Jul 10, 2008

A Review of What Works

Introduction
Alcoholism affects millions of people in the United States alone. According to the National Institute of Alcohol Abuse (NIAA), a division of the National Institutes of Health in Bethesda, Maryland USA, at least 700,000 Americans receive treatment for this disease every day. Some kinds of treatment, such as Alcoholics Anonymous (AA) have been around for many years while others are relatively new. Clinical research to determine the effectiveness of these various treatments has resulted in some important findings.
In October 2000 the NIAA released a summary of its conclusions based on fifteen years of research on alcohol treatments. According to the NIAA, self-help programs such as AA, psychotherapy and pharmacotherapy, either alone or in combination, are in fact effective and do reduce the use of alcohol.
Alcoholics Anonymous
Of all the treatments for alcohol misuse, Alcoholics Anonymous (AA) is probably the most well known. In AA, a form of “self-help” treatment, participants take part in a series of mental, written and verbal activities that can lead to recovery and abstinence. In one study, alcoholic patients who received inpatient and outpatient psychotherapy, as well as AA, had better outcomes than those patients who attended only one kind of treatment.
It is thought that AA helps people because it provides a new social network that replaces the alcohol abuser’s usual group of friends who drink with him or her, and provides a fellowship that inspires motivation and lends support toward the goal of reaching and maintaining abstinence. AA also teaches a set of coping skills so that, when stressed, the alcohol abuser has more constructive ways of coping, and does not need to turn to alcohol to escape his or her problems.
Another study, conducted at a Department of Veteran Affairs hospital, indicated that those alcoholic patients who underwent either cognitive-behavioral therapy (CBT) or a 12-step program in combination with CBT did better, over the long run, than those who participated in the 12-step program alone. (CBT entails learning coping skills, new ways of interpreting and reacting to stressful situations, and changing one’s destructive or maladaptive behavior patterns.) The patients who received the combination treatment stayed sober longer and were able to hold down a job for longer periods than those patients who received only CBT.
Both of these studies seem to show that a combination of some kind of psychotherapy and a 12-step program such as AA produces the most beneficial results for patients who use alcohol in excess.
Other beneficial treatments
Other promising treatments of alcohol abuse that are being studied include Motivational Enhancement Therapy (MET); couples therapy; Brief Intervention Therapy; dual-addiction treatment; and pharmacotherapy.
Motivational Enhancement Therapy: The key component of MET is an interviewing technique conducted by a trained psycho-therapist. The goal of this method is to increase an individual’s degree of motivation to stop drinking and to maintain abstinence. This is accomplished by the therapist gauging the individual’s readiness to change and then adjusting feedback accordingly. An intensive, individualized interviewing strategy, MET was demonstrated to overcome many patients’ disinclination to address their alcohol problem in treatment and increase their willingness to change.
Couples Therapy: Patients who include their non-alcohol abusing partners in their psychotherapy are more apt to attend therapy, and more likely to alter their unhealthy drinking habits. In one model of couples therapy known as Behavioral-Marital Therapy (BMT), communication and conflict-resolution skills are taught. When a relapse-prevention plan was added to this model, alcohol abstinence rates were even higher.
Brief Intervention Therapy: This treatment method usually takes place when alcohol users visit their primary care physicians. It typically entails the imparting of information about the negative consequences of drinking to excess, as well as supportive programs in the community. Two studies, carried out in the United States and Canada, showed that patients did reduce their alcohol consumption as a result of these interventions. This treatment seems to work best with those individuals who are at-risk for alcohol abuse. Those who are already dependent are better off being referred to specialized treatment programs.
Dual-addiction treatment: This method attempts to target both cigarette (nicotine) and alcohol dependencies at once. The use of one of these substances seems to make an individual more susceptible to dependence on the other. The rationale behind dual-addiction treatment is that reducing dependence on one may help a person reduce his or her reliance on the other. Although this is a newer approach to treatment, a recent study seems to suggest that this is indeed the case.
Pharmacotherapy: Finally, if taken on a regular basis, the drug naltrexone, approved by the U.S. Food and Drug Administration in 1995, can be a valuable aid in preventing relapse among recovering alcoholics receiving psychotherapy. Another medication, acamprosate, proved helpful in several European trials. (Editor’s note: It is now undergoing clinical trials in the United States.) Zofran, a medication usually used to prevent nausea during chemotherapy for cancer, was beneficial in the treatment of early-onset (i.e. those who started drinking heavily before age 25) alcoholism. Sertraline (Zoloft), an anti-depressant, was found to be helpful in reducing drinking in those with late-onset alcoholism.
Summary
Using proven methods of evaluating medical therapies, recent research reveals that many effective treatments exist to help people to stop drinking and maintain abstinence. These treatments include self-help groups such as AA, psychosocial approaches and medications.
Continued research in the field of alcoholism is likely to produce highly specific medications that will reduce the craving for alcohol. It will also yield an even broader range of therapies, including those mentioned here, that will improve the alcohol abusing person’s chance for recovery.
Over time, those who suffer from alcohol abuse and/or dependence will have even more and possibly better options for successful treatment. In the meantime, effective treatments already being offered by mental health professionals and community groups have been demonstrated to reduce alcohol use and promise a better life for people who make use of them.

Source: Jul 10, 2008 WorldWideAddiction.com

“Drug driving tests have been an outstanding success in reliably identifying drivers whose capacity to drive is dangerously compromised,” Mr Holding said. “There can be no mistake that driving under the influence of illicit drugs is just as dangerous as driving while affected by alcohol and is a major contributor to death and trauma on Victoria’s roads.

“The first four months of the saliva drug testing program have identified a worrying level of substance use among drivers that will not be tolerated.” Mr Holding said a three-step process ensured the integrity of the tests. Drivers are initially asked to provide a saliva sample by placing a small absorbent pad on their tongue for a few seconds.

Drivers who return a positive test are then asked to accompany police into a drug bus, similar to a booze bus, for two further saliva samples – one to be kept by the driver and the other for further on-the-spot analysis. If this indicates a positive result, the sample is sent to a laboratory for verification. Motorists who return positive laboratory results for cannabis or methamphetamines are fined $307 and lose three demerit points, or are prosecuted in court. If the offence progresses to court, the maximum penalty for a first offence is $614 and three months’ licence cancellation. Subsequent convictions can result in fines of up to $1227 and up to six months’ licence cancellation.

Mr Holding said in the four months to 17 March 2005, a total of 4619 drivers were tested, with 63 drivers testing positive for drugs. He said 21 drivers tested positive for cannabis and methamphetamine-based drugs. Five drivers tested positive for only cannabis, with 37 testing positive to only methamphetamine-based drugs.

Of the 3488 car drivers tested, 47 returned a positive result. Sixteen out of 1131 truck drivers tested positive for drugs. Eight preliminary tests were not confirmed by the drug bus.

Mr Holding said test handling procedures had been reviewed after three drivers’ final tests ultimately came up negative in the very early stages of the program. “Independent laboratory tests since have conclusively verified the accuracy of saliva drug testing,” Mr Holding said.

White ‘repackaged’ drug facility idea as crime prevention tool
The newcomer to Ottawa credited with being the catalyst for a new residential drug-treatment centre for youth managed the feat by “repackaging” the proposal from a health issue into a crime prevention issue.
Yesterday, as a who’s who of politicians and community leaders gathered for a multi-million-dollar funding announcement by Premier Dalton McGuinty, police Chief Vern White was praised for being instrumental in putting together the deal that has eluded Ottawa for two decades.
Chief White has been in Ottawa only 15 months, but has done what no one else had managed to do in
“Everyone complains about lack of health care. So I called it a ‘crime prevention tool’,” said Chief White after the press conference yestserday. “The old packaging wasn’t working, so I repackaged it.”
According to Chief White’s calculations, taking 20 youths with drug addictions off the street would result in 80 to 160 fewer minor crimes each day. Each addicted youth commits four to eight crimes a day, ranging from prostitution to vehicle smash-and-grabs to support a drug habit, he estimates.
Chief White took his repackaged argument on the road in the Ottawa area, speaking to more than 50 community groups and service clubs. He didn’t talk about youth, he talked about parents.
“They’re our kids,” he said.
As it stands, drug-addicted youths must go to Thunder Bay and even farther for residential drug-treatment programs. According to figures from the United Way of Ottawa, one in six Ontario high school students reports symptoms of drug use, which translates into 9,000 Ottawa high school students. Young people typically begin to experiment with alcohol at age 12 and with illicit drugs at 14.
Long-term residential treatment for addicts results in a 71-per-cent decrease in substance use and a 61-per-cent decrease in criminal behaviour, according to the United Way.
A campaign to get a residential treatment centre had been on the agenda for years, but plan after plan fell apart.
In June 2006, a proposal to buy the former Rideau Correctional Centre near Burritts Rapids and convert it into a treatment centre was shelved amid concerns about a native land claim encompassing the property.
A likely location for a new anglophone residential centre is the Meadow Creek treatment facility on Carp Road, currently used for programs helping adult addicts. The program is scheduled to be moved into Ottawa in about a month. East-end locations are still being scouted for a francophone program.
Chief White credited restaurateur and fundraiser Dave Smith with being the “DNA” behind the project.
“I have been hollering and screaming for 20 years,” said Mr. Smith yesterday. “Sending kids to the American side wasn’t the answer.” Mr. Smith’s campaign to get a residential centre for youth resulted in the creation of an outpatient drug treatment program. It wasn’t what he wanted, but it was “better than nothing at all,” he said. Mr. Smith said he’s just glad Ottawa will finally be getting a residential centre.
Source: The Ottawa Citizen Published: Wednesday, June 11, 2008

New law puts alcohol and drugs on an equal footing in roadside checks for impaired driving, and promises to reduce driving “high”

The Canadian Centre on Substance Abuse (CCSA), Canada’s national addictions agency, welcomes new legislation set to go into effect on July 2 that, for the first time in Canada, establishes parity between drug- and alcohol-impaired driving under the law. Bill C-2, the Tackling Violent Crime Act, comes into force after a decade of rising rates of drug-impaired driving in Canada. Canadian studies indicate that drugs, often in combination with alcohol, are detected in up to 30% of fatally injured drivers. CCSA’s 2004 Canadian Addiction Survey found 5% of Canadian drivers admitted to driving within two hours of using cannabis—a 50% increase since 1989. Among 16–18 year olds, 21% reported driving after using cannabis, slightly higher than the 20% of their peers who reported driving after alcohol use. ―Such findings suggest that the drugs-and-driving problem is by no means insignificant and appears to be increasing,‖ said CCSA Manager of Research and Policy Doug Beirness. Mandatory roadside checks for alcohol impairment are recognized as having a deterrent effect on drinking and driving because of the perceived risk of being caught and charged. However, before Bill C-2, a police officer who suspected a driver of being impaired by drugs could only request that the driver undergo voluntary testing and there was no sanction if the driver refused. This left officers with little chance of pursuing a conviction on the basis of drug-impaired driving. ―As a result, many drug-impaired drivers have been risking their own safety and the safety of others because they believed they would not be caught,‖ said Beirness. Beginning July 2, refusing a roadside drug test will be equivalent to declining a breath test for alcohol and will be subject to the same sanctions. Refusing to take a breath test is a Criminal Code offence. ―The legislation clarifies that you must comply with demands from police to assess whether you are impaired, and if you refuse, you are subject to the same penalties,‖ said RCMP Cpl. Evan Graham, National Coordinator, Drug Evaluation and Classification Program, Traffic Services. The new legislation empowers Canadian police who suspect a driver of being impaired by any drug, illegal, prescription or over the counter, to conduct a Standardized Field Sobriety Test, a roadside test of physical coordination. If found to be impaired, the driver must submit to a mandatory Drug Evaluation and Classification (DEC) assessment, a 12-step process that requires the driver to provide a bodily fluid sample (blood, saliva or urine). The DEC is conducted by a Drug a DEC-trained community police officer, and takes 45–60 minutes to complete.

In this way, Bill C-2 has the potential to reduce the harms associated with drugs by enabling police officers to remove dangerous drivers from Canadian roads, whether they are impaired by drugs or alcohol” said Beirness.
The DEC programme has been operating in Canada for 13 years, but only in cases where drivers agree to participate. Research on the DEC programme, including studies conducted by CCSA staff, has established the accuracy and reliability of this method in determining impairment from a variety of drugs and drug combinations.

Impaired drivers will face new penalties under the law, including a fine of not less than $1,000 for the first offence, and imprisonment for the second offence of not less than 30 days, and not less than 120 days for each subsequent offence.

Impaired drivers who cause an accident can face a maximum 10 year sentence in the case of causing bodily harm, and a life sentence in the case of causing death.

Anyone convicted of operating a vehicle under the influence of drugs, alcohol or both will be prohibited from driving a vehicle for one to three years for the first offence and two to five years for the second offence.

We hope that by creating awareness of the new legislation, its tests and penalties, we can prevent Canadians from getting behind the wheel while they are impaired by drugs, alcohol or both, said Beirness.

Source: Canadian Centre on Substance Abuse June 25th 2008

―In this way, Bill C-2 has the potential to reduce the harms associated with drugs by enabling police officers to remove dangerous drivers from Canadian roads, whether they are impaired by drugs or alcohol,‖ said Beirness.
The DEC program has been operating in Canada for 13 years, but only in cases where drivers agree to participate. Research on the DEC program, including studies conducted by CCSA staff, has established the accuracy and reliability of this method in determining impairment from a variety of drugs and drug combinations.
Impaired drivers will face new penalties under the law, including a fine of not less than $1,000 for the first offence, and imprisonment for the second offence of not less than 30 days and not less than 120 days for each subsequent offence.
Impaired drivers who cause an accident can face a maximum 10-year sentence in the case of causing bodily harm, and a life sentence in the case of causing death.
Anyone convicted of operating a vehicle under the influence of drugs, alcohol or both will be prohibited from driving a vehicle for one to three years for the first offence and two to five years for the second offence.
―We hope that by creating awareness of the new legislation, its tests and penalties, we can prevent Canadians from getting behind the wheel while they’re impaired by drugs, alcohol, or both, said Beirness.

Source:

―In this way, Bill C-2 has the potential to reduce the harms associated with drugs by enabling police officers to remove dangerous drivers from Canadian roads, whether they are impaired by drugs or alcohol,‖ said Beirness.
The DEC program has been operating in Canada for 13 years, but only in cases where drivers agree to participate. Research on the DEC program, including studies conducted by CCSA staff, has established the accuracy and reliability of this method in determining impairment from a variety of drugs and drug combinations.
Impaired drivers will face new penalties under the law, including a fine of not less than $1,000 for the first offence, and imprisonment for the second offence of not less than 30 days and not less than 120 days for each subsequent offence.
Impaired drivers who cause an accident can face a maximum 10-year sentence in the case of causing bodily harm, and a life sentence in the case of causing death.
Anyone convicted of operating a vehicle under the influence of drugs, alcohol or both will be prohibited from driving a vehicle for one to three years for the first offence and two to five years for the second offence.
―We hope that by creating awareness of the new legislation, its tests and penalties, we can prevent Canadians from getting behind the wheel while they’re impaired by drugs, alcohol, or both, said Beirness.

Controversial new law takes effect in a week

OTTAWA – Drivers who get behind the wheel while high on drugs will face roadside testing and they could be ordered to surrender urine, blood or saliva samples at the police station under a controversial new law that takes effect one week from today.

Drivers who refuse to comply will be subject to a minimum $1,000 fine — the same penalty for refusing the breathalyzer.

Police will be given their new powers to nab drug-impaired drivers after almost five years of intense debate in the federal Parliament.

The law, passed this year after three failed attempts, has been lauded by law enforcement and groups who say drug-induced drivers are escaping unpunished at a time when their numbers are climbing.

“Love it,” said Gregg Thomson, a father from Kanata, Ont., who predicted yesterday that the new testing will deter people from driving under the influence of drugs, just as the breathalyzer test produced a drop in drunk driving.

Mr. Thomson has been lobbying for a new law since 1999, when his son, Stan, and four of his high-school friends were killed when a 17-year-old who had been smoking marijuana attempted a highway pass that led to a pileup.

The crash became a catalyst for the group Mothers Against Drunk Driving to start pushing for changes to the Criminal Code, which outlaws drug-impaired driving but until now has not included measures that allow police to order a battery of tests.

The new law, however, has sparked warnings about potential court battles from critics who contend that demanding bodily fluids is overly intrusive and scientifically unreliable in detecting drug impairment.

“This is going to be challenged left and right,” predicted Murray Mollard, executive director of the British Columbia Civil Liberties Association.

Beginning July 2, drivers suspected of being high will be required to perform physical tests at the side of the road, such as walking a straight line. If they fail, they will be sent to the police station for further testing by a trained “drug recognition expert” and then be forced to give blood, urine, or saliva samples if they flunk the second test as well.

Critics say the new law could cause more problems that it solves, particularly because there is no reliable scientific test to detect drug use. Also, while there is a measurable link between blood alcohol levels and driving ability, research is lacking to equate drug quantity and impairment.

Another potential problem in testing bodily fluids is that they can detect marijuana smoked several days or months earlier and the effect has worn off.

“This kind of testing doesn’t test for impairment, it tests for past use of a substance and we know with certain substances they stay for a long time,” said Mollard.

Federal privacy commissioner Jennifer Stoddart and the Canadian Bar Association have also raised alarm bells.

Testing is already happening in Quebec, Manitoba, and British Columbia — but only when the driver voluntarily participates. But that hardly ever happens because nobody “is going to consent to pee in a bottle” when they are not legally required, said Andy Murie, chief executive officer of Mothers Against Drunk Driving.

Source http://www.nationalpost.com/todays_paper/story.html?id=612887 June 2008

ALCOHOL problems in the Western Isles are so widespread that experts find it difficult to decide which section of the population to target.

A new report says moves towards a cultural change must be maintained and developed to make excessive drinking less acceptable.

It says it makes sense to focus on young people, to attempt to reduce future problems. In addition to education and prevention, help must be given to young people affected by adult drinkers. Another study suggests a significant proportion of youth homelessness in the islands is related to parental alcohol misuse.

The report by the Western Isles Alcohol and Drugs Action Team will be discussed by the islands’ health board on Thursday. It shows men in the Western Isles drink more than women and are more likely to drink above sensible guidelines, but youngsters aged 18-24 drink more than older age groups.

Overall, the number of people taken to hospital with alcohol-related illnesses rose by 30 per cent between 1990-2000 and 2004-5, compared with a 21 per cent rise across Scotland. Most of these – 338 out of 437 (77 per cent) – were men, an increase of 23 per cent in the five years.

Over the same period, alcohol-related discharges of women from hospital in the Western Isles rose by 60 per cent, compared with a 20 per cent increase in the rest of Scotland. The report recommends this as a priority area for investigation and action.

Findings among children shows 53 per cent of 13-year-olds in the Western Isles (57 per cent nationally) have had an alcoholic drink, as have 92 per cent of 15-year-olds (84 per cent nationally).

Source: The Scotsman 26th August 2008

Teenagers are to be banned from buying alcohol in France, as health advisers dismiss the cherished Gallic belief that children should be initiated in the art of wine-drinking at an early age. With British-style binge drinking gaining ground among French youth, officials say they want to send out a clear message against adolescent consumption. Roselyne Bachelot, the Health Minister, said that she was planning to make it illegal to sell alcohol to the under18s, with legislation likely to be introduced next year.
Her announcement signals a sea change in a society where 16-year-olds have been able to buy wine and beer, although not spirits, in cafés and restaurants and all alcoholic drinks in supermarkets and other shops with an off-licence. It marks a shift in official thinking over the hallowed French tradition of initiating the young in drinking rituals, notably involving wine. The French consensus has been that the first sips should be taken in early adolescence – or before – under parental supervision. This is believed to foster a mature, sensible approach to alcohol far removed from Anglo-Saxon excesses – a couple of glasses of red with lunch and dinner throughout the week, rather than ten pints of lager on a Saturday night.
A senior French health adviser told The Times that his compatriots were deluding themselves. Bernard Basset, deputy managing director of the National Institute for Health Prevention and Education, said that not only did childhood tippling encourage adult alcoholism, but it was also no barrier to binge drinking. He said: “In effect, you are authorising them to drink and suggesting that alcohol consumption is a normal thing.”
Studies showed that those who started drinking under the age of 18 were likely to consume more in later life than those who started afterwards, he added. Mr Basset hopes that the ban on serving alcohol to teenagers in public will encourage a similar move within Gallic families. “What we say is, don’t drink before adulthood.”
Research has debunked the idea that the French were immune to le binge-drinking, as it has become known. The percentage of under18s saying they got drunk regularly rose from 19 to 26 per cent between 2003 and 2006, for instance. According to the Health Ministry, the number of people under 24 treated in hospital in connection with alcohol increased by 50 per cent between 2004 and 2007.
Gilles Demigneux, a public health specialist, said: “The fact that you can get completely smashed in an Anglo-Saxon way, using alcohol as a drug, is something we couldn’t have imagined in France in the 1980s.”
In an attempt to curble binge-drink-ing the Health Ministry released Boire Trop(Too Much to Drink), a hard-hitting advertising campaign this summer, cautioning that excessive alcohol could lead to comas, violence, accidents and sexual abuse.
Critics say the government action could be counter-productive, however. The Federation of General Student Associations, a leading students’ union, said: “There is a tendency to infantilise young people when it would be better to make them take responsibility for themselves.” Olivier Douard, a sociologist at the Laboratory for the Study of and Research into Social Intervention in southern France, said: “Bans are not generally efficient as far as adolescents are concerned. They often lead to transgression.”
The debate has been given added urgency by the death from alcohol poisoning last month of an 18-year-old student in central France who had been out to celebrate passing his end of school exams. In another well-publicised case this week, a father from Brittany sued the supermarket that had sold three bottles of spirits to his 16-year-old daughter, who was taken to hospital after losing consciousness.
Source: The Times August 26, 2008

The Jornal da Tarde, a newspaper published in Sao Paulo, in its edition of September 1, 2008 (see below) exposes some of the never ending new formulas for the drug trraffickers to attract and keep their drug using clients. Now in Brasil, they have found a new way to go about the fact that the Brazilian Matihuana is of “low quality” (less that 1% THC content). They simply have started adding
crack to the marihuana cigarettes which are old so that their clients can have stronger psicoactive effects when they smoke those cigarettes.

The alert was first given by the Director of the Toxichology Center of the prestigious Hospital das clinicas in São Paulo, Anthony Wong.
Luiz Carlos Freitas Magno, a Delegate of the Denarc which is São Paulo State Department of Narcotic Investigations, has known about this practice of adding crack to marihuana.
About a year and a half ago, the drug traffickers of Rio de Janeiro started selling marihuana mixed with crack, but they sell it as a new drug called crackonha (in English it would sound as crackonia).
Dr. Womng says that the danger of young people using this new mixture drug is that it is very addictive. Another problem pointed out is that when somebody arrives at an Emergency Room because of drug problems, it is more difficult to know rapidly which was the drug causing the problem
Source: Journal da Tarde Sept. 1st 2008

Counselling centres for the prevention of drug abuse would be opened in various parts of the capital, Chief Minister Sheila Dikshit said here Thursday.”The Delhi government would set up counselling centres to bring forceful awareness about prevention. It is better to prevent occurrence of any bad incident than cure it after it takes shape and grows gradually,” Dikshit said while inaugurating a day-long seminar on drug abuse prevention.
She said the administrative reforms department has already cleared the proposal for appointment of counsellors and it would take sometime to make such centres functional.
Dikshit called upon NGOs to come forward and put an end to menace of drug abuse, which is affecting the youth.
“There would be no dearth of funds for extending help to NGOs to enable them to substantially contribute in prevention of drug abuse,” said state Health and Social Welfare Minister Yoganand Shastri here.
Source: Thaindiannews.com 4th Sept.2008

Dutch growers earn around €2bn from exporting marijuana to the rest of the world every year, a senior police chief told the NRC newspaper this weekend. This compares to €5.5bn for the country’s entire flower and plant export trade, paper says.
Every year, more than 500 tonnes of marijuana grown in the Netherlands is shipped abroad, police commissioner Max Daniel told the paper. The figures are based on police research.
Daniel says that 80% of cannabis grown in the country is for export. ‘In the Netherlands, we have 400,000 cannabis users. If that was it, we would have a much more manageable problem.’
He claims that the involvement of organised crime in the marijuana trade is increasing. ‘Hemp has a role in almost every major murder, guns and drugs case,’ he tells the paper.
Organised crime
And the police chief claims that the lines between the underworld and ordinary society are becoming increasingly blurred. Banks give mortgages to hemp growers, while companies allied to universities help them improve their production techniques, says Daniel.
This summer the government set up a task force involving the police, justice ministry officials, energy companies and housing corporations to look at the role of organised crime in marijuana production.
It is illegal to grow marijuana in the Netherlands although police turn a blind eye if they find up to four plants. Marijuana possession is also technically illegal, but up to five grammes will be ignored.
Source: Drugwatch International quoting DutchNews.nl Oct. 20th 2008

The mother of popular hip-life musician Okomfuo Kwaadee, known as Jerry Anaba in private life, has confirmed the open secret that the artiste smokes.
Auntie Cecilia, who made the disclosure last Saturday on Peace FM, an Accra radio station, openly said her son smokes Indian hemp, locally called “wee”, adding, that was what led to the musician’s psychological problem some time ago.
Kwaadee has for some years now been off the music scene due to a mental problem.
However reports last year indicated that he was healed by a Man of God and is now leading a normal life.
“Musicians smoke, so by all means Kwaadee also smokes wee,” she said, adding, “I believe that was what worried him.”
Kwaadee, she indicated, was introduced to smoking through bad company, but did not say whether the influence was from colleagues in the music industry or elsewhere.
By the grace of God, she said, Kwaadee has stopped smoking because “he has come to the understanding that it would not help him.”
The singer, she revealed, was now fit and lives a normal life.
She, however, could not get the son to speak on air as he was not around at the time his mom was contacted.

Source: Francis Addo Daily Guide. Ghana 23 Oct 2008

Australian Premier John Brumby’s promise to battle the social ills of alcohol has been undermined by inaction on the expansion of big discount liquor stores and bottle shops, often in socially disadvantaged areas. The State Government has accepted only two of the 27 recommendations from its Liquor Control Advisory Council on how to control the booming retail liquor market and its impacts on binge and under-age drinking.
The council’s report found the number of retail liquor stores had increased more than 60% in Victoria in the past decade — to 1851 outlets. The report also revealed the dominance of the state’s biggest purveyor of alcohol — Woolworths.Since the Government lifted the cap on big players in the liquor market five years ago, Woolworths, which owns the Dan Murphy’s chain, has boosted its outlets from 135 to 233 stores. Coles liquor group owns 178 licences.
Woolworths has recently been involved in several cases where communities and local councils, concerned about a saturation of liquor stores, have fought to stop the company establishing new Dan Murphy’s outlets. In September, residents and Manningham City Council lost its bid to stop Woolworths turning a Doncaster Safeway supermarket into a Dan Murphy’s. Last year, against the wishes of police and the Darebin Council, a Dan Murphy’s was approved next to a Salvation Army alcohol treatment centre in Preston. (if ever there was a case of big business succeeding over a community need this must surely be it NDPA)
In its submission to the council’s review of the liquor store market — or packaged liquor — the Liquor Stores Association of Victoria said the state’s saturated market would lead to irresponsible discounting “in direct conflict with the principle of harm minimisation”. Most submissions to the inquiry, including some from the liquor industry, said communities should be given more power to object to new liquor store licences, and community or social impact statements should be included in the application process.
The council, however, did not recommend giving more power to communities. It did say the State Government should review home delivery of alcohol with takeaway meals and groceries because it was concerned the practice gave minors easier access to alcohol. The council, which advises the Government on alcohol issues in the community, is made up of community, police and alcohol industry representatives. The State Government, after sitting on the report for seven months, recently adopted two of the council’s recommendations: one that requires outlets to have extra shelf signage about under-age drinkers, and another about applicants advertising their intentions in local newspapers.
A spokeswoman for Consumer Affairs Minister Tony Robinson said the other recommendations would be looked at during a review of all categories of liquor licences, as outlined in the Victorian Alcohol Action Plan. Two recommendations have been referred back to the council. Mr Robinson said the Government was committed to reducing alcohol abuse in the community. He denied that the community had little say in fighting liquor store applications. Input was also sought from local councils and the police.
“Each application is judged on its merits, and the director of Liquor Licensing’s decision may be challenged at the Victorian Civil and Administrative Tribunal,” he said. But Mary Wooldridge, the Opposition’s community services spokeswoman, said the minister was doing nothing to curb the saturation and inappropriate location of liquor stores, despite evidence linking them to a range of social problems, including property damage.
The Government’s alcohol plan only briefly mentioned packaged liquor, she said.
In its battle against booze culture, the State Government has been accused of unfairly focusing on nightclubs. A recent government report into the regulatory impact of increasing licence fees shows that although packaged liquor licences have massively increased over 10 years, the bigger growth has been in “on-premises” licences for bars, clubs, restaurants and cafes. The overall growth in new licences peaked in 2002-03 and has since been in decline.
The report, released last month, shows the number of offences recorded at licensed premises in Victoria has actually decreased from 8166 in 2002-03 to 6835 in 2006-07.
But total police incidents where the offender was alcohol or drug-affected (including those on licensed premises) rose from 11,808 to 14,556 in the same period.
A spokesman for Woolworths declined to comment for this report.

Source: TheAge.com.au Sun 2nd Nov.2008

President Evo Morales has announced he is suspending “indefinitely” the operations of the US Drug Enforcement Administration in Bolivia.
Mr Morales accused the agency of having encouraged anti-government protests in the country in September. He did not say whether its staff would be asked to leave the country, as coca- growers have been pressing him to do.
Bolivia’s first indigenous president once served as the leader of the country’s union of coca-growers. Relations between Bolivia and the US have been strained since Evo Morales won presidential elections in January 2006.
Coca is the raw material used in the production of cocaine and is widely grown in Bolivia. The country is a major producer of cocaine, but millions of Bolivians poorest people also chew coca leaves as part of their daily routine. Many believe the leaf offers health benefits.
‘Defending Bolivia’
“From today all the activities of the US DEA are suspended indefinitely,” the Bolivian leader said in the coca-growing region of Chimore, in the central province of Chapare.

Coca is widely used by Bolivian Indians
“Personnel from the DEA supported activities of the unsuccessful coup d’etat in Bolivia,” he added, referring to the unrest in September which left 19 people dead.
“We have the obligation to defend the dignity and sovereignty of the Bolivian people.”
US officials have denied any wrongdoing. In recent months, a string of tit-for-tat expulsions of diplomats and agencies increased tensions between both countries, the BBC’s Andres Schipani reports from Bolivia. Bolivia’s government expelled the US international development agency and the US ambassador to La Paz.
Washington retaliated by expelling its Bolivian counterpart, while last month President George W Bush himself put the Andean country on an anti-narcotics blacklist that cuts trade preferences. Making his announcement, Mr Morales also declared that his government had eradicated more than 5,000 hectares (12,300 acres) of illegally planted coca.
Source: BBC News Sat.1st Nov.2008

Harm reduction, which has been the central focus of drug policy in this country since 1992, by its very definition does not focus on getting drug users off drugs. ‘Harm reduction’ is defined by the International Harm Reduction Association as ‘efforts to reduce the health, social and economic costs of mood altering drugs without necessarily reducing drug consumption’.Alarmingly, leaders of the harm reduction movement want Australia to move on to the next step, getting rid of the prohibitions against drug use, prohibitions which the Australian
community support so strongly.

Dr Alex Wodak, Australia’s most prominent proponent of harm reduction both nationally and internationally, responsible for introducing it to Australia in 1985, wants currently prohibited
drugs made legal for personal use. He says,

“In many countries it is time to move from the first phase of harm reduction – focusing on reducing adverse consequences – to a second phase which concentrates on reforming an ineffective and harm-generating system of global drug prohibition.”

Dr Alex Wodak; Paper presented to the 15th InternationalConference on the Reduction of Drug Related Harm

Many leaders of the harm reduction movement in Australia are seeking government support for new harm reduction interventions which show little interest in getting users off drugs,
but rather perpetuate their drug use while spending large amounts of tax-payer funds for programs to keep them safe while their use continues.

Injecting rooms
The Kings Cross injecting room does little to get users off drugs, with less than 4.5% of clients being sent to detox or rehab. Rather it spends $2.5 million per year saving clients from overdoses. The 2003 evaluation showed there was 36 times more overdoses in the
injecting room than on the streets of Kings Cross, despite injecting room clients injecting 97% of the time on the streets of Kings Cross rather than in the room. Proponents are working for multiple injecting rooms in every Australian city. Injecting rooms are very ineffective in reducing drug use.

Heroin On Prescription
It is not legal in Australia for the government to provide heroin to heroin users, with methadone being substituted instead. However many harm reductionists want an expensive program providing heroin on prescription to heroin users. Heroin on prescription focuses most on maintaining a user’s addiction. Other agendas that perpetuate drug use are the decriminalisation or legalisation of cannabis, the legalisation of raw cannabis for medical purposes, and pill testing at RAVEs.

EX-INJECTING ROOM CLIENT TELLS WHY INJECTING
ROOMS HAVE SO MANY OVERDOSES
“They feel a lot more safer, definitely because they know they can be brought back to life straight away. They know that they can, like some people go to the extent of using even more. So in a way they feel it is a comfort zone, and no matter how much they use if they drop they just get brought back. What users look for is in heroin and pills is to get the
most completely out of it as they can, like virtually be asleep but awake for 4 – 5 hours. For instance to get that you have to test your limits. And by testing your limits that is how you end up dropping.”
desire for a society free of illicit drugs
CHRISTOPHER
I became addicted and it took seven years for me to realise that I had to stop .In those seven years . . . I would get windows of opportunity to get out. I would feel like I could go to rehab or detox and everything like that but, when I would get on the phone to get in contact with [a treatment agency],there would not be a place available. The feeling of ‘okay, I’ve had enough, Ican get out’ would disappear. I would go back into it.

Christopher, transcript, 7 April 2007 p 68 – cited in Winnable War on Drugs, House of Representatives Standing
Committee on Family and Human Services. p209

TIM
With early inquiries in September 2006, and desperate to rid himself of drugs, Tim was assessed and approved for suitability to participate in a drug rehabilitation program at the Woolshed Drug Rehabilitation Community, Adelaide. Elated at such an opportunity he diligently marked off the list of preparatory requests made, he telephoned regularly as required on 22, 26 and 29 September, and 3, 6, 10, 13, 17 and 20 October for a period
extending five weeks, hoping and waiting desperately for a placement, for an opportunity to learn how to live without drugs.

Throughout this time, Tim had returned to live with us. He had stated that it was a particularly difficult time as not only did he have to deal with the long-term effects of taking drugs and withdrawal, he had to deal with the loss of autonomy in living in his own place of residence. He felt unable to apply for employment outside of the family business, because of his commitment to securing a placement at the Woolshed. Rehabilitation could take as long as six months, with then ongoing support required. On Sunday, 22 October 2006, in a desperate bid to end his pain and suffering, Tim committed suicide in our family home. I have been informed by the Woolshed that there is only accommodation for 24 participants, with up to as many as 34 waiting for a bed at one time for periods as long as 12 weeks. As of 24 May this year, 30 people were waiting. Tim could wait no longer.

Drug Free Australia Ltd

Alberta Health Services (AHS) and the Alberta Alcohol and Drug Abuse Commission (AADAC), together with the RCMP, recently announced the launch of a new prevention program called Kids and Drugs — A Parent’s Guide to Prevention. The program is intended to assist parents and other concerned adults in helping school age children avoid alcohol and drug abuse. Kathie Gavin, prevention co-ordinator for AADAC, says the new program goes beyond the basic drug education provided to parents in the past, addressing important protective factors for youth including effective parenting practices.

“In the past, when parents asked about drug information sessions we would give them the good, bad and ugly … The new program broadens the scope of parents’ understanding. It’s about giving your kids confidence, having open communication and giving them support,” says Gavin.

Content of the program is built on known factors that prevent substance abuse, says Gavin, like improved communication, support, decision-making and discipline.
The programs four core areas examine the importance of parental role modeling, enhancing communication skills, decision making, and the final area, “What parents need to know about drugs.” This final workshop provides information on commonly used drugs and their risks, as well as reasons why kids use drugs and the signs and symptoms of a developing problem.

Gavin says different substances are used according to different trends, but a constant remains in that tobacco, alcohol and marijuana are the most likely drugs of choice.
“Other illicit drugs are small in number with regard to use by young people. The really common ones are right in front of us, ingrained in our culture. We need to talk about prevention with consideration of all the substances we use in our culture, and develop some respectful attitudes about that.”

Gavin says prevention is a long-term investment, and it’s an important one that involves consideration of cultural values, attitudes and norms. The focus of the new program is on prevention, not on intervention or treatment, says Gavin, so the program’s workshops are designed for families where there is no significant problem already.

Gavin says input into the new program was gathered from addictions, enforcement and educational specialists then piloted at six sites across Canada. Through formative evaluation, Gavin explains that certain aspects of the program were then revised. For example, because one of the objectives was to give communities flexibility in when and how they offer the program, suggestions like offering it at work sites or through school councils was incorporated into the program’s design.
The Kids and Drugs prevention program was developed over a three year period by AADAC and the RCMP, says Gavin, and replaces an earlier RCMP program called Two Way Street.
For more information about the program, including a free download of the parent’s booklet, go to http://www.aadac.com/565_502.asp. The AADAC website also contains a parent information series, addressing prevention, intervention and treatment of substance abuse in youth (http://www.aadac.com/). AADAC can also be reached toll free;
Source: Prairie Post West. Canada. Jan. 22nd 2009

Today, Sunday, the prestigious daily newspaper paper O Globo (Rio de Janeiro) publishes a text with the title: The absolute Majority prefers Marihuana. The text presents the results of a study by the name: Drug Consumption in Rio’s Nightlife” (which had already been published by the O Globo magazine on Nov 2, 2008, and which was done by Retrato Consultoria and Marketing. The numbers presented are staggering. Anyone who knows a little bit of Statistics sees that this data and this analysis are very biased and do not represent in any way the general situation of a city. For example: they interviewed 857 people who were partying in nightclubs and/or attending shows, gas stations, restaurants and other places where there are concentrations of people from 15 to 40 years.

Some of the results: 71.7% of those who answered were males, 47% do not work, just study; 90.7% are single, 82.7% do not have children, and so on and on. Those figures do not represent Rio’s population but the title of the text implies otherwise. Well, 71% declared that they can obtain easily the drugs of their choice although 91.3% of those using drugs prefer Marihuana over any other drug.

What is frightening is that 85% of those who were interviewed declared that they had driven after using alcohol and taking illicit drugs. Of those, 6% declared having had some sort of accident.

Source: Drugwatch International Forum 25th Jan.2009

MEXICO CITY (AP) – President Felipe Calderon’s war on drug trafficking has
led to his own doorstep, with the arrest of a dozen high-ranking officials
with alleged ties to Mexico’s most powerful drug gang, the Sinaloa Cartel.

The U.S. praises Calderon for rooting out corruption at the top. But
critics say the arrests reveal nothing more than a timeworn government
tactic of protecting one cartel and cracking down on others.

Operation Clean House comes just as the U.S. is giving Mexico its first
installment of $400 million in equipment and technology to fight drugs.
Most will go to a beefed-up federal police agency run by the same people
whose top aides have been arrested as alleged Sinaloa spies. “If there is anything worse than a corrupt and ill-equipped cop, it is a corrupt and well-equipped cop,” said criminal justice expert Jorge Chabat, who studies the drug trade.

U.S. drug enforcement agents say they have no qualms about sending support
to Mexico. “We’ve been working with the Mexican government for decades at the DEA,” said Garrison Courtney, spokesman for the Drug Enforcement Administration. “Obviously, we ensure that the individuals we work with are vetted.”

Agents who conduct raids have long suspected Mexican government ties to
Sinaloa, and rival drug gangs have advertised the alleged connection in
banners hung from freeways. While raids against the rival Gulf cartel have
netted suspects, those against Sinaloa almost always came up empty – or
worse, said Agent Oscar Granados Salero of the Federal Investigative
Agency, Mexico’s equivalent of the FBI. “Whenever we were trying to serve arrest warrants, they were already waiting for us, and a lot of colleagues lost their lives that way,” Salero said.

The U.S. government estimates that the cartels smuggle $15 billion to $20
billion in drug money across the border each year. Over the last five months, officials from the Mexican Attorney General’s office, the federal police and even Mexico’s representatives to Interpol have been detained on suspicion of acting as spies for Sinaloa or its one-time ally, the Beltran Leyva gang. An officer who served in Calderon’s presidential guard was detained in December on suspicion of spying for Beltran Leyva.

Gerardo Garay, formerly the acting federal police chief, is accused of
protecting the Beltran Leyva brothers and stealing money from a mansion
during an October drug raid. Former drug czar Noe Ramirez, who was
supposed to serve as point man in Calderon’s anti-drug fight, is accused
of taking $450,000 from Sinaloa.

Most of such tips are coming from a Mexican federal agent who infiltrated
the U.S. embassy for the Beltran Leyva drug cartel. No such infiltrators
have been found for the Gulf cartel, which controls most drug shipments in
eastern Mexico and Central America. Sinaloa controls Pacific and western
routes. The DEA’s Courtney agrees that there has been a greater crackdown on the Gulf Cartel in both the U.S. and Mexico, with more than 600 members of the
gang arrested in September. But he declined to answer questions about
Mexico favoring Sinaloa.

Calderon has long acknowledged corruption as an obstacle to his offensive,
which involved sending more than 20,000 soldiers to battle drug
trafficking throughout the country. The U.S. aid plan includes technology
aimed at improving the way Mexico vets and supervises police. The president vows to create a “new generation of police,” consolidating agencies under Public Safety Secretary Genaro Garcia Luna, who heads all federal law enforcement.

That’s what worries Granados Salero and other agents. So many of Garcia
Luna’s associates are under suspicion of Sinaloa ties that many wonder how
he could not have known. Calderon has publicly backed Garcia Luna, calling him “a man of great capacity.”

“Obviously, if there was any doubt about his honesty, or any evidence that
would call into question his honesty, he would certainly no longer be the
secretary of public safety,” the president said recently.

But some see the alleged Sinaloa ties with Garcia Luna’s lieutenants as an
old tactic used widely under the Institutional Revolutionary Party, or
PRI, which ruled Mexico for 71 years with a tight fist. Officials in the
past preferred to deal with one strong cartel rather than many warring
gangs – what Calderon faces now. More than 5,300 people died in
drug-related slayings in 2008.

“I fear that Secretary Garcia Luna … is working on the idea that once
one cartel consolidates itself as the winner, that is, Sinaloa, the
violence is going to drop,” said organized crime expert Edgardo Buscaglia,
who tracks federal police arrests and has studied law enforcement
agencies’ written reports.

Garcia Luna has denied being involved in corruption. He has acknowledged
that authorities in the past chose the path of managing cartels. But in an
interview with the newspaper El Sol, he said that approach only
strengthens the gangs in the long run. Others say the high number of Sinaloa infiltrators is a reflection of the two cartels’ very different styles.

The Gulf cartel is led by military-trained hit men so violent that they
reportedly planned to attack even U.S. law enforcement agencies.
“They don’t necessarily try to build networks of corruption. They prefer
networks of intimidation,” said Monte Alejandro Rubido, who leads Mexico’s
multi-agency National Security System.

Sinaloa, on the other hand, appears to use bribery and infiltration at
least as much as its gunmen. Cartel leader Joaquin “El Chapo” Guzman
bribed his way out of a Mexican prison in 2001, provoking suspicions the
government was on his side.

Many Mexicans worry about giving so much money and power to a still
corrupt force. Of more than 56,000 local and state police officers
evaluated between January and October last year, fewer than half met the
recommended qualifications, Calderon reported to Congress in early
December. No similar numbers are available for federal police.

Agents like Granados Salero wonder who is in charge of police integrity.
“We agents find out about a lot of things,” he said, “but who can we turn
to?”

Source: Drug Watch International Sun.25th Jan.2009

A Review of Australian public opinion surveys on illicit drugsA strong trend since the 1998 NDSHS (National Drug Strategy Household
Survey) has been a hardening in attitudes towards cannabis, a review from Australia revealed. The review, published by National Drug and Alcohol Research Centre in December 2008, analysed a range of illicit drug opinion surveys conducted in the country.

Cannabis is now more associated with “a drug problem”, is a greater concern to the general community, its use is approved of less than in 1998, and there is also less support for cannabis legalisation and decriminalisation, it is pointed out in the review.

In 2004, 25 per cent of Australians approved use of cannabis compared to 10 per cent in 2007.
The strongest support for legalisation of cannabis was observed around
1998 and since then the support has been declining down to 19 per cent in 2007.

Certainly there has been an increased interest in the link between cannabis and mental health, with new evidence showing the link between cannabis use and disorders such as schizophrenia; It is possible that an increased research and policy focus on cannabis and mental health has affected public opinion on this matter, says Pr Ritter from the Drug Policy Modelling Program at the University of New South Wales, one of the authors of the review.

The change in attitudes to the cannabis legalisation has not resulted in support for increased penalties. The majority of the Australians would like to see increased spending for education and treatment.

Source: ECAD Newsletter, 26. Jan. 2009

In May 2008 the current Home Secretary Jacqui Smith announced that she would reverse the 2004 decision and put cannabis back into category B.
The move went against the ACMD’s latest recommendations, but was, she said, necessary because of research linking heavy use of the drug with schizophrenia and other mental illnesses.

Ms Smith said she was particularly concerned over the rise in consumption of super-strength strains of cannabis, such as “skunk”.
The Home Office say such strains account for 80% of all cannabis seizures in the UK.

Read the article
http://news.bbc.co.uk/go/pr/fr/-/2/hi/uk_news/7845023.stm

*** THE NEW APPROACH

Class A: Ecstasy, LSD, heroin, cocaine, crack, magic mushrooms,
amphetamines (if prepared for injection).
Possession: Up to seven years in prison or an unlimited fine or both.
Dealing: Up to life in prison or an unlimited fine or both.

Class B: Cannabis, amphetamines, Methylphenidate (Ritalin), Pholcodine.
Possession: Up to five years in prison or an unlimited fine or both.
Dealing: Up to 14 years in prison or an unlimited fine or both.

Class C: Tranquilisers, some painkillers, Gamma hydroxybutyrate (GHB),
Ketamine.
Possession: Up to two years in prison or an unlimited fine or both.
Dealing: Up to 14 years in prison or an unlimited fine or both

Source: ECAD Newsletter 25th Jan. 2009

Germany’s health minister announced on January 22, 2009 that the government banned the production, sale or possession of a synthetic marijuana-like drug known as “Spice” (CP-47,497 and JWH018).
Health Minister Ulla Schmidt says Spice must “quickly be taken out of circulation.”
Germany is the fourth nation to ban the substance, marketed as an herbal room-freshener, after Austria, the Netherlands and Switzerland.Read the article
http://www.washingtonpost.com/wp-dyn/content/article/2009/01/21/AR2009012100543_pf.html

Source: ECAD Newsletter Jan. 2009

MANILA, Philippines – Dangerous Drugs Board (DDB) chairman Vicente Sotto III on Friday expressed disappointment over the Commission on Human Rights’ opinion that the planned random drug testing could violate an individual’s rights.

During a meeting with education officials on Friday morning, Sotto insisted that the random drug testing – set to be conducted in over 8,000 schools – would not trample any human rights as claimed by various sectors.

“They (CHR) got it completely wrong. The objective of the drug test is not punitive, but preventive. This is a health issue. The students’ confidentiality is assured and anyone testing positive can be rescued in time through counseling,” Sotto said in a statement. “In fact, Sotto said “any attempt to block the implementation of the latest effort against illegal drugs should be the one considered as a violation of human rights. Preventing drug testing is a violation of human rights because you are preventing the government to cure drug dependence,” Sotto said in a separate radio interview.

It’s like stopping efforts to stamp out drug dependence and help drug addicts,” he added. Sotto gathered officials form the Department of Education, the Commission on Higher Education, and the Technical Education and Skills Development to draw up guidelines in the planned random testing for high school and college students nationwide. Sotto said they did not invite the CHR to Friday’s meeting, but added that the rights body is more than welcome to send a delegate to supervise or contribute ideas in the creation of the guidelines. He also reiterated during the meeting that the random drug testing could no longer be taken out of the government’s intensified anti-drug campaign because it is considered as its most important part.

The measure’s significance lies in the fact that it not only involves the “prevention” of drug dependence, but also the government’s “intervention” in ensuring that the students would be subjected under counseling to cure them of their addiction. In his statement, Sotto assured transparency in the conduct of the testing, adding that various sectors including the Supreme Court had approved of the measure.

“The student’s family will also be alerted about the situation. Those who fear that drug-testing will violate the privacy of students and put them behind bars are mistaken,” he said. “The matter of drug testing was the product of consultation and had been the subject of DDB Resolution No. 6 promulgated since August 1, 2003. Likewise, the Supreme Court, in the case of Social Justice Society vs. DDB promulgated on November 3, 2008, decided that random drug-testing in schools is constitutional,” Sotto added.

He also said that passing a drug test has in fact been a requirement for admission in a number of schools in Metro Manila for quite some time now.
The government is slated to carry out the initial stages of the drug testing in March. Then at the start of the school season in June, the government would resume the program for its second instalment.

The DepEd earlier said it would expand its random drug testing to include more students and more schools, ultimately targeting to include about 6 million students from 8,000 schools. For its part, the Department of Health on Thursday suggested that the drug testing which it had been conducting since 2005 should now include the detection of cocaine, Ecstasy, and barbiturates – and not just shabu and marijuana.

