Source: John Coleman Drug-Watch International Feb.2010

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

Source: Times Online 17th March 2010

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

“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.
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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.

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

Source: www.guardian.co.uk 28th May 2010

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

Source:www.addictiontoday.org. July 10th 2010

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

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

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

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

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

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

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

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

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

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 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

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

• 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

Research Summary

Alcohol consumption prompts the brain to release the pleasure chemical dopamine, but genes may influence the degree to which the brain responds to drinking and — by extension — how effective medications like naltrexone are in treating alcoholism.
Researchers at the National Institute on Alcohol Abuse and Alcoholism (NIAAA) found that genetic variations in the mu-opioid receptor sites in the brain’s reward system seem to influence the release of the neurotransmitter dopamine and the degree of pleasure that individuals get from drinking.
Researchers also found that naltrexone — a drug that works to block the release of dopamine resulting from drinking — was more effective for patients with some genetic profiles than others.
“Our data strongly support a causal role of the 118G variant of the mu-opioid receptor to confer a more vigorous dopamine response to alcohol in the ventral striatum,” said NIAAA researcher Vijay A. Ramchandani, Ph.D. “The findings add further support to the notion that individuals who possess this receptor variant may experience enhanced pleasurable effects from alcohol that could increase their risk for developing alcohol abuse and dependence. It may also explain why these individuals, once addicted, benefit more from treatment with blockers of endogenous opioids.”
Markus Heilig, NIAAA’s clinical director, noted that naltrexone also worked better in the early stages of alcoholism, when the body still believes it is being rewarded for drinking (‘reward craving’). At a certain point, however, the brain switches to a pattern called ‘relief craving’ — what Heilig called a “pathological pattern of anxiety” — where naltrexone isn’t nearly as helpful.
The latest findings were published online in the journal Molecular Psychiatry.

Source: Join Together May 20, 2010

Hospitalizations for alcohol and drug overdoses – alone or in combination – increased dramatically among 18- to 24-year-olds between 1999 and 2008, according to a study by researchers at the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health.

Led by Aaron M. White, Ph.D. and Ralph W. Hingson, Sc.D., of NIAAA’s division of epidemiology and prevention research, the study examined hospitalization data from the Nationwide Inpatient Sample, a project of the U.S. Agency for Healthcare Research and Quality designed to approximate a 20 percent sample of U.S. community hospitals. The findings appear in the September issue of the Journal of Studies on Alcohol and Drugs.

Drs. White, Hingson, and their colleagues report that, over the 10-year study period, hospitalizations among 18-24-year-olds increased by 25 percent for alcohol overdoses; 56 percent for drug overdoses; and 76 percent for combined alcohol and drug overdoses.

“In 2008, 1 out of 3 hospitalizations for overdoses in young adults involved excessive consumption of alcohol,” noted Dr. White. “Alcohol overdoses alone caused 29,000 hospitalizations, combined alcohol and other drug overdoses caused 29,000, and drug overdoses alone caused another 114,000. The cost of these hospitalizations now exceeds $1.2 billion per year just for 18-24-year-olds.”

According to the authors, this is a growing problem for those outside of the 18-24 age range, as well.

“Among the entire population 18 and older, 1.6 million people were hospitalized for overdoses in 2008, at a cost of $15.5 billion, and half of these hospitalizations involved alcohol overdoses,” added Dr. Hingson.
The current study also showed an increase of 122 percent in the rate of poisonings from prescription opioid pain medications and related narcotics among 18-24 year olds. An alcohol overdose was present in 1 of 5 poisonings on these medications.

“The combination of alcohol with narcotic pain medications is particularly dangerous, because they both suppress activity in brain areas that regulate breathing and other vital functions,” Dr. White said.

The researchers noted that the steep rise in combined alcohol and drug overdoses highlights the significant risk and growing threat to public health of combining alcohol with other substances, including prescription medications. They call for stronger efforts to educate medical practitioners and the general public about the dangers of excessive alcohol consumption alone or in combination with other drugs.

“An increase in screening for alcohol misuse would help clinicians identify patients at particularly high risk for excessive drinking and for alcohol and medication interactions,” said NIAAA Acting Director Kenneth Warren, Ph.D. “Clinicians should use brief intervention techniques to help young adults evaluate their relationship with alcohol and other drugs and make wise choices regarding future use

Source www.cadca.org Sept. 2011

(St. Petersburg, FL) The National Survey on Drug Use and Health conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) and released this week shows a significant rise in marijuana use. In 2007, 4.4 million Americans 12 and older used marijuana; as of 2010 that number has risen to 17.4 million. The National Office of Drug Control Policy’s Director, Gil Kerlikowske, said the increases are prominent in states in which “medical” marijuana is legal. The survey also shows that 21.5 percent of young adults aged 18 to 25 used illicit drugs in 2010, an increase from 19.6 percent in 2008.

“Other than the lone voice of Director Kerlikowske and large marijuana dispensary raids by the DEA, the Obama Administration has basically turned a blind eye to the medi-pot issue, a matter that fuels the rise in marijuana use and continues to be the biggest scam ever to be perpetrated on the American public. While a crude toxic weed is peddled to sick and dying people as a medicine, our government has done far too little to protect the public. It is absolutely no surprise to me that marijuana use has sharply increased,” said Calvina Fay, executive director of Drug Free America Foundation, Inc. and Save Our Society From Drugs.

“Surveys have shown for years that when the perception of the harms of drugs decreases, use rises. The ruse that marijuana is a medicine has created a false sense that this addictive, dangerous drug is not harmful, but in fact helpful. Clearly, this belief has contributed to the increase of marijuana use among young people. In order to protect the public, it is time for our government to take its head out of the sand and aggressively push back against marijuana legalization for any purposes! Perhaps it’s time to withhold federal funds from states that fail to uphold our nation’s drug laws,” Fay concluded.

Source: Press Release Drug Free America Foundation 9th Sept.2011

A significant increase (more than 10-fold) in the number of newly diagnosed HIV-1 infections among injecting drug users (IDUs) was observed in Greece during the first seven months of 2011. Molecular epidemiology results revealed that a large proportion (96%) of HIV-1 sequences from IDUs sampled in 2011 fall within phylogenetic clusters suggesting high levels of transmission networking. Cases originated from diverse places outside Greece supporting the potential role of immigrant IDUs in the initiation of this outbreak.

Source: Eurosurveillance, Volume 16, Issue 36, 08 September 2011

Removing branding and wrapping cigarettes in plain packaging helps remove the appeal of smoking according to new a Cancer Research UK-funded study published in Tobacco Control.
The researchers found that more women than men smoked less and found smoking less enjoyable when using the plain packs.
Some smokers also claimed that they would be more likely to attempt quitting if all cigarettes came in the dark brown unbranded packs used in this study.
In the first study of its kind nearly 50 young adult smokers used non branded cigarette packets in normal everyday situations for two weeks. The researchers then compared the reaction to this packaging to the reactions of using regular packs for two weeks.
The plain brown packs were given a fictional name with standard branding and the health warning “Smoking Kills”. Twice weekly questionnaires were followed up with face to face interviews for more in depth analysis of reaction.
Plainly wrapped cigarettes were rated negatively against the original packs. Taking out the cigarettes less often, handing out cigarettes less frequently and hiding the pack more were all reported as a result of the plain packaging.
Dr Crawford Moodie, the study’s lead author based at the University of Stirling, said: “Despite the small size of this study it adds an important real world dimension to the research on the way smokers respond to plain packaging. The study confirms the lack of appeal of plain packs, with the enjoyment and consumption of cigarettes being reduced. We’re now looking to build on this research to understand more about the impact of packaging on smokers.”
The UK government is expected to begin a public consultation on the future of tobacco packaging later this year.
Australia should be the first country in the world to wrap cigarettes in plain packaging. The Australian government has announced that all tobacco must be sold in plain packaging from July 1, 2012. Picture health warnings will also cover 75 per cent of the front and 90 per cent of the back of packs.
Jean King, Cancer Research UK’s director of tobacco control, said: “While a small study, this research provides important insights into the power of cigarette packaging. Colourful and slickly designed packs are one of the last remaining avenues for tobacco companies to market their deadly product, so it’s interesting to see what might happen if and when this is removed. It’s important to remember that smoking remains the single biggest preventable cause of death in the UK, so preventing more people from starting and helping smokers to quit is vital. We look forward to the possibility of removing the silent salesman of cigarette packets.”

Source: http://www.cancerresearchuk.org/ 8tj Sept. 2011

Guernsey’s Health and Social Services Department has issued a warning about the danger of a toxic chemical found locally in cocaine.
The department said levamisole had been detected in recent samples of the drug.
It said that some people who ingested the chemical developed agranulocytosis, a potentially fatal condition that harms the immune system.
Dr Roland Archer, the States analyst, said: “This is the first time that it has been detected in Guernsey.”
He said: “Once levamisole has been added to cocaine, it is nearly impossible to remove it and it even survives processing of cocaine into ‘crack’.”
New equipment costing £80,000 has enabled the department to examine drugs at a molecular level.
A gas chromatograph mass spectrometer, recently purchased by the department, helped find the substance.
Dr Archer said: “It gives us a lot more confidence when presenting the data on controlled drugs.”

Source: www.bbc.co.uk 26th August 2011

AstraZeneca is adding a new heart warning to the labels of Seroquel, a antipsychotic drug, at the request of the Food and Drug Administration. The revised label, posted on the Federal Food and Drug Administration website, says Seroquel and extended-release Seroquel XR “should be avoided” in combination with at least 12 other medicines (including methadone) linked to a heart arrhythmia that can cause sudden cardiac arrest.

Source: http://www.nytimes.com/2011/07/19/health/19drug.html?_r=1 July 2011

Slovenian study identifies which chemicals in the blood best identify dependent drinkers in the sense of not missing those who are dependent, confirming when they have stopped drinking, and not falsely identifying non-dependent people as dependent.

Summary

The aim of this study was to determine the value of biochemical tests for glutamate dehydrogenase (GLDH) in the blood as way of diagnosing alcohol dependence, in particular as compared to or in combination with other biochemical markers including gama-glutamyltransferase (GGT), aspartate-aminotranferase (AST), alanine-aminotransferase (ALT) and erythrocyte mean cell volume (MCV). All these levels were assessed three times in 238 alcohol dependent patients admitted to hospital (on admission, after 24 hours and after seven days) and also in healthy members of the public.
Main findings All the values were significantly higher in the patients than in healthy persons. GLDH exhibited the fastest decrease in levels after the resumption of abstinence. 24 hours of non-drinking is sufficient for a reliable evaluation of the fall in GLDH activity, even more so when alcohol dependants had not drunk for three to seven days, offering a way to confirm the cessation of drinking. The time course of changes in GLDH and AST were more applicable than for GGT after a week, but GLDH changes were most reliable. GLDH was the most specific marker with almost 90% specificity, correctly identifying nine in 10 of the healthy subjects as non-dependent. A decision tree combining MCV,
GGT and GLDH markers was selected as the best diagnostic procedure because of its simplicity, easy examination and moderate cost. It gave a model with 84.5% accuracy, excellent specificity at 90% (correctly identifying 9 in 10 healthy subjects as non-dependent) and very high sensitivity at almost 80% (correctly identifying 8 in 10 alcohol dependent patients as dependent).

Conclusions

The high accuracy of our classification model provides an opportunity to apply it as a helping method in finding and diagnosing alcohol dependence in everyday practice, with our exclusion criteria and differential diagnostic cautions taken into consideration. We strongly believe that watching changes in the activity of laboratory markers of alcoholism is an effective yet overlooked aid.
Thanks for their comments on this entry in draft to Matej Kravos of the Psychiatric Hospital Ormoz in Slovenia. Commentators bear no responsibility for the text including the interpretations and any remaining errors.

Source: Kravos M., Malešic I.
Alcohol and Alcoholism: 2010, 45(1), p. 39–44. Revised 22 Aug.2011

It was the party drug of the 90s. But alarmingly Ecstasy’s popularity seems to be rising again. A worrying trend is re-emerging for the illegal substance after U.S. hospital admissions involving Ecstasy leapt 74.8 per cent in just four years, according to a national study.
Most of the Ecstasy-related hospital visits involved patients aged 18 to 29, but notably 17.9 per cent involved children as young as 12
The Substance Abuse and Mental Health Services Administration (SAMHSA) study indicated the number of hospital emergency visits involving Ecstasy increased from 10,220 in 2004 to 17,865 visits in 2008.
Slightly more than half (52.8 per cent) of the emergency visits were male, the study found. More than a third of the Ecstasy-related visits were made in the South (34.0 per cent) while nearly a third were in the West (31.4 per cent).
Nearly a fifth were made in the Midwest (18.5 per cent), and nearly a sixth were made in the Northeast (16.1 per cent).
But in another alarming trend the study also found that 77.8 per cent of these visits – almost 8 in 10 cases – also involved the use of at least one of more other substances alongside Ecstasy.
The most common drugs used in combination with Ecstasy are marijuana, alcohol and cocaine.
In cases where patients were 21 or older 39.7 per cent had taken Ecstasy with three or more other drugs.
‘The resurgence of Ecstasy use is cause for alarm that demands immediate attention and action,’ said SAMHSA Administrator Pamela S Hyde, J D.

