceeds.
Rosie, who started taking heroin at the age of 14, was prescribed methadone after leaving a young offenders’ institution and said that she had never seen a succesful methadone-led withdrawal from drug use. “It’s almost more of a poison than heroin, there doesn’t ever seem to be an end to it,” she said. She became drug-free after attending an abstinence-based treatment centre provided by the Nelson Trust.
To its advocates, though, methadone is a useful tool. At best, it stabilises addicts before they are weaned off; at worst, it can be used to maintain addicts long term, minimising the need for them to commit crime to pay for street heroin. Overall, drug-related crime is estimated to cost the country more than £13 billion a year.
There are also risks associated with forcing prisoners to go cold turkey. Cynics suggest the prison authorities’ increasing enthusiasm for methadone may have something to do with the £750,000 it was forced to pay out in 2006 after almost 200 drug-addicted prisoners sued the Government, claiming that their rights were infringed when they were forced to withdraw suddenly.
Even for those who claim to have benefited from it, methadone is at best a stopgap. James, 30, from Renfrewshire, had been a heroin user for nine years when he was given methadone in Barlinnie Prison, Glasgow. “Everything in prison was all about drugs,” he said. “Sometimes you couldn’t get any heroin and you couldn’t eat your dinner, you were in bed with all your clothes on, teeth rattling. They put me on 30ml of methadone, a low dose, and it settled me. I was a lot calmer; it was like a safety net.”
Roger Howard, the chief executive of the UK Drug Policy Commission, an advocate for methadone, admits that it could not alone cure drug addicts. “What everyone wants is to reduce deaths from dangerous street heroin and to reduce criminality,” he said. “Methadone is not the problem. These people come with a bucketful of problems: abuse, unemployment, homelessness, family.”
Professor McKeganey, who works at the Centre for Drug Misuse at the University of Glasgow, warned that Britain was sleepwalking into a situation similar to that in the Netherlands, where the Government provided places at old people’s homes for those with long-term methadone habits: the so-called “geriaddicts”. Mr Howard agreed: “There is a cohort who are probably so damaged and with such profound health problems that they will never get a job and will for ever rely on the State.”
As he prepared to pad the darkened streets of West London in shoes as punctured as his bony, needle-marked forearm in an all-consuming search for his next hit, Jay pondered a parting question: if you could survive in prison on methadone alone, why not, when outside, give your daily, drug-free urine sample, take the supervised dose of methadone and shun street drugs?
“But where would it get me? All right, the craving for smack’s not there but you soon get the craving for the meth. Nobody I know on a heoin ’script is getting any better. They’re just surviving.”

Source: Times Online 17th March 2010

The cost of a quick fix
2.4m Methadone prescriptions written in 2007, a rise of 60 per cent since 2003
£1.2bn Amount spent annually by government (central and local) tackling drug use in England in 2009-10
£15.3bn The cost per year to society of problem drug use
£13.9bn The estimated cost of drug-related offending in 2003, made up of a £9.9 billion cost to victims of crime and £4 billion costs incurred by the criminal justice system
330,000 Estimated number of problem drug users in England, of whom 166,000 are in some form of treatment programme

Sources: NAO, Drugscope, Home Office

Reliance on methadone a dangerous game for both users and the Government

ndpa — Mon, 14 Nov 2011 12:11:06 +0000

Whichever way you look at it, the Government’s increasing reliance on methadone to treat heroin addicts involves moral issues. Predominant among these is that the State is in effect cast in the role of drug dealer — conceivably for as long as the addicts live.
The uneasy relationship becomes especially problematic when users die of overdoses, having supplemented methadone with other street drugs.
Never forget how dangerous this is. When official figures show that in some areas a third of the people who die from drug-related causes have methadone in their bodies, put there by the taxpayer, and that this proportion doubled from 2006-08, we are on dodgy ethical ground.
Increasingly, it means the substance that is supposed to be a primary solution appears to be an intrinsic part of the problem. What methadone also represents is the transfer of personal responsibility for addiction away from the drug user. In this sense, the heroin substitute symbolises the cultural shift in modern drug policy: the addict is a victim who needs support and maintenance, rather than someone who should change their behaviour.
This official non-judgmentalism is interesting, especially when there is public debate about the resources devoted to the consequences of smoking, alcohol and overeating — which are not illegal. The merits of a humane approach to drug addiction are apparent. No one argues that methadone is not a useful part of the weaponry. It’s relatively cheap; it can stabilise the lives of addicts who shoplift or supply heroin to others; and of course, rather importantly, it allows the Government to say that it is doing something.
But what worries critics of methadone is not only its excessive use, but the lack of an exit strategy. In parts of the country there are addicts who have been taking it for decades. Even advocates concede that people are being kept on the drug for too long without any target to get them off.
All of which makes it troubling to hear that young offenders are being prescribed it, if only because, without any commitment to get them off drugs, they may end up “parked” for many years of dependency.
Professor Neil McKeganey, in his latest book, laments the lack of consensus about the goals of treatment, pointing out that although the majority of addicts want to be free of drugs, this is not facilitated by government policy. He wants to see a target limiting use to two years.
Methadone is a smokescreen for the absence of alternatives when it comes to problem use. There appears to be no new thinking, no initiatives, few open minds; and indeed little political will.
In a sense, the ubiquity of the heroin substitute is an admission that not only have social policies failed, but that we have no solutions for the consequences.

Source: Times Online 17th March 2010

Methadone: ‘Too many use it as part of their drugs routine’

ndpa — Mon, 14 Nov 2011 12:00:45 +0000

THE Conservative’s Holyrood justice spokesman Bill Aitken is no stranger to controversy and his plain-spoken attack on the methadone programme has re-ignited the debate about how best to tackle Scotland’s appalling epidemic of drug addiction.
The debate about the effectiveness of the methadone programme has raged since its inception and there has always been opposition to the principle of handing out free opium-based drugs like methadone to addicts. But there is much in the basis of the scheme to commend it, not least that it has the potential to place those on the programme outwith the reach of criminals. Something that means addicts no longer have to steal to manage their habit and keeps them out of the clutches of gangsters should be a good thing. However, too many just use the methadone as part of their daily drugs routine and find ways of selling it on, despite measures like forcing them to take it in front of the pharmacist.

But the biggest flaw in the current system is that there is no incentive for the addicts to wean themselves off drugs altogether. The methadone programme is only a means to manage the habit, not break it and that must change. There is a great deal of truth in the belief that addicts must genuinely want to give up before any treatment can be successful, and that applies as much to alcohol, nicotine and gambling as it does to drugs. But therein lies the weakness in the system – following the logic, why should alcoholics not get free booze if it helps prevent them following a life of crime? Of course, that would be absurd, but so too is supplying junkies with more drugs for as long as they want without any prospect of a cure.

The extent of drug addiction across the whole of Scotland is only one facet of a wider social malaise, especially in the sprawling sink estates. Edinburgh has its own well-documented drug problems, but its scale is dwarfed by the problems affecting places like Easterhouse. Why is it that some of these places have lower life-expectancy than deprived Third World countries? Why are thousands of people in a prosperous country able to see out their lives without ever doing a useful day’s work? And why is it necessary to lock up more people here than in most comparable Western countries? That there is a deep social malaise in much of Central Scotland is not in any doubt and the answer does not lie in throwing more public money at the problems without a radical re-think.

Bill Aitken’s description of drug addicts sitting “fat and happy” on the methadone programme might be over-blown – few of them are what any normal person would recognise as happy – but he does have a point. Free drugs on the state should only be part of a habit-breaking programme – anything less is little more than state-funded dealing.

Source: Edinburgh Evening News 17 March 2008

What Mr. Barnes failed to mention

ndpa — Mon, 14 Nov 2011 11:58:05 +0000

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

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

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

What Mr. Barnes failed to mention.

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

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

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

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

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

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

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

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

Follow-Up Opinions

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

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

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

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

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

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

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

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

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

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

Is it the number of needles issued?

The injury to children and others arising from discarded needles?

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

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

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

The grim reality of 574 addicts’ wasted lives

ndpa — Mon, 14 Nov 2011 11:56:07 +0000

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

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

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

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

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

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

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

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

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

Prisons keeping inmates dependent on drugs, says new report

ndpa — Mon, 14 Nov 2011 11:54:28 +0000

Almost 30,000 prisoners are being kept dependent on drugs by the prison service rather than being put through detox programmes, according to a new report.
Methadone, along with similar drugs, is being prescribed too easily thanks to risk-averse clinical guidelines and inexperienced prescribers, concludes the Policy Exchange report, to be released on Monday.
“Perversely, the massive increase in opiate substitute medication has created a new kind of trade for drugs in prisons, as methadone and buprenorphine are readily traded among inmates,” said Max Chambers, author of the report, Coming Clean, Combating Drug Misuse in Prisons.
The report criticises clinical guidelines for not taking into account the length of sentence a prisoner is serving when prescribing treatment for drug addiction.
“Maintenance treatment, which is when a stable dose is prescribed often continued indefinitely, should only be given to prisoners serving 13 weeks or less and who don’t have time to complete a detoxification programme,” said Chamber.
Under current practices, however, every prisoner who has been receiving methadone in the community will have their drug habit maintained in prison, regardless of the length of their sentence.
Almost 20,000 maintenance prescriptions were made in 2008 to 2009. By 2011, when the Integrated Drug Treatment System is rolled out to all prisons in England and Wales, an additional 8,788 prisoners a year will be receiving methadone maintenance treatment.
The report also cites research showing that around £100m of drugs are smuggled into prisons each year. The majority of drug-dealing in prison involves the collusion of about 1,000 corrupt members of staff – equating to seven prison officers per prison. “They are able to smuggle drugs due to lax security arrangements and, given the inflated value of drugs in prison, are able to make substantial profits without fear of detection,” said Chambers. “A prison officer bringing a gram of heroin into prison every week – about the size of two paracetamol tablets – could expect to more than double his basic salary.”
Chambers cites evidence that accusations of corruption by prison officers are not routinely investigated by the Serious Organised Crime Agency or the Prison Service. “Information on the number of officers accused, charged, prosecuted or convicted of smuggling drugsor other contraband is apparently not collected at all by central government,” he said.
The report reveals that the number of prisoners using drugs is hugely underestimated. Mandatory drug testing figures indicate 7.7% of prisoners are using drugs but in a survey of prisoners conducted for the new report, the figure was found to be 35%, with 16% using drugs at least once a week – equivalent to about 14,000 prisoners.
Harry Fletcher, assistant general secretary of probation union Napo, said officers who smuggled drugs into jail routinely avoided detection. “It’s a serious problem but the government doesn’t keep statistics on how many staff are caught, which is extraordinary,” he said.
Fletcher said there were more than 6,000 prison officers convicted of disciplinary offences over the past four years, with 19 of them currently serving sentences. “Because there is no data on the extent of the problem we can’t devise solutions,” he said.

Source: www.guardian.co.uk 28th May 2010

Dawn is almost here,but hope seems far away.

ndpa — Sun, 13 Nov 2011 23:53:31 +0000

Dear Friend,

They wait to welcome their child into the world. They wait in cars after the team practice. They wait in line to buy their family’s dinner. They wait for texts to pick up their child from birthday parties, sleepovers and play dates. Others wait for thick college acceptance envelopes. But imagine this: You are one of the millions of parents with a teen or young adult abusing drugs or alcohol. You? You wait for a phone call. You wonder if your child will come home. You worry she’s hurt.

Like so many others, you don’t know where to start to find the answers you need, let alone how you will confront your child, if she needs help, or if there are others like you, parents who have stood in your shoes, paced beside doors or waited for a call. Having a child with an alcohol or drug problem can be emotionally taxing and financially devastating for families.

Suddenly, a lifeline.

You are searching the Internet for help and find The Partnership at Drugfree.org. The website, created with and for parents, allows you to connect with others, tap into expert advice and find support as you find help for your child. You find insight and tools you can use. You find a community who understands. You find hope. That’s what The Partnership at Drugfree.org exists to do – be a partner to parents all along their journey of parenting a teen, whether that’s prevention, intervention or treatment.

The The Partnership at Drugfree.org is there, a steady, supportive hand, offering services to help parents and caring adults. Not a government agency, but a nonprofit made up of partners in science, parenting and communications, and one that relies on the generosity of individuals.

Right now…

We are building support for You Are Not Alone… a campaign dedicated to letting families of teens and young adults who are struggling with addiction know that they are not alone. By enlisting and uniting the millions who have been affected by addiction, we are removing barriers to seeking treatment and creating a new dialogue around addiction.
We are growing the staff and services of our Parents Toll-Free Hotline… 1-855-DRUGFREE… a new, nationwide support service that offers assistance to parents and other primary caregivers of children who want to talk to someone about their child’s drug use and drinking. Our trained and caring parent specialists will help parents plan a course of action for teens who are struggling with substance abuse and lead them to resources or treatment facilities in their area.
We have downloadable e-books and kits available… which equip parents with conversation starters and step-by-step direction to talk to their kids or take action if they think or know their child is using. Kids who learn a lot about the risks of drugs from their parents are up to 50% less likely to use.

Meeting these specific needs of parents, in conjunction with the everyday services we provide to families, will take a huge effort, cost money, and stretch our resources to the limit.

Stephen J. Pasierb, President & CEO

Source: www.drugfree.org to learn more

Parents: Know warning signs of drug abuse

ndpa — Sun, 13 Nov 2011 23:45:01 +0000

Q: How can I tell if my child has been using marijuana?

A: There are some signs you might be able to see. If someone is high on marijuana, he or she might:

Seem dizzy and have trouble walking;

Seem silly and giggly for no reason;
Save very red, bloodshot eyes; and
Have a hard time remembering things that just happened.

When the early effects fade, the user can become very sleepy.

Parents should be aware of changes in their child’s behavior, although this may be difficult with teens. Parents should look for withdrawal, depression, fatigue, carelessness with grooming, hostility and deteriorating relationships with family members and friends.

In addition, changes in academic performance, increased absenteeism or truancy, lost interest in sports or other favourite activities, and changes in eating or sleeping habits could be related to drug use. However, these signs may also indicate problems other than using drugs.

In addition, parents should be aware of:

Signs of drugs and drug paraphernalia, including pipes and rolling papers;

Odour on clothes and in the bedroom;
Use of incense and other deodorizers;
Use of eye drops; and
Clothing, posters, jewellery, etc., promoting drug use.