Source: GMANews.TV Jan.16 2009

PARIS: France will ban the sale of alcohol to minors and drinking in public near schools as part of a broad crackdown on binge drinking among youths, the health minister said in an interview published on Sunday.
Roselyne Bachelot said that a recent study showed an over all decline in alcohol consumption among youths but the frequency of drunkenness was increasing.
“Almost half of youths said they had had five glasses of alcohol on a single night on at least one occasion in the previous 30 days, which is the definition of binge drinking,” she said in an interview with Journal du Dimanche newspaper. She said she was working on a new bill that would also ban promotions known as “open bar” which allow customers to drink as much as they want to for a fixed price. “We are also going to ban open bars … which are a classic at student parties and which encourage binge drinking,” Bachelot said.
She said the number of under-25s hospitalised because of excessive drunkenness had doubled between 2004 and 2007. “Drinking alcohol in public places close to schools will also be forbidden,” she said.
She told the newspaper that at present there was a grey area surrounding sales of alcoholic drinks to teenagers aged 16 to 18, with different rules depending on the kind of alcohol and whether the sales point was a bar, a club or a supermarket. She said her bill would unambiguously ban any sale of alcohol to under-18s anywhere in France.
Another measure will be to ban sales of alcohol in filling stations. Bachelot said that at present, such a ban exists only from 10 p.m. to 6 a.m. and the new rule should help curb drunk driving.
Bachelot said the measures, which she expected will come into force in 2009, would be accompanied by an advertising campaign featuring youths in a heavenly environment that turns hellish after they have been drinking. In May, a government body in charge of fighting drug and alcohol addiction said it was considering banning “happy hours” during which bars offer cheaper drinks early in the evening to attract customers. Bachelot’s interview made no mention of this.
Source: Reuters July 13, 2008

Long-term addicts to get two free doses of heroin a day in a Danish scheme that could be replicated across the UK Danish drug users will inject heroin in clinics under doctors’ supervision.
State-funded heroin is becoming a reality in Denmark, the latest in a small, but growing, number of European countries – including the UK – concerned with improving drug users’ quality of life and reducing criminality.
Since 1 January, hundreds of drug addicts in the Nordic country have the right to receive two free doses of heroin a day, paid for by their health system. The offer is only for adult, long-term users for whom substitutes such as methadone and subutex have not worked.
“The aim is to improve their state of health, help them avoid committing crimes and stabilise their lives,” explains Dr Anne Mette Doms at the Danish Board of Health, which supervises the project. “Quitting altogether is not a realistic option for most of these patients. For them, this will be a chronic treatment, as if you were treating a chronic disease.” Addicts will need to attend one of five specialist drug clinics across the country, where they will inject diamorphine – pharmaceutical-grade heroin – under doctors’ supervision. The drug will not be available on prescription so as to avoid resale on the street.
Danish authorities are in the process of setting up the clinics, registering the doctors who will work there, and finding out which drug companies they will source the heroin from. The £7.2m project is expected to be up and running by March.
The initiative was adopted by overwhelming consensus in February 2008, after all but one of the parties represented at the Danish parliament voted in favour of the policy – the only one against it was a tiny far-left party that did not oppose the project per se, but the way it was funded. Among those in favour was the far-right Danish People’s Party, a movement not usually known for its progressive views: at the last general election in 2007, it described some Danish Muslims as benefit-scroungers and fifth columnists who threatened Danish democracy.
Some might think this initiative is not surprising in a country with a historical tradition of progressive, social democratic policies. But, just as in the UK, the drug debate has been bruising in Denmark. And unlike in Britain, where heroin is available on the NHS for some cancer patients, heroin as a palliative is completely forbidden in the Nordic country.
“Five years ago I decided I would not participate in yet another debate on drugs,” recalls Preben Brandt, the chairman of the Council for Socially Marginalised People and an advocate of the policy. “It was too emotional, with different groups being very aggressive.”
“The counter-argument was always ‘you kill people by giving heroin’ or ‘with this initiative, you are telling people that taking heroin is OK’,” he says. “It is very difficult to have a rational debate when you are arguing against beliefs.”
The turning point came when results became available from experiments trialling the policy in other European countries, including Switzerland and the Netherlands. “The politicians became convinced that it could help those with the most severe drug problems,” says Mads Uffe Pedersen, the head of the Centre for Alcohol and Drug Research at the University of Aarhus. “You could not argue against the (positive) findings.” “The debate became more practical,” agrees Brandt. “It was about what policies worked and which ones did not. It was no longer about morality.”
Attitudes towards drugs addicts improved too. “Drug addicts in Denmark are less stigmatised,” says Brandt. “They are no longer perceived as criminals who are a danger to society. They’re seen as patients who have a disease they need help with. The new scapegoats in Denmark are the foreigners.”
Could a similar initiative be possible in the UK? It’s actually happening already, with three schemes taking place in Brighton, Darlington and south London, where long-term heroin users can inject drugs under medical supervision at specialised clinics. Early results indicate that the scheme has cut crimes and stopped street sales.
Crimes committed by the addicts involved in the scheme dropped from about 40 to six a month after six months of treatment, Professor John Strang, the head of the National Addiction Centre at the Maudsley hospital, told the Independent newspaper. A third of addicts stopped using street heroin and the number of occasions when the rest used it dropped from every day to four or five times a month, on average.
It remains to be seen whether UK politicians will expand the policy nationwide, especially if they fear a possible backlash from voters. But if British voters are similar to their European cousins, this would not be an issue. Last November, Swiss voters approved the scheme overwhelmingly, with 68% supporting the plan. And there has been no popular backlash in Denmark, following the adoption of the policy by parliament.
Source: www.guardian.co.uk 5th Feb.2009

While a worldwide study has found teenagers on the whole are smoking less marijuana and going out less often with friends, Maltese teenagers have been found to be doing exactly the opposite in both respects.

A study published this week has found that the prevalence of smoking marijuana and going out with friends are inextricably linked. Out of 31 countries, marijuana use among 15-year-old boys and girls between 2002 and 2006 had increased only in Malta, Estonia and Lithuania, and among Russian girls.

Malta’s increases in both sexes were the highest recorded, as were the increased number of nights out with friends. Between 2002 and 2006, the prevalence of cannabis use among Maltese 15-year-old boys increased by 2.7 per cent – from seven per cent in 2002 to 9.7 per cent in 2006 – while the female increase was even higher at 5.6 per cent – from 4.2 to 9.8 per cent in 2006.

In both years, more Maltese girls reported having used cannabis over the previous year than boys while the female rate of increase was also far higher. In both sexes, Malta saw the largest increase in cannabis use, but in terms of overall prevalence Malta’s was ranked in an overall 26th place, and its 9.7-9.8 per cent usage rate paled in comparison to leading countries Canada, Switzerland and the United States – all of which saw rates in the mid to high 20s.

In tandem, Malta also saw the highest increase in the numbers of nights spent out with friends – from 1.9 in 2002 to 2.61 in 2006 for boys and from 1.63 to 2.43 for girls. Both were also the highest increases across the 31-country spectrum. While rates varied widely among countries, prevalence was highest both years in Canada, where 30 per cent of boys and almost 28 per cent of girls used marijuana in 2006. That was down 13 per cent among boys and almost 10 per cent among girls.

According to a study of 15-year-olds across 31 countries between 2002 and 2006, going out with friends and smoking marijuana are related, mostly because research has found that children who spend many evenings out are more likely to smoke marijuana than those who prefer to stay at home.

Since few parents approve of marijuana use, teenagers are most likely to smoke cannabis secretly away from home, said lead author Emmanuel Kuntsche of the Swiss Institute for the Prevention of Alcohol and Drug Problems. While reasons for the declines are unclear, the researchers said drug prevention efforts and technology may have contributed. Moreover, instant messaging, email and mobile phones “may have partly replaced face-to-face contacts, leading to fewer social contacts in the evenings,” Dr Kuntsche said. But while the latter trends have also seen a sharp increase among Malta’s teenagers, so has the practice of going out at night with friends.

The researchers analysed data on 93,297 15-year-olds from periodic health surveys, the “Health Behaviour in School-Aged Children” study, conducted in collaboration with the World Health Organisation, which, among a multitude of other things, asked about marijuana use and evenings out with friends in the past year. Responses to 2006 surveys were compared with those from 2002. The next such research is due to cover the year 2010.

The results of this week’s study – titled “Decrease in Adolescent Cannabis Use from 2002 to 2006 and Links to Evenings Out with Friends” – were published in February’s Archives of Paediatrics and Adolescent Medicine, released on Monday.

Source: Malta Independent Online 6th Feb 2009

The Government will look at an open-minded and balanced approach to reducing drug use but there will be no relaxation of the laws around cannabis, Associate Health Minister Peter Dunne said today.

There were too many mental health problems, respiratory diseases and social issues related to cannabis for the Government to consider legalising the drug, he told an international drug policy symposium in Wellington.

Reports that levels of cannabis and methamphetamine use had levelled off were encouraging, but were not a reason for complacency, he said. “Evidence indicates a balance is needed between reducing supply of drugs through interdiction and enforcement, and also reducing the demand for drugs through prevention and treatment strategies, if we are to be effective in reducing adverse health and social consequences of drug misuse.”

Drug Foundation chairman Tim Harding said it was important the issues were taken seriously. “The problem we face is that sound policy is not always popular or, for that matter, obvious. It has to be based on solid foundations of research, experience and a liberal dose of wisdom.”

Police Deputy Commissioner Rob Pope released an Illicit Drug Strategy at the conference, which detailed the police response to drug related crime until 2010.
The strategy focused on methamphetamine, cannabis and how to protect and deter groups that were most at risk of using the drugs. “We now have increased capacity with the new National Intelligence Centre (NIC) based at Police National Headquarters.” Mr Pope said. “This is going to enable us to more actively record intelligence around drug related crime from each police area and district.”

The strategy recognised that cannabis and methamphetamine were the biggest drug issues in New Zealand, he said. “Preventing today’s young people from becoming tomorrow’s drug users contributes to reducing harm and reducing the overall crime rate.”

United Nations director of policy analysis and public affairs at the office on Drugs and Crime, Sandeep Chawla, told the conference the international community needed to work together to continue stemming the use of illicit drugs.

The multilateral drug control regime had contained illicit drug use to less than 5 percent of the world adult population, and hardcore problem drug users to less than 1 percent, he said.

“There has been considerable reduction over recent decades in the consumption of opiates, the most problematic of drugs, and opium cultivation and production has been limited to just one or two countries in the main.” However, he said containment did not mean the problem had been solved and consequently a thriving criminal black market in drugs had emerged.

“It also appears we have created a system where those who fall into the web of addiction find themselves excluded and marginalised, tainted with a moral stigma, and often unable to find treatment even when they want it.”

Mr Chawla said the international community must renew its commitment to existing conventions and work together on reforms based on empirical evidence rather than ideology, and that public health, the first principle of drug control, must be brought back to centre stage.

The symposium is being held as a precursor to a March meeting of the UN Commission on Narcotic Drugs in Vienna where the direction of global drug policy for the next 10 years will be set.
Source: http://www.3news.co.nz/News/NationalNews/No-relaxation-on-cannabis-laws- Wed, 18 Feb 2009

Due to the UAE’s strategic location, policies and free zones, the nation is a thriving commercial hub. This country should take pride in the way it has become both a marketplace of goods and services as well as a marketplace of ideas.

But not all the influences that arrive on the UAE’s shores are positive. Yesterday’s revelation of the seizure of 100kg of the stimulant Captogan, an amphetamine commonly used as a recreational drug, came only weeks after customs officials confiscated 16kg of heroin at Dubai International Airport. The Ministry of Interior’s department of anti-narcotics has said that drug related crimes have risen significantly due to the increase in population and in the transit of people and goods through the country.
These recent discoveries and other high profile arrests such as the jailing of a British DJ last year for possession of cannabis illustrate how seriously the Government takes the threat. This no nonsense approach is commendable. No amount of investment in narcotic control is big enough. Drug use may be an individual crime but it has tremendous social costs. Crack-cocaine ravaged American cities in the 1980s and a dependence on the flowering plant khat, chewed by 80 per cent of Yemen’s adult population for its stimulative effects, has been widely attributed as a cause of that nation’s unemployment and poverty levels.
The UAE’s large population of young people, particularly those living outside the cities, have a limited amount of entertainment outlets and drugs all too often become an insidious escape route from boredom. The authorities must continue their vigilant approach, but through education and the creation of more extra-curricular options for youth, the false appeal of drug use can be diminished.

Dubai Customs’s ability to locate the Captogan stash in 152 industrial sized spools of thread through a study of their density is a testament to the effectiveness of their technology and their thoroughness. But drug smugglers will still attempt to flout the law. Strategies for education and rehabilitation are needed to help further reduce the risks that drugs pose to society.
Source: TheNational digital edition Feb. 2009

Six to 10 thousand youth in Ottawa will have a better chance of saying ‘no’ to drugs thanks to a federal government donation. On Feb. 10, Pierre Poilievre, MP for Nepean-Carleton on behalf of the Honorable Leona Aglukkaq, minister of health, announced the federal government will contribute $1 million over a four year period to help eradicate youth addiction and drug usage.
Poilievre announced the government’s support for S.T.E.P. (support, treatment, education and prevention) – a project that provides targeted help for youth in Ottawa who are at risk of engaging in substance abuse. S.T.E.P. is Ottawa’s response to addressing the need for residential addiction treatment, education and prevention for young people aged 13 to 17. It is a fundraising campaign involving community partners such as Ottawa West-Nepean MPP Jim Watson, Ottawa Police chief Vern White, Mayor Larry O’Brien and Michael Allen, president and CEO of United Way Ottawa.
“This project will help to prevent young people in high schools from taking drugs in the first place,” said Poilievre “Activities will be held in those schools for students who are at risk of drinking or taking drugs. This strategy helps to prevent the use of drugs, treats people with drug addictions, and combats drug trafficking. The strategy also emphasizes education for young people and their parents on the damages that drug use can cause.” The initiative was announced at the Ottawa Police headquarters and is part of the government’s national anti-drug strategy, which was introduced in 2007.
“That’s why our Conservative government is providing the project S.T.E.P. with up to $1 million in support—over the next four years—from its drug treatment funding program,” Poilievre added. According to Allen, this initiative “will no less than double the capacity for counsellors and prevention education” and will -double the infrastructure that is already in place in Ottawa schools. “It’s a good day for the future of our community,” said White.
“A number of schools don’t have the resources they need and a number of schools certainly don’t have the capacity to deal with the challenges they are facing right now.” White said six to 6,000 to 10,000 youths in Ottawa will benefit from this programming. Poilievre concluded by saying this initiative is close to his heart since he has seen some of his loved ones battle drug addiction.
“It’s very important that lives are spared from this terrible destructive path and I’m hoping that this million dollar donation will help us to achieve that goal.”
Source: meghan.graham@nepeathisweek.com Feb.21 2009

The so called war on drugs is 100 years old this year, yet the taking of illicit drugs is showing few signs of coming under control.

The International Opium Commission, first convened in Shanghai in 1909 and since then the number of internationally-controlled substances has grown to more than 200. The United Nations’ International Narcotics Control Board, in its annual report released yesterday, paints a picture of an ever-expanding and increasingly violent drugs market, with new trafficking routes being opened regularly, many of them in our region.

WATTERS: It will be an ongoing battle. I think it’s like a lot of other things we face in life, poverty, discrimination and racism. It’s a continuing battle. But certainly things would be a great deal worse if it hadn’t been for what was launched in China in the year 2009 [1909]. For example, in 2009 [1909], there was, in China alone there was three thousand tonnes of morphine equivalent of opium being consumed. Now in the whole world today, there’s not that much, including what’s being used legally. So we know there’s been a very significant downturn in the use of that drug, even though it’s very much in the hands of very clever criminal syndicates, but we’ve certainly controlled it to a very large extent.

LAM: Your report also notes that the internet is playing an increasing role in the trafficking of legal and unauthorised prescription drugs. How is the Internet being used for drug trafficking?

WATTERS: Well Sen, like a lot of other areas in our modern life, we’re having to cope with changes in technology and certainly the rapid movement of information and the free movement of information on the Internet allows for criminal syndicates around the world to plan their movements of drugs and place their orders using various sorts of cryptology, avoiding the open statement. Then on top of that, we have what we call the Internet pharmacy proliferation around the world and these pharmacies are very often, not all, but a significant number of fronts for Illegal organisations to allow controlled substances to be moved freely from country to country through the postal systems.

LAM: And indeed, with modern communications being so efficient now, the drugs do pass quite easily from country to country. For instance, your report pointed out that Chinese chemicals are being used by Canadian ecstasy manufacturers to make drugs which then end up being sold in Australia and Japan. So it’s quite a daunting challenge, isn’t it?

WATTERS: Yes, it’s an international movement and certainly part of what we’ve been doing at the International Narcotics Control Board is seeking to control those precursors and we do very, very well in many ways, but when you think that a country like China with its vast numbers, they tell us they have got 50,000 factories there that are producing chemicals that could be diverted illicitly into the methamphedamine markets, so it’s a huge task and the India similarly has a big task just to control these things.

LAM: So is there a sort of common attitude by world authorities towards drugs and drug use. For instance, the chair of Britain’s Advisory Council on the Misuse of Drugs, Professor David Nutt, recently said that using ecstasy was no more dangerous than horse riding. So are we wasting resources by targeting drugs like ecstasy?

WATTERS: Well, with all due respect, I think he’s being very foolish to even talk like that. One of the difficulties we face in many countries is to use the term recreational or party in relationship to dangerous drugs. We do know that more than 95 per cent of the member states of the United Nations are signatories to the convention and that covers 99 per cent of the world’s population. So in principle, they all agree that we should control drugs, make available where necessary, but certainly not allow for the recreational use of these dangerous substances and to suggest that…there is so much medical evidence that these methamphetamine type drugs can have seriously long term psychotic affects. I suppose it could be said if you fell of a horse and landed on your head, that might be equivalent.
presenter: Sen Lam
Speaker: Major Brian Watters from the Salvation Army is a Member of the International Narcotics Control Board and Chairman of the Australian National Council on Drugs
Source:www.radioaustralia.net Feb20th 2009

The effects of cannabis use on health and social adjustment are profound.
Substance misuse by Indigenous people has long been recognised
as one of the devastating consequences of contact with
Western culture. Misuse of tobacco, alcohol and petrol
among Indigenous Australians has received much attention. Cannabis,
by contrast, has not been viewed as a major problem. But
since the 1990s, it has become apparent that heavy cannabis use is
common in some remote Indigenous communities.1 The associated
health and social burdens are now being recognised.
Indigenous Australians, whether living in urban or rural
settings, are more likely than other Australians to report cannabis
use. Recent reports suggest that cannabis use is also relatively
high among Indigenous populations in New Zealand, Canada
and North America. Limited data are available on patterns of
cannabis use among Indigenous Australians. However, a recent
5-year study of adolescents and young adults in three remote
communities in Arnhem Land in the Northern Territory has
found that not only is cannabis use common in remote Indigenous
settings, but its effects on health and social adjustment are
profound. These three communities are close to one another but very
isolated, being over 550 kilometres from the nearest city. There is
one local Indigenous language, and English is a secondary language.
Tobacco use was found to be the norm in these communities,
with over 90% of adolescents and young adults smoking.
Because of restricted access to alcohol, problem drinking was
uncommon. In contrast, cannabis use was endemic, with over
70% of males and 20% of females being current users. Cannabis
was typically consumed mixed with tobacco and smoked using a
locally fashioned “bucket bong” that gives the user a rapid and
intense dose with little smoke lost. Regular heavy use (_6
“cones” daily) was found in almost 90% of users. This is around
twice the consumption of regular cannabis users elsewhere in
Australia. Furthermore, about 90% of the Indigenous users
reported symptoms of cannabis dependence. This compares with
about 20% of users aged 18 or over in the general Australian
population.3 Of even greater concern was a suggestion that, for
most Indigenous users, cannabis was not a passing adolescent
phase. After 5 years of follow-up, the great majority reported
continuing heavy use.
Cannabis use was linked to substantial health problems and
social burdens in these communities, which are already disadvantaged
by isolation and poverty. Up to 10% of the communities’
total income and between 31% and 62% of a user’s median weekly
income was spent on cannabis. Cannabis users were less likely
than non-users to participate in education or training and more
likely to report auditory hallucinations, suicidal ideation, symptoms
of depression, and having been imprisoned. Community
violence increased when cannabis supplies were scarce. The
effects on traditional life were described by one NT Indigenous
mental health clinician in the following way:
Too many of my people are chained to [cannabis]. They don’t
go out hunting or spend time by the river with their family.
They just sit and smoke [cannabis], then look for money to buy
more [cannabis] and get into fights when they can’t get any
(Muriel Jaragba, personal communication).
What accounts for the unusual patterns of cannabis misuse in
these remote Indigenous communities? There is little evidence that
cannabis is grown locally, but much anecdotal evidence that
market networks supplied by dealers based in urban or regional
centres are extensive and resilient, making cannabis readily available
(A R C, unpublished observation). Alcohol restrictions have
been effective in reducing problem drinking within communities,
but may have had the undesirable consequence of encouraging an
increase in cannabis use where it could be easily obtained. As
with risks for other forms of substance misuse in these communities,
the social context is important. Limited employment and
education opportunities; crowded, poor-quality housing; community-
wide feelings of disempowerment; and grief and loss related
to high mortality, morbidity and incarceration rates are all likely
risk factors for substance misuse. Cannabis misuse is likely to be
both a consequence of this type of social disadvantage and a
perpetuating influence.
Cannabis misuse in remote Indigenous communities has been
overlooked for too long. It is now clear that it is yet another major
problem for these already disadvantaged communities, with evidence
of cannabis misuse across a broad area of northern Australia.
As well as in the NT, concerns about the level of cannabis
use have recently been noted in Cape York and anecdotally in
other parts of remote and regional Australia. Further research is
needed to investigate the impact of cannabis use on urban
Aboriginal and Torres Strait Islander Australians.
Effective responses will not be easy. Controls on supply by
state- or territory-based police are one of the few available
measures. In order to be effective, policymakers and service
providers would need to work collaboratively with local communities
to tie in local prevention and treatment initiatives with
existing supply control initiatives. Such programs would need to
use Indigenous language and cultural frameworks, build capacity
of local Indigenous professionals, and improve understanding of
the harms associated with cannabis misuse. Ultimately, tackling
the misuse of cannabis and other substances in remote settings
will depend on creating opportunities for social development
and for continuing education, training and employment of
adolescents and young adults.

Source: 228 MJA • Volume 190 Number 5 • 2 March 2009

Tuesday 03 March 2009
The tax on alcohol should be doubled to discourage under-age drinking, according to a group of experts in Tuesday’s AD. The move would also save billions of euros as the damage caused by drunken teenagers declined, says the paper.
The call comes from the alcohol prevention foundation Stap, criminologist Jan van Dijk and paediatrician Nico van der Lely, who say it is time for drastic measures. They say the soft approach of the past 20 years has not worked and the only option is to raise the price of alcohol.
The Netherlands has been wrestling the problem of teenage drinking in recent years. Last December new figures from the national statistics office CBS showed that Dutch teenagers are now drinking less. The number of teens who use alcohol fell from 85% in 2003 to 79% in 2007. This is ‘probably’ due to the need to prove you are at least 16 when buying alcohol, said CBS researcher Jan Latten.
Source: Daily Dose 4th March 2009

We, participants of the World Mayors’ Conference against drugs – reaffirm our support for the UN Conventions and declare that all people have the right to expect their governments to work according to the conventions and their intentions.Worldwide, cannabis is the most frequent used illicit drug, which calls for action from each city and country. Extensive research confirms that the use of cannabis is detrimental to health, causes crime, and is addictive. Cannabis, and certain other drugs, for example khat, should be viewed in the same way as other types of illicit/psychotropic drugs for example cocaine,
heroine and amphetamine, when it comes to control policy, rehabilitation and preventive measures.

We, participants …..
 Reaffirm our unwavering determination and commitment to overcoming the world drug problem through international and domestic strategies to reduce both the illicit supply of and demand for drugs;

 Recognize that action against the drug problem is a common and shared responsibility requiring an integrated and balanced approach in full conformity with the purposes and principles of the Charter of the United Nations and international law;

 Affirm our determination to provide the necessary resources for treatment and rehabilitation and to enable social reintegration to restore dignity and hope to children, youth, women and men who have become drug abusers, and to fight against all aspects of the world drug problem;

 Urge all people to work with their governments to strengthen, support, and encourage the UN system of drug control, in order to reduce the global demand and supply of illicit drugs;

 Emphasize the immediate need for all countries and cities to place drug issues as one of the high priorities on their development agendas;

Together we can meet the challenge and make a difference!

Minister of State for Community Affairs John Curran has expressed “grave concern” that people addicted to drugs “seem to be on methadone for an extended period of time”.
He said “not everybody who uses methadone uses it exclusively” and it appeared to be taken with a combination of other drugs. “I may not be in my position long enough, but I would like to see the hard evidence to show progression” and an “active methadone-reduction programme”.
The Minister was answering questions about Health Research Board figures which revealed 2,442 drug-related deaths in the eight-year period from 1998-2005.
Labour spokesman Jack Wall expressed concern that 60 deaths in 2005 involved the use of methadone. If drug addicts were getting access to methadone from more than one source “instead of curing themselves, addicts are creating more problems for themselves” with addiction to methadone. Mr Curran said the HSE “is in the process of implementing a national overdose-prevention strategy which would address the issue of benzodiazepines, prescription drugs and methadone”.
Referring to the figures for 2005, the Minister said of the 400 drug-related deaths “cocaine was implicated in 100 deaths”, while 25 per cent of deaths from poisoning were “the result of alcohol in conjunction with another drug”.
He said while illegal drugs were involved in many cases, “prescribed drugs and over-the-counter medication, such as anti-anxiety drugs like valium, antidepressants and pain-killers, are frequently involved in such deaths, either alone or in conjunction with illegal drugs”.
Catherine Byrne (FG, Dublin South Central) expressed concern about service cutbacks in drugs task force areas. “I will not criticise the Minister, whose heart is in the right place,” she said.
However, she warned that crime was greatly linked to drugs, and the Government had to “take the drugs issue seriously if we are to get anything done”. She said the local Inchicore drugs team had to reduce its budget by €30,000, and other services in Wexford and Tipperary had being asked to reduce their budgets by 14 per cent.
Mr Curran said while the funding in 2008 was €34.776 million, it was €34.6 million for 2009, a slight reduction. However, spending had increased significantly over the years.
Source, Marie O’Halloran, The Irish Times,05/03/2009

NDPA COMMENT
The following item on BBC Online (Newsbeat) 13th July has a spokesperson from the Department of Health declaring that “The government has invested £406 million for drug treatment in 2009/10, of which £24.7 million is available to support young people’s treatment,” … And yet the only residential rehab in the country for those age under 18, Middlegate Lodge, is fighting closure for lack of funds. ‘Treatment’ in the UK often means methadone maintenance (useless for cocaine addiction) or counselling sessions for a few weeks – also useless if the young person is still living in the same area and meeting the same using friends. The Department of Health and the National Treatment Agency need to seriously re-consider ‘treatment’ – and not only for young people – and to seriously invest in more effective drug prevention.

Cocaine A&E cases hit record high
Seventeen people a week are now being admitted to accident and emergency departments after taking cocaine, according to official government figures seen by Newsbeat.

More than one million people regularly use cocaine in the UK
Doctors treated 894 people in England for a “cocaine-induced health emergency” in 2007/8, compared with 740 in 2006/7 and just 448 in 2003/4.
The total number of people taken to hospital after using any type of illegal drug has risen 45% in five years to 9,543, according to the figures obtained by the Liberal Democrats.

“These statistics are really shocking,” said the Liberal Democrat health spokesman Norman Lamb. The price of cocaine has come down significantly but at the same time it has also [become] chic. That hides the massive health risks.”

Health problems
More than one million people regularly use cocaine in the UK – more than any other European country – according to the UN’s latest report.

Snorting the drug in large or strong quantities often leads to hallucinations and disorientation. At the extreme end “cocaine poisoning” can occur where the user starts fitting and vomiting.
Cocaine use also constricts blood vessels and can result in a rise in body temperature, burst blood vessels and, in some cases, death from brain seizures, heart failure and respiratory problems.
Research in the medical journal Circulation suggests that up to 25% of heart attacks in people under 30 can be blamed on regular cocaine use, instead of the more typical coronary artery disease.
John, not his real name, from Northampton told Newsbeat he collapsed in a pub after months of serious cocaine use.
“I had bought coke that day and had been using it. As the night went on I got more paranoid to the point where not a lot was making sense. That’s when the anxiety set in,” he said.
“I remember getting up and thinking I need to get out and within five steps I collapsed and started having fits on the floor. It felt as if I was being kicked to pieces on the ground.”
“I can’t remember a great deal from that evening. I went straight to hospital and was seen by the mental assessment team and that is when I realised I needed to change my life.”

Falling price, growing use
Doctors say the falling price of cocaine means users are more likely to take larger amounts on a night out, increasing the risk of an accidental overdose. The average street price of the drug is now down to £42 a gram – partly because it is increasingly cut with other chemicals – according to the charity DrugScope.

That could make a line more dangerous as people either react badly to the cutting agent or get used to the low purity making them more vulnerable if they accidentally come across a strong batch.
The government’s drug advisors warned last year that they are seeing more cases of young people ending up in hospital after snorting lines of MDMA – or powdered ecstasy – thinking it was cocaine.
Kerry, 23, from Kent, told Newsbeat she had a couple of bad nights on coke before deciding to stop taking the drug for good.
“I was doing too much of it. I remember being sick a few times and eventually I was found underneath the building fitting with my eyes rolling up the back of my head,” she told Newsbeat.
“I don’t remember any of it. I just remember waking up with my friends in front of me crying. They wanted to call an ambulance but I just about managed to come round but was hazy for about three days.”

‘Record investment’
Six months later one of Kerry’s best friends died on a night out after taking the drug.
“She hadn’t touched it for a while and then one weekend she got the wrong sort of stuff – which was mixed with MDMA and some other things – and then once it went up her nose it killed her,” she said.
“By the time she got to the hospital it was too late; she died in the ambulance. I was devastated because we both just thought it was a bit of fun and it would never happen to us.”
While government surveys show that drug use as a whole has fallen since records began in 1995, the number of adults taking cocaine has risen from 0.6% in 1994 to 2.3% last year.
A spokesperson for the Department of Heath said tackling drug misuse remains a priority.
“The government has invested £406 million for drug treatment in 2009/10, of which £24.7 million is available to support young people’s treatment,” she said.
“Drugs use amongst young people is actually declining. Thanks to record investment, specialist substance misuse services have expanded greatly and there are now more young people getting treatment.
“This is encouraging and reflects our continuing efforts to tackle drug use amongst young people.”

While treatment is an important component in many people’s recovery, its effect becomes less and less pronounced the further away you get from the treatment episode. As William White, the recovery researcher and historian says, the further away you get from treatment, the more important is the post-treatment environment.
Aftercare and mutual aid are evidence-based components of the post-treatment environment. We know that those who come out of treatment who take up aftercare and mutual aid do better than those who don’t.
In Scotland, we have a long tradition of mutual aid groups and they form an important part of the recovery community. In the USA, there are much better developed recovery communities in many areas. We need to nurture recovery communities locally here.
On Friday 17th July, in Edinburgh, there will be the first of several ‘Recovery Cafes’ this summer. This one will be held at Old St. Paul’s in Jeffrey Street and will run from 6.00pm to midnight.
The cafe has been developed by those in recovery and those who support recovery and will offer a safe and sober meeting place for those in recovery to gather. If these cafe nights are successful then dedicated premises will be sought and Edinburgh will have a permanent facility to support and nurture the recovery community.
If you are in the city on Friday and you are in recovery or support those who are, check it out! Like Wired In, this is a valuable resource and recovery tool. It’s also another piece of evidence of how recovery is here in Edinburgh and growing.
Source: Wired In July 2009

Four out of ten teenagers know someone with mental health problems caused by cannabis, a report shows. More than half of youngsters questioned also believed that those smoking the drug lose motivation and do badly at school.
The survey, by the Home Office funded drugs advice service Frank, is fresh evidence that the supposedly soft drug has harmed the health, education and careers of millions of teenagers. It comes a week after a study showed that even one-off users of cannabis show signs of behaviour linked to schizophrenia, with half of those tested having an ‘acute psychotic reaction’.
The results challenge the orthodoxy – followed by Frank in its guidance to youngsters – that cannabis is dangerous only to heavy users or those who already have mental health problems.
The advice service’s report showed that 42 per cent of 11 to 18-year-olds knew someone who had suffered mental problems from the drug, including paranoia, panic attacks and memory loss. The figure suggests that 1.5million teenagers have had direct experience of the harm caused by cannabis.
It could be a reason why fewer youngsters have been taking the drug, with use falling since 2001. However, the number of under-25s smoking cannabis was still almost one in five last year. Among those who knew someone who had suffered damage from cannabis, 64 per cent said the harm took the form of panic attacks.
The survey of 28,000 teenagers, which was carried out through a social-networking website, also found that 56 per cent of those questioned ‘associate cannabis use with losing motivation and doing badly at school or college’. Almost 15 per cent said they used cannabis, which they claimed helped them cope with life. But only 11 per cent said they thought using the drug made them look cool.
The criminal status of cannabis was downgraded to Category C by Labour in 2004, meaning it ranked alongside performance-enhancing drugs used by cheating athletes. This meant users would be arrested only rarely if caught by police.
However, deepening concerns over the mental health effects of the drug – and the stronger varieties now sold on the streets – meant it was pushed back into the more serious Category B this year. But still only a few of those caught with cannabis will be arrested, with police more likely to use powers to hand out on-the-spot fines.
Frank spokesman Chris Hudson said: ‘The majority of teenagers don’t want to risk their health by using cannabis, however some people choose to take the risk.
‘Others wrongly believe cannabis is harmless because it is a plant. Cannabis messes with your mind – and reactions can be more powerful with stronger strains such as skunk, which is around twice as potent.’ The organisation is to start an anti-cannabis advertising campaign next week, timed to catch teenagers during their summer holidays when they may be tempted to use drugs.
The Frank website currently states that only regular use of cannabis is associated with the risk of mental illness. It also says that nobody knows whether stronger strains of the drug carry higher risks. Phone lines run by the advice organisation, paid for out of a Home Office subsidy of £6.5million a year, can be even less discouraging.
One caller was told earlier this year: ‘Alcohol is a powerful drug in what it does to your body and how many brain cells it kills and stuff. Cannabis is not to be taken lightly, but it’s a lot less powerful. If alcohol were illegal it would be a Class A drug. Cannabis should just be a Class C drug. In terms of its effects it’s a lot less powerful than drinking.’
Anti-drug campaigners welcomed the Frank research. Mary Brett of Europe Against Drugs said: ‘Frank has been stuck in a time warp. Their website still isn’t up to date. They have always said you should steer clear of cannabis if you have a history of mental illness. It doesn’t seem likely that the damaged people known to 42 per cent of teenagers all had a history of mental illness.’
Source: Daily Mail 6th Aug. 2009

The following letter from Peter O’Loughlin regarding the NTA Report is very illuminating. Harm Reduction is central to the UK government policy on drugs but the continued increase in deaths related to drug misuse must surely necessitate a change. Prevention first, then intervention, then treatment leading to abstinence. Treatment should include the choice of residential for those who desire it and harm reduction should be used as a last resort for a limited time.
SMMGP POLICY UPDATE – Good Practice in Harm Reduction Report NTA (October 2008)

I would respectfully point out that the claim regarding reduction in drug related deaths fails to acknowledge the fact that there was an increase between 2003-4, largely accounted for by deaths involving heroin/methadone and morphine (1)

Your update also disregards the fact that drug related deaths are at their highest for 5 years.(2) In fact as you should be aware the total number of drug poisoning deaths in 2007 including a staggering 16 per cent rise in deaths involving heroin and morphine compared to 2006, increased to 2,640.

It is even more regrettable that you chose not to point out that deaths from heroin and morphine appear to be increasing year on year, or the fact that in 2007 there were 196 deaths involving cocaine, the highest recorded number of deaths involving cocaine since the ONS database began in 1993.

A further notable omission are the deaths relating to methadone, which increased by a wholly unacceptable increase of 35 percent over 2006 to 325 and once again the highest level since 1999.

An even more glaring omission is the fact that in males no less than 67 per cent of drug poisoning deaths were attributable to ‘drug misuse’.

In the light of the foregoing, I have to consider whether your update ‘Good practice in Harm Reduction’ is being unrealistically optimistic, or, like the title, misleading. I will reserve judgement pending your comments.

(1) Office of national Statistic in 2007s: April 2007

(2) Office of national Statistics: Health Quarterly Statistics autumn 2008.

Source: e-mail from Peter O’Loughlin, The Eden Lodge Practice.
Date: Fri, 6 Feb 2009

In 2008 organized crime in Australia is estimated conservatively to cost $10 billion according to the Australian Crime Commission.
The estimate includes the loss of legitimate business revenue, loss of taxation revenue, law enforcement expenditure, regulation and social harms where criminal activity compromises the health, safety and wellbeing of individuals and communities.
Illicit drugs account for at least 50 per cent of the costs of organized crime which are conservatively estimated at $5 billion per year.
As the illicit drug profits are repatriated overseas the costs involving money laundering will add to the cost of organized drug crime.
The Australian Crime Commission believes that organized crime gangs are highly efficient, use the latest technology and employ highly paid professionals to protect their activities.
(Source: Organised Crime in Australia, Australian Crime Commission, February 2009).

The romance with weed is never-ending for California marijuana devotees. Now, they claim their beloved drug can save the state by solving its unrelenting budget nightmare.
State legislation is afoot to legalize and tax marijuana to backfill the state budget. But, like the grandiose daydreams of a stoner, the reality of this plan would be far different from its vision. I won’t go all “Reefer Madness” on you or claim that hemp T-shirts are a slippery slope to damnation. The problem with marijuana legalization is simpler and worse.
California cannot afford more stoned people, especially stoned young people. We need a lot fewer stoned people.
Prevention experts understand the problem with legalization: The greater the access to an intoxicant, the more abuse there will be of that intoxicant. Alcohol isn’t the most dangerous drug in the world because it’s worse than heroin or cocaine. It’s the most dangerous drug because it’s so easily accessible. You can get large quantities of it anywhere, and cheaply, too. Underage drinking is a big problem because kids can get alcohol so easily.
Legal marijuana would mean more access to marijuana. The number of marijuana users would spike, including teens. Problems related to marijuana use would spike. Marijuana lobbyists argue that if a dangerous drug such as alcohol is legal, then marijuana should be, too. I’ve never understood that. With all the problems we have with alcohol, why would we want to legalize another intoxicant?
Right now, there are 127 million alcohol users and 14 million marijuana users in this country – because one is legal and the other isn’t. But, most alcohol users don’t get intoxicated. About one-fifth of alcohol users binge drink or regularly drink heavily.
The serious problems from alcohol occur when people get intoxicated. With marijuana, you get intoxicated every time you use it. That’s the whole point. Marijuana intoxication and alcohol intoxication may be different, but both are bad for society.
Marijuana intoxication means cognitive impairment, grandiosity, short-term memory loss, difficulty in carrying out complex mental processes and impaired judgment. It severely hurts your ability to perform at school and work. It saps initiative and drive. It increases confusion. In other words, it makes you stupid.
An increase in stoners among California’s young people and work force would be very bad for the state. Right now, we’re in a recession in which people without college degrees are losing jobs twice as fast as people with college degrees. Our future economy will be based on innovation, education and highly skilled labor.
But we’re already not producing enough college graduates for our future work-force needs. With many more stoned teens and young people, the problems of an unskilled, uneducated and unmotivated work force will get worse. Stoned people can’t learn or work very well. Marijuana is the loser drug: That’s the big problem with it.
What about the idea that California can balance its budget by legalizing marijuana and taxing the heck out of it? You haven’t been paying attention to special-interest politics if you believe that.
Moneyed special interests run policy in this state. Look what happened when California criminal justice policies made prison guards one of the most powerful lobbies in the state. The union quickly began dictating policy in its own interest.
The alcohol industry is so powerful in California that beer taxes haven’t increased in nearly 20 years; the last time they were raised was by a minuscule amount and the industry almost killed that. A wealthy marijuana industry will soon co-opt policy-makers and dictate how much tax we charge, where we sell the product and who gets to buy it. Why would a marijuana industry be different from any other special interest?
Personally, I don’t think the marijuana lobby believes its own arguments. When I talk to legalization proponents, it usually boils down to their angry demand that people should be left alone to get stoned if they want to. That libertarian sentiment shows a complete disregard for the public good. If legalizers can’t understand that, elected policy-makers certainly should.
The disingenuousness of the marijuana lobby becomes clear on the subject of medical marijuana. For marijuana lobbyists to push both recreational marijuana and medicinal marijuana at the same time is duplicitous. It’s nakedly obvious where their real desires lie.
Recreational drug use and medical drug use have nothing in common. If pharmaceutical lobbyists pushed recreational and medical use of the same drug, they’d get hauled before Congress and slammed by state attorneys. But the marijuana lobby sees nothing wrong with its tactics.
How about a little more candour from marijuana romantics? Like the panhandler standing on a street corner with a sign that says, “Why lie? I just want a beer.”
Source: San Diego Union Tribune March 26, 2009

Bandar Seri Begawan – The Narcotics Control Bureau (NCB) in its tireless vigilance has once again apprehended several individuals suspected of consuming and distributing illegal drugs openly in public.
According to a press release from NCB, investigations into these activities have warranted the arrests of 10 men between the ages of 18 and 38, including two men who had been reported to have blatantly sold these drugs to passers by at a jetty and the back streets of Kg Saba Darat in the capital.
Some 70 NCB officers were involved in the drug bust last Thursday where they succeeded in seizing several packets of illegal drugs.
The operation is part of a series that NCB will be conducting in known drug hotspots in their commitment to clean up the streets of illegal drugs.
According to Section 39(a), Paragraph 27 of the Misuse of Drugs Act, any person found guilty for possession of controlled drugs will face a minimum sentence of 20 years imprisonment and 15 strokes of the cane, and a maximum sentence of 30 years with 15 strokes of the cane.
But possession of controlled drugs exceeding 500 grammes carries the death penalty in Brunei.
Meanwhile, suspects found guilty of consuming controlled drugs will be charged under Section 6(b), Paragraph 27 of the Misuse of Drugs Act and will face a minimum of three years and a maximum of 10 years or imposed with a $20,000 fine or both.
Source: Borneo Bulletin www.BruDirect.com March 2009

The number of babies being referred for temporary foster care in Edinburgh because of parental drug misuse has doubled in the last year.
Edinburgh City Council said the statistics showed that the capital was in “desperate need” of more carers. An appeal has been launched to encourage more people to help care for vulnerable babies.
The plea was made at the launch of a training DVD to help people looking after vulnerable babies. Some 99 babies under six months old were referred for foster placement in 2008, double the number in the previous year.
Fifty of those babies were referred before they were born and two thirds of all the babies were suffering from the effects of alcohol or drug addiction as a result of the mother’s addiction problems.
Growing demand
Those babies often suffer from a range of physical, cognitive and emotional problems and need extra care. Councillor Marilyne MacLaren, Edinburgh City Council’s leader for children and young people, said: “The city’s foster carers are dedicated people but the problem we have now is that there aren’t enough carers to meet the growing demand.
“We want the people of Edinburgh to know that a wide range of people can be foster carers. Whether you are in your 20s or your 50s, in a couple or single, you can apply as long as you’re committed and are willing to help a child who has had a tough start in life.”
Ms MacLaren said the increasing number of cases meant social workers were stretched and services could not be sustained or improved without adequate investment.
“It’s a vicious cycle. If we don’t have the resources to tackle the problem at its source then we will see more vulnerable babies,” she added. I’ll be approaching the Scottish Government to ask them to revisit the issue and to take action because if things don’t change, the lives of vulnerable children will get even harder.”
Source: BBC NEWS: go2009/03/26
http://news.bbc.co.uk/ /pr/fr/-/1/hi/scotland/edinburgh_and_east/7965526.stm

Brandon Muir was only 23 months old when he was killed by the boyfriend of his drug-addicted mother.
BBC Scotland’s home affairs correspondent Reevel Alderson reports on the children who are living with drugs. The statistics are shocking and bleak – and they reveal the human consequences of Scotland’s drugs epidemic.
Glasgow University has estimated that between 40,000 and 50,000 children live with at least one drug-addicted parent.
The number of children removed from their own home because they are being neglected is rising.
And, according to a report seen by BBC Scotland, 30% of those taken into emergency care in Edinburgh are newly born.
The report, produced by Scotland’s Children’s Reporter Administration (SCRA) but not published outside the organisation, examined the cases of children in Edinburgh made the subject of a Place of Safety Warrant – an emergency removal from their own home.
In 2006-07, just over 60% were under 24 weeks old, and a further 30% were newly born. Warrants were issued by a Children’s Hearing because, in 80% of cases, the baby was feared to be in danger of neglect.

Sadly, this is a familiar picture for social workers across Scotland. Ruth Stark, spokesperson for the British Association of Social Workers, says her colleagues must make an assessment about whether a child can not safely remain at home.
“For young mothers and fathers who are already addicted to drugs, often we find ourselves having to go into a situation where this is a key issue that is interfering with their ability to look after their children. In some circumstances, we have to take drastic action,” she said.
A Place of Safety Warrant follows a Children’s Hearing called to address emergency or high-risk situations, and allows measures to be put into place immediately to protect a vulnerable child.
They only last three weeks – although after investigation children can be placed in care away from the family home.
The Principal Reporter of the SCRA, Netta MacIver, said drug-dependency was not by itself a ground for concern.

But she added: “If there’s a degree of chaos in the household, then the basics of feeding, changing, cleaning – the repetitiveness of a lot of that is quite often challenging, so you can have ancillary supports.
“But if there are behaviours within the parents which aren’t moderated, then the risks will continue.”
Brandon Muir is the latest in a series of tragic cases in which drugs, alcohol or the chaotic lives of adults have led to the death of a young child.
There are a number of projects around Scotland which aim to help parents to better care for their children, while also coping with their own problems.
Andrew Horne, director of Addaction in Linthouse in Glasgow, said it was vital that drug or alcohol-dependent parents were given help – not just for them, but for all of us.

“People don’t see that this has a huge impact both on our resources in terms of our taxpayers, but also on our communities.
“If we can help children stay safe and happy, and in families, then we are not paying for children to be in care systems, to be in foster care, being involved in social work.”
There are controversial solutions to this problem. Duncan McNeil, Labour MSP for Greenock and Inverclyde, has suggested administering contraception with addicts’ methadone to prevent them having children.
A new inquiry, under the former chief constable of Fife, Peter Wilson, is now to be held to learn lessons from the Brandon Muir case.
Perhaps the real question to be asked is how does society cope with children brought up in the midst of Scotland’s drugs epidemic?

Source: BBC News Channel 3 March 2009

DRUG exporters are turning to the postal system in a bid to get illicit drugs into Australia.
And border authorities admit they face a challenge to detect the substances amid the estimated 160 million pieces of mail to be sent into the nation this year.
The Courier-Mail has learnt that drug dealers are sending small parcels through the post, fully expecting to lose some to border authorities but expecting they will get enough through to make a profit. Ecstasy traffickers were keeping parcels to between 300 grams and 500 grams and were increasingly sending through MDMA powder because it was more difficult to detect than pills.
Australian Customs national intelligence manager Andrew Rice said MDMA or ecstasy detections in the post were rising, with more than two every week in the past financial year. “The detections in the post are going up in their sheer number, not necessarily in weight,” Mr Rice said. “There is no pretence from us that we do miss things just because of the volumes. Even in that environment of mass input, we do quite well in terms of significant proportion of drugs being sent through the postal system. But we do see criminals moving between different importation methods and the significant shipments are still likely to be attempted by sea cargo.”
Australia is obliged under a United Nations charter to accept mail from across the world. This year, Customs expects 120 million letters and 40 million parcels to be sent from overseas to the checking points in Brisbane, Sydney, Melbourne and Perth.
Mail is screened by Customs or the Australian Quarantine and Inspection Service, through the likes of sniffer dog patrols and X-rays, before being handed to Australia Post for distribution. “We think about every item of mail. Some items are given different treatment based on the different risks that we assess,” Mr Rice said.
The figures for ecstasy busts in the last three years have been distorted by the monster find of 4.4 tonnes or 15 million pills in a shipping container in Melbourne in June 2007. The container, sent from Italy, was stacked with tinned tomatoes but Customs authorities were suspicious when X-rays revealed inconsistencies in the tins’ contents. Customs alerted the Australian Federal Police, which decided to seek more information by following the drugs. They opened each tin and replaced the ecstasy with harmless tablets and then followed the trail. An investigation lasting more than a year, involving 400 AFP agents and 20,000 hours of surveillance, resulted in 20 arrests.
In the last financial year, Customs detected 172kg of MDMA/ecstasy and a further 260kg of amphetamine-type stimulants among mail and cargo. This compares with 611kg of cocaine, 72kg of heroin and 49kg of cannabis.
Customs also made large detections of precursor chemicals to methamphetamines, including 105kg of pseudoephedrine in air cargo 18 months ago.
Mr Rice said the criminal networks that controlled much of the world’s illicit drug trade had “access to specialist knowledge around the import and export fields”. “The game is all about concealment,” he said.
Source: www.couriermail.com.au 31st March 2009

Texas Prevention Impact Index or TPII numbers for the past 4 years show decreases across the board here in Amarillo.
The Texas Prevention Impact Index is a report showing statistics in the usage of drugs, alcohol, tobacco, and violence among students in the Amarillo independent school district.
The TPII look at risk and protective factors that lead students to or away from the various substances. They look at perceptions in the community towards alcohol, drugs, and tobacco use. The numbers also reflect the usage of these substances by the students that fill out the survey.
25 hundred surveys are filled out by a cross section of students in the Amarillo school district, ranging from the 6th grade up to seniors in high school.
Here a few noteworthy statistics you may find interesting from the data collected by Research and Educational services, a private evaluation and research firm based out of Houston. The company has done the surveys and completed the data for A.I.S.D. since 2002.
47.9% of students say they would go to parents if they had a question about alcohol or drugs, versus 20.7% say they would ask a friend their age.
The number of students who say it’s ok to have alcohol to have a good time is 26% down from 30% just 4 years ago.
The number of students who think schools do NOT enforce rules on drinking have gone down form 30% to 19%, which means more students are getting the idea that it’s not acceptable to use alcohol from the school district.
In the category of usage in the past 30 days here are some numbers that show improvement.
In the past 30 days, seniors are using alcohol 7% less, using tobacco 6% less, and nearly 14% less of the students serveyed say they have participated in binge drinking in the past 30 days. All are positive stats.
87% of all students across the board have NOT used Marijuana in the past 30 days.
Frequency of usage numbers also show decreases. Tobacco is down 12%, alcohol is down 6%, marijuana is down 11%, this means that those kids that do use these substances are not using as frequently.
Some statistics that show perception changes are the following: 93% of the students surveyed say that they are harming themselves by smoking. 79% of students, up from 69% say that they are harming themselves by smoking marijuana.
Switching gears to violence and safety issues.
15% of students say they have been bullied during the past 30 days.
12% say they’ve been involved with a group fight.
In the past year the percentage of students who have been in a fight at school was 15%.
33.4% of the students say they have discussed safety issues with family in the past 30 days.
All in all, some of the numbers shown are alarming and some show great improvement in prevention and awareness programs here in Amarillo. The Amarillo community should be proud that the students have made progress and the school district is working decrease these all important problems.
“It shows, basically that the efforts that are being conducted here are working, to be honest with you when you look at the rest of the state or other areas in the state, I don’t think you see the same kind of trends or same kind of change in those areas, it’s been very successful here,” said Dr. Robert Landry, Director of Research and Educational Services.
“We’re seeing some decreases in some types of drug use which we’re glad to see, we also know that we need to continue the education K-12 for our students and be able to share current information with them,” said Teresa Kenedy, A.I.S.D. Prevention Specialist.
Source: www.connectamarillo.com 31st March 2009

Alcohol was officially recognised by the Government today as a gateway drug that can lead users to other addictive substances. The Cabinet decided to re-designate the issue of problem drinking with anti-drugs initiatives as part of a new national strategy.

Minister John Curran, who has responsibility for the National Drugs Strategy, said alcohol abuse is causing huge levels of public concern around the country. Mr Curran said a combined strategy will facilitate a more coherent approach to the issues and consequences of alcohol and illicit drug use, including addictive behaviours.

“We cannot continue to look at these problems in isolation. The time has come for more joined-up thinking,” he said. Mr Curran and Health Minister Mary Harney brought the issue to today’s Cabinet meeting, where it was approved.

Mr Curran said: “Alcohol is seen, for many, as a gateway to illicit drug use and poly-drug use, often including alcohol, is now the norm among illicit drug users. “People also have serious concerns in relation to the high level of alcohol consumption in Ireland, the pattern of drinking, especially binge drinking among young people and in the community generally, and the wider social harms which are associated with the misuse of alcohol.”