The drug induces feelings of euphoria but can produce psychedelic and stimulant side effects such as anxiety attacks, hypertension and even hypothermia.
The variety and severity of these can increase when the drug is used in combination with other substances.
Dr Peter Delany, director of the Centre for Behavioural Health Statistics and Qualities at SAMHSA, said the agency ‘needed to start digging’ to find the cause of the spike in admissions. ‘Kids are getting it (Ecstasy) at raves and parties, which may indicate a return to social gatherings,’ he said. ‘It is also probably a very cheap drug,’ he added.
‘The largest group of people (doing Ecstasy) are 18 to 29. These are people who have a lot more freedom and a lot more money,’ he said. He also cited the need for prevention education to continue well into adulthood to address this age group.
The more pressing issue, Dr Delany said was the people who were admitted to hospital with more than one substance in their system. ‘Ignorance is part of it,’ he said. ‘There is a lot of risk taking in that age group. ‘This (Ecstasy) is not a safe drug. The first time out of the door can have some serious side effects. When you are mixing it with multiple drugs you don’t know what the reaction will be. Everyone is different,’ he said.
Dr Delany also cited so-called ‘pharm’ or ‘trail mixing’ parties, when young people put a collection of drugs into a bowl and it becomes a very dangerous lucky dip.
But these bowls don’t just contain illegal drugs, they also contain prescription drugs raided from parents’ medical cabinets. Another report by SAMHSA found there has also been a dramatic rise in emergency visits associated with the misuse of prescription drugs.
From 2004 to 2008 these rose from 144,644 visits to 305,885 visits a year and occurred among men and women, as well as among those younger than age 21 and those 21 and older.
The three prescription opioid pain relievers most frequently involved were Oxycodone products (rose 152 percent), Hydrocodone products (rose 123 per cent) and Methadone products (rose 73 per cent).
‘These alarming findings provide one more example of how the misuse of prescription pain relievers is impacting lives and our health care system,’ said SAMHSA administrator Pamela S Hyde. ‘This public health threat requires an all-out effort to raise awareness of the public about proper use, storage, and disposal of these powerful drugs.’

Source: www.dailymail.co.uk 25th March 2011

WEEKLY DRINKING
Weekly drinking is reported among even the youngest children in the survey. At age 11, 3% of young people report drinking alcohol every week (4% of boys and 2% of girls)). One in ten 13-year olds (10%) and more than a quarter of 15- year olds (27%) are weekly drinkers. Among 13 and 15-year olds, there is no gender difference in weekly drinking.
In all six surveys since 1990, young people have been asked about their alcohol consumption frequency2. The highest rates of weekly drinking were found in 1998 (45%of girls and 44% of boys). Reporting of weekly drinking in 2010 is similar to that in 1990, with a particularly large decline since 2006 among both boys and girls (29% of boys in 2010 compared with 39% in 2006 and 25% of girls in 2010 compared with 36% in 2006) .

TYPES OF ALCOHOL DRINKS
Young people were asked to report how frequently they drink each of seven listed alcoholic drinks. They were instructed to include those times when they only drink a small amount. Beer is the alcoholic drink most commonly consumed at least once a week by 15-year old boys, whereas, for 15-year old girls, spirits and alcopops are the preferred drinks. Boys are almost 5 times more likely to drink beer weekly than girls. Girls are 1.5 times more likely to drink alcopops.

DRUNKENNESS
Overall, a fifth of young people (20%) have been drunk on at least two occasions. Prevalence of drunkenness is much higher among older adolescents; 43% of 15-year olds report having been drunk at least twice compared with 15% of 13-year olds and 2% of 11-year olds .
At age 15, girls are more likely than boys to report drunkenness (47% of girls compared with 40% of boys).
Reporting of drunkenness among 15-year olds increased in the 1990s and then subsequently declined
Among boys, prevalence in 2010 (40%) is similar to that in 1990 (44%). Among girls, rates of drunkenness have declined slightly since the late 1990s, but have not changed since 2006 (48%), and remain higher in 2010 (47%) than in 1990 (36%).

FREQUENCY OF CANNABIS USE
Nineteen percent (19%) of 15-year olds and 4% of 13-year olds have used cannabis at least once in their lives
Boys are more likely to have ever used cannabis than girls. Sixteen percent (16%) of 15-year olds and 3% of 13-year olds reported cannabis use within the previous year (Figure 12.13), with 15-year old boys being more likely to have used cannabis in the previous year than 15-year old girls (19% and 13% respectively). Nine percent (9%) of 15-year olds used cannabis in the previous month, compared to just 2% of 13-year olds. Among 15-year olds, boys are more likely than girls to report cannabis use in the last month (12% of boys and 6% of girls).
Between 2002 and 2010, there has been a decrease in lifetime cannabis use among 15-year olds, from 39% to 23% among boys and from 35% to 15% among girls (Use of cannabis in the previous year has also decreased since 2002, from 31% to 19% among boys, and from 30% to 13% among girls .

CANNABIS USER GROUPS AMONG 15-YEAR OLDS
Six percent (6%) of 15-year olds are classified as ‘experimental’ cannabis users (once or twice in the past 12 months), 7% as ‘regular’ users (between 3 and 39 times in past 12 months) and 2% as ‘heavy’ users (40 times or more in past 12 months) A small number (3%) report using cannabis, but not in the previous 12 months and were therefore classified as ‘former’ users. Boys are more likely to be heavy users, but there is no gender difference among other user groups. The proportion of young people in each category of cannabis use is lower than in 2002

Source:THE HEALTH BEHAVIOUR IN SCHOOL-AGED CHILDREN: WHO COLLABORATIVE CROSS-NATIONAL STUDY (HBSC) SCOTLAND NATIONAL REPORT 2010 SUBSTANCE USE

A new study from the Department of Energy’s Brookhaven Natural Laboratory released this week suggests that people addicted to certain types of drugs might actually have lower density in crucial parts of their brain.
This and previous studies have shown that cocaine-addicted individuals, relative to non-addicted individuals, have lower gray matter density in frontal parts of the brain – which is important for paying attention and organizing one’s own behavior – and in the hippocampus, a brain region important for learning and memory.
But it doesn’t stop at cocaine. The study revealed that persistent alcohol or cigarette consumption may have a similar effect.
The longer cocaine, alcohol, and cigarettes were abused, the lower gray matter was found in the hippocampus and frontal regions of the brain.

This result means that curtailing drug use may be protective against such brain changes.
The study did not test the effects of other substances. It did, however, clarify that genetic makeup may predispose certain individuals to lose brain matter over

Source: www.huffingtonpost.com 2011/03/13

Mar 24, 2011

Marijuana use during adolescence and young adulthood increases the risk of psychotic symptoms, while continued cannabis use may increase the risk for psychotic disorder in later life, concludes a new study published in the British Medical Journal.

Cannabis is the most commonly used illicit drug in the world, particularly among adolescents, and is consistently linked with an increased risk for mental illness. However, it is hasn’t been clear whether the link between cannabis and psychosis is causal, or whether it is because people with psychosis use cannabis to “self- medicate” their symptoms.

So a team of researchers, led by Professor Jim van Os from Maastricht University in the Netherlands, investigated the association between cannabis use and the incidence and persistence of psychotic symptoms over 10 years.

The study occurred in Germany and involved a random sample of 1,923 teens and young adults from the ages of 14 to 24.

Incident cannabis use almost doubled the risk of later incident psychotic symptoms, even after accounting for factors such as age, sex, socioeconomic status, use of other drugs, and other psychiatric diagnoses. Furthermore, in those with cannabis use at the start of the study, continued use of cannabis over the study period increased the risk of persistent psychotic symptoms. There was no evidence for self medication effects as psychotic symptoms did not predict later cannabis use.

These results “help to clarify the temporal association between cannabis use and psychotic experiences,” the authors said in their study summary. “In addition, cannabis use was confirmed as an environmental risk factor impacting on the risk of persistence of psychotic experiences.”

Source: British Medical Journal March 2011

24 February 2011

DrugScope has welcomed new research demonstrating that drug treatment services for young people are extremely cost effective, with long term savings of between £5 and £8 for every pound invested.
Published by the Department for Education, the report, Specialist drug and alcohol services for young people – a cost benefit analysis, finds that drug and alcohol treatment for young people reduces otherwise significant economic, social and health costs. Immediate savings are achieved in reduced crime and improved health. In the longer term, there are reductions in costs associated with problematic drug use in adulthood, including unemployment, crime and drug and alcohol dependency.

Approximately 24,000 young people received specialist drug and alcohol treatment in the UK in 2008/09. Most were treatedprimarily for alcohol (37%) or cannabis (53%); one in ten were treated for problems associated with Class A drugs, including heroin and crack.
A report published by DrugScope in 2009, Young people’s drug treatment at the crossroads, found that as well as helping young people with their drug or alcohol problems, treatment services also address wider needs, such as mental health issues, involvement with the criminal justice system and social exclusion.
Despite evidence of the cost effectiveness of spending on substance misuse treatment, many young people’s services have contacted DrugScope to report significant cuts in local funding.
Commenting on the report, Martin Barnes, Chief Executive of DrugScope said:
“At a time when many drug and alcohol services for young people are facing funding cuts, this research makes a timely, compelling and robust case for continued investment. Even on quite cautious and conservative estimates, the evidence shows that there are immediate net gains in return for spending on drug and alcohol treatment. Not only will cuts in services have a negative impact on vulnerable young people, the research confirms that greater costs are likely to be incurred in terms of crime, unemployment and poor health.
“The concern is that with a record number of young people not in education, employment or training there will be a greater demand on prevention and treatment services. It is far easier to prevent young people from developing problems at an early stage that it is to treat adults with addiction issues. A considered assessment of the benefits to local communities of investment in drug and alcohol treatment services needs to be made to inform decisions on funding.”

Source: www.drugscope.org.uk 24 Feb 2011

Research suggests marijuana may be a ‘component cause’ of psychosis

Joseph M. Pierre, MD
Co-Chief, Schizophrenia Treatment Unit, VA West Los Angeles Healthcare Center, Health Sciences Associate Clinical Professor, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA

Over the past 50 years, anecdotal reports linking cannabis sativa (marijuana) and psychosis have been steadily accumulating, giving rise to the notion of “cannabis psychosis.” Despite this historic connection, marijuana often is regarded as a “soft drug” with few harmful effects. However, this benign view is now being revised, along with mounting research demonstrating a clear association between cannabis and psychosis.
In this article, I review evidence on marijuana’s impact on the risk of developing psychotic disorders, as well as the potential contributions of “medical” marijuana and other legally available products containing synthetic cannabinoids to psychosis risk.

CANNABIS USE AND PSYCHOSIS

Cannabis use has a largely deleterious effect on patients with psychotic disorders, and typically is associated with relapse, poor treatment adherence, and worsening psychotic symptoms.1,2 There is, however, evidence that some patients with schizophrenia might benefit from treatment with cannabidiol,3-5 another constituent of marijuana, as well as delta-9-tetrahydrocannabinol (?-9-THC), the principle psychoactive constituent of cannabis.6,7
Three meta-analyses have concluded cannabis use is associated with an increased risk of psychosis

The acute psychotic potential of cannabis has been demonstrated by studies that documented psychotic symptoms (eg, hallucinations, paranoid delusions, derealization) in a dose-dependent manner among healthy volunteers administered ?-9-THC under experimental conditions.8-10 Various cross-sectional epidemiologic studies also have revealed an association between cannabis use and acute or chronic psychosis.11,12
In the absence of definitive evidence from randomized, long-term, placebo-controlled trials, the strongest evidence of a connection between cannabis use and development of a psychotic disorder comes from prospective, longitudinal cohort studies. In the past 15 years, new evidence has emerged from 7 such studies that cumulatively provide strong support for an association between cannabis use as an adolescent or young adult and a greater risk for developing a psychotic disorder such as schizophrenia.13-19 These longitudinal studies surveyed for self-reported cannabis use before psychosis onset and controlled for a variety of potential confounding factors (eg, other drug use and demographic, social, and psychological variables). Three meta-analyses of these and other studies concluded an increased risk of psychosis is associated with cannabis use, with an odds ratio of 1.4 to 2.9 (meaning the risk of developing psychosis with any history of cannabis use is up to 3-fold higher compared with those who did not use cannabis).11,20,21 In addition, this association appears to be dose-related, with increasing amounts of cannabis use linked to greater risk—1 study found an odds ratio of 7 for psychosis among daily cannabis users.16
There are several ways to explain the link between cannabis use and psychosis, and a causal relationship has not yet been firmly established (Table 1).1-7,11-19,21-25 Current evidence supports that cannabis is a “component cause” of chronic psychosis, meaning although neither necessary nor sufficient, cannabis use at a young age increases the likelihood of developing schizophrenia or other psychotic disorders.26 This risk may be greatest for young persons with some psychosis vulnerability (eg, those with attenuated psychotic symptoms).16,18
The overall magnitude of risk appears to be modest, and cannabis use is only 1 of myriad factors that increase the risk of psychosis.27 Furthermore, most cannabis users do not develop psychosis. However, the risk associated with cannabis occurs during a vulnerable time of development and is modifiable. Based on conservative estimates, 8% of emergent schizophrenia cases and 14% of more broadly defined emergent psychosis cases could be prevented if it were possible to eliminate cannabis use among young people.11,26 Therefore, reducing cannabis use among young people vulnerable to psychosis should be a clinical and public health priority

Source: www.currentpsychiatry.com Vol.10 Sept 2011

Volatile substance abuse can cause sudden death. Stephen Ream offers advice to youth workers on helping young people.

What is volatile substance abuse?

Volatile substances readily evaporate at room temperature, giving off a “sniffable” vapour. Volatile substance abuse (VSA) is when these substances are deliberately inhaled through the mouth and/or nose to achieve a change in mental state or “high”. The most commonly misused products are butane gas from cigarette lighter refills, aerosols (deodorants or hair sprays), petrol and some glues.
Many people assume that, because these products are legal, they are safe. In fact, inhaled volatile substances can kill suddenly and unpredictably, and there is no way to avoid this risk.

How many young people inhale volatile substances?

The cheapness and accessibility of products make younger and more vulnerable children particularly susceptible. In the annual NHS report Drug Use, Smoking and Drinking Among Young People in England, VSA continues to be the most common form of substance misuse among 11- to 13-year-olds, and second only to cannabis by the age of 15. However, we have seen the positive effects of preventive education, with usage falling from 5.5 per cent of pupils in 2009, to 3.8 per cent in 2010.
According to the annual St George’s University of London report, VSA kills about 50 people a year in the UK. In the past decade it has killed more under-15s than all illegal drugs combined.