Source: The National Institute on Drug Abuse 2010

Characteristics Of Effective Prevention

ndpa — Sun, 13 Nov 2011 23:38:56 +0000

Written by Bonnie Benard, NIDA, USA.(Originally in training manuals for Project Snowball, Illinois Teen Institutes, 1987)

Published in Britainin ‘Drug Prevention – Just say Now’ by Peter Stoker, pub. David Fulton Publishers,London, 1992.

Programme comprehensiveness/intensity

A. Multiplicity: the causes of drug/alcohol abuse are multiple: personality, environmental, behavioural (Kandel, Logan, 1984; Hawkins et al, 1951). Programmes tackling only one area usually fail. You should target multiple systems (youth, families, schools, community, workplace, media, etc). Also use multiple strategies (information, lifestyles, positive alternatives, community policies) (Botvin, 1982).

B. Target whole community. School-based programmes achieve less than community-based approaches.

C. Target all youth for prevention – not just “high risk”. Adolescence is seen to be a high-risk time for all youth in terms of health-compromising behaviour. Labelling “high risk” youth can provoke stigmatisation and lead to self-fulfilling prophecies. There is however an argument for defining “high risk” communities where an additional resource over and above the general prevention effort could be justified.

D. Build drug prevention into general health promotion. Drug abuse has been found by several (Lofquist, 1993) to be part of a complex pattern of interrelated factors – e.g. delinquency, truancy, school failure, precocious sexuality, which share common antecedents.

E. Start at an early age and keep going! Even in infancy there are influences in later behaviour. Developmental difficulties by age 3 are difficult to overcome (Burton, White). Here, it is of course relevant to mention Trevor Williams, Noreen Wetton and Alysoun Moon of the Southampton University team who have demonstrated so graphically in their “Jugs and Herrings” research papers that primary age children are not blissfully ignorant of drugs and alcohol. Prevention programmes starting from what children actually know are essential. Many secondary schools still seem to regard years 11 and 12 as the age at which discussion of drugs (or indeed sexuality) should be facilitated. Don’t wait until the horse has run away before you lock the stable doors!

F. Adequate quantity. ‘One-shot prevention efforts do not work” (Kumpfer, 1988) there must be a substantial number of interventions, each of a substantial duration. Project D.A.R.E. (Drug Abuse Resistance Education) initiated by Los Angeles Police and now in several countries, delivers no less than seventeen one-hour lessons to any given year and this is only part of the school programme.

G. Integrate family/classroom/school/community life. This is easier to say than do, but where it has happened results have been enhanced.

H. Supportive environment, empowerment. Where young people are encouraged to participate and take responsibility their behavioural outcomes are improved. InBritain now peer-education methods which have been proven elsewhere have been applied to good effect.

Programme strategies

J. ‘KAB’ - Knowledge/Attitudes/Behaviour. Address these as a set, i.e. each must be directly tackled rather than assuming one will flow from another. The behavioural component is in part addressed by social skills development, but also supported by positive reinforcement activities – drug free social/sporting events, commendations (preferably with something for everyone), media coverage, etc. Research suggests that social learning theory (Bandura, 1977) produces some of the most profound improvements.

K. Drug specific curriculum. Affective education programmes that had not specifically covered drugs (including alcohol) were found unsuccessful, even though they addressed knowledge, attitudes and lifeskills.

L. Gateway drugs. So-called because people now using heavy-end drugs almost always started on these. Gateway drugs can be tobacco, alcohol and cannabis or, these days inBritain, even heroin! Concentration on prevention of these is therefore likely to prevent all substances. British research by PaT (Parents against Tobacco, 1990), showed that of youth who smoked tobacco 50% had also tried an illegal drug compared with only 2% of those who did not smoke tobacco. It should be particularly noted that cannabis is far from harmless; physical, mental and social damage is now being increasingly accepted as a reality.

M. Salient material. Whatever is used needs to identify with the audience, including:

• ethnic/cultural sensitivity

• appeal to youth’s interests

• short term outcomes to be emphasised as important to youth as well as long term

• appropriate language, readability

• appealing graphics

• appropriate to real age/reading age – a key factor

In a survey of 3, 700, 000 young American children, 25% of 9 year olds felt “some” to “a lot” of peer pressure to try drugs or alcohol (Weekly Reader, 1987).

N. Alternatives. Activities have to be plausible, be more highly valued than the health-compromising behaviour. Too often these alternatives are poorly thought through. ( ‘Ping-pong = prevention’? No!)

P. Lifeskills. Development of these will be of wider benefit than drug prevention. Included will be

communication, problem solving, decision-making, critical thinking, assertiveness, peer pressure reversal, peer selection, low-risk choice making, self-improvement, stress reduction and consumer awareness (Botvin, 1985).

Choosing your friends has been found in some research to be more effective than resisting the peer pressure of said friends. Consumer awareness is a “companion” to resisting peer pressure, i.e. resisting media pressure.

Q. Training prevention workers. For the school setting the greater emphasis on experiential and interactive work requires teacher training to extend into youth work skills. Community development skills are valuable in taking school initiatives into the community. Imported “prestige” role models are all very well, but good results have been achieved with parents, peers, teachers, or outside agency workers.

R. Community norms. Consistency of policies throughout schools, families and communities can greatly enhance impact.

S. Alcohol norms. Because of its dual status as a beverage and as a culturally accepted drug, alcohol is problematic for prevention. However, heart disease and tobacco prevention programmes have shown that societal norms can be changed.

T. Improve schooling! Listed here as a target because of its important correlation with healthy lifestyle. Within the current British economic and academic climate one realistic hope may lie with co-operative learning, see the ‘Tribes’ programme, for example.

U. Change society. Don’t just stop with improving schools; add your voices to pressure for improvement in employment, housing, recreation and self-development; it is naïve to suppose that prevention can take place in a political vacuum. Jessor recognises that failing to acknowledge the need for macro-environmental improvement while at the same time placing the responsibility for health solely with the individual is tantamount to “blaming the victim”.

The planning process

V. Design, implementation, evaluation. Evaluations have generally concentrated on outcomes rather than the quality of design. However, implementation is as much dependent on engaging all sectors of the community (be it a school, a workplace, or a town) as it is on quality of design. Evaluation should therefore measure process as well as outcome.

W. Goal-setting. Unrealistic or immeasurable goals help no-one. It is important to set not only long-term outcome goals (for prevention is long-term) but also “process goals” such as increased involvement of parents and community, academic success, increased student-teacher interaction, and so on.

X. Evaluation and amendment. Prevention workers have been criticized for giving too little attention to this area, the crushing shortage of funds has much to do with it (inAmerica the ratio of funding between interdiction-policy and prevention is about 200:1). This lack of emphasis on evaluation has been the Achilles heel that pro-drug campaigners have gleefully attacked. Effective evaluations have been those including longitudinal design, multiple measures of process as well as outcome (Tobler, 1986), and cost-benefit analysis (CBA). CBA is perhaps the greatest marketing tool prevention has; where CBA has been applied substantial cost effectiveness has been demonstrated.

National Drug PreventionAlliance

PO Box 594, Slough SL1 1AA J Tel / Fax: +44 (0)1753 677917

E-mail: NDPA@drugprevent.org.uk J Internet: www.drugprevent.org.uk

Number of Prescription Painkiller Deaths More Than Tripled in Last 10 Years

ndpa — Sat, 05 Nov 2011 21:05:17 +0000

The number of Americans who died from overdoses of prescription painkillers more than tripled in the past decade, according to the Centers for Disease Control and Prevention (CDC). More people now die from painkillers than from heroin and cocaine combined.

An estimated 14,800 people died in the United States from painkiller overdoses in 2008, a more than threefold jump from the 4,000 deaths recorded in 1999, the CDC said in a new report. Prescription and illegal drugs caused 36,450 deaths in 2008, compared with 39,973 deaths from motor vehicle crashes, according to the Associated Press.

The CDC said painkiller abuse and deaths are rising because the drugs are easier than ever to obtain. They cited the growth of “pill mills,” clinics that prescribe opioids without first conducting medical exams, and “doctor shopping,” or receiving multiple prescriptions from different doctors. According to the CDC, enough painkillers were prescribed in 2010 to medicate every American adult around the clock for a month. “Right now, the system is awash in opioids—dangerous drugs that got people hooked and keep them hooked,” said CDC Director Thomas Frieden.

“Prescription drug abuse is a silent epidemic that is stealing thousands of lives and tearing apart communities and families across America,” Gil Kerlikowske, Director of National Drug Control Policy, said in a CDC news release. He noted health care providers and patients should be educated on the risks of prescription painkillers. “Parents and grandparents should properly dispose of any unneeded or expired medications from the home and to talk to their kids about the misuse and abuse of prescription drugs,” he noted.

Source: ww.drugfree.org. 2nd Nov.2011

Nicotine Acts as “Gateway” Drug to Cocaine, Study in Mice Finds

ndpa — Sat, 05 Nov 2011 20:56:51 +0000

Nicotine appears to be a “gateway” drug that primes the brain to be susceptible to cocaine, according to a new study in mice. The researchers say if further studies show the findings apply to humans, a decrease in smoking rates in young people would be expected to lead to a decrease in cocaine addiction, the Los Angeles Times reports.

The study found mice exposed to nicotine in drinking water for at least seven days showed an increased response to cocaine. The researchers also looked at data on cocaine use among a group of high school students, and found 81 percent of those who started using cocaine did so in a month when they were smoking tobacco.

The findings appear in the journal Science Translational Medicine.
Previous studies have shown that most illegal drug users report using tobacco products or alcohol before they started illicit drug use, according to a news release by the National Institute on Drug Abuse, which funded the study. Until now, studies have not shown a biological mechanism through which exposure to nicotine increases vulnerability to illegal drug use, the release notes.

“Now that we have a mouse model of the actions of nicotine as a gateway drug this will allow us to explore the molecular mechanisms by which alcohol and marijuana might act as gateway drugs,” lead author Eric Kandel, MD, of Columbia University Medical Center, said in the release. “In particular, we would be interested in knowing if there is a single, common mechanism for all gateway drugs or if each drug utilizes a distinct mechanism.”

Source: www.drugfree.org. 4th Nov.

Record high: Gallup poll shows FIFTY per cent of Americans favour legalising marijuana

ndpa — Sat, 05 Nov 2011 20:54:16 +0000

The headline below from the Daily Mail on the 18th October 2011, suggests that 50% of the population of America favour legalizing marijuana.   However Jose Paulo Carneiro, a statistics expert from Brazil, writes a critique of this survey and shows that the results issued by Gallup Poll are not what they seem to be suggesting.
The saying ‘Lies, Damn Lies and Statistics’ comes to mind.    NDPA
*  *  *  *  *  *
Record high: Gallup poll shows FIFTY per cent of Americans favour legalising marijuana    -    18th October 2011
• Up from 46 per cent last year
• Liberals and those 18 to 29 most in favour
• Americans 65 and older most oppose
Read more: http://www.dailymail.co.uk/news/article-2050348/Legalisation-marijuana-50-Americans-favour.html#ixzz1boJx8Vwj
*  *  *  *  *  *

“First of all, what is the methodology of this survey? What is the universe? Of course, it cannot be all the Americans.   Suppose it is the American population between 15 and 64 years (approximately 205.7 million).

If the sample were a simple random sample (that is, all the individuals have the same probability of being selected), the fact that the sample size is a tiny proportion of the population would not matter, because in the formula for the sample standard deviation (let us call it s) of a proportion to be estimated, the size N of the universe only appears in a factor, which, for a sample size of 1,005, equals 0.999995, which is practically 1.

Then, the maximum value for s, which occurs precisely for the 50% proportion and is independent of N, reduces to 1.6%. This means (supposing, as usual, the normality of the sampling distribution) that there is a probability of 95% that a real proportion of 50% will appear in the sample between 46.8% and 53.2% (this is the meaning of the phrase “the survey error is 3.2%”), which is a very acceptable value.

The problem is not in the sample size. The problem is that a telephone survey is not a simple sample survey, because not all individuals have the same chance of being selected. If you don’t have a telephone number, your probability of being selected is zero. If you have three telephone numbers and your neighbor has only one, your probability of being selected is three times his. Moreover, even inside a specific household, the probabilities are different. In certain households (mine, for instance), the probability that the husband answers the phone is very small compared with the probability that the wife does it. And, what is worse: the sample is biased, because there may be – and usually there is – a specific profile of people who answer, opposed to that of people who don’t answer the call.

In summary, it is very surprising that an Institute so renowned as Gallup, in a country so developed in matters of survey and research, makes a telephone survey and draws a conclusion about the opinion of “half of the Americans”.

Jose Paulo Carneiro, Expert in Statistics and Surveys, Rio de Janeiro, Brazil. Oct.2011

Medical Marijuana May Impair Thinking of MS Patients

ndpa — Sat, 05 Nov 2011 20:50:12 +0000

Feinstein says the marijuana users performed significantly worse than the non-users on tests measuring attention, speed of thinking, visual perception, and cognition related to planning and organizing. Scores on one test measuring speed of processing information were about a third lower among marijuana users compared to non-users. Thirty-two percent of non-users and 64% of users met the definition of globally cognitively impaired, meaning that they had measurable impairments in two or more aspects of intellectual functioning.

Neurologist Lily Jung Hensen, MD, of Seattle’s Swedish Neurosciences Institute, tells WebMD that the findings make a strong argument that the cognitive risks associated with marijuana use outweigh potential benefits for MS patients.

Source: http://www.cbs47.tv/webmd/ms/story/Medical-Marijuana-May-Impair-Thinking-of-MS/FmQ00ndFKkKhQ199RrPTDQ.cspx Oct.2011

Impact On Lungs Of One Cannabis Joint Equal To Up To Five Cigarettes

ndpa — Sat, 05 Nov 2011 20:43:59 +0000

A single cannabis joint has the same effect on the lungs as smoking up to five cigarettes in one go, indicates research published ahead of print in the journal Thorax.

The researchers base their findings on 339 adults up to the age of 70, selected from an ongoing study of respiratory health, and categorised into four different groups.

These comprised those who smoked only cannabis, equivalent to at least one joint a day for five years; those who smoked tobacco only, equivalent to a pack of cigarettes a day for at least a year; those who smoked both; and those who did not smoke either cannabis or tobacco.

All the participants had high definition x-ray scans (computed tomography) taken of their lungs and they took special breathing tests designed to assess how well their lungs worked.