The minister is preparing a new National Drugs Strategy for the period 2009/16. Discussions will be held around a new National Substance Misuse Strategy in coming days. Meanwhile, Ms Harney announced today she is banning the stimulant drug BZP, which is available in so-called “head shops”. Possessing or selling the substance is now an offence under the Misuse of Drugs Act 1977.

She said: “This will now make the possession of BZP illegal and make sure that BZP is no longer available for sale in ’head shops’ around the country, which has been an issue of concern to my Department and the wider public.”
SOURCE: WWW.IRISHNEWS.COM THURSDAY, APRIL 2, 2009

On a day when the government is meeting to discuss drivers of crime it is worth looking beneath the veneer of the Police offence statistics for the past 10 years to understand just how endemic the violence caused by methamphetamine and drug abuse has become in New Zealand and the need for strategies to address this according to MethCon Group director Mike Sabin.

“Again through 2008 violent offences continued to increase unabated but when you look at the past 10 years you get a far better feel for the way our communities have been held to ransom by failed drug policy”, said Mr. Sabin
“Violent offences and serious assaults increased by 51 percent and 59 percent respectively. Robbery has increased by 57 percent, while intimidation and threats have increased by 73 percent with offences involving grievous harm increasing by a staggering 105 percent, up from 92 percent last year” said Mr. Sabin

“During the same 10 year period there has also been dramatic increases in offences related to methamphetamine including 169 percent increase in supply offences, 208 percent increase in possession for supply, 400 percent increase in importation, while importation of pseudoephedrine to manufacture the drug has increased by well over 10,000 percent with methamphetamine manufacture increasing by over 9500 percent since 1998”, claimed Mr. Sabin “On the back of that we have also become some of the highest recorded use rates of cannabis in the world with 80 percent of those aged 25 in this country now saying they have used the drug”, said Mr. Sabin

“My point is that there is a clear nexus between increased drug abuse in this country, particularly with regard to methamphetamine, and violent crime. While alcohol is a lead contributor to violence, what are we doing to actually identify and respond to poly drug abuse, which is far more common than any other form of drug abuse?”

“For example, as much as 89 percent of our prison population are drug users and yet too often we hear that alcohol is the driver of violent crime and disorder. Drugged driving is more frequently a contributor to fatal vehicle accidents than alcohol use alone, but what do we do to identify drugged drivers on our roads?” said Mr. Sabin.

“Beyond this, why has New Zealand become the highest recorded users of methamphetamine and cannabis in the world over the past 10 years? The answer is quite simple; since 1998 our national drug policy has focused centred on ‘harm minimisation’. Rather than focusing on prevention of drug use and healing drug abusers to a point of abstinence, our national drug policy has focused on accepting drug use as an inevitability and finding ‘safe ways’ to use, while treatment has been more about methadone maintenance programmes and giving addicted users clean needles”, said Mr. Sabin

Justice Minister Simon Power signalled their clear intentions to look at new approaches to address the drivers of crime and I commend the government for having a forum to begin this process as it goes to the heart of solving the cause of the problems rather than tinkering with the symptoms. The role of drug abuse as a driver cannot be underestimated and I would encourage efforts to arrive at strategies which reflect this”, said Mr. Sabin

Source: www.methcon.co.nz. (NZ’s specialist methamphetamine education providers and policy consultants). 3rd April 2009

Executive Summary

Following two decades of progress dealing with alcohol impaired driving, greater attention is now being directed toward the issue of driving while impaired by drugs. Currently, there is far less information related to drug impaired driving than alcohol-impaired driving. This report describes a study on the extent of drug use by drivers. A random survey of drivers was conducted at pre-selected locations in British Columbia from Wednesday to Saturday nights in June 2008. The purpose was to collect information on the prevalence of alcohol and drug use among night time drivers. Those surveyed were asked to provide a voluntary breath sample to measure their alcohol use and an oral fluid sample to be tested subsequently for the presence of drugs. Of the 1,533 vehicles selected, 89% of drivers provided a breath sample and 78% provided a sample of oral fluid.
Key findings include:
• 10.4% of drivers tested positive for drug use
• 8.1% of drivers had been drinking
• 15.5% of drivers tested positive for alcohol, drugs or both
• Cannabis and cocaine were the drugs most frequently detected in drivers
• Alcohol use among drivers was most common on weekends and during late-night hours; drug use was more evenly distributed across all survey nights and times
• Alcohol use was most common among drivers aged 1to 24 and 25 to 34; drug use was more evenly distributed across all age groups
• No drivers aged 16 to 18 were found to have been drinking
• While driving after drinking has decreased substantially since previous surveys, the number of drivers with elevated alcohol levels (over 80 mg%) was higher than in the past

Source: Beirness, D.J., & Beasley, E.E. (2009). Alcohol and Drug Use Among Drivers: British Columbia Roadside Survey 2008. Ottawa, ON: Canadian Centre on Substance Abuse. 2009

A new Australian study has found that the number of newborns suffering serious drug withdrawal symptoms is now more than 40 times higher than in 1980.

The research, published in the latest edition of the international journal Pediatrics, also found that these infants were at greater risk of neglect and of being taken into care.
The data analysis revealed that of 637195 live births in Western Australia between 1980 and 2005, 906 were diagnosed with Neonatal Withdrawal Syndrome. For every year, there was an average 16.4% increase in children born with the syndrome.
Report co-author, Professor Fiona Stanley from Perth’s Telethon Institute for Child Health Research, said the study identified a range of factors that should assist with the early identification of children at risk.
“It is clear that if we are to reduce the number of these children suffering from abuse and neglect, then there is a need to start working with their mothers before these babies are born, and ideally, pre-conception,” Professor Stanley said.
“Our data show that the majority of the mothers had already had contact with hospitals for mental health and substance use issues which suggests there could have been numerous opportunities to intervene to prevent unplanned pregnancy and provide intensive support with antenatal care and substance abuse treatment.”
“A multidisciplinary team that includes obstetricians, social workers, drug and alcohol workers, and welfare workers is required to case manage and support the women through the complex issues that they face. However it is imperative that this support continues long term.”
Professor Stanley said the increase in babies suffering NWS reflected the overall rise in substance abuse within the community and the increased recognition of NWS by health professionals. While this study was in WA, it is likely that it reflects a national trend.
“We now have the situation where 4 babies out of every 1000 births are born suffering the effects of illicit drugs — that is over 1000 newborns per year in Australia. This has serious implications for the child, the family and the whole community and is an issue that must be tackled well before these children suffer potential harm.”
The study was made possible by a groundbreaking agreement by the Western Australian Government Departments of Health and Child Protection that allowed health and welfare records to be linked and the de-identified information given to researchers for analysis.
The research was supported by an Australian Research Council Linkage Project Grant.

Source: Telethon Institute for Child Health Research (2009, April 24). Alarming Increase In Drug-affected Newborns. ScienceDaily. Retrieved April 27, 2009, from http://www.sciencedaily.com¬ /releases/2009/04/090423100821.htm

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The United Nations Office on Drugs and Crime has praised Sweden for pioneering the most successful illicit drug policy in all Europe, reports David Perrin.

Sweden’s illicit drug use is lower than any other European country. The UN has praised the Swedish policy of wanting a drug-free society and has endorsed its program of increasingly strong laws against drugs as the reason for its success.

In 2003, lifetime prevalence of drug use among 15-16 year olds in Europe was 22 per cent. In Sweden, by comparison, it was only 8 per cent. In 2006, Swedish teenage drug use had fallen to 6 per cent.

Illicit drug use in Sweden has declined in recent years, whereas it has increased in other European countries. Sweden has low levels of HIV/AIDS infections resulting from injecting drug use. Its laws require the country’s small number of syringe exchange programs to divert users into detoxification and rehabilitation programs.

Measuring success

Sweden regularly polls its citizens to determine whether drug use is increasing or decreasing. Surveys are made of teenagers (15-16), the general population (18-64) and military conscripts. The surveys look at drug use in the past month, the past year and over a lifetime. These surveys are important not only to determine drug use trends, but to see which policies are working.

Sweden has enjoyed a broad political consensus over the direction of drug policy with changes in government not leading to changes in drug policy. One of the key planks of Swedish drug policy is the courts’ powers to divert users into detoxification and rehabilitation.

Sweden targets its drug policies at teenagers to stop them trying drugs and, if they get hooked, to get them off drugs quickly and permanently. Sweden’s experience is that if a young person has not taken an illicit drug by age 20, he or she is highly unlikely to use illicit drugs later in life.

Australia has high levels of illicit drug use, similar to most of Europe. We have adopted permissive “harm minimisation” policies which have led to high levels of demand for illicit drugs, with new drugs such as “ice” (methamphetamines) coming on the scene.

Ice is known to cause mental illness, psychosis, violent behaviour and even death in those who try it. The drug is highly addictive with few known methods of rehabilitation.

Sweden has succeeded in its drug policy because it has reduced the number of drug-users, and hence the demand for illicit drugs. This is a lesson Australia has yet to learn. Sweden is not on a known drug route, so drug crime syndicates avoid trafficking to Sweden because of the difficulty involved. High prices, few outlets and strong drug policies deter the supply of drugs.

Like Sweden, Australia is not on a known drug supply route; but we have weak policies, low drug prices and a permissive culture that accepts the use of drugs. None of the strong drug policies of Sweden, as outlined here, are present in Australia, so, like Europe, we continue to suffer high drug usage.

In Canberra, the House of Representatives’ standing committee on family and human services is looking at the impact of illicit drugs on families and is due to report before the federal election.

This committee could perform no better service to our nation than study the United Nations Office of Drugs and Crime report, Sweden’s Successful Drug Policy: A Review of the Evidence (September 2006) – obtainable at its website www.unodc.org – and use the findings to replace Australia’s failed drug policy with the successful Swedish approach.

With a federal election due later this year, political parties have an opportunity to offer the Australian public a proven strategy to combat illicit drug use.

Source: Article by David Perrin of the Australian Family Association reported in
Drugwatch International 30th April 2009.

Why do the young turn into drug addicts and what could be the reasons for their increasing number in our country? Riti Naik looks for answers.

The ‘d’ generation
Ranmeet never came second in class throughout his school life, he was that brilliant. Besides, being an excellent drummer and a swift swimmer, he was also an obedient child. However, when he got through IIT Kharagpur, he lost interest in studies as he had never wanted to take up engineering. With a huge syllabus before him and an adamant mother behind, today, the boy stays with his father in his room. Ranmeet is a drug addict, and his father tries day and night to help him out, fully aware that sending him to a rehab would put an end to his studies. And this is just the tip of the iceberg.
This incident talks about a victim who has been treated mercilessly by circumstances. Yet, everyday, thousands of students, all over the country are actually willing to become drug abuse victims. Among these, numerous have already become addicted and blighted their lives.
No one ever aims to become an addict. Who knew that a brilliant boy like Ranmeet would turn his life into such a hell? Well, a question can be asked here: did he turn his life into that of an addict? The answer is ‘yes’ because no one could have taken the drug for him to become an addict. Yet, is he solely responsible for his state? Can we put the entire blame on him? This is the general mistake made by society, which comprises people like you and I – to put the blame on the user. No doubt the user is most guilty, but the contribution of circumstances is something undeniable here.
First, why did a studious boy like Ranmeet take a drug? Or, if we expand the question: why do students of the twenty-first century take drugs?
In most cases youngsters ‘try out’ drugs. When peer pressure threatens to label someone as an outcaste, people generally give in. After the effects are experienced, whenever, a youngster feels s/he cannot cope with her/his circumstances, they fall back on drugs. In this way, they become dependent on drugs during their stressful times. Once a person is under the influence of drugs, s/he will subsequently need more amounts of it every time to produce the same effect. If this is not nipped in the bud, there is very little chance of the person not to turn into an addict.
This is a very crucial point of one’s life, where s/he needs support from loved ones, which is denied most of the times. And specially, after becoming an addict, society turns its face away once they push her/him to a rehab. We must understand that they are what they are today because, somewhere in their lives, they have made a wrong choice, somewhere they haven’t been guided well. And because of this mistake, their lives have changed, they have become unknown beings to themselves, the spark within them flickered out.
So, if we consider ourselves to be responsible people who are wise enough not to make that wrong choice, don’t you agree that it’s our responsibility to accept them too? To try to give them what they deserve? To at least help them get back to their previous life?
No matter how much we try, we cannot run away from drugs. The menace has crept into the very roots of society. Drug abuse is rampant everywhere, all around us -some in large magnitudes, others in less significant numbers. In Australia, selling of loose petrol (which is directly not put inside the engine), is banned. Addicts inhale the smell of petrol for they can’t pay for ‘harder’ drugs. Many times, while waiting at road signals, we see little boys and girls coming with scraps of cloth to wipe the car windows and ask for alms. Some of them, in a quick gesture of picking up something on the ground, wipe the exhaust pipe, preferably of bikes. Once the signal is back , they wait for the next one, sniff the cloth to kill hunger. The child becomes a victim of drug abuse.
One does not become a drug addict only from heroin, cocaine, crack, marijuana(or any other form of it) or club drugs (like Ecstasy, LSD). Many times some addicts even sniff Fevicol, dendrite, nail polish removers, enamel paints and correction pen fluids. These are referred to as ‘inhalants’ and cause severe permanent damages to the brain in the long run. These volatile substances, if taken in good quantity can actually give the user a ‘high’ and lead to addiction. And along with this, we also have alcohol, cigarettes, and pharmaceutical products (sleeping pills, cough syrups and painkillers). Even if they don’t make addicts, they pave the road for one.
The human body can function well without drugs. Mentally, we are quipped with reasoning power with which we can fight every thought that disturbs us. We therefore can solve every problem ourselves, and in case some of us are unable to, there are various other options. Seeking refuge in drugs is not the solution.
Drugs are illegal, hard to obtain and have terrifying after effects – we all know that. So why fall victim to something as heinous as drugs, when you can manage everything yourself? Many take drugs to get that feeling of confidence and being on top of the world. This feeling can be experienced the moment you know what you are doing and your conscience favours you.
The reasons why the youth take drugs, like stress management, for getting that euphoric feeling, making their bodies feel they way they want to —can be all achieved with a little bit of hard work which will in turn do wonders for the mind and body as well.
A human being is a natural creation and a part of it cannot be artificial. Drugs produce effects that are artificial; be it the painkiller or the LSD effect, when you become part of another world. Once, one starts using drugs, one is less dependent on her/his own body functions and more dependent on this foreign stimulant. At first the body refuses to take in excess of such stuff and the person rejects it by throwing up. But once the bodily functions are somewhat affected and the normal working of the human body has decreased, the body gives in and the addict becomes a victim of overdose.
Many movies depict the complete destruction of a character due to drug abuse. Fashion portrays a super model Shonali (played by Kangana Ranaut), who initially a drug addict, spoils her entire career and subsequently, her whole life with her increasing dependence on drugs. In Dev D, Dev (Abhay Deol), doesn’t care to see how much he has started deteriorating in the eyes of those who love him. Other movies like Devdas, Don-2, we see that though the protagonists knew that another drink would kill them, yet they could not restrain themselves. They chose drugs over normal life, destruction over self-restraint.
Many times, events in our lives compel us to give up all hope and shut ourselves up in darkness. Most people use drugs in such a situation to escape that dreadful feeling of loss. And this is the excuse many of our friends give when we come to know about their addictive habits. Most of the times we let them indulge in it, thinking it would be better for them to forget the incident. However, supporting the usage of drugs is as dangerous as misuse of drugs. As a responsible generation, we have to make a decision now; we have to say ‘No’ to drugs.
Nothing can equal the confidence with which an innocent child dreams. These dreams long to be fulfilled by the child buried deep inside us as we grow up. Some claim to need drugs just to feel confident, yet a major bulk of the world population is functioning very well without drugs.
A drug is not a prerequisite for existence. With an able mind and body, we can surely create our own style, we can have our own vision. With a little awareness we can be naturally high on confidence and nurture our own dreams.
And now that we know that we can do well without drugs, we must completely do away with it. We can only be great individuals once we are completely independent, when we do not have to depend on anything to bring out the best in us.
A drug is not a scary subject. It’s just about a strong decision we’ve have make and say “No thanks, I’m fine without drugs”, whenever someone offers it to us.

Coordinator, La Martiniere for Girls
Source: Daily Dose May 2009

THE effectiveness of the country’s main drugs education programme for schools has been seriously questioned in the new National Drugs Strategy (NDS).
The NDS 2009-2016 said the design and concept of the Social, Personal and Health Education (SPHE) programme was in line with best international practice.

“However, its effectiveness at second level was consistently questioned during the NDS consultation process, in particular by school-goers themselves.”

According to the national strategy, the aim of the SPHE is to build the esteem and confidence of young people by developing their life skills and substance misuse is regarded as “an integral” part of the curriculum.

The Walk Tall programme and On My Own Two Feet are key parts of the SPHE curricula at primary and post- primary level respectively.

The NDS said one of the “key concerns” was the level of commitment given to the programme by individual schools and the supports available to teachers.

The report said an external evaluation by NUI Galway found a number of limitations with the programme:

* Support services were crucial for school and teachers that find it difficult to implement SPHE.

* There is little engagement with parents in the planning and development of the programme.

* Curriculum overload, timetable pressures and lack of status for SPHE affect its provision in schools.

The NDS concluded: “School-based education programmes, on which the NDS places particular emphasis, were considered to be very uneven in their delivery and, therefore, in their overall impact.

“The impact fundamentally depends on the commitment of individual schools and the confidence and competence of individual teachers. Young people consulted were highly critical of their experiences of the delivery of SPHE.”

The strategy called for improved delivery of SPHE in primary and secondary levels, taking into account the views of the evaluation.

The NDS said only 72% of schools responded to a Department of Education survey as to whether they had substance misuse policies. Of those, 71% of primary schools and 75% of post-primary schools had policies.

The strategy said the provision of drug education in non-school settings remained “fragmented and uncoordinated”.

It said that the provision of alternative recreational facilities for young people was also “underdeveloped”.

That was despite the provision of facilities under the Young People’s Facilities and Services Fund, which had provided e127.5 million between 2002 and 2007 to 500 services and facilities.

The strategy said the Office for the Minister for Children was currently examining the issue of youth cafes.

“During the consultation phase for the new strategy, the need to ensure late night and weekend opening of such facilities was highlighted,” it said.

The NDS regards a stabilisation in recent (last year) drug use among young people and a reduction in current (last month) usage as a key performance indicator in the area of prevention.
Source: Irish Examiner Tuesday, June 02, 2009

Aim is reducing first-time use of dangerous narcotic through outreach, media
The Hawaii Meth Project kicks off today at the Kalihi YMCA, citing a new survey that says 30 percent of Hawai’i teens believe there is no risk to trying meth, and 19 percent say it’s readily available.
The statewide drug prevention project targets youths 12 to 17 years old and is aimed at reducing first-time methamphetamine use through a community outreach program and aggressive — some would say graphic — media campaign that begins today.
In one radio spot, Gloria, a 15-year-old recovering drug user, confesses:
“When you’re doing ice, everything is fast, everything is going like 500 mph, and all you can think about is getting high. And then I started doing things I normally wouldn’t do. I would have sex with my dealer for money. I would have sex with guys for money. I lost myself completely in one month.”
Hawai’i has one of the nation’s worst meth problems, ranking behind just four other states in a 2007 survey measuring meth use.Meth is one of the most addictive, destructive drugs in terms of the financial burden and human cost, said Michael Broderick, lead judge of the Special Division of First Circuit Family Court.
“Once someone has begun using, it’s very difficult to get them to stop,” Broderick said. “The Hawaii Meth Project is crucial to our efforts to combat this epidemic by preventing our young people from ever trying meth.”
In Hawai’i the perception among youths is that meth is good and consequences are minimal, so using it once or twice is not a problem, said Cindy Adams, executive director for the Hawaii Meth Project.
“It’s really alarming that kids see significant benefit with meth use in the way of weight loss, increased energy and alleviating boredom,” Adams said. “They don’t correlate risk with use.”
The television portion of the project’s Not Even Once campaign shows young, vibrant teens promising to try the drug just once, then spiraling out of control, losing their good looks, selling their bodies and turning to crime to sustain a habit they thought they could control. Radio ads made from testimonials by recovering teen drug users like Gloria will also be used.
Gloria goes on to say in her ad: “I lost my friend. (He) hung himself because of it, because he couldn’t handle hearing all the voices he heard,” Gloria said. “My friends were all selling their bodies. They’re in jail. Two of them are dead.”
Adams acknowledged that some people might have a visceral reaction to the spots, but she said the kids say this is what gets their attention. Before the campaign, the Meth Project surveyed 1,065 teens, 318 young adults and 400 parent of teens. Their replies demonstrate the need to change youths’ perception, Adams said.
The 2009 Hawaii Meth Use & Attitudes Survey found that one in three teens believes there is little or no risk in trying meth, 35 percent believe it can help you lose weight, 24 percent believe it gives you energy, 21 percent believe it can make you happy and 19 percent believe it helps alleviate boredom.
The survey also shows that teens and young adults are at high risk of exposure to meth, with 19 percent of the teens and 36 percent of young adults reporting that meth is readily available.
According to a 2007 Youth Risk Behavior Survey, 7.3 percent of Hawai’i 10th-graders said they had used meth, up 87 percent from 2005. National surveys on drug use and health conducted by the U.S. Department of Health and Human Services found that Hawai’i ranked fifth in the nation for meth use by people 12 and older as recently as 2007.
Besides the television and radio ads, the project will place posters in areas where youths visit and run banner ads on www.MySpace.com, a popular Internet destination for youth ages 12 to 17. Eight radio spots were made from interviews with Hawai’i teenage drug users. Their names and neighborhoods were changed to protect their identities, but their stories are real, Adams said.
Lucien, 18, would use the rent money to buy his drugs and he said he didn’t care when his mother would cry about it.
“I started doing meth when I was 12 years old,” Lucien said in his radio spot. “My mom used to cut open her pillow and put her wallet inside and sleep on the pillow. It was so hard for her to trust us.”
Alan Shinn, executive director of Coalition for Drug Free Hawaii, said meth use is reportedly down in the Islands, but the state’s love affair with the drug persists. He said preventive education is a proven way to reduce the problem. When Montana launched the first such Meth Project in 2005, it was ranked No. 5 in the nation for meth use. Two years later, meth use among teens had dropped by 45 percent, and Montana ranked 39th.
“(Hawaii Meth Project) is looking at youths who have not ever used it, so they’re trying to keep them from using it at all,” Shinn said. “So for some of them, yes, I think it will be very effective, and for others, I think we’re going to have to look at other methods or strategies.”
Source: Honolulu Advertiser. 5th June 2009

An examination into the €140 million spent by State agencies on drug treatment services has found a very small proportion of heroin-users on methadone maintenance ever get off the drug.
About 8,000 people in the greater Dublin area are on methadone maintenance, the main form of treatment for heroin addiction, according to a special report by the Comptroller Auditor General. However, it is estimated annually that about 1.25 per cent progress to detoxification treatment or follow-on rehabilitation.
The report says there are no national targets for treatment progression and calls on health authorities to set objectives to help provide better planning. However, it acknowledges that long-term methadone treatment is likely to be the best outcome that can be achieved for a significant proportion of heroin users.
It is one of a series of often critical findings in a report which raises questions about how effectively the Government’s National Drugs Strategy is being implemented. Other key findings in the report are:
* About 460 people were waiting over a year for methadone treatment in April 2008. The official target is to provide treatment within a month of assessment.
* Cannabis and cocaine use is increasing, but there has not been a proportional increase in the number of cases treated for problem-use of these drugs.
* Non-opiate drug users in the capital are less likely to get treatment than elsewhere in the country, possibly due to the heavy focus on opiate drug treatment services in Dublin.
* Drug treatment courts – where drug use may be a contributory factor in offending – handled just 22 cases a year, rather than about the 100 originally envisaged. The completion rate of this programme is just 17 per cent.
Responding to the report yesterday, Fine Gael’s community affairs spokesman Michael Ring TD described the drug problem as a “national crisis” and said Government spending cutbacks on treatment services would create massive problems in the future.
“We have a drugs time bomb, just when the Government is cutting back on treatment services,” he said. “The budgets for local drugs task forces have been slashed by 20 per cent, while funding for the Government’s own drugs advisory board has been slashed by 23 per cent.”
The report itself raises questions about whether the aims of the National Drugs Strategy – which is aimed at improving and co-ordinating the delivery of treatment of preventative services – are being reached.
The strategy, for example, envisaged that treatment would be based on a “continuum of care” model, which would co-ordinate services and provide for a better transition between different phases of care.
However, it says health authorities have still not put in place a national framework for care planning and management across the State. This would play a key role in providing wider social support – such as accommodation, education and training – to people with drug use problems.
The report also says it is important for local drugs projects to be governed by service level agreements that specify the services to be provided and the standards to be met. In addition, it calls for greater transparency on the cost of treatment and rehabilitation services, and says responsible agencies must provide more information on the effects of their actions or services.
The report says that more research is needed to continue evaluating the effectiveness of drug treatment services. While it says good and informative work has been done in the past, it is important to do follow-up studies to identify long-term outcomes for those in receipt of treatment.
Source:IrishTimes.com 6th June 2009

MAASTRICHT — About 30 cannabis-vending coffee shops in the south of the Netherlands announced Tuesday they would become private members’ clubs at the start of next year to keep out foreign drug tourists.
“We will transform the coffee shops from open establishments, accessible by all, to closed establishments of which clients need to be members,” Maastricht’s Mayor Gerd Leers told a press conference in the border town.
In the latest move away from the traditionally liberal Dutch approach to such issues as soft drugs and prostitution, coffee shops in the province of Limburg said they would start issuing membership cards.
The application procedure would take several days, in effect preventing short-term tourists from buying marijuana. The move is backed by the national government, and is seen as a pilot project for possible expansion to other areas.
Some four million foreigners travel to Limburg every year to buy cannabis, according to a municipal official.
The measure, to be applied uniformly by all coffee shops in the province which borders Belgium and Germany, would seek to “discourage the majority of drug tourists,” said Leers. “We have been fighting for years against the nuisance brought here by the Belgians, the French and the Germans,” he added. These included damage to city property, heavy road traffic, a rising trade in hard drugs and other criminal activities.
From January 1 next year, the province will limit the sale of cannabis in its coffee shops to three grams per person per day. Each buyer would have to present a membership card that would work on the basis of a fingerprint, iris or some similar identification system. Purchases will only be possible by bank card or credit transfer.
Dutch law allows the consumption and possession of up to five grams of cannabis per individual, but prohibits the cultivation and mass retail of the soft drug. Some 700 so-called coffee shops nationwide have special licenses to sell marijuana but are allowed to keep no more than 500 grams on site.
Home Affairs Minister Guusje ter Horst told Tuesday’s launch that the new project was the first step in a “harder approach to illegality” by Dutch law enforcement. Also, the Dutch Council of State, which advises the government on legislation, had asked the European Court of Justice to weigh the legality of limiting access to Dutch coffee shops to Dutch citizen. An answer is expected in about 18 months.
Several Dutch municipalities have recently announced plans to close all or part of the coffee shops within their borders, partly to discourage crime and drug tourism.
But Leers said closing coffee shops was not a viable alternative, as this risked “chasing clients into illegality”.
Source: Agence France-Presse 05/13/2009

AUSTRALIA is in a mental health crisis. It’s not impending. It’s here. Government figures show one in four people under 25 will suffer a mental illness.
While we’re worrying about lifting the retirement age and caring for our ageing population, it will cost billions to treat people who develop mental illness in their youth. This bill will soar if we don’t act now.

The ready availability of alcohol and its enthusiastic promotion to make it a normal part of society are major contributors to the youth mental health problem.
According to the 2007 National Drug Strategy Household Survey, more than 20 per cent of 14 to 19-year-olds drink alcohol weekly. A third of boys aged 12-17 downed seven-plus drinks at a time and one in three girls put away five or more in a session.
One in 20 students put away 50 standard drinks or more in a month. An Australian study published in international medical journal The Lancet found that alcohol caused 27 per cent of deaths involving 15 to 29-year-olds in 2002.
That’s tragic, but the physiological effects of drinking on young, developing brains are much more insidious. Brain development continues until the age of 20. Damage from alcohol during this time can be long-term and irreversible. Adolescents need only drink half as much as adults to suffer the same memory loss.
Kids who binge once a week, or increase their drinking between the ages of 18 and 24, increase their chances of not attaining the goals of young adulthood like marriage, educational attainment, employment and financial independence.
While alcohol consumption rates among young people have remained stable for 30 years, what’s really disturbing is the rising intensity of drinking in a small proportion of young people, especially girls.
TV networks have profited tremendously from aggressive alcohol industry ads. The Australian Medical Association has called for a ban on cable and free-to-air TV alcohol ads before 10pm but why not go a step further and ban all alcohol marketing?
Alcohol is a legal product, but why allow it to be marketed so aggressively when the Government is spending millions telling Aussie kids not to binge?
Parents set an example, but an Australian Childhood Foundation report in 2004 said 60 per cent of parents felt they could do better. About 75 per cent said being a mother or father did not come to them naturally. That tallies with research this year by Generation Next, the parenting education group that I will represent in a town hall-style seminar at the Melbourne Exhibition Centre on Saturday.
The Generation Next survey of the parents of 500 children found half were worried or concerned by the challenge of raising children and one in five felt overwhelmed.
When we give them a no-nonsense helping hand and take away the alcohol marketing that makes their job harder, they may become confident enough to take the next step of talking to their kids.
Dr Michael Carr-Gregg is a Melbourne adolescent psychologist. More information about the Generation Next seminars at www.gennext seminars.com.
Source: heraldsun.com.au 9th June 2009

According to a report CASA issued this morning, federal, state and local governments spend almost half a trillion dollars every year — almost 11 percent of their total budgets — as a result of alcohol, tobacco and other drug abuse and addiction. The worst part is that, for federal and state spending, about 95% of that money is spent “Shoveling Up” the mess created by a failure to provide enough money for prevention and treatment.
That’s right. Out of every dollar federal and state governments spent on substance misuse in 2005 (the latest data available), 95 cents paid for the enormous burden of this problem on health care, criminal justice, child welfare, education, and other programs. And only 2 cents were invested in prevention and treatment programs that could reduce many of these costs – and save lives.
1. See detailed expenses for your state and download the report:
http://www.jointogether.org/NO
Our researchers studied all federal, state and local budgets for 2005 using careful, conservative methods to determine how much of each major budget category was directly linked to substance misuse. For example, they determined how much of each state’s Medicaid and other health care expenses were due to one of over 70 medical diagnoses that are caused or made worse by alcohol, tobacco and other drug abuse and addiction. They did the same for criminal justice, welfare and other key government budgets. They also identified all government spending on prevention, treatment and research, regulation of alcohol and tobacco products and drug interdiction.
When the numbers are added up, the total is really shocking: 467.7 billion dollars. Spending less than 2% of the federal and state costs for prevention and treatment, and more than 95% shoveling up the mess, is upside down public policy that wastes billions in taxpayer dollars at a time when resources are scarce, and results in untold human suffering.
David L. Rosenbloom, President and CEO
The National Center on Addiction and Substance Abuse at Columbia Univ.
Source: CASA May 2009

ROUGHLY one-third of Australians have tried it. Half of all people aged 20 to 29 have used it and some of those, like Jade, have smoked so much cannabis that their mental health has crumbled, triggering depression, psychosis, panic attacks, paranoia and even suicidal thoughts.
Former cannabis user Jade experienced paranoia and psychosis before she successfully sought treatment. “It was very scary. I thought people could read my mind. I was getting messages from watching TV. I was very paranoid. I felt like there was a big conspiracy and that everyone was in on this agenda and it was all about me. Cameras were on me. It was something I’ll remember forever and I wouldn’t wish it on anyone,” recalls Jade, now 29, off “bongs” and studying for a career in youth work.
Jade — who began smoking when she was only 13 — says the psychosis she experienced from using and eventually abusing cannabis landed her in Melbourne University’s Orygen Youth Health in-patient clinic for eight days. She wishes someone had helped her recognise that she had a serious cannabis use problem before she hit the wall. Unfortunately, if anybody noticed, they did nothing.
Now somebody is doing something, if not for Jade then for other young people at risk of cannabis-induced mental health problems. The Orygen Youth Health Research Centre has teamed up with the National Cannabis Prevention and Information Centre — based at the University of NSW — to produce the first evidence-based guidelines to help people such as Jade’s friends and family identify and assist users who may be sliding down the slope to mental illness. The so-called “first aid” guidelines reflect NCPIC’s job description, says its director Jan Copeland. “There’s a lot of community misinformation about cannabis and only a small proportion of people with problems seek treatment”. And that’s a worry, claims Copeland, a research psychologist specialising in drug and alcohol addiction: “The earlier the intervention the better the outcome.”
Not only can heavy cannabis use lead to the kind of mental illness Jade suffered, it can worsen problems associated with the use of alcohol and other illicit drugs. The resulting emotional cocktail has a host of consequences: impaired judgment, breakdown of families and social connections, legal problems and injuries from car crashes and other accidents. While many of such difficulties can be alleviated by getting off cannabis, others may persist for years, or even life. That’s especially true if people being using very early.
Neuroscientists have learned that different parts of a young brain develop at different rates. Final “wiring” is not complete until the mid-20s, addiction psychiatrist Dan Lubman says. According to Lubman, with Orygen and Melbourne University, that discovery goes a long way to explain why 75 per cent of mental disorders commence before age 25. “It’s a time of huge developmental growth,” he says, noting that stress, drugs and genetic predispositions can make developing brains even more vulnerable.
Most experts agree that developmental mis-wiring involves the brain’s endocannabinoid system. That’s so, as it appears to modulate brain chemicals called neurotransmitters, which relay and regulate signals between brain cells. Lubman says: “Certainly, there’s some evidence from animals that early use of cannabis can cause cognitive problems and problems with social interaction that persist and aren’t seen in adult animals.” There’s also solid evidence that young humans with abnormal brain development often experience a cascade of problems. For instance, cognitive difficulties may lead to poor school performance which may drive poor self-esteem, mixing with other uses, dropping out of school, multi-drug problems and so it goes.
Moreover, Jade’s raging paranoia may have been heightened by the increased potency of cannabis. Unlike the pot smoked by 60s hippies, today’s plants have been selectively bred to increase the amount of the active ingredient of euphoria and mood alteration, tetrahydrocannabinol, or THC. In a gardening twist, the rise in THC has been accompanied by a reduction of another cannabis ingredient, cannabidiol. Lubman says cannabidiol reduces anxiety and has been trialled as an anti-psychotic drug for conditions such as schizophrenia.
Little wonder that Jade found herself going from “giggling on the floor for hours” at 13 to full-blown psychosis at 20. As she escalated her intake of cannabis from light use to “a gram or two per day shared between friends”, her brain and behaviour went haywire. It’s quite possible that people close to Jade noticed that she had a problem. It’s also likely that they didn’t want to get involved, wished to keep the matter quiet or simply believed, incorrectly, it was a matter of morality. “A problem is the notion of hedonism, that users should be punished. They brought it on themselves and they don’t deserve help,” Lubman says. Hence, “Helping Someone with problem Cannabis Use: Mental Health First Aid Guidelines”. As well as simple information about cannabis abuse problems, the guidelines provide practical advice about issues such as approaching a person about their cannabis use, what to do if the person does not want professional help, how to find professional help and where to go for support.
Critically, every bit of information was identified and scrutinised for effectiveness and accuracy by 87 participants, divided into three panels: clinicians, carers of users and former users. Co-ordinated by Lubman’s group, the experts came from Australia, Canada, New Zealand, the US and Britain. Copeland claims this extensive process was necessary as much of the advice online and in books and other literature is inaccurate, useless or in some cases downright dangerous. While many suggestions are very specific — stay calm, don’t criticise the persons’ cannabis use, don’t bully or nag, ask about the person’s use instead of making assumptions, offer to help find professional help and the like — there are key things to keep in mind, claim both Lubman and Copeland. The key one being that many good treatments are available, from counselling to self-help groups.
Lubman ticks off important basics: “Be realistic about the outcomes. It may be the first time a person has been approached or thought about a problem. Be aware of local options. “Be prepared that the person may not want help and decide how you’ll respond, and understand what you will and won’t do to support the person.” Do the guidelines make sense? “Absolutely,” says Jade. In fact, right now she’s doing a placement with Orygen, working as a peer-support person. “When you’ve got somebody who’s been through it it’s good. They know what’s in your head. That’s why I’m here at Orygen. I’m trying to give back and be here for anyone else going through it.”
Source www.ncpic.org.au, www.mhfa.com.au 19 June 2009

Unlike their larger mainland cousins, the wallabies of Tasmania appear to be more trippy than Skippy. No lesser an authority than the island’s attorney general has discovered that hungry marsupials and thousands of acres of legal opium poppy fields do not mix.
“We have a problem with wallabies entering poppy fields, getting as high as a kite and going around in circles,” Lara Giddings told a budget hearing on Wednesday. Nor does the problem end there. Even drugged-up marsupials, it seems, cannot break free of the physical law that demands that what goes up must come down. “Then they crash,” said Giddings. “We see crop circles in the poppy industry from wallabies that are high.”
Tasmania is the world’s biggest producer of legally grown opium for the pharmaceutical market. About 500 farmers grow the crop on 49,420 acres (20,000 hectares) of land, producing around half the raw opium for morphine and other opiates. Giddings was answering questions about the security of the island’s poppy stocks, which are estimated to be among the safest in the world. However, the attorney general noted that 2280 poppy heads had been stolen over the last financial year.
Rick Rockliff, field operations manager for Tasmanian Alkaloids – one of the two Tasmanian companies licensed to take medicinal products from poppy straw – said that deer and sheep that munched the poppies had been known to “act weird” afterwards.
“There have been many stories about sheep that have eaten some of the poppies after harvesting and they all walk around in circles,” Rockliff told the Mercury newspaper. He said growers did their best to stop the local lifestock invading the fields as there were worries over the contamination of meat from animals that ate the drug crops.
“There is also the risk to our poppy stocks, so growers take this very seriously but there has been a steady increase in the number of wild animals and that is where we are having difficulty keeping them off our land,” he said.
British animals appear to be more conservative in their choice of intoxicants. Last October, a drunk pony called Fat Boy had to be rescued from a Cornish swimming pool after gorging himself on fermented apples and falling into the water.
Source: www.guardian.co.uk 25 June 2009

The rapidly changing HIV subepidemic at the border of the United States and Mexico, likely caused by population mobility and the drug and sex trades, may be rapidly affecting the overall HIV epidemic in Mexico. In a recent editorial, NIDA-funded researchers discussed studies of HIV infection at the United States–Mexico border in an effort to better understand factors shaping individual and network-level risks for acquiring HIV. Two different studies in the Mexican border cities of Tijuana and Ciudad Juarez showed a high prevalence of HIV infection among sex workers who were also injection drug users: 6 percent and 12 percent, respectively. Considerable population mobility exists at the Tijuana–San Diego (United States) border in both directions, with one study showing that one-fifth of injection drug users in Tijuana had traveled to the United States in the previous year. This mobility also occurs in other high-risk populations—for example, “nearly half of men having sex with men (MSM) in Tijuana and three-quarters of MSM in San Diego report having male sex partners from across the border,” explain the authors. The populations of border cities such as Tijuana largely come from other states in Mexico, and HIV-positive people can carry the infection back to their home states. Mexico now faces several challenges at the national level, including integrating treatment for HIV and other sexually transmitted infections that are risk factors for HIV infection, and increasing the availability of antiretroviral therapy. The authors conclude that due to the high level of migration in all directions, bordering countries must be involved for HIV prevention, diagnosis, and treatment in Mexico to be effective.

Source: Strathdee SA, Magis-Rodriguez C. Mexico’s evolving HIV epidemic. JAMA. 2008;300(5):571–573.

Men diagnosed with cancer are less likely to survive the disease if they were smokers or heavy drinkers, Reuters reported Nov. 7.
Smoking and drinking are well-known risk factors for cancer, but researchers have begun looking into how these addictions affect survivability, as well. Researcher Young Ho Yun and colleagues at the National Cancer Center in Goyang, South Korea tracked 14,578 cancer patients for about nine years and compared mortality data to patients’ history of smoking and alcohol use.
The researchers found that former smokers were more likely to die from any kind of cancer than non-smoking cancer patients, possibly because smoking causes tumors to grow more aggressively. Smokers also may be less likely to get cancer screening tests, the authors noted, so their disease is often further advanced when treatment begins.
Among patients with head, neck, or liver cancer, heavy drinkers were more likely to die than non-drinkers, with risk increasing with consumption levels.
“Our findings suggest that groups at high risk of cancer need to be educated continually to improve their health behaviors — not only to prevent cancer, but also to improve prognosis,” the study authors noted.
The research appears in the Nov. 1, 2006 issue of the Journal of Clinical Oncology.

Limit the sale of cannabis to local users, reconsider the distinction between hard and soft drugs, raise the legal age for drinking alcohol from 16 to 18 and appoint a drug czar to overlook policies. These are the most striking recommendations published on Thursday by a committee chaired by Christian democrat Wim van de Donk.
The Dutch government had asked the committee to lay the groundwork for a new memorandum on Dutch drug policies to be drafted this fall. The report is in line with repressive measures already taken in recent years, but the committee explicitly says it does not want to end the so-called ‘gedoogbeleid’ (tolerance policy), nor does it want to legalise the cannabis trade completely.
The three parties in the Dutch coalition government – Christian democrats, Labour and ChristenUnie (orthodox Christian) – agree that the present drugs policy needs to be revised. The country has seen a dramatic increase in drug tourism and exports of Dutch-grown cannabis have soared. That is not just causing problems at home, it also gives offence to other EU member states unhappy with the Dutch policy.
But the coalition parties don’t see eye to eye on which direction to take.
The current drugs policy is ambiguous at best: cannabis users are not prosecuted and coffee shops are licensed, but the cultivation and wholesale of cannabis are still prohibited. The Labour party has advocated including the production and wholesale of cannabis in the tolerance policy, but the Christian democrats favour complete prohibition.
Original purpose
Despite its international reputation as a Mecca for legal drugs, the use or possession of weed or hash is in fact still a misdemeanour in the Netherlands. But since a 1976 revision of the Opium Law separated hard drugs (e.g. cocaine, xtc) and soft drugs (cannabis), personal use of the latter is no longer prosecuted and the cafes that sell them are tolerated as well.
Dutch tolerance
# The use, possession or sale of cannabis have never been legalised in the Netherlands. Possession and production for personal use are considered misdeameanours. However, possesion of cannabis for personal use is not prosecuted up to five grammes or five cannabis plants.
# Coffee shops are allowed to stock a maximum of 500 grammes of cannabis.
# Large-scale production, export or import of cannabis are illegal, and should always prosecuted.
# In other words: coffee shop owners can legally sell cannabis but they cannot legally buy it.
The Van de Donk committee now wants the coffee shops to go back to their original purpose: they should be limited in number and size and cater to registered local users rather than the “large-scale facilities that supply consumers from neighbouring countries” they have become. This should reduce the nuisance caused by tourists who cross the German and Belgian borders to buy drugs.
Part of the motivation for the Dutch tolerance policy was to take soft drugs out of the criminal sphere by separating them from hard drugs. But as law professor Cyrille Fijnaut, a member of the Van de Donk committee, noted in an article published last March, this has never happened. Even if coffeeshops are legal, the production and trade are still in the hands of criminals, if only because supplying the coffeeshops is by definition illegal.
Experiment
The Van de Donk committee doesn’t propose changing that equation. It does suggest a limited experiment with regulating the supply line for coffee shops. It also wants to raise the maximum amount of cannabis a coffee shop owner can legally have in stock; it is currently capped at 500 grammes.The committee also questions the wisdom of the distinction between soft and drugs, and suggest that more research needs to be done on the subject.
The criminal character of a large part of the cannabis trade and the high values of the psychiactive ingredient tetrahydrocannabinol (THC) found in Dutch weed, could be reasons to revise the distinction, the committee said. However, experts have said that THC levels have gone down again in the past four years and research suggest that users adjust the amounts they smoke to the strength of the weed.
Committee suggestions
# limit the sale of cannabis to local users
# experiment with legal production and supply of members-only coffee shops
# order more research, possibly rethink distinction between soft and hard drugs
# appoint a drug czar to coordinate all initiatives
A substantial part of the report is dedicated to young people and how to protect them from the harmful effects of drugs and alcohol . Van de Donk wants to raise the legal age for drinking alcohol from 16 to 18, which is also the legal age for smoking cannabis.
Statistics actually show a decline in the number of Dutch teenagers using soft drugs, from 14 percent in 1996 to 10 percent today. Of the Dutch population between 15 and 64 less than 5 percent smokes drugs on a regular basis.
Drug czar
It is unclear if this is a result of the tougher approach recently taken to soft drugs. Although no drastic measures have been taken at the national level – apart from a ban on hallucinogenic ‘magic’ mushrooms last year – local authorities have clamped down on the cultivation, sale and use of soft drugs.
In Amsterdam and Rotterdam, coffee shops are banned within a 250 meters radius of high schools. Border towns Bergen op Zoom and Roosendaal closed all their eight coffee shops to put a stop to the flood of Belgian drug tourists crossing the border to buy supplies. The largest coffee shop in the country, in the town of Terneuzen, was shut down in 2008 because it exceeded the allowed amounts of marijuana bought and sold. Its owner is being prosecuted for running a criminal organisation. The southern city of Maastricht is transforming its coffee shops in to members-only clubs.
Between 1997 and 2007 the number of coffee shops went down from 846 to 702.
The diversity of local initiatives calls for a clear national direction, the Van de Donk report says. Too many authorities are currently involved in developing and enforcing policies, which are related to issues of justice, health care, public safety, education and even foreign policy. The report calls for one drug czar to overlook all these areas. “The problem justifies a more binding ambition, based on political leadership, which also extends to connect us with our neighbours and the US”, according to Van de Donk.
Source: DailyDose. July 16th 2009

EMERGENCY departments in Queensland public hospitals are being strained by hundreds of thousands of drunken and violent patients.
Almost one person a minute is thought to be attending the state’s emergency departments for alcohol-related reasons, but experts fear that could be a conservative estimate. Australasian College for Emergency Medicine chairman David Rosengren said studies showed alcohol was a factor in 25-30 per cent of presentations at emergency departments.
The latest figures produced by Queensland Health showed that 373,000 people presented at its emergency departments in three months.
“Alcohol is such an insidious undercurrent in a lot of other presentations,” Dr Rosengren said. “It can be one of three things – the cause of that presentation, someone intoxicated or on the receiving end of intoxication. The vast majority of what we see in an emergency departments from the violence of alcohol is people who have been in fights punched up.”
Dr Rosengren said the true extent of the problem was unknown because alcohol was not recorded in emergency data. “It’s a very big issue, but we can’t actually record that because there’s no system in place,” he said. So any figure that we’re going to see is going to be a gross underestimate of the actual true incidents of alcohol-related problems. All we can do is correlate from other data sets that exist but we work on specific studies that are published, which indicate 25-30 per cent of all ED presentations have alcohol as a factor in some manner – either the primary or secondary cause.”
Dr Rosengren, a staff specialist at Royal Brisbane Hospital, said Friday and Saturday nights were the busiest times for the hospital. “A hospital such as Royal Brisbane, which is close to the nightclub spots in the Fortitude Valley, just fills up,” he said.
Since October last year, RBH, Gold Coast and Cairns hospitals have been part of a Queensland Health trial targeting people presenting for alcohol and drug problems. Addiction Psychiatry director Mark Daglish said it saw up to 480 people a month and 80 per cent of those cases were because of alcohol.
“We know we’re missing a significant proportion because there are those ones who come in, particularly on a Friday and Saturday night, who have been discharged,” he said. “We reckon it’s usually about a third of all inpatients usually have drug and alcohol problems – so it’s big numbers. The common ones we see in the morning are losers of fights.”
Dr Daglish said three-quarters of people presenting in emergency for alcohol or drugs were males and almost all were under 45. “If you’re talking about alcohol and violence, you’re generally talking about men unless they’re taking it out on women,” he said.
“Alcohol and testosterone is a dangerous mix – it really is. On the Gold Coast, they’re seeing a younger population than we’re seeing, which would be in keeping with their demographic on the Gold Coast.”
Dr Daglish said people needed to be made more aware of the acute impacts of binge drinking, and recommended rolling the intervention program across all Queensland hospitals. “The impetus for the service came from this realisation that a lot of the problems from alcohol and drugs come from the early users who are often not yet dependent or not yet in treatment but are still causing themselves and other people a lot of damage,” he said.
“A lot of them were young and not in treatment, but one place they did go was the emergency department, usually on a Friday and Saturday night, usually intoxicated at the time, and there’s a fair few frequent attendees. If you intervene in their drug and alcohol use early, you can shorten the duration of their admission, which means they’re spending less time in the hospital and they’re in treatment towards their substance abuse as well as the trauma.
“Once they’re dependent, you need a lot more.”
Source www.couriermail.com.au 21st July 2009

A new ordinance in Milan bans alcohol for those under 16 in an effort to curb drinking problems among youth. The ordinance calls for fines of up to €500 for younger teens caught drinking and for those who give or sell them alcohol. Italy has no minimum drinking age – only a rarely enforced ban on serving alcohol in public to those under 16. According to the article, “In Milan, 34 per cent of 11-year-olds have had problems with alcohol…. Overall, 22.4 per cent of boys aged 11-18 and 13 per cent of girls in Italy have drinking habits that pose a health risk, according to the National Observatory for Alcohol.”
Source: Associated Press 20 July 2009 published in New Zealand Herald

Arnold Schwarzenegger believes it could solve California’s spiralling financial crisis and supporters rave about its positive effects, so could marijuana be coming to a shop near you? Shane Dunphy reportsChanging attitudes: Legalising cannabis may be on the horizon in California, thanks to a softened stance from Arnold Schwarzenegger

The drug of choice for the free-love counterculture, marijuana has probably received more mixed press than any other recreational drug. Regular users speak of its positive effects: relaxation, warm, friendly feelings towards others and an expanded world-view.

Medical research, however, suggests that marijuana smoke actually contains more toxic substances than tobacco smoke. A study commissioned by the Canadian government, for example, determined that marijuana smoke contained 20 times more ammonia, and five times more hydrogen cyanide and nitrogen oxides than its legal counterpart, making it potentially much more harmful.

Yet the debate as to whether marijuana and its various related substances ( hashish, kief, and hash oil ) should be decriminalised continues, and the latest place to consider the ramifications of such a move is the US state of California.

Supporters of legalised marijuana claim that the drug can solve California’s spiralling financial crisis. A series of television ads was launched last week supporting a bill by Democratic assemblyman Tom Ammiano that would regulate and tax the sale of marijuana in the Golden State, where Arnold Schwarzenegger’s administration is in a $26bn ( €18.7bn ) black hole.

One of the 30-second films features an “actual marijuana user”. She is a retired, 58-year-old civil servant called Nadine Herndon, shown in front of her family portraits at home in Sacramento County, where she began using the drug after suffering a series of strokes three years ago. She speaks of the huge cuts to police, schools and healthcare that are imminent due to California’s budget crisis. She points out that Schwarzenegger and his legislature are ignoring millions of Californians who want to contribute by paying taxes on their marijuana usage.

The series of advertisements seem to have achieved their goal, as even the arch-conservative ‘Governator’ has softened his stance, and publicly stated that it is time to open the debate on fully legalising the weed, medical use of which was introduced in California by a majority vote in a 1996 referendum.