Why do young people do it?

VSA is an enticing high for teenagers in that it is cheap, accessible and fast-acting, and a volatile substance such as butane has little or no hangover effect. VSA is often a sign of problems in other areas of a young person’s life, such as bereavement, divorce or stress. But the motivating factors might just be sheer accessibility, peer pressure, boredom or a desire to shock parents or carers.

What are the warning signs?

Like any drug, these can include mood or behavioural changes such as appearing drunk or dizzy, or seeming secretive, withdrawn, irritable, restless or inattentive. A chemical smell might be noticed, a runny nose, watery eyes, rashes or spots around the nose and mouth, throat irritation or nausea.
Environmental evidence of use might include empty gas, aerosol or glue containers with teeth marks in the nozzle, or products disappearing from around the home. At least one parent told us that it was a “family joke” how much deodorant their teenager used until they realised what was going on.
Social evidence might include truancy, poor academic performance, a new social group or isolation from previous friends, and a withdrawal from activities.

What can youth workers do?

VSA can cause cardiac arrhythmia – a problem with the rate or rhythm of a heartbeat – and kill instantly. The only way to avoid this risk is to stop.
If no advice is likely to encourage a user to stop VSA immediately, it might be appropriate to give information that helps them avoid other risks, such as: don’t do VSA alone or in dangerous or out-of-the-way places; don’t impede breathing in any way; don’t use near a naked flame or lit cigarette; and don’t drink alcohol or take other drugs. However, while these will reduce the risk of suffocation or fatal accident, the toxic effects of VSA can still kill at any point.
If you find a young person intoxicated from VSA remain calm. Do not excite them or try to use force to remove the product. Any stress or physical exertion can trigger cardiac arrhythmia.
When working with a young person engaging in VSA: strip the environment of temptations; have clear, visible policies on the use and storage of volatile substances; openly discuss the potential dangers to their health; explore carefully how and why VSA started; and arrange support from other agencies, such as generic drug services, GPs and counsellors.

Source:www.cypnow.co.uk 20th Sept 2011

A brief look at the confusing messages emerging from current ‘prevention’ application in Australian drug policy.

QUIT – MODERATE – ACCOMMODATE? WHICH EMPHASIS ARE WE FOLLOWING?

What is going on with Australian Drug Policy Prevention application? It appears to be struggling with, what can only be described, as a Dis-associative Identity Disorder (D.I.D). The current interpretation continues to baffle the average Australian, and leaves many of us who are active in the Alcohol and Other Drug (AOD) field scratching our heads in bewilderment and sometimes utter disbelief!

SMOKING – The new leprosy?

The growing and relentless assault against tobacco via the QUIT campaign is something only ‘mushrooms’ would know little of. This vital and effective demand-reduction and education ‘war’ has been clear from its inception, and has continued to burgeon, evermore aggressively to the crusade we now see today.
The message is at the very least unambiguous, at times, bombastic! There is no guessing what the outcome of this endeavour is to be. The message and mandate is not ‘slow down’, it is not ‘moderate’ it is QUIT. The end game is the only game. There are no illusions about the time it may take to reach that goal, but that goal is the only target to aim at and as a consequence measures and outcomes are effective – more and more Australians are quitting!
Let’s commence by acknowledging the following principle, which is all but irrefutable… accessibility, availability and permissibility all increase consumption. When you reduce these, you reduce consumption. For example, the following details shows how education and legislation all reduced demand. Accessibility, availability and permissibility are all restricted and consumption drops.
In 1945 approximately 72% of Australian men smoked. The rate has been dropping ever since then. In 2007 only 18% of Australian males were daily smokers. In 1945 26% of Australian women smoked…In 2007 women were smoking at a lower rate than men with 15.2% still smoking daily. 1
• increases in getting help to quit smoking, especially use of the Quitline (2% to 4%) and nicotine replacement therapy (7% to 10%);
• increase in one year quit rate from 8% to 11% among smokers and recent quitters;
• a statistically significant reduction of about 1.5% in the estimated adult prevalence of smoking. 2
However, as successful as this message has been, the fight is not over yet, as the following excerpt so irrefutably affirms…
“ANTI-SMOKING campaigners have far from finished their battle with the tobacco industry, with some pushing for a ”license to smoke” and many predicting that cigarettes could be outlawed within a decade.” 3
Well so was the bold opening statement in recent article ‘Now butt out: new push seeks to outlaw cigarettes’ in The Age Newspaper.-

Fascinating…outlawing cigarettes, even though around 17% of Australians are still smoking – outrageous! The article went on to note that if such a ban were to take place the government would stand to lose around $6 billion dollars in tax revenue, but save an estimated $31 billion dollars currently spent per annum on smoking related health problems.
No doubt to everyone who is not a smoker this makes good health and fiscal sense…maybe even to some smokers too?
So how is that we have managed to convince a society that a ban could actually be possible on a legal drug – tobacco, that in its boom era (during the 40’s, 50’s and 60’s) was a key social accessory, that a legal ban be actually possible? A quick inventory of the processes engaged may give us some insight…

• A clear and uncompromising acknowledgement from health, government and fiscal sectors that cigarette smoking was damaging our community.

• The ensuing resolve that this must change for both fiscal, but more importantly, health reasons.

• The continuing single voice of disapproval of cigarettes from academics, politicians and health professionals. (Stopped the propaganda of the pro-smoking academics/doctors and started the recognition of the undeniable facts that ‘every cigarette is doing you damage’.)

• The sustained political will to create and implement policies to bring about change, including increased taxation, total advertising ‘blackouts’ and bans on smoking in defined places.

• These have been followed by the creation and implementation of Demand Reduction strategies that only grow in number and intensity and the relentless public education campaign on the dangers of smoking.

It would appear from both empirical data that such resolute policies work…even with a once widely accepted and socially palatable ‘legal drug’ like tobacco.
In a recent war of words over the zealous, if not poorly thought through, ‘plain packaging’ strategy, the Federal Minister for Health Nicola Roxon was quoted as saying…. “Big tobacco are fighting to protect their profits, but we are fighting to save lives.” 4 If that vitriol wasn’t enough, she was also quoted in the Australian Newspaper, again in regard to challenges to the plain packaging strategy …‘”We’re Australians. We can make laws in Australia to protect Australians…” 5 Feisty! I like it! However, comes the question… protect Australians from what? Well, Captain Obvious may answer that in this context it would be protection from the health and health budget destroying wrecking ball that is tobacco.
But is ‘health’ the real motivator that is underpinning this zeal for the wellbeing of Australians? I hope it is, but the utter inconsistency of this focused passion belies another agenda. Or is it that some people just can’t see the utter inconsistencies or, at worst, hypocrisies of this unbalanced policy focus?
If ‘health’ was the sole or main issue, then wouldn’t that same zeal, that same passion for justice of Aussie’s Health be mirrored in other areas of drug policy too? I mean, Roxon is pursuing a policy – plain packaging – that has a number of downsides to it, and only small possibility of a reduction in smoking – But that was enough, it seems, for her to implement the policy! Great I say, go for it, but why doesn’t this same ‘doggedness’ apply to the two other big monsters in the drug arena?
The Federal minister seems passionate about the anti-smoking message, passionate enough to make those sweeping statements we just read – ‘fighting to save lives!’ – ‘Making laws to protect Australians!’ and pursuing every possible vehicle to STOP people killing themselves (and our health budgets)on the way.
In a very recent interview published by the Financial Review, we get a glimpse into some of the motivators behind Roxon’s campaign against tobacco – ‘This is a defining moment for Roxon one that transcends politics and is deeply personal. Her father, a one-time smoker, died of oesophageal cancer at the age of 42…“All of us girls keenly felt the loss of not having our father as we grew up but that is not the same as being out on the street as some families are…it has made me very aware of the impact that smoking can have,” Said Roxon. This mother of a 6 year old daughter went on in the interview to declare that, ”This fight is about the past and the future. “We might be making the world a healthier place for our children, and that is very motivating. I don’t think the political gains will be very high or very quick, but the long-term health impact and feeling [that] you are in government to do some good is rewarding.”’*
I have no issue at all with this motivation from Roxon, I mean it is the personal encounter with tragedy and/or the grief of loss/dysfunction that adds undisputable weight to the abundance of health-destroying evidence that exists. But again, why isn’t this same passion for health/safety/future of children applied to the other life and health destroying drugs in the ‘recreational’ arena? Nicola would do well to spend time at Rehabilitation clinics, with families of alcohol and other drug using individuals who have not only shattered their lives but their families. Countless stories of lives and potential ruined at young ages because a drug was accessible, permissible, available and cheap. This very powerful evidence should also inform the prevention focused emphasis of alcohol and other drugs policy platform. All measures including high volumetric tax, plus clear and powerful warning labels should also be taken immediately to further ensure that children and families have the greatest protection from the damage of these drugs.
Alcohol – The protected substance?
When it comes to the other ‘legal drug’ the (it would appear) culturally entrenched alcohol – options for management have one glaring omission. Can you guess what it might be? No prizes if you said ‘QUIT’. The conspicuousness of the absence of this goal in the strategy is probably the noisiest of all elephants in the ‘Drug policy’ room. So, why is that?

We seem to have no problems creating what ‘defenders of the right to self destruct’ call a ‘Nanny State’ posture when it comes to cigarette smokers or our indigenous communities for that matter – But when it comes to the rest of the population quitting or abstaining from alcohol, then howls of derision chanting anti-‘Nanny State’ mantras are deafening!
James Campbell in his article ‘wowsers enough to drive you to drink’ featured in Herald-Sun 6 drew out, in his classic libertine framework article, some of the same inconsistencies we are bringing to attention in this paper – but I’m quick to add, for very different reasons. (Of course James would never have used the term ‘wowser’ in his title if he had even an inkling of what it stands for – We Only Want Social Evils Rectified – This of course is what all socially responsible people want. Yes, a free society, but a freedom that doesn’t disregard a) the liberty, safety and wellbeing of others b) the protection of the young, and c) bestowal of dignity on every human being… all of which are casualties when the imbibing begins.)
In his article he noted the data and subsequent recommendations recently released by the Cancer Council, but also what he has interpreted their seeming ‘double standard’ on the ‘drink’ issue. Professor Olver was quoted in the Age as saying… ”If you want to reduce your cancer risk as far as possible [abstinence] would be the option you have.” 7 yet in his article, Campbell states they stopped short of recommending abstinence from alcohol and settled for NHRMC recommendations of ‘a couple of standard drinks at any time’.
Now whilst I can see the point of incongruence, I would like to challenge Campbell’s ‘framing’ of the response. It is clear that not all cancers are caused or even added to, by alcohol, but it is equally clear, through evidence based science, that alcohol is carcinogenic.*
The point now is what do we do with that information? Certainly promoting abstinence as an option should be absolutely imperative…but that’s the problem… the ‘A’ word isn’t permitted, even in the ‘optional’ category!
Our culture is either so deeply addicted to this drug or so completely gripped by fear at being labelled something less than human because they don’t drink, that they actually cannot see the option of saying ‘No Thank you!’
Now if this was just, fully developed ‘grown ups’ who don’t care about their health or even worse, are self-medicating the vicissitudes of life with the grog, and never venture into the public space and expose others in the community to their less than sober persona, I suppose it would make less difference if one ‘partook’ (except for the medical and health bills the tax payer will have to fund)! However, it is the vulnerable in our society – the young (under 25 – still developing brains), the mentally ill, the socially and relationally isolated, the violent, the elderly, children and often women, who end up casualties of not only their own drinking, but that of others!
Whilst the link between cigarettes and disease is clear, it is no less clear with alcohol…
Alcohol consumption is the world’s third largest risk factor for disease and disability; in middle-income countries, it is the greatest risk. Alcohol is a causal factor in 60 types of diseases and injuries and a component cause in 200 others. Almost 4% (1 in 25) of all deaths worldwide are attributed to alcohol, greater than deaths caused by HIV/AIDS, violence or tuberculosis. 8
A couple of questions that are often conspicuous by their absence, when it comes to the inconsistencies in drug policy when dealing with tobacco and alcohol, are to do with impact on others. Yes, it is good to have gone to considerable lengths to minimise ‘passive smoking’, but what of the impact of what Professor Rob Moodie calls ‘passive drinking’? A couple of quick questions to ponder…
The real tragedy in all this ‘cultural reinforcement’ is that the imperative message for this demographic of abstinence, and delayed onset of drinking as long as possible, has completely disappeared .
When was the last time a cigarette caused a man to beat his wife to death?
When was the last time a cigarette caused an automobile accident killing two and disabling one for life?
When was the last time a cigarette caused a pub brawl or ‘glassing’ incident?
For the sake of brevity (and being seen to be too merciless on the sensibility of the Aussie imbiber) the following are just some of the long known, but only recently quantified data on this so called ‘social lubricant’….

a) Fiscal Cost: The research by the Australian Education and Rehabilitation Foundation (AER Foundation) has now put the total economic impact of alcohol misuse at $36 billion per annum which is over double 2005 estimates. This comprises $24.7 billion in tangible costs, which include out-of-pocket expenses, forgone wages or productivity and hospital and childcare protection costs. There are a further $11.6 billion in intangible costs, which includes lost quality of life from someone else’s drinking9

b) Consumption: Drinking more than ever before, at least 10.2 litres pure alcohol per person per annum 10

c) Cancer: “Alcohol use has been linked to thousands of cases of cancers including bowel, mouth, pharynx and larynx. 1 in 5 cases of breast cancer are linked to alcohol”. 11

d) Violence: There are more than 70,000 Australians who are victims of alcohol related assaults each year…alcohol-fuelled violence and abuse affects one in five people 12

e) Emergency Services: Ambulance Call outs in Greater Melbourne alone, for predominantly alcohol abuse have increased almost 600%: 1998-99: 1043 by 2008-09 it was 6924 13

f) Crime – In just one State alone, alcohol-related crime in Queensland has increased by 30 per cent, and public disorder offences by 65 per cent just in the past few years alone…Alcohol abuse in Queensland is now responsible for 100,000 crimes annually, or one-quarter of all offences.14

You get the point! This is, if not worse, then at the very least as bad as the smoking issue…. So, why aren’t all zeal, all passion and all strategies being implemented to prevent or stop the impact of alcohol on the Australian people and the economy?
So entrenched is the alcohol culture that according to the Australian Drug Foundation, parental supply has eclipsed all other sources of supply of alcohol to children aged 12-17. Now the excuses tabled for this kind of outrageous conduct are as follows…

a) Parents want to either, initiate their child into alcohol ‘wisely’ or at least ‘know’ how much they are drinking.

b) Parents want to be friends with their child and not parents. Believing they are avoiding stress at home by giving in to negative social influences.

c) Parents believe that if their children are going to ‘experiment’ then it’s better to do so with the legal drug.

d) ‘It’s part of being Aussie, it’s gonna happen, so might as well try and be ‘responsible’ and give them a hand in using this legal drug ‘properly’.’