They were also questioned about their smoking habits.
Seventy five people smoked only cannabis, and 91 smoked both. Eighty one people did not smoke either, and 92 smoked only tobacco.

Combined smokers tended to use less tobacco, the findings showed.
Cannabis smokers complained of wheeze, cough, chest tightness and phlegm. But emphysema, the progressive and crippling lung disease, was only seen in those who smoked tobacco, either alone or in combination.
But cannabis still damaged the lungs and stopped them from working properly.

It diminished the numbers of small fine airways, which are important for transporting oxygen and waste products to and from the blood vessels effectively.
And it damaged the large airways of the lung, blocking airflow, and forcing the lungs to work harder.
The extent of this damage was directly related to the number of joints smoked, with higher consumption linked to greater incapacity.

The effect on the lungs of each joint was equivalent to smoking between 2.5 and five cigarettes in one go.
The authors explain that the impact of cannabis is strongly associated with the way in which it is smoked. It is usually smoked without a filter, and at a higher temperature. Smokers tend to inhale more deeply and to hold their breath for longer.

Source: Retrieved August 8, 2009, from http://www.sciencedaily.com

Marijuana Use and Motor Vehicle Crashes

ndpa — Sat, 05 Nov 2011 20:42:22 +0000

Abstract

Since 1996, 16 states and the District of Columbia in the United States have enacted legislation to decriminalize marijuana for medical use. Although marijuana is the most commonly detected non alcohol drug in drivers, its role in crash causation remains unsettled. To assess the association between marijuana use and crash risk, the authors performed a meta-analysis of 9 epidemiologic studies published in English in the past 2 decades identified through a systematic search of bibliographic databases. Estimated odds ratios relating marijuana use to crash risk reported in these studies ranged from 0.85 to 7.16. Pooled analysis based on the random-effects model yielded a summary odds ratio of 2.66 (95% confidence interval: 2.07, 3.41). Analysis of individual studies indicated that the heightened risk of crash involvement associated with marijuana use persisted after adjustment for confounding variables and that the risk of crash involvement increased in a dose-response fashion with the concentration of 11-nor-9-carboxy-delta-9-tetrahydrocannabinol detected in the urine and the frequency of self-reported marijuana use. The results of this meta-analysis suggest that marijuana use by drivers is associated with a significantly increased risk of being involved in motor vehicle crashes.

Source: Epidemiology Rev (2011) doi: 10.1093/epirev/mxr017

Impact of cannabis use on thalamic volume in people at familial high risk of schizophrenia

ndpa — Sat, 05 Nov 2011 20:33:28 +0000

1. Killian A. Welch, MD, MRCPsych et al

Correspondence:: kwelch1@staffmail.ed.ac.uk

Background
No longitudinal study has yet examined the association between substance use and brain volume changes in a population at high risk of schizophrenia.

Aims
To examine the effects of cannabis on longitudinal thalamus and amygdala-hippocampal complex volumes within a population at high risk of schizophrenia.

Method
Magnetic resonance imaging scans were obtained from individuals at high genetic risk of schizophrenia at the point of entry to the Edinburgh High-Risk Study (EHRS) and approximately 2 years later. Differential thalamic and amygdala-hippocampal complex volume change in high-risk individuals exposed (n = 25) and not exposed (n = 32) to cannabis in the intervening period was investigated using repeated-measures analysis of variance.

Results
Cannabis exposure was associated with bilateral thalamic volume loss. This effect was significant on the left (F = 4.47, P = 0.04) and highly significant on the right (F = 7.66, P = 0.008). These results remained significant when individuals using other illicit drugs were removed from the analysis.

Conclusions
These are the first longitudinal data to demonstrate an association between thalamic volume loss and exposure to cannabis in currently unaffected people at familial high risk of developing schizophrenia. This observation may be important in understanding the link between cannabis exposure and the subsequent development of schizophrenia.

Source: bjp.rcpsych.org Sept.2011

Hepatitis C transmission via injecting drug use: look beyond needles and syringes

ndpa — Sat, 05 Nov 2011 20:25:35 +0000

Important insights into the continued spread of hepatitis C among injecting drug users are provided by two studies published in the online edition of the Journal of Infectious Diseases. An international team of investigators showed that infectious quantities of hepatitis C could survive on inanimate surfaces for up to seven days. However, the virus can be rendered inactive by commercially available disinfectants, or heating to a temperature of 65-70° for approximately 90 seconds.

In a separate study, French investigators detected the virus on 80% of alcohol swabs obtained from injecting drug users. They suggest that the swabs may be shared by users, risking the transmission of hepatitis C.

Holly Hagan of the New York University College of Nursing in an accompanying editorial stated: “The studies contribute new knowledge to our understanding of the mechanisms by which HCV [hepatitis C virus] may be transmitted among PWID [people who inject drugs] via injection-related materials.”

There are an estimated 130 million hepatitis C infections worldwide. Hepatitis C is a blood-borne infection and a major mode of transmission is injecting drug use. Needle and syringe exchange programmes have been introduced in many countries to control the epidemic. The have been highly effective at preventing new HIV infections, but hepatitis C transmissions still continue. This is possibly because viral load tends to be high in individuals with chronic hepatitis C infection, and even small quantities of contaminated blood are potentially infectious.

A team of investigators led by Juliane Doerrbecker wished to establish a clearer understanding of the survival of the virus, and the effectiveness of disinfectants and heat at rendering the virus non-infectious. Steel discs were contaminated with infectious quantities of hepatitis C which were then allowed to dry. Reassuringly, commercially available disinfectants were also shown to have “a high virucidal efficacy against HCV.”

Tests also showed that infectious quantities of hepatitis C of approximately 30 TCID50/ml could still be detected on inanimate surfaces up to seven days after contamination. However, the investigators emphasised that “all tested biocides were able to inactivate HCV infectivity to undetectable levels.”

The investigators then examined the effect of heat on the virus. Spoons and/or cookers are used to heat diluted heroin into solutions. The liquid is then drawn into a syringe, potentially contaminating the spoon if hepatitis C-infected blood is present in the syringe. The investigators therefore contaminated spoons with the virus, which were then heated to various temperatures using tea candles.

Infectivity started to decrease at temperatures of approximately 50°. Levels of the virus fell below the limit of detection when temperatures reached 67-70°. It generally took between 80 to 95 seconds for heating to produce small bubbles in the spoon.

“Reusing HCV contaminated cookers could lead to infection even if using sterile syringes,” comment the investigators. Holly Hagan emphasised that injecting drug users rarely heat spoons for more than 15 seconds.

In separate research, Dr Vincent Thibault and his colleagues collected drug-using paraphernalia from individuals known to be infected with hepatitis C. The used paraphernalia included syringes, filters and water cups, swabs for cleaning of skin before injecting and pads employed to stop bleeding after withdrawal of needles. A total of 160 pieces of equipment were collected.

The virus was detected on 44% of the pooled materials. A further 620 items used by individuals of unknown infection status were also obtained. Approximately 83% of the pools obtained from swabs had detectable hepatitis C. Moreover, viral load was highest (above 3 log10 iu/ml) within these swab pools. Hepatitis C was also commonly detected in syringes, but viral load tended to be at low levels (12 to 890 iu/ml). The investigators therefore believe that there is “a higher chance for PWID to be contaminated though sharing of a tainted spoon rather than a tainted syringe.”

They note that blood was often visible on swabs. The researchers therefore suggest that transmission of the virus could occur if swabs were being used inappropriately. “The chaotic and rushed atmosphere of the injection setting, where swab sharing and mixing could take place, is…an important factor that should be considered.”

Holly Hagan believes the two studies have important implications for hepatitis C prevention programmes. “Cleaning cookers or perhaps impregnating injection equipment with safe biocides may help reduce the incidence of new infections. Promoting safe swab use to emphasize avoidance of reuse seems a prudent measure.”

Reference
Doerrbecker J et al. Inactivation and survival of hepatitis C virus on inanimate surfaces. J Infect Dis, online edition, doi: 101093/infdis/jir535 (click here for the abstract).

Thibault V et al. Hepatitis C transmission in injecting drug users: could swabs be the main culprit? J Infect Dis, online edition, doi: 101093/infdis/jir650 (click here for the abstract).

Source: www.aidsmap.com 4th Nov.2011

Drug advisers told no chance of decriminalising possession laws

ndpa — Sat, 05 Nov 2011 20:14:16 +0000

Theresa May, the Home Secretary, issued a humiliating rebuke to her drug advisers after they called for the possession of drugs to be decriminalised.

The Home Office said there was no intention to give people a “green light” to use drugs because they “destroy lives and cause untold misery”.

The ACMD called for a review on how those caught in possession of drugs are handled in a submission to the Sentencing Council, which is consulting on guidelines for courts on drug offences.

However, it is not in the remit of the Sentencing Council to consider what would effectively decriminalisation and the ACMD only included its comments in the final section asking for any further comments. It wrote: “There is an opportunity to be more creative in dealing with those who have committed an offence by possession of drugs.

Source: www.telegraph.co.uk 18th Oct 2011

California Medical Association Not So Medical Says Drug Policy Experts

ndpa — Sat, 05 Nov 2011 20:10:17 +0000

The California Medical Association (CMA) took a major leap lacking science and common sense. With the issuance of a White Paper calling for the legalization of marijuana for medical and non-medial purposes, they have transitioned from a medical group into a lapdog of the drug legalization lobby.
“I am thoroughly appalled by the CMA’s decision to release this policy in an attempt to legalize a drug that we know causes so much harm to individuals and families,” said Eric Voth, M.D., F.A.C.P. and Chair of the Institute on Global Drug Policy. “The CMA has managed to single-handedly make a mockery of modern medicine and the ethical practices of physicians. There is nothing scientific about this White Paper – it is total politics.”

The White Paper just released contains a number of incorrect statements. Contrary to what the paper states:
• According to the National Household Survey on Drug Abuse, the rate of current, past 30-day use of marijuana by Americans aged 12 and older in 1979 was 13.2%. In 2008 that figure stood at 6.1%. This 54% reduction over that 29-year period is a major public health triumph, not a failure! Now, we must not only push back against the drugs but, the advocates who seek to normalize and legalize them.
• The Netherlands reclassified high potency marijuana as a “hard drug” because of the harms that have occurred from the drug and moved to shut down hundreds of “coffee shops” that serve marijuana. Their lenient policy caught up with them and they are moving back to more conservative actions.
• Portugal’s policy that decriminalized consumption and possession of illicit drugs in 2001 was a dismal failure. The 2007 national drug survey showed an increase in life-time prevalence of drug use in the general population, especially regarding cannabis use and use of cocaine has nearly doubled. Cocaine seizures increased seven-fold between 2001and 2006 and murders increased 40%.

“The CMA is dead wrong in asserting that the marijuana legalization movement is driven by the public. Instead it is driven by a group of well-financed legalization advocates. The ballot initiative to legalize pot was defeated in California and no other state has approved such an ill-advised policy, despite millions of dollars poured into this effort by ivory-tower elitists unaffected by the impact of drug use, like the rest of us. Even the issue of marijuana as medicine was rejected by two-thirds of the country,” stated Calvina Fay, Executive Director of Drug Free America Foundation.

“It is laudable that CMA supports more research and more education efforts to reduce marijuana use among children, adolescents, and young adults (although we believe it should include all adults). Ongoing research into potential medicines and cures is an important endeavor but, the solution should be to require marijuana to meet the standards of modern medicine, not by ballot initiatives or legislation and certainly not by legalizing it for recreational use” Fay concluded.
Drug Free America Foundation, Inc. is dedicated to fighting drug use, drug addiction and drug trafficking and to promoting effective sound drug policies, education and prevention.

Source: www.dfaf.org October 17, 2011

Estimated expenditure on cannabis in Australia is twice that of wine

ndpa — Sat, 05 Nov 2011 20:03:04 +0000

The price of cannabis has declined more than 40% (4.9% p.a.) in real terms during the 1990s, far greater than for most other agricultural products. Cannabis price may be declining because of increasing use of more efficient hydroponic cultivation techniques and also because decreasing law enforcement lowered the ‘full cost’ of cannabis. The number of national arrests and prosecutions per 100,000 population fell by almost one third between 1996 and 2001. Penalties also became less severe. If cannabis price had been constant, consumption of beer would have been 2.4% higher, wine 4.9% higher, spirits 9.8% higher and cannabis 10.4% lower.

Comment: As the health, social and economic costs of alcohol are greater than for cannabis, decreasing cannabis prices may have reduced harm from legal drugs.

Source: Clements KW. The Australian Journal of Agricultural and Resource Economics. 2004. 48:2; 271-300

Drunk behaviour – a question of immunity

ndpa — Sat, 05 Nov 2011 20:00:24 +0000

University of Adelaide researchers have found that immune cells in your brain may contribute to how you respond to alcohol. Lead researcher Dr Mark Hutchinson, ARC Research Fellow with the University’s School of Medical Sciences, said his team’s research provided new evidence that an immune response in the brain was involved in behavioural responses to alcohol. This immune response lies behind some of the well-known alcohol-related behavioural changes, such as difficulty controlling the muscles involved in walking and talking.

“It’s amazing to think that despite 10,000 years of using alcohol, and several decades of investigation into the way that alcohol affects the nerve cells in our brain, we are still trying to figure out exactly how it works,” says lead researcher Dr Mark Hutchinson from the University’s School of Medical Sciences.
“Alcohol is consumed annually by two billion people world-wide with its abuse posing a significant health and social problem,” said Dr Hutchinson. “Over 76 million people are diagnosed with an alcohol abuse disorder. “This work has significant implications for our understanding of the way alcohol affects us, as it is both an immunological and neuronal response. Such a shift in mindset has significant implications for identifying individuals who may have bad outcomes after consuming alcohol, and it could lead to a way of detecting people who are at greater risk of developing brain damage after long-term drinking.”

The research is published in the latest edition of the British Journal of Pharmacology by PhD student Yue Wu, supervisor Dr Hutchinson, and others. Laboratory mice were given a single shot of alcohol and the researchers studied the effect of blocking toll-like receptors, a particular element of the immune system, on the behavioural changes induced by alcohol. The researchers studied the effects of blocking the receptors by drugs, and also the effects of giving alcohol to mice that had been genetically altered so that they were lacking the functions of the selected receptors.