Commentators propose that there is a huge demographic in California who will support legalisation — children of the participants of the Summer of Love, who were raised within a hippy ethos, believing that smoking the occasional joint is perfectly normal.

The logical extension to this argument is obvious: if legalising marijuana can solve bankrupt California, then why not Ireland? A recent survey by the HSE showed that as many as 15pc of the Irish population use marijuana regularly ( at least once a year ), while 2pc use it daily. The highest using group, the study found, was 15–34 year olds.

Marijuana, as most people encounter it, is a dry, shredded green and brown mix of flowers, stems, seeds, and leaves derived from the hemp plant Cannabis sativa. The main active chemical in marijuana is delta-9-tetrahydrocannabinol; THC for short.

The average user will buy marijuana by the quarter ounce, the average price of which is around €100. This will make approximately 20 average sized joints, putting the price of a joint at around a fiver, making it a reasonably competitive alternative to alcohol. Whether legalisation and an added tax would increase this price is open to conjecture. Perhaps a government sanctioned hash farmer, growing in bulk and without the need to hide from the law, would be able to produce a crop more cheaply than the current black market gardeners. And think of all the green jobs.

The campaign for legalisation in Ireland has been ongoing for many years, making a minor celebrity out of its most outspoken and flamboyant spokesperson, Luke “Ming the Merciless” Flanagan, currently a county councillor in Roscommon. Occasionally a TD ( usually in need of some cheap publicity ) will attempt to reopen the legalisation debate, but Ireland has never taken the argument really seriously — a fact that might change if California bites the hemp bullet.

Legalisation has been tried in other countries, with varying degrees of success. Some countries, Belgium, for instance, while not overtly legalising cannabis, tolerate its usage, and so long as the amount in your possession could be reasonably defined as for personal usage, the authorities will turn a blind eye. Canada legally permits small amounts of the drug to be held for personal usage, although marijuana is still grown and traded on the black market and is not yet centrally controlled.

Holland has become synonymous with the legalisation of marijuana, where it can be purchased legally through specially designated coffee shops, in the form of marijuana cigarettes, in teas and in cakes and biscuits. Interestingly, Holland does not condone the purchase of marijuana wholesale or in bulk, and this has, apparently, led to continued problems with the black market sale of the drug, and what the Dutch describe as “nuisance drug users”.

Recent studies of schools in Amsterdam show that the incidence of young people using marijuana regularly is slightly higher than Ireland, at 15.8pc. These studies have also commented on the growing levels of THC, the active ingredient, in Dutch cannabis, suggesting that long-term exposure has created an appetite for stronger and stronger crops, which private growers are doing their best to engineer.

New findings which link regular use of the drug to depression and lethargy have also brought the Dutch government under fire, and earlier this year 27 coffee shops were closed, all within 200 metres of schools. The traditional Dutch stance that marijuana is a harmless and relatively innocent soft drug seems to be under revision.

So while California is considering broadening its laws, Holland, with many years’ experience of selling marijuana openly, is tightening its legislation.

It would seem that this is a debate we will be hearing much more about as the international recession continues.
Source: Irish Independent 25th July 2009

For years, Germany has been famous for its tolerant stance toward public drinking. Now many communities are finding that drunken youths are a public nuisance and a danger both to others and themselves. Although several approaches have been taken to solve the problem, few have worked.
The teenager should be home by now but, instead, he’s lying here passed out on the grass next to a pool of his own vomit. His friend says the boy is 15 — and that he actually laid off things a bit tonight. He only had a couple of beers and a few swigs from a bottle — “something sweet with vodka” — being passed around. And then he suddenly just fell down.
German municipalities are battling an epidemic of youths whose drunken rowdiness is upsetting local residents and spawning a number of tough legal countermeasures.
For Ingrid Friedrich and Dirk Geist, both public safety officials in the southwestern German city of Heidelberg, this is the first completely intoxicated teenager they will have to attend to tonight — but he certainly won’t be the last. The weather is good, it’s summer, and it’s just past 10 p.m. Hundreds of drinking youths have taken their usual places in Heidelberg’s Neckarwiese Park.
It’s Geist and Friedrich’s job to patrol the area until 2 a.m. and make sure things don’t get too far out of hand. They’ll hand out fines to people who urinate on trees or in house entryways. They’ll summon an ambulance for those who collapse, like the boy here on the grass. And they’ll call in the police if drunk people start fighting or jumping into the Neckar River.
Battling the Boozing
Scenes like this have become commonplace throughout Germany. All over the country, police, public safety officials and private citizens have been complaining about excessive drinking in public. Their complaints stem from garbage left in parks, the stench of urine and techno music blaring until late at night. But they’re also about the rioting and violence that drinking unleashes in these young people.
The state can’t make these teens grow up. But it can try to bring their drinking under control through laws and new regulations. Or it can use another strategy — offering them healthier and less disruptive leisure-time activities, such as beach volleyball instead of sunset boozing, or youth clubs instead city bus stops, where they party, make out and fight.
The past few weeks have shown that blanket bans are hard to enforce. For example, an administrative court in the southwestern German state of Baden-Württemberg recently decided in favor of a law student from Freiburg who felt that the nighttime ban imposed early last year on alcohol consumption in that city’s old town was an unacceptable restriction on the freedom of people who don’t necessarily destroy park benches after enjoying a beer or two in the evening sun. The court’s reasoning drew parallels with how swimming bans aren’t imposed on lakes just because someone has drowned in them.
Nevertheless, Germany’s towns and states are still trying to find ways — including some that are used in the United States — to effectively prevent public beer and liquor consumption in certain squares, streets and parks. Following the ruling related to Freiburg, Heribert Rech, Baden-Württemberg’s interior minister, announced that he now wants to amend relevant police laws. “I won’t leave the towns in the lurch,” he says.
Berlin has already imposed an alcohol ban in its famous Alexanderplatz, where “Friday get-togethers” used to draw around 500 young people a week. The gatherings frightened tourists away, annoyed local residents and put a strain on the city’s garbage-disposal service, which had to cart off truckloads of bottles and cans each week after the party was over.
What particularly upsets the residents is the mountain of waste left behind by careless revelers. In 2008 alone, Berlin’s poison control hotline recorded 260 cases of small children who swallowed cigarette butts they had found in parks or playgrounds. And in Berlin’s hip, young district of Friedrichshain-Kreuzberg, a recent citizens’ clean-up day collected 3,100 bottle caps left in grassy areas and bushes. Resentment toward young drinkers in the neighborhood has gotten so strong that some people have even thrown water balloons on them from several flights up.
Priggish Party Poopers?
City officials and residents in Hamburg are also losing patience with the level of chaos there in Europe’s most famous nightlife district, the Reeperbahn. The behavior exhibited by some drinking teens has “changed dramatically,” says Ulrich Wagner, head of the local Davidwache police station. The proportion of crimes committed under the influence of alcohol in the St. Pauli area, which encompasses the Reeperbahn, lies at 42 percent — or three times the citywide average for Hamburg. Since drunks have been known to strike passersby with bottles, the city’s senate has now banned glasses and bottles from the Reeperbahn at night.
Rainer Thomasius, a physician specializing in addiction research at the University Medical Center Hamburg-Eppendorf, considers it an “absolutely reasonable approach” to make the area surrounding the Reeperbahn at least partially dry. Germany makes it much too easy, he says, for minors to get drunk any time and anywhere. Thomasius also thinks that it is “utterly wrong” that a six-pack of beer sometimes costs less than €2 ($2.90). He says these give-away prices are partly responsible for the fact that more and more young people are finding wild drinking binges that ultimately bring them to his clinic.
Throughout Germany’s cities and states, there is a wide range of ideas being bandied about, but they all relate to the same thing: how to spoil the fun for these pedestrian-zone partiers. Baden-Württemberg wants to cut off their access to more supplies by forbidding gas stations and newsstands from selling alcohol between 11 p.m. and 5 a.m. Police there also started conducting checks last week on teenagers carrying soft drink bottles to see if they had spiked them with vodka.
The state of Lower Saxony, on the other hand, has started sending young mystery shoppers to sniff out supermarkets that sell beer and liquor to 13-, 14- and 15-year-olds. And Sabine Bätzing, the federal government’s chief anti-drug official, is using a two-pronged positive approach of using “attractive leisure-time activities and informational campaigns” to lure minors away from drinking.
Moving Targets
Wolf-Egbert Rosenzweig is the mayor of Neu Wulmstorf, a town of 20,000 just outside Hamburg. He has already tried just such a positive approach. He hired social workers to counsel teens on the streets, and he gave the local youth center more funding. But even after months of funding and counseling, no one succeeded in winning the teens’ trust. Unimpressed by the government’s efforts, the first young drinkers still turned up in the town’s marketplace in the early afternoon to get plastered on cheap beer bought at a nearby discount shop.
Still, word had already gotten out that Neu Wulmstorf was a happening place, and more teens started showing up on its streets. Pedestrians felt threatened by the young drinkers, sales at retail shops and restaurants took a nosedive, and residents of a nearby retirement home complained about garbage and dirty benches.
The town decided to take a tougher approach, but it’s been hard to implement. There simply aren’t enough police officers and public safety officials to constantly keep their eyes on what’s happening and pinpoint individual wrongdoers each time while staying within their legal boundaries.
Ultimately, after a 15-year-old girl was found unconscious and covered in vomit on the edge of the marketplace, Rosenzweig and the town council threw all caution to the wind — and imposed an alcohol ban. Now drinking is only allowed in the town’s marketplace under one set of circumstances — when newlywed couples want to have a champagne toast after their marriage ceremony.
In the beginning, local teens demonstrated against the ban and demanded that it be at least partly lifted. But Rosenzweig didn’t budge.
The teens eventually gave up their protests, but the mayor still hasn’t gotten rid of the real problem. The owner of a local gas station recently complained to him that the drunken youths were back, only this time they were on his property.
Source: Spiegel Online International 3rd August 2009

Drug treatment programmes are only successful for around half of the drug addicts who enrol on them, figures have shown.

Health minister, Dawn Primarolo, said just 35,441 patients out of 69,612 were given “successful discharges” from structured treatment programmes in 2007-08. This works out at about 51%.

That left 34,171 patients who failed to complete their treatment for drug misuse, figures released in a written parliamentary answer to shadow home secretary Dominic Grieve showed.

This included 19,591 – or 28% – who simply dropped out or left, with a 2,169 turning down the treatment and 2,078 having treatment withdrawn. A total of 4,240 (6%) failed to complete their course due to be admitted to prison.

Of the successful cases, only 11% were considered to be “completely free of using illegal drugs”. This totalled about 7,324 ex-users. The remainder were either using drugs in a “non-dependent way” or were referred on to other services.

Source: Nursing in Practice 15th Jan 2009

The United Nations’ crime and drug watchdog has indications that money made in illicit drug trade has been used to keep banks afloat in the global financial crisis, its head was quoted as saying on Sunday.
Vienna-based UNODC Executive Director Antonio Maria Costa said in an interview released by Austrian weekly Profil that drug money often became the only available capital when the crisis spiralled out of control last year.
“In many instances, drug money is currently the only liquid investment capital,” Costa was quoted as saying by Profil. “In the second half of 2008, liquidity was the banking system’s main problem and hence liquid capital became an important factor.”
The United Nations Office on Drugs and Crime had found evidence that “interbank loans were funded by money that originated from drug trade and other illegal activities,” Costa was quoted as saying. There were “signs that some banks were rescued in that way.”
Profil said Costa declined to identify countries or banks which may have received drug money and gave no indication how much cash might be involved. He only said Austria was not on top of his list, Profil said. (Reporting by Boris Groendahl; Editing by Charles Dick)
Source: Reuters 25th Jan. 2009

Last month this blog highlighted an article by Times columnist Libby Purves about late night policing in Ipswich and pointed out the lack of formal sanctions she saw being used while spending a shift with officers dealing mainly with pub and club goers. In particular, the following passage demonstrated the light touch policing method employed:
I question PC Rafferty about his interpretation of “drunk and disorderly”, since one in five of those around us is now, in my view, disorderly. If there were any peace they would be breaching it. He laughs: “Drunk and hopeless.” There aren’t enough cells, or time for the paperwork. The police merely contain the bingers, keep them friendly. By and large it works.
I then asked whether this did in fact ‘work’, and questioned if merely managing or containing drunken and disorderly behaviour was preferable to a more comprehensive solution.Another Times article a few days later by Anjana Ahuja outlined evidence from experiments which help confirm the ‘broken windows’ theory – that tolerating minor wrongdoing results in more serious crime and disorder. One of the experiments conducted was outlined thus:
Dr Keizer’s team left an envelope hanging out of a postbox; the stamped and addressed envelope had a window through which could clearly be seen a five-euro note. How would passers-by, or those posting a letter, react when they saw it? The vast majority (87 per cent) either left it alone, or pushed it into the postbox. Only 13 per cent took it away (this was regarded as stealing).

But roughing up the environment had a dramatic effect. When the postbox was tagged with graffiti, 27 per cent of people stole the letter. When the postbox was surrounded by rubbish (but not graffitied), 25 per cent pocketed the cash.

The academics, who reported their startling results last month in Science, suggest that disorder does indeed beget disorder; when one social or legal norm is obviously violated, we are tempted to loosen our grip on others.
The broken windows theory forms the basis for zero tolerance policing. But, as the experience of policing in Ipswich demonstrates, the reality on the ground is arguably nearer to zero enforcement than the more robust approach required by the science, which in turn perhaps provides some insight into why the UK has such a self-evident law and order problem.

Another important facet of this debate is how out of touch the powers that be – desk-bound senior police officers, politicians, councillors and public servants – are with what happens at the sharp end of policing, and the implications this has for policy-making. Yet another recent Times article provides some evidence relating to this. In a piece about drugs legislation and enforcement, Andy Hayman, an ex-assistant commissioner at Scotland Yard, argues that the reclassification of cannabis and ecstasy will make little difference to policing on the ground. In relation to the bureaucracy he says:
I used to serve on the [Advisory Council on the Misuse of Drugs] in my capacity as the leading police officer on drugs policy. By the end of my stint I felt that its detachment from grassroots reality had eroded its credibility. Its purpose seemed to be to generate endless rounds of meetings and glossy reports to send to ministers.

Up to 70 members – made up of representatives from all sorts of government and voluntary bodies – attended the unwieldy full meetings, which were supported by a plethora of smaller working groups and sub-committees. I was always struck by how the experience of those living in the thick of the drugs problem got lost among the grey suits having highbrow technical and medical discussions.
As regards enforcement and prosecution:
The council would be horrified to learn that its recommendations on drugs classification are not taken seriously. But that is the case. The public either don’t understand the process or are not interested in it. For the police, the advisory council is a sideshow; officers prefer to apply their professional discretion on whether to caution or arrest suspects.

Put bluntly, how a drug is classified doesn’t help police officers in their day-to-day duties. The first thought of an officer confronted by a user of an illegal drug is to weigh up whether the possession warrants anything more than a caution. To make an arrest and charge doesn’t guarantee a prosecution so it may be simpler to deal with it on the street. That decision is made regardless of the classification of the drug involved.

For the courts, categorising a drug does help to provide a tariff for punishment. But even that idea has become dated as the Crown Prosecution Service now tends to apply its own prosecution guidelines. In practice, the classification of a drug does not significantly change how the courts or police deal with drug offenders.
Of course, these examples are a mere microcosm of the bigger problem, but extrapolate them to policing and crime generally – not to mention the even bigger picture of government and the public services – and the implications are surely self-evident.
About this site
Planet Politics is about disillusionment with the political process.
Planet Politics has absolutely no links to any political party, pressure group or the press, and is best described as anti-politics rather than non-aligned.

Source: planet–politics.blogspot.com Feb 2009

Should cannabis be decriminalised or not? Should it be classifed as a class B or C drug? Debates are irrelevant while they are entrenched in misinformation and disinformation
This article by Deirdre Boyd appeared in Addiction Today, November 2000 – before the ACMD advised then Home Secretary David Blunkett to reclassify it downwards to a class C drug. On the urging of prime minister Gordon Brown, the ACMD is again hearing evidence this February. The facts here have not dated – in fact, more recent research validates them further.
The most noticeable factor in ongoing debates about cannabis is the vast foundation of ignorance on which people are basing the most emotive, entrenched arguments. The fewer facts people have, the more heated they seem to be. This country needs a strategy of health information about cannabis which is as available and comprehensive as that eventually offered by anti-tobacco campaigners.
Cigarette smoking started to reduce because people were – after a battle spanning decades – given the facts about its risks. Cannabis smokers also deserve the truth so that they can make informed decisions about their own health and that of their families.
For example, are the people – including government ministers – who argue that they took pot in the 1960s and 1970s without any harm aware that the pot/marijuana/cannabis of today is not the same substance they took back then? Like every other profitable product, cannabis has been refined over the decades so that it is now four to 12 times more potent than it was 20 years ago.
So, for the moment, let’s put to one side the legal and criminal ramifications and look at what studies show about the effects of cannabis on health.
IDENTIFIABLE SYMPTOMS
When asked by a teacher suspicious of wide swings in academic performance in some of his students what symptoms could help to identify a pupil using cannabis, Dr James West of the Betty Ford Center gave the following answer.
“Cannabis affects the cerebral, cardiovascular, pulmonary and neuroregulatory systems. Acute or chronic use leads to: euphoria, decreased mental functioning, faster pulse, decreased pulmonary function, exacerbation of asthma, conjunctival injection (red eyes), pharyngitis (sore throat), bronchitis, stuff nose, dry mouth, sinusitis, perceptual delusions, paranoia, mood shifts, sleepiness, sexual arousal, anxiety/panic, lethargy and lack of ambition, plus angina in a pre-existing heart disease.
“The symptoms of overdose are very rapid pulse, very high blood pressure, delusions, hallucinations, seizures in epileptics and acute mental changes including psychosis. There are also withdrawal signs for regular users who quit abruptly: irritability, restlessness, insomnia, mild tremors/ bouts of chills and sometimes a low-grade fever.”
CANCER
A report by the British Medical Association found that smoking a cannabis cigarette leads to three times more tar inhalation than from a tobacco cigarette – and long-term use can lead to lung cancer. Dr West states that cannabis contaiins four to five times the lung-cancer-producing hydrocarbons as does tobacco.
BRONCHITIS AND OTHER RESPIRATORY DISORDERS
Such disorders linked with smoking can also be caused by long-term use. It is unclear if there is more risk of these disorders than with tobacco. But cannabis users tend to inhale more deeply and the drug does contain more tar. “Cannabis irritates the respiratory system and obstructs smaller airways with a form of bronchitis-emphysema,” explains Dr West.
HEART PROBLEMS
The heart responds to cannabis with an increased heart rate proportional to the dose of the drug. Usually, after smoking pot, the heart rate increased by 20-40 beats per minute, and rapid rates of 140 beats per minute are not unusual. Chronic use can lead to angina in people with pre-existing heart problems.
ADDICTION
Although infamous for recommending the decriminalisation of cannabis, the Runciman Report states that “the number of people seeking help from drug agencies for problems with cannabis use has doubled from 1,400 in 1993 to 3,300 in 1998 (10% of the total seeking help). This is only the people who identified cannabis as their “main drug”.
Cannabis is addictive, concludes a survey by the US National Institute of Drug Abuse. It found that 75% of people who gave up cannabis had cravings for it, and 70% switched to tobacco in an attempt to stay off. Almost 50% said they became irritable and many were bored after giving up the drug.
And in more recent experiments with monkeys, a NIDA team warned that cannabis might be as addictive as heroin and cocaine.
A 1994 report from the Center on Addiction and Substance Abuse at Columbia University found that 60% of children who smoked pot before the age of 15 years moved on to cocaine, and 20% of those who first smoked pot after age 16 then used cocaine.
RELAXING QUALITIES versus DEMOTIVATION & DEPRESSION
Cannabis is best known as a relaxant. This can lead to lower blood pressure, increased appetite, feelings of relaxation, mild intoxication and increased sociability. Smokers usually feel its effects in minutes and they can last up to three hours. The effect is delayed when eating or drinking, so that it lasts longer and can be harder to control. And the relaxing effect can go too far. Research shows that cannabis affects almost ever bodily system, slowing down reaction times, causing drowsiness and confusion.
MEMORY LOSS
Because cannabis is absorbed into the brain cell wall, it is considered more destructive to brain tissue than opioids. Heavy use impairs general intellectual functioning such as memory and comprehension. Even in small doses, dope smoking is known to cause short-term memory loss.
ACCIDENTS
Even “casual use” of cannabis impairs psychomotor skills like those needed to drive a car. It increases the chance of a traffic accident or accidents while operating machinery.
LEARNING IMPAIRMENT
Studies sow that regular heavy use can cause nerve damage and affect learning.
HALLUCINATIONS, PARANOID DELUSIONS
These can result from even small doses. Anxiety and panic are common.
COORDINATION
This, too, is affected by cannabis.
COMA
High doses can cause coma. But we are not aware of any records of fatal overdose.
PSYCHOTIC ILLNESS
“It can have adverse psychic effects ranging from temporary distress, through transient psychosis, to the exacerbation of pre-existing mental illness,” the Runciman Report states about cannabis.
Dr Andrew Silski, consultant psychiatrist and medical director at Pembury Hospital in Tunbridge Wells, backs this. “I estimate taht 75% of the young people I see suffering psychotic illness have a history of cannabis abuse,” he revealed.
The drug contains hundreds of active ingredients, most importantly cannabinoids, which interfere with the chemical functioning of the brain. Its most serious effect seems to be depleting neurotransmitters – such as dopamine, which is linked with pleasure – and hindering electrical currents vital for brain function.
People with personality disorders can succumb to amotivational syndrome. They lose motivation, drive and willpower, leading to depression. This can damage education, work prospects and relationships.
“There is also an unknown number of people with a mental or chemical predisposition for psychotic illness,” states Wilski. “In them, cannabis can trigger altered moods, confusion, delusions or hallucinations. Cannabis also has a profoundly worrying effect on people with unspecific brain impairment or weakness, such as dyslexia. And it is no coincidence that some ethnic communities, in which cannabis use is endemic, suffer hugely increased levels of psychosis: six to 20 times greater than the norm.”
FALL IN FERTILITY
Abnormalities can occur in the reproductive systems of men and women. Cannabis can cause irregularities in the menstrual cycle. And studies of males have shown reduced sperm count and mobility as well as sperm of abnormal appearance. Sterility and infertility have occurred in users.
LEUKAEMIA IN CHILDREN OF USERS
Smoking pot in pregnancy has been found to be linked to a form of leukaemia in infants.
The facts are here. The choice is yours.
Source: Addiction Today, November 2000

In Britain, Europe’s biggest consumer of narcotics, the Home Office reckons that drugs are brought in by about 300 major importers, who pass them to 30,000 wholesalers and then to 70,000 street dealers. Cocaine, meaning both the sniffable powder and smokable “rocks” of crack cocaine (which can be made using a simple microwave), accounts for about half the value of this industry, being less widely taken than cannabis but much pricier.
Some rare light was shed on the business by a Home Office study in 2007, in which 222 drug-dealers were interviewed in prison by analysts from Matrix Knowledge Group, a consultancy, and the London School of Economics. One dealing partnership, based in London and Spain, bought cocaine from a Colombian importer in 10kg bundles, which they sold to retailers using an employee whom they paid £500 ($703) per transaction. A second employee, paid £250 a day, would collect money from the buyers and pass it to a third member of staff, who would count it (processing up to £220,000 each day). Other employees would pay the Colombians and smuggle the rest of the cash, on their bodies, back to Spain.
Most drug businesses are forced to stay small and simple to evade the police. Only one dealer claimed to be part of an organisation of more than 100 people, and a fifth were classified by researchers as sole traders. Fear of being uncovered also hampers recruitment: most dealers stuck to family and friends, and people from the same ethnic group, when hiring associates. Just like other businessmen, they carried out criminal-record background checks on potential employees—except that, in this case, a record was a good thing.
Kevin Marsh, an economist at Matrix Knowledge, argues that most players in the drug business have a poor knowledge of the market. “Shopping around for new wholesale suppliers is risky, so many retailers stick to the same one and pay over the odds,” he says. Most of the dealers interviewed knew little about the purity of what they were buying, and money laundering was usually fairly shambolic. Managing cashflow is one of dealers’ biggest weaknesses, according to one drug specialist at the Serious Organised Crime Agency (SOCA): “Supply of powder is the most resilient thing. To destroy the business, you have to go after the money.” That, and extradite foreign dealers, as America has long done. Britain is believed to be negotiating its first-ever extradition of a Colombian, on drug charges, at the moment.
Times may at last be getting harder for cocaine-dealers. Shortly before Christmas, the wholesale price in Britain shot up to £40,000 per kilo, the highest in years. Better policing was one cause; another was the slump of sterling. European retailers’ margins have been chipped away. To protect their profits, dealers are diluting what they sell. A decade ago, average street-level purity was about 60%; police say it is now nearer 30%. “People think there is a lot of cocaine around, but two thirds of it isn’t cocaine at all,” says one SOCA officer.
That would be fine if the remainder were talcum powder. But in the past few years dealers have turned to pharmaceutical cutting agents such as benzocaine, a topical anaesthetic, which mimic the effects of cocaine and may be more harmful. Dealers call such agents “magic” because of their effect on profits. “Grey traders”, who knowingly sell such chemicals to dealers, are starting to be convicted.
Educating drug-takers about what is getting up their noses may lower demand. But cutting raises bigger questions for drug policy. “We may have to say at some stage that taking heavily adulterated cocaine is more physically harmful to the user than taking cocaine that’s less adulterated,” a senior SOCA official says. “That is not the case at the moment. But we’ve got to keep asking the question. I’m aware that the health equation could one day say: Stop trying to stop cocaine coming in.”
Source: Economist.com 5 March 2009

Notwithstanding research carried out by the National Treatment Agency (NTA) which clearly established that the majority of those who have developed dependence, wish to become drug free; here in the UK, the focus for the past 10 years has been on ‘harm reduction’, rather than seeking to engage users into abstinence focused recovery. The outcome of this disastrous and misguided policy has been an escalation in drug related deaths which are at their highest for 5 years, 325 of which are attributed to methadone, the flagship of the harm reductionists, together with a devastating increase in the spread of blood born disease among Injecting Drug Users (IDUs) The statistics provided by the Health Protection Agency for England and Wales are as follows:

• The level of HIV infection among Injecting Drug Users (IDUs) in England and Wales is higher now than at the start of the decade.

• In London where the prevalence of HIV in IDUs is higher than elsewhere in England and Wales, 1 in 20 IDUs is infected.

• In the remainder of England and Wales HIV among IDUs has increased from approximately 1 in 400 in 2002 to around 1 in 150 in 2006.

• The prevalence of Hepatitis C among IDUs has increased from 33 percent in 2000 to 42 per cent in 2006.

• Approximately 1 in 5 IDUs has Hepatitis B infection, which extrapolates as an increase approaching 200 per cent since 1997.

The escalating increase in blood born disease has occurred despite the plethora of needle exchange facilities throughout England and Wales, and the growth of supervised drug consumption rooms

It is self evident from the foregoing that here in the UK at least, it is not the lack of harm reduction measures which is contributing to avoidable deaths and the epidemic of blood born disease being wreaked on our society, but the use of toxic psycho active substances.

It is not so called prohibition which has failed, but the encouragement by way of the tacit permission, and in many instances, the not so tacit encouraging of continued use, inherent in the harm reduction ideology, which has failed users and society so abysmally.

The supporters of Harm Reduction, under their various guises have never allowed the truth to interfere with their propaganda, or indeed their more covert agenda, to legalise drug use; the main beneficiaries of which would be the pharmaceutical industry. Such a move would be to inflict further incalculable harm on society, since it would result in a growth of use and addiction, similar, if not more widespread, to that seen in the late 1800’s when most of the drugs which are controlled today, were in fact legal.

The growth of drug use during that period was the direct result of concerted efforts by leading members of the medical profession in promoting drug use, many of whom were influenced by Sigmund Freud, who was so unethical in his dealings that he accepted separate commissions from two competeing, large pharmaceutical companies, both of whom are still in business today, to write papers extolling the benefits of that destructive substance, cocaine, not only as the ‘elixir of life’, but also as a cure for alcohol and morphine addiction. The rest as they say is history

One has to ask is it a coincidence that many of the bodies, who are pressing for an end to what they term as prohibition, receive ‘research grants’ from the pharmaceutical industry?
Source: Daily Dose; posted by Peter O’Loughlin on 13 Mar 2009 at 6:23 am

By Seth Freedman – Guardian columnist – 5th June 2009.

A simplistic advertising campaign masks the corrosive, corrupting nature of narcotics
Yesterday afternoon, I met Release’s spokeswoman Claudia Rubin outside Old Street station in London. In a perfect piece of vehicular choreography, the first bus to veer past us at the roundabout bore the slogan “Nice People Take Drugs”, the phrase Rubin coined for Release’s latest campaign to kickstart a drug-policy debate.
The advert’s minimalist design was, she told me, inspired by the atheist bus campaign which caused such a stir last year. Release’s version dispenses with pictures or logos, relying instead on bold, orange lettering to convey the four-word mantra to street level. As marketing strategies go, it is a stroke of genius – guaranteed to achieve maximum impact, and luring viewers towards Release’s website to pique their curiosity.
However, the brilliance of the way the message is marketed does not automatically render brilliant the message itself. The intention behind the campaign is to attempt to break the societal taboo on drugs. According to Release, “the public is tired of the artificial representation of drugs in society” – informing passers-by that “nice people take drugs” will help “de-stigmatise drug use”, says Rubin.
Which is all well and good, but the fact that “nice” people have their faults doesn’t mean that their failings should be decriminalised and tolerated by everyone else. Nice people also break the speed limit, download pirated music, and commit any number of apparently minor misdemeanours, but the law isn’t meant to bend to accommodate such immoral behaviour just because a critical mass of people partake in a certain activity.
Defining what makes a nice person is, of course, an utterly subjective matter – as Release knows full well – as is determining at what point a person’s misdeeds turn them from nice to nasty. On one level Release is right: Rubin and I have been friends since we were 12, and the circles in which we mixed would definitely have passed the “nice” test, despite the vast majority of us having done drugs throughout our teenage years.
That we all came, saw and conquered our own mini-addictions and vices without turning to crime or violence is testament to our triumph over temptation, but to pass off our drug use as simply part and parcel of life is to gloss over the darker side of our experiences. Using drugs as an escape route, or a quick fix to our problems, was not a “nice” way to behave. Implying that drug abuse is socially acceptable, as Release are doing via their adverts, is not a noble message to hurl at impressionable children and teenagers who are unable to spot the nuance and meaning behind the stark sloganeering.
To claim, simplistically, that “nice people take drugs” masks the corrosive, corrupting nature of narcotics, as well as the underlying void they fill in users’ lives. The desire to get wasted – to blot out reality and allow substances to numb one’s senses to the present – is a desperate urge, and one which has held vast swaths of society in a vice-like grip since time immemorial. Ridding people of that impulse would do wonders for both their mental and physical health; bowing to so-called public demand and sugar-coating the truth about the dangers of drugs simply passes off as acceptable a wholly insidious behavioural streak.
Release believes that “the current [proscriptive] system has brought us powerful drugs like crack cocaine, skunk, and methamphetamine”, suggesting that the ban on the underlying narcotics has prompted cartels to invent stronger and deadlier variants of the original product. Such a theory is backwards: the demand for more potent strains is what spurs suppliers into action, not the other way round. I smoked skunk with my friends to achieve a deeper and darker haze: the legal status of cannabis was neither here nor there, just as those addicted to high-grade whisky or vodka couldn’t care less whether or not 3% lager is authorised for sale or not.
Addiction is a disease that affects tens of thousands of people in every generation. Allowing greater access to drugs will, as with alcohol and tobacco, only put more vulnerable citizens in temptation’s way – which neither Release nor anyone else should want to happen. Just as speeding laws shouldn’t be changed despite their impact on those drivers able to safely handle a car at 100mph, so too must drugs remain illegal to prevent risking the lives of the majority of the population.
Of the four words in Release’s advert, two leave too much open to interpretation: “nice” and “drugs”. “Good people smoke crack” would be a far more blunt and direct way to make the same point, but whether their message would be so blithely tolerated by the advertising authorities or the public is another matter – highlighting the essential error of drugs campaigning in the first place.
Source: Guardian.co.uk 5th June 2009Seth Freedman is a writer living in Jerusalem. He grew up in Hampstead Garden Suburb and worked as a stockbroker in the City for six years, before moving to Israel. Seth Freedman has written articles published in The Guardian and The Times – 81 articles published in 14 news websites since April 2008. No email address known for Seth Freedman.

Comment by NDPA:

The publicity provoked by the ‘Bus Slogan’ campaign by Release talks of ‘opening the drug debate’. This debate has been on-going for at least thirty years – and every time those who want to legalise drugs, or change the existing laws, lose the argument. They lie low for a few months. Then up they rise like a phoenix and declare ‘we must have a debate about drugs’. What they actually mean is ‘we must keep on debating about drugs until we get the answer we want’. Release and others of that ilk persistently turn a blind eye to the fact that the vast majority of the public (in the UK and worldwide) do not use illegal drugs themselves and they do not want their families impacted by the use of drugs by others. Drugs are unhealthy, unlawful, antisocial and unnecessary. Nice policies don’t accept drugs.

No one wants others to suffer. That’s the “Chink in the Armor” that Serra talks of. There may be some maladies that can be helped by marijuana, even if it is only psychologically. Those who are ill have been catapulted into the middle of the debate … a war, by a heartless and cruel group of people who want to get high and those who will not go speechless to watch our loved ones become like them. There seems to be no middle ground for those on our side understand all too well what the wrong message and role-modeling wrong behavior means.
These days, people on both sides of an issue are so polarized they won’t talk to each other, much less listen. Our side, with some willing to listen and talk, allowed the legalizer’s side to take ground that didn’t belong to them and more of the youth and those ill, (the vulnerable) are being hurt because they are now addicted.
Talking with and listening is an important issue with me – one is often surprised where one finds truth.
A friend suggested I read Sun Tzu’s book for the perspective of “know your enemy”. Understanding this, plus at the prodding of those I work with against drug use, I began to learn about the legalizers – an interesting study.
And then tonight; it’s ironic sometimes what one stumbles upon, poking around on the net! I happened onto a site that offered schooling toward a Criminal Justice Degree. I paused as I perused it; something wasn’t right, but as I looked it over, I couldn’t figure out what it was. I was thinking their ad, offering a salary of $40,000 as a DEA agent, wasn’t much of a motivation – not much to put one’s life on the line for! Still, I couldn’t quite leave that site. That “something’s wrong feeling” was stronger every moment; maybe I was seeing it, but I couldn’t recognize it. As I decided to search for it, I found it, printed lightly – almost as if it were not meant to be noticed.
What I’d noticed was the logo of one of the five schools offering the degree, one I’d seen before, many times now in my study. Evidently this time, for me it had been subliminal . . . . the link probably won’t mean anything to someone who hasn’t studied the players in the legalization movement – “it’s near impossible to keep up on even most issues in this ‘age of information’. I wonder if the DEA knows about this?”, I thought as I shook my head and began to laugh. “I wonder if my prohibitionist friends know about this? Gotta be someone’s idea of a bad joke – a legalizer’s school teaching future DEA agents”, I told myself. “I’ll bet users have noticed, … some of them”.
The school offering the degree? It’s the University of Phoenix. The university’s founder is John Sperling – one of the three men in what I call the “Daddy Warbucks Cartel”, the three men most responsible for funding the ballot measures all across the nation for the legalization of marijuana. (no; they’re not local grass-roots [pun intended] campaigns.)
Another is Peter B. Lewis, of Progressive Insurance. Wouldn’t it seem fitting that the government require all the “medical marijuana users” who drive, to sign with Progressive for their auto insurance? Could be real revealing, couldn’t it? The third man, is George Soros – all three radical politicos.
Another interesting thing I found that ties in as well – on an OSI, Open Society Institute’s site, (one of Soros’ numerous non-profits), I listened to a panel discussion over the net – about how nations like Iran have been successful at shutting down communications and the internet – what works and what doesn’t in totalitarian nations.
I found it interesting that it’s just exactly how the government of Iran recently reacted, attempting to shut down the ability of the people to talk with each other after this fraudulent election. Does anyone else find it ironic that proponents of drug legalization are in bed with a man who (I believe) essentially plans to take away others’ freedom?
If all three groups won’t talk, won’t listen, won’t give, it’s a loose / loose / loose, for everyone! Again, our side gave up or lost too much ground here and all sides are willing to fight to the end.
Source: examiner.com June 18th 2009

THE United Kingdom is the cocaine capital of Europe, with more than a million regular users taking the drug, according to a new report.
And one of Scotland’s top drug experts said yesterday that given the biggest per capita consumption was north of the Border, the country was probably Europe’s capital of the class A substance.The United Nations Office on Drugs and Crime said the UK was Europe’s largest cocaine market. But its report said the quality of the drug had declined dramatically in recent years. The report said a crackdown on traffickers had pushed cocaine prices up and led to dealers diluting the drug even more.

Some seizures by police revealed that substances being passed off as cocaine that were only 5 per cent pure. The UN found dealers mixing their product with cutting agents such as dental and veterinary anaesthetics, which mimic the effects of cocaine but are much cheaper.

There are estimated to be 860,000 cocaine users in England and Wales and about 140,000 in Northern Ireland and Scotland combined. The World Drug Report 2009 revealed that cocaine use had increased dramatically in the UK from the mid-1990s, but remained stable over the past two years.

Data given to the UN by the UK’s Serious Organised Crime Agency shows that wholesale prices have risen to record levels. The cost of a kilogram of cocaine has increased by 50 per cent – from £30,000 to £45,000 – since 2007. The report says: “The UK thus continues to be – in absolute numbers – Europe’s largest cocaine market, with its second highest cocaine use prevalence rate.”

Professor Neil McKeganey, director of the Centre for Drug Misuse Research at Glasgow University, said he was not surprised at the UN’s conclusions. “A few years ago I said that in due course cocaine would overtake heroin, and I think that’s what we’re going to see. Heroin use may have plateaued at quite a high level, but cocaine use has been rising quite dramatically.” He added: “Scotland typically is the highest centre of drug consumption in the UK anyway, so it could well be that it is the cocaine capital of Europe.”

Source: The Scotsman 25th June 2009

The breakdown shows health boards and councils forked out £77 million on drug services in 2007 and just under £26 million on alcohol services.
Drug and alcohol abuse is costing Scotland nearly £5billion a year, according a report by the watchdog Audit Scotland. The breakdown shows health boards and councils forked out £77million on drug services in 2007 and just under £26million on alcohol services.
The report said spending patterns did not always reflect national priorities or need, and funding arrangements are often “complex and fragmented”.
Death rates for alcohol and drug abuse in Scotland are amongst the highest in Europe and have doubled in the last 15 years. This is while rates decrase in other parts of Europe. The number of alcohol-related deaths in 2007 was 1,399 – compared to 455 drugs-related deaths.
The report has called for a more co-ordinated approach to services.
Auditor General Robert Black said: “The range of services for people in need of help can depend on where they live and there is not enough information about the effectiveness of these services.”
Scottish ministers have not set out minimum national standards that victims and their families can expect from drug and alcohol services. The report says ministers need to work with the NHS, councils and others to ensure they all know their responsibilities. While recent Scottish Government strategies have a focus on prevention, only 6 per cent of direct spending was on preventive activities.
Scottish Conservative leader Annabel Goldie said: “This report came about as a result of Scottish Conservative pressure in the 2008 budget. We suspected there was chaos in how funding streams were directed towards addressing addiction. The horrific truth has now been exposed and I am shocked at the sheer scale of the drugs and alcohol problem in Scotland.”
Labour’s Cathy Jamieson added: “I am particularly concerned that Audit Scotland’s report states that the Scottish Government is not funding services in the most effective way as they have no way of measuring performance. This is completely unacceptable and must change.”
A Scottish Government spokesman said the Government had asked for the report and welcomed its findings. He added: “It details the system we inherited from the previous administration.” The spokesman also said spending on drug and alcohol services had increased.

Source: www.stv.tv 26 March 2009

The cost of providing methadone to drug addicts has almost doubled in the past five years to nearly £17million.
The total bill for dispensing the heroin substitute north of the Border rose by 84% – from £9,049,792 in 2003/4 to £16,637,636 in 2009.
Annabel Goldie, leader of the Scottish Conservatives, said the figures were evidence that current drug treatment methods are failing. Drug misuse experts believe addicts should have a maximum of two years on methadone, which is prescribed to an estimated 22,000 people as an alternative to heroin.
Professor Neil McKeganey, director of the Centre for Drugs Misuse Research at Glasgow University, said millions of pounds were being wasted on methadone prescriptions.
The Scottish Government announced a new drugs strategy in 2008. The document promised a change in treatment methods but failed to set targets for cutting methadone use.
Reacting to the latest revelations, Ms Goldie said: “Even in the past year alone the cost of prescribing methadone has risen by over 10 per cent. Under eight years of Labour and the Lib Dems, Scotland’s drug dependency became a methadone dependency.
“The SNP must not make the same mistake. “Methadone must stop being the treatment of first resort. A new political will and a new national strategy were the first steps but now it’s time for action.”
There are an estimated 50,000 “problem” drug users in Scotland. A United Nations report last week showed Scots had the second-highest rate of heroin use in Europe.
Prof McKeganey added: “We have got to move away from it and politicians have to be determined and show leadership, because otherwise the costs of the methadone programme will rise and they will strangle the development of alternative treatments. “You can’t spend that much money on a single treatment and not make other possible treatments suffer as a result.”
However, a Scottish government spokesman insisted its drugs strategy would open up access to alternative treatment methods. He continued: “We want a much wider range of services to be available for drug users. We are transforming the delivery of drug services to ensure that help is available when people need it most. The new target to reduce waiting times will help ensure this happens.”
Source: http://www.stv.tv. 05 July 2009

One of Scotland’s leading drugs experts says there is a big question mark over the size of the country’s methadone programme. Professor Neil McKeganey’s research found many people on the heroin substitute were still taking heroin as well.
22,000 adults in Scotland are on methadone, and that costs at least £25 million a year.
The report from Glasgow university’s centre for drug misuse research says the programme is “gargantuan in size and scale.”
The study, which looked at the behaviour of 400 drug users, found there was no significant difference between those on methadone and others when it came to not using heroin. It also found no significant difference between the groups in terms of committing crimes to pay for drugs.
The Scottish Government says there is evidence methadone can help stabilise those with chaotic lifestyles. It says the drugs strategy launched earlier this year recognises the need to move people on from methadone, but adds the challenge is to make sure the right support is available rather than promoting one type of treatment over others.
Source: www.stv.tv 14 December 2008

More than 11,000 children under 16 years old were treated last year for addictions to alcohol and drugs, including heroin, according to new figures released this week.
The National Treatment Agency for Substance Misuse puts the total figure of children treated at 11,294. This includes 6,075 under-16s addicted to cannabis, of which 102 are under 12 years old.
More than 4,000 children received help for alcoholism, including 57 under-12s.
The children addicted to class A drugs included ten under-12s who were dependent on heroin, out of 93 under-16s. A further 323 children were treated for cocaine misuse, 165 for ecstasy, and 36 for crack.
Conservative Health Secretary Andrew Lansley said the government is neglecting a ‘forgotten generation’ of children. “It’s a sad indictment of our broken society that so many are turning to things like drug and alcohol abuse at such a young age” he said.
The Department of Health said the high figures were due to an increase in spending on treatment, a rise of £10million, from £15million to £25million in the past five years,
Funding for the government’s national anti-drug campaign which is aimed at teenagers has been cut by 41 per cent from £9.05million in 2006-7 to £5.35million today.
Charity Drugscope offered an optimistic approach to the figures, saying the overall numbers of young people using illegal drugs has fallen in recent years, especially cannabis.
Source: www.askamum.co.uk 8th July 2009

Resolutions agreed by the Executive Council will obviously be subject to change and augmentation as NDPA itself grows. Full listing of Resolutions is available on request, but this brief synopsis gives a good measure of NDPA’s current strategy:
• NDPA will campaign for Prevention’s potential to be fulfilled, especially for the very young: a rational and ‘seamless’ set of policies across all age ranges is the aim; these should ideally combine to form a ‘Systems Approach’ which unites and empowers all sections of society.
• Policies and programmes should have the aim of healthy lifestyles free of drug misuse. Policies that condone or encourage drug use based on ‘Harm Reduction’ are not acceptable. Treatment interventions seeking to limit damage with known individual drug users have their place, but must be accompanied by an unequivocal health-promoting message. (As National Strategy indicates).
• NDPA supports laws and justice systems which reinforce drug-free and wholly healthy lifestyles, and endorses efforts to maintain and improve this situation. NDPA seeks improved, more accurate public information and far more accuracy and balance in the media. NDPA supports adherence to scientific research standards and ethics prescribed by the world scientific community.

“What do we mean by recovery? We mean a process through which an individual is enabled to move on from their problem drug use, towards a drug-free life as an active and contributing member of society.
Furthermore, it incorporates the principle that recovery is most effective when service users’ needs and aspirations are placed at the centre of their care and treatment. In short, an aspirational, person-centred process.”
This has recovery as a process, not an event. It has the concept of moving on, sets a drug free life as the goal and has the issue of becoming a contributing member of society at its heart.
Measurement:
How many people achieve the recovery goals on their care plan?
How many people move into education, training and employment?
How many report positive developments in their lives rather than just the absence of pathology?
How many achieve full citizenship? How many drug free?
How many move on to manage their own recoveries?
The government in Scotland have taken a courageous view. When we aim this high and believe it can happen, many more people will get there.

The use of the most dangerous Class A drugs has hit a 12 year-high as more people take cocaine, new figures show.
Drug misuse figures show that one in six of people of working age – 15.6 per cent – expect to have taken a Class A drug in their lifetimes. This compares with 9.6 per cent in 1996.
The document revealed, for the first time, an official acceptance that use of Class A drugs is on the increase. Analysis of the figures showed a “slight underlying upward trend” which is “significant over the long term” between 1996 and 2008, Home Office statisticians wrote.
The figures also revealed a sharp rise in cocaine use. The survey found that 9.4 per cent of adult expect to take the Class A drug in their lifetime – compared with just 3.1 per cent in 1996.
Three per cent of all adults admitted taking cocaine in the previous 12 months, up from 2.4 per cent – meaning that there are an estimated 974,000 users.
Figures from the British Crime Survey showed cocaine use by 16-24 year-olds went from 5.1 per cent to 6.6 per cent between 2007/8 and 2008/9.
Drug experts said the increases, particularly in the case of cocaine, were of “significant concern” and blamed falls in price and increased supply.
Martin Barnes, chief executive of charity DrugScope, said: “These figures show a marked and worrying increase in the use of cocaine powder, in the adult population as a whole and among 16 to 24-year-olds. While this is not necessarily a surprise given the drug’s decrease in price and increase in availability over recent years, it is of significant concern, particularly the rise in use among younger people.”
The figures also showed that a third of people – 31.1 per cent – now expect to have taken cannabis in their lifetimes, up from 23.5 per cent in 1996.
Chris Grayling, shadow Home Secretary, said: “Hardly a day goes by without yet another depressing set of statistics about the scale of Britain’s social problems under this Government. Drug addiction causes family breakdown, is linked to a substantial proportion of crime and causes long-term damage to people’s health. We have to turn this round.”
Home Office Minister Alan Campbell said: “We are not complacent. We are taking comprehensive action to tackle cocaine use, from increased enforcement to reduce the supply, along with effective treatment, education and early intervention for those most at risk.
“Police and their partner agencies are seizing record numbers of drugs and cocaine purity is recorded at an all-time low. When people think they are taking cocaine, in some instances the actual purity is as low as 4 per cent.”
Source: www.Telegraph.co.uk 23rd July 2009

History has valuable lessons to teach policy makers but it reveals its lessons only grudgingly. Close analyses of the facts and their relevance is required lest policy makers fall victim to the persuasive power of false analogies and are misled into imprudent judgments.¬ Just such a danger is posed by those who casually invoke “The lessons¬ of Prohibition” to argue for the legalization of drugs.What everyone “knows” about Prohibition is that it was a failure. It did not eliminate drinking; it did create a black market. That in turn spawned criminal syndicates and random violence. Corruption and widespread disrespect for law were incubated and, most tellingly, Prohibition was repealed only 14 years after it was enshrined in the Constitution.

The lesson drawn by commentators is that it is fruitless to allow moralists to use criminal law to control intoxicating substances. Many now say it is equally unwise to rely on the law to solve the nation’s drug problem.

But the conventional view of Prohibition is not supported by the facts.

First, the regime created in 1919 by the Volstead Act, which charged the Treasury Department with enforcement of the new restrictions, was far from all-embracing. The amendment prohibited the commercial manufacture and distribution of alcoholic beverages: it did not prohibit use, nor production for one’s own consumption. Moreover, the provisions did not take effect until a year after passage ¬– plenty of time for people to stockpile supplies.

Second, alcohol consumption de¬clined dramatically during Prohibition. Cirrhosis death rates for men were 29.5 per 100,000 in 1911 and 10.7 in 1929. Admissions to state mental hospitals for alcoholic psychosis declined from 10.1 per 100,000 in 1919 to 4.7 in 1928.

Arrests for public drunkenness and disorderly conduct declined 50 percent between 1916 and 1922. For the population as a whole, the best estimates are that consumption of alcohol declined by 30 percent to 50 percent.

Third, violent crime did not increase dramatically during Prohibition. Homicide rates rose dramatically from 1900 to 1910 but remained roughly constant during Prohibition’s 14 year rule. Organized crime may have become more visible and lurid during Prohibition, but it existed before and after.

Fourth, following the repeal of Prohibition, alcohol consumption increased. Today, alcohol is estimated to be the cause of more than 23,000 motor vehicle deaths and is implicated in more than half of the nation’s 20,000 homicides.

In contrast, drugs have not yet been persuasively linked to highway fatalities and are believed to account for 10 percent, and 10- 20 percent of homicides.

Prohibition did not end alcohol use. What is remarkable, however, Is that a relatively narrow political movement, relying on a relatively weak set of statutes, succeeded in reducing, by one-third, the consumption of a drug that had wide historical and popular sanction.

This is not to say that society was wrong to repeal Prohibition. A. democratic society may decide that recre¬ational drinking is worth the price¬ — traffic fatalities and other consequences. But the common claim that laws backed by morally motivated political movements cannot reduce drug use is wrong.

Not only are the facts of Prohibition misunderstood, but the lessons are ¬misapplied to the current situation.

The U.S. is in the early to middle stages of a potentially widespread cocaine epidemic. If the line is held now, we can prevent new users and increasing casualties. So this is exactly not the time to be considering a Liberalization of our laws on cocaine. We need a firm stand by society against cocaine use to extend and reinforce the messages that are being learned through painful personal experience and testimony.

The real lesson of Prohibition is that the society can, indeed, make a dent in the consumption of drugs through laws.

There is a price to be paid for such restrictions, of course. But for drugs such as heroin and cocaine, which are dangerous but currently largely unpopular, that price is small relative to the benefits.

Source: Mark H. Moore New York Times, October 16, 1989

Instead of fighting drug-related crime, we need to stop people taking drugs, says Iain Duncan SmithYesterday, the UK Drug Policy Commission recommended that the fight against drugs should focus on dealing with the criminal and anti-social elements that surround their sale. In other words, as long as drug dealers don’t start shooting each other, the police should turn a blind eye to their activities.