So, how has that been working for us as a community? Well the evidence seems to correspond with the mindset. Again an Australian Drug Foundation recent release shows that by 16, one in five teenagers regularly binge drinks; by 18 it is 50 per cent.
It would appear this level of permissibility has only added to accessibility and availability and thus consumption has increased. I mean… ‘after all Mum and Dad are giving it to me and they use it, so it must be ok?’
The real tragedy in all this ‘cultural reinforcement’ is that the imperative message for this vulnerable demographic of abstinence and delayed onset of drinking as long as possible, has completely disappeared. All the scientific evidence reveals that their vulnerable developing brains need this option to be aggressively promoted as best practice and their parents, above all, need to get this reality check too.
Again, what continues to generate this disconnect between policy emphasis around the legal drugs of tobacco and alcohol? Both drugs are legal, but perhaps smoking an easy target now that fewer Australians do it, and is marginalised so much that scathing vitriol and uncompromising legislation will have little opposition? “But, not so with alcohol – Whilst approximately 14% of Australians who are legally permitted to drink, don’t, the amount of alcohol being consumed per person, per annum is near record highs. It would seem that challenging this second ‘monster’ can prove a difficulty, if a) votes matter b) the power brokers themselves are unable to say NO to alcohol; c) It has become the central and often sole ‘social amenity’ or even worse, d) it becomes the medication of choice for the ever growing epidemic of community wide psycho-social dysthymia.
Whatever the reason, a clear gulf exists in zeal, attention and endeavour when we juxtapose tobacco and alcohol. A gulf that screams, at best inconsistency, but at worst hypocrisy!
A quick recap…
When it comes to tobacco the policy aim for smoking is ‘quit’, and we have no problem aggressively challenging ‘smoking’ as a reckless act that needs stronger management. We have used Prohibition in its legal context to prevent smoking in a number of places and breaches of such prohibitions have met with not only social censure, but a fiscal punitive response – fines. And in this framework there appears no fear about attracting the pejorative ‘nanny state’ label.
When it comes to Alcohol, the policy aim (at the moment at least) is to avoid the ‘nanny state’ label, calling instead for management, more like a caring friend provoking a peer to a healthier choice. So the push seems to be toward ‘moderation’.
But what is happening in the arena of current illicit drug policy?
We appear to be losing the plot – the pro-drug lobby is trying to take over the judiciary, if not legislature!
When it comes to illicit drugs there appears to be a departure from all regulatory sanity. The ‘State’, on whose advice we can easily guess (George Soros funded propagandists) works ruthlessly to assassinate, mutilate and bury all processes that are focused on prevention or abstinence. Such processes the patronizingly dump into the ‘Nanny-State’ model/basket . Nor, would it seem are they interested in a Good Parent model, or even the ‘caring friend’ model… No, it would appear from all current debate this confederacy has opted for the ‘go with whatever feeling grabs you; it’s your ‘right’ and let the State clean up the mess’ approach!
There appears little to no censure, no label of ‘bad’ or ‘harmful’ or ‘destructive’ to the conduct that is illicit drug using. In fact great pains are taken to remove all terms from public documents that could potentially ‘marginalise’ the drug user. Whilst ‘name calling’ should never be condoned, conduct that illegal and destructive needs to be called for what it is and measures taken to change it. Whether the terms are legal or medical, they can never be ‘neutral’, or worse complimentary and condoning.
What is of greater concern is the tacit message oozing through the permissive interpretation of Harm Minimisation policy by the Harm Reduction Only Lobby, which is that the State sanctions and promotes – not challenges or changes – a drug user’s ‘habit’. (Yet it is the ‘habit’ that needs to change – more on that later.)
For example, they seem to be saying :

a) Please come to a special place with your illegal substance and we will assist you to take the drug of your choice (Medically Supervised Injecting Centre – MSIC). At no point will anyone ‘judge’ you for your ‘lifestyle choice’. Instead we will ensure you are comfortable and enabled in your drug taking activity whilst funding this process with tax-payer’s money. (No matter that this process breaks international laws on illicit drug use)

b) We will give you as many clean ‘needles’ as you like and will not hold you accountable for the return of used ones. In fact we will pay someone to go around and pick up your discarded syringes so you can continue to be free (not irresponsible, that would be pejorative)to continue, unhindered in your substance use, wherever and whenever you choose.

c) If the substance user opts to seek a change in conduct, only then may we humbly recommend a referral to a treatment facility. However, after we have just enabled you to continue your substance abuse (in our MSIC) and you are ‘feeling’ better (yet getting worse) after your State assisted ‘fix’, then it is unlikely that you’ll ‘feel’ the need for detox, let alone rehabilitate. So, the passive referral is ignored or forgotten.

d) If you are one of the single digit percentage of substance users that actually ‘follows through’ on referral, then no requirement will be placed on you to become drug free. No, we are only interested in trying to minimise your potential to kill yourself and make you as comfortable as possible. We will introduce you to other substances that may, or may not lead you to drug free recovery, but again, that is NOT our aim. This, after all, is only for the ‘problematic’ drug user and we must not have anyone feeling discomfort or distress from the withdrawal from drug use, even if is for a week – That would be ‘unkind’. So rather than treat you like a precious, intelligent, whole human being, we’ll simply treat you like a wounded pet and only treat the symptoms and not address the real problem.

e) The recent aggressive upsurge of promotion and use of, so called, ‘legal highs’ has produced an even clearer manifestation of this policy D.I.D/hypocrisy/inconsistencies. As these synthesized ‘designer’ concoctions started getting a more public profile, several States in Australia were quick to react by imposing age restrictions and then applying significant financial penalties (six figure fines) for those involved in distributing/using these products. Yet in some of these same States the use of current illicit drugs such as cannabis (and other currently illicit drugs that have clearly documented health damaging properties) attracts no more than a slap on the wrist for use and little more for trafficking!
It would seem no effort is spared, to ensure the drug user is rarely, if ever, is called to make changes. More than that, and at any point, an act of horrendous nature can be perpetrated against another citizen as we saw recently in the senseless murder of a deaf octogenarian pensioner, murdered by yet another (it would appear by the new label) ‘problematic drug user’. Diminished responsibility, mitigation, equivocation, even obfuscation, are employed to avoid ownership of the issue by the substance user. What’s more disturbing is that at no point is the abysmally interpreted Harm Minimisation Policy used to bring about change, let alone drug free wellness of these dysfunctional people.
The following (conveniently) long forgotten words of the remarkable Statesmen, Edmund Burke, are even more appropriate today than at any other time in recent history…
“Men are qualified for liberty in exact proportion to their disposition to put moral chains upon their own appetites… Society cannot exist, unless a controlling power upon will and appetite be placed somewhere; and the less of it there is within, the more there must be without. It is ordained in the eternal constitution of things, that men of intemperate minds cannot be free. Their passions forge their fetters.” Sir Edmund Burke

The very thing that is needed as outlined by Burke is the very thing the pro-drug lobby works tirelessly to negate. Morality is ‘off the table’ in this arena (The only time morality is invoked these days is when it comes to climate change; nowhere else is this allowed in the public discourse) In this ‘amoral’ space all attempts to impugn drug taking are perceivably removed. Terms like ‘wrong’, ‘bad’ ‘irresponsible’ are no longer permitted. So, if it is no longer referred to as ‘wrong’ then comes the next manipulative question: on what grounds should substance use still be illegal? The next step is to turn the debate into a purely ‘health’ issue. It is true, it is also a health issue, but, it is still a social, psychological and moral issue as well. But even just at the level of health policy, would think that all measures should be taken to rectify the dysfunction /disorder/ailment in order to remove the health damaging substances at least from the patient, even if not the community. Ah, but no, that’s not the agenda of this lobby faction is it!
The health issue is invoked only to manage some of the damage of substance taking and other second tier outcomes of these bad health choices, such as blood borne infections and or death. The call now in this decriminalised, so called amoral and consequence avoiding space, is that all health measures be taken to keep the patient alive and as healthy as possible to continue their ‘lifestyle choice’ of drug consumption.
This is not Australian – Time to Stand up!
At the moment the vast majority of Australians are still smart enough to know (perhaps drug free enough to know) that ultimately there I absolutely no gain/benefit in illicit drug use for individuals or society; The current National Household survey (2007) has the vast majority of Australians declaring their disapproval of illicit drugs and their use.

• 99% don’t want use of hard drugs accepted
• 95% don’t want hard drugs legalized
• 94% don’t want use of cannabis accepted
• 79% don’t want cannabis legalized
• Most Australians want tougher penalties for drug dealers.15

The largest youth survey done in our nation with a sample of around 50,000 young people saw alcohol and others drugs as the second highest on ‘what is an important issue for Australia’. This issue is the most worrying to the youngest in this most susceptible to damage of Australia’s demographic – the ones we need most protect – our children 16

When the overwhelming majority of people disapprove of illicit drugs, it might just be a cue to do something more significant than concede ground to it. You’d think that even the process (let alone value) of democracy, had any weight then the above mentioned majority opinion would mandate all and every action be taken to eradicate illicit drug use from society. According to collected data, around 6% of the world’s population aged between 15 and 64 currently use illicit drugs. 17 Australia’s stats are only a little higher than that. So here we have a user group that is arguably (at most) between a half or a third of current tobacco users, who are involved in a wilful breaking of the law to their own and the wider community’s detriment generating an exorbitant cost to our community.
So what has the response been to this? Well, it depends on where you look, who you talk to and who is playing the strings of the propaganda harp.
In recent years there has been a rising noise, about the need for illicit drug policy change. The standard mantra has been ‘the war on drugs has failed!’ Consequently we need to stop and rethink our processes and priorities.

What ‘war on drugs’? Where did this notion come from?
Well, let’s pretend for a moment there actually was a ‘war on drugs’. How could it possibly be won? Well, again it depends on how this ‘war’ was fought and what priorities were set. If the war on drugs simply attempted supply removal and arrest, then it will have limited success. However, as with most ‘battle strategies’, if they only have one tactic, then success will always be limited or the potential for failure increased. If a ‘war on drugs’ isn’t really waged as it should be then it is locked into only limited success and more likely subject to criticism of its limitation. However, as in all wars the first casualty is always truth and that is no different in this theatre of combat, as the following reveals…

The term “war on drugs” was not used in 1971 and is not used today by anyone except those who mischaracterize history and current drug policy in the US. However, if one were going to connect the term to President Nixon, then it would be more accurate to say that Nixon ended, rather than launched, the “war on drugs.”
The Nixon Administration repealed federal mandatory minimum sentences for marijuana, and on June 17, 1971, for the first time in US history, the long-dominant law enforcement approach to | 12 drug policy, known as “supply reduction”, was augmented by an entirely new and massive commitment to prevention, intervention and treatment, known as “demand reduction”. President Nixon announced this new, balanced approach to drug policy and it received full bipartisan support. Since that time, the idea of taking a balanced approach has enjoyed strong and sustained support through the terms of the seven US Presidents that followed. The US drug prevention policy, fully described in the annual National Drug Control Strategy published by ONDCP, maintains this twin-commitment to supply reduction and demand reduction, with the aim of reducing illegal drug use and the corresponding medical and social burdens that drug abuse imposes upon our nation.18
Supply reduction remains a key tactical component and criminalisation will always lend weight to that vital strategy component. Time and space here will not permit us to go into all the local and national impact on drug use that supply reduction has facilitated, but just two examples will give us a clear indication:

a) ABS 2000 death stats collection: Heroin: 417; methadone: 118;Benzos: 403; anti-depressants: 268; Cannabis: 49 Note the reduction in Heroin deaths the following year when the heroin drought (for whatever reason) caused availability to dry up, the ABS 2001 death stats collection showed: Heroin: 113; methadone: 107;Benzos: 252; anti-depressants: 194; cannabis: 28!

b) According to the Australian Institute of Criminology, the four top reasons why detained illicit drug users had not used in the previous month 19 was in order of main reason to least.