“The results showed that blocking this part of the immune system, either with the drug or genetically, reduced the effects of alcohol,” Dr Hutchinson said. He believes similar treatment could work in humans. “Medications targeting this specific receptor ‒ toll-like receptor 4 ‒ may prove beneficial in treating alcohol dependence and acute overdoses,” Dr Hutchinson said.

Source: http://ahha.asn.au/news mark.hutchinson@adelaide. 29th Sept.2011

Do drug policies affect cannabis markets? A natural experiment in Switzerland, 2000–10.

ndpa — Sat, 05 Nov 2011 19:03:57 +0000

Killias M., Isenring G.L., Gilliéron G. et al.
European Journal of Criminology: 2011, 8(3), p. 171–186.

Studies of a ‘natural experiment’ in Switzerland in the 2000s suggested that the effective re-criminalisation of cannabis production and distribution did diminish availability and use of the drug. The results contradict other findings suggesting that national policies have little effect on cannabis use.

Summary
A ‘natural experiment’ in Switzerland in the 2000s revealed the impacts of changes in the enforcement of cannabis production and distribution laws. By 2001, in response to public sentiment Switzerland had already relaxed its enforcement of laws against the use and distribution of cannabis. At this time the government prepared reforms to enshrine this in law by officially tolerating the sale, possession and use of small amounts of cannabis (usually below 5g), and the production and sale of larger quantities as long as producers and retailers agreed to act under strict control by police and the Department of Agriculture. Though this change had yet to be implemented, in anticipation over the following years visible and quasi-official structures of production, distribution and sale emerged. Concerned over some of the consequences, in 2003 and again in 2004 the Swiss parliament rejected the proposed changes. Over the following months, police and prosecutors resumed former more repressive policies, especially in respect of production and distribution. As a result, shops and production centres were closed during 2005 and 2006. It was this reversal which offered the opportunity to evaluate the impact of tolerance of legal production and distribution versus lack of tolerance.

Main findings
Early in 2004 shortly before most of their shops were closed, a survey of cannabis retailers suggested that competition between shops was quite stiff, particularly in respect of price. Nearly all felt they had to provide excellent products and service to keep their customers. Though many said they had never sold high strength and/or smokeable cannabis, this conflicted with the number of prosecutions for selling cannabis whose main active ingredient (THC) was above the legal limit.

In summer 2004 when many cannabis shops were still operating, two young men aged around 18 conducted ‘test purchase’ operations at 50 shops. Of these, 29 sold cannabis without reservation and 26 did so regardless of the young men’s age. Usually, the fake clients asked for 5g or the quantity available for about 50 Swiss francs. The quantities actually sold generally varied between 3.8g and 6.5g and THC levels between 8% and 28%, averaging 16%. Overall, the study confirmed that minors easily obtained high-strength cannabis. Most samples contained THC close to the average of 16% and prices varied little around 11 Swiss francs per gram. In short, quality and prices were fairly well standardised.
In 2009 when all known cannabis shops had closed, a second ‘test purchase’ operation was conducted, but this time to test the availability of supplies on the now fully illicit market. Two young men walked through inner-city areas where police said cannabis was most available, looking for potential dealers. Over 15 afternoons they made 29 relevant contacts; during 27 they were able to obtain cannabis. All the sales took place in streets and parks. Usually the fake clients were able to spot a dealer in under 20 minutes. The quantity purchased varied far more than in 2004, ranging from 0.38 to nearly 13 grams. Equally inconsistent were prices, varying greatly between 8 and 200 francs per gram. A typical price was 28 francs. The THC content varied between 4% and 18% and averaged 12%, lower than in 2004. At every transaction, the fake clients asked whether the dealer might be able or willing to supply other substances. Only one said they could.

Compared to 2004, typical prices paid per gram had increased from 11 to 28 francs and the variability in price and quantity was much greater and THC content lower. From the relatively standardised market of 2004, by 2009 the price structure was, from the clients’ point of view, relatively obscure and bore little relation to the origin or strength of the product.

The authors’ conclusions
The results of our studies suggest that legal policies can strongly affect production, supply, distribution and sale of cannabis. The switch from a liberal to a more repressive policy meant that large-scale agricultural was partly replaced by small-scale production on private premises, and sales moved back from shops to the streets. Formerly an export country, illegal import of cannabis in to Switzerland resumed, though probably not enough to compensate for lost local production. For users without links to home-based production networks, availability of cannabis may have decreased substantially, probably prompting decreased consumption. However, the market and its price structure became far more variable and obscure. Prices soared, possibly reflecting reduced supply and more marginal and criminal suppliers. Street sales favoured cheating because quantities cannot be accurately weighed and suppliers had little interest in repeat sales to unknown customers, feeling little need to gain their trust. On the other hand, and contrary to a widely held view, markets for cannabis and other substances seem to have remained separated.

Surveys in Switzerland and abroad suggest that policies making cannabis more easily available were followed by increasing rates of use, whereas Switzerland’s opposite policy after 2004 was associated with a drop in both the prevalence and frequency of cannabis use. Establishing to what extent policy changes caused changes in use is for the moment impossible, but data is consistent with the assumption that policies affect the availability and (indirectly) use of cannabis.

This draft entry is currently subject to consultation and correction by study authors.
Last revised 06 October 2011
Source : European Journal of Criminology: 2011, 8(3), p. 171–186.

One in four at risk of cannabis psychosis

ndpa — Sat, 05 Nov 2011 18:54:15 +0000

ONE in four people carries genes that increases vulnerability to psychotic illnesses if he or she smokes cannabis as a teenager, scientists have found.

A common genetic profile that makes cannabis five times more likely to trigger schizophrenia and similar disorders has been identified, increasing pressure on the Government to reverse the drug’s reclassification from Class B to Class C.

The increased risk applies to people who inherit variants of a gene named COMT who also smoked cannabis as teenagers. About a quarter of the population have this genetic make-up, and up to 15 per cent of the group are likely to develop psychotic conditions if exposed to the drug early in life.

Neither the drug nor the gene raises the risk of psychosis by itself.

The study, led by Avshalom Caspi and Terrie Moffitt, of the Institute of Psychiatry at King’s College London, offers the best explanation yet for the way that cannabis has a devastating psychiatric impact on some users but leaves most unharmed. Scientists had suspected that genetic factors were responsible for this divide, but a gene had not been pinpointed.

The findings, to be published in Biological Psychiatry, also reinforce a growing consensus that nature and nurture are not mutually exclusive forces but combine to affect behaviour and health. The King’s team has previously identified genes that raise the risk of depression or aggression, but only in conjunction with environmental influences.

Mental health campaigners said that the results vindicated their concerns about the decision last year to downgrade cannabis to a Class C drug, which means that possession is no longer an arrestable offence.

Marjorie Wallace, chief executive of the mental health charity Sane, said that it was becoming clear that cannabis placed millions of users at risk of lasting mental illness. About fifteen million Britons have tried cannabis, and between two million and five million are regular users, according to the Home Office British Crime Survey. The research suggests that a quarter could be at risk.

The evidence will be considered by a review of the drug’s classification announced last month by the Home Secretary. It may be possible to develop a test for genetic susceptibility to cannabis. “If we were able genetically to identify the vulnerable individuals in advance, we would be able to save thousands of minds, if not lives,” Ms Wallace said.

Dr Caspi, however, rejected the idea of screening based on the COMT gene. “Such a test would be wrong more often than it is right. Cannabis has many other adverse effects, especially on developing teenagers, on respiratory health and possibly on cognitive function. Effects may be pronounced among a genetically vulnerable group but that doesn’t mean we should encourage others not genetically vulnerable to use cannabis.”

The King’s team tracked 803 men and women born in Dunedin, New Zealand, in 1972 and 1973, who were enrolled at birth in a research project. Each was interviewed at 13, 15 and 18 about cannabis use, tested to determine which type of COMT genes they had inherited, and followed up at 26 for signs of mental illness.

COMT was chosen as it is known to play a part in the production of dopamine, a brain-signalling chemical that is abnormal in schizophrenia. It comes in two variants, known as valine or methionine, and every person has two copies, one from each parent.

Among people with two methionine variants, the rate of psychotic illness was 3 per cent, the background rate for the general population, regardless of whether they had used cannabis as teenagers.

Among those with two valine variants the rate was 3 per cent for non-users but 15 per cent for those who had smoked cannabis in their teens.

Dr Caspi said research had shown that the valine gene variant and cannabis affect the brain’s dopamine system in similar fashion, suggesting that they deliver a “double dose” that can be damaging. The work needs to be replicated by others to confirm the findings, Dr Caspi said. It also is possible that the gene involved is not COMT but a neighbour.

THE DRUG OF CHOICE FOR MILLIONS

• Cannabis was reclassified from a Class B to a Class C drug in January 2004. Possession remains illegal, but is not an arrestable offence. The Home Secretary has asked for a review by November
• The Home Office estimates that fifteen million people have tried cannabis, two million to five million are regular users and reclassification has saved 199,000 hours’ police work
• Liberalisation campaigners argue that millions smoke the drug with fewer ill-effects than others suffer from alcohol or tobacco
• A recent study at Maastricht University found that cannabis doubles the risk of schizophrenia, hallucinations and paranoia among a genetically susceptible group

Source: www.timesonline.co.uk 14 April 2005

‘Cannabis causes chaos in the brain’

ndpa — Sat, 05 Nov 2011 18:40:55 +0000

Cannabis causes chaos in the brain as nerve activity becomes uncoordinated and inaccurate, a study has found. The results may help explain links between cannabis and schizophrenia, scientists believe.
Researchers at the University of Bristol measured the brain responses of rats given a drug that mimics the psychoactive ingredient in cannabis. They found that the drug completely disrupted co-ordinated brain waves across the hippocampus and prefrontal cortex.
The first brain region plays a key role in the formation of memories. The second is essential to planning, decision making and social behaviour. Both are heavily implicated in schizophrenia. Rats exposed to the cannabis-like drug became unable to make accurate decisions when navigating through a maze.
The research is reported today in the Journal of Neuroscience.
Study leader Dr Matt Jones said: “Marijuana abuse is common among sufferers of schizophrenia and recent studies have shown that the psychoactive ingredient of marijuana can induce some symptoms of schizophrenia in healthy volunteers.
“These findings are therefore important for our understanding of psychiatric diseases, which may arise as a consequence of ‘disorchestrated brains’ and could be treated by retuning brain activity.” Co-author Michal Kucewicz, also from the University of Bristol, said: “These results are an important step forward in our understanding of how rhythmic activity in the brain underlies thought processes in health and disease.”
The research was part of a Medical Research Council-funded collaboration between the university and drug company Eli Lilly & Co.

Source: The Independent. 26th October 2011

Children of addicts ‘more likely to experience problems in adulthood’

ndpa — Sat, 05 Nov 2011 18:08:43 +0000

Children of drug addicts are suffering in desperation as shame and secrecy shroud the substance misuse in families, it was claimed today.

Youngsters whose parents take drugs are also more likely to have problems with substances, as well as their mental health, social skills and academically, a seminar heard. Joan O’Flynn, director of the National Advisory Committee on Drugs (NACD), said there is a need for more integration between addiction services, children’s services and medical professionals.

“Alcohol and drugs misuse by parents can impact negatively on a child’s experience of positive parenting and can create stressful family circumstances that impact on child development,” she said. “For many of the affected children, the effect of their parents’ substance misuse continues into their adult lives.

“For some, the impact can be multifaceted and persist not only into adult life but even into the lives of the next generation.” She added that stress, combined with the increased likelihood of the child being in care or homeless, leaves young people at a high risk of emotional isolation or social marginalisation.

Alcohol Action Ireland estimates between 61,000 and 104,000 children aged under 15 are living with parents who misuse alcohol. Director Fiona Ryan said: “Shame and secrecy shroud the issue of substance misuse in families with children living lives of quiet desperation.

“Alcohol Action Ireland has spent the past three years campaigning for children affected by parental alcohol problems to be seen and heard.” An NACD report – ‘Parental Substance Misuse: Addressing its Impact on Children’ – was launched at a seminar it jointly hosted with the Health Service Executive (HSE) and Alcohol Action Ireland, the national charity for alcohol-related issues.

The report reviewed all major international research on the impact of parental substance misuse on children and identified what steps can be taken in Ireland to reduce its impact.

It recommended additional research and data be collected to properly estimate the number of children whose parents have substance misuse problems. It also wants an assessment of which adult alcohol and drug treatment services are supporting parents and liaising with child support services. Women should also be educated on the adverse effects of consuming alcohol and drugs during pregnancy, it added.

Source: www.IrishExaminer.com 26th October 2011

Apparent Success of Drug Treatment Aimed at Heroin is Misleading

ndpa — Fri, 04 Nov 2011 13:35:48 +0000

Irish research shows addicts on methadone programme still abusing crack cocaine and other substances. The Irish Government drugs policy needs to change
There has been an apparent levelling off of the need for opiate centred drug treatment. However the researchers believe their findings show that this is misleading. Their evidence suggests that multiple drug use is the norm among many addicts.

Realities of Drug Misuse Investigated

The study was led by Dr A. Jamie Saris (Principal Investigator) and Fiona O’Reilly (Primary Field Researcher), Dept of Anthropology at NUI Maynooth and is the result of a long-term study which closely examined the realities of drug misuse in three adjacent neighbourhoods.
Of 92 abusers surveyed, 98% were on a methadone drugs treatment programme yet almost two thirds claimed to have used heroin within the past 3 months. Whilst over half were on prescription tranquilisers almost as many had used illegally obtained tranquilisers. Nearly one third had used crack cocaine and more than one in five powder cocaine. “Multiple drug use is the reality for nearly all users, and official policy needs to have this understanding at its centre”, claims Dr Saris.

Stigma Against Heroin Among the Young

A surprising finding was that there is a stigma against heroin among many of the younger users (aged 16 to 25). But these individuals still abuse what the study team describe as a “dizzying array” of other substances. The established approach to treatment, being so heavily focused on heroin, means that the issues faced by such people are not being addressed.
Another problem with the focus on crack and heroin is that it sets the users of those drugs apart from society when, in fact, such people are rarely defined solely by their addiction. A lot of local community activities aimed at assisting users recognise that they often lead lives that are not so very different from everyone else.
Drug Treatment Services Should Focus on Individuals
However it is often difficult to justify such activities to official funders under the rubric of ‘treatment’, as currently understood. Dr Saris believes that it is important to understand who users are, what they are taking and why, so that the authorities can assign the appropriate resources, treatments or management systems.
Tony MacCarrthaigh chairs the Local Drugs Task Force that covers the area of the study and he agrees with Dr Saris. “Individuals and not chemicals, need to become the focal point of treatment, and that treatment needs to assist individuals in developing another orientation not just to drugs, but to life,” he said. (A Dizzying Array of Substances; An Ethnographic Study of Drug Use in the Canal Communities, Department of Anthropology, NUI Maynooth, 2010.)