Yet the irony is that this plan has been followed all too often – with devastating consequences. In a notorious experiment in Brixton, dealers were left alone to sell cannabis, forcing local people to dodge them as they wandered up and down the streets, and to worry that their children would get caught up in the trade and the police would do nothing about it.

In Balsall Heath in Birmingham, the police also decided to leave the dealers to get on with their trade, preferring to monitor their activities. Residents saw front gardens became littered with needles, and prostitutes moved in. Thanks to the leadership of the sociologist Dick Atkinson, the community drove the dealers and the prostitutes out, and forced the police to treat them normally.

The truth is that the sort of communities where the police are being encouraged to adopt this approach are poor, with high deprivation, high crime and high levels of addiction – in other words, places that have already been written off, and which no one seems to care about. Just imagine the outrage if they suggested doing this to a middle-class suburb.

Yes, we have had a decade of failed drugs policy. But instead of more of the same, we should accept that the present policy has failed because it is centred on the wrong premise: that the purpose of our drugs strategy should be simply to minimise the harm that they do.

This approach is not only defeatist, but dangerous. It is a policy which seems to believe that so long as an addict doesn’t mug someone, kill them or rob their house, then that’s fine. It is a policy that parks addicts on methadone, entrenching addiction and ensuring that many of their children follow suit. It fails to address the problems of drugs and alcohol in terms of breaking the cycle of addiction, or in terms of recovery – which is why a significantly higher percentage of Britons are addicts than is the case with any of our neighbours. Rehabilitation treatment has been marginalised, with only a tiny number of addicts helped to get off drugs. The problem is made worse by the authorities’ failure to recognise that high levels of alcohol consumption among young people have a strong connection to the rise in the drugs culture.

Contrast this with Sweden, or even Holland. There, they understand that a successful drugs strategy needs to have a strong emphasis on clear laws, with the expectation they be policed. People are clear about what will happen if they are caught in possession of illegal drugs. In Holland, they spend three quarters of identifiable funding on law enforcement. Typically, this includes interdicting local production and trafficking. In the UK, the corresponding figure is far less, and there is little clarity about enforcement.

Second, these countries use the justice system to divert criminal drug users to care programmes, the purpose of which is to reduce reoffending and break the cycle of addiction. In Sweden, they tie successful involvement in such programmes to the expunging of the criminal record. Unlike in Britain, rehabilitation is seen as an integral part of the approach – and, unsurprisingly enough, the number of addicts as a proportion of the population is considerably lower than here.

What we need is not more rhetoric about a “war on drugs”, which is political nonsense. Instead, we must start a sustained process that aims to reduce drug-taking behaviour rather than containing it, and thus improves the quality of life for addicts, their families, and their communities.

Iain Duncan Smith is chairman of the Centre for Social Justice

Source: Telegraph UK. 30 July 2009

UK Advocates threatens legal action against health authorities providing drug-based treatments over rehabilitation. Alcohol dependency affects 1.1 million people
NHS authorities that offer alcoholics controlled drinking treatments relying on medication rather than total abstinence could face legal action from a patients’ organisation. UK Advocates, a pressure group campaigning for the wider availability of rehabilitation courses for addicts, is preparing to file claims against the Department of Health and local health services.
The charity maintains it has found evidence of thousands of patients with severe alcohol problems being given “psycho-active drugs” while they are still drinking. The combination, it is alleged, can be “potentially lethal” and is at odds with the manufacturer’s prescription advice and guidelines. “In many cases,” UK Advocates claims, “drugs and controlled drinking programmes are administered to sufferers without the doctor or clinicians involved having performed effective liver function tests to establish the extent of liver damage from excessive drinking.
“Treating alcoholics with drugs and on a basis of ‘moderation’ is similar to advising someone with lung cancer to cut down their smoking,” says Bob Beckett, founder of UK Advocates. “Controlled drinking programmes … hark back to the 1960s and 70s when we believed pharmaceuticals would cure everything, including addiction to alcohol. They simply have not worked.
“There are nearly one million people with alcohol problems taking up NHS beds. If we are serious about dealing with alcohol addiction then we have to look at cessation programmes, not drug-based detox, not hypnotherapy, but properly defined, intensive abstinence treatment.”
UK Advocates says its insistence on abstinence programmes follows guidelines adopted by the World Health Organisation (WHO). The organisation is now assessing whether programmes offered by primary care trusts (PCTs) meet “these statutory requirements as adopted by the European Union in accordance with WHO recommendations”. It says it will take “legal action against those it believes have been negligent by failing to offer day and residential abstinence treatments where clearly required”.
In May, the all-party parliamentary group on alcohol criticised “a general lack of capacity and variety in alcohol treatment services, due to poor levels of funding and, in some cases, a harm reduction agenda driven largely by crime and disorder rather than health considerations”. The committee found that although as many as 1.1 million people are classified as alcohol dependent nationally, only 1 in 18 enter any sort of specialist treatment each year. Spending on drug addiction outweighs that on alcohol dependency. UK Advocates says that it will issue proceedings in the administrative division of the high court “against PCTs and clinicians who may be proven to have acted negligently”.
Tom Gard, a spokesman for the group, said: “We have heard of someone who has been drinking two bottles of wine a day and has [only] been told to cut down to one and a half.” The charity claims that an audit of PCTs across the East Midlands and Yorkshire has revealed a picture, reflected nationwide, of many trusts offering no residential or intensive day abstinence treatment at all.
“In many areas those suffering from alcohol dependence are instead offered only ‘controlled drinking’ programmes, often without appropriate prior tests to establish whether or not the person needs to stop drinking completely to avoid developing serious physical and mental health problems.”
A Department of Health spokesperson said: “We have a comprehensive strategy to tackle health-related alcohol harm. The number of structured alcohol treatment places is increasing. Around 104,000 people were recorded as receiving treatment in 2007-08, against an estimated number of 63,000 in 2004.
“We have launched the alcohol improvement programme which assists PCTs in understanding local need and planning commissioning decisions. Most specialist alcohol services aim to help people reduce the harm associated with drinking. For those with moderate and severe dependence, this will usually involve advice and support to become abstinent, whether in the community or in-patient settings.
“Where a clinician considers medication would be the most appropriate treatment it is normal practice to discuss the effects and potential side-effects of the medication with the patient.”
Source: guardian.co.uk, Monday 3 August 2009

by Kathy Gyngell on Tuesday, 04 August 2009 09:51 Last week brought a new twist to the myth that law enforcement – hyperbolically designated as ‘prohibition’ by the pro drugs lobby – rather than drug use itself is the root of the country’s drug problem.

Tom Feiling, an advocate of legitimising of cocaine, a drug which pretty much he alone rates as neither dangerous nor addictive, started off the week’s drug debate. Plugging his new book, the equally hyperbolically titled, ‘The Candy Machine: how cocaine took over the world’, he pushed the view that pro drugs activists want us to buy – that you can’t stop people using drugs so don’t try. Conveniently bypassed was the fact that cocaine has only ‘taken over’ those countries where enforcement is weak and penalties and asset stripping are rarely or ineffectively imposed. He did not point out that the UK, far from being draconian in anything other than its imposition of methadone, is one such country – hence its rates of cocaine use 2 to 3 times higher than nearly every other country in Europe.

Not everyone bought into Tom’s take on the subject, Stuart Holmes, a medical student, for one. Expressing his horror at the impact of cocaine ‘on swathes of the population to whom the NHS directs so many of its resources’ he found ‘Tom Feiling’s tirade against the illegality of cocaine and other hard drugs a little galling.’ Instead of the balanced exposition of cocaine use in this country, discussion of the source of cocaine and the legal framework surrounding the drug here that he had expected, he found ‘a thinly veiled manifesto for the legalisation of hard drugs.’

Nor, did former Police Commander, Brian Paddick, he who infamously instigated the Brixton experiment of warning rather than arresting people found with cannabis (and many of the negative consequences that followed). Forcefully dissociating himself from Feiling on Sky News he stressed the total unacceptability of both cocaine and crack cocaine, outlining the violence and destruction of lives its use has led and does lead to, quite apart from that involved in its trafficking. He should know.

Nor, clearly, did he think much of the UK Drug Policy Commission’s (UKDPC) contribution to the debate also published this week disingenuously titled “Moving towards Real Impact Drug Enforcement”. When confronted with their innovatory contribution that some drug dealers but not others – the less violent ones – should officially be tolerated because (according to the UKDPC) arresting them ‘can increase violent crime’, he made clear this approach was both impracticable and wrong. His scepticism and his call for nothing less that a total change of social attitudes to a non acceptance of drug use – something singularly missing from any of the UKDPC reports – was an unexpected breath of fresh air. If we can change attitudes to smoking in a generation we can change them to drug use, he declared.

So where have the UKDPC’s ideas come from? They are premised on a variant of the discredited policy idea that only some drug use is harmful which, in this wishful two world view of drug use, can be isolated. That this lobby should make the tactical switch of applying their ideas to enforcement now their preferred but ethically dubious policy of applying liquid handcuffs to so called HHCU’s (high harm causing users) to stop their acquisitive crime has so categorically failed, is perhaps not surprising. After all if you believe that most drug use is non harmful then you are bound to have to think that most dealing is not harmful either – or only if the strong arm of the law comes down on it.

Unbelievably this is the gist of the UKDPC’s Alice in Wonderland view of the illicit drug trade – that the violence that ensues is a function of police actions/enforcement not of the trade – so good dealers can be tolerated while only bad (i.e. violent) dealers will be targeted. Well that’s all right then – all dealers can no doubt be ‘good’ if no one gets in their way. But heaven protect the children, families and communities exposed to the plying of a sanction less trade on their doorsteps with no police to support or protect them. To say nothing of how such a policy would make the UK an even softer target, turn us into an even larger market and encourage more use and incremental damage.

This is political correctness or liberalism taken too far. Will we be blaming the police action as opposed to inaction for murder and robbery next?

Yet startlingly in all the prime time coverage respectfully devoted by the BBC’s Today programme to the report – summaries thoughout the morning each with Home Affairs Editor Mark Easton’s imprimatur – none of these points were raised. The premise of the report was uncritically accepted. Yet as well as being numbingly illogical the report is nothing less than a formula for the backdoor legalisation of drugs’ trafficking – ‘a harm reduction stepping stone to legalisation’, as drugs policy expert, Professor Neil McKeganey, has called it.

According to McKeganey, “the form of policing UKDPC are advocating would in reality give rise to the creation of areas of our cities and our rural communities in which drug use had effectively become legalised. Such a policy raises the frankly idiotic scenario in which we are punishing drug users in some areas and accepting them in others (hardly a sound basis for English law).”

For my own part I would like to see Roger Howard (CEO of the UKDPC) or Dame Ruth Runciman (its Chairman) going to those communities they would designate as suffering minimal harm from drug dealing and which, as a result of their counsel, would be forced to accept the existence of local drug markets. My guess is that these are unlikely be the ones in which they themselves reside.

To judge by the reported comments of Bill Hughes, the agency director of SOCA, following the report’s publication, the thinking of some of those currently involved in senior drug enforcement positions may be equally muddled. He, it would seem, accepts the idea that the report asserts that we focus too much on seizures and arrests, has abdicated the idea of vigorous enforcement and is misguidedly advocating this implausible approach. The UK’s already declining drug seizures and arrests, seen in this context, are even more revealing (see my report, The Phoney War on Drugs) not least by contrast with Holland’s rising cocaine seizures and drug arrests.

The need for smarter enforcement is undeniable. But not of the UKDPC’s interpretation of the concept. Nothing less than a top to bottom rethink – a new, committed and well resourced national strategy with local action to protect our borders, to hit middle and local markets, keeping operations flexible, adaptable and most importantly ongoing – is called for.

This, not the UKDPC’s policy of quasi legalisation, will protect Antonia Senior’s daughter as she grows up; and not her mother’s appallingly ill thought ideas in the Times second ‘legalising’ article in 5 days; the one which brought this particular week’s drug debate offerings to an exhausting end.
Category: prisons and addiction
Comments
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Backdoor legalisation
John J. Coleman, PhD, presiden 2009-08-04 13:22:17
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An excellent commentary that exposes the illogical premise that more of a bad thing is good for us. It is not the poor of the world who beg for the legalisation of drugs but the elite who can afford to destroy the lives of the poor to preserve their own self-indulgent mandarinic lifestyle. Have they no shame in calling up the hallowed symbols of liberty and compassion to justify their drug lust? The tyrant always seeks to convince the innocent that the effect is causal and not the other way around. To understand this, one only needs to look at the level of violence wherever weak, corrupt, or non-existent government intervention in the drugs trade has produced de facto legalization.
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Professor
Neil McKegney 2009-08-04 15:24:29
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The UKDPC have called for enforcement resources to be targetted at those areas within which the drugs trade has caused greatest harm. This is a variant of the current drug policy that is focussed on the most harmful drugs (heroin and cocaine) and which by implication increasingly accepts other forms of drug use. However enforcement needs to tackle the fledgling drug markets with as much vigour as it tackles the well developed drug markets if it is to offer an effective deterrent to drug use and drug dealing. The idea that enforcement agencies increasingly desert those communities where drug use is occurring but not yet reaching the level of harm of other communities is simply a recipe for enforcement failure. What one wonders would the UKDPC say to any community that was seeking enforcement protection but which did not yet reach the bar of high harm that the UKDPC envisages? Communities need protection from the drugs trade and that more than anything else is what enforcement needs to provide. The idea of triaging enforcement resources and concentrating on the most harmed areas may sound attractive on paper but in reality may amount to no more than an abrogation of our responsibility to protect all of the communities affected by the drugs trade.
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UKDPC-Alice in Wonderland policies
David Raynes 2009-08-04 17:18:23
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If the ideas of UKDPC on allowing drug dealing/trafficking in some places but not others were to be followed (and Bill Hughes of SOCA apparently & allegedly gave it some positive consideration!)-the limited current system of control would be further undermined. Is that what UKDPC want? Actually this idea and the adverse consequences were demonstrated in several recent episodes of “The Wire”. Of course it is necessary to prioritise, THAT is a different thing from what is being suggested.

Give some dealers/traffickers (even relatively) safe passage in some areas
of activity by location or by methods and experienced law enforcers KNOW, dealers will gravitate there and expand their activity there and grow operations through that ignored system/location/method.
The objective of enforcement policy should be to make dealing and
trafficking a risky business and UK Plc a hard target rather than a soft target for external traffickers, most especially for those who are not British based. Internally to the UK, the objective of enforcement policy should be to make dealing/traficking a risky and unpredictable
business-everywhere. A clear secondary objective is to deter new entrants to the business. To suggest otherwise, as is simply nonesense. It is very much against the experience and evidence of the last 35 years of enforcement and of course would further undermine the current very weak overall UK Plc efforts. Seizures & arrests are not always the answer but they certainly help. Attrition and deterrence without those measures eg by seizing cash & assets can be undertaken but it has not been wonderfully effective so far. Local addict dealers can be persuaded into treatment by making their efforts non viable. Police need to work in partnership with other agencies to achieve this. Of course there has to BE some treatment available!

Containment of traficking IS possible, especially for an island nation. It needs, in the UK, much better coordination of effort between the Border Agency/Customs, SOCA & Constabularies. Does the Home Office understand why this has not happenned? Who was tasked to lead this? Was anyone? If not, why not?
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Drugs & Law Enforcement
Terry Byrne 2009-08-04 21:39:07
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UKDPC is right – but only so far as it calls for smarter law enforcement and says that law enforcement cannot eradicate drugs markets. Beyond that, UKDPC shows a low understanding and no sensible ideas about focusing law enforcement effort that is only matched by Bill Hughes of SOCA it would seem. Law enforcement can, at best, only provide a framework of deterrence and prevention so that other vital factors – parents, families and communities, schools, public figures, employers and health agencies – can secure and maintain our UK society’s rejection of drug misuse.
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correcting a number of errors and misconceptions
Steve Rolles 2009-08-04 22:03:50
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“the myth that law enforcement – hyperbolically designated as ‘prohibition’ by the pro drugs lobby – rather than drug use itself is the root of the country’s drug problem.”

– ‘prohibition’ is a term in wide use to describe the current approach to drug control – in contrast to regulated markets or free markets. There is no controversy over this and nothing ‘hyperbolic’ about it; it is a purely descriptive term – one used by the UK Government in drug strategies, and by the UNODC.

– ‘The pro-drugs lobby’ is an deliberately derogatory term based on the absurd premise that because you determine your views as anti-drug, those who disagree with you must be ‘pro-drug’. This is a classic example of a false binary, ignoring the obvious reality of many people who are passionately anti-drug but also support reform of ineffective and unjust policy and law – including a debate on legal regulation. Transform’ supporters include bereaved parents, religious leaders and public health professionals. Law Enforcement Against Prohibition is made up of over 10,000 serving and enforcement professionals – are they ALL pro drug? Please stop using this offensive and childish slur.

– finally, the central point of your opening sentence is wrong. Reform advocates such as Transform make a clear distinction between harms created by drug use – for which we advocate a public health response (treatment, education, prevention) and harms created or exacerbated by prohibition/ illicit markets – for which we advocate a rational exploration of regulated market alternatives. You should be aware of this from our meetings, and our publications in which it is clearly stated and which you have referenced.

Regarding Tom Feiling’s piece – it was clearly an opinion piece, and he is entitled to his opinion, just as you are . The reality of cocaine use/demand is a fact – it is the idea that an enforcement response can eradicate it that is delusional, as evidenced by the past 40 or so years. You, again, provide no evidence that increased enforcement is a key variable in decreased use (there is little/none as the WHO found in a massive global research project published last year to which I have directed you previously), beyond your cherry picked examples. Interesting that you again bypass the US experience again re cocaine use and enforcement spend / punitiveness.

Paddick’s views, like Cameron’s, seem to have shifted since he moved into the political mainstream, but clash with those of another met commander you have failed to mention, who responded in the Times this week: http://www.timesonline.co.uk/tol/comment/letters/a rticle6736613.ece
likewise Eddie Ellison former head of the met drug squad, and numerous other police (www.LEAP.cc’ etc).

I don’t have time to deconstruct your analysis of the UKDPC report, beyond highlighting that you have confused legalisation (legal regulation of markets and supply) with de-facto decriminlisation through tolerant policing of certain activities (use or low level dealing). The two are entirely different propositions, the UKDPC having made great efforts to distance itself from the former, whatever conspiratorial silliness you appear to be implying.

Again you provide no evidence that increased enforcement reduces use or more importantly (as a pragamatist) reduces harms, and fail to engage with the overwhelming evidence that enforcement has been largely counterproductive.
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Drug Free Scotland
Bill Cameron 2009-08-04 22:47:13
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As a parent for whom the jargon and politics of the battling “pro” and “anti” lobbies is confusing, the latest suggestion from UKDPC to allow drug dealing in certain areas and not in others, merely adds to our confusion. Surely some member of UKDPC can imagine the scenario from a parent’s point of view and conclude that the dealers will expand their activity in the areas relatively ignored by law enforcement. Current drug policy does not, as it seems to have been accepted, focus on only the most harmful drugs and dismisses any other form of drug misuse. UKDPC would be hard pressed to single out one area in Scotland where the uncontested violence and corruption due to drug abuse does not exist.
Why are parents lulled into a false sense of “ your kids are going to use drugs anyway, so just let’s stop trying to stop them”? Rubbish! – not in my home – and anyway who told you that? And are we also to ignore the effects of drugs: stealing; violence; corruption; family breakdown; illness’ death? Certainly not – sorry boys, the two go together.
No one wishes legalisation but currently the state exists where at one side of the street a young person can be lifted for possession of Cannabis (even perhaps for his parent’s M.S.) and at the other side of the street there are lines of young addicts waiting to collect their kit from a needle exchange (no exchange of needles ever evident) after which the go home to use Cocaine or Heroin – legally?
Smarter enforcement? Cooler catching? There is no argument that we require countrywide change across the board, adequately resourced to squash local drug markets. In my own unhappy and tiresome experience that has ever happened.
I am told it was Antonia Senior who quoted “Drugs are evil. Legalise them now” and who went on to protest her fear that her daughter would join the “addict” club. I would advise her to speak to a parent whose child is already a paid up member of that elite club.
Harm reduction, legalisation – call it what you like – is a paraphrase or extension of what the snake said to Eve. “You will surely NOT die……………..(implied) for I will teach you how to sin safely!”
So let’s get smart and expose such things so that social thinking people are able to promote their human rights in their own society. Everything else has not failed. It has not happened yet!
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The effect of increased enforcement
David Raynes 2009-08-04 23:08:18
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Steve Rolles you say:
“no evidence that increased enforcement is a key variable in decreased use”.

There is plenty of evidence & well founded suspicion that REDUCED enforcement in the UK has been a variable in increased use of drugs and pecifically certain drugs.

Some recent examples:-

Post 1999, Customs stopped targetting the main importers of cannabis, (though still acting aginst it when found), the market became flooded and in the words of one academic analyst “mature”. That led on to-may indeed have influenced- the unwise declassifying of cannabis, the weird “Lambeth experiment” (wider drug dealing effects conveniently forgotten by UKDPC?) and also the ubiquity of supply and use that we experienced around 2003/4. (Though just maybe I agree, use is falling a little now in older, better educated age groups as a result of increased publicity about harms and reclassification upwards). Even that conclusion is uncertain, cannabis may just have become unfashionable, in favour of cocaine, crack and other drugs.

At the end of the 1990s Customs to a certain extent, ignored or were by what was considered THEN, as pragmatic prioritisation choice, under-active against the organisers of cocaine courier traffic targetted into black communities. This was done in favour of targetting larger bulk consignments. It was significant in effect because the courier traffic was quite suddenly, in mid to late 90s, feeding a crack explosion. This crack explosion-forcast at the end of the 80s by Bob Stutman had been succesfully held off for nearly ten years.

More recently SOCA has focussed on “upstream disruption” and been noticeably unsuccsessful against both heroin and cocaine, direct, UK imports. SOCA has also often neglected to service Customs/Border Agency cold finds (having taken in the resources that previously did that work). They may have learned from that major error though by now and are changing their approach. SOCA is to date, much less successful against serious drugs traficking into the UK than the agencies that operated before it was formed. Cocaine is now ubiquitous in a way it was not, even five years ago. Seizures are down, arrests are down, interdiction of direct smuggling by boat is ata 15 year low.

I do not expect you to know about these things, they are not within your experience nor are they easy to understand from published sources but if you leap in to defend the silliness of UKDPC you ought to make a better effort to understand the history.

There is no defence for the utter garbage of what UKDPC are trying to suggest. Nature abhors a vacuum, so self-evidently does crime. Without a reasonable level of enforcement against any type of organised & profitable criminality it is highly likely to increase. For your evidence look at societies where the power of the state breaks down or the writ of the limited authority that exists, does not run.

It is not just the experience in the examples I have given you, I could give you many more.

Are you supporting UKDPC because legalisation of drugs is what you campaign for and because, having failed to persuade the public and the two relevant dominant political parties, you see causing a creeping breakdown of the present system as your best way forward?

Observers are entitled to be suspicious of both your motives and those of UKDPC. Neither of you in my opinion, are likely to be part of any solution to the UKs worsening drug problems. You have been part of the paid advocacy for liberalisation/legalisation, about which I so often complain and which I suggest has been part of the mixed messages about drugs which has so worsened the UK position in comparison with some neighbours.
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Steve Rolles 2009-08-05 09:41:11
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David – none of the examples you cite demonstrate that enforcement has a major impact on overall use, misuse or harm. Its impacts – when they do occur – will largely be displacement – between regions, or criminal networks(or occasionally between drugs) – this is true from producer country activity through to domestic street dealing. I think you identify the real issue re cannabis when you note that the fall in use was probably due to a shift in fashion. Determinants of drug use are largely social, cultural and economic, not enforcement/punishment related.

The fact that there is no international correlation between levels of enforcement and levels of availability and use is an inconvenient reality that you and Kathy both choose to avoid, instead cherry picking examples that support a link (eg sweden)and ignoring those that don’t (eg the US). Neither of you has ever cited or responded to the WHO study I have repeatedly flagged up.

Re UKDPC – we support their call for better evidence and I have personally been impressed with some of the research and analysis they have commissioned and published. We have, however, been publicly critical of much of their analysis (I had a critique of a previous report published in the Guardian – and a recent blog critiqued their new crime report – search the blog for UKDPC), where we disagree with it or feel it misses the point. This is as it should be and is no different from our engagement with Kathy’s work or anyone else’s.
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to enforce or not…
simon aalders 2009-08-05 10:05:44
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For the UKDPC to arrive at the conclusion that we should hand over communities to drug dealing, to avoid conflict between gangs was what i heard in the report, is astounding.
As has been stated, if the UKDPC think this is a good idea perhaps they should live in an area blighted by drug dealing and gang culture, or talk to the families trying to bring up children and live fulfilling lives in those areas before making such crass public statements.

There are numerous failed examples of apeasement to criminal gangs across the globe we do not need another failed experiment in the UK. The victims would not be shown on TV, nor gain the headlines as they struggle through the consequences of increased criminal activity. Those that propagate such policies will be long gone and deffinitely nowhere near any of those areas.

In my local area the community praise the Police for sustained enforcement activity, they want the public services to act vigourously to deal with drug/gang culture, and they want drug addicts treated properly – by that I mean taken off drugs to give them the best opportunity to turn their lives around.

They don’t want society to throw up it’s hands and say we give up, it’s too hard.

If the UKDPC have run out of steam and this idea tells me they have, there are plenty of others out here actually making a difference for communities.

Legalisation is no solution.
Decriminalistaion is not a solution.

Proper treatment, enforcement and community involement are.
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Displacement of criminal activity
David Raynes 2009-08-05 10:10:06
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Steve Rolles you say :
“Its impacts – when they do occur – will largely be displacement – between regions, or criminal networks(or occasionally between drugs) – this is true from producer country activity through to domestic street dealing”.

Well exactly. You make my very point. THAT is why UKDPC are fundamentally not just misguided, they are categorically wrong. They demonstrate no understanding of how crime operates. What they suggest is intellectually unsound. Displacement quite obviously operates in both directions. It was once said, I think by Da Costa, that countries get the drug problems they deserve. The UK has one of the worst drug problems in Europe now, it was not always thus (my historical view on high level traficking extends back 40 years) and it has got worse at an accelerating rate in the last 15 years compared to some of our neighbours. Precisely the period during which those at the top of UKDPC (Ruth Runciman & Roger Howard) have been most influential on policy and most active proselytising. Correlation is not causality but it is certainly a starting place for analysis. It should cause policy makers in the Home Office to think more clearly about why we are where we are and the history. They should do that and you should not ignore it.
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Good and bad drug dealers
Derek 2009-08-05 10:31:34
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Kathy wrote:

“Unbelievably this is the gist of the UKDPC’s Alice in Wonderland view of the illicit drug trade – that the violence that ensues is a function of police actions/enforcement not of the trade…”

So the likes of Al Capone were not a function of alcohol prohibition then? How come the off licence down the road here in Norwich isn’t run by the mob? It is, after all, the same drug being sold and only the regime it’s sold under is different.

Likewise whilst we’re discussing drug harms was not the existence of moonshine or bathtub gin down to the prohibition laws? Quite clearly they were Kathy. Quite clearly the prohibition law creates problems all of its own and these are in addition to any harms drugs can cause.

To deny any connection between the violence and other harms of the illegal drugs supply side with the application of prohibition is surely to deny reality and worse, to ignore the lessons of history.

Almost worse is to write that “law enforcement – hyperbolically designated as ‘prohibition’ by the pro drugs lobby”. Please Kathy, call a spade a spade. What we have is prohibition and is correctly called prohibition. Defend it by all means, but please don’t pretend it’s something else.

It’s interesting also that you claim cocaine use has become established in countries with liberal regimes whilst ignoring the situation in the USA, the leader of the war on drugs and hardly a “liberal” regime. Actually the most compelling reason for the growth of the Euro zone cocaine market is probably the Euro with its usefully high denominations.

It’s very telling though that after all this time the issue of drug law reform not only hasn’t gone away but is again gaining ground. The fact that it’s gaining ground not only here, but in the home of prohibition the USA is most illuminating.
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Corrigendum
ukdpc 2009-08-05 11:13:07
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We would like to correct some of the misreading of the UKDPC review on enforcement which Kathy and others have made.

In fact the review is all about making the best use of enforcement resources. It is thus about targeting supply side interventions more effectively, not giving up on enforcement as some have suggested. The thrust of our approach is about using a focus on the wide range of harms that individuals and communites experience from drug markets to stimulate innovation and to encourage assessment of impact to ensure that the maximum benefit is achieved.

We would urge people to read the reports themselves rather than assume that all that is written about them in the media or on blogs is accurate. The full reports can be found on our website at
http://www.ukdpc.org.uk/publications.shtml
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Drug enforcement and Drug Prevalence
Neil McKeganey 2009-08-05 11:56:15
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It is puzzling that UKDPC having authored the report on enforcement have not contributed to its blog discussions. However taking up the point made by Steve Rolles that there is no evidence of a link between enforcement and drug consumption. Quite the reverse is indeed the case since none of the currently illegal drugs are consumed at the same level as the legal drugs (tobacco and alcohol). The experience with these two legalised drugs is powerful evidence of the potential level of consumption of the illegal drugs were they to be legalised. As I have pointed out to Steve Rolles before in China at the time of the opium wars an estimated 20% of the population were thought to be addicted to opium. This shows us that there is nothing in the drugs themselves that necessarily limits their appeal to only a tiny minority of the population. If organisations like Transform truly believe that enforcement has no evident impact on level of use one wonders why they spend so much time lobbying for a change in drug laws and enforcement practices.
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Prohibition
Alison Hughes 2009-08-05 11:58:00
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If prohibition is so good – why isn’t Kathy Gyngell campaigning for the prohibition of the two most dangerous drugs in th UK – alcohol and nicotine? Instead she focuses her attention on an emotional and ill-informed attack on methadone, which is a useful treatment in helping people come off street drugs and changing their lives around. This does happen and a lot of people do eventually come off methadone but it takes a long time.
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legalisation and drug prevalence
Neil McKeganey 2009-08-05 12:00:18
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Taking up the point made by Steve Rolles that there is no evidence of a link between enforcement and drug consumption. Quite the reverse is indeed the case since none of the currently illegal drugs are consumed at the same level as the legal drugs (tobacco and alcohol). The experience with these two legalised drugs is powerful evidence of the potential level of consumption of the illegal drugs were they to be legalised. As I have pointed out to Steve Rolles before in China at the time of the opium wars an estimated 20% of the population were thought to be addicted to opium. This shows us that there is nothing in the drugs themselves that necessarily limits their appeal to only a tiny minority of the population. If organisations like Transform truly believe that enforcement has no evident impact on level of use one wonders why they spend so much time lobbying for a change in drug laws and enforcement practices
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legalisation and drug prevalence
Derek Williams 2009-08-05 13:04:16
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Neil McKeganey wrote: “none of the currently illegal drugs are consumed at the same level as the legal drugs (tobacco and alcohol)”.

Whilst this may be true, illegal drugs aren’t (or haven’t been) advertised and promoted. This is especially true for alcohol of course which is marketed ruthless at young people with designer drinks and drug speak advertising. Tobacco use in recent years has dropped considerably partly due to advertising bans and suchlike.

Regarding illegal drugs, we don’t really know how many people take them of course. The number of people who use cannabis is of a comparable order to the number who smoke tobacco and no-one would pretend the estimates for that number are anything better than an underestimate.

If the law was so effective, how are the high levels of use in the US explained? Or come to that the success of the Portuguese regime?

And please, we are all agreed that despite what Kathy might think, what we have out there is prohibition, isn’t it?
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Your Times letter 30/07/09
John Watson 2009-08-05 15:00:28
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Kathy,

In your letter to The Times 30/07/09, you say: “As cannabis use rises so, too, does psychosis.”

I have been looking for statistics that show this, as it would be almost certain proof that cannabis causes psychosis. However, I have been unable to do so.

I have found “Assessing the impact of cannabis use on trends in diagnosed schizophrenia in the United Kingdom from 1996 to 2005.” (PubMed: http://www.ncbi.nlm.nih.gov/pubmed/19560900 ), “Between 1996 and 2005 the incidence and prevalence of schizophrenia and psychoses were either stable or declining. […] In conclusion, this study did not find any evidence of increasing schizophrenia or psychoses in the general population from 1996 to 2005.”

Which seems to contradict your statement.

Where did your statistics come from, please?
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Director Crew 2000
John Arthur 2009-08-05 17:18:05
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‘If we were starting with a blank canvas which drugs would be legal and which illegal’ is a well practiced tool in substance use training (attitudes to substance use) which we have used with professionals, young people and community groups for many years now. It is amazing how many would put alcohol in the illegal bracket and allow many of the currently illegal drugs to be sold ‘under regulation’. This is not people who are ‘pro drugs’ or indeed soley people who have suffered alcohol or other drug probems themselves or in their family, but a wide range of professionals across health, social work, police and the justice system. Kathy, as someone who has lost a lot of family & friends through addiction and dependency and who thinks that there are serious flaws in our present system I am saddened by your Bush-esque like pronouncement that everyone who is not happy with the present drug laws and think there may be other solutions must be ‘pro drugs’. Nothing could be further from the truth and I’d like you to at least take that comment back and consider your rhetoric in the future. Of course you are entitled to your opinion as we all are, how else are we to achieve consensus as a society, however your remarks are at best often ill considered and increasingly appear to be deliberately provocative and insulting. To what ends I can only imagine.
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Steve Rolles 2009-08-05 18:52:32
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I await – from Kathy, David, Neil, or anyone, some evidence showing a statistically significant link between enforcement spend or punitiveness of enforcement and levels of use or drug harm between states (or regions), or some comment on the WHO (not pro-drug crazies) study last year the headline conclusion of which was;

“Globally, drug use is not distributed evenly and is not simply related to drug
policy, since countries with stringent user-level illegal drug policies did not have lower levels of use than countries with liberal ones.”

Degenhard et al, World Health Organisation, 2008 ‘Toward a Global View of Alcohol, Tobacco,
Cannabis, and Cocaine Use: Findings from the WHO World Mental Health Surveys’

Available in full online
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Drug harm and enforcement
Neil McKeganey 2009-08-06 06:24:28
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Steve an absolutely fundamental assumption of the legalisation position adopted by Transform and other organisations is that the greatest harm associated with drug use arises from the enforcement and what you call punitive drug policies. It is that assumption which in essence underpins your arguments for legalisation as being the most effective means of reducing drug harm. But where is the quantitative evidence that shows enforcement is a greater source of drug harm than drug use itself?
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drug harms vs policy harms
Steve Rolles 2009-08-06 10:47:47
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Its more complicated than that Neil. The nature of the drugs used, the way in which they are used and the environments in which they are used – are all negatively impacted by prohibition and the illicit anarchic underground culture controlled by criminal entrepreneurs it has created. So drug use itself becomes more harmful under prohibition than it would under a regulated system controlled by the appropriate state authorities, one in which a regulatory environment could progressively encourage a shift in culture towards safer products, behaviours (including abstinence), and using environments.

This is quite aside from the secondary harms created by prohibition in terms of crime, corruption, destabilisation of producer countries, conflict, environmental damage, human rights abuses, erosion of respect for authority and so on. I have made this argument very clearly in a number of publications comparing a user of illicit heroin to one on a heroin prescription.

Which causes more harm is impossible to gleam in this context – its the wrong question. More important is that harm is greater under the current regime than it would be under alternative approaches – which is the core of our argument – (something that in no way makes us ‘pro-drug’ as Kathy, Costa, David and others -but not you Im pleased to say- continue to childishly parrot). We also argue that the political nature of prohibition interferes with the development of evidence based responses, by immunizing the policy from scrutiny and diverting resources away from proven public health interventions into demonstrably counterproductive enforcement ones.

I’m wary of blaming enforcement per se, as that appears to put the blame on the police/army, when in fact they are merely the expression of a political program or ideology – ie prohibition; which is punitive by its very nature (it establishes a set of rules and punishements for breaking them) and place within the criminal justice system (not something I have determined). Would you say prohibition was non punitive, and if so how would you describe it?

And meanwhile, how about an answer to my other questions?

Kathy – why do you never get involved in the blog discussions that follow your comment pieces? I think you are possibly missing the point of blogs – which are supposed to be about dialogue.
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Drug Harm and Enforcement
Neil McKeganey 2009-08-06 17:54:24
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Steve I take your point that the ways in which drug use may be harmful are many and varied but in essence you must surely be operating with some notion of the amount of harm associated with the legal position of certain drugs relative to the quantity of harm associated with the consumption of those drugs in whatever legal context. If you are not then the prospect arises that you may well be arguing for the legalisation of substances that are substantially harmful in their own right and where the quantity of harm associated with their use may be only minimaly reduced by a change in their legal status. My sense is that the legalisation position has to assume that harm would be very substantially rather than minimally reduced by a change in the legal status of the drugs concerned. But the question remains as to what you base that assumption on. In the combined article you wrote with Danny K you said that:

The question is not whether human rights or public health comes first. Rather it is whether we collude with a policy that invariably degrades and sometimes destroys our clients and the communities in which they live, or whether we speak out against it, both as individuals and organisationally…More importan(t) is the question of how organisations can most effectively challenge the status quo, terminate prohibition and replace it with an effective system that is effective, just and humane (Kushlick and Rolles 2004:245).

That extract rather assumes that the health harms associated with drug use come a long way second to what you regard as the harms arising from the illegal status of the drugs concerned. If that is indeed you view then surely you need to make clear what your assessment of relative harm is actually based upon.
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Steve Rolles 2009-08-06 19:00:43
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We assume that harms to individual users would diminish (as argued above and in the CBA paper we discussed recently), and that harms associated with illegal markets would diminish (for obvious reasons). I don’t think even the UK government or UNODC would disagree with this.
I understand your argument (and theirs) that these gains would be more than outweighed by an increase in health harms associated with an increase in use were drug markets legally regulated – but I don’t agree with your assumptions that underpin this argument – and i also dont think you understand the sort of regulation we are calling for. I find the Chinese peasant opium use in the 19th century a particularly non-useful parallel for modern drug culture in urban Britain, and also do not agree that the experience with alcohol and tobacco supports your contention. Not only are alcohol (which is a deeply culturally embedded food and beverage, as well as drug)and tobacco (which does not intoxicate like most drugs – so does not seem to raise the same degree of moral indignation, despite its awful public health impacts)qualitatively different from most drugs we are concerned about (particularly problematic use of heroin and cocaine), they have also been subject to decades, even centuries, of aggressive marketing (something that would be forbidden under the regulatory models we advocate for other drugs), and had few of the other controls over product, price, vendors, outlets, users etc that we are calling for. Where such have been begun to belatedly implemented use has fallen without resorting to blanket prohibitions – e.g. tobacco in the UK – use of which continues to fall whilst cocaine (7 years in prison for possession, billions spent annually on interdiction) continues to rise.

We have, from the outset, called for better, indeed stricter, regulation of alcohol and tobacco as well – something entirely consistent with finding the optimum regulatory models, re outcomes, for all drugs. The reason we do not focus on these issues more is because there are plenty of agencies (Alcohol concern, ASH, the royal colleges etc) who already do it very well.
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Legalisation and Drug Harm
Neil McKeganey 2009-08-06 20:14:51
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Steve where is the template (evidence) for successfully regulated drug markets that Transform clearly aspire to extend to other currently illegal substances? I can see why you do not want to accept the Chinese opium situation fostered by the UK against the expressed wishes of the Chinese government because it does indeed indicate a level of opium consumption that Transform would rather discount as an impossibility within a developed “regulated”heroin market. But of course these awkward historical events are not se easily dismissed simply because they do not mesh with ones preferred view of hisotry and future drug policy and in that sense the examples do have to be considered for their possible relevance to current discussions.
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Steve rolles 2009-08-06 21:30:42
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surely a more relevant ‘awkward historical event’ (than opium use in peasant china 150 years ago) for you to respond to would be the steady increase in drug availability, use, misuse, crime, and overall harms (by any measure) under prohibition in the modern world – despite ever increasing resources being thrown at its enforcement. Wheres *your* evidence base for the policy we have now, and how much failure do you think is required before alternatives are regulatory are meaningfully explored. its fine to keep throwing questions at me but what about answering a few of mine?

I obviously cant produce an evidence base for the regulation we are advocating as it has not happened yet – beyond limited and often flawed/problematic models (coffee shops, heroin prescribing etc) or equally problematic – although useful paralell examples (e.g. regulation of gambling, and sex work), so you will always win on that front – I cant provide evidence from the future. I can only speculate with the evidence we have, whilst pushing for more to be gathered.

The problem is that, perhaps uniquely in health and social policy, an entire avenue of policy options has been closed down in perpetuity, on ideological grounds not evidential ones, not just re implementation – but even experimentation and research. This is particularly peverse and anomalous given that regulating risky commodities and and activities is absolutely the social policy norm, indeed it is one of the primary functions of Governments.

To be able to have flexible policy options in almost all aspects, except one; legal regulation of production and supply – is intellectually offensive and profoundly anti-science. Are archaic drug laws create an arbitrary line in the sand that should be an affront to everyone in public health or social policy. By all means make the evidential case for prohibition (and ill argue with you), but not on the basis of preventing others from exploring the alternatives. For ever.
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Drugs and Enforcement
Neil McKeganey 2009-08-07 09:32:20
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Steve although you cite the continuing use of illegal drugs as a failure of existing drug laws surely the fact that the level of use of those drugs is not comparable in any country to the level of use of the legal drugs in all countries is the clearest evidence there could ever be that existing drug laws have indeed succeeded in limiting the use of certain substances. I don’t know of any scientific study that could in any way provide evidence on a par with the consistent international pattern of illegal drug use consumption falling a long way short of the level of consumption of the legal drugs. However to argue for a change in our existing drug laws surely has to be based on something more than an ill-defined belief that in some vague ways things would be better under a legalised or regulated regime- better for whom, by how much and for how long? and with what unintended consequences? The standard response that organisations arguing for legalisation provide is to ask for the evidence of success of our current drug laws and then to claim that the failure of drug laws to entirely cease such drug use is a sign of their inevitable failure. This of course is a deeply ironic position for a legalisation group to adopt since illegal drug consumption is not something that they themselves wish to cease anyway. However your point that there is some kind of international policy conspiracy stopping the experimentation with different types of drug laws including legally regulated markets seems a bit strong to be honest since there are many countries that could be cast as having experimented with widely different drug laws including those that have adopted heroin prescribing safe injecting centres lower level penalties for drug possession etc.

Our debate started with the UKDPC publication of their report on evidence and Kathy Gyngell’s blog on that report I still think that it is strange that an organisation such as UKDPC that is clearly wanting to make a contribution to public and policy debate on the drugs issue is so reticent at contributing to this debate leaving you largely on your own as it were to argue for the position they have set out in their paper on harm reduction focussed drug enforcement.
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steve rolles 2009-08-07 13:49:06
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(im not arguing for the UKDPC position – which, I repeat, is distinctly NOT legalisation / regulation – this debate took a different turn)

I think you ignore the fact that there are plenty of legal drugs that are not so widely used (inhalants for example), and that amongst illegal drugs some are used far more than others – cocaine use is about ten times that of heroin for example, but it is equally illegal. This – along with the fact that trends in drugs go up and down apparently independtly of legal changes and even price, suggests that people’s drug choices are primarily determined by factors other than legality/punitive sanctions and related deterrence. The evidence base for a deterrent effect is incredibly poor – and just repeating alcohol and tobacco does not fill this yawing evidential abyss at the heart of entire prohibitionist paradigm.

There is no conspiracy against experimenting with legal regulatory options for supply – there are 3 UN conventions that that specifically prevent it, the single convention in particular (much of which was drafted in the 40s) tying states into a system that is no longer relevant to the world today. Challenging the conventions would raise unacceptable political and diplomatic costs (largely in terms of US pressure – but also potentially undermining the valuable aspects of the drug treaty system, and indeed the wider treaty system). Countries can experiment with decrim of possession and medical prescription models but decrim does not involve supply and prescription only covers a tiny proportion of users and the illicit market. Wider exploration of regulated legal supply remains undeniably off limits. The brief experiment with BZP in New Zealand is the only one I am aware of anywhere in the world; whilst not a total disaster, the regulation was inadequate and it has been reversed when the political pressure got too hot (and BZP is also not covered by the Conventions).

Trying to establish a link in international comparisons between levels of enforcement/punitiveness and levels of use is reasonable if done with appropriate methodological caveats (indeed it is something that many people, including Kathy and Costa, like to do – albeit in a cherry picked methodologically laughable fashion -in comparing UK and Sweden – the whole thing about ‘getting the drug problem you deserve’). The WHO did it more systematically and found no link (still waiting for a comment on this).

Significant correlations have, however, been found between levels of use/misuse and income inequality (Wilkinson/Pickett) . I doubt Kathy would want to push on that fascinating finding and see where it leads, but for me it once again highlights the key role in social, economic and cultural factors in determining the contours of drug culture, and relative marginal nature of enforcement policy.

The critique of prohibition’s failure on its own terms (reducing availability,use) is surely legitimate, as is highlighting the unintended consequences. Long term failure of this policy is not the only reason to explore alternatives but it is a perfectly rational and reasonable catalyst. We want to see reduced overall harm (to users and the wider community) and maximised health and wellbeing (rather than obsessing over reduced use). This obviously does not preclude reduced demand, but pragmatically focuses on reducing problematic use (which the UNODC interestingly acknowledges says is only 5% of total illicit use). Reducing non-problematic use is not the priority because it is, well, not problematic (unless one sees it as a issue of personal morality in which case it is a different debate to the pragmatic public health policy and law one).

11/17/2004

News Feature
By Erika Miles Edwards

South Boston is a close-knit community of 3 square miles and 30,000 people. It’s the kind of place where everyone knows everyone else, and gossip, good or bad, spreads like wildfire.

South Boston also is a community with a significant heroin problem. In the past three years alone, 125 young people from South Boston aged 17-24 have died from using heroin. An estimated five to ten times as many have overdosed — some several times — but lived. The community is on the front lines of an epidemic of heroin use among young adults in the greater Boston area, where the drug is $4 a bag and so potent that it can be snorted instead of injected. Heroin overdoses are one of the leading causes of death among young adults in the region.

People in communities that lose children to tragic circumstances tend to bond together, and South Boston is no exception. In response to the crisis, a group of 10 mothers with children addicted to heroin formed the South Boston Family Resource Center and started a 24-hour hotline for families who need help. The group finds treatment for those who want it, even driving people to their first appointment. For many young adults, they are a lifeline.

Strange Remedy

Sometimes crises bear solutions that, under any other circumstance, would seem strange. In the case of the mothers of the South Boston Family Resource Center, that solution came in the form of the Dorchester Drug Court, founded by Judge Robert Ziemian, presiding justice of the South Boston District Court, with help from the Robert Wood Johnson Foundation.

The drug court is a collaborative process designed to help addicted individuals facing criminal charges get through treatment, a process that can take 15 months or more. Participants start out in detox, and then go to residential treatment for a minimum of six months. When they’re ready, they move to outpatient treatment, then relapse prevention, before being left unsupervised. Then, they are on their own, their criminal charges erased.

Drug-court participants are motivated through the system with sanctions, drug testing, encouragement, and support. Most adult drug-court clients are severely addicted, with long histories in the criminal-justice and social-service systems.

“If you think someone should be in jail, that’s who we want in drug court, because we know drug court keeps people in treatment,” said Ziemian. “Most people have setbacks, but from our experience, we know when those are going to occur. We’re watching them, and we’re encouraging them to succeed.”

After Ziemian started his drug court in 1995, word spread quickly of this place where people with criminal records were getting treatment and leaving clean and sober. He soon was approached by a mother in South Boston, asking him what he could do to help stem the tide of heroin overdoses.

“We normally work with hardened addicts,” said Ziemian. “They’re older, and have had a longer history with substance abuse. It’s easier to convince them that they need treatment. But we had to do something to help these kids. We needed to stop the overdosing before another death occurred.”

Mothers of children at risk of overdoses received letters from the probation office, inviting them to discuss solutions. The result: The women decided to apply for restraining orders against their heroin-addicted kids. Since a child breaking a restraining order is subject to criminal charges, the parents reasoned, these young adults would get connected to the criminal-justice system and be supervised in the South Boston Drug Court, receiving life-saving treatment in the process.

Not surprisingly, word of the solution spread like wildfire throughout South Boston. Even with a shortage of resources, the court has produced dramatic results. “One of the things we’ve learned about drug court is that you can usually coerce someone into treatment with the threat of jail or brief incarceration,” Ziemian said. “We and the parents have a chance to get through to them.” Notably, not a single person under active supervision of the drug court has died of a drug overdose.

Building on History

For years, America has fought an expensive war against drugs, using tactics ranging from extensive eradication efforts to lengthy periods of incarceration. In 1989, a judge in Miami dared to try something different, offering people with criminal cases treatment instead of incarceration and, in doing so, created the nation’s first drug court.

Around the same time, Ziemian returned to Massachusetts from Operation Desert Storm. Assigned to the Dorchester District Court in South Boston, he processed cases involving guns and drugs, and gained a reputation for sentencing criminal defendants to lengthy periods of incarceration.

Ziemian’s first impressions of drug courts were less than positive. “I went to a workshop about it at a bar association meeting, and I thought the guy was out of his mind,” he recalled. But Ziemian was urged by the Boston Coalition Against Drugs and Violence and by Join Together to look into the concept. A turning point was when Ziemian went to Miami to see the first drug court in action.

“For those familiar with court proceedings, drug courts are very different,” said Ziemian. “You really have to go, watch what happens, talk about it afterwards. But once you’ve seen it in action, it all makes sense.”

Today, Ziemian is the driving force behind the development of more than 30 drug courts in Massachusetts, Connecticut, Maine, New Hampshire, and Rhode Island. His Dorchester drug court is a model recognized by the National Association of Drug Court Professionals.

Each drug court develops differently, but in Massachusetts and throughout New England, many follow Ziemian’s model — with his assistance. The process starts with the support of a district’s presiding judge, who brings the other justices on board. Ziemian then meets with the justices and the clerks, probation officers, lawyers, treatment providers, and public-health officials who need to work together to make the drug court succeed.

Over objections heard from every drug court he has ever established, Ziemian sets the first drug-court date for as soon after the initial meeting as possible; the only way to learn is to do, he believes. Cases stay in their courts of origin, which forces teams in those regions to work together to come up with solutions. Every probation officer, for example, has to learn how to work with serious drug offenders and treat substance use disorders holistically, coach people through treatment, even find them treatment slots.

Strong Results, But a Struggle for Funding

But do drug courts work? Research shows that addiction treatment significantly reduces drug use, crime, and additional medical problems. Drug courts specifically reduce recidivism, or re-entry into the criminal-justice system, which saves states significant amounts of money. Nationally, incarceration costs at least $20,000 annually per person, whereas drug court costs about $4,000. Additionally, one study found that the Lackawanna Drug Court in upstate New York State saved over $2.1 million annually in public assistance, foster care, substance-free births, and child support.

Despite widespread support within the criminal-justice system, however, Ziemian and his drug-court colleagues struggle for financial stability. The Massachusetts state legislature has never provided line-item funding for drug courts, so the state’s drug courts run on skeleton crews of committed lawyers, justices, and probation officers. Ziemian has received federal grant funding to hire a coordinator that he shares with other regional courts, but worries about what he will do when that support runs out.

“Drug courts have a lot of moving pieces — many more than regular courts,” said Ziemian. “People are with us for much longer than people with other types of sentences. We build relationships with them. They count on us. We don’t want to give up on it because of lack of resources.”