1) Dealer didn’t have drug of choice (highest reason by far)

2) No Dealers available

3) Poor quality product

4) Police presence

I want you to notice that supply reduction elements are the key factor in reducing illicit drug consumption. Again, when you reduce permissibility, accessibility and availability you reduce consumption. This is why complementary Supply Reduction strategies are imperative in conjunction with Demand Reduction strategies and compulsory detox and rehabilitation strategies.
When Ethan Nadelmann and Dr. Alex Wodak, the well-known supporters/ purveyors of the George Soros brand of cultural chaos, were on the media stage peddling their brand of harm ‘reduction’( (including the decriminalisation of illicit drugs), the voices of dissent from any other quarter were hard to hear, but not because they don’t exist considering over 90% of Australians disapprove of illicit drugs. It was the classic situation where the sane majority simply expect the government to do all that is necessary to eliminate drug use without bothering to mobilise against that small, but very ‘squeaky wheel ‘of pro-drug propaganda at legislators doors. Consequently, the long standing anti-drug movements were given no space at all.
The Nadelmann/Wodak ‘spin’ had people believing prohibition drug policy had failed and therefore the only option left was to decriminalise or legalise. They even used cleverly spun unrelated science and misrepresented data from other nations and calling that ‘enlightened’ (Such as the so called Portugal decriminalisation ‘success’). Or they hijacked the debate away from drug use and placed it in the framework of management of damage caused by drug use, which actually increases dysfunction.
It is remarkable that few clinicians or policy makers care to see or even acknowledge that the current illicit drug policy in Australia (among other western nations) has be completely hijacked by the single dimensional ‘harm reduction’ element and that has distanced them even further from the problems of drug use.
This one dimensional focus has barely anything to do with drug use and absolutely nothing to do with reducing drug use. ‘Harm Reduction’ as it currently stands, when it is all distilled down to its core (a one step process) is only focused on the attempted prevention of death and blood borne infections. Whilst this may be a noble aim, we need to move drug policy back to the forgotten reduction or prevention of drug use in our society. We are all for having a policy for reducing the spread of blood borne infections and death, but let’s call it that and move drug policy back to what drug policy is supposed to be about – the prevention and reduction of drug use in our society. Of course, even a ‘blind man’ could see, that if you prevent and/or reduce drug use, you reduce the incidence of the other damage so focused on – but that is the very thing the pro-drug lobby doesn’t want to happen, the reduction of drug use! They advocate continuation of drug use, funded by tax-payer’s who keep them alive and pay for their treatment.
So in our mind, an unavoidable question is – Where was Federal Minister for Health, Roxon on these issues? Where was the same zeal that was focused on cigarettes? At the time where this ‘drug reform’ lobby has used special arguments to remove the protection, where was the declaration, ‘making laws that protect Australians’ from substances that have long been banned because of the undeniable damage they do?
Is it utter ignorance that generates this silence? Or is it as one prominent AOD Clinician once said ‘Harm minimisation is just a euphemism for ‘we don’t know what the hell to do, so we’ve just given up!’. Or is it, reason spare us, a tacit yet wilful pursuit of cultural sabotage foisted on society because a minority of drug users who believe they can control their ‘habit’ have ‘friends’ in high places?
Prohibition is a word that has been marginalised and disparaged, again by hijacking the meaning and reinterpreting it in a different context – the context of purely a moral control of a majority. However, prohibition is, in this context, a matter of law and not a simple moral based endeavour.
We prohibit by law things that are injurious to individuals and the community. With Tobacco law, cigarette smoking is prohibited in restaurants, government buildings, some public spaces, inside cars and so on. Illicit drugs are prohibited at a higher level because of the health, family and social damage and the impediment of function and increased danger they that create. The prohibiting is based on minimising the harms done by these toxins to the community and individuals. Decriminalisation will only lead to greater substance use and experimentation and simply bolsters well the ranks of the damaged and dysfunctional. It will perpetuate this damage in an emerging generation that has little capacity to handle it. This is a crime!

Will the real drug policy emphasis, please stand up and will it stand for health, justice, responsibility and protection of the young?

Source: Shane Varcoe – Executive Director, Dalgarno Institute. www.dalgarnoinstitute.org.au August 2011

Endnotes
1 http://www.cancercouncil.com.au/editorial.asp?pageid=371
2 CHANGES ASSOCIATED WITH THE NATIONAL TOBACCO CAMPAIGN PRE AND POST CAMPAIGNSURVEYS COMPARED by Melanie Wakefield http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-publicat-document-metadata-tobccamp.htm/$FILE/tobccamp_c.pdf
3 Stark , Jill The Age, 22.5. 2011 http://www.theage.com.au/victoria/now-butt-out-new-push-seeks-to-outlaw-cigarettes-20110521-1ey2s.html#ixzz1OBTg5SRQ
4 http://www.smokernewsworld.com/market-cheap-cigarettes/
5 Nicola Roxon solid on cigarette packaging Sallie Don and Sue Dunlevy From: The Australian May 27, 2011 http://www.theaustralian.com.au/national-affairs/nicola-roxon-solid-on-cigarette-packaging/story-fn59niix-1226063781056
6 James Campbell – wowsers enough to drive you to drink, page 78, Sunday Herald-Sun May 28, 2011,
7 http://www.theage.com.au/lifestyle/wellbeing/quit-drinking-to-cut-cancer-risk-20110501-1e38g.html
8 Global Status Report on Alcohol and Health. Taken from Introduction page x, ISBN 978 92 4 156415 1 (NLM classification: WM 274) © World Health Organization 2011
9 Alcohol Education and Rehabilitation Foundation – Range and Magnitude of Alcohol’s Harm to Others August 2010
10 Wine link to rise in alcohol intake, Sikora, Kate; Page 16, Herald-Sun Edition 1 – 2/11/2010
11 Medical Journal of Australia (published May 2011)
12 Alcohol Education and Rehabilitation Foundation – Range and Magnitude of Alcohol’s Harm to Others August 2010
13 http://www.heraldsun.com.au/news/more-news/mateship-abandoned-drunks-left-behind/story-fn7x8me2-1226063706968
14 “Punch Drunk Campaign”, QLD Courier Mail – July 2009

O’Leary-Barrett M., Mackie C.J., Castellanos-Ryan N. et al.

Addressing the substance use promoting tendencies of the personality traits of London secondary school pupils at particular risk of substance misuse led to fewer drinking and, among the drinkers, fewer drinking heavily. The study showed that school staff could effectively conduct the focus group interventions.
Summary An alternative to prevention approaches applied to all children whatever their risk levels, the Preventure programme is a short intervention which targets youngsters who score highly on four personality dimensions which make different kinds of early-onset substance use and other risky behaviours particularly rewarding or hard to resist. As assessed by the Substance Use Risk Profile Scale personality questionnaire, these traits are:
Hopelessness A tendency to unhappiness, depression and feeling a failure, feelings relieved by intoxication;
Anxiety-sensitivity Fear of anxiety-related bodily sensations due to beliefs that such sensations will lead to catastrophic outcomes, for which substance use can represent a form of self-medication;
Impulsivity An inability to restrain seeking gratification in the presence of immediate rewards (such as the feelings available through substance use) despite longer term negative consequences; and
Sensation-seeking Desire for intense and novel experiences, which can be expressed as a desire to ‘get high’ through drugtaking or heavy drinking.

The Preventure intervention

The manualised Preventure intervention addresses these risk factors by drawing on psychoeducational approaches, motivational enhancement therapy, and cognitive-behavioural therapy, applied to real-life scenarios shared by high-risk young people in Britain. As implemented in the featured study, it occupied two 90-minute focus groups of on average six pupils led by two trained facilitators. Groups were formed of pupils who shared elevated scores on the same personality dimension, and the variant of the intervention applied to that group particularly targeted that dimension and the associated risks. In the first session participants were guided in a goal-setting exercise to enhance motivation to change behaviour, taught about the personality dimension and how it can predispose to problematic coping behaviours, and guided in breaking down personal experience according to the physical, cognitive, and behavioural components of an emotional response. All the exercises were specific to the personality risk factors identified in the children. The second session involved identifying and challenging personality-specific cognitive distortions which lead to problematic behaviours.
Preventure interventions have been found to prevent the onset and escalation of drug use over the following two years, but so far only as delivered by skilled research therapists. The featured study tested whether school staff, with moderate levels of training and expertise and competing responsibilities, could be trained to effectively deliver this unfamiliar interactive, small group intervention. Another issue was whether pupils would be open with adults who may hold disciplinary positions. On the other hand, it was possible that the teachers’ familiarity with their pupils would aid participation, and provide a platform for later addressing individual problems.
The study
Across nine randomly selected London boroughs, 21 randomly selected secondary schools were asked to join the study and randomly allocated to the Preventure intervention or to act as control schools which simply carried on (as all the schools had to) with the drug education components required by the national curriculum. Three schools could not be included in the featured analyses, leaving 18 schools and 2506 of the original 3021 year nine (ages 13–14) pupils. Of these pupils, 1159 or just under half scored as high risk on the Substance Use Risk Profile Scale; their responses were the basis for the featured report. 1008 could be followed up six months later; the probable responses of the remainder were estimated on the basis of earlier assessments and other data.
School staff running the Preventure intervention were trained in a three-day workshop followed by at least four hours of supervised practice and feedback on their performance while practising the full intervention with year 10 pupils from their schools. Though broader and longer-term outcomes are being assessed, the featured report focused on drinking six months post-intervention.

Main findings

Over 8 in 10 of the school staff members in the study completed training and supervision and qualified to facilitate the intervention. Each conducted on average six intervention sessions. Researchers observed at least one session by each facilitator. They judged that two thirds of the sessions had covered most of the core components of the intervention, and that two thirds also had been delivered in ways which embodied the required counselling skills of listening, enabling, involving the entire group, and being inquisitive and empathic. Facilitators themselves were all rated as at least satisfactory as cognitive therapists.

As expected, at the start of the study more of the high risk than the lower risk pupils (41% v. 32% ) had drunk alcohol in the past six months and more too had drunk heavily during that period (22% v. 12% ), defined as at least five drinks at one sitting for boys and four for girls. Six months later and compared to control schools, in schools allocated to Preventure the increase in the proportion of high risk pupils who were drinking was significantly less steep (rising from 43% to just 50% v. from 38% to 57%) chart. Narrowly missing statistical significance was a similar disparity in trends in the proportion drinking heavily across the entire population of high risk pupils; in intervention schools this rose from 22% to 25%, in control schools, from 21% to 28%.
A second set of analyses focused on the four in ten high risk pupils drinking at the start of the study. Among these drinkers, the proportion later drinking heavily actually fell in Preventure schools (from 52% to 48%) but rose in control schools (from 54% to 63%), another statistically significant difference. They were also consuming less alcohol overall, and were less likely to report drink-related problems.
These effects were comparable to those noted in previous trials of the intervention with specialist interventionists.

The authors’ conclusions

The was the first evaluation of a school-based personality-targeted intervention for substance misuse delivered by trained educational professionals. Compared with controls, the intervention was associated with significantly decreased drinking and drink-related problems six months later, and with fewer ‘binge’ drinkers among participants drinking at the start of the study – a particularly high risk group for future substance misuse. The potential health benefits of this delayed uptake of drinking are substantial: a one-year delay can decrease the risk for future alcohol-related problems by 10%.
These results replicate findings from personality-targeted intervention trials in the UK and Canada, but within an implementation model that has a higher likelihood of being adopted in the real world. The demonstration that trained and supervised school staff can achieve results comparable to specialist therapists means the intervention has the potential to become a sustainable school-based early prevention strategy with youth most at risk for developing future alcohol-related problems. However, it remains unclear whether ongoing expert supervision and/or performance and outcome feedback is required to maintain standards.
Among baseline drinkers, this trial and others have found that just from four to six young people need to be allocated to the intervention in order to later prevent one from drinking heavily – a ratio much more favourable than typically found for ‘universal’ prevention programmes which target all the young people in a population rather than just those at high risk, and which are typically of much longer duration.
The possibility that it was simply a group intervention which was effective rather than the particular content of that intervention is contradicted by studies which have compared the Preventure intervention to alternative group sessions, and by general findings that few interventions decrease substance misuse. From a similar UK trial which found reduced use of illicit drugs, it also seems unlikely that Preventure pupils in the featured study substituted these for alcohol.
In sum, the evidence appears to strongly support the use of this programme in schools, whether delivered by trained clinicians external to the school or trained school staff. However, implementations should include the expert training and supervision components unless and until it is shown that schools are able to deliver the interventions autonomously and effectively.
Relative to basic education without much if any intended prevention content, this and other studies have demonstrated substantial effects in delaying the onset of and retarding the growth of substance use. Few of the usual limitations on the generalisability of the findings to the normal run of schools apply to this study. Neither schools nor pupils were highly selected, all but a small proportion of sampled pupils were followed up, and the schools’ own staff conducted the intervention. As the authors comment, an impediment to widespread implementation may be the availability of expert trainers and supervisors. Another may be the willingness of schools to release four staff for three days training each followed by hours of supervision, and to let them spend many more hours addressing non-academic issues with a subset of high risk pupils. What may help convince them will be further results from the study if these demonstrate impacts not just on drinking but on mental health, other substance use, conduct, and academic achievement.
Among the findings is however the narrow failure to find a statistically significant impact on regular heavy or ‘binge’ drinking across all high risk pupils rather than just among those already drinking at the start of the study – a finding which seems to reflect the dilution of the results due to the inclusion of pupils unlikely to go on to drink heavily. This finding almost certainly also means no significant impact on regular heavy drinking across all the pupils in the school. Drinking as such at these ages is a concern, but in the British context, even more so is teenage binge drinking. That the intervention could not register even a short-term impact on this priority concern will lessen its appeal.
Its matching strategy above all distinguishes the featured intervention from other approaches. Plausibly, the developers argue that addressing each individual’s particular personality vulnerability to substance use should more effectively reduce or prevent that use than a more scatter-gun or generic approach. However, this remains to be convincingly demonstrated in studies which have offered essentially the same intervention, but not matched to the individual’s personality. It is possible that the advance made by the broad matching strategy embodied in the intervention’s manuals is not sufficiently great to improve on the ‘natural’ and possibly more fine-tune matching which occurs as a sensitive therapist or counsellor adapts their interpersonal style and the content of the intervention to the individual. Also at issue is the persistence of the effects past the first six months.
Other studies of the featured intervention
This study is one of the latest in a series investigating the same or similar interventions co-authored by the intervention’s developers. Given that allegiance to an intervention is associated with finding that it works, a fully independent demonstration by researchers with no personal investment in the intervention is desirable. Despite this, the body of work to date is methodologically sound, often convincing in its results and based on a plausible theory of how the intervention should work.
Among the British trials was another in London, but this time of a highly selected set of 347 schoolchildren counselled by a professional psychologist rather than school staff. As in the featured study, the intervention was associated with drinking reductions six months later, but these effects dissipated to insignificance over the next six months and remained so over the remainder of the two-year follow-up. This was in contrast to drink-related problems, experience of which increased over the first six months in the control group and remained higher than in the intervention group over the follow-up period.
Another similar study in London found that over the following six months the intervention delayed the expected increase in drinking among high risk pupils over the first six months of the follow-up, though again, by a year there was no significant difference in the drinking behaviour of pupils who had or had not been allocated to the intervention. The same trial found reduced uptake of cocaine and other drug use and a reduced frequency of drug use overall (but not cannabis in particular) over the two-year follow-up. In Canada too, the intervention was found to result in at least short-term (four months) drinking reductions in secondary school pupils.
As well as these trials among schoolchildren, earlier versions of the intervention have been trialled with adults and young adults. One trial focused on female undergraduates in Canada characterised by one of the personality traits investigated in the featured study – anxiety-sensitivity. Over the next 10 weeks, drink-related problems were relatively lower (but not quite to a statistically significant degree) among women allocated to an intervention targeted to their personality profiles compared to those allocated to a ‘placebo’ group intervention, but drinking itself was unaffected. Another study involved largely alcohol-dependent women in Canada aged 30 to 50 recruited via ads asking them to get in contact if they were concerned about their drinking or prescription drug use. A variant of the featured intervention was compared to a control intervention involving a motivational film on substance use problems and a supportive discussion with a therapist, a combination which it fairly consistently outperformed in reducing substance use. However, there were no statistically significant findings (though there were tendencies in this direction) indicating that the intervention bettered another intervention similar in every other way except that the content was not matched to the individual’s personality profile. These findings call in to question the matching strategy which above all distinguishes the featured intervention from other approaches.