Source: Apparent Success of Drug Treatment Aimed at Heroin is Misleading

http://news.suite101.com/article.cfm/apparent-success-of-drug-treatment-aimed-at-heroin-is-misleading-a259572#ixzz0tO3OAGXw

Abolist NTA to Cut Drug Addiction

ndpa — Fri, 04 Nov 2011 13:33:31 +0000

“Methadone prescriptions for heroin addicts would be cut and the National Treatment Agency that runs the programme scrapped under plans from the Tories favourite think-tank,” reports Rosemary Bennett, social affairs correspondent of The Times newspaper.
“The Centre for Social Justice, set up by Iain Duncan Smith, the Work and Pensions Secretary, said it was unacceptable that only 4% of addicts in treatment ever get “clean” and accused the agency of “pushing aside” proper rehabilitation. The Times has also learnt that the highly influential think-tank will use a report on Monday to throw its weight behind Ken Clarke, the Justice Secretary, who called for short prison sentences to be scrapped.The report will state that the CSJ agrees with him that short sentences of two months do nothing to help to rehabilitate offenders and should be replaced by community orders.”
The CSJ’s Green Paper on Criminal Justice and Addiction comes as the government considers major changes to drug policy and the future of the National Treatment Agency. Set up in 2001, the NTA oversees the controversial “harm reduction” strategy – most recent NTA treatment statistics show that of the 207,000 addicts a year who use ‘treatment’ services, only 8,980 completed their treatment drug free.4,600 addicts have access to residential rehabilitation.Numerous residential drug rehabilitation centres have closed because of lack of patients, despite no sharp fall in the number of addicts.
The CSJ said that the NTA, the running costs of which have spiralled to £18million a year, merely processes addicts with a “fatalistic” belief that they can never get clean. It wants it scrapped and replaced by an Addiction Recovery Board, chaired by a minister and charged with getting addicts off drugs altogether, using the best local private sector and charity programmes, or “recovery communities”.
The report says there is a role for methadone, but it should be used only as part of a wider treatment programme, with abstinence the goal.
“There is no strategy or incentive to reduce the numbers on maintenance treatment and move people into recovery,” the CSJ said. The report is also highly critical of how drug use is tolerated in prison: 55% of prisoners received into custody each year are classified as problematic drug users. According to the Ministry of Justice, one in five men who reports using mainstream drugs first used them in prison.

Source:www.addictiontoday.org. July 10th 2010

Experts Call New Strategies on AIDS Prevention Ineffective!

ndpa — Fri, 04 Nov 2011 13:31:26 +0000

On Tuesday, July 20th 2010, internationally recognized anti-drug experts from every region of the world united to oppose a set of dangerous unproven global strategies recommended in the Vienna Declaration. The declaration is based on three false premises: 1) that the criminalization of illegal drug use fuels the HIV/AIDS epidemic, 2) that criminal justice and health promotion are conflicting approaches to drug policy, and 3) that the major costs of illegal drug use are those generated by the criminal justice system.
This document was released in anticipation of the 18th International AIDS Conference and has been under scrutiny by several non-governmental organizations. Calvina Fay, Executive Director of Drug Free America Foundation says, “There is no ‘reasonable evidence’ that supports the strategies outlined in the Vienna Declaration. Further, we should reject ineffective harm reduction tactics that are not based on scientific evidence while accepting drug use and creating an illusion that drugs can be used safely or responsibly. Such ill-conceived schemes foster the misunderstanding that drug use itself is not harmful and increases addiction.”
Many of the experts who opposed the Vienna Declaration know from research and practical experience that the optimal way to truly beat addiction, prevent the spread of AIDS and other sexually transmitted diseases, and prevent drug-related harm are effective strategies that target drug use and include prevention, education, treatment and law enforcement efforts and do not trade one for the other.
“The best foundation for prevention is policy. We know from experience that a balanced and restrictive drug policy is effective in keeping drug use at low levels. Since drug utilization in itself is an important risk factor for being infected by HIV, it is good AIDS-prevention to preclude illicit drug use. We must always strive to protect young people from getting involved with illegal drugs,” says Sven-Olov Carlsson, International President, World Federation Against Drugs.

To view the full joint statement issued opposing the Vienna Declaration, please visit www.wfad.se. If you would like to conduct an interview with Ms. Fay, Mr. Carlsson and/or other drug policy and prevention experts on this statement, please contact Lana Beck, Director of Communications with Drug Free America Foundation, Inc. at 727-828-0211 or 727-403-7571.

The World Federation Against Drugs (www.wfad.se) is a multilateral community of non-governmental organizations and individuals. Founded in 2009, the aim of WFAD is to work for a drug-free world. Drug Free America Foundation (www.dfaf.org) is a national and international nonprofit organization dedicated to fighting drug use, drug addiction and drug trafficking and to promoting effective sound drug policies, education and prevention. Drug Free America Foundation is a Non-Governmental Organization (NGO) in Special Consultative Status with the Economic and Social Council of the United Nations.

For More Info Contact Lana Beck 727-828-0211 or 727-403-7571 after hours

Source: Joint Press Release from www.wfad.se and www.wfad.se July 2010

Joint Statement in Opposition to the Vienna Declaration Released July 20, 2010

ndpa — Fri, 04 Nov 2011 13:29:21 +0000

The criminalization of illicit drug use provides positive health and social benefits by deterring nonmedical use of substances that cause great harm to HIV/AIDS-affected individuals. Incarceration that respects human rights and provides drug treatment services can accelerate an individual’s recovery from drug dependence and prevent drug-related harms to HIV/AIDS-affected individuals and prevent further proliferation of both diseases – HIV/AIDS and substance abuse.
In anticipation of the International AIDS Conference (AIDS 2010) from July 18-23, 2010,i the Vienna Declarationii was released by a group of non-governmental organizations (NGOs) and signed by private individuals to outline a global strategy to deal with the modern drug epidemic. The Vienna Declaration is based on three false premises:
1) that the criminalization of illegal drug use fuels the HIV/AIDS epidemic,
2) that criminal justice and health promotion are conflicting approaches to drug
policy, and
3) that the major costs of illegal drug use are those generated by the criminal justice system.

The prohibition of illegal drug use does not encourage the spread of HIV/AIDS, but rather it reduces illegal drug use among HIV/AIDS patients, as well as the non-infected population and thereby reduces the population vulnerable to HIV/AIDS infection by contaminated needles. Illegal drug use exacerbates weaknesses of the immune system, making individuals with AIDS more susceptible to infection and death. iii Marijuana use causes impaired immunity,iv v vi vii and opens the door for the virus that causes Kaposi’s Sarcoma,viii life-threatening for individuals with HIV/AIDS. Marijuana also contains bacteria and fungi that put users at risk for infection. ix x xi Illegal drug use among AIDS patients is life-threatening because these drugs lessen the effectiveness of anti-retroviral (ARV) medications.xii Nonmedical drug use is associated with increased risky sexual behaviors which promote transmission of HIV/AIDS in a way that needle exchange cannot prevent. xiii xiv
Illegal drug use also increases sexual violence which in turn results in more HIV infections, particularly among the most vulnerable members of society including womenxv as well as children. Mother-to-child transmission of HIV/AIDS now can be largely prevented by medical intervention; however, there is no protection for unborn fetuses from the adverse effects of a drug-using mother. xvi Joint Statement in Opposition to the Vienna Declaration Released July 20, 2010 Page 2

There are 200 million illegal drug users globally, making up 5% of the world population aged 16-64,xvii and an estimated 33.4 million people living with HIV/AIDS.xviii Since the emergence of the HIV/AIDS epidemic in 1981, an estimated 25 million people have died of HIV/AIDS-related causes and two million people die each year from this disease.xix These numbers are tragically high, but so is the number of global drug-related deaths, estimated at 223,000 each year. xx As previously noted, illegal drug use increases the risks associated with both contracting and treating HIV/AIDS. Reducing drug use must be part of the solution to curb the distressingly high HIV/AIDS death toll
.
The Vienna Declaration concludes that “reorienting drug policies towards evidence-based approaches that respect, protect and fulfill human rights has the potential to reduce harms deriving from current policies and would allow for the redirection of the vast financial resources towards where they are needed most: implementing and evaluating evidence-based prevention, regulatory, treatment and harm reduction interventions.” Prevention and treatment are admirable goals which aim to reduce illegal drug use; however many so-called “harm reduction” interventions normalize illegal drug use and inevitably lead to more nonmedical use of drugs, leading to more drug-caused harm. Real harm reduction is achieved by rejecting illegal drug use to improve the health and safety of would-be drug users.

To promote public health and public safety, and to reduce both illegal drug use and HIV/AIDS, the World Federation Against Drugs (WFAD), Drug Free America Foundation, Inc. (DFAF), Institute for Behavior and Health, Inc. (IBH) and numerous other organizations and individuals support a balanced restrictive drug policy that uses the criminal justice system, and the illegal status of nonmedical drug use, to reinforce both prevention and treatment. The current globally-endorsed balanced drug abuse prevention policy can be improved. Treatment systems can work together with the criminal justice system by incorporating new, effective and evidence-based strategies to reduce illegal drug use among criminal offenders. These approaches also reduce the commission of new crimes and associated incarceration.
The greatest costs of illegal drug use are not generated by the criminal justice system but by the nonmedical drug use itself. These costs include not only sickness and death but reduced productivity and the high healthcare costs generated by illegal drug use.

We are committed to efforts to improve current drug policy to further reduce illegal drug use by building on a balanced strategy that includes the criminal justice system. Rather than choosing between prevention and treatment on the one hand, and the criminal justice system on the other, it is important to find better ways for them to work together to achieve vital public health and public safety goals that neither can achieve alone. We know that the prevention of illegal drug use and HIV/AIDS prevention must go hand-in-hand; they are not in conflict with one another.

Organizations:
Sven-Olov Carlsson, International President, World Federation Against Drugs, www.wfad.se
Robert L. DuPont, M.D., President, Institute for Behavior and Health, Inc., www.ibhinc.org
David Evans, Esq., Executive Director, Drug Free Projects Coalition,
www.studentdrugtesting.org/
Calvina Fay, Executive Director, Drug Free America Foundation, Inc., www.dfaf.org
Members, International Task Force on Strategic Drug Policy, www.itfsdp.org Joint Statement in Opposition to the Vienna Declaration Released July 20, 2010 Page 3

Source: Joint Press Release www.dfaf.org and www.wfad.se July 20 2010

REFERENCES: XVIII International AIDS Conference. (2010). Retrieved July 12, 2010 from http://www.aids2010.org/
ii The Vienna Declaration. (2010). Retrieved June 30, 2010 from http://www.viennadeclaration.com/the-declaration.html
iii Antoniou, T., & Tseng, L. (2002). Interactions between recreational drugs and antiretroviral agents. Annual of Pharmacotherapy, 36, 1598-1613.
iv Cabral, G.A., & Vasquez, R. (1992). Delta-9-Tetrahydrocannabinol suppresses macrophage extrinsic anti-herpes virus activity, Proceedings of the Society for Experimental Biology and Medicine, 199(2), 255-63.
v American College of Allergy, Asthma and Immunology. (2004, November 17). Immunological changes associated with prolonged marijuana smoking.
vi Tashkin, D.P., Baldwin, G.C., Sarafian, T., Dubinett, S., & Roth, M.D. (2002). Respiratory and immunologic consequences of marijuana smoking. Journal of Clinical Pharmacology, 42(11 Suppl), 71S-81S.
vii Wu, T.C., Tashkin, D.P., Djahed, B., & Rose, J.E. (1988). Pulmonary hazards of smoking marijuana as compared with tobacco. New England Journal of Medicine, 318(6), 347-351.
viii American Association for Cancer Research. (2007, August 2). Marijuana component opens the door for virus that causes Kaposi’s sarcoma. ScienceDaily. Retrieved July 7, 2010 from http://www.sciencedaily.com/releases/2007/08/070801112156.htm
ix Fleisher, M., Winawer, S.J., & Zauber, A.G. (1991). Aspergillosis and marijuana. [Letter]. Annals of Internal Medicine, 115, 578-579.
x Ramirez, J. (1990). Acute pulmonary histoplasmosis: newly recognized hazard of marijuana plant hunters. American Journal of Medicine, 88(5), 60N-62N.
xi Taylor, D.N., Wachsmuth, I.K., Shangkuan, Y.H., Schmidt, E.V., Barrett, T.J., et al. (1982). Salmonellosis associated with marijuana: A multi state outbreak traced by plasmid fingerprinting. New England Journal of Medicine, 306(21), 1249-1253.
xii Ghaziani, A. (2005, October). Crystal methamphetamine use and antiretroviral drug resistance: A pilot study of behavioral and clinical correlates. International Association of Physicians in AIDS Care. IAPAC Monthly, 297-299. Retrieved July 9, 2010 from http://img.thebody.com/legacyAssets/22/36/meth.pdf
xiii Wechsberg, W.M., Parry, C.D.H., & Jewkes, R.K. (2010, May). Drugs, sex, gender-based violence, and the intersection of the HIV/AIDS epidemic with vulnerable women in South Africa. RTI Press. Retrieved July 9, 2010 from http://www.rti.org/pubs/pb-0001-1005-wechsberg.pdf
xiv Colfax, G., Coates, T.J., Husnik, M.J., Huang, Y., Buchbinder, S., Koblin, B., et al. (2005). Longitudinal patterns of methamphetamine, popper (amyl nitrite), and cocaine use and high-risk sexual behavior among a cohort of San Francisco men who have sex with men. Journal of Urban Health, 82(1 Suppl 1), i62-i70.
xv Wechsberg, W.M., Parry, C.D.H., & Jewkes, R.K. (2010, May). Drugs, sex, gender-based violence, and the intersection of the HIV/AIDS epidemic with vulnerable women in South Africa. RTI Press. Retrieved July 9, 2010 from http://www.rti.org/pubs/pb-0001-1005-wechsberg.pdf
xvi World Health Organization. (2010). PMTCT strategic vision 2010-2015: Preventing mother-to-child transmission of HIV to reach the UNGASS and millennium development goals. Retrieved July 9, 2010 from http://www.who.int/hiv/pub/mtct/strategic_vision.pdf
xvii United Nations Office on Drugs and Crime. (2010). World Drug Report 2010. New York: United Nations. Retrieved July 7, 2010 from http://www.unodc.org/documents/wdr/WDR_2010/World_Drug_Report_2010_lo-res.pdf
xviiiUNAIDS. (2009, December). Global facts & figures. Retrieved July 7, 2010 from http://data.unaids.org/pub/FactSheet/2009/20091124_FS_global_en.pdf
xixUNAIDS. (2009, December). Global facts & figures. Retrieved July 7, 2010 from http://data.unaids.org/pub/FactSheet/2009/20091124_FS_global_en.pdf
xx National Drug Research Institute. (2003, February 25). Tobacco, alcohol and illicit drugs responsible for seven million preventable deaths worldwide. Media release. Retrieved July 7, 2010 from http://db.ndri.curtin.edu.au/media.asp?mediarelid=40

Mexico looks to legalisation as drug war murders hit 28,000

ndpa — Fri, 04 Nov 2011 13:25:55 +0000

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

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

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

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

NADCP and Drug Court Leaders Respond to Criticisms With the Facts

ndpa — Fri, 04 Nov 2011 13:22:56 +0000

The following is an interesting article about Drug Courts in the USA and how successful they are. It is in response to criticisms by the NACDL about drug courts.
Setting the Record Straight: Criticisms Answered

The National Association of Drug Court Professionals (NADCP) Board of Directors has unanimously approved an official position statement regarding the 2009 report by the National Association of Criminal Defense Lawyers (NACDL) purporting to identify deficiencies in the practices of Drug Courts. Following the release of their report last September, NACDL used attacks on Drug Courts to launch an aggressive media campaign. Each attack on Drug Courts was met with a thorough and factual response from NADCP. These responses, and others, are listed below.