“We want to do everything we can to help these kids,” added Ziemian. “We need to institutionalize this system. We need data to show that it works. We need an alumni network that could mentor the kids in the system. We can’t do that without help.”

Despite such funding worries, Judge Ziemian hopes that all judicial districts in New England will soon have drug courts. “The only thing I don’t have to do is convince people that their communities have problems with drugs. Drugs are everywhere,” he says. “With drug courts, we can do something about it.”

The directors offer specific steps for planning and instigating the changes, provide real-life examples from diverse communities across the nation, and provide a road map for communities to adopt the six-step model all at once or one step at a time.

The report recommends screening each teen for drug and alcohol problems, assessing the severity of his/her drug and alcohol use, providing prompt access to a treatment plan coordinated by a service team; and connecting the teen with employers, mentors, and volunteer service projects.

The report describes how judges, probation officers, treatment specialists, families and community members can take steps right now to improve the future of these youth.

Upon completion of a brief survey, the full report is available as a PDF to download at no cost.

http://www.reclaimingfutures.org/?q=judicial_report_survey&reportname=ProjectDirectors

Publication Year: 2007

Publisher

Reclaiming Futures
Portland State University
527 SW Hall, Suite 400
Portland, or 97201
Phone: 503.725.8911
Website: http://www.reclaimingfutures.org/

2. Injecting into the groin and the injection of crack cocaine, which are associated with higher levels of
infection and risky injecting, have become more common.

3. Injecting site infections are common, with around one third of injecting drug users reporting having had an
abscess, sore or open wound at an injecting site in the last year.

4. Transmission of HIV and HCV infection through injecting drug use remains higher than in the late 1990s, with a fifth of recent initiates having hepatitis C and around one in 100 having HIV. Overall almost half of injecting drug users are now infected with hepatitis C and about one in 90 with HIV.

5. There has been a marked increase in the number of injecting drug users receiving the hepatitis B vaccine,
with two-thirds now reporting vaccination.

6. Services to reduce injecting related harms and support for those who want to stop injecting should continue to be developed in line with published guidance.

Key Findings
Behaviours: Levels of reported needle and syringe (direct) sharing have declined in recent years, following an increase in the late 1990s. In 2007, around a quarter of injecting drug users (IDUs) reported direct sharing in the previous month; this level remains higher than in the mid-1990s when about a sixth reported this. The sharing of other injecting equipment remains even more common. There are also indications that
two other factors associated with a greater risk of infection have become more common, with almost one in three IDUs now reporting injecting into the groin (femoral vein) and athird reporting the injection of crack-cocaine.

Hepatitis C: Overall, almost half of IDUs in the UK have been infected with hepatitis C. However, there are marked variations in hepatitis C prevalence within the UK, with low prevalences found in some areas. The overall prevalence of hepatitis C infection among IDUs has probably increased in recent years. Current levels of hepatitis C transmission remain higher than in the late 1990s with a fifth of IDUs becoming
infected within three years of starting to inject.

HIV: The incidence of HIV among IDUs is higher than in the late 1990s with around one in 100 now becoming infected within three years of starting to inject. The overall prevalence of HIV infection among IDUs however remains low compared to many other countries. In England & Wales, the overall HIV
prevalence among IDUs is currently around one in 90. Within England and Wales prevalence has increased amongst IDUs outside London: where it has risen from around one in 400 in 2002 to about one in 150 in 2007. However, the prevalence is higher in London, with around one in 20 HIVinfected. In Scotland, the prevalence of HIV among IDUs was around one in 350 in 2007, which is the lowest level reported
since this was first measured in 1989.

Voluntary confidential diagnostic testing: Uptake of testing for hepatitis C among IDUs in contact with drug services, after increasing markedly, now appears to be levelling off with around three-quarters having ever had a test. It is estimated that around half of IDUs with hepatitis C in contact with these services remain unaware of their infection, and that this proportion has not changed in recent years. There are also likely to be many current and former IDUs not in contact with services that will be unaware they have hepatitis C. Whilst most IDUs in contact with services report having had a test for HIV at some point, only two thirds
of those with HIV are aware of their infection.

Vaccination: The proportion of IDUs reporting uptake of hepatitis B vaccination has increased in recent years, with around two-thirds now reporting accepting at least one vaccine dose. However, the transmission of hepatitis B continues among IDUs.

Bacterial infections: Injecting site infections, which may cost the NHS as much as £47 million per annum, remain common with around one-third of IDUs reporting having had an abscess, sore or open wound at an injecting site in the last year. There are continuing problems ranging from localised injection site infection through to invasive disease associated with meticillin resistant Staphylococcus aureus and severe
group A streptococcal infection. The ongoing occurrence of wound botulism and tetanus cases also remains a concern.

Professor Susan GreenfieldIt is folly to legalise a drug that is known to leave users with permanent damage to their ability to reason, argues Susan Greenfield, the distinguished expert on brain processes (Sunday August 18 2002, The Observer) now that those anxious to look cool can puff cannabis freely in without fear of arrest, perhaps those of us who have argued that relaxing the laws on cannabis is Irresponsible and dangerous should retreat gracefully behind our chintz curtains. Yet the downgrading of
the classification of cannabis perpetuates the same tired old myths and the same serious problems.

Take the myth that cannabis is ‘just the same as’ alcohol. A glib yet logical riposte might be that if the drugs are truly identical why not just stick with the booze? What is the distinct appeal of cannabis that can be ignored in equating the two drugs? Such sophistry is inappropriate because alcohol and cannabis work on the brain and body in very different ways. Alcohol has a range of non-specific actions that affect the tiny electrical signals between one brain cell and another; cannabis has its own specialised chemical targets, so far less has a more potent effect.

Moreover, although drinking in excess can lead to terrible consequences, there are guidelines for the amount of alcohol that constitutes a ‘safe’ intake. Such a calculation is possible because we know alcohol is eliminated relatively quickly from the body.

With cannabis, it is a different story. The drug will accumulate in your body for days, if not weeks, so, as you roll your next spliff, you never know how much is already working away inside you. I challenge any advocate of cannabis to state what a ‘safe’ dose is. Until they do, surely it is irresponsible to send out positive signals, however muted? Another notion is that cannabis is less harmful than cigarettes. I’m not sure how this idea came about, certainly not as the results of any scientific papers.

We do know cannabis smoke contains the same constituents as that of tobacco: however, it is now thought that three to four cannabis cigarettes a day are equivalent to 20 or more tobacco cigarettes, regarding damage to the lining of the bronchus, while the concentration of carcinogens
in cannabis smoke is actually higher than in cigarettes. And if cannabis were ‘just the same’ as alcohol and cigarettes, why are people not taking those already legal drugs for the much-lauded
pain-relief effects? After all, another case for the relaxation of the laws on cannabis is the ‘medical’ one that it is an effective analgesic. But there is a world of difference between medication prescribed in a hospital, where the cost-benefit balance tips in favour of pain relief, compared to a healthy person endangering their brain and body needlessly. Even the most loony of liberals has not suggested tolerance for morphine or heroin abuse, because they are prescribed clinically as potent painkillers.

And think about it: if cannabis brings effective relief from pain, then how does it do so? Clearly by a large-scale action on the central nervous system. Further wishful thinking is that, because cannabis doesn’t actually kill you, it is OK to send out less negative legal signals, even though the Home Secretary admits that the drug is dangerous. Leaving aside the issue that cannabis could indeed be lethal, in that
the impaired driving it can trigger could well kill, there is more to life than death. It is widely accepted that there is a link between cannabis and schizophrenia: as many as 50 per cent of young people
attending psychiatric clinics may be regular or occasional cannabis users. The drug can also precipitate psychotic attacks, even in those with no previous psychiatric history. Moreover, there appears to be a
severe impairment in attention span and cognitive performance in regular cannabis users, even after the habit has been relinquished.
All these observations testify to a strong, long-lasting action on the brain. Some attempts have been made in laboratories to work out what cannabis could actually be doing to brain cells. So far, some data have suggested that there can be damage to neurons, and at doses comparable to those taken on the street.

None the less, others argue that the experimental scenario of isolated neurons growing in a lab dish are hardly a natural situation, and that such data have to be interpreted with caution. But absence of evidence is not evidence of absence. The effects on the brain in real life are most probably subtle and therefore hard to monitor: it’s not so much that cannabis will create great holes in your brain, or deplete you wholesale of all your best neurons. Instead, by acting on its own special little chemical targets (and because it will therefore work as an impostor to a naturally occurring transmitter), the drug is likely to modify the configuration of the networks of brain cell connections. These configurations of connections make you the unique person you are, since they usually reflect your particular experiences. So a change
will be hard to register from one person to another, and certainly from one slice of rat brain to another: but still, it will make you see the world in a different way – characteristically one depleted of
motivation.

It is hard for me, as a neuroscientist, to accept that a drug that has the biochemical actions that it does, that hangs around in the brain and body, and that has dramatic effects on brain function and dysfunction, could not be leaving its mark, literally, on how our neurons are wired up and work together. It is argued that we will never stamp out cannabis use, and therefore we should
give up trying. But we will not stamp out murder or house break-ins or mugging, yet I’ve never heard an argument for freeing up police time by liberalising the law on these acts. Laws, it is said, are
only enforceable when the majority wants them enforced, yet the arguments used for easing up on cannabis apply equally to promoting ecstasy or other mind-bending substances.
Do we really want a drug-culture lifestyle in the UK? Cynically, one could argue that it is politically expedient to court the youth vote, to open up the inevitable prospect of revenue from a new source of taxes and to help the ailing tobacco industry prosper from a great new product of readymade packets of spliffs. The condoning of chemical consolation also distracts from other problems. We have failed our young people in providing homes and jobs and, by giving them an easy route into a chilled-out oblivion, have turned our backs on the far more challenging prospect of initiating policies to help them realise their potential and live better and more fulfilling lives. They are paying a high price for cool.

Source: www.guardian.co.uk/science Aug.2002

The high prevalence of co-morbidity between drug use disorders and other mental illnesses does not mean that one caused the other, even if it appeared first. In fact, establishing causality or directionality is difficult for several reasons. Some symptoms of a mental disorder may not be recognized until the illness has substantially progressed, and imperfect recollections of when drug use/abuse started can also present timing issues. Still, three scenarios deserve consideration:
1. Drugs of abuse can cause abusers to experience one or more symptoms of another mental illness. The increased risk of psychosis in some marijuana abusers has been offered as evidence for this possibility.
2. Mental illnesses can lead to drug abuse. Individuals with overt, mild, or even subclinical mental disorders may abuse drugs as a form of self-medication. For example, the use of tobacco products by patients with schizophrenia is believed to lessen the symptoms of the disease and improve cognition (“Smoking and Schizophrenia: Self-Medication or Shared Brain Circuitry?”).
3. Both drug use disorders and other mental illnesses are caused by overlapping factors such as underlying brain deficits, genetic vulnerabilities, and/or early exposure to stress or trauma.
All three scenarios probably contribute, in varying degrees, to how and whether specific comorbidities manifest themselves.
Overlapping Conditions– Shared Vulnerability
High Prevalence of Drug Abuse and Dependence Among Individuals With Mood and Anxiety DisordersHigh Prevalence of Mental Disorders Among Patients With Drug Use Disorders

Higher Prevalence Smoking Among Patients With Mental Disorders

Because mood disorders increase vulnerability to drug abuse and addiction, the diagnosis and treatment of the mood disorder can reduce the risk of subsequent drug use. Because the inverse may also be true, the diagnosis and treatment of drug use disorders may reduce the risk of developing other mental illnesses and, if they do occur, lessen their severity or make them more amenable to effective treatment. Finally, because more than 40 percent of the cigarettes smoked in this country are smoked by individuals with a psychiatric disorder, such as major depressive disorder; alcoholism; post-traumatic stress disorder (PTSD); schizophrenia; or bipolar disorder, smoking by patients with mental illness contributes greatly to their increased morbidity and mortality.
Data in top two graphs reprinted from the National Epidemiologic Survey on Alcohol and Related Conditions (Conway et al., 2006).
Data in bottom graph from the 1989 U.S. National Health Interview Survey (Lasser et al., 2000).
Common Factors
Overlapping Genetic Vulnerabilities. A particularly active area of comorbidity research involves the search for genes that might predispose individuals to develop both addiction and other mental illnesses, or to have a greater risk of a second disorder occurring after the first appears. It is estimated that 40-60 percent of an individual’s vulnerability to addiction is attributable to genetics; most of this vulnerability arises from complex interactions among multiple genes and from genetic interactions with environmental influences. In some instances, a gene product may act directly, as when a protein influences how a person responds to a drug (e.g., whether the drug experience is pleasurable or not) or how long a drug remains in the body. But genes can also act indirectly by altering how an individual responds to stress or by increasing the likelihood of risk-taking and novelty-seeking behaviors, which could influence the development of both drug use disorders and other mental illnesses. Several regions of the human genome have been linked to increased risk of both, including associations with greater vulnerability to adolescent drug dependence and conduct disorders. The rate of smoking in patients with schizophrenia has ranged as high as 90 percent.
Involvement of Similar Brain Regions.
Some areas of the brain are affected by both drug use disorders and other mental illnesses. For example, the circuits in the brain that use the neurotransmitter dopamine–a chemical that carries messages from one neuron to another– are typically affected by addictive substances and may also be involved in depression, schizophrenia, and other psychiatric disorders.
Indeed, some antidepressants and essentially all antipsychotic medications target the regulation of dopamine in this system directly, whereas others may have indirect effects. Importantly, dopamine pathways have also been implicated in the way in which stress can increase vulnerability to drug addiction. Stress is also a known risk factor for a range of mental disorders and therefore provides one likely common neurobiological link between the disease processes of addiction and those of other mental disorders.
The overlap of brain areas involved in both drug use disorders and other mental illnesses suggests that brain changes stemming from one may affect the other. For example, drug abuse that precedes the first symptoms of a mental illness may produce changes in brain structure and function that kindle an underlying propensity to develop that mental illness. If the mental disorder develops first, associated changes in brain activity may increase the vulnerability to abusing substances by enhancing their positive effects, reducing awareness of their negative effects, or alleviating the unpleasant effects associated with the mental disorder or the medication used to treat it.
Smoking and Schizophrenia: Self- Medication or Shared Brain Circuitry?
Patients with schizophrenia have higher rates of alcohol, tobacco, and other drug abuse than the general population. Based on nationally representative survey data, 41 percent of respondents with past-month mental illnesses are current smokers, which is about double the rate of those with no mental illness. In clinical samples, the rate of smoking in patients with schizophrenia has ranged as high as 90 percent.
Various self-medication hypotheses have been proposed to explain the strong association between schizophrenia and smoking, although none have yet been confirmed. Most of these relate to the nicotine contained in tobacco products: Nicotine may help compensate for some of the cognitive impairments produced by the disorder and may counteract psychotic symptoms or alleviate unpleasant side effects of antipsychotic medications. Nicotine or smoking behavior may also help people with schizophrenia deal with the anxiety and social stigma of their disease.
Research on how both nicotine and schizophrenia affect the brain has generated other possible explanations for the high rate of smoking among people with schizophrenia: The presence of abnormalities in particular circuits of the brain may predispose individuals to schizophrenia; increase the rewarding effects of drugs like nicotine; or reduce an individual’s ability to quit smoking. The involvement of common mechanisms is consistent with the observation that both nicotine and the medication clozapine (which also acts at nicotine receptors) can improve attention and working memory in an animal model of schizophrenia. Clozapine is effective in treating individuals with schizophrenia. It also reduces their smoking levels. Understanding how and why patients with schizophrenia use nicotine is likely to help us develop new treatments for both schizophrenia and nicotine dependence.
The Influence of Developmental Stage
Adolescence–A Vulnerable Time. Although drug abuse and addiction can happen at any time during a person’s life, drug use typically starts in adolescence, a period when the first signs of mental illness commonly appear. It is therefore not surprising that co-morbid disorders can already be seen among youth. Significant changes in the brain occur during adolescence, which may enhance vulnerability to drug use and the development of addiction and other mental disorders. Drugs of abuse affect brain circuits involved in reward, decision making, learning and memory, and behavioral control, all of which are still maturing into early adulthood. Thus, understanding the long-term impact of early drug exposure is a critical area of co-morbidity research.
The brain continues to develop into adulthood and undergoes dramatic changes during adolescence. One of the brain areas still maturing during adolescence is the prefrontal cortex– the part of the brain that enables us to assess situations, make sound decisions, and keep our emotions and desires under control. The fact that this critical part of an adolescent’s brain is still a work in progress puts them at increased risk for poor decisions (such as trying drugs or continuing abuse). Thus, introducing drugs while the brain is still developing may have profound and long-lasting consequences.
The high rate of co-morbidity between drug abuse and addiction and other mental disorders argues for a comprehensive approach to intervention that identifies, evaluates, and treats each disorder concurrently.
Early Occurrence Increases Later Risk. Strong evidence has emerged showing early drug use to be a risk factor for later substance abuse problems; additional findings suggest that it may also be a risk factor for the later occurrence of other mental illnesses. However, this link is not necessarily a simple one and may hinge upon genetic vulnerability, psychosocial experiences, and/or general environmental influences. A recent study highlights this complexity, with the finding that frequent marijuana use during adolescence can increase the risk of psychosis in adulthood, but only in individuals who carry a particular gene variant (see sidebar, “The Influence of Adolescent Marijuana Use on Adult Psychosis Is Affected by Genetic Variables”).
The Influence of Adolescent Marijuana Use on Adult Psychosis Is Affected by Genetic Variables

Percentage of Individuals Meeting Diagnostic Criteria for Schizophreniform Disorder at Age 26

Source: Caspi A, Moffitt TE, Cannon M, et al., 2005.
The above figure shows that variations in a gene can affect the likelihood of developing psychosis in adulthood following exposure to cannabis. The Catechol-O-Methyltransferase gene regulates an enzyme that breaks down dopamine, a brain chemical involved in schizophrenia. It comes in two forms: Met and Val. Individuals with one or two copies of the Val variant have a higher risk of developing schizophrenic-type disorders if they used cannabis during adolescence (dark bars). Those with only the Met variant were unaffected by cannabis use. These findings hint at the complexity of factors that contribute to co-morbid conditions; however, more research is needed.
Source: NIDA Jan.2009

Though unable to securely document outcomes, three projects have shown that British communities can generate the kind of coordinated action which new reports from the USA and Sweden have shown curtail alcohol-related violence and injury, creating substantial cost-savings for society.
FINDINGS Rather than targeting risky drinkers, all the projects targeted high-risk neighbourhoods, aiming to modify features of the social and physical environment which generate alcohol-related violence and disorder.
UK From 2004, parallel projects Jointly known as the UK Community Alcohol Prevention Programme. in Glasgow, Cardiff and Birmingham sought to generate action locally to promote responsible service of alcohol in bars and shops, enforce licensing and allied laws, limit alcohol outlets, and to modify the environment and transport services to improve safety. Awareness-raising initiatives aimed to stimulate support from residents, politicians, licensees and local services. The projects were among only five in the UK found to meet international criteria1 for ‘multi-component’ programmes which simultaneously bring a range of influences to bear on alcohol problems.
The featured report2 documented how all three were able to generate activity of the kind they sought. In the absence of a systematic evaluation, official statistics and data gathered by the projects themselves was used to assess whether this activity had reduced alcohol-related problems – problematic, because the projects’ effects could not easily be isolated and the figures fluctuated due to factors other than the real levels of crime or injury.
Perhaps clearest was the impact in Birmingham, where in the targeted area (a transport corridor crossing three suburbs) the project started with a clean slate in terms of existing community organisation. Birmingham too seems to have had the strongest enforcement component, shown by research ( In context) to be the greatest single influence. Trading standards staff visited all the area’s alcohol outlets, alerting staff to their responsibilities and warning of future ‘sting’ operations to test whether outlets would sell to underage youngsters. Police recorded reports of licensing infringements, followed up with an advice visit, and mounted highly visible operations similar to those used in relation to illicit drugs.
Possibly as a result, offences such as vehicle crime, domestic burglary and robbery in the area fell by over a third compared to just 9% in a neighbouring area, and public place wounding fell by 30% compared to 17%, though the numbers involved were small. Unlike elsewhere, after the project was established few premises sold to underage test purchasers and most asked for proof of age.
USA The US project targeted two poor neighbourhoods relatively crowded with alcohol outlets and blighted by crime and alcohol-related problems. A robust Staggered implementation at the two sites and before and after measures benchmarked against the rest of the city offered multiple checks on whether the interventions were responsible for any improvements.evaluation3 documented reductions in violent crime and injuries, among the priorities for UK projects.
Local community organisations prioritised control of alcohol outlets to tackle underage drinking and alcohol-related violence. Training in responsible beverage service was taken up by 40–70% of outlets after personal and persistent approaches by project staff and police. Shop managers were warned that police would mount test purchases by underage youngsters. An accompanying officer immediately initiated proceedings against offending outlets. Given this backing, there was a clear reduction in sales, prompting replication city-wide. Similar operations were not undertaken in bars where, without enforcement backing, staff training on its own did not lead more premises to refuse service to drunk patrons. The bottom-line finding was that across both sites, the interventions were followed by significantly greater falls than in the rest of the city in assaults According to both police and medical records. and injuries Before the waters were muddied by city-wide implementation, there was also a greater reduction in injuries specifically related to drinking or drug use. due to traffic accidents. Some of the relative reductions were substantial – over a third for assaults and traffic accidents. Given the social costs imposed by such incidents, the project was likely to have been cost-beneficial.
SWEDEN The Swedish report4 showed that such programmes can indeed save society money. It attached monetary values to an earlier finding5 that a city-centre programme targeting licensed premises reduced violence Represented by reports to the police. by 29%. The resulting estimate was that it saved society 39 times more than it cost, primarily due to reduced criminal justice expenditures. The calculations were subject to potential error but even when savings were limited to police work, the most securely estimated element, they were seven times greater than costs. A dip in quality of life after being the victim of a crime meant that the interventions also gained one quality adjusted life year (QALY) for each 3000 Euros spent, well within the Swedish yardstick of 54,000 Euros.
After an upsurge in violence when on-licence outlets expanded, Stockholm County Council initiated the programme to curb serving of drunk patrons in the central district. Test purchases by apparently drunk actors generated support for responsible beverage service training, later made a condition of licence renewal for late-night venues. Liquor law enforcement (especially the ban on serving drunk patrons) was stepped up by police and the licensing board, largely in the form of warning letters rather than formal proceedings. Resulting reductions Inevitably the calculations incorporated arguable assumptions, but the magnitude of the gains were such that substantial benefits seem certain. in violence were estimated on the basis of before and after trends in the intervention district compared to the next most similar area. Benefits grew in line with the unfolding of the programme, reinforcing the case that this was an active ingredient. Once again, enforcement was thought to have been the main influence. Even in the comparison area, underage sales fell after activists organised test purchases and notified offenders to the police, who banned some from selling alcohol.
IN CONTEXT Reviewers6 have concluded that the ‘environmental’ approach7 (controlling the geographic, retailing and social environments in which alcohol is distributed, sold or consumed, and stepping up enforcement) tested in these studies can be more effective than trying to affect individuals through education or persuasion. However, impacts sometimes remain modest, partly because the scope for local action is limited by national or regional laws.
Police or licensing authority action backed by ultimate legal sanctions can on its own have a major impact, but requires other components to amplify and sustain its effects. Publicity makes authorities aware of the need for action and licensees aware of the potential consequences of failing to comply, while local lobbying helps gain support for the required intensity and persistence of effort.8 9 Possibly enforcement works because it stimulates defensive management actions10 such as firm and clear policies on adhering to regulations and a system for monitoring staff compliance. Commercial considerations often mitigate against such policies, but can also generate them if otherwise the business faces closure or costly restrictions.
British research includes a landmark study11 based on test purchases by underage youngsters which suggested that many vendors’ primary concern was not to avoid underage selling as such, but to avoid successful prosecution for selling to children who were clearly underage. In Cardiff,12 the main lessons of a programme to curb alcohol-related city-centre violence and disorder seemed to be that intensive implementation is needed to have a major impact. Planning and licensing decisions which increase the density of drinking outlets, and competitive and financial pressures driving the policies of large club or pub chains, can counter the benefits. However, benefits remained and were probably enough to create substantial cost-savings for society. Though not formally evaluated, similar enforcement-led programmes13 stimulated by the 2004 English national alcohol strategy have encouraged licensee compliance and appear to have reduced alcohol-related crime and disorder. Sales to underage youngsters have also been curbed by recent test purchase14 operations15 allied with trading standards and/or police follow-up.
PRACTICE IMPLICATIONS The UK report argued for environmentally-based community projects on the grounds that these probably represent the best chance for minimising harm in the face of national deregulation and promotion of alcohol consumption. Yet the leverage local projects can exert depends partly on the tools made available by national laws and policies to the projects and to the authorities they seek to influence, tools abolished or weakened or by deregulation. Given adequate powers, local lobbying and coordination can maximise their potential and tackle factors beyond the reach of the law.
So a crucial issue is how far national UK frameworks provide the required support and legislative tools. New British alcohol strategies and laws and attendant funding do provide a basis for projects similar to those featured, particularly the powerful tool of test purchases to expose underage service. But at the same time (less so in Scotland) they limit the scope for licensing authorities to respond to community concerns. Click here for summaries of the situations in England, Wales and Scotland.
Flexibility is essential because the impacts of commonly used tactics depend on the environment with which they interact; a different mix works best in different situations.1 10 The ideal16 is when national support and regulations afford localities the required tools within an accountability framework which motivates effective action, but which also gives localities discretion on what to target and how.
There are however some general principles. Regardless of the interventions built upon them, test purchasing and the construction of a database linking untoward incidents to particular premises are important in motivating and targeting action and assessing its impact. The visible and credible possibility of enforcement action against alcohol outlets must be persistently maintained if it is to have anything but a fleeting impact. Attention should be paid both to alcohol consumption and the factors17 (such as crowding, transport problems, divorcing alcohol from food, poorly kept or managed premises, glasses easily transformed in to weapons, inadequate training and monitoring of staff) which potentiate violence and disorder.
In the UK guidance on local strategies18 is available and a new database19 features examples. International lessons on community alcohol interventions have also been usefully encapsulated.20 These include: devolve decision-making to the community while supplying research-based knowledge; rapid feedback of results motivates participants and keeps projects on track; recruit influential and respected local leaders; considerable lead-in time is needed to build the social and organisational infrastructure for community action, and projects need a few years to fully deliver; project staff must expect and permit adaptation not just of methods but also aims in response to the community’s strengths and self-perceived needs; success comes easier in communities where the project’s aims are already high on the agenda; community norms and alcohol availability restrictions have their greatest impacts in self-contained, stable communities whose residents and businesses cannot easily escape their impact; a key element is the surer detection and sanctioning of transgressors brought about by the more intensive use of existing legal powers; however, these legal powers must in the first place have the potential to be effective.
Source: address http://findings.org.uk Feb.2009

In good faith, the Substance Misuse Management in General Practice issued guidance now proven to be based on unfounded figures – they were taken at face value from the National Treatment Agency for Substance Misuse. Peter O’Loughlin puts the record straight.
Many – perhaps most of us – have become accustomed, even weary, of the plethora of self-congratulatory announcements issued by the National Treatment Agency for Substance Misuse. Most of the spin aims to persuade us that protocols and implementations of the current drug treatment strategy are succcessful. Indeed, such is the glut of these proclamations of success, that there is a temptation, at least by this writer, to skip them in favour of more factual and unbiased reading.
On the other hand, when a responsible and professional network such as the Substance Misuse Management In General Practice chooses to re-issue verbatim one of the more misleading documents emanating from the NTA, and endorse it as an “important report”, this writer sits up and pays attention.
The document in question is Good Practice in Harm Reduction (NTA report, October 2008).
While acknowledging that government targets for reducing drug-related deaths have not been met, it makes the following claim: “Drug related deaths have gone down in recent years”.
It then purports to show how harm reduction “combines work aimed directly at reducing the number of drug-related deaths and blood-borne virus infections, with wider goals of preventing drug misuse and of encouraging stabilisation in treatment and support for abstinence”.
It is the intention of this article, with the aid of statistical evidence from the National Audit Office and the Health Protection Agency, to show that the claim relating to drug deaths is palpably misleading – and that the current emphasis on harm reduction is failing not only in reducing drug deaths, but that they are actually increasing. This is alongside the abysmal failure of inappropriately named “harm reduction” methods to contain the escalation of blood-borne diseases.
NATIONAL AUDIT OFFICE FIGURES.
The following facts for drug deaths arising from misuse were published by the NAO in its April 2007 and autumn 2008 reports.
• Drug deaths from heroin and morphine are increasing year on year
• In 2003-4 there was a marked increase in drug-related deaths which were largely attributed to heroin, methadone and morphine.
• Drug-related deaths are the highest in five years.
• The total number of drug-poisoning deaths arising from drug misuse in 2007 increased by 16% from 2006, to 2,640.
• In 2007, 196 deaths involving cocaine occurred, the highest number of deaths involving cocaine since records by the Office of National Statistics began in 1993.
•
Deaths attributed to methadone are at their highest since 1999. In 2007, methadone-related deaths increased by 35% over 2006 to 325.
HEALTH PROTECTION AGENCY FACTS.
The following facts were published by the Health Protection Agency.
• The level of HIV infection among injecting drug users (IDUs) in England and Wales is higher now than at the start of the decade.
• In London, where the prevalence of HIV in IDUs is higher than elsewhere in England and Wales, one in 20 IDUs is infected.
• In the remainder of England and Wales, HIV among IDUs has risen from about one in 400 in 2002 to about one in 150 in 2006.
• The prevalence of hepatitis C among IDUs has risen from 33% in 2000 to 42% in 2006.
• About one in five IDUs has hepatitis B infection, which extrapolates as an increase approaching 200% since 1997.
FACING THE FACTS.
It is self evident from the facts that the disproportionate emphasis on harm reduction is failing to achieve that which the NTA document would have us believe.
The author(s) of the document contents have – knowingly or unknowingly – resorted to a technique known as ‘perception management’. This process could be regarded as more sinister than spin, since it seeks to bury the truth under a garbage of rhetoric in order to manufacture a ‘truth’ designed to influence or change the perceptions of a targeted audience.
Via email, I expressed my disappointment to the SMMGP for publishing as a “policy update” the NTA document, together with the endorsement the SMMGP gave. I now place on record my appreciation to Dr Chris Ford for the courtesy and promptness of her response.
In an age where avoidance of responsibility is so common, I also take this opportunity of expressing my admiration and respect for the forthrightness of her “mea culpa”, together with the integrity and that rare quality of humility which she displayed in our subsequent correspondence.
PETER O’LOUGHLIN is certificated in substance misuse and dependency by the Department of Addictive Behaviours, St George’s Medical School and Addaction, is an associate member of the Medical Council on Alcohol, a registered psychotherapist and clinical hypnotherapist. His 25 years’ experience spans detox, street work, rehabilitation,1:1 and group counselling.
Source: Addiction Today Feb.22nd 2009

“Britain’s rehab services are facing collapse. No fewer than 15 of the UK’s 100 rehab centres have closed in the past 15 months, despite an increase in the number of people seeking help for addictions.
Because of changes in government health policy, private rehab centres are finding fewer and fewer health authorities are willing to foot the bill for addicts to have residential treatment, despite that fact that it is much more effective in getting them off drugs, according to the Addiction Recovery Foundation.
The Independent on Sunday learnt this weekend that a flagship rehab centre – £26m Winthrop Hall in Kent – is preparing to shut after only one year of operation.
According to the latest Department of Health figures, 202,660 drug users were seen by addiction services in England in 2007-08.
The National Treatment Agency (NTA) has spent millions of pounds getting thousands more drug users into contact with addiction services since it was set up in 2001. Yet last year only 3 per cent of cases were referred to a residential rehab service, while two-thirds were prescribed heroin-substitute medication by GPs and NHS doctors working in addiction services.
Critics claim there are few long-term benefits of this medication-centred approach. The majority of rehab services use a version of the 12-step programme, and abstinence – becoming drug free – is the goal after four to six weeks of intense therapy. Clinics are run by large companies such as The Priory or small charitable organisations such as the Providence Projects in Bournemouth.
Up to now, rehab has been paid for by the drug abusers themselves or their local health service. But, increasingly, government policy supports putting as many addicts as possible into methadone-substitute programmes because they are cheaper.
As a result, rehab clinics such as Winthrop Hall have become reliant on private clients. The hotel-style addiction clinic was opened in October 2007 by Jon Moulton, a venture capitalist and millionaire, to provide specialist treatment in luxury surroundings for high-flying City executives. But yesterday, staff confirmed that the £32,000-a-year clinic is no longer accepting new patients.
Advocates of rehab say that the closure encapsulates the problem with government thinking on rehab. They point to research by the University of Glasgow, which found drug users who go through residential rehab are seven times more likely to be drug-free after three years than those who go to methadone clinics.
The Health Care Commission last week identified the low use of residential rehab services as a weakness.
Dr David Best, from the Department of Psychiatry at the University of Birmingham, said: “Commissioners have spent bigger and bigger slices of the pie on harm reduction services at the expense of rehab, despite the evidence that rehab works. Users now have to jump through so many hoops to get there, it has become much harder, and rehab centres have closed as a result. It’s not because we don’t need these services but the system has become saturated in methadone clinics, which are a much cheaper and easier way to ‘treat’ people.”
Professor Neil McKeganey, director of the Centre for Drug Misuse in Glasgow, said: “When we stop patting ourselves on the back and look back on this period, we will see that this was a shameful dereliction of our responsibility and we failed the majority of drug users by keeping them locked into addiction. Drug services fail addicts, contrary to official figures which report overwhelming success. Our research shows that those lucky enough to get residential rehab are seven times more likely to be drug free after three years. This is an inconvenient finding for politicians and civil servants who have preferred to support cheaper services that deal with large numbers of people.”
Anecdotal evidence suggests addicts who want to come off drugs are often met with reluctance from drug workers. In some areas, primary care trusts will only pay for rehab if the individual’s health or public safety is deemed to be in imminent danger because of their chaotic drug use. And there are growing reports of desperate addicts committing crimes as they try to convince the authorities to pay for rehab.
The not-for-profit Providence Projects in Bournemouth was forced to open its doors to private clients in 2005 after a drop in NHS referrals pushed it close to ruin. Paul Spanjar, the treatment director, said: “We get calls on a regular basis from friends and relatives who are desperate because the user’s primary care trust will not pay for rehab. Don’t get me wrong, there are great NHS trusts, but in some areas it is impossible for an addict to get funding.”
The NTA points to research that shows substitute prescribing reduces dangerous injecting and crime rates among addicts. It also claims that overcoming dependence is the ultimate goal of all treatment it supports. Paul Hayes, the NTA’s chief executive, disputes the number of rehab closures and believes the proportion referred to rehab is closer to 8 per cent.
ROAD TO REHAB: “YOU MUST LEARN WHY YOU’RE AN ADDICT”
Andy Hayden, 40, a former addict, lives and works with ex-offenders in Weymouth, Dorset. He has been clean for five years.
“I started on alcohol, glue and gas when I was 12, but within a few years I’d progressed on to anything I could get my hands on. At my worst, my girlfriend and I spent £600 a day on crack and heroin. Eventually I ended up living on the streets, picking food up off the floor, and was in and out of hospital with abscesses and cellulitis.
“About six years ago I suddenly realised that if I didn’t do something I was going to die. I went to the local methadone clinic and was immediately prescribed 50ml ‘maintenance’ a day. This was enough, but I told them I needed more so they doubled my dose. I still had no idea what was wrong with me; we never talked about that. So I kept stealing to buy drugs because while methadone stops you feeling ill, it doesn’t give you a high. When the clinic threw me out for using extras, my addiction was even worse. Methadone is a horrible drug to come off, much harder than heroin.
“In 2003 I heard about a project that sent prolific offenders into rehab. I was so desperate by this point that I made up loads of offences, just so that I’d get in. I was eventually referred to the Providence Projects in Bournemouth and have never looked back since. I know rehab is more expensive, but you have to learn why you’re an addict before you can stop.” ”
Source: The Independent Feb.1st 2009

CASE REPORT

Cannabinoid hyperemesis syndrome: Clinical diagnosis of an underrecognised manifestation of chronic cannabis abuse

Siva P Sontineni, Sanjay Chaudhary, Vijaya Sontineni, Stephen J Lanspa
Online Submissions: wjg.wjgnet.com World J Gastroenterol 2009 March 14; 15(10): 1264-1266
wjg@wjgnet.com World Journal of Gastroenterology ISSN 1007-9327
doi:10.3748/wjg.15.1264 © 2009 The WJG Press and Baishideng. All rights reserved.
Siva P Sontineni, Sanjay Chaudhary, Vijaya Sontineni,
Stephen J Lanspa, Department of Medicine, Creighton
University, Suite 5850, 601 N 30th Street, Omaha, NE 68131,
United States
Author contributions: Sontineni SP provided the patient’s data,
organized, conceptualized and contributed to the manuscript
writing and final approval; Chaudhary S collected the patient
data, reviewed the literature and contributed to the manuscript
writing; Sontineni V reviewed the literature and compiled the
references; Lanspa SJ supervised, provided critical review
and obtained financial support from the division; All authors
approved the final manuscript.
Correspondence to: Siva P Sontineni, MD, Department
of Internal Medicine, 601 N 30th St Suite 5850, Creighton
University Medical Centre, Omaha, NE 68131,
United States. ssontineni@gmail.com
Telephone: +1-402-4158319 Fax: +1-402-2804220
Received: October 25, 2008 Revised: February 8, 2009
Accepted: February 15, 2009
Published online: March 14, 2009

Abstract

Cannabis is a common drug of abuse that is associated with various long-term and short-term adverse effects.
The nature of its association with vomiting after chronic abuse is obscure and is underrecognised by
clinicians. In some patients this vomiting can take on a pattern similar to cyclic vomiting syndrome with
a peculiar compulsive hot bathing pattern, which relieves intense feelings of nausea and accompanying
symptoms. In this case report, we describe a twentytwo year-old-male with a history of chronic cannabis
abuse presenting with recurrent vomiting, intense nausea and abdominal pain. In addition, the patient
reported that the hot baths improved his symptoms during these episodes. Abstinence from cannabis led
to resolution of the vomiting symptoms and abdominal pain. We conclude that in the setting of chronic
cannabis abuse, patients presenting with chronic severe nausea and vomiting that can sometimes be
accompanied by abdominal pain and compulsive hot bathing behaviour, in the absence of other obvious
causes, a diagnosis of cannabinoid hyperemesis syndrome should be considered.
© 2009 The WJG Press and Baishideng. All rights reserved.

INTRODUCTION
Cannabis has been used recreationally for millennia and is the third most commonly used drug after tobacco
and alcohol[1,2]. Research into the neurobiology of the compound has led to the discovery of an endogenous
cannabinoid system. The therapeutic potential of cannabinoids has been recognized and these compounds are
utilized as anti-emetics[3-5]. Recently, a distinct syndrome in chronic cannabis abusers characterized by recurrent
vomiting associated with abdominal pain and a tendency to take hot showers has been increasingly recognised.
This clinical manifestation is paradoxical to the previously identified therapeutic role of cannabinoids as antiemetics.
We describe the case of a young male seeking repeated emergency room care with recurrent nausea
and vomiting.

CASE REPORT
A 22-year male presented with recurrent episodes of nausea, refractory vomiting, and colicky epigastric pain
for one week. The symptoms were characterized by treatment-resistant nausea in the morning, continuous
vomiting, and colicky epigastric abdominal pain. Each episode lasted 2 to 3 h and increased with food intake.
He often had two or more episodes a day during the symptomatic period. He had been treated for the severe
nausea and vomiting in the emergency room on two occasions in the preceding two months. He also reported
having learned to help himself by taking a hot bath each time the symptoms appeared, which dramaticallyimproved his symptoms. This habit had become a compulsion for him for symptom relief with each episode
of hyperemesis. On physical examination his mucous membranes were dry, his pulse rate was 102/min and
blood pressure was 140/100 with positive orthostasis. The remainder of the physical examination was unremarkable.
His complete blood count and comprehensive metabolic panel were unremarkable. In addition, serum
amylase and lipase levels were within the normal range. His urine drug screen was positive for tetrahydrocannabinol
(THC). Abdominal X-ray series and ultrasonography were within normal limits.
Oesophagogastroduodenoscopy revealed Grade 2 distal oesophagitis and hiatal hernia. On further interviewing,
he admitted to consistent marijuana abuse for the past 6 years, often smoking cannabis every hour or
two on a daily basis. The patient and his mother did not recall any significant past illnesses or recurrent vomiting
when he was a child. He was treated with intravenous fluids with steady improvement in symptoms, and metoclopramide,
pantoprazole and morphine for the abdominal pain. It was explained that marijuana was the cause
of his symptoms and he was advised not to resume marijuana abuse. On subsequent follow-up, he had abstained from cannabis and remained symptom-free.

DISCUSSION
Cannabis is one of the most commonly abused drugs worldwide. Over the past decade, marijuana has
remained the most commonly used illicit substance with close to 50% of high school seniors admitting use at
some time[1]. It is estimated that each year 2.6 million individuals in the USA become new users and most are
younger than 19 years of age[6].
The long-term and short-term toxicity of cannabis abuse is associated with pathological and behavioural
effects. However, cannabis has also been suggested to have therapeutic properties with anticonvulsive,
analgesic, antianxiety and anti-emetic activities. Cannabis has also been used to treat anorexia in patients with
acquired immunodeficiency syndrome[3-5]. The actions of cannabis are mediated by specific cannabinoid
receptors. The first of the cannabinoid receptors-CB-1- was identified in 1990 and this finding revolutionized the
study of cannabinoid biology. Since then, a multitude of roles for the endogenous cannabinoid system has been
proposed. A large number of endogenous cannabinoid neurotransmitters or endocannabinoids have been
identified, and the CB-1 and CB-2 cannabinoid receptors have been characterized[7]. The CB-1 receptors exert
a neuromodulatory role in the central nervous system and enteric plexus[8]. Cannabinoid type 2 receptors
have an immunomodulatory effect and are located on tissues such as microglia[5]. The presence of other
receptors, transporters, and enzymes responsible for the synthesis or metabolism of endocannabinoids are
being recognised at an extraordinary pace. Cannabinoids have a wide variety of effects on the body systems and
physiologic states (Table 1) due to their actions on the receptors as well as direct toxic effects.
The anti-emetic effect of cannabinoids is largely mediated by CB-1 receptors in the brain and the
intestinal tract, although some of their effect may also be receptor-independent. However, in this report,
we were presented with the paradoxical effect of hyperemesis in a susceptible chronic cannabis abuser.
Such a paradoxical response has previously only been demonstrated following acute toxicity to an intravenous
injection of crude marijuana extract[9]. Proposed mechanisms of cannabinoid hyperemesis include
toxicity due to marijuana’s long half-life, fat solubility, delayed gastric emptying, and thermoregulatory and
autonomic disequilibrium via the limbic system[10].
Cannabinoids are known to impair peristalsis in a dosedependent manner[11,12], which can theoretically override
the centrally mediated anti-emetic effects, thus leading to hyperemesis. It is not known why the hyperemesis
syndrome surfaces after several years of cannabis abuse. The effects of cannabinoids on the functions of the
thermoregulatory and autonomic mechanisms of the brain can lead to behavioural changes[10]. Such effects
might be the underlying mechanism for the compulsive hot bathing behaviour. There is also a supposition that
the syndrome could represent a type of cyclic vomiting.
Cyclic vomiting syndrome (CVS) in adults is now very well recognized, and it has been proposed that marijuana
contributes to CVS[13]. However, unlike the other forms of CVS, patients with cannabinoid hyperemesis are not
likely to have a history of migraine or other psychosocial stressors and the peculiar behaviour of hot showers is
Cognitive and mental health
Impaired memory
Impaired attention, organization and integration of complex information
Association with schizophrenia
Increased risk for depression
Pulmonary
Carcinogenic effect
Obstructive lung disease
Increased propensity toward infections
Acute and chronic bronchitis
Behavioural
Weapon possession and physical fighting
Unwanted and unprotected sexual encounters
Unwanted pregnancies
School dropout
Amotivational syndrome
Impairment of driving skill and coordination
Endocrine
Decreased testosterone, sperm motility and production, disruption of
ovulatory cycle
Pregnancy
Low birth weight
Problems with attention, memory and higher cognitive function
Cardiovascular
Stroke
Dose-dependent increase in HR
Orthostasis
Decreased exercise tolerance
Precipitation of angina or myocardial infarction unique to this syndrome.

Allen et al[10] first noted this condition in a group of nineteen patients from Australia with chronic
cannabis abuse and cyclical vomiting illness. An earlier case report by de Moore et al[17] described a chronic
cannabis abuser with psychogenic vomiting, which was complicated by spontaneous pneumomediastinum.
Subsequent reports have identified similar clinical presentations[7-9,18]. Given the high prevalence of chronic
cannabis abuse worldwide and the paucity of reports in the literature, clinicians need to be more attentive to the
clinical features of this underrecognised condition.

REFERENCES
1 National Institutes of Health website: NIDA Info Facts:
Marijuana. National Institute on Drug Abuse. Available
from: URL: http//www.nida.nih.gov/Infofacts/marijuana.
html. Accessed January 23, 2008
2 Baker D, Pryce G, Giovannoni G, Thompson AJ. The
therapeutic potential of cannabis. Lancet Neurol 2003; 2: 291-298
3 Walsh D, Nelson KA, Mahmoud FA. Established and
potential therapeutic applications of cannabinoids in
oncology. Support Care Cancer 2003; 11: 137-143
4 Tramèr MR, Carroll D, Campbell FA, Reynolds DJ, Moore
RA, McQuay HJ. Cannabinoids for control of chemotherapy
induced nausea and vomiting: quantitative systematic
review. BMJ 2001; 323: 16-21
5 Davis M, Maida V, Daeninck P, Pergolizzi J. The emerging
role of cannabinoid neuromodulators in symptom
management. Support Care Cancer 2007; 15: 63-71
6 Foley JD. Adolescent use and misuse of marijuana. Adolesc
Med Clin 2006; 17: 319-334
7 Childers SR, Breivogel CS. Cannabis and endogenous
cannabinoid systems. Drug Alcohol Depend 1998; 51: 173-187
8 Simoneau II, Hamza MS, Mata HP, Siegel EM, Vanderah
TW, Porreca F, Makriyannis A, Malan TP Jr. The cannabinoid
agonist WIN55,212-2 suppresses opioid-induced emesis in
ferrets. Anesthesiology 2001; 94: 882-887
9 Vaziri ND, Thomas R, Sterling M, Seiff K, Pahl MV, Davila
J, Wilson A. Toxicity with intravenous injection of crude
marijuana extract. Clin Toxicol 1981; 18: 353-366
10 Allen JH, de Moore GM, Heddle R, Twartz JC. Cannabinoid
hyperemesis: cyclical hyperemesis in association with
chronic cannabis abuse. Gut 2004; 53: 1566-1570
11 Pertwee RG. Cannabinoids and the gastrointestinal tract.
Gut 2001; 48: 859-867
12 McCallum RW, Soykan I, Sridhar KR, Ricci DA, Lange
RC, Plankey MW. Delta-9-tetrahydrocannabinol delays the
gastric emptying of solid food in humans: a double-blind,
randomized study. Aliment Pharmacol Ther 1999; 13: 77-80
13 Abell TL, Adams KA, Boles RG, Bousvaros A, Chong SK,
Fleisher DR, Hasler WL, Hyman PE, Issenman RM, Li BU,
Linder SL, Mayer EA, McCallum RW, Olden K, Parkman
HP, Rudolph CD, Taché Y, Tarbell S, Vakil N. Cyclic
vomiting syndrome in adults. Neurogastroenterol Motil 2008;
20: 269-284
14 Roche E, Foster PN. Cannabinoid hyperemesis: not just a
problem in Adelaide Hills. Gut 2005; 54: 731
15 Boeckxstaens GE. [Cannabinoid hyperemesis with the
unusual symptom of compulsive bathing] Ned Tijdschr
Geneeskd 2005; 149: 1468-1471
16 Chepyala P, Olden KW. Cyclic vomiting and compulsive
bathing with chronic cannabis abuse. Clin Gastroenterol
Hepatol 2008; 6: 710-712
17 de Moore GM, Baker J, Bui T. Psychogenic vomiting
complicated by marijuana abuse and spontaneous
pneumomediastinum. Aust N Z J Psychiatry 1996; 30: 290-294
18 Chang YH, Windish DM. Cannabinoid hyperemesis relieved
by compulsive bathing. Mayo Clin Proc 2009; 84: 76-78
S- Editor Li LF L- Editor Kerr C E- Editor Yin DH
Essential for diagnosis:
History of regular cannabis use for years
Major clinical features of syndrome
Severe nausea and vomiting
Vomiting that recurs in a cyclic pattern over months
Resolution of symptoms after stopping cannabis use
Supportive features
Compulsive hot baths with symptom relief
Colicky abdominal pain
No evidence of gall bladder or pancreatic inflammation
Table 2 Clinical diagnosis of cannabinoid hyperemesis

Source: 1266 ISSN 1007-9327 CN 14-1219/R World J Gastroenterol March 14, 2009 Volume 15 Number 10
www.wjgnet.com

There were 1810 deaths from benzodiazepine overdose 1990–1996 according to Home Office Statistics and there are an estimated 1600 benzodiazepine-related traffic accidents with 110 deaths each year in the UK.
C.H. Ashton, Emeritus Professor of psychopharmacology, Newcastle UniversityThe current number of benzo addicts in the UK is estimated at one and a half million although no official figures exist. Many more people are ingesting benzos and are on their way to addiction. Many other ex-addicts have withdrawn but remain damaged. There is no treatment for benzo damage. Post-benzo sufferers are often left to struggle alone, stigmatised and excluded by the Health Service that made them ill.
Mick Behan, Parliamentary Researcher, Submission to the Health Select Committee Enquiry into the Influence ofthe Pharmaceutical Industry 2004

“It is estimated that 1.5 million people’s lives have been destroyed by involuntary tranquilliser addiction leading to long periods of mental ill health. A man whom I met recently had been on tranquillisers for 45 years. Those people want to work, but cannot do so. As far as I am aware, the only primary care trust that has introduced a withdrawal programme is Oldham. Will the Secretary of State encourage his Department and the Department of Health to
study the Oldham model with the aim of getting some of those people off prescription drugs and back to work? That would improve their quality of life, and would reduce the benefits bill as well.”
Jim Dobbin (Heywood and Middleton) (Lab/Co-op) Hansard 31 March 2008

Manslaughter by gross negligence
“Negligence is generally defined as failure to exercise a reasonable level of precaution given the circumstances and so may include both acts and omissions. The defendants in such cases are often people carrying out jobs that require special skills or care, such as doctors who fail to meet the standard which could be expected from them and cause death. In R v Bateman (1925) 19 Cr App.R. 8, the Court of Criminal Appeal held that gross negligence
manslaughter involved the following elements:

1. the defendant owed a duty to the deceased to take care
2. the defendant breached this duty
3. the breach caused the death of the deceased
4. the defendant’s negligence was gross, that is, it showed such a disregard for the life and safety of others as to amount to a crime and deserve punishment.”

Negligence
“Failure to exercise the care toward others which would reasonably be expected of a person in the circumstances,or taking action which a reasonable person would not. Failure to exercise care, resulting in injury to others.”