Source.: www.findings.org.uk 16 August 2011
Journal of the American Academy of Child & Adolescent Psychiatry: 2010, 49(9), p. 954–963

Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Addiction affects neurotransmission and interactions within reward structures of the brain, including the nucleus accumbens, anterior cingulate cortex, basal forebrain and amygdala, such that motivational hierarchies are altered and addictive behaviors, which may or may not include alcohol and other drug use, supplant healthy, self-care related behaviors. Addiction also affects neurotransmission and interactions between cortical and hippocampal circuits and brain reward structures, such that the memory of previous exposures to rewards (such as food, sex, alcohol and other drugs) leads to a biological and behavioral response to external cues, in turn triggering craving and/or engagement in addictive behaviors.
The neurobiology of addiction encompasses more than the neurochemistry of reward.1 The frontal cortex of the brain and underlying white matter connections between the frontal cortex and circuits of reward, motivation and memory are fundamental in the manifestations of altered impulse control, altered judgment, and the dysfunctional pursuit of rewards (which is often experienced by the affected person as a desire to “be normal”) seen in addiction–despite cumulative adverse consequences experienced from engagement in substance use and other addictive behaviors. The frontal lobes are important in inhibiting impulsivity and in assisting individuals to appropriately delay gratification. When persons with addiction manifest problems in deferring gratification, there is a neurological locus of these problems in the frontal cortex. Frontal lobe morphology, connectivity and functioning are still in the process of maturation during adolescence and young adulthood, and early exposure to substance use is another significant factor in the development of addiction. Many neuroscientists believe that developmental morphology is the basis that makes early-life exposure to substances such an important factor.
Genetic factors account for about half of the likelihood that an individual will develop addiction. Environmental factors interact with the person’s biology and affect the extent to which genetic factors exert their influence. Resiliencies the individual acquires (through parenting or later life experiences) can affect the extent to which genetic predispositions lead to the behavioral and other manifestations of addiction. Culture also plays a role in how addiction becomes actualized in persons with biological vulnerabilities to the development of addiction.
Other factors that can contribute to the appearance of addiction, leading to its characteristic bio-psycho-socio-spiritual manifestations, include:
a. The presence of an underlying biological deficit in the function of reward circuits, such that drugs and behaviors which enhance reward function are preferred and sought as reinforcers;
b. The repeated engagement in drug use or other addictive behaviors, causing neuroadaptation in motivational circuitry leading to impaired control over further drug use or engagement in addictive behaviors;
c. Cognitive and affective distortions, which impair perceptions and compromise the ability to deal with feelings, resulting in significant self-deception;
d. Disruption of healthy social supports and problems in interpersonal relationships which impact the development or impact of resiliencies;
e. Exposure to trauma or stressors that overwhelm an individual’s coping abilities;
f. Distortion in meaning, purpose and values that guide attitudes, thinking and behavior;
g. Distortions in a person’s connection with self, with others and with the transcendent (referred to as God by many, the Higher Power by 12-steps groups, or higher consciousness by others); and
h. The presence of co-occurring psychiatric disorders in persons who engage in substance use or other addictive behaviors.
Addiction is characterized by2:
a. Inability to consistently Abstain;
b. Impairment in Behavioral control;
c. Craving; or increased “hunger” for drugs or rewarding experiences;
d. Diminished recognition of significant problems with one’s behaviors and interpersonal relationships; and
e. A dysfunctional Emotional response.
The power of external cues to trigger craving and drug use, as well as to increase the frequency of engagement in other potentially addictive behaviors, is also a characteristic of addiction, with the hippocampus being important in memory of previous euphoric or dysphoric experiences, and with the amygdala being important in having motivation concentrate on selecting behaviors associated with these past experiences.
Although some believe that the difference between those who have addiction, and those who do not, is the quantity or frequency of alcohol/drug use, engagement in addictive behaviors (such as gambling or spending)3, or exposure to other external rewards (such as food or sex), a characteristic aspect of addiction is the qualitative way in which the individual responds to such exposures, stressors and environmental cues. A particularly pathological aspect of the way that persons with addiction pursue substance use or external rewards is that preoccupation with, obsession with and/or pursuit of rewards (e.g., alcohol and other drug use) persist despite the accumulation of adverse consequences. These manifestations can occur compulsively or impulsively, as a reflection of impaired control.
Persistent risk and/or recurrence of relapse, after periods of abstinence, is another fundamental feature of addiction. This can be triggered by exposure to rewarding substances and behaviors, by exposure to environmental cues to use, and by exposure to emotional stressors that trigger heightened activity in brain stress circuits.4
In addiction there is a significant impairment in executive functioning, which manifests in problems with perception, learning, impulse control, compulsivity, and judgment. People with addiction often manifest a lower readiness to change their dysfunctional behaviors despite mounting concerns expressed by significant others in their lives; and display an apparent lack of appreciation of the magnitude of cumulative problems and complications. The still developing frontal lobes of adolescents may both compound these deficits in executive functioning and predispose youngsters to engage in “high risk” behaviors, including engaging in alcohol or other drug use. The profound drive or craving to use substances or engage in apparently rewarding behaviors, which is seen in many patients with addiction, underscores the compulsive or avolitional aspect of this disease. This is the connection with “powerlessness” over addiction and “unmanageability” of life, as is described in Step 1 of 12 Steps programs.
Addiction is more than a behavioral disorder. Features of addiction include aspects of a person’s behaviors, cognitions, emotions, and interactions with others, including a person’s ability to relate to members of their family, to members of their community, to their own psychological state, and to things that transcend their daily experience.
Behavioral manifestations and complications of addiction, primarily due to impaired control, can include:
a. Excessive use and/or engagement in addictive behaviors, at higher frequencies and/or quantities than the person intended, often associated with a persistent desire for and unsuccessful attempts at behavioral control;
b. Excessive time lost in substance use or recovering from the effects of substance use and/or engagement in addictive behaviors, with significant adverse impact on social and occupational functioning (e.g. the development of interpersonal relationship problems or the neglect of responsibilities at home, school or work);
c. Continued use and/or engagement in addictive behaviors, despite the presence of persistent or recurrent physical or psychological problems which may have been caused or exacerbated by substance use and/or related addictive behaviors;
d. A narrowing of the behavioral repertoire focusing on rewards that are part of addiction; and
e. An apparent lack of ability and/or readiness to take consistent, ameliorative action despite recognition of problems.
Cognitive changes in addiction can include:
a. Preoccupation with substance use;
b. Altered evaluations of the relative benefits and detriments associated with drugs or rewarding behaviors; and
c. The inaccurate belief that problems experienced in one’s life are attributable to other causes rather than being a predictable consequence of addiction.
Emotional changes in addiction can include:
a. Increased anxiety, dysphoria and emotional pain;
b. Increased sensitivity to stressors associated with the recruitment of brain stress systems, such that “things seem more stressful” as a result; and
c. Difficulty in identifying feelings, distinguishing between feelings and the bodily sensations of emotional arousal, and describing feelings to other people (sometimes referred to as alexithymia).
The emotional aspects of addiction are quite complex. Some persons use alcohol or other drugs or pathologically pursue other rewards because they are seeking “positive reinforcement” or the creation of a positive emotional state (“euphoria”). Others pursue substance use or other rewards because they have experienced relief from negative emotional states (“dysphoria”), which constitutes “negative reinforcement.“ Beyond the initial experiences of reward and relief, there is a dysfunctional emotional state present in most cases of addiction that is associated with the persistence of engagement with addictive behaviors. The state of addiction is not the same as the state of intoxication. When anyone experiences mild intoxication through the use of alcohol or other drugs, or when one engages non-pathologically in potentially addictive behaviors such as gambling or eating, one may experience a “high”, felt as a “positive” emotional state associated with increased dopamine and opioid peptide activity in reward circuits. After such an experience, there is a neurochemical rebound, in which the reward function does not simply revert to baseline, but often drops below the original levels. This is usually not consciously perceptible by the individual and is not necessarily associated with functional impairments.
Over time, repeated experiences with substance use or addictive behaviors are not associated with ever increasing reward circuit activity and are not as subjectively rewarding. Once a person experiences withdrawal from drug use or comparable behaviors, there is an anxious, agitated, dysphoric and labile emotional experience, related to suboptimal reward and the recruitment of brain and hormonal stress systems, which is associated with withdrawal from virtually all pharmacological classes of addictive drugs. While tolerance develops to the “high,” tolerance does not develop to the emotional “low” associated with the cycle of intoxication and withdrawal. Thus, in addiction, persons repeatedly attempt to create a “high”–but what they mostly experience is a deeper and deeper “low.” While anyone may “want” to get “high”, those with addiction feel a “need” to use the addictive substance or engage in the addictive behavior in order to try to resolve their dysphoric emotional state or their physiological symptoms of withdrawal. Persons with addiction compulsively use even though it may not make them feel good, in some cases long after the pursuit of “rewards” is not actually pleasurable.5 Although people from any culture may choose to “get high” from one or another activity, it is important to appreciate that addiction is not solely a function of choice. Simply put, addiction is not a desired condition.
As addiction is a chronic disease, periods of relapse, which may interrupt spans of remission, are a common feature of addiction. It is also important to recognize that return to drug use or pathological pursuit of rewards is not inevitable.
Clinical interventions can be quite effective in altering the course of addiction. Close monitoring of the behaviors of the individual and contingency management, sometimes including behavioral consequences for relapse behaviors, can contribute to positive clinical outcomes. Engagement in health promotion activities which promote personal responsibility and accountability, connection with others, and personal growth also contribute to recovery. It is important to recognize that addiction can cause disability or premature death, especially when left untreated or treated inadequately.
The qualitative ways in which the brain and behavior respond to drug exposure and engagement in addictive behaviors are different at later stages of addiction than in earlier stages, indicating progression, which may not be overtly apparent. As is the case with other chronic diseases, the condition must be monitored and managed over time to:
a. Decrease the frequency and intensity of relapses;
b. Sustain periods of remission; and
c. Optimize the person’s level of functioning during periods of remission.
In some cases of addiction, medication management can improve treatment outcomes. In most cases of addiction, the integration of psychosocial rehabilitation and ongoing care with evidence-based pharmacological therapy provides the best results. Chronic disease management is important for minimization of episodes of relapse and their impact. Treatment of addiction saves lives †
Addiction professionals and persons in recovery know the hope that is found in recovery. Recovery is available even to persons who may not at first be able to perceive this hope, especially when the focus is on linking the health consequences to the disease of addiction. As in other health conditions, self-management, with mutual support, is very important in recovery from addiction. Peer support such as that found in various “self-help” activities is beneficial in optimizing health status and functional outcomes in recovery. ‡
Recovery from addiction is best achieved through a combination of self-management, mutual support, and professional care provided by trained and certified professionals.