NADCP CEO West Huddleston and NADCP Chief of Science, Law, and Policy Doug Marlowe authored the official position statement to correct assertions made in the NACDL report that are unsupported by research, as well as address some areas of common concern. NADCP encourages Drug Court professionals to use the statement as a tool for answering these criticisms and concerns should they arise.

Missouri Law Quarterly
April, 2010

Drug Courts Save Lives and Money: So Why the Criticisms?
by Dr. Douglas Marlowe, Chief of Science, Law and Policy, NADCP

More research has been published on the effects of Drug Courts than on virtually all other criminal justice programs combined. By 2006, the scientific community had concluded beyond a reasonable doubt from what are called meta-analyses (highly advanced statistical procedures) that Drug Courts reduce crime and return financial benefits to society which are several times the initial investments. A large-scale study funded by the National Institute of Justice and recently completed in 2009—called the Multi-Site Adult Drug Court Evaluation, or MADCE— has confirmed, once again, that Drug Courts reduce crime, reduce substance abuse, improve family relationships, and increase employment and school enrollment.

Yet, just as the scientific evidence is coming in decidedly in favor of Drug Courts, criticisms of Drug Courts appear to be reaching a surprising crescendo in opinion editorials and non-scientific law journals. How can we explain this seeming paradox? If the criminal justice system endorses evidence-based practices, why should negative sentiments be rising alongside favorable research findings?

The answer is at least two-fold. One group of critics appears to be turning an intentionally blind eye to the research evidence to serve a drug-decriminalization policy agenda. Although they may use scientific language to defend their objections, no amount of data could ever dissuade them from their position. A second group of critics, however, recognizes the proven efficacy of Drug Courts, but worries that some Drug Courts might produce other negative side-effects which should also be taken into account, such as impeding zealous representation by defense counsel. Because these latter critics are swayed by data, their concerns are capable of being empirically tested; and if confirmed, can point the way toward corrective measures that will advance the field rather than move it further and further behind.

One would be hard-pressed to point to a negative commentary on Drug Courts that does not, within the same pages, endorse a drug-decriminalization or legalization agenda. For decades, drug legalizers could take steady aim at the so-called “War on Drugs” with its undue emphasis on mandatory sentencing and incarceration. Such criticisms were easy to level, because the War on Drugs has been both prohibitively costly and largely ineffective at reducing drug abuse or crime.

But Drug Courts throw a potential curve ball to these arguments. Drug Courts prove that drug abuse can remain illicit without necessitating a costly and draconian punitive response. We can hold people accountable for their dangerous behavior, while at the same time supervising them in the community and providing them with needed treatment and other services. This finding could be seen by some as sweeping the legs out from under the strongest rationale for drug decriminalization. And for this reason, it has elicited a steady stream of vehement antagonism framed in the guise of an objective scientific analysis.

Other critics, however, recognize that even beneficial treatments have the potential to cause unwanted side-effects. For example, aspirin is proven to reduce pain but in some cases can cause unintended ulcers or blood thinning. This has required the medical field to take remedial measures to reduce the likelihood that such side-effects will occur and to treat any negative symptoms that do emerge. By analogy, there is always the possibility that some Drug Courts might misapply their authority or mishandle their operations to the detriment of their participants. Moreover, there is the possibility that some types of addicted offenders might not respond well to the Drug Court model and should be treated in other ways.

There are two problems, however, with how these arguments have typically been framed by critics of Drug Courts. First, they assume facts not in evidence, and second, they often seek the wrong remedy. A review of the research literature through February of 2010 failed to uncover a single empirical study confirming any of the untoward effects that have been attributed by critics to Drug Courts. For example there is no reliable evidence (apart from some critics’ personal anecdotes) that Drug Courts impede adequate evidentiary discovery by defense counsel or sentence terminated defendants more harshly than if they had never entered the Drug Court.

It would not be a difficult matter, however, to study these questions in a scientifically defensible manner. If such negative effects do exist, then corrective measures can be developed and tested to address them. And finally, practice guidelines can be developed to ensure that all Drug Courts adhere to best practices and take reasonable efforts to avoid foreseeable injuries. There is no need to “throw out the baby with the bath water.” The indicated remedy is not to abandon the most successful program we have in the criminal justice system. The appropriate course of action is to conduct more sophisticated research to improve the intervention and to develop standards to guide the actions of Drug Court professionals.

Drug Courts are here to stay not because they are politically palatable, but because they have withstood, time and again, rigorous empirical scrutiny. They work where few other programs have. The time has come for the Drug Court field to reach full maturity. And like other mature disciplines, such as medicine or psychology, this means developing guidelines for effective and ethical practices.

The time has come for serious-minded constituencies to cease taking blind swipes at Drug Courts and vying for attention and limited resources. We need to come together to determine who should be treated in Drug Courts, how to optimize Drug Court operations, and how to avoid or redress any potential harms. This is what is meant by rational drug policy.

Governing Magazine
January, 2010
by West Huddleston, Chief Executive Officer, NADCP

John Buntin’s recent profile of Judge Stephen Alm and Hawaii’s promising H.O.P.E program is an encouraging sign that our nation’s probation system is ready for change (Swift and Certain, Hawaii’s Probation Experiment – November, 2009). In highlighting the development of the H.O.P.E. program, Mr. Buntin correctly identified systemic changes to our criminal justice system brought about by the growth and widespread success of Drug Courts, which now exceed 2,300 nationwide. In doing so, however, Mr. Buntin also raised serious questions about Drug Courts that rigorous research has already answered.

In the twenty years since the first Drug Court was founded there has been more research published on its effects than virtually all other criminal justice programs combined. The verdict? Drug Courts significantly reduce substance abuse and crime at less expense than any other justice strategy.

Mr. Buntin inferred that little is known about Drug Court participants once they leave the program. Here are the facts. Research demonstrates that nationwide, 70% percent of the 120,000 annual participants in Drug Court complete the program and 75% remain arrest-free. The longest study on Drug Courts to date shows that community reductions in drug abuse and improved employment and family functioning outcomes can last as long as 14 years.

Judge Alm suggested that most Drug Courts employ an “ineffective” reliance on future punishment. This is not the case. Drug Courts utilize close supervision, urine monitoring, and a system of graduated sanctions to ensure participants are immediately held accountable for not living up to their obligations. The approach is a vast improvement over traditional criminal justice responses, which are often applied inconsistently and in an all or nothing manner which emphasizes the draconian response of incarceration. This is just part of the reason why Drug Courts work better than probation, jails or prison and better than treatment alone.

The Sacramento Bee
October 16, 2010

Drug courts unfairly attacked
by West Huddleston, Chief Executive Officer, NADCP

Re “Fresh look at drug courts could also ease prison crisis” (Viewpoints, Nov. 9): In its latest attack on drug courts, the National Association of Criminal Defense Lawyers reveals a startling comfort with distorting facts and ignoring the truth. In misrepresenting its recent anecdotal report as a “study,” the NACDL chooses to ignore two decades of conclusive research, including hundreds of studies that prove drug courts reduce crime, reduce drug abuse, reunite families and save considerable money for taxpayers.

Here are the facts. Nationwide, 70 percent of the approximately 120,000 seriously addicted individuals who voluntarily enter drug courts with the assistance of their defense attorney complete it a year or more later and 75 percent of them remain arrest-free. A drug court participant is more than twice as likely to stay clean and remain arrest-free than is a newly released state inmate. Research also concludes that drug courts reduce drug abuse and improve employment and family functioning.

These effects are not short-lived. The longest study on drug courts to date shows these outcomes last as long as 14 years. Clearly, drug courts are not an experiment. They must be expanded to serve the 1.2 million substance-abusing arrestees before the courts. That is the real issue.

With every blind attack on drug courts, the National Association of Criminal Defense Lawyers calls into question only its own credibility.

The Miami Herald
October 13, 2009

Keep drug courts — they’re effective
by Dr. Douglas Marlowe, Chief of Science, Law and Policy, NADCP

The National Association of Criminal Defense Lawyers chooses to attack our nation’s most successful justice intervention for substance abusing offenders: drug courts (Cynthia Orr, Sept. 29 Other Views column, Rethink how we fight drugs).

It minimizes the impact of drug courts like the one in Miami-Dade, which has restored more than 12,000 lives and reunited tens of thousands of family members. NACDL only begrudgingly accepts drug courts as an interim improvement over the war on drugs until decriminalization is accomplished.

Two decades of research have proven that drug courts reduce crime, reduce drug abuse and save considerable money for taxpayers. The most conservative estimate is that every $1 invested in drug courts reaps between $2 to $3 in direct cost-savings to society.

Between 50 percent and 80 percent of all crimes are committed by substance abusers. NACDL’S assertion that drug courts are only treating low-level offenders is patently false. The majority of drug courts now treat serious offenders who have failed repeatedly in treatment and other dispositions.

NACDL recommends that drug courts treat high-risk offenders who would otherwise be in jail or prison bound in programs that do not require a guilty plea for entry.

But this would mean that serious and potentially violent offenders would face no legal repercussions whatsoever if they failed to complete treatment or even to attend it. When we consider the safety of our communities such recommendations cannot be taken seriously.

The Philadelphia Inquirer
October 24, 2009

Drug courts are needed; New Jersey shows why
by Yvonne Smith Segars, New Jersey Public Defender (As New Jersey Public Defender, Yvonne Smith Segars is the head of the New Jersey Office of the Public Defender, an agency overseeing the Public Defender offices throughout state.)

Last Saturday’s editorial, “Who needs drug courts?,” asks a simple question. In reality, the answer is far more complex. Drug courts are certainly not for everybody, and they were never intended to solve all of the problems plaguing the criminal-justice system.

In New Jersey, with all major stakeholders having a voice at the table, the judiciary, law enforcement, the defense bar, and the addiction-services community worked diligently to create a successful model. Nonviolent offenders clinically addicted to alcohol and drugs are given an opportunity to receive effective treatment.

The New Jersey Office of the Public Defender represents more than 90 percent of drug court participants, undermining the claim that drug courts favor a more privileged socioeconomic group. Of the 8,004 people who, with the advice of lawyers at their sides, participated in New Jersey’s drug-court program, 1,577 successfully graduated. While 61 percent of those entering the program complete it, the employment rate at the time of graduation is 90 percent and the percentage of negative drug tests is 96 percent. Within three years of graduating, only 3 percent return to prison for a new crime, compared with a 60 percent rate of recidivism for inmates who do not receive treatment.

Although there are serious concerns raised by the National Association of Criminal Defense Lawyers that need attention, we should not be dismayed nor distracted. Funding should continue for easily accessible substance-abuse education, prevention, and treatment. As a community, we all benefit each and every time a person triumphs over his addiction to alcohol or other drugs and becomes a law-abiding, tax-paying citizen. Who needs drug court? We all do.

Los Angeles Daily Journal
October 22, 2009

Drug Courts Are the Most Sensible and Proven Alternative to Incarceration: So What’s the Problem?
by West Huddleston, Chief Executive Officer, National Association of Drug Court Professionals

The National Association of Criminal Defense Lawyers recently released a report criticizing 2,100 (there are actually 2,369) Drug Courts that offer effective treatment instead of incarceration for drug addicted offenders. Instead, the NACDL calls for the decriminalization of highly addictive drugs such as methamphetamine, heroin and crack cocaine as the solution to the drug problem. According to Cynthia Orr, President of the NACDL, “Drug Courts have not stymied the rise in both drug abuse or exponentially increasing prison costs to taxpayers” because, according to the NACDL report, “Drug Courts focus on first-time or nonviolent offenders.” The evidence says differently.

It is now 20 years since the first Drug Court was initiated and there has been more research published on its effects than on virtually all other criminal justice programs combined. The scientific community has put Drug Courts under a microscope and concluded that Drug Courts work better than jail or prison, better than probation, and better than treatment alone. Most medications have less scientific evidence supporting their safety and benefit to the public. The research is unequivocal: Drug Courts significantly reduce drug abuse and crime and do so at less expense than any other justice strategy; and according to rigorous and replicated studies conducted by the University of Pennsylvania, the more serious the offender’s drug addiction and length of criminal record, the better Drug Courts work. Drug Courts are not for the fist time or the non-addicted offender. Those individuals will do just as well by diverting them to a disposition that leads to record expungement upon successful completion of court conditions. Drug Courts focus on high-value offenders; those who have the highest need for treatment and other wrap-around services, and who have the highest risk of failing out of those services without support and structure.