On 23 February 2009 the Archer report on the 4,800 or so haemophiliacs who were infected with hepatitis C (and around 1,200 who were also infected with HIV) through blood transfusions in the late 1970s and early 1980s was made public. The report plainly sets out the pattern of negligence and injustices of successive governments.
The inquiry was privately funded by donations and received no support from government, either financial or through evidence. At the time of the inquiry’s launch, in February 2007, there had been 1,757 deaths and the number is increasing. The inquiry was set up by Lord Morris of Manchester and chaired
by the former solicitor general, Lord Archer. The report runs to 113 pages and Lord Archer told the press conference that the infection of the haemophiliacs was “the worst treatment disaster in the history of the NHS” and a “horrific human tragedy”. But has there been an even greater disaster with nearly fifty years of tranquilliser over-prescribing by doctors?
As with tranquillisers, the blood scandal campaigners have been religiously rejected by the Department of Health over the years and although some have received a small degree of compensation (tranquilliser victims have received none), little has in fact been done to help them or their families. Some UK families have had nothing because their HIV-infected breadwinners died before 2003. Others live anxious and needy lives because they have been unable to work. Canada and Ireland on the other hand acted much more quickly with more generous financial help and assistance with mortgages and insurance. The report has urged the government to offer a more substantial compensation package with survivors and their families but the Department of Health has so far offered only sympathy and a promise to look at the findings. No-blame assistance could be given though it is nearly 20 years since Virginia Bottomley, as health minister, promised that the needs of haemophiliacs would be kept under constant review. That review has sunk without trace.
The Department of Health also looked at the findings of the 2004-5 Health Select Committee report on the Pharmaceutical Industry, which included criticism of the provision for prescribed Tranquilliser addicts, but then rejected almost all of them. Sympathy is cheap but action and recognition costs money and impacts on the image of the NHS and politicians. The DoH is blame averse and addicted to the avoidance of responsibility and the recognition of avoidable scandals. Charles Dickens summed it up very well:
‘Regard our place [The Circumlocution Office] from the point of view that we only ask you to leave us alone and we are as capital a Department as you will find anywhere…It’s like a limited game of cricket. A field of outsiders are always going to bowl in at the Public Service, and we block the balls…Clennam asked what became of the bowlers? The airy young Barnacle replied, that they grew tired, got dead beat, got lamed, got their backs broken,
died off, gave it up, went in for other games.’ Charles Dickens, Little Dorrit, pp 736, 737

The reality of Benzodiazepines
Benzodiazepines are much more than a question of harm done by the medical profession. There is the crucial fact that successive governments of both parties allowed them to do it. Government and medical dismissal of patient experience as relatively minor and short-term is nothing more than a repetition of false assertions, the original source of which (if it was ever known), has been lost. What cannot be rationally doubted, is the fact that benzodiazepines are frequently seriously
damaging—something which might not be immediately apparent, judging by the truly enormous quantities that doctors have prescribed over the years, both in the UK and in other countries. There were warnings from very early in the life of these drugs that this was so, but the drug companies successfully fought off the findings for nearly thirty years until benzodiazepines were old news. Benzodiazepines might well help some people in the short-term, owing to their properties as hypnotics, anticonvulsants, muscle relaxants, amnesics and anxiolytics. But benzodiazepines have potentially incredibly serious adverse effects made even worse by polypharmacy, excessive dosages and long-term use. Benzodiazepines were largely sold to doctors as being much less toxic than their predecessors the barbiturates but they are a long way from being safe drugs. High doses of benzodiazepines lead to over-sedation. Benzodiazepines impact on the ability to think, make decisions,
and to remember. They make it much harder to learn new information. There are people who have withdrawn from benzodiazepines who find they have lost whole years and decades of their lives. In the elderly, these effects can lead to a false diagnosis of Alzheimer’s disease. In spite of this fact, many occupants of old people’s homes and in the community are regularly prescribed benzodiazepines. The primary effect of benzodiazepines is one of addiction. With regular use for only a few months
or even weeks the body comes to depend on them both psychologically and physically for normal
functioning. As a consequence of this dependence, tolerance develops, so that larger doses are needed to produce the same initial effects. There is clear evidence showing that hypnotic effects are no longer effective after a few weeks and anxiolytic effects after only a few scant months. People unknowingly continue taking them mainly to prevent withdrawal effects. If dosage is insufficient once tolerance has
developed, or if the drug is completely stopped, withdrawal symptoms then develop. This is an important reason why the long-term prescribed feel so ill all the time. The Department of Health stubbornly and perversely ignores this basic scientific truth and has illogically introduced an instalment prescription plan. Quite how doling out prescriptions over days will benefit addicted patients is a question it refuses to
answer. It looks like action and to government that is probably enough of a recommendation, but doctors tempted to give it a try, may well find the ‘problem’ becoming much more noticeable in their surgeries as a result. At present there are over a million long-term prescribed benzodiazepine users in the UK. Several
studies, including those carried out by Newcastle University, have shown from computerised prescribing records, that there are 180 or so such patients in every GP practice. These long-term patients, while continuing their drug use, often suffer from adverse effects and from withdrawal effects afterwards —for
a sizeable proportion this is permanent. Long-term use is commonly accompanied by increasingly diverse illnesses.
“Withdrawal symptoms can last months or years in fifteen percent of long-term users. In some people chronic use has resulted in long-term, possibly permanent disability.” C.H. Ashton 2003

Professor C.H. Ashton, unlike those who advise government behind the scenes, ran an effective benzodiazepine withdrawal clinic from 1982–1994 at Newcastle University. She has described the morbidity in the first 50 consecutive patients who attended. They had been taking prescribed “therapeutic” doses of benzodiazepines for between five and twenty years and had decided to withdraw because they did not feel well while taking the drugs. Of these, 20% suffered from agoraphobia and/or
panic attacks, 10% had had neurological investigations (three for Multiple Sclerosis) and 18% had had gastrointestinal investigations. Backing up the argument that long-term benzodiazepines lead to other prescriptions, she said that 62% of the first group had been prescribed other psychotropic drugs since starting benzodiazepines, the most common being antidepressants. In addition, 28% had been prescribed two benzodiazepines, thereby doubling the addiction potential and the possibility of side effects. Professor Ashton has said categorically that the symptoms which led to the investigations and the polypharmacy, were not the reason for starting benzodiazepines, but developed during long-term use. She has said on several occasions, that there is a likelihood that health for everyone does not
necessarily return to normal after prescriptions cease.

“From the current evidence it appears that the symptoms that are most likely to be long-lasting are anxiety and insomnia, cognitive impairment, depression, various sensory and motor phenomena, and gastrointestinal problems. Tranquilliser drugs undoubtedly cause thought deficits and impair coping abilities. There may be an extended period after the taking of benzodiazepines has ceased when former patients find stressful situations difficult to deal
with, though of course many still taking the drugs have the same experience as well. Something as basic as queuing in a shop, or answering the phone, can often seem a frightening and stressful situation. Complete recovery may require the individual to learn new strategies to replace the years of coping through drugs. For some people whose economic and social circumstances, have been severely impacted, this learning may prove to be
inordinately difficult and sometimes impossible.”
C.H. Ashton, 2003
On any patient leaflet you will find advice saying that anxiety occurring after withdrawal is due to pre-existing symptoms recurring. Indeed it is normally cited by the profession as a reason why most doctors continue prescriptions. Patients who were not prescribed the drugs for clinical anxiety (and that is the majority) know that the self-serving ‘symptoms recurring argument’ is untrue. This can be a Catch
22 situation. Depression is common in long-term benzodiazepine users and patient experience points to the drugs being the cause. Depression also appears when patients withdraw. There may be pharmacological reasons for this but who would not be depressed by the realisation of what had been done to them by what they thought was a safe medicine? Depressive symptoms may appear for the very first time after withdrawal—often some weeks later, and may be severe and protracted for a long
time. Suicide has been reported in some studies. Government maintains a supreme indifference to this benzodiazepine research. Instead it continues a parrot-like repetition of the need to prevent addiction occurring in the first place, ignoring the plight of many thousands of people disabled through medical prescribing.
It will be difficult for most people to believe that members of a highly regarded profession could inflict such damage, but the fact is that most doctors have an affinity with potions, and with the rise of drug company influence, they developed an affinity with the manufacturers of them.

“Doctors prescribe by nature. I had a patient who told me that her doctor had warned her that if she came off her medication she might die. I just saw another patient who was on seventy tablets a day. There are doctors out there who are absolutely committed to prescribing, and if the patient doesn’t get better, they just up the dose.”
Dr Robert Lefever, Director of the Promis Recovery Centre in Kent

It was the psychopharmacalogical era beginning in the late fifties that led to the explosion of medically-induced ill health. Benzodiazepines were pushed by their manufacturers as appropriate for virtually anything. Doctors followed the logic of this advert religiously: “In the face of ill health there is anxiety and where there is anxiety either as a complicating factor or as a cause of illness itself, there is a place for LIBRIUM.”
Today, in spite of this undeniable fact, the UK Department of Health rigidly maintains an illusion that the drugs are always prescribed for clinical anxiety and therefore suffering patients fall within the psychiatric sphere of responsibility. That way, it can say that any psychological problems while taking benzodiazepines or following withdrawal, are due to pre-prescription symptoms returning. They will not engage with the fact that patients, who were given the drugs for other reasons, are as likely to experience the same psychological difficulties as those who were given them for clinical anxiety. Physical side-effects are ignored. It has been claimed that benzodiazepines are the most researched drugs in the world but much of the early research was basic and superficial to say the least, and would not meet today’s standards.

Long-term research has never taken place, either then or subsequently. Patients who took the drugs for years—many for decades—therefore have their claims of health damage ignored and rejected in the face of zero scientific evidence that it did not happen. Between the introduction of benzodiazepines and 2004, Home Office and other figures suggest 17,000 deaths associated with benzodiazepines but as with all official statistics, they may well be an underestimate. In reply to a question from the Parliamentary Health Committee in 2004, Professor Alasdair Breckenridge, the Chairman of the UK drugs regulator stated that he thought there had been
approximately 170 deaths. As Professor Heather Ashton said at the time, this represented 1% of the total and was a gross under-representation on the part of the regulator. There are people who have taken the drugs and claim to have experienced no untoward effects or problems during ingestion or in withdrawal. On one side of the argument about the benefit of benzodiazepines and possible symptoms, there is Professor David Nutt of Bristol University, who believes the downside of benzodiazepines has been over-emphasised and that medics are being unduly
constrained in their use. Nutt outlines his position on benzodiazepines in his paper “The Psychopharmacology of Anxiety”. He recommends prescribing practices that directly contradict the 1988 CSM Guidelines on prescribing and what the Department of Health says is its position. Professor Nutt takes every opportunity to air these views, most recently in a lecture to students and medical staff at Newcastle University. Professor Heather Ashton agrees that some people can withdraw from benzodiazepines with few if any symptoms and that there are probably many reasons why. Personality may play a part and this ultimately has a physical basis, shaped by genetics and environment which determines the “wiring up” of the brain—e.g. the synaptic connections which mediate the ways that individuals have learnt to cope
with anxiety and stress. There is evidence that anxious people have fewer GABA/benzodiazepine receptors in the emotional areas of the brain than more stolid people—so perhaps those without withdrawal symptoms had more GABA receptors to utilise. They may not develop so much benzodiazepine tolerance (down-regulation of GABA/benzodiazepine receptors) and so suffer less rebound of GABA under activity related to withdrawal symptoms. The distribution and sensitivity of these
receptors may vary so that some people may have more physical symptoms in withdrawal while others experience more psychological symptoms. She also says that the nature of withdrawal may depend partly on the type of benzodiazepine used. Withdrawal symptoms are usually worse in those using short acting
and/or potent benzodiazepines such as lorazepam, alprazolam, and clonazepam even if these are withdrawn slowly
A crucial ingredient, seldom if ever, ever mentioned in relation to benzodiazepine withdrawal, is the factor of polypharmacy, which Professor Ashton agrees may also play a part. She says that over 60% of the long-term dependent she saw in her National Health Service Withdrawal Clinic, had also been prescribed other drugs, usually antidepressants, along with the benzodiazepines. Antidepressants, antipsychotics, and morphine-based painkillers, all have side-effects themselves—with symptoms not dissimilar to benzodiazepine withdrawal. Any discussion by anyone on the subject of benzodiazepine withdrawal is therefore necessarily incomplete, if it does not take into account the fact that for many people, benzodiazepine prescriptions led to other drug prescriptions—many of them producing physical dependence. It is often a situation of withdrawing from multi-drug use, rather than single drug use. So, the experience of people who have taken (or who are still taking) benzodiazepines and indeed other mind-altering drugs, varies. There are a number of reasons for the individuality of response, not least, differences in human physical make-up, length of prescription and differences in personal circumstances. A person working in a job, which does not require high-level intellectual thought, or constant decision-making, for instance, may find it altogether easier to avoid the impact of benzodiazepines on cognition.
But there needs to be some sort of true representation for the stories of the very large numbers of UK citizens whose existence has been needlessly harmed and sometimes destroyed by prescribed benzodiazepine addiction. Benzodiazepines are not the only treatment to destroy health and lives as the recent Vioxx disaster and the haemophilia scandal testify. There are strong common elements between
the stories—pharmaceutical company deceit, regulatory inaction, and dogged medical belief in benefit, is common to all. But it is the scale of benzodiazepine prescribing and its longevity that makes this story unique. Benzodiazepines have been prescribed in their billions to millions of patients, based on a jigsaw
of poor and non-existent research, pharmaceutical power, amateur regulation, medical ignorance and disdain, and organised government cover-up.
How are statistics of large benefit and little harm arrived at? What rigorous investigation is it based on? Is it, for instance, based on the absence of complaint to doctors, regulators or drug companies? Is it based on collected endorsements from patients? Or is based on neither of these? Is it, in fact, not a statistic at all—merely another plank in the house built by the indoctrinators? But the desire to believe is strong. It is a sad but observable fact that we look beyond positive claims and assurances only after we have personally met the hidden downside of drugs that ‘help millions’, through our own experience.

Socio-economic cost of benzodiazepine addiction
Benzodiazepines have been a near 50 year horror story for tens of thousands of people in the UK but this medical disgrace has never been addressed. Weak, belated and spasmodic warnings have been issued over the years and they have had the unfortunate side-effect for patients, of allowing government and the benzodiazepine manufacturers to further draw a veil over the historic and ongoing impact of
inappropriate prescribing in the public mind. It is possible to make an argument that much of the medical profession does not fully realise what it has done, given the speed of consultations, the failure of regulators to pass on the horror stories they
have been told, and the distance between the patient in the doctor’s surgery and the patient’s actual life outside it. But above all, it is the chemical ability of benzodiazepines to produce apparent mental instability and engender a belief, not only in doctors but also in patients, that this drug-produced harm is genuine illness that has led to the greatest medical damage. The belief has been fostered among
doctors (and unwittingly by the patients), that the drugs and consequent ones have been necessary. It is simply not true that benzodiazepine injury has ever been addressed.
There are still far too many prescribed addicts in the UK and thousands of former addicts who took the drugs long-term, and as a result are living with ruined health which cannot be rebuilt. Many are living in poverty because of the effects of benzodiazepines. Whole lives have been lost and cannot be relived. Families have
disintegrated, never to reunite. The real severity of benzodiazepine damage has never been officially recognised. In the face of it the Department of Health believes that repeated utterance of statements such as ‘we take the problem seriously’ or ‘our priority is to prevent addiction occurring in the first place’ makes it true for actual and
former patients and is adequate support for those badly in need of it. The debate on benzodiazepines has largely centred on addiction versus efficacy, but addiction
can be seen as only part of the picture—mostly important in relation to the fact that once addicted, patients keep taking them— the far more serious side of the issue centres around what continued addiction often leads to, and its dire effects on general health, thinking abilities, and life. There are extensive costs to the patient and to society, caused by benzodiazepines but not studied by medicine, because their nature is not seen as medical. There are costs produced by benzodiazepines which are medical but which have never been researched, and which are therefore not
recognised by medicine

There are costs to the National Health Service of medical investigations for symptoms which are in reality a result of the effects of benzodiazepines. These costs must be very high indeed, if patient reporting is taken into account, but they are officially unquantified. Investigations for MS, ME, IBS, Arthritis and Thyroid deficiency and other ‘ghost illnesses’ are common—usually the results are negative.
For people taking benzodiazepines and particularly the elderly, there is a much increased risk of accidents. The cause of the accidents, whether occurring in the home, on the road, at work or in a care home is routinely not recognised, but has a cost for the individual beyond the cost to the NHS. There is a great deal of evidence that the unborn are severely affected by the addiction of the mother. The link between benzodiazepines and foetal harm was denied in Parliament in 1999 but it
undoubtedly occurs.
“The developing foetus can be congenitally malformed; it can have heart attacks in the womb. We also know that the newborn baby born to somebody taking benzodiazepines will have difficulty breathing and they would have floppy muscles—what doctors call a ‘floppy baby’ and they may be unduly cold because the temperature regulation, which is so important to a baby, is disrupted…Well I think if any doctor is prescribing benzodiazepines to a pregnant woman, he should check his indemnification status because it is in fact illegal prescribing.”
Robert Kerwin, Professor of Psychopharmacology at the Maudesley Hospital in London, ‘Face the Facts’, BBC Radio 4 1999

Prescribed benzodiazepines can lead to loss of control over actions which means in practice that drug-induced violence occurs in the home involving partners and children. Unwanted pregnancies are another side-effect of the drugs. Inhibition reduction leads to anti-social acts such as theft and vandalism. People end up in gaol because the impact on thought and emotion is not recognised. As Professor Ashton says:
“Benzodiazepines can occasionally cause paradoxical aggression and have been associated with baby-battering, wife-beating and grandma-bashing. They can also cause depression and can precipitate suicide in depressed patients. They should not be used in depression although they are still commonly prescribed long-term for depressed and anxious patients. They can also cause emotional blunting and apathy, with inability to cope with the needs of children and family, an effect bitterly regretted by many long-term users.”

Benzodiazepines cause job loss either whilst taking them or while attempting to withdraw. Not everyone loses their job of course but a significantly large number do, and it is not surprising, given the deadening effects of the addiction and the high number and severity of possible withdrawal effects. This effect on the individual and on families is totally ignored by government. In 2004 the Chief Medical
Officer, Professor Liam Donaldson, reminded doctors of their continuing over-prescribing. He referred to the cost to the NHS of the drugs themselves, but made no mention of the costs to the individual. There is a large financial impact to the state generally, which benzodiazepine addiction is responsible for. People who are unable to work pay no taxes or national insurance. Their spending power is curtailed and therefore they pay less VAT. Addicted and unemployed the benzodiazepine dependent make very little contribution to the economy. Although many iatrogenic benzodiazepine addicts are to all intents and purposes disabled, few receive disability benefits. Thousands do receive incapacity benefit at a lower figure, because of the length of their ‘illness’, and this is of course a drain on the national economy. Many iatrogenic victims have not worked for decades. Perhaps the biggest loss for a proportion of the dependent (and who knows how big this proportion is) is the loss of choice. They cannot choose to buy a house or might lose a house because of
the drug effects. They cannot take holidays or buy a new car. They cannot socialise or take up hobbies because of induced anxiety and the inability to concentrate and think clearly. Some discover after they have withdrawn from the drugs that they never left the house or indeed a room, for years because of benzo-induced agoraphobia—prisoners because of drug prescriptions. There is much exhortation from government these days about the need to build up personal pensions to maintain a secure lifestyle in retirement—we are all living longer and the state is becoming
more hard-pressed to finance pensioners. There are thousands, addicted for decades to benzodiazepines, who feel assaulted anew when they hear that message. Through state avoidance of responsibility for health protection, they had no chance to build up a personal pension, leaving them entirely dependent on the state for the future. What a supreme irony it is then, that at a time when the state is telling everyone that the state pension is completely inadequate and that they should save for a personal one, there are many condemned to poverty through state inactivity and denial.
The most insidious effect of the drugs in the estimation of many is the effect the drugs have had on their family. The family was not prescribed the drugs but it was as certainly and indelibly marked as the taker. The lack of emotional response due to benzodiazepines is something a child does not understand and may never understand, even as an adult. The life chances of children of the unemployed
and sick iatrogenic addict are necessarily reduced and their emotional needs may remain unsatisfied, leading to problems for them later in life. It can be very difficult afterwards to re-establish relationships between a formerly addicted parent and children. Where does the patient find closure in the face of orchestrated denial, lack of government recognition and help, and a spirit within the medical profession that sees each new drug as a wonder drug, taking decades each time before it exercises control? The three components of continuing good health are psychological, physical and social. Benzodiazepines have a three-pronged negative effect on health—the effects of taking of them, the realisation afterwards of the impact they had on a life and the realisation for the individual that they are powerless to achieve recognition. It is a deep and genuine kind of grief which is not in the annals of medicine. Within the present political, legal and medical structures, there is little hope of closure.

A Selection of Informed Comments on Tranquillisers
“Thousands of people could not possibly invent the bizarre symptoms caused by therapeutic use of benzodiazepines and reactions to their withdrawal. Many users have to cope, not only with a frightening range of symptoms, but also with the disbelief and hostility of their doctors and families. It is not uncommon for patients to be “struck off” if they continue to complain about withdrawal symptoms. Even when doctors are concerned and understanding about the problem, they often have little knowledge of withdrawal procedure, even less about
treatment…”
Trickett S, Withdrawal from Benzodiazepines, Journal of the Royal College of General Practitioners 1983; 33: 608

“The medical profession took nearly 20 years from the introduction of benzodiazepines to recognise officially that these minor tranquillisers and hypnotics were potentially addictive. The ‘happiness pills’, which had been propping up a fair proportion of the adult population since the early 1960s, were found to have an unexpectedly bitter aftertaste: doctors and patients alike were unprepared for the problems of dependence and withdrawal that are
now known to be common even with normal therapeutic doses.”
Editorial (Anon), The Benzodiazepine Bind, The Lancet, 22 September 1984, 706

“There’s certainly a problem, the NHS are concerned. The NHS spends about £40 million per annum on these drugs. There are a substantial number of people who do suffer from this problem long-term. I know that the withdrawal symptoms can be agonising for some people and can be very difficult indeed.”
John Patten, Health Minister, 1984

“In the UK, 11.2% of all adults take an anti-anxiety drug at some time during any one year. But over a quarter of these people (3.1% of all adults) are chronic users, taking such medication every day. Even at a conservative estimate, 20% of these will develop symptoms when they attempt to withdraw. That means a quarter of a million people in the UK. The sooner the medical profession faces up to its responsibilities towards these iatrogenic
addicts, the sooner it will regain the confidence of the anxious members of our community.”
M.H. Lader, Anna C. Higgitt, Management of benzodiazepine dependence, Update 1986, Brit J Addiction, 1986, 81, 7–10

“The benzodiazepines are probably the most addictive drugs ever created and the vast army of enthusiastic doctors who prescribed these drugs by the tonne have created the world’s largest drug addiction problem.”
Dr Vernon Coleman, ‘The Drugs Myth’, 1992

Dear Mr Haslam,
Thank you for your recent letter regarding Benzodiazepine Tranquillisers. Dawn Primarolo and myself have been taking up cases and have advised on how best the groups involved might organise a parliamentary lobby and keep attention on these issues. We have also tried to assist through both Parliamentary Questions and raising the matter on the floor of the House, in pushing the Government to accept its own responsibilities and to take action now to ensure that it does not happen again.

This is something we will be returning to both in the House and in terms of our own future policy development. I am passing your letter to Paul Boateng who, as the legal affairs spokesman, has specific responsibility for the litigation side of what is a national scandal.
David Blunkett MP, Shadow Secretary of State for Health,
24 February 1994

“…the risks [of benzodiazepines] were always obvious and…the providers of medicine between them, readily let this happen.”
Charles Medawar, Social Audit, Power and Dependence 1991

They [benzodiazepines] are very effective at relieving anxiety, but we now know that they can be addictive after only four weeks regular use. When people try to stop taking them they may experience unpleasant withdrawal symptoms which can go on for some time. These drugs should be only used for short periods, perhaps to help during a crisis. They should not be used for longer-term treatment of anxiety.
The Royal College of Psychiatrists, July 2001

“Benzos are responsible for more pain, unhappiness and damage than anything else in our society.”
Phil Woolas MP, Deputy Leader of the House of Commons and Local Government Minister, Oldham Chronicle, February 12 2004

Parallels
“My family believe my brother was murdered, and I stick by that.”
Brother of Blood Transfusion Victim, Daily Telegraph, February 23, 2009
Interviewer: I don’t want to sensationalise this Susan but, in the last couple of minutes, you’ve actually accused doctors of murder. Campaigner Sue Bibby: Well I think that they do have a case to answer – it would be very nice if one or two of them would actually stand up and speak.
Talk Radio UK Interview on Tranquillisers with Mike Dicken and Susan Bibby
December 5, 1998

Is one scandal greater than the other, a larger case of inertia and unconcern? A scandal is a scandal, both are sizeable and have involved a large number of deaths, both have involved government inaction, but the 48 year benzodiazepine scandal must be seen as the greater if only for its longevity and absence of recognition. The heyday of vast tranquilliser over-prescribing took place in the 1970s and 1980s. The 4,800 or so haemophiliac victims received their contaminated blood at that time. But the tranquilliser scandal rolled on and new addicts are still, without warnings, being created today.

“The Department of Health fails even to collect figures that might be considered unpalatable.”
Alice Miles, The Times, July 4 2007

“[Benzodiazepines] have been prescribed for sports injuries, muscle spasms, premenstrual tension, exam nerves, depression, general malaise and much else…”
Professor C.H. Ashton, Bristol and District Tranquilliser Project AGM, October 2005

The benzodiazepine story has many unique qualities and the Department of Health has developed a policy of no-admission and steadfast denial. Instead of action it has:
•Routinely insisted that its priority is “to prevent addiction occurring in the first place” in the face of much evidence of injury and the fact that those injuries have been occurring for nearly half a century. Crucially, it also maintains that doctors must be free to exercise clinical judgement, even when that judgement (as in the case of David Nutt) is likely to increase addiction and harm.

•It has made no effort to commission research into the wide variety of injuries reported by patients and sticks rigidly to the message that tranquilliser addiction is a mental health problem when in fact it is a problem of chemical addiction with physical responses to that addiction.

•It has left campaigners to provide detailed information on the scale and nature of the problem but has not accepted it; neither has it made any attempt to investigate and provide its own data.

•It has always insisted that treatment and withdrawal assistance is available when it has been shown to be non-existent and in the knowledge that prescribers who addicted patients have little interest in the addiction or the expertise to assist.

•It has consistently evaded all responsibility for the situation, preferring historically to blame it on prescribers, though lately it has moved towards the blaming of patients and stigmatising them as drug misusers. Medical and government defence of the benzodiazepine scandal has moved through several stages, not necessarily in this order and not necessarily one at a time. Sometimes previous positions are
resurrected:

•The drugs are not addictive
•And if they are, it is because of an addictive personality
•Patients ask for them
•Patients bully doctors into prescribing
•The drugs are cheap to provide for government
•Doctors have no time to assist in withdrawal/doctors find it very difficult
•There are no alternatives to pills in UK healthcare
•Aware or former iatrogenic addicts are merely seeking compensation
•It’s all down to defective genes
•It’s all in the past, it was regrettable but we have learned lessons
•Patients abuse the drugs and must be controlled
•Benzo campaigners select their evidence

In 1988 the Committee on the Safety of Medicines issued 4 week prescribing Guidelines to doctors but these were never seriously followed up and the CSM had no remit to discover whether they were being followed. There was no plan to audit the number of patients on individual prescriber lists who had already exceeded the Guidelines and offer withdrawal assistance. Hence there are tens of thousands of
people today who have been taking tranquillisers for decades without knowledge that their life is being harmed.

“GPs will be asked to trawl through their patients’ records to identify those most at risk of developing cardiovascular disease and call them in for an assessment, the National Institute for Health and Clinical Excellence proposed today.
The Guardian in June 2007

Hearing the victims of the haemophilia scandal speak is like a rerun of the tranquilliser scandal: “I would just like to see someone apologise, but they won’t do it because they think they will be subject to criminal actions.” “One of the reasons the government had been so successful in keeping the whole thing silent was because there
were so few people willing to stand in public and campaign.” “People say move on with your life, but that’s hard if you have had no resolution and you are surviving on £59 a
week.” “We need an apology, just the acknowledgement that this happened and it shouldn’t have happened. I don’t think they realise how much that means to people.”
“People need to be able to live comfortably without having to go cap in hand to the local authority or a fund whenever they need the slightest thing. All we are asking for is to be able to live with decency and dignity.”

Tranquilliser victims
“[But] for a large proportion of those on incapacity benefit—half of them claiming for five years or longer—the benefit is a (cheap) compensation for the fact that they have no future. And never will have…”
Yvonne Roberts, Where’s the Benefit? The Guardian, February 6 2008

Tranquilliser victims have received no recognition, no support, no apologies, no compensation and no closure—and this in spite of the fact that so many of them cannot work, have no pensions or security and live with ruined health because there is no agonist for the damage inflicted. Many victims do receive state benefits and the government refuses to investigate how many of those on benefits are there because of the drugs, but benefits are not large and do not represent security. In fact because the Department of Works and Pensions, reliant on Department of Health information, does not take benzodiazepine injury seriously, the victims live constantly with the fear of losing those benefits. The Archer report acknowledges how the extraordinary financial burden of long term ill-health had been placed upon people who had lost their jobs, lost their insurance and, as has so often been the case, lost the breadwinners in their families. There has been no such acknowledgement in the case of tranquillisers. In this horror story the victims have been left to their own devices.

•Government has allowed health, social and economic destruction through addiction to take place and still allows it.
•Government knows what has happened and avoids recognition of it.
•Government has left many to wither on benefits and has made no attempt at rehabilitation.
•Government now believes as part of its political struggle with other parties that such people can continue to remain unrecognised and can be viewed in exactly the same light as every other benefit claimant.

Tranquilliser Quotes

“…apart from people’s physical health going down (although luckily, some people seem to be able to stand up to that), they are described by their families as being “Jekyll and Hyde”. Agoraphobia (not being able to go out) is a very, very common symptom which very few people actually have before they’re given the drugs – sometimes they might have it, but mostly they don’t have it until they’ve been put on the drugs. This of course makes them [the
patients] incapable of doing anything much. They can’t go out to the local shops, they can’t look after their children properly; they are very distressed by this and feel it’s their own fault. Usually they go back to the GP and the GP will say: “Oh you’re an anxious personality and that’s what’s wrong with you,” and they usually give them more benzodiazepines, or other antidepressant drugs as well.
Sue Bibby Talk Radio UK Interview with Mike Dicken and Susan Bibby December 5, 1998

“In fact the drug was poisoning my central nervous system. Emotionally I felt numb…Those pills cheated me of myadult life – I lived like a robot…”

“….After 30 years of tranquillisers mixed with a variety of anti-depressants, the mother-of-six says the drugs have left her physically and mentally handicapped. Over the years Mrs Dixon’s health has deteriorated and she has suffered a host of problems including panic attacks, muscle weakness, mood swings, bowel problems, nausea and severe pelvic pain. Her condition has left her unable to leave her home for the past 10 years and watch her children
and 20 grandchildren growing up….”

“One Barnet woman, who wanted to remain anonymous, says she was left housebound after being addicted to benzodiazepines for more than 20 years. She was originally prescribed the drugs for a stomach upset, but now suffers thyroid problem, asthma, ME and leg pain so severe she can hardly walk – all of which she attributes to the drugs.”
Hendon & Finchley Times August 2003

“I was prescribed Lorazepam at 16. I am now aged 44 and have been off tranquillisers for two years, after a GP suggested that I had perhaps been on them too long! After suffering most of my life with Agoraphobia and Panic Attacks, I cannot believe that this drug is still manufactured. It is high time the drug companies were held accountable and something positive was done. How many people have to lose their quality of life and battle so hard, with little help to regain it, before someone says stop.”
The Tranquilliser Trap, May 2001

“If the government knows these drugs to be harmful why are they allowing them to be dispensed? Why have they not implemented resources to help patients come off the drugs? It takes more than a guideline…the problem will not go away…indeed it will not ‘die’ off which is one method some GPs are using to reduce their prescriptions, i.e. they are waiting for those patients who have been addicted for 20+ years to die because it is easier to give a 2
minute prescription rather than seeing a demanding patient for 20 minutes a visit every day until they get what they demand.”
The Tranquilliser Trap, May 2001

“I believe I am one of the longest addicts of Lorazepam, I started taking them in 1974 following a car accident and finished taking them in 2000 (26 years). I was 18 when I was first prescribed them and the effect upon my life has been devastating, like others I thought I was going out of my mind, a fact my doctor was only too willing to agree with…I am forty five and I can’t remember what it was like when I was 18, I can’t remember a time when my life was
not governed by fear. I may function in society, but that does not mean I can lead a normal life. However I find that the medical profession believes that now I no longer take these drugs that I am back to full fitness…I was offered no support from anywhere and yet if I was a Heroin addict, I would have had masses of help and support.” The Tranquilliser Trap, May 2001

“There are people out there…who are hooked, unknowingly, unwillingly, and they feel that society has ‘chucked them overboard’. They feel they no longer belong anywhere. They feel they’ve lost such a lot, that they can no longer regard themselves as fully human.”The Tranquilliser Trap, May 2001

Source: Published in Daily Dose 4th April 2009 Colin Downes-Grainger 25 .02.2009

BackgroundStreet drugs known as ‘ecstasy’ have been sold for
about 20 years in the UK. The active substance that
such tablets contain – or purport to contain – is
3,4-methylenedioxymethamphetamine (MDMA).
Shortly after consumption, MDMA releases
chemicals in the brain that tend to bring about
a sense of euphoria, exhilaration and increased
intimacy with others. It is thought to be the third
most commonly used illegal drug in the UK after
cannabis and cocaine, with estimates suggesting
that between 500,000 and 2 million tablets are
consumed each week. Most people who take
ecstasy also use other legal and illegal drugs,
sometimes at the same time. Ecstasy is commonly
taken in nightclubs and at parties and is very often
associated with extended sessions of dancing.
Along with the pleasurable effects sought by users
of MDMA, it has become clear that the drug can
cause a range of unintended harms. In the short
term, a range of adverse events have been reported
– some fatal – and consumption of MDMA may
also have long-term consequences, especially with
regard to users’ mental health.
Objectives
This review aims to address the question: ‘What
are the harmful health effects of taking ecstasy
(MDMA) for recreational use?’ It does not examine
the harmful indirect and/or social effects, such as
effects on driving and road traffic accidents and
the consequences of any effect MDMA may have on
sexual behaviour.

Previous research syntheses
(Level I evidence)
For each identified Level I synthesis, it was difficult
to ascertain the exact methods adopted and
evidence included. Three reviews reported worse
performance for ecstasy users compared to controls
in a variety of neurocognitive domains (attention,
verbal learning and memory, non-verbal learning
and memory, motor/psychomotor speed, executive
systems functioning, short- and long-term
memory). A fourth study reviewed self-reported
depressive symptoms and found that ecstasy users
had increased levels compared to controls. The
final synthesis was primarily concerned with the
acute intoxication effects of ecstasy rather than
health harms. In all analyses, the effect sizes seen
were considered to be small.
Controlled observational
studies (Level II evidence)
Of the 110 controlled observational studies
included, there was one prospective study, the
Netherlands XTC Toxicity (NeXT) study, which
recruited a cohort of participants likely to start
using ecstasy and followed them for a year. Those
who started using ecstasy were then compared to
a group of matched controls who had remained
ecstasy-naïve. Ecstasy-exposed participants had
poorer performance in some memory tests,
although the absolute test scores for both cohorts
were comfortably within the normal range.
Other tests suggested an association between
ecstasy exposure and certain aspects of sensation seeking,
but there was no evidence of an effect on
depression or impulsivity. The cumulative dose of
ecstasy consumed was small (median 3–6 tablets).
The remaining Level II evidence consisted of cross sectional
studies only. Data were directly pooled
for seven individual outcomes. Six were common
measures of immediate and delayed verbal recall,
in which ecstasy users performed significantly
worse than polydrug controls. Effect sizes appeared
to be small, with the mean scores for each group
falling within the normal range for the instrument
concerned. No difference was seen between ecstasy
users and polydrug and drug-naïve controls in the
remaining measure, IQ.
A total of 915 outcome measures were grouped
into broad outcome domains as suggested in
the literature and after consultation with expert
advisers. For 16 of these meta-outcomes, there
were sufficient data for meta-analysis: immediate
and delayed verbal and visual memory, working
memory, sustained and focused attention, three
measures of executive function (planning, response
inhibition and shifting), perceptual organisation,
self-rated depression, memory, and anxiety and
impulsivity measured objectively and subjectively.
Ecstasy users performed significantly worse than
polydrug controls on all outcome domains with
the exception of executive function (response
inhibition and shifting) and objective measures of
impulsivity. Fewer comparisons were possible with
drug-naïve controls, with statistically significant
effects seen for verbal and working memory and
self-rated measures of depression, memory and
impulsivity. With both control groups, former
ecstasy users frequently showed deficits that
matched or exceeded those seen among current
users.
The small effect sizes seen were not consistently
modified by any study-level demographic variables.
There was little evidence of a dose–response
effect: studies reporting heavier average use
of ecstasy did not provide more extreme effect
measures than those consisting of lighter users,
and there was no demonstrable effect of length
of abstinence from ecstasy. When assessing the
impact of inter-arm differences on results, no
consistent effect was seen for imbalances in age
or gender. However, in several cases, it appeared
that imbalances in intelligence between cohorts
may have been important. Use of other drugs also
appeared to modify effects: alcohol consumption
proved the most consistent effect modifier, with
increased exposure in ecstasy-exposed populations

apparently reducing the magnitude of deficits
across a range of neurocognitive outcomes.
For the remaining outcome domains, there
were insufficient data for quantitative synthesis
and the results were summarised narratively.
For psychopathological symptoms, there was a
significant deficit for ecstasy users compared to
polydrug controls in the obsessive–compulsive
domain only, with greater deficits seen in
comparison to drug-naïve controls. In a few studies,
ecstasy users have been shown to have higher
levels of subjectively rated aggression than drug naïve
controls. It was not possible to draw clear
conclusions about the possible effects of ecstasy
consumption on dental health, loneliness, motor
function or sleep disturbance.
Case series and case reports
(Level III evidence)
Registry data from the np-SAD and GMR are not
directly comparable due to differences in data
sources and recording of drug use. The GMR
(1993–2006) suggests that there were, on average,
17 deaths a year where ecstasy was recorded as the
sole drug involved (2.5% of all deaths ascribed to a
single drug) and another 33 per year where it was
reported as co-drug use. Ecstasy-associated deaths
appear to have increased up to 2001 but to have
stabilised thereafter. In the 10 years to 2006, the
np-SAD recorded an average of 50 drug-related
deaths in which ecstasy was present (69 in 2006; 5%
of the total for the year). Ecstasy was believed to be
the sole drug implicated in an average of 10 deaths
annually over the same time period. According to
this registry, the typical victim of an ecstasy death
is an employed white male in his twenties, who
is a known drug user co-using a number of other
substances. Nearly half of ecstasy-related deaths
occur on a Saturday or Sunday night.
Published case series and case reports document
a wide range of fatal and non-fatal acute harms,
often very selectively. Two major syndromes
are most commonly reported as the immediate
cause of death in fatal cases: hyperthermia (with
consequences including disseminated intravascular
coagulation, rhabdomyolysis and acute liver and
renal failure) and hyponatraemia (commonly
presenting with confusion and seizures due to
cerebral oedema). Ecstasy users presenting with
hyponatraemia have invariably consumed a large
amount of water. We found 41 deaths relating to
hyperthermia reported in the literature and 10
from hyponatraemia (all women).
Other acute harms associated with fatal cases
include cardiovascular dysfunction, neurological
dysfunction (seizures and haemorrhage) and
suicide. Acute renal failure and sub acute liver
failure can occur without association with
hyperthermia. All these presentations were also
seen in non-fatal cases, alongside an additional
range of symptoms including acute psychiatric
effects, urinary retention and respiratory
problems including pneumothorax and
pneumomediastinum.
There are difficulties in estimating taken dose
of MDMA from the available literature, and it is
not clear why some people seem to have acute,
even fatal, reactions to doses that are commonly
tolerated in others.
Discussion
The evidence we identified for this review
provides a fairly consistent picture of deficits in
neuro-cognitive function for ecstasy users compared
to ecstasy-naïve controls. Although the effects
are consistent and strong for some measures,
particularly verbal and working memory, the effect
sizes generally appear to be small: where single
outcome measures were pooled, the mean scores of
all participants tended to fall within normal ranges
for the instrument in question and, where multiple
measures were pooled, the estimated effect sizes
were typically in the range that would be classified
as ‘small’.
However, there are substantial shortcomings in the
methodological quality of the studies analysed.
Because none of the studies was blinded, observer
or measurement bias may account for some of
the apparent effect. There is a suggestion of
publication bias in some analyses, and we saw clear
evidence of selective reporting of outcomes.
Selection bias is an inevitable problem: due to the
observational nature of all relevant evidence, there
is no guarantee that the cohorts being compared
were not subject to differences in areas other than
exposure to ecstasy. This effect will have been
exaggerated in those studies comparing ecstasy exposed
participants to drug-naïve controls; in
these instances, it is impossible to isolate the effect
of ecstasy exposure from the impact of other
substances. Within-study imbalances in intelligence
and the use of other substances, particularly
alcohol, appeared to explain some of the effects
seen. We suggest that the apparently beneficial
Methods
The following databases were searched using
a comprehensive search syntax: MEDLINE,
EMBASE, PsycINFO (run 19 September 2007)
and Web of Knowledge (run 7 October 2007).
The search outputs were considered against pre specified
inclusion/exclusion criteria; the full text
of all papers that could not confidently be excluded
on title and abstract alone was then retrieved and
screened. Only studies published in English were
included. Meeting abstracts were included only
if sufficient methodological details were given
to allow appraisal of study quality. Studies were
categorised according to a hierarchy of research
design, with systematic research syntheses (Level
I evidence) being preferred as the most valid and
least open to bias. Where Level I evidence was
not available, controlled observational studies
(Level II evidence) were systematically reviewed. If
neither Level I nor Level II evidence was available,
uncontrolled case series and case reports (Level
III evidence) were systematically surveyed. Data
extraction was undertaken by one reviewer and a
sample checked by a second.
Synthesising Level II evidence posed substantial
challenges due to the heterogeneity of the included
studies, the number and range of outcome
measures reported, the multiplicity of comparisons
(differing ecstasy exposures, differing comparator
groups) and outcomes, repeated measures and
the observational nature of the data. Analyses
were stratified for current and former ecstasy
users, with separate analyses for control groups
using other illegal drugs but not ecstasy (polydrug
controls) or controls naïve to illegal drugs (drug naïve
controls). Random-effects meta-analyses were
used throughout. Heterogeneity was also explored
through study-level regression analysis (meta regression).
Where a sufficient number of studies
had reported identical outcomes, they were meta analysed
on their original scale. Other outcome
measures were grouped into broad domains
and effect sizes expressed as standardised mean
differences in order to combine data derived from
multiple instruments. Objective and self-reported
outcome measures within each domain were
analysed separately.
For the Level III evidence, only narrative synthesis
was possible.
Results
Of 4394 papers identified by our searches, 795
were reviewed in full and 422 met the inclusion
criteria. Five systematic syntheses, 110 controlled
observational studies and 307 uncontrolled
effect of alcohol consumption may be explained
in two ways: either alcohol may mitigate the
hyperthermic effects of ecstasy in the acute setting,
attenuating damage to the brain, or ecstasy users
who co-use alcohol may represent a population of
more casual ecstasy takers than those who tend not
to drink.
Although the NeXT study suggests that small
deficits in memory may be secondary to ecstasy
exposure, all other included studies were
cross-sectional in nature; without evidence of
the temporal relationship between exposure
and outcome, it is difficult to draw any causal
inferences.
We did not find any studies directly investigating
the quality of life of participants, and we found
no attempts to assess the clinical meaningfulness
of any inter-cohort differences. The clinical
significance of any exposure effect is thus
uncertain; it seems unlikely that these deficits
significantly impair the average ecstasy user’s
everyday functioning or quality of life. However,
our methods are unlikely to have identified
subgroups that may be particularly susceptible
to ecstasy. In addition, it is difficult to know how
representative the studies are of the ecstasy-using
population as a whole. Generalising the findings is
therefore problematic.
Ecstasy is associated with a wide range of
acute harms, but remains a rare cause of death
when reported as the sole drug associated with
death related to drug use. Hyperthermia and
hyponatraemia and their consequences are the
commonest causes of death, but a wide range of
other acute fatal and non-fatal harms are reported.
Due to the poor quality of the available evidence, it
is not possible to quantify the risk of acute harms in
any meaningful way.
Research recommendations
Large, population-based, prospective studies are
required to examine the time relationship between
ecstasy exposure and neuro-cognitive deficits and
psychopathological symptoms.
Further research synthesis of the social and other
indirect health harms of ecstasy would provide a
more complete picture. Similar synthesis of the
health harms of amphetamines generally would
provide a useful comparison.
Future cross-sectional studies will only add to the
evidence-base if they are large, as representative as
possible of the ecstasy-using population, use well validated
outcome measures, measure outcomes
as objectively as possible with researchers blind
to the ecstasy-using status of their subjects, report
on all outcomes used, and provide complete
documentation of possible effect modifiers.
Cohorts should be matched for baseline factors,
including IQ and exposure to alcohol.
The heterogeneity of outcome measures used by
different investigators is unhelpful: consensus on
the most appropriate instruments to use should be
sought. Investigators should collect data directly
reflecting the quality of life of participants and/or
attempt to assess the clinical meaningfulness of any
inter-cohort differences.
A registry of adverse events related to illegal
intoxicants presenting to medical services (akin to
the ‘yellow card’ system for prescription medicines)
would enable useful estimation of the incidence of
harmful effects of ecstasy in comparison to other
substances.
Future case reports of acute harms of ecstasy are
unlikely to contribute valuable information to the
evidence-base. Where novel findings are presented,
care should be taken to report toxicological
findings confirming the precise identity of the
substance(s) consumed by the individual(s) in
question.

Source: Rogers G, Elston J, Garside R, Roome C, Taylor
R, Younger P, et al. The harmful health effects
of recreational ecstasy: a systematic review of
observational evidence. Health Technol Assess
2009;13

Approximately 36% of East Asians (Japanese, Chinese, and Koreans) show a characteristic physiological response to drinking alcohol that includes facial flushing , nausea, and tachycardia [1] . This so-called alcohol flushing response (also known as “Asian flush” or “Asian glow”) is predominantly due to an inherited deficiency in the enzyme aldehyde dehydrogenase 2 (ALDH2) [2]. Although clinicians and the East Asian public generally know about the alcohol flushing response (e.g., http://www.echeng.com/asianblush/), few are aware of the accumulating evidence that ALDH2-deficient individuals are at much higher risk of esophageal cancer (specifically squamous cell carcinoma) from alcohol consumption than individuals with fully active ALDH2. This is particularly unfortunate as esophageal cancer is one of the deadliest cancers worldwide [3], with five-year survival rates of 15.6% in the United States, 12.3% in Europe, and 31.6% in Japan [4] Our goal in writing this article is to inform doctors firstly that their ALDH2-deficient patients have an increased risk for esophageal cancer if they drink moderate amounts of alcohol, and secondly that the alcohol flushing response is a biomarker for ALDH2 deficiency. Because of the intensity of the symptoms, most people who have the alcohol flushing response are aware of it. Therefore clinicians can determine ALDH2 deficiency simply by asking about previous episodes of alcohol-induced flushing. As a result, ALDH2-deficient patients can then be counselled to reduce alcohol consumption, and high-risk patients can be assessed for endoscopic cancer screening. Based on the sizes of the Japanese, Chinese, and Korean populations and the expected frequency of ALDH2-deficient individuals in each [1], we estimate that there are at least 540 million ALDH2-deficient individuals in the world, representing approximately 8% of the population. In a population of this size, even a small reduction in the incidence of esophageal cancer could result in a substantial reduction in esophageal cancer deaths worldwide.

Summary Points

ALDH2 eficiency resulting from the ALDH2 Lys487 allele contributes to both the alcohol flushing response and an elevated risk of squamous cell esophageal cancer from alcohol consumption.
Knowledge of the flushing response is useful clinically, as it allows doctors to identify their ALDH2-deficient patients in a simple, cost-effective, and non-invasive manner.
Doctors should counsel their ALDH2-deficient patients to limit alcohol consumption and thereby reduce the risk of developing esophageal cancer.
In view of the approximately 540 million ALDH2-deficient individuals in the world, many of whom now live in Western societies, even a small percent reduction in esophageal cancers due to a reduction in alcohol drinking would translate into a substantial number of lives saved.

A Primer on the Genetics of Alcohol Metabolism

Ethanol is first metabolized primarily by alcohol dehydrogenase (ADH) into acetaldehyde (Figure 2), a mutagen and animal carcinogen that causes DNA damage and has other cancer-promoting effects [5–7]. Acetaldehyde is subsequently metabolized to acetate, mainly by the enzyme ALDH2 [8]. In East Asian populations there are two main variants of ALDH2, resulting from the replacement of glutamate (Glu) at position 487 with lysine (Lys) [9]. The Glu allele (also designated ALDH2*1) encodes a protein with normal catalytic activity, whereas the Lys allele (ALDH2*2) encodes an inactive protein. As a result, Lys/Lys homozygotes have no detectable ALDH2 activity. Because the Lys allele acts in a semi-dominant manner, ALDH2 Lys/Glu heterozygotes have far less than half of the ALDH2 activity of Glu/Glu homozygotes; in fact, the reduction in ALDH2 activity in heterozygotes is more than 100-fold [8].

Alcohol consumed by ALDH2-deficient individuals is metabolized to acetaldehyde, which accumulates in the body due to absent ALDH2 activity and results in facial flushing, nausea, and tachycardia [2]. These unpleasant effects are the result of diverse actions of acetaldehyde in the body, including histamine release [10]. Because of the intensity of this unpleasant response, ALDH2 Lys/Lys homozygotes are unable to consume significant amounts of alcohol. As a result, they are protected against the increased risk of esophageal cancer from alcohol consumption [11]. This observation also provided evidence for a causative role for ethanol in esophageal cancer, and a key role for acetaldehyde in mediating this effect [11].
ALDH2 Lys/Glu heterozygotes experience a less severe manifestation of the flushing response due to residual but low ALDH2 enzyme activity in their cells. As a result, some are able to develop tolerance to acetaldehyde and the flushing response and become habitual heavy drinkers, due in part to the influence of societal and cultural factors (see below). Therefore, paradoxically, it is the more common low-activity ALDH2 heterozygous genotype that is associated with greatest risk of esophageal cancer from drinking alcohol.