Source: www.asam.org April 2011

Explanatory footnotes:
1. The neurobiology of reward has been well understood for decades, whereas the neurobiology of addiction is still being explored. Most clinicians have learned of reward pathways including projections from the ventral tegmental area (VTA) of the brain, through the median forebrain bundle (MFB), and terminating in the nucleus accumbens (Nuc Acc), in which dopamine neurons are prominent. Current neuroscience recognizes that the neurocircuitry of reward also involves a rich bi-directional circuitry connecting the nucleus accumbens and the basal forebrain. It is the reward circuitry where reward is registered, and where the most fundamental rewards such as food, hydration, sex, and nurturing exert a strong and life-sustaining influence. Alcohol, nicotine, other drugs and pathological gambling behaviors exert their initial effects by acting on the same reward circuitry that appears in the brain to make food and sex, for example, profoundly reinforcing. Other effects, such as intoxication and emotional euphoria from rewards, derive from activation of the reward circuitry. While intoxication and withdrawal are well understood through the study of reward circuitry, understanding of addiction requires understanding of a broader network of neural connections involving forebrain as well as midbrain structures. Selection of certain rewards, preoccupation with certain rewards, response to triggers to pursue certain rewards, and motivational drives to use alcohol and other drugs and/or pathologically seek other rewards, involve multiple brain regions outside of reward neurocircuitry itself.
2. These five features are not intended to be used as “diagnostic criteria” for determining if addiction is present or not. Although these characteristic features are widely present in most cases of addiction, regardless of the pharmacology of the substance use seen in addiction or the reward that is pathologically pursued, each feature may not be equally prominent in every case. The diagnosis of addiction requires a comprehensive biological, psychological, social and spiritual assessment by a trained and certified professional.
3. In this document, the term “addictive behaviors” refers to behaviors that are commonly rewarding and are a feature in many cases of addiction. Exposure to these behaviors, just as occurs with exposure to rewarding drugs, is facilitative of the addiction process rather than causative of addiction. The state of brain anatomy and physiology is the underlying variable that is more directly causative of addiction. Thus, in this document, the term “addictive behaviors” does not refer to dysfunctional or socially disapproved behaviors, which can appear in many cases of addiction. Behaviors, such as dishonesty, violation of one’s values or the values of others, criminal acts etc., can be a component of addiction; these are best viewed as complications that result from rather than contribute to addiction.
4. The anatomy (the brain circuitry involved) and the physiology (the neuro-transmitters involved) in these three modes of relapse (drug- or reward-triggered relapse vs. cue-triggered relapse vs. stress-triggered relapse) have been delineated through neuroscience research.
Relapse triggered by exposure to addictive/rewarding drugs, including alcohol, involves the nucleus accumbens and the VTA-MFB-Nuc Acc neural axis (the brain’s mesolimbic dopaminergic “incentive salience circuitry”–see footnote 2 above). Reward-triggered relapse also is mediated by glutamatergic circuits projecting to the nucleus accumbens from the frontal cortex.
Relapse triggered by exposure to conditioned cues from the environment involves glutamate circuits, originating in frontal cortex, insula, hippocampus and amygdala projecting to mesolimbic incentive salience circuitry.
Relapse triggered by exposure to stressful experiences involves brain stress circuits beyond the hypothalamic-pituitary-adrenal axis that is well known as the core of the endocrine stress system. There are two of these relapse-triggering brain stress circuits – one originates in noradrenergic nucleus A2 in the lateral tegmental area of the brain stem and projects to the hypothalamus, nucleus accumbens, frontal cortex, and bed nucleus of the stria terminalis, and uses norepinephrine as its neurotransmitter; the other originates in the central nucleus of the amygdala, projects to the bed nucleus of the stria terminalis and uses corticotrophin-releasing factor (CRF) as its neurotransmitter.
5. Pathologically pursuing reward (mentioned in the Short Version of this definition) thus has multiple components. It is not necessarily the amount of exposure to the reward (e.g., the dosage of a drug) or the frequency or duration of the exposure that is pathological. In addiction, pursuit of rewards persists, despite life problems that accumulate due to addictive behaviors, even when engagement in the behaviors ceases to be pleasurable. Similarly, in earlier stages of addiction, or even before the outward manifestations of addiction have become apparent, substance use or engagement in addictive behaviors can be an attempt to pursue relief from dysphoria; while in later stages of the disease, engagement in addictive behaviors can persist even though the behavior no longer provides relief.

Several jurisdictions in the U.S. have taken steps toward decriminalizing marijuana possession for personal use or when prescribed by a physician for medicinal purposes. Other jurisdictions have pending ballot initiatives or legislative bills proposing such changes in the law.
The Board of Directors of the National Association of Drug Court Professionals (NADCP) has determined that it is essential for drug court practitioners to be fully and objectively informed about the effects of marijuana on their participants and the public at-large. This document briefly reviews the scientific evidence concerning the effects of marijuana.

Incarceration for Marijuana Possession

It is exceedingly rare to be incarcerated in the U.S. for the use or possession of marijuana. According to the National Center on Addiction & Substance Abuse at Columbia University (CASA, 2010), less than 1 percent (0.9%) of jail and prison inmates in the U.S. were incarcerated for marijuana possession as their sole offense.
Excluding jail detainees who may be held pending booking or release on bond, the rates are even lower. Prison inmates sentenced for marijuana possession account for 0.7 percent of state prisoners and 0.8 percent of federal prisoners (see Table). And, considering that many of those prisoners pled down from more serious charges, the true incarceration rate for marijuana possession can only be described as negligible.
State Prisoners Federal Prisoners
Marijuana offense only 1.6% N.R.
Marijuana possession only 0.7% 0.8%
First-time marijuana possession 0.3% N.R.

Source: Office of National Drug Control Policy, Who’s Really in Prison for Marijuana? [NCJ #204299] (citing BJS, 1999, Substance abuse and treatment, state and federal prisoners, 1997 [NCJ #172871]; U.S. Sentencing Commission, 2001 Sourcebook of Federal Sentencing Statistics). N.R. = not reported. 2

Addiction Potential

By the early 1990’s, the scientific community had concluded from rigorous laboratory and epidemiological studies that marijuana is physiologically and psychologically addictive. Every drug of abuse has what is called a dependence liability, which refers to the statistical probability that a person who uses that drug for nonmedical purposes will develop a compulsive addiction. Based upon several nationwide epidemiological studies, marijuana’s dependence liability has been reliably determined to be 8 to 10 percent (Anthony et al., 1994; Brook et al., 2008; Budney & Moore, 2002; Kandel et al., 1997; Munsey, 2010; Wagner & Anthony, 2002). This means that one out of every 10 to 12 people who use marijuana will become addicted to the drug.
Importantly, the dependence liability of any drug increases with more frequent usage. Individuals who have used marijuana at least five times have a 20 to 30 percent likelihood of becoming addicted to the drug, and those who use it regularly have a 40 percent likelihood of becoming addicted (Budney & Moore, 2002).
The hallmark feature of physical addiction is the experience of uncomfortable or painful withdrawal symptoms whenever levels of the substance decline in the bloodstream. This is, in part, what drives addicts to continue abusing drugs or alcohol despite suffering severe negative medical, legal and interpersonal consequences. Carefully controlled, rigorous laboratory studies have proven beyond further dispute that marijuana addiction is associated with a clinically significant withdrawal syndrome. When marijuana-addicted individuals stop using the drug, they experience symptoms of irritability, anger, cravings, decreased appetite, insomnia, interpersonal hypersensitivity, yawning and/or fatigue (Budney et al., 2001; Preuss et al., 2010). In fact, the features and severity of the marijuana withdrawal syndrome are virtually indistinguishable from those of nicotine (cigarette) withdrawal.
A second hallmark feature of addiction is psychosocial dysfunction resulting from repeated use of the substance. The most commonly diagnosed symptoms of psychosocial dysfunction among marijuana addicts include persistent procrastination, bad or guilty feelings, low productivity, low self-confidence, interpersonal or family conflicts, memory problems and financial difficulties (Budney & Moore, 2002; NIDA, 2005). This constellation of symptoms has been collectively referred to as an “amotivational syndrome” (e.g., Hubbard et al., 1999) because marijuana abusers tend to be characteristically languid and often achieve considerably below their true intellectual potentials.
Based on this substantial body of empirical research, the American Psychiatric Association (APA) has long recognized cannabis dependence as a valid and reliable psychiatric disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM is the official psychiatric diagnostic classification system in the U.S. A diagnosis of cannabis dependence has been continuously included in the 3rd and 4th editions of the DSM since 1980 (APA, 1980, 1987, 1994, 2000). In the soon-to-be published 5th edition of the DSM, a cannabis withdrawal syndrome will now also be officially recognized as part of the diagnostic criteria for cannabis dependence.

Medical Harm

In many respects, smoked marijuana has the potential to be as, or more, harmful than cigarettes. Although marijuana does not contain nicotine, it does contain 50 to 70 percent more carcinogenic compounds, including tar, than cigarettes (NIDA, 2005; Hubbard et al., 1999). Marijuana also produces high levels of a particular enzyme which converts certain hydrocarbons into their carcinogenic or malignant forms (NIDA, 2005).
Although gram for gram, marijuana smoke is clearly more carcinogenic than cigarette smoke, it is difficult to predict whether actual incidence rates of induced cancers are likely to be as high as they are for cigarettes. On one hand, cannabis smokers tend to use the drug on fewer occasions than cigarette smokers. On the other hand, they typically inhale larger amounts of the drug per occasion, hold the smoke in their lungs for longer intervals of time, and are unlikely to employ filters. This makes it difficult to compare the predicted magnitudes of the harms. The best estimate from the National Institutes of Health (NIH) is that a person who smokes five marijuana cigarettes per week is likely to be inhaling as many cancer-causing chemicals as one who smokes a full pack of cigarettes every day.1
See U.S. Dept. of Justice, Drug Enforcement Administration, Exposing the myth of medical marijuana: The facts. Available at http://www.justice.gov/dea/ongoing/marijuanap.html.
Like nicotine, cannabis increases heart rate, alters blood pressure, can induce tachycardia (rapid or irregular heartbeat), increases myocardial (heart) stress, decreases oxygen levels in the circulatory system, and exacerbates angina (Hubbard et al., 1999). As a result, a person’s risk of a heart attack is increased four-fold during the first hour after smoking marijuana (NIDA, 2005).
There is no question that regular marijuana use is associated with a wide spectrum of chronic respiratory ailments. A nationally representative study of 6,728 adults found heavy marijuana use to be substantially associated with chronic bronchitis, coughing on most days, wheezing, abnormal chest sounds and increased phlegm (Moore et al., 2005).
Marijuana has undisputed negative effects on cognitive functioning, including memory, learning and motor coordination. These negative effects persist long after the period of acute intoxication, averaging approximately 30 days of residual cognitive impairment (Bolla et al., 2002; NIDA, 2005; Pope et al., 2001). This means that individuals are apt to wrongly believe they are capable of performing critical tasks, such as driving a car, operating heavy machinery, caring for children or solving work-related intellectual problems, when in fact they may be performing in the mildly to moderately impaired range of functioning.
Like any drug, marijuana’s negative effects tend to be most pronounced in elderly persons, individuals with chronic medical illnesses, and those with compromised immune systems. This is of particular concern given that marijuana is being specifically touted for “medicinal” use by elderly patients, cancer patients, and those with immunodeficiency
syndromes such as HIV/AIDS (e.g., Munsey, 2010). Rather than benefiting such individuals, marijuana has the serious potential to further suppress or compromise their immune systems and exacerbate the disease process (NIDA, 2005).

Medicinal Effects

Marijuana is a “Schedule I” drug according to the Drug Enforcement Administration (DEA), meaning it has a high abuse potential and no recognized medical indication. However, the Food and Drug Administration (FDA) has approved a particular ingredient within marijuana (THC) in a non-smoked form for certain medical indications, such as for treatment of nausea, vomiting and poor appetite. Recent studies have also supported its use in treating chronic neuropathic pain (e.g., Munsey, 2010).
To date, research indicates that oral THC (when administered at adequate doses) is as effective as smoked marijuana in achieving these therapeutic effects (e.g., Munsey, 2010). Anecdotal testimonials are the only evidence favoring smoked marijuana over oral THC for therapeutic purposes. Further research is called for to determine whether other compounds within marijuana might have medicinal properties as well, but at this juncture any such indications are purely experimental and speculative.
Regardless, smoked marijuana could no more be considered a “medication” than cigarettes or alcohol. Although cigarettes and alcohol have undeniable effects that many people may find palliative (such as alleviating short-term stress), they are very “dirty” drugs. This means they contain dozens, if not hundreds, of other physiologically active compounds which are irrelevant to their palliative effects and may actually work at cross-purposes against those effects. For example, many people believe alcohol and nicotine lower their stress level, but in fact these drugs are proven to increase anxiety, lower stress tolerance and exacerbate insomnia over the longer term. These drugs are also associated with a host of serious medical conditions, including cancer, heart disease, liver disease and respiratory illnesses. For these reasons, physicians would rarely, if ever, “prescribe” these drugs to treat a medical condition.
More research is needed to isolate the potential therapeutic effects of specific compounds within marijuana, and to determine how to administer those compounds in a manner that is medically safe and does not threaten to cause heart, lung and other diseases. Administering the “dirty” form of the drug would never be a legitimate medical end-goal.

Impact on Crime

Two recent meta-analyses (advanced statistical procedures) have concluded that marijuana use during adolescence or young adulthood significantly predicts later involvement in criminal activity and criminal arrests (Bennett et al., 2008; Pedersen & Skardhamar, 2010). The risk of criminal involvement was determined to be between 1.5 and 3.0 times greater for cannabis users than for non-users. 5 The results suggest that, all else being equal, cannabis users are at a statistically increased risk for associating with antisocial individuals, engaging in illegal conduct, and eventually getting a criminal record.