Research demonstrates that nationwide, 70% of the approximately 120,000 seriously addicted individuals who voluntarily enter Drug Court with the assistance of their defense attorney complete it a year or more later and 75% of them remain arrest-free. A Drug Court participant is over twice as likely to stay clean and remain arrest-free as a newly released state inmate. Research also concludes that Drug Courts reduce drug abuse and improve employment and family functioning. These effects are not short-lived. The longest study on Drug Court to date shows these outcomes last as much as14 years. And more research is coming out every day.

Still, no one would argue that Drug Courts have realized their full potential. Drug Courts have not been made available to everyone who needs them. Half of U.S. counties do not have a Drug Court and the Drug Courts that do exist only have capacity to serve 10% of the serious drug-abusing and addicted offenders estimated to be in need. That’s the real issue.

New York has implemented a Drug Court in every county in the state. In a three year study, the New York State Court System estimates that $254 million in incarceration costs were saved by diverting 18,000 drug offenders into Drug Court. During the entire fifteen-year time period Drug Courts have been in operation throughout the state, New York has witnessed historic reductions in crime. And through the first half of this year, crime has fallen another 4.7 percent. According to a recent Northwestern University report, alternatives to incarceration like Drug Courts could lead to the closing of four half-empty adult prisons in New York. And a number of states such as Alabama, Missouri, New Jersey and Texas, among others, are following suit. In fact, in 2008, 44 state budgets included a specific appropriation for Drug Courts, totaling $208,000,000 nationwide. The Obama Administration and Congress is also investing in new Drug Courts and increasing the capacity of the 2,369 Drug Court already in existence in all fifty states and U.S. territories with a 250% increase in federal appropriations from the year before. That’s a great start, but far from what we need to reach the 1.2 million seriously drug abusing or addicted offenders who need treatment.

If no other sentencing option can compare with its success, shouldn’t we finish the job and give everyone who needs it access to these life-saving courts? It’s simple really. Drug Courts remain constrained by limited resources and by the more popular thinking that an alcoholic or addict can be punished out of their dependence.

It is no secret that prison has accomplished little to stem the tide of crime or drug abuse. Upon their release from prison, between 60% and 80% of drug abusers commit a new crime (typically a drug-related crime) and 85% to 95% relapse quickly to drug abuse. In some states, such as California, more than 75% will be returned to prison. And amazingly, these disappointing figures have done little to curb prison spending. National expenditures on corrections well exceed $60 billion annually. On average, states spend $65,000 per bed, per year to build new prisons and $23,876 per bed, per year to operate them

Unfortunately, it is also not sufficient to simply offer more treatment. Left to their own devices without intensive supervision by a judge, approximately 25% of offenders never arrive for a single treatment session. And among those who do show for treatment, most drop out prematurely before receiving any benefits. The power and authority of the Court is necessary to keep them engaged in treatment long enough to experience any lasting gains.

Drug Courts are judicially supervised court dockets that strike the proper balance between the need to help addicted offenders get free from the gasp of drugs and the need to protect community safety; between the need for effective treatment and the need to hold people accountable for their actions; between hope and redemption on the one hand and productive citizenship on the other. Drug Courts keep drug-addicted individuals engaged in treatment for long periods of time, while supervising them closely and holding them accountable for their obligations to society, their families and themselves. Participants are regularly and randomly tested for drug use, required to appear frequently in court for the judge to review their progress, and immediately receive rewards for doing well and sanctions for not living up to their obligations. All of this with one simple goal; get the addict clean and sober.

And everybody benefits when an addict gets clean and sober in Drug Court. The most conservative estimates by researchers show that for every 1.00 invested in Drug Court, $3.36 are saved by the justice system and up to $12.00 (per $1 investment) are saved by the community on reduced emergency room visits and other medical care, foster care, and property loss.

In Drug Court, we have an effective intervention that is not being fully implemented. Now is not the time to change course. It is our hope that a drug-addicted citizen should not need to be arrested in order to receive the help they require. But for the 1.2 million drug-addicted arrestees currently involved in the adult criminal justice system, the verdict is in: Drug Court is the solution and the passport to a new way of life. Now we must make the investment and finish the job.

Source: http://www.nadcp.org/setting-the-record-straight 2010

Can These Leopards Change Their Spots?

ndpa — Fri, 04 Nov 2011 13:17:47 +0000

RESPONSE TO THE NTA BUSINESS PLAN 2010/2011

Deirdre Boyd, CEO of the Addiction Recovery Foundation
Kathy Gyngell, chair of the Centre for Policy Studies’ Addictions working group

With the threat of abolition hanging over its head, the National Treatment Agency has cleverly extended its longevity by promising to mend its ways. It will, it announced on Friday, use the final two years of its now-extended life to change the policy it has promulgated over the past nine years.
“We’ve got to get rid of the centralised bureaucracy that wasteS money and undermines morale,” prime minister David Cameron stated in July. But the NTA would seem to have got the last laugh, with over £42.8million of taxpayer‘s money now allocated to it for two more years to change the disastrous system it created and has so steadfastly defended even in face of the indefensible.
The NTA will, it promises, help people get off the methadone dependency, tier 2/3 organisation dependency and state dependency which it created via its performance-managed targets. Its new Business Plan 2010/11, in a truly Orwellian “four legs bad, two legs good” style, now seemingly advocates the very abstinence approach its spokespeople have repeatedly declared to be unviable.
It will even consult rehabs, the NTA graciously announced – those very rehabs it has ignored for almost a decade and of whose success in getting addicts into drug-free and rewarding recovery Paul Hayes (yes, still the NTA’s CEO) has publicly belittled, scorned or downright denied. Could it be less than two years ago that the NTA’s ‘first point-of-contact’ told BBC Home Affairs editor Mark Easton that “rehab doesn’t work”? (see Comment 5th from bottom here for more derogatory comments from NTA senior managers).
But maybe this was not such a hard promise for the NTA top brass to make, as they look forward to their ‘brobdingnagian’ pension pots in two years’ time. After all, there are fewer rehabs to consult… For under the NTA regime, only 2-4% of addicts seeking help to quit drugs were actually referred to them. The result? Financial hardship, redundancies, the closure of over 20 specialist rehabs, more wing and bed closures and a loss of the real expertise required to rehabilitate addicts. And with their own personal futures well secured, would success of change be in their interest?
There isn’t any evidence for abstinence or for rehab, they have repeated declared. This is despite two national treatment outcomes surveys – Ntors and Doris – which indicate strongly to the contrary. It is also in face of experience. As Sir Ian Gilmore said yesterday, the “absence of evidence” about school milk for under fives is only that; it does not mean that it is not a good thing and has not helped children’s health. All experience suggests it certainly has, he insisted. Similarly with rehab: a joint report in 2008 by the Commission for Social Care Inspectorate with the NTA itself that “residential rehabs outstrip other sectors in every outcome group we measure”.
The NTA seems to have bamboozled the Department of Health and a too readily believing government. For who have they tasked to change their policy and now shift people into ‘recovery’? Brazenly, it has appointed as one of the duo the addiction psychiatrist most closely associated with the failed medico-clinical treatment approach of the past 20 years years, one of the the proponents and instigators of the last government’s failed treating-drugs-with-drugs approach so loved by the NTA, key lobbyist for counterintuitive, expensive and ethically questionable prescribing programmes: John Strang of the National Addiction Centre.
In his capacity as a director of the UKDPC – recipient of millions of charitable funds to, among other briefs, redefine for the nation the notion of (addiction) recovery – Strang chose to use this remit to ensure that any new official definition of recovery excluded full abstinence, ignoring all expert advice to the contrary.
Nor did he stop there. His UKDPC’s plan was to use this new definition of “recovery” to replace real total drug-free outcomes as the measure for the NTA’s Treatment Outomes Profile forms, meaning that their targets could be easily be hit. Very convenient. For, in one Orwellian sleight of hand, the NTA could claim a recovery outcome when no such thing had been achieved. A reduction in injection frequency would suffice. This would be the basis of NTA’s (aspirationless) claims of treatment success. In face of the derision this deserved, the NTA has gone on record saying it does not define recovery at all now – despite the fact that “recovery” is the raison d’etre of its Janus-faced Business Plan 2010/2011. That all the goals and actions therein are meaningless can thus be taken as read.
For example, there is apparently no plan to replace the discredited and bureaucratically heavy Top form. It will be forced on ever more people. The NTA states, too, that it has looked at the ASAM patient placement criteria. Yet instead of contacting the creators of this highly-researched method, it plans to reinvent the wheel and spend taxpayer money developing a version for its own purposes. It also plans to spend more taxpayer money on a mutual aid directory. Yet this is already provided free by Addiction Today. Under Championing abstinence-focussed treatment in the business plan… well, for further help interpreting the Business Plan’s double speak, read our glossary.
It is, however, commendable that Dr David Best, who has wriiten so cogently and expertly on abstinence-based recovery in the pages of Addiction Today and other professional journals, has been appointed as the other half of the recovery duo. We wish him the very best of luck in counterbalancing his former mentors, and getting them on the true road to recovery with a Damascene conversion. They should heed him, for he is the only person giving this exercise any credibility.
As David Cameron said in June,“There is a problem in our national health service, in that we spend too much time treating the symptoms rather than necessarily dealing with the causes… All addictions need proper attention, and proper treatment and therapy, to rid people of their addictions”.
We really would love to believe, as he and many in government must wish to believe, that we will witness the NTA’s respecting the trust that has been placed in it and seeking the rehab expertise that actually helps people to get off life-destroying drugs and rebuild their lives and their families’ lives. But the serious worry is that this initiative for change get will be lost in adherence to disinformation and blowback, and submerged in intransigent ideology about the non-recoverability from addiction. Of even more concern, will its lack of understanding continue to marginalise the expertise necessary to help the 330,000 or so addicts desperate for the sobriety which is the basis for them to get back, or get for the first time, their self esteem and their lives?
We will be happy to be proved wrong. But we are not holding our breath.

Source: www.addictiontoday.org. 10th August 2010

Methadone is linked to one in three drug deaths

ndpa — Fri, 04 Nov 2011 13:14:12 +0000

CALLS have been made for a rethink on the use of methadone in Scotland after official figures revealed the number of deaths in which it was implicated reached a ten-year high last year.
Amid a general fall in people being killed by drugs, fatalities in which the heroin substitute was cited as a contributory factor rose to 173 in 2009, up from 169 in 2008 and a surge of 51 per cent since 2007 when it was associated with 114 deaths. The controversial drug treatment was found to be at least partly responsible for more than a third (32 per cent) of all of the 545 drug-related fatalities in Scotland last year, and was associated with the second-highest number of drug-addict deaths after heroin or morphine, which contributed to 322 losses of life – 59 per cent of the total.

The 2009 methadone figure also equates to roughly one death every 48 hours.

The rising number of deaths linked to methadone led to calls for the policy of wide prescription of the treatment to addicts to be reviewed, with one drug-misuse expert describing the current situation as being of “enormous concern”.

Professor Neil McKeganey, the director of the Centre for Drug Misuse Research at Glasgow University, said: “The situation in relation to methadone – where it appears we have around a third of addict deaths associated with the drug we are prescribing most widely to treat drug addiction – is of enormous concern. We really ought to be looking again at this policy of widespread methadone prescribing. The statistics are inescapable – we ought to be looking at why we are doing it and whether all of those to whom it is being prescribed are deriving benefit from it.”

Peter McCann, the chairman of the Castle Craig Hospital for alcoholism and drug addiction, lent his weight to the calls, adding: “Today’s drug-death figures would have been described as totally catastrophic just a few years ago. There must now be a total rethink in Scotland along the lines of the National Treatment Agency in England which totally reversed its policy earlier this month. “They will be limiting the use of methadone with strict multi-disciplinary assessments at regular intervals. The policies prescribing methadone in Scotland have obviously failed and must be revised.”

Murdo Fraser, Scottish Conservative health spokesman, said the focus of the Scottish drugs strategy should be on recovery and abstinence. He said: “The attempts of the last decade to merely manage the problem, based on harm reduction and an over-reliance on methadone, just have not worked. The challenge now is to expand the range of rehabilitation services on offer and move to abstinence and recovery.”

But the treatment was defended by Biba Brand of the Scottish Drugs Forum: “We know from research that staying on methadone tends to prolong their life by about 13 per cent. “We also know that of those deaths that are occurring (overall], two-thirds are outwith treatment, so being in treatment – and generally that involves methadone – is helping people stay alive. Methadone can help save lives, but we need to help people progress through treatment.”

A Scottish Government spokesman added: “We do not favour one form of treatment over any other. Decisions on the most appropriate treatment to prescribe an individual are for clinicians, in discussion with their patients and in line with national guidelines.”

Overall, the number of people killed by drugs in Scotland fell by 5 per cent since 2008, but the 545 drug-related deaths during 2009 equated to the second-highest total ever recorded; an increase of 20 per cent since 2007 and a rise of 87 per cent since 1999.

A wider analysis, using figures recorded by the Office for National Statistics, showed the number of deaths related to drugs in Scotland last year was 716, down from 737 in 2008, but a rise from the 2007 total of 630.

This figure included people killed by solvent abuse, legal highs and through overdoses of prescription medication. It also included people dying with mental-health problems linked to drug abuse, as well as those killed by the health complications allied to contaminated drugs. More than a third of all deaths in Scotland, some 200, were in the Greater Glasgow and Clyde NHS board area, and this represented the highest total on record. Deaths in Lothian dropped, by 13 to 81, as did fatalities in Fife (37 to 32) and Forth Valley (23 to 14).

There was also a rise in the number of older people dying from drugs, with deaths among those aged 35 and over rising from 271 in 2008 to 296 in 2009, while at the same time deaths among users under 35 dropped from 303 to 249.

Source: News.Scotsman.com 18th Augutst 2010

Planning Commission to consider ban on medical marijuana dispensaries

ndpa — Fri, 07 Oct 2011 11:03:23 +0000

by Eric Pierce

The Planning Commission will consider on Wednesday asking the City Council to revise the city charter to permanently bar medical marijuana dispensaries from operating in Downey.
Citing federal law that still makes it a crime to grow, use or possess marijuana, city administrators recommend the charter be amended to prohibit the dispensaries.

The City Council last year enacted a moratorium on medical marijuana clinics that is scheduled to expire Nov. 10.