Conclusion

Marijuana is an intoxicating and addictive drug that poses serious medical risks akin to those of nicotine and alcohol. Although some physicians may consider it to have palliative indications, no national or regional medical or scientific organization recognizes marijuana as a medicine in its raw or smoked form.
If marijuana becomes decriminalized or legalized in a given jurisdiction, this does not necessarily require drug court practitioners to abide its usage by their participants. The courts have long recognized restrictions on the use of a legal intoxicating substance (i.e., alcohol) to be a reasonable condition of bond or probation where the offender has a history of illicit drug involvement. If there is a rational basis for believing cannabis use could threaten public safety or prevent the offender from returning to court for adjudication, appellate courts are likely to uphold such restrictions in the drug court context.
Individuals who have a valid medical prescription for marijuana present a more challenging issue, but one that is probably also not insurmountable. Under such circumstances, the judge might subpoena the prescribing physician to testify or respond to written inquiries about the medical justification for the prescription. In addition, the court may be authorized by the rules of evidence or rules of criminal procedure to engage an independent medical expert to review the case and offer a medical recommendation or opinion. Having a Board-certified addiction psychiatrist on hand to advise the drug court judge may provide probative evidence about whether a particular marijuana prescription is medically necessary or indicated.
It remains an open question what degree of deference appellate courts are likely to give to the conclusions of a treating physician. In the absence of clear precedent, the best course of action is to develop a factual record and make a particularized decision in each case about the medical necessity for the prescription and the rationale for restricting marijuana usage during the term of criminal justice supervision.
If judges make these decisions based on a reasonable interpretation of medical evidence presented by qualified experts, it seems unlikely that drug courts — which were specifically designed to treat seriously addicted individuals — could not restrict access to an intoxicating and addictive drug as a condition of criminal justice supervision.

About NADCP

It takes innovation, teamwork and strong judicial leadership to achieve success when addressing drug-using offenders in a community. That’s why since 1994 the National Association of Drug Court Professionals (NADCP) has worked tirelessly at the national, state and local level to create and enhance Drug Courts, which use a combination of accountability and treatment to compel and support drug-using offenders to change their lives.
Now an international movement, Drug Courts are the shining example of what works in the justice system. Today, there are over 2,400 Drug Courts operating in the U.S., and another thirteen countries have implemented the model. Drug Courts are widely applied to adult criminal cases, juvenile delinquency and truancy cases, and family court cases involving parents at risk of losing custody of their children due to substance abuse.
Drug Court improves communities by successfully getting offenders clean and sober and stopping drug-related crime, reuniting broken families, intervening with juveniles before they embark on a debilitating life of addiction and crime, and reducing impaired driving.
In the 20 years since the first Drug Court was founded in Miami/Dade County, Florida, more research has been published on the effects of Drug Courts than on virtually all other criminal justice programs combined. The scientific community has put Drug Courts under a microscope and concluded that Drug Courts significantly reduce drug abuse and crime and do so at far less expense than any other justice strategy.
Such success has empowered NADCP to champion new generations of the Drug Court model. These include Veterans Treatment Courts, Reentry Courts, and Mental Health Courts, among others. Veterans Treatment Courts, for example, link critical services and provide the structure needed for veterans who are involved in the justice system due to substance abuse or mental illness to resume life after combat. Reentry Courts assist individuals leaving our nation’s jails and prisons to succeed on probation or parole and avoid a recurrence of drug abuse and
Today, the award-winning NADCP is the premier national membership, training, and advocacy organization for the Drug Court model, representing over 27,000 multi-disciplinary justice professionals and community leaders. NADCP hosts the largest annual training conference on drugs and crime in the nation and provides 130 training and technical assistance events each year through its professional service branches, the National Drug Court Institute, the National Center for DWI Courts and the National Veterans Treatment Court Clearinghouse. NADCP publishes numerous scholastic and practical publications critical to the growth and fidelity of the Drug Court model and works tirelessly in the media, on Capitol Hill, and in state legislatures to improve the response of the American justice system to substance-abusing and mentally ill offenders through policy, legislation, and appropriations.
For more information please visit us on the web at www.AllRise.org.

Source: National Association of Drug Court Professionals. Sept. 2010

BANGOR, Me. — The mother got the call in the middle of the night: her 3-day-old baby was going through opiate withdrawal in a hospital here and had to start taking methadone, a drug best known for treating heroin addiction, to ease his suffering.
The mother had abused prescription painkillers like OxyContin for the first 12 weeks of her pregnancy, buying them on the street in rural northern Maine, and then tried to quit cold turkey — a dangerous course, doctors say, that could have ended in miscarriage. The baby had seizures in utero as a result, and his mother, Tonya, turned to methadone treatment, with daily doses to keep her cravings and withdrawal symptoms at bay.
As prescription drug abuse ravages communities across the country, doctors are confronting an emerging challenge: newborns dependent on painkillers. While methadone may have saved Tonya’s pregnancy, her son, Matthew, needed to be painstakingly weaned from it. Infants like him may cry excessively and have stiff limbs, tremors, diarrhea and other problems that make their first days of life excruciating. Many have to stay in the hospital for weeks while they are weaned off the drugs, taxing neonatal units and driving the cost of their medical care into the tens of thousands of dollars.
Like the cocaine-exposed babies of the 1980s, those born dependent on prescription opiates — narcotics that contain opium or its derivatives — are entering a world in which little is known about the long-term effects on their development. Few doctors are even willing to treat pregnant opiate addicts, and there is no universally accepted standard of care for their babies, partly because of the difficulty of conducting research on pregnant women and newborns.
Those who do treat pregnant addicts face a jarring ethical quandary: they must weigh whether the harm inflicted by exposing a fetus to powerful drugs, albeit under medical supervision, is justifiable. “I’ve had pharmacies that have just called back and said: ‘This lady’s pregnant. Why do you want me to fill this scrip? I can’t do that,’ ” said Dr. Craig Smith, a family practitioner in Bridgton, Me. “But when you stop and think about what actually happens during withdrawal and how violent it can be, that would certainly be not in the baby’s best interest.”
Still, even doctors who advocate treating pregnant addicts have had moments of doubt. “At first I was going, ‘Gosh, what am I doing?’ ” said Dr. Thomas Meek, a primary care physician in Auburn, Me. “ ‘Am I really helping these people?’ ”
There are no national figures that document the extent of the problem, but interviews with doctors, researchers, social workers and women who abused painkillers while pregnant suggest that it has grown rapidly, especially in rural regions, where officials say such abuse is most common.
In Maine, which has been especially plagued by prescription drug abuse, the number of newborns treated or watched for opiate withdrawal, known as neonatal abstinence syndrome, at the state’s two largest hospitals climbed to 276 in 2010 from about 70 in 2005. Hospitals in states including Florida and Ohio reported similar increases, and experts said the numbers were probably higher since pregnant women are rarely tested for drug use and many mothers do not admit to abusing opiates.
Tonya, 24, said she was introduced to painkillers like OxyContin, Percocet and Vicodin while working the overnight shift at an industrial bakery an hour from her home. Everyone — including co-workers, the boyfriend she met on the job and their manager — was taking pills, she said. “It was a lot easier to get through life and have energy,” Tonya said at Eastern Maine Medical Center here in January, holding Matthew a month after his birth. He was still being weaned off methadone.
Before she was pregnant, Tonya said, she quickly became addicted, spending all of her money on pills bought on the street. She and her boyfriend, Josh, needed to stave off withdrawal and get through the day, she said. Now that she is in treatment, Tonya, who like most mothers interviewed for this article did not want her last name used, said her focus was on Matthew. “We put him in this situation,” she said, “and we have to help him out of it.”
‘How Little We Know’
Rigorous studies on treating infant withdrawal are scarce, and the American Academy of Pediatrics has not published guidelines since 1998. “It’s really remarkable how little we know about the effect of prescription drugs and even nonprescription drugs on the fetus,” said Dr. Nora D. Volkow, director of the National Institute for Drug Abuse. “There are real roadblocks in terms of helping us advance the field.”
Dr. Mark L. Hudak, a neonatologist in Jacksonville, Fla., is helping to revise the pediatrics academy’s guidelines. “There are commonalities, but it’s not like you can go to a Web site that says, ‘This is what should be used by everyone,’ ” Dr. Hudak said. “No one knows what the best approach is.”
Within states, every hospital that delivers babies exposed to painkillers may have its own approach. Eastern Maine treats affected newborns with tiny doses of methadone, while Maine Medical Center in Portland uses morphine combined with phenobarbital, a barbiturate that prevents seizures. Some hospitals are also experimenting with clonidine, a mild sedative that can relieve withdrawal symptoms.
There is growing debate over treatment for pregnant women addicted to prescription drugs, in light of concerns over the effects on their babies. Many are slowly weaned from their dependence with methadone, the standard of care for decades. Methadone, when taken in prescribed doses, keeps a steady amount of opiate in the body, preventing withdrawal and drug cravings that occur when levels dip. But it, too, can be addictive and cause nagging side effects like drowsiness. And for addiction treatment, it can be obtained only at federally licensed clinics where most users have to report for a daily dose.
A growing number of addicts are instead taking buprenorphine, another drug used to treat addiction that some studies suggest staves off drug cravings as effectively as methadone but is less likely to cause withdrawal in newborns. In rural areas of the nation, where methadone clinics are few, buprenorphine is considered a promising alternative because it can be prescribed by primary care doctors and taken at home. But buprenorphine also appears not to work for some addicts.
Still, a study published in December in The New England Journal of Medicine showed that babies whose mothers had taken buprenorphine required significantly less medication after birth and less time in the hospital than did babies whose mothers were treated with methadone. But researchers cautioned that exposure to buprenorphine in utero can still cause withdrawal symptoms and that further study was needed. “We don’t want it misconstrued that buprenorphine is a miracle drug,” said Hendrée E. Jones, a Johns Hopkins University researcher and the study’s lead author.
Even less is known about longer-term effects on babies exposed to painkillers, though in a second leg of their study, Dr. Jones and her fellow researchers plan to follow the 131 babies in the cohort until they turn 3. A recent study by the Centers for Disease Control and Prevention found that babies exposed to opiates in utero, in this case legally prescribed painkillers, had slightly higher rates of birth defects, including congenital heart defects, glaucoma and spina bifida.
Experts say that since many drug users also smoke and abuse alcohol, not to mention that they face extenuating circumstances like poverty, it is difficult to tease out the effects of each substance on their offspring. “Most of the literature suggests consistently that the drug exposure itself is not the primary concern,” said Karol Kaltenbach, a professor at Jefferson Medical College in Philadelphia who studies addiction in pregnant women. “It’s the cumulative effect of the drug-using lifestyle — poverty, chaos in the home, domestic violence. All those things affect development.”
Not all newborns exposed to opiates have severe enough withdrawal to need medicine; at Maine Medical Center since 2003, about 55 percent of babies exposed to buprenorphine and 80 percent of those exposed to methadone have needed treatment. But it is hard to predict which ones will need it: a newborn whose mother was on a high dose of either drug might need none, while a baby whose mother took a low dose might experience acute withdrawal. Babies known to have been exposed to drugs are often kept in the hospital for at least five days because withdrawal symptoms usually do not set in immediately. Nurses examine them for a checklist of symptoms every few hours, assigning each baby a score that, if high enough, calls for treatment.
“They don’t stop crying, they can’t settle down, they don’t relax,” said Geraldine Tamborelli, nursing director of the birthing unit at Maine Medical Center, which in 2010 diagnosed opiate withdrawal in 121 newborns. “They’re struggling in your arms instead of snuggling into you like a baby that is totally fine.”
In the neonatal intensive care unit at Eastern Maine, Kendra, 3 days old, was sleeping in a dark, silent room one morning, away from the bustle and bright lights that can be especially irritating to babies going through withdrawal. Nurses frequently crept in to observe her, though, and by the afternoon her limbs had stiffened and she was crying excessively and having tremors; it was enough to begin treatment. “This seems to be ramping up fairly quickly for her,” said Dr. Mark Brown, the hospital’s chief of pediatrics, “so the decision was to start treatment more quickly.”
On the pediatric ward, Matthew started fussing while his mother, Tonya, talked to reporters that afternoon in January; his cry had a strange, reedy pitch that nurses say is common to babies with his condition. The small dose of methadone he had received gave him gas and heartburn, for which he was given two stomach medications. He also was on clonazepam, a muscle relaxant and anti-anxiety drug that helped him metabolize the methadone more slowly.
Tonya said that at first she “didn’t believe in” methadone treatment during pregnancy and that doctors had to persuade her that it would not hurt her fetus. She had experienced wrenching withdrawal when she stopped using painkillers after learning she was pregnant, she said, and the doctors had warned her that “when I was feeling that bad, he was feeling 1,000 times worse.” Tonya said that in a previous pregnancy, she quit using drugs altogether and miscarried a month later. “That was the last thing I wanted to happen this time,” she said.
Avoiding Addicts, and Liability
Treating drug-dependent mothers and babies is often lonely work, with little communication among the doctors who take it on. As Dr. Brown said, “My network for people who do this is really very small.”
Dr. Mark R. Publicker, an addiction medicine specialist at Mercy Recovery Center in Westbrook, Me., is on a mission to get more of the state’s doctors to treat pregnant prescription drug abusers and more hospitals to deliver their babies. Only a handful of doctors here treat pregnant women with buprenorphine, Dr. Publicker said, partly because they fear liability and do not want to deal with addicts. The fact that most hospitals will not deliver the babies makes doctors even less likely to treat the women. “It’s mostly ignorance,” Dr. Publicker said. “It’s a concern that it’s a risky proposition and that they’re going to wind up with an ill baby.”
In February, Dr. Smith persuaded Bridgton Hospital, which has only 25 beds, to deliver the babies of women on buprenorphine — a major victory, he said, because until then women in rural southwestern Maine had to drive an hour or more to Maine Medical to deliver. Courtney, a patient of Dr. Smith’s who discovered she was pregnant while in jail for stealing OxyContin from her landlord, said buprenorphine treatment seemed the best of her bleak options. “I just don’t want to mess up,” she said.
Tonya, too, said she was determined to make things right for Matthew, who was five weeks old when she took him home to a trailer outside Bangor. He is off the methadone now and appears healthy, but Tonya still has to go to a methadone clinic in Bangor every day for her dose and resist the pressures to return to illicit drug use. Her boyfriend began using opiates as a young teenager, she said, and his father and grandmother abused OxyContin along with him. “I’m proud that I changed my life,” Tonya said. “But at the same time, when you see your child in pain and you know your child is in pain because of a life decision you made, it’s the hardest thing in the world.”

Source: New York Times April 9th 2011