In a report prepared by community development director Brian Saeki and senior planner David Blumenthal, city officials also cited reports of violent crime — specifically robberies and homicides — at dispensaries in neighboring cities.

“Besides crimes against persons and property, the operation of medical marijuana dispensaries has been linked to organized criminal activity, money laundering and firearm violations,” the report states.

California voters approved the use of marijuana for medicinal purposes in 1996. The state created a voluntary medical marijuana identification card program in 2003 to protect residents from state marijuana laws. The San Diego Union-Tribune reported in June that of California’s 481 incorporated cities, 132 have banned medical marijuana dispensaries. Another 101 have enacted temporary moratoriums.

Best, Best & Krieger, before they were fired as the city’s law firm, wrote a whitepaper suggesting Downey had the discretion to either regulate or prohibit medical marijuana clinics. The law firm also warned the city against “adverse secondary impacts” dispensaries could pose. “On balance, any utility to medical marijuana patients in care giving and convenience that marijuana dispensaries may appear to have on the surface is enormously outweighed by a much darker reality that is punctuated by the many adverse secondary effects created by their presence in communities,” Best, Best & Krieger wrote. “These drug distribution centers have even proven to be unsafe for their own proprietors.”

The city of Los Angeles recently approved a restrictive ordinance aimed at corralling the city’s estimated 400 medical marijuana dispensaries. Attorneys representing marijuana dispensaries given shut-down notices have said they will sue Los Angeles to remain open.

Only one medical marijuana dispensary has operated legally in Downey. It closed after the city’s moratorium went into effect late last year.

Source: www.thedowneypatriot.com 31st Aug.2010

Drug seizures almost treble at city prison

ndpa — Fri, 07 Oct 2011 11:01:39 +0000

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

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

Marijuana and Youth – Experiences From a Practising Physician

ndpa — Fri, 07 Oct 2011 10:59:50 +0000

The impact medical marijuana has had on our adolescent substance-abuse treatment program in Denver is profound.

The 2009 boom in marijuana distribution coincides with a tripling of teens referred to our program. Currently, 51 percent of our patients report getting their marijuana from someone with a medical marijuana license.

Not surprisingly, patient attitudes about marijuana are changing – and in ways that make it much more difficult for us to help them stop using the drug. Recently, a teenage boy said he couldn’t stop smoking marijuana because “it is my medicine for anger.”

Even worse, a few young adult patients in treatment for marijuana addiction have marijuana licenses. These patients struggle with conflicting messages from one physician who recommends smoking marijuana and another who recommends stopping.

In Denver, marijuana is advertised on billboards and in magazines and newspapers using themes that appeal to young people. Because youth are highly vulnerable to both the effects of advertising and the addictive potential of marijuana, it is not surprising that 60 percent of the state’s medical marijuana users are under 44 years old.

We must act swiftly to prevent situations such as this from getting worse.
Christian Thurstone, M.D. is the Medical Director of Adolescent Substance Treatment, Education and Prevention at Denver Health and Hospital Authority and Assistant Professor, Department of Psychiatry, University of Colorado Denver.

Source: http://ofsubstance.gov/cs/blogs Wednesday, October 13, 2010

New habits for old

ndpa — Fri, 07 Oct 2011 10:56:45 +0000

The extension of “payment by results” to the treatment of drug addicts will test the method’s limits

AT PHOENIX FUTURES in Birmingham, Karen is six weeks into a programme of group therapy sessions, life-skills training and one-on-one meetings with her keyworker, Dean. Things are looking pretty good. A former heroin user, she was on methadone for years before going into residential rehab last October. Karen now takes a relatively low dose of Subutex, a weaker heroin substitute, which she intends to come off altogether over the next six weeks. She credits her treatment with giving her the stability to have her three-year-old son to stay with her at weekends, and hopes to take a course or get a job—and eventually to work with drug users—once she is fully abstinent.
There are many Karens in Britain, though most are not doing as well as she is. Around 320,000 people are thought to be on heroin or crack cocaine or both in England alone. Many more use cannabis (the most popular drug), powder cocaine or a constantly changing clutch of designer drugs and legal highs: in all, almost 3m in England and Wales used some sort of illegal drug in 2009-10. A big push by the previous Labour government lifted the numbers in treatment (see chart), and drug use seems to be falling a bit now. But it remains high by European standards. Some argue that too many users have been “parked” on methadone rather than encouraged to kick chemical dependence altogether.
Intent on remedying what the Conservatives see as the persistent ills of “broken Britain”, the Tory-led coalition government has big ambitions in drugs policy. It wants to get more people through treatment and functioning again—free of drugs if possible, but also employed, housed and law-abiding. There is a moral dimension to its emphasis on recovery rather than harm reduction, but also an economic one. Use of heroin or crack cocaine is linked to between a third and a half of all acquisitive crimes; an estimated 400,000 benefit claimants who are dependent on drugs or drink cost the Treasury £1.6 billion a year; and demands on the health service and criminal-justice system are great. The coalition’s commitment is real: at a time of screaming budget cuts, central-government funds for drug treatment in communities and prisons have barely been hit.
A key plank of the strategy is “payment by results”. This approach to delivering public services—rewarding charities, community groups or private firms not for what they do but for how well they do it—has been seized on gratefully by a cash-strapped government. Versions are being tried to get welfare recipients into work and discourage criminal reoffending. Now eight drug-treatment pilots are to be launched. This breaks new ground internationally, says Martin Barnes, the head of DrugScope, a drug-information charity.
No magic wand
The theoretical argument for payment by results is that, by rewarding only success, it drives up standards while reducing costs. “It will make organisations focus on delivering quality services because they won’t survive if they don’t,” says David Biddle, deputy chief executive of CRI, a charity whose drug and alcohol services have grown rapidly. Kent is one area chosen for a payment-by results pilot. “Commissioners will now have the opportunity to reward those who innovate, and deliver efficient and effective services,” says Amanda Honey of Kent County Council.
Not everyone is sure that payment by results will work in drug treatment, however. Outcomes are hard to measure. In welfare-to-work schemes, a claimant either gets and holds a job or he doesn’t. A prisoner is convicted of reoffending or he isn’t. With drugs, progress often consists of baby steps on various fronts, which is why the government proposes to pay for a range of positive outcomes including jobs, housing and so forth. Coming up with precise measures is proving hard.
Setting tariffs is difficult, too. Payment by results works only if risk is transferred to the provider. But drug users are prone to relapses, and recovery can take years. Most not-for-profits in drug treatment are small; they need payment along the way to cover their costs. If instead they become subcontractors to larger outfits, a one-size-fits-all approach could replace the tailored solutions seen by many as a key to success. Whoever is contracted, “if the basic tariff isn’t enough, it will wipe out the chances of the provider doing anything good. If it’s too much, then there is no risk transfer. If it’s the wrong mix [of incentives], then it encourages gaming,” says Lord Adebowale, the chief executive of Turning Point, a health and social-care organisation.
Despite the challenges, Turning Point and CRI are both interested in the trials. For its part, smaller Phoenix Futures has started offering a payment-by-results option off its own bat. “I wanted us to be ready,” says Karen Biggs, its chief executive.
But other uncertainties loom, as more administrative power is pushed down from Whitehall. From 2013 the funds earmarked by central government for drug treatment in the community (currently about £500m) will be handed over by Public Health England, a new bit of the NHS, to local authorities; drug and alcohol funding will merge, and perhaps disappear into the overall public-health pot. New elected police and crime commissioners will have a say in this area, as might local GPs newly charged with commissioning health care.
Anne Milton, the minister for public health, is determined that money will not leak away from drug treatment, counting on a national “outcomes framework” to make sure that needs which are not regarded as a priority locally continue to be met. Payment by results in this complicated and difficult area might prove transformative in all the right ways—or it might turn out an unholy mess. If it does work, says one sceptical charity, “they can use payment by results to deliver absolutely anything.”

Source: www.economist.com 14th April 2011

Letter – Portugal is hardly a resounding success

ndpa — Fri, 07 Oct 2011 10:54:27 +0000

Letter published in The Times April 25th 2011
Sir,
Portugal is hardly the resounding success that the drugs liberalising lobby would have us believe
That fewer young people are trying drugs in Portugal may be the case (“Radical drug law could be imported to Britain”, April 22). But this simply reflects a Europe-wide trend, nowhere more evident than in the United Kingdom. The alarming Europe-wide increase in young people’s illicit drug use between 1995 and 2003 has come to a halt and is decreasing — in Portugal by rather less than the European average.
The picture painted by your report is less rosy overall when the data is examined fully. For according to Portugal’s Special Registry of the National Institute of Forensic Medicine, there has actually been an increase in Portugal’s drug-related deaths since decriminalisation was enacted, from 280 in 2001 to 314 in 2007. In well over half of these cases, opiates or opiates in combination with other substances (mainly cocaine or alcohol) were cited as the main substance involved.
Furthermore Portugal has been the only European country to show a significant increase in [drug-related] homicides between 2001 and 2006, by 40 per cent over a five-year period (2009 UNODC World Drug Report).
Finally, Portugal’s Instituto da Droga e da Toxicodependência reports that the overall prevalence of life time drug use increased from 7.8 per cent to 12.0 per cent in the period from 2001 to 2007, cocaine more than doubling and ecstasy close to doubling, with the prevalence of heroin abuse up from 0.7 per cent of the adult population to 1.1 per cent in the same period.
As to the decreases in new cases of HIV/Aids, not only is this also in line with a Western European trend but it is just as, if not more, plausible to associate this with Portugal’s annual increases in funding for treatment, detox and harm reduction than with the act of decriminalisation per se.
Portugal is hardly the resounding success that the drugs liberalising lobby would have us believe. And if it is what they are relying on to convert politicians and public to their cause it makes for a poor case.
Kathy Gyngell
Research Fellow, Centre for Policy Studies
Neil McKeganey
Professor of Drug Misuse, Centre for Drug Misuse Research, University of Glasgow
Mary Brett
Trustee, Cannabis Skunk Sense

Source: http://www.thetimes.co.uk/tto/opinion/letters/article2997948.ece 25.4.2011

Radio 4 Any Questions – Drug Police Debate

ndpa — Fri, 07 Oct 2011 10:51:31 +0000

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

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

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

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

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

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

Finally, the suggestion that legalisation would somehow remove criminality from drug supply is ridiculous. Criminality loves use-reinforcing substances and behaviours. Over 20% of the UK tobacco market is smuggled, counterfeit or both. In some other countries, the figures are worse. Legalisation or decriminalisation of substances unfit for human consumption should occur only if a demonstrable “public good” can be evidenced. The problem for the legalisation lobby is that it
cannot.
DAVID RAYNES is executive councillor of the
UK National Drug Prevention Alliance (http:// drugprevent.org.uk/ppp/about-us).

Source: Addiction Today July/August 2011

Genetic Risk Factors for both Marijuana and Alcohol Misuse Similar

ndpa — Tue, 04 Oct 2011 13:51:59 +0000

• Marijuana is the most commonly used illicit drug in the United States.
• New research shows that the use and misuse of alcohol and marijuana are influenced by a common set of genes.
Marijuana is the most commonly used illicit drug in the United States. Roughly eight to 12 percent of marijuana users are considered “dependent” and, just like alcohol, the severity of symptoms increases with heavier use. A new study has found that use and misuse of alcohol and marijuana are influenced by a common set of genes.
Results will be published in the March 2010 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.
“Results from a large annual survey of high-school students show that in 2008, 41.8 percent of 12th graders reported having used marijuana,” explained Carolyn E. Sartor, a research instructor at Washington University School of Medicine and corresponding author for the study. “Although many may have used the drug on only a few occasions, 5.4 percent of 12th graders reported using it daily within the preceding month.”
“The active ingredient in marijuana is THC, which mimics natural cannabinoids that the brain produces,” added Christian Hopfer, associate professor at the University of Colorado School of Medicine. “The cannabinoid system is critical for learning, memory, appetite, and pain perception. Most users of marijuana will not develop an ‘addiction’ to it, but perhaps one in 12 will. What is not commonly appreciated about marijuana use is that strong evidence has emerged that it increases the risk of developing mental illnesses and possibly exacerbates pre-existing mental illnesses.”
“Like any drug, marijuana can be used in a way that negatively impacts quality of life, interfering with functioning at school or work or leading to problems with family and friends,” said Sartor. “Although at least three of six symptoms listed in the Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition (DSM-IV) are needed to meet full criteria for cannabis (marijuana) dependence … the presence of even one or two of these symptoms could create distress or interfere with day-to-day functioning. There is strong evidence for a genetic component to use and dependence on marijuana as well as alcohol, and the use (and misuse) of these substances frequently occur together.”
Researchers examined 6,257 individuals (2,761 complete twin pairs and 735 singletons) listed in the Australian Twin Registry, 24 to 36 years of age. Alcohol and marijuana use histories were gathered in telephone diagnostic interviews and used to derive levels of alcohol consumption, frequency of marijuana use, and DSM-IV alcohol and cannabis dependence symptoms.
“Our findings indicate that … many of the same genetic factors that contribute to alcohol use also contribute to marijuana use,” said Sartor. “Likewise, alcohol dependence symptoms and cannabis dependence symptoms can be traced to some of the same genetic influences. For both alcohol and marijuana, the majority of genetic factors that contribute to use also contribute to dependence symptoms.”
“In other words,” said Hopfer, “the genetic influences on drug use are not specific to individual drugs, but seem to influence a general tendency to engage in drug use. This is important to note because there is a tendency to study drugs in isolation – alcohol, tobacco, marijuana, cocaine, etc. These findings add support to the notion of common mechanisms underlying all addictions.”
“The fact that very little of the environmental influences on alcohol and marijuana use, or on alcohol and cannabis dependence symptoms, could be traced to common sources indicates that there may be important distinctions between those environmental factors that influence alcohol-related outcomes and those that influence marijuana-related outcomes,” said Sartor. “Identifying alcohol- and marijuana-specific risk factors is an important next step in this line of research.”
“Marijuana research is relatively sparse compared to alcohol or nicotine research,” added Hopfer. “However, if you look at reports of at least adolescents and young people using, it becomes clear that marijuana use, including daily marijuana use, is quite common and the effects of this are not well understood. The mental illness/marijuana connection has not received much press, although I think the evidence has grown substantially that marijuana is a causal risk factor for the development of mental illness.”

Source: http://www.attcnetwork.org/explore/priorityareas/science/tools/asmeDetails.asp?ID=643