Evidence That ALDH2 Deficiency Increases the Risk of Alcohol-Related Squamous Cell Esophageal Cancer
Following the first study [12], which was conducted in the Japanese population, case control studies in Japan and Taiwan have consistently demonstrated a strong link between the risk of esophageal squamous cell carcinoma and alcohol consumption in low-activity ALDH2 heterozygotes, with odds ratios (ORs) ranging from 3.7 to 18.1 after adjustment for alcohol consumption. Moreover, most studies show ORs of over 10 for increased risk in heterozygotes who are heavy drinkers [13,14]. An independent meta-analysis has also confirmed an increased risk, even among moderate drinking heterozygotes [11]. In the Japanese and Taiwanese studies, a strikingly high proportion (58%–69%) of the excessive risk for esophageal cancer is attributable to drinking by low-activity ALDH2 heterozygous individuals [13,14].
Consistent with the results of case control studies, prospective studies in cancer-free alcoholics have also shown that the relative hazard for future upper aerodigestive tract (UADT) cancers in low-activity ALDH2 heterozygotes is approximately 12 times higher than in individuals with active ALDH2 [15]. (The UADT includes the oral cavity, pharynx, larynx, and esophagus.) In addition, alcohol consumption in low-activity ALDH2 heterozygotes has been associated with other cancer-related outcomes, including the presence of multiple areas of esophageal dysplasia (i.e., premalignant lesions) and multiple independent UADT cancers [13].
It is important to note that ALDH2 deficiency does not influence esophageal cancer risk in non-drinkers [11]. Furthermore, the magnitude of the ALDH2-associated esophageal cancer risk depends on the relative importance of alcohol versus other risk factors in a given population. In rural areas of China, where there is a high rate of esophageal cancer but alcohol drinking plays a less important role than in Japan and Taiwan, there is a more modest positive association (ORs, 1.7 to 3.1) between low-activity ALDH2 heterozygotes and esophageal cancer risk (e.g., [16]).
Acetaldehyde Is Responsible for Facial Flushing and Esophageal Cancer Risk in ALDH2-Deficient Individuals Top
Acetaldehyde is responsible for the facial flushing and other unpleasant effects that ALDH2-deficient individuals experience when they drink alcohol [10]. Importantly, there is now direct evidence that ALDH2-deficient individuals experience higher levels of acetaldehyde-related DNA and chromosomal damage than individuals with fully active ALDH2 when they consume equivalent amounts of alcohol, providing a likely mechanism for the increased cancer risk. A study in Japanese alcoholics [17] showed that the amount of mutagenic acetaldehyde-derived DNA adducts (Figure 4) in white blood cells was significantly higher in ALDH2-deficient heterozygotes than in individuals with active ALDH2 (Table 1). In this study, while the two groups were matched for alcohol consumption, the ALDH2-deficient group consumed slightly less alcohol on average than the controls. Also, ALDH2 heterozygotes who drank alcohol had higher levels of white blood cells with chromosomal damage than drinkers with active ALDH2 [18]. Because of these as well as other data, the 2007 International Agency for Research on Cancer Working Group on alcohol and cancer specifically noted the substantial mechanistic evidence supporting a causal role for acetaldehyde in alcohol-related esophageal cancer [19].

Five Key Papers in the Field
Harada et al., 1981 [2] The first documentation of the relationship between ALDH deficiency and the flushing reaction.

Yoshida et al., 1984 [9] Identification of the amino acid variant responsible for ALDH deficiency.

Yokoyama et al., 1996 [12] The first evidence demonstrating that ALDH2-deficient individuals have a dramatically elevated risk of esophageal cancer when they drink alcohol.

Yokoyama et al., 2003 [25] Demonstrates that an updated flushing questionnaire containing two simple questions is approximately 90% sensitive and specific for identifying ALDH2-deficient individuals.

Baan et al., 2007 [19] Summary of the conclusions from the 2007 International Agency for Research on Cancer Working Group on the Consumption of Alcoholic Beverages. This is the first report to conclude that ethanol in alcoholic beverages is carcinogenic to humans. The report also adds the female breast and colorectum to the list of sites for alcohol-related carcinogenesis and notes substantial mechanistic evidence linking acetaldehyde to esophageal cancer risk based on studies from ALDH2-deficient individuals.

While the UADT is exposed to acetaldehyde from alcoholic beverages [20] and tobacco smoke, increasing evidence points to the metabolism of ethanol by microorganisms in the oral cavity as an important source of acetaldehyde in saliva and, by extension, in the esophagus. Acetaldehyde levels in saliva are 10–20 times higher than in blood, due to the local formation of acetaldehyde by oral microorganisms [21]. Importantly, ALDH2 heterozygotes had two to three times the acetaldehyde levels in their saliva compared to fully active ALDH2 individuals after a moderate dose of oral ethanol [22].

Social and Cultural Factors Modulate Alcohol Drinking by ALDH2 Heterozygotes

Alcohol consumption is a social activity, and as such can be strongly influenced by cultural and social forces. In Japan, where the risk of alcohol-related esophageal cancer in ALDH2 heterozygotes has been most well documented, going out drinking after work with colleagues is an essential element of Japanese business society, and the idea of group harmony is particularly powerful. The percentage of heavy drinking men who are low-activity ALDH2 heterozygotes has risen substantially in the last few decades, in parallel with the proliferation of business society in Japan and increases in per capita alcohol consumption. Harada et al. [23] first reported that the frequency of inactive ALDH2 was very low (only 2%) in Japanese alcoholics in 1982. In a later study using archival DNA samples, Higuchi et al. [24] determined that in 1979, 3% of Japanese alcoholics were ALDH2 heterozygotes, compared with 8% in 1986 and 13% in 1992. In a more recent study, approximately 26% of heavy drinking (consuming more than about 400 g of ethanol per week) men in Tokyo were ALDH2 Lys487 heterozygotes [35]. In other East Asian countries, estimates of the percentage of alcoholics who are low-activity ALDH2 heterozygotes range from 17% in Taiwan in 1999 [26] to 4% in Korea in 2007 [27]. Taken together, these observations indicate that the inhibitory effect of heterozygous ALDH2-deficiency on alcohol consumption can be strongly influenced by local social and cultural factors which may change over time.

There are many East Asians now living in Western societies, particularly at universities and in metropolitan areas. A sub-population of special concern is ALDH2-deficient university students who may face peer pressure for heavy drinking and binge drinking. Furthermore, anecdotal evidence indicates that some young people view the facial flushing response as a cosmetic problem and use antihistamines in an effort to blunt the flushing while continuing to drink alcohol [28]. This practice is expected to increase the likelihood of developing esophageal cancer.

Education and Early Detection Can Reduce the Global Health Burden of Esophageal Cancer

Clinicians who treat patients of East Asian descent need to be aware of the risk of esophageal cancer from alcohol consumption in their ALDH2-deficient patients. Importantly, clinicians can determine whether an individual of East Asian descent is ALDH2 deficient simply by asking whether they have experienced the alcohol flushing response. In the Japanese population, ALDH2 deficiency can be identified accurately based on the answers to a flushing questionnaire consisting of two questions (see Box 1) about previous episodes of facial flushing after drinking alcohol [25]. The two questions can be easily included as part of a standard clinical interview. In a Japanese male population, the flushing questionnaire had a 90% sensitivity and 88% specificity [25] and a positive predictive value of 87% (based on the tabulated data in [25]). The flushing questionnaire gave a similarly high sensitivity (88%) and specificity (92%) when administered to Japanese women [29].

Clinical Tests To Assess ALDH2 Deficiency Due To the ALDH2 Lys487 Allele
1. The Flushing Questionnaire

The flushing questionnaire consists of two questions: (A) Do you have a tendency to develop facial flushing immediately after drinking a glass (about 180 ml) of beer?; (B) Did you have a tendency to develop facial flushing immediately after drinking a glass of beer in the first one or two years after you started drinking? For both questions, the choice of answers are: yes, no, or unknown.
If an individual answers yes to either question A or B, they are considered to be ALDH2 deficient [25]. The addition of question B is important because some individuals can become tolerant to the facial flushing effect.
The questionnaire that was tested referred to a small (about 180 ml) glass of beer. However, it seems likely that similar results would be obtained if the question were asked about beer or other beverages containing a similar amount of alcohol (about two-thirds of a glass of wine or shot of hard liquor).

2. The Ethanol Patch Test

The ethanol patch test is performed as follows: 0.1 ml of 70% ethanol is pipetted onto a 15 × 15 mm lint pad fixed on an adhesive tape. The patch is attached to the inner surface of the upper arm for a 7-minute period and then removed. A patch area that shows erythema 10–15 minutes after removal is judged as positive. The sensitivity, specificity, and positive predictive value for inactive ALDH2 are more than 90% in Japanese youth [34].

Once ALDH2-deficient patients have been identified, they should be informed about their elevated risk of developing esophageal cancer risk from drinking alcohol. As can be seen from Figure 5, ALDH2 deficiency increases esophageal cancer risk at all three drinking levels, but the slope of the line relating alcohol consumption to esophageal cancer risk is steeper in ALDH2-deficient individuals. Clinicians might therefore use this graph to explain the increased risk when counseling their ALDH2-deficient patients to reduce alcohol consumption.

Alcohol consumption amounts: low, 1–8.9 units/week; moderate, 9–17.9 units/week; high, ≥18 units/week; where 1 unit = 22 g of ethanol. The referent (OR = 1) is never/rare drinkers (<1 unit/week) of either genotype. Odds ratios were adjusted for age, frequency of drinking strong alcohol beverages, pack-years of smoking, and intake of fruit and green-yellow vegetables, based on a multiple logistic regression model. Error bars are 95% confidence intervals. The graph is based on the data in [25].
doi:10.1371/journal.pmed.1000050.g005
The ORs in Figure 5 are adjusted for smoking. However, patients should also be informed that smoking further increases the esophageal cancer risk in a synergistic manner with alcohol [30]. As noted above, cigarette smoking dramatically increases acetaldehyde levels in saliva, and ALDH2-deficient individuals have a reduced capacity to clear salivary acetaldehyde.
For patients at high risk of esophageal cancer, doctors should also consider endoscopy for early cancer detection. A health risk assessment tool to select candidates for endoscopic cancer screening, including data on alcohol flushing as well as alcohol consumption, smoking, and dietary habits, is currently being developed and validated [31]. Using a version of the health risk assessment that includes the flushing questionnaire as a major component, it has been estimated that approximately 58% of esophageal cancers in the Japanese population could be detected by screening only the individuals with the top 10% risk scores [31].
When detected early, esophageal cancer can be treated by endoscopic mucosectomy, a standard and relatively non-invasive procedure. However, once the cancer has grown large enough to penetrate the submucosal layer, the likelihood of lymph node metastasis increases significantly [32]. Only about 20% of esophageal cancer patients survive three years after diagnosis [3], emphasizing the importance of disease prevention.
ALDH2-deficient university students may have their first experiences with heavy drinking while at university. Therefore, it is particularly important for university health professionals to be aware of the relationship between ALDH2 deficiency, facial flushing, and alcohol-related cancer risk. Informing ALDH2-deficient young people of their risk of esophageal cancer from alcohol drinking represents a valuable opportunity for cancer prevention. However, most of the data on the accuracy of the flushing questionnaire have come from individuals over 40 years old. To assess ALDH2 deficiency in young people with little experience of alcohol consumption, an ethanol patch test (see Box 1) can be used [13]. In the patch test, ethanol is applied to the skin, where it is metabolized to acetaldehyde. (Both ADH and ALDH can be detected in skin fibroblasts [33].) If the acetaldehyde is not further metabolized to acetate, it causes vasodilation, which is detected visually as localized erythema. Like the flushing questionnaire, the ethanol patch test is simple and inexpensive to perform, and the sensitivity, specificity, and positive predictive value for inactive ALDH2 have been shown to be more than 90% in Japanese youth [34].

How Many Cancers Could Be Prevented by Reducing Alcohol Consumption in ALDH2-Deficient Individuals?
Finally, it is important to consider how many esophageal cancer cases might be prevented if ALDH2-deficient individuals reduced alcohol consumption. To address this question, the tabulated data of [35] were used to recalculate the population-attributable risk by Bruzzi’s method [36]. The results of this calculation indicate that if moderate or heavy drinking ALDH2 heterozygotes were instead only light drinkers, 53% of esophageal squamous cell carcinomas might be prevented in the Japanese male population.

Source: PLoS Med 6(3): e1000050. doi:10.1371/journal.pmed.1000050
Published: March 24, 2009

A tiny genetic mutation is the key to understanding why nicotine–which binds to brain receptors with such addictive potency–is virtually powerless in muscle cells that are studded with the same type of receptorBy all rights, nicotine ought to paralyze or even kill us, explains Dennis Dougherty, the George Grant Hoag Professor of Chemistry at Caltech and one of the leaders of the research team. After all, the receptor it binds to in the brain’s neurons–a type of acetylcholine receptor, which also binds the neurotransmitter acetylcholine–is found in large numbers in muscle cells. Were nicotine to bind with those cells, it would cause muscles to contract with such force that the response would likely prove lethal. Obviously, considering the data on smoking, that is not what happens. The question has long been: Why not?

“It’s a chemical mystery,” Dougherty admits. “We knew something subtle had to be going on here, but we didn’t know exactly what.” That subtlety, it turns out, lies in the slight tweaking of the structure of the acetylcholine receptor in muscle cells versus its structure in brain cells.
The shape of the acetylcholine receptor, and the way the chemicals that bind with it contort themselves to fit into that receptor, is determined by a number of different weak chemical interactions. Perhaps most important is an interaction that Dougherty calls “underappreciated”–the cation-π interaction, in which a positively charged ion and an electron-rich π system come together.

Back in the late 1990s, Dougherty and colleagues had shown that the cation-π interaction is indeed a key part of acetylcholine’s ability to bind to the acetylcholine receptors in muscles. “We assumed that nicotine’s charge would cause it to do the same thing, to have the same sort of strong interaction that acetylcholine has,” says Dougherty. “But we found that it didn’t.”
This would explain why smoking doesn’t paralyze us; if the nicotine can’t get into the muscle’s acetylcholine receptors, it can’t cause the muscles to contract.

But how, then, does nicotine work its addictive magic on the brain? It took another decade for the scientists to be able to peek at what happens in brain cells’ acetylcholine receptors when nicotine arrives on the scene. Turns out that in brain cells, unlike in muscle cells, nicotine makes the exact same kind of strong cation-π interaction that acetylcholine makes in both brain and muscle cells. “In addition,” Dougherty notes, “we found that nicotine makes a strong hydrogen bond in the brain’s acetylcholine receptors. This same hydrogen bond, in the receptors in muscle cells, is weak.”

The cause of this difference in binding potency, says Dougherty, is a single point mutation that occurs in the receptor near the key tryptophan amino acid that makes the cation-π interaction. “This one mutation means that, in the brain, nicotine can cozy up to this one particular tryptophan much more closely than it can in muscle cells,” he explains. “And that is what allows the nicotine to make the strong cation-π interaction.”

Dougherty says the best way to visualize this change is to think of the receptor as a box with one open side. “In muscle cells, this box is slightly distorted, so that the nicotine can’t get to the tryptophan,” he says. “But in the brain, the box is subtly reshaped. That’s the thing: It’s the shape, not the composition, of the box that changes. This allows the nicotine to make strong interactions, to become very potent. In other words, it’s what allows nicotine to be addictive in the brain.”

“Several projects in our labs are converging on the molecular and cellular mechanisms of the changes that occur when the brain is repeatedly exposed to nicotine,” adds study coauthor Henry Lester, the Bren Professor of Biology at Caltech. “We think that the important events begin with the rather tight and selective interaction between nicotine and certain receptors in the brain. This Nature paper teaches us how this interaction occurs, at an unprecedented level of resolution.”
Dougherty notes that these findings might one day lead to better drugs to combat nicotine addiction and other neurological disorders. “The receptor we describe in this paper is an important drug target,” he says. “It might help pharmaceutical companies develop a better drug than nicotine to do the good things nicotine does–enhance cognition, increase attention–without being addictive and toxic.”

Source: Xiu et al. Nicotine binding to brain receptors requires a strong cation–π interaction. Nature, March 26, 2009; DOI: 10.1038/nature07768 Science Daily 29.03.09

Deterrence is preferable to encouraging marijuana use, which would follow alcohol and tobacco in soaring costs to society.Last month, Gov. Arnold Schwarzenegger reignited a heated debate when he called for a civilized discussion on the merits of marijuana legalization. Indeed, the governor was responding to new public opinion polls showing greater interest in the policy idea — and with the mounting problems associated with the drug trade in Mexico and here at home, it is hard to blame anyone for suggesting that we at least consider all potential policy solutions.

One major justification for legalization remains tempting: the money. Unfortunately, however, the financial costs of marijuana legalization would never outweigh its benefits. Yes, the marijuana market seems like an attractive target for taxation — Abt Associates, a research firm, estimates that the industry is worth roughly $10 billion a year — and California could certainly use a chunk of that cash to offset its budget woes in the current economic climate.

What is rarely discussed, however, is that the likely increase in marijuana prevalence resulting from legalization would probably increase the already high costs of marijuana use in society. Accidents would increase, healthcare costs would rise and productivity would suffer. Legal alcohol serves as a good example: The $8 billion in tax revenue generated from that widely used drug does little to offset the nearly $200 billion in social costs attributed to its use.

In fact, both of our two already legal drugs — alcohol and tobacco — offer chilling illustrations of how an open market fuels greater harms. They are cheap and easy to obtain. Commercialization glamorizes their use and furthers their social acceptance. High profits make aggressive marketing worthwhile for sellers. Addiction is simply the price of doing business.

Would marijuana use rise in a legal market for the drug? Admittedly, marijuana is not very difficult to obtain currently, but a legal market would make getting the drug that much easier. Tobacco and alcohol are used regularly by 30% and 65% of the population, respectively, while all illegal drugs combined are used by about 6% of Americans. In the Netherlands, where marijuana is de facto legalized, lifetime use “increased consistently and sharply” after this policy shift triggered commercialization, tripling among young adults, according to data analysis from the Rand Corp. We might expect a similar or worse result here in America’s ad-driven culture.
An honest debate on marijuana policy also carefully considers the costs of our current approach. Arrest rates for marijuana are relatively high, reaching about 800,000 last year. Though these numbers are technically recorded under the category of “possession,” the story that is seldom told is that hardly any of these possession arrests result in jail time (that is why former New York City Mayor Rudolph Giuliani made headlines when he aggressively arrested public marijuana users and detained them for 12 to 24 hours in the 1990s).

One of the most astute minds in the field of drug policy, Carnegie Mellon’s Jonathan Caulkins, formerly the co-director of Rand’s drug policy research center, found that more than 85% of people in prison for all drug-law violations were clearly involved in drug distribution, and that the records of most of the remaining prisoners had at least some suggestion of distribution involvement (many prisoners plea down from more serious charges to possession in exchange for information about the drug trade). Only about half a percent of the total prison population was there for marijuana possession, he found. He noted that this figure was consistent with other mainstream estimates but not with estimates from the Marijuana Policy Project (a legalization interest group), which, according to Caulkins, “naively … assumes that all inmates convicted of possession were not involved in trafficking.” Caulkins concluded that “an implication of the new figure is that marijuana decriminalization would have almost no impact on prison populations.” This is not meant to imply that marijuana arrests do not have costs, but rather, that these concerns have been highly exaggerated.

Finally, legalizing marijuana would in no way ensure that the most vicious drug-related problems — violence, economic-related crime, street gang activity — would disappear. Most of those problems stem from the cocaine, heroin and methamphetamine markets. Marijuana’s share of the black market is modest (the cocaine market is three times larger), and the money that is spent on the drug is spread over so many users and distributors that few are working with amounts that motivate or encourage high levels of crime.

Moving beyond the simplistic and unrealistic option of legalization, what can we do to reduce marijuana use and the costly harms it brings? Increasing the ferocity of enforcement isn’t the answer, but increasing its potential for effectiveness through deterrent methods might be. Programs like Project HOPE in Hawaii, which perform regular, random drug testing on probationers and others and implement reliable, swift (but short) sanctions for positive screens, have shown remarkable success. Innovative solutions, grounded in sound research on prevention, treatment and enforcement, present the shortest route out of marijuana-related costs. But an open market for the stuff? That doesn’t pass the giggle test.

Kevin A. Sabet worked at the Office of National Drug Control Policy in the Clinton and Bush administrations. He is currently a consultant in private practice.

Source: LA Times Sunday 7th June 2009

Effects on Neurocognitive Functioning
Maternal cannabis use during pregnancy has subtle effects on offspring’s neurocognitive functioning.

Beginning at age three to four, children of mothers who used cannabis heavily while pregnant have demonstrated deficits in memory, verbal and perceptual skills, and verbal and visual reasoning after adjusting for potentially confounding variables (Day et al., 1994; Fried & Watkinson, 1990).

Impaired performance in verbal and quantitative reasoning and short-term memory has also been found among six-year-old children whose mothers reported smoking one or more marijuana cigarettes per day, after controlling for significant covariates (Goldschmidt, Richardson, Willford, & Day, 2008).

In children around the age of nine, prenatal cannabis exposure has been linked with impaired abstract and visual reasoning, poor performance on tasks reflecting
executive functioning (i.e., visual-motor integration, nonverbal concept formation, and problem solving), and deficits in reading, spelling, and achievement, independent of various covariates (Fried, Watkinson & Gray, 1998; Fried & Watkinson, 2000; Goldschmidt, Richardson, Cornelius, & Day, 2004; Richardson, Ryan, Willford, Day & Goldschmidt, 2002)

Vulnerability in visual-cognitive functioning has been shown to persist into early adolescence among those offspring heavily exposed to cannabis (Fried, Watkinson, & Gray, 2003). Findings from brain imaging studies of young adults aged 18–22 indicate that in utero cannabis exposure negatively impacts the neural circuitry involved in aspects of executive functioning, including response inhibition and visuospatial working memory (Smith, Fried, Hogan, & Cameron, 2004, 2006).

These findings are particularly noteworthy as they demonstrate the long-term impairing effects of prenatal exposure to cannabis on offspring’s neurocognitive functioning.Global intelligence does not appear to be impacted by prenatal cannabis exposure (Fried et al., 1998, 2003).

When children reach age six, the effects of maternal cannabis use during pregnancy become much more evident. Compared to offspring of non-users, children born to cannabis users— particularly heavy users—have been found to be more hyperactive, inattentive, and impulsive (Fried, Watkinson, & Gray, 1992; Leech, Richardson, Goldschmidt, & Day, 1999), even after controlling for extraneous variables.

At age 10, prenatally exposed children display increased hyperactivity, inattention, and impulsivity, and show increased rates of delinquency and externalizing problems as reported by their mothers and teachers, compared to those children who were not exposed prenatally to cannabis (Fried et al., 1998; Goldschmidt, Day, & Richardson, 2000).

In children aged 13–16, however, some aspects of attention (i.e., flexibility, encoding and focusing) appear to no longer be affected by cannabis exposure (Fried et al., 2003).

There is accumulating evidence that suggests prenatal cannabis exposure may contribute to the initiation and frequency of subsequent substance use during
adolescence. Porath and Fried (2005) reported that 16- to 21-year-old offspring (particularly males) of cannabis users were at increased risk, in a dose-related
manner, for the initiation of cigarette smoking and cannabis use, and daily cigarette smoking, compared to offspring of non-using mothers, independent of potential prenatal confounds. Similar results were noted by Day, Goldschmidt, and Thomas (2006); compared to offspring of non-users, youth of mothers who heavily used cannabis while pregnant not only reported using this substance more frequently at age 14, but they also initiated use at an earlier age. This result was significant even after controlling for potential confounds.

Effects on Mental Health
There is emerging evidence linking in utero cannabis exposure to depressive and anxious symptomatology. After controlling for prenatal exposure to other drugs and risk factors for childhood depression, offspring of maternal cannabis users expressed significantly more depressive and anxious symptoms at age 10 compared to children of non-users (Gray, Day, Leech, & Richardson, 2005; Leech, Larkby, Day, & Day, 2006).

Mechanisms of Action
The mechanisms responsible for the effects of prenatal cannabis exposure are not well understood. Cannabinoids are able to cross the placental barrier and may affect the expression of key genes for neural development, leading to neurotransmitter and behavioural disturbances (Gomez et al., 2003). The presence of cannabinoid receptors in the placenta and fetal brain may also mediate adverse actions of prenatal cannabis exposure (Park, Gibbons, Mitchell, & Glass, 2003), as these receptors are associated with aspects of brain functioning including cognition and memory (Kumar, Chambers, Pertwee, 2001). Animal studies have documented that cannabinoids can lead to changes in dopamine activity and impaired functioning of the hypothalamus-pituitaryadrenal axis (Kumar et al., 2001), which may affect mood and neurobehavioural outcomes in offspring. It is also possible that an underlying genetic factor may account for both the lifestyle habits of the pregnant mother (i.e., cannabis use) and her child’s neurodevelopment and behaviour.

Conclusions and Implications
Evidence does suggest that prenatal exposure to cannabis (particularly heavy exposure) has subtle adverse effects, beginning at approximately three years of age, on subsequent cognitive functioning, behaviour, substance use, and mental health in offspring. Cannabis-related deficits in the cognitive domain could impair a child’s academic functioning and may require educational remediation, enrichment or placement to help protect against future learning problems.

Prevention efforts directed towards reducing maternal cannabis use during pregnancy could have significant effects in reducing such cognitive impairment. Prevention and intervention programs aimed at reducing prenatal cannabis exposure could also help reduce the percentage of youth who experience mental health conditions and other comorbid problem behaviours, such as substance use and delinquency. It has been reported that at least half of all pregnancies in North America are unplanned (Walker, Rosenberg, & Balaban, 1999). That, combined with the fact that nearly 7% of American women of childbearing age (15–44 years) reported past-month use of marijuana and hashish in 2005 (SAMHSA, 2006) indicates the potential risk for offspring to be prenatally exposed to cannabis.

Cannabis use is a preventable prenatal risk factor; the findings reviewed from the literature suggest that it is prudent to advise pregnant women, and women thinking of becoming pregnant, of the risks associated with cannabis use during pregnancy.

Source Clearing the Smoke on Cannabis . Maternal Cannabis Use During Pregnancy http://www.ccsa.ca/ 2009

Despite this government spending £10billion – £1.5billion a year – on its drugs policy, the numbers emerging from government treatment programmes are the same as if there had been no treatment at all, revealed Kathy Gyngell in a recent document from the apolitical Centre for Policy Studies. We share its seminal factsThis summer saw the release of The Phoney War on Drugs by researcher Kathy Gyngell, chair of the Centre for Policy Studies’ Prisons and Addictions forum and editor of the 400-page Addictions section of Breakthrough Britain. It is a devastating critique of the failure of the UK’s drugs policy, the waste of valuable resources and lives.

Many experts implementing good practice will have witnessed the reality of the conclusions Gyngell arrives at, but perhaps not known the exact statistics. Truth gives power. Not only might counterproductive policies and practices be reduced, but Gyngell offers some tried-and-tested solutions. The UK is compared with Sweden and the Netherlands throughout The Phoney War. Both countries were chosen because they have adopted drug policies which are markedly different to
those of the UK and their drug use is lower. It is noteworthy that, despite the perception that the Netherlands has a liberal drugs policy, 76% of Dutch municipalities now operate local zero tolerance drug policies. Coffee shops are now increasingly tightly regulated and policed. A third have been closed in recent years. Sweden and the Netherlands also have more effective prevention strategies.

BLIGHTING THE NEXT GENERATION.

“Trae-blue Lane had just turned three when she died from an overdose of methadone, the heroin substitute supplied to her mother,” reported the Sunday Telegraph in January 2009. A Channel 4 Freedom of Information request found that between 2005-2006 police caught over 6,000 children selling drugs from class-A substances to cannabis, and caught a further 53,497 children in possession of drugs.

The deaths of infants are small windows on the UK’s worsening and chaotic drugs culture which Labour’s drug policy has, inadvertently, promoted. Consider these trends:

Naltrexone implants after in-patient treatment for opioid dependence: randomised controlled trial.

In the first randomised trial, implants which block opiate-type drugs for months helped heroin addicts in Norway avoid relapse after detoxification. If these or allied products gain a UK licence, they could help pave the way to abstinence for the minority of suitable addicts.
Abstract Naltrexone is a medication which blocks the effects of heroin and other opiate-type drugs. Its considerable potential in helping to prevent post-detoxification relapse has not been realised because patients generally refuse to take it or quickly discontinue. However, these limitations apply to the oral formulation which has be taken daily. Longer-lasting formulations in the form of a depot injection or an implant inserted under the skin avoid the need to take the medication daily. This is the first randomised trial of an implant whose opiate-blocking effects last for about six months.
Over 18 months from January 2006, staff at inpatient drug clinics in south-eastern Norway invited opiate-dependent patients on abstinence–oriented programmes to participate in the study. Patients who agreed were contacted by researchers at the end of their detoxification or residential treatment. The 56 who joined the study were told that for the first six months they would be randomly allocated to the implant or to usual aftercare arrangements, but that then all would be offered (re)implantation. Typically they were male injectors in their 30s who had used heroin for on average seven years; nearly all also used other drugs.

Three of the implant group left the clinic before they could be implanted and another three had the implants removed. All but three of the surviving (there were two deaths) patients were reassessed six months later. The main analysis included all the patients whether or not they had received or retained their implants. Over the six months of the follow-up, usual-care patients recalled using opiate-type drugs on average on 97 days, the implant group on just 37 days chart. This differential remained in the last month of the follow-up, when the corresponding figures were 17 and six days, a statistically significant difference. Average frequency of use was also significantly higher among the usual-care patients. At the six-month follow-up assessment, 18 out of 27 usual-care patients but just 9 of the 29 implant patients continued to meet criteria for opioid dependence. In line with this, implant patients were much less likely to experience craving. Nevertheless, during the study over half (18 of 29) tried opioids at least once.
In the last month of the follow-up, implant patients scored significantly lower on an index of multiple drug use and injected less often, but there were no significant differences in drinking or use of non-opioid drugs. Over the follow-up, usual-care patients averaged significantly more repeat detoxifications (0.71 versus 0.21); there were no significant differences in outpatient treatment attendance or use of aftercare services. By the end of the follow-up, implant patients expressed greater satisfaction with their lives but there were no significant differences in levels of depression, work, or criminal activity.
One patient in the implant group reported three non-fatal overdoses (there were four in the usual-care group) while using combinations of opioids, amphetamines and benzodiazepines. Three had implants removed due to infection, discomfort or side-effects. In another two, wound-opening required antibiotic treatment, and three had allergic reactions treated with antihistamines. The single death among patients allocated to implants was an overdose prior to implantation. There was also one overdose death among the usual-care patients.
The authors concluded that naltrexone implants safely and significantly reduced opioid use in a motivated population of patients.
As with oral naltrexone, the main limitation of the treatment is its acceptability to patients. In Norway acceptability will have been heightened by restricted access to substitute prescribing programmes, particularly for people unwilling to contract to forgo not just heroin, but persistent substance use of any kind. Nevertheless, recruitment to the study seems to have been slow. The 56 out of 667 patients who joined the study were probably unusually highly motivated to sustain abstinence from opiates, yet over half the implant patients tried resuming opiate use, and those who did used for on average 60 days. This degree of persistence seems incompatible with the implant having totally eliminated opiate-type effects. The reduction in multiple drug use seems to have been mainly due to the effect on opiate use, since drinking and use of other drugs were not significantly affected. As this study shows, implants and depot injections do not guarantee abstinence. Implants can be removed and both these and depot injections can be sidestepped by turning to non-opiate drugs (as may have happened in Australia) or overridden by very high doses of opiate-type drugs, attempts which risk overdose.
The implants were compared against relatively weak aftercare arrangements; more active and structured aftercare (for example, regular monitoring, continued well organised care from the initial service, or active referral) might have narrowed the differences between the groups. However, highly motivated patients and imperfect aftercare arrangements probably reflect the conditions in which implants would be deployed in normal practice, as does the fact that patients knew whether they had an active implant; unlike some other studies, there was no placebo comparison group.
Of the 26 patients who were implanted, eight (nearly 1 in 3) experienced complications which led three to have the implant removed. One other potential problem is that implants impede opiate-based pain relief. To cater for this, participants were given a card to carry which specified the presence of a naltrexone implant, its expected duration, possible pain relief options, and contact details for study staff. Without this (as reported in Australia) hospital staff sometimes make futile attempts to relieve pain using opiate-type medications. The same report of hospital admissions after implantation identified severe withdrawal symptoms after rapid detoxification to the point where hospitalisation was required. Long-acting naltrexone means the most effective way of relieving these symptoms (using opiate-type drugs) is denied to the patient.
Other occasionally severe reactions to implants and injections have been observed, but generally these are mild and/or short-lived and treatable. As with any abstinence-based treatment, overdose due to lost tolerance to opiate-type drugs is a serious concern. However, the few studies to date suggest these products protect against overdose while they are active, and that in caseloads prepared to undertake these procedures, opiate overdose reductions can outlast the active period of the implants. These findings are consistent with findings from Britain (1) and elsewhere (1 2 3 4 5) tentatively suggesting that long-acting naltrexone can be used to create an opiate-free period which extends beyond the initial blockade, sometimes aided by further administrations (1 2). In the UK, neither implants nor depot injections of naltrexone have been licensed for medical use; they can still be (and have been; 1 2 3 4) used, but patient and doctor have to accept the added responsibility of a product which has not yet been shown to meet the safety and efficacy requirements involved in licensing. See background notes for more on these important issues of adverse effects and overdose protection.
Among the studies is another randomised trial of a different long-acting form of naltrexone conducted in the USA. Compared to placebo, this injection lasting four weeks nearly doubled the time heroin dependent patients were retained in aftercare following inpatient detoxification. On the credible assumption that drop-outs relapsed, there was a similar impact on heroin use. At the four-week choice point when the naltrexone patients could have refused the second set of injections, few did so, most committing themselves to another period without (or with reduced) opiate effects. Though encouraging, multiple exclusions (such as psychiatric conditions or dependence on other drugs) and the recruitment procedures (partly through newspaper ads) meant the patients may not have been typical of usual caseloads.
A criticism of trials to date is that they included highly selected patients. However, in this they may have reflected normal practice. Patients will only opt for such procedures if they are prepared (irreversibly in the case of depot injections) to commit to weeks or months without the effects of heroin or other opiate-type drugs, or with severely attenuated effects requiring higher than usual doses. From the control groups in naltrexone implant/depot studies, we know that even in these caseloads, treatment drop-out and relapse are common. Long-acting naltrexone helps these highly motivated patients sustain their resolve. The clearest candidates for the treatment are patients who are motivated to return to a life without opiate-type drugs (including prescribed substitutes), have the resources, stability and support to sustain this, are unlikely to simply use other drugs instead, but who when free to experience heroin and allied drugs cannot resist using them, possibly reflected in their poor compliance with oral naltrexone regimens. The treatment may also be considered for unstable patients at very high risk of overdose, but who will not accept or do poorly in substitute prescribing programmes.
Thanks for their comments on this entry in draft to Nikolaj Kunøe of the Norwegian Centre for Addiction Research, Liv Langberg of the Drammen Council Drug Addiction Prevention Centre in Norway, and Duncan Raistrick of the Leeds Addiction Unit. Commentators bear no responsibility for the text including the interpretations and any remaining errors.
Source: Drug and Alcohol Findings July 2009 British Journal of Psychiatry: 2009, 194, p. 541–546.

Jordan Diplock, Irwin Cohen, and Darryl Plecas
School of Criminology and Criminal Justice,
University College of the Fraser Valley, Abbotsford, British Columbia, Canada
Abstract
The truth about the risks and harms associated to personal marijuana use is rarely a feature of the ongoing debate over the legal status of the drug, with advocates on both sides at fault. Some consensus over the potential harms needs to be reached before any meaningful discussion can occur on this issue. This article reviews research published between 2000 and 2007 and suggests that there are many risks associated to marijuana use with regards to impairment, academic and social development, general and mental health, and continued drug use. Although some findings highlight very serious concerns for users, the numbers that become adversely affected by marijuana use do not represent the majority of users. A debate on the legal status of marijuana based on the facts about the risks and harms of this drug will greatly aid in determining the appropriate actions to address personal marijuana use around the world.
Keywords: Academic Performance; Gateway; Harms; Health; Impairment; Marijuana; Mental Health; Risks
Introduction
The debate over the personal use of marijuana in North America and around the world is extremely contentious with supporters for decriminalization and legalization, and others who assert the importance of strict prohibition. The exceptionally adversarial nature of this debate is likely one of the main obstacles to determining the most appropriate way to address marijuana use within society. As a result of interested parties remaining resolute in their particular positions, the marijuana debate often becomes characterized by selective reporting or the misuse or misinterpretation of the available information. In addition, the popular debate rarely transcends ideological arguments on marijuana’s potential harms. With proponents of legalization championing marijuana as a benign drug and prohibitionists stressing its dangerousness, the debate often fails to consider the totality of the empirical research evidence. The purpose of this review is to discuss the harms associated with marijuana use from an objective viewpoint to provide a basis for the development of further research on how to best address the issues of marijuana use.
As research on marijuana use and its effects is constantly providing additional information, the full extent of the effects of marijuana on users will likely not be known conclusively in the near future. This should not be regarded negatively, as it is the nature of research that future studies improve upon the methodologies and results of previous research. For example, in 1997, The Independent, a popular British newspaper, was a strong supporter of the decriminalization of marijuana in the United Kingdom. In part, this support led to a pro-cannabis march that pressured the government to downgrade the classification of marijuana . Ten years later, that newspaper printed a public apology for its leadership role in the legalization campaign with a headline stating “If only we had known then what we can reveal today”. This example demonstrates the importance of considering new evidence and being willing to refine one’s position based on the best available information. By reviewing the current research on the potential harms associated with marijuana use, this review intends to synthesize the best evidence to inform the debate.
Ensuring that one considers the most current research on marijuana use is not only important because of the changing nature of academic research, but also because the drug under study has changed over the years. In other words, marijuana does not refer to cannabis with a particular level of -Tetrahydrocannabinol (THC). Over time, the level of THC in marijuana has changed; typically, it has increased. However, because there have been very few studies on the changes in potency of marijuana over the years, it cannot be confirmed conclusively that marijuana users in the 1970s were typically consuming a different drug than today’s users. The information that does exist suggests that, on average, marijuana users today are exposed to higher levels of THC than in past decades. Research on potency trends of seized marijuana between 1980 and 1997 concluded that average THC levels of marijuana seized in the United States increased from less the 1.5% in 1980 to approximately 3% in the early 1990s, to over 4% in 1997 . Moreover, in an article published by the Drug Enforcement Administration (DEA), Newell reported that average THC concentrations in marijuana from 36 samples seized in the state of Florida in 2002 were over 6%. These levels were determined to be at par with the averages reported by the Marijuana Potency Monitoring Project . In Canada , the Royal Canadian Mounted Police [RCMP] reported that on average seizures of marijuana in Canada had THC concentrations over 10%. Seizures in Europe of imported marijuana typically had THC levels between 2% and 8%, but the potency of hydroponically-grown “skunk” may be as high as double that of the imported marijuana . However, it must be kept in mind that the nature of marijuana production and distribution is such that a regular user would likely be exposed to marijuana of various different concentration levels of THC. As the majority of marijuana production remains the industry of criminals, many of whom use hydroponic operations and compete with each other to produce the most and the ‘best’ marijuana, there is no reason to believe that the quality of street marijuana has remained consistent over time.
In addition to levels of THC, the understanding of the number of different constituents of marijuana and their potential to interact with each other changes over time. ElSohly and Slade reported that the number of known natural compounds in marijuana increased from 423 to 489 between 1980 and 2005. Of those numerous chemicals, 70 were Cannabinoids, 9 of which were discovered since 1980 . The changes in knowledge about the complex chemical makeup of marijuana further complicate the study of the potential dangers of its use.
Because marijuana is used around the world by approximately 160 million people, there has been a great deal of research conducted on its effects on users . The use of marijuana results in a variety of changes within the user’s body that can have a range of effects . Given this, the focus of this review is limited to the research evidence on potential harms associated with marijuana use in the areas of: impairment; academic and social development; general physical health; mental health; and continuing drug use. Although there is also a substantial body of research on the medical use of marijuana for particular patients, a review and discussion of the research on medical marijuana is not included in this study. This exclusion is not meant to suggest that marijuana is universally accepted as a safe or effective treatment for any illness, as Voth has clearly demonstrated that the wider debate over the use of marijuana extends into the issue of the drug’s medical use. The discussion presented in this review will concentrate on the use of marijuana within the general population and the empirical evidence for how marijuana use effects the general population in the five previously listed areas.

Methodology
To ensure that this review considered the most current research, information was collected from articles published from 2000 to 2007. Articles were identified by searching a number of databases, including Medline, Pub.Med, PsychINFO, and Google Scholar. To ensure a more complete search, a variety of keywords were combined with ‘marijuana’ to search the databases. In particular, these keywords related to the five aforementioned areas. An extremely partial list of keywords included ‘impairment’, ‘academics’, ‘heart disease’, ‘respiratory’, ‘cancer’, ‘psychosis’, and ‘gateway’.
Once an article was identified, it was assessed for appropriateness based on a review of the article’s title and abstract. One potential limitation of this review was that only full-text-available articles written in English were considered for this review. However, in order to expand the number of articles considered, both original research studies and articles that reviewed topics related to the harms of marijuana use were included. In order to ensure objectivity in the selection process, the inclusion or rejection of articles occurred without consideration of authorship or the conclusions or recommendations made by the authors. Given this, the articles considered in this review represented the continuum of current research on the harms that may be associated with marijuana use. Because of the scope of this topic and the amount of literature on marijuana use, the articles included in this review do not represent all available research on the effects of marijuana use. However, because many of the articles included in this review included extensive reviews of previous literature, the areas of focus for this review were well represented.
Finally, when considering the evidence presented in this review, it is critical to keep in mind that many of the studies based their results and conclusions on self-reported effects of marijuana use by the users themselves. While self-report studies are extremely valuable, they are susceptible to a variety of methodological problems, such as social desirability effects, errors in memory, exaggeration, and deception, which must be considered when evaluating results or conclusions . In addition, it is also extremely difficult to link or establish a direct causal relationship between drug use and other specific behaviours as it is likely that behaviours or outcomes are the result of multiple factors, rather than exclusively one factor, such as drug use.
Marijuana Related Impairment
One of the important debates in the research literature is the effect of marijuana use on cognitive and motor skills. Several studies have focused on determining whether there are any negative effects on cognitive or motor skills within hours of marijuana use . A number of studies have more specifically focused on the effect of marijuana use on abilities related to operating a motor vehicle . In addition to studies of short-term impairment, research has been conducted on long-term impairments associated with prolonged marijuana use .
Short-term Impairment
Impairment immediately after the consumption of marijuana may be a concern for users and the community at large. Short-term impairment has generally been assessed anywhere from 5 – 10 minutes to several hours after use. Testing the effects of marijuana on working and episodic memory determined that focusing attention and response accuracy were impaired immediately after smoking marijuana, even marijuana with less than 4% THC. The authors concluded that the marijuana resulted in difficulty maintaining a coherent train of thought and disruptions to selective filtering processes, both of which impaired memory. Similarly, another study reported that acute marijuana intoxication was accompanied by impairment of brain function related to goal-oriented activities. Further, it was suggested that marijuana consumption inhibited impulse and anger control in some users implying a possible link between marijuana use and violent or antisocial behaviour in some individuals . However, impaired attention was not found in a study of marijuana’s effects on auditory focused attention tasks where participants responded to a tone by pressing a button as quickly as possible. Results of an examination of brain functioning hours after using marijuana found that heavy marijuana users did not present impaired abilities on simple spatial working memory tasks, as deficits were compensated for by employing regions of the brain not commonly used during such tasks.
Although the research reported that short-term cognitive impairment could occur among marijuana users, the level of impairment and its seriousness was not significant. However, this does not suggest that there are no or few short-term risks of impairment. Instead, this conclusion may be due to the small sample sizes of only 10 to 12 participants in the studies examined . In effect, the sample sizes in these studies limited the ability to draw any firm conclusions about the range or seriousness of short-term cognitive impairments associated with marijuana consumption.
Researchers also examined the relationship between marijuana induced cognitive impairment and common abilities, activities, or behaviours, such as operating a motor vehicle. Ramaekers and co-workers concluded that decision-making, planning, tracking, reaction time, and impulse control were impaired by high-potency marijuana. Although the 20 subjects were considered only light users, substantial impairment of executive and motor functioning for a period of at least six hours was found. Although the 13% THC level in the marijuana used in this study was higher than the averages reported by the DEA and RCMP , this study demonstrated that serious impairment lasting for many hours was common when consuming high potency forms of marijuana.
Operating a motor vehicle can be dangerous at any time. However, doing so while impaired by marijuana significantly increases the risks of accident. Although some studies revealed that recent marijuana use was a causal factor for only a small proportion of accidents, short-term marijuana impairment does contribute to serious motor vehicle accidents To better determine marijuana impairment among drivers, standardized field sobriety tests have been designed to detect impairment by marijuana in a manner similar to alcohol. Research on field tests concluded that, as expected, impairment increases with the level of THC . Even low levels of THC can moderately impair driving abilities, but driving is severely impaired when either higher levels of THC marijuana is consumed or marijuana with lower levels of THC is consumed with even small amounts of alcohol . Considering the research examined for this review on the relationship between marijuana consumption and impairment, there appears to be a strong consensus that marijuana use has a negative and potentially harmful effect on driving.
Long-term Impairment
There are few studies on the long-term impairment of chronic marijuana consumption compared to the acute effects of marijuana use. Still, some researchers examined the potential for impairment as a result of long-term use, even during periods of abstinence . From the results of one study of older participants (33-50 years old), it appeared that, although heavy marijuana users showed impaired cognitive abilities after a week of abstinence, there were no noticeable impairments after twenty-eight days of abstinence . When compared to a control group, long-term marijuana using teens (aged 16 – 18) had equivalent task performance on a go/no-go task after twenty-eight days of abstinence . However, marijuana users committed more errors on cognitive tests and showed increased brain processing effort during the inhibition task . When comparing early-onset users to late-onset users, even after twenty-eight days of abstinence, early-onset frequent marijuana users had a greater likelihood of suffering a range of cognitive functioning impairments, in particular verbal IQ, compared to late-onset and non-users .
One interesting finding about long-term marijuana users was that there was an increase in brain activity in more regions of the brain when performing a variety of cognitive tests when compared to non-users. The researchers concluded that this finding was the result of the brain working harder and differently to overcome the deficits resulting from the marijuana use . In addition to working harder and differently, significantly increased blood volumes in various regions of the brain have been discovered , even after a period of abstinence of six to thirty-six hours. The researchers indicated that it remained unknown how these changes affected brain functioning and whether these changes were permanent, long-lasting, or temporary. However, these findings do suggest that there is a potential for some type of long-term brain impairment. Nonetheless, with the exception of impairments caused by psychosis and other mental illnesses discussed later in this review, when considering the totality of the research literature on the relationship between marijuana use and long-term cognitive or motor impairment, there appears to be little evidence to support the assertion that serious impairment is a likely result from long-term marijuana use, especially after a period of abstinence.
The Effects of Marijuana Use on Academic and Social Development
As marijuana is the drug of choice for many young people, it is necessary to understand whether marijuana has any negative effects on academic performance and the transition from adolescence to adulthood. The evidence for both immediate impairment and the possibility of longer-term impairment supports the notion that marijuana use may have negative consequences on the development of young users. In a consideration of academic performance and graduation, a number of studies have focused on the relationship between marijuana use and absenteeism , I.Q. , and academic achievement . By examining the lifestyles of adults who reported being heavy marijuana users in their youth, other researchers have attempted to assess the effects of marijuana use on social development . The following section provides a discussion of the literature in these areas.
Marijuana and School Performance
There are many factors that contribute to academic achievement, such as general intelligence, interest/curiosity, motivation, lifestyle, and social relationships/networks. Since the adolescent human brain is still developing, it is possible that recreational marijuana use may disrupt ‘normal’ development, which may manifest in, among other things, poorer school performance. Survey research revealed that students who were absent on the day of a school-based survey were more likely to use marijuana, alcohol, and cigarettes than students who were present. Although it is unsupportable to conclude that one specific day of absence from school was caused by or related to marijuana use, this study provides some small support for the more impressive findings of Lynskey and Hall’s review of cross-sectional studies on marijuana and school-related issues. Their review of over 50 research studies concluded that marijuana appeared to have a strong relationship with absenteeism, lack of retention, and not graduating.
An examination of the relationship between academic achievement and drug use in a diverse sample of 18,726 students concluded that marijuana use, when examined alone, was statistically significantly related to lower standardized test scores in math, science, reading, and social studies. Average scores on the math comprehension test for marijuana users were further below the mean than on any other test, while reading comprehension appeared to be affected the least. However, when marijuana was combined with alcohol or cigarettes, the results were much less robust. In effect, both regular smoking and alcohol intoxication explained much more of the variance, thus reducing the influence of marijuana on test scores. The explanation provided for this finding was the relatively small number of students who reported ever being under the influence of marijuana at school compared to the number of students who regularly used alcohol and/or cigarettes at school . Similarly, a study by Diego and colleagues found that grade point averages decreased as the reported frequency of marijuana use increased. Marijuana use had a larger negative correlation with grade point average as frequency of use increased than alcohol or cigarettes. While these findings suggested a link between marijuana use and academic achievement, the research could not establish a direct causal relationship or the direction of the relationship. Nonetheless, for the most part, social scientists agree that marijuana use is detrimental to school performance .
Since marijuana has been linked to short-term impairment and a decrease in school performance, some researchers have studied the effects of marijuana on IQ (29). However, measuring the direct effects of marijuana use on IQ has been difficult as there is rarely a baseline measure of a subject’s IQ prior to their initiation into marijuana use. One longitudinal study that had baseline measures of IQ prior to the subject ever using marijuana reported a statistically significant decrease in IQ score among individuals who smoked five or more marijuana cigarettes per week. On average, a 4.1 point decrease was measured between the time the subject was 9 – 12 years old (no prior use) and 17 – 20 years old (current and/or past use). However, when considering the degree of marijuana use for the sample of 70 marijuana users, only those characterised as heavy users showed any decreases in IQ compared to slight users, former users, and non-users who demonstrated increases in IQ . These results suggested that marijuana use has an effect on general intelligence but is more severe for regular and chronic marijuana users.
Marijuana Use and Later Social Development
Success in adulthood is related to a wide range of developmental and social variables throughout childhood and adolescence. It has been hypothesised that many of these contributing dynamics could be negatively affected by the use of marijuana. For example, some people contend that one of the possible outcomes of marijuana use is chronic low motivation. In effect, the hypothesis is that marijuana use among young people contributed to the development of low motivation which has long-term effects on school and employment performance. In their research, however, Lynskey and Hall concluded that there was little evidence to support the low motivational syndrome hypothesis because the majority of supportive evidence was based on older uncontrolled studies of case histories and observational reports, while controlled field or laboratory studies did not find compelling evidence of such a syndrome. Moreover, long-term (over 20 years), regular marijuana use among males was not associated with any specific negative socio-demographic effects such as alcohol or nicotine abuse or dependence, hospitalizations, and health-related quality of life .
However, other researchers have found several adverse associations between marijuana use and social development. A study of the relationship between marijuana use in 2,842 high school students and later occupational attainment concluded that marijuana had some differential negative associations with occupational attainment for males and females . Specifically, for males, self-reported abstinence or low frequency use of marijuana had no effect on occupational attainment, although high prestige jobs typically had a greater percentage of non-users or former low frequency users. However, for male users, after a certain threshold level was passed, success in occupational attainment decreased with increased early marijuana use. The threshold for this relationship in this study was ambiguous as the linear relationship began with the category associated to between 3 and 39 occasions of marijuana use in one year. Among females, early marijuana use was found to have strong negative outcomes on occupational attainment, but the pattern was different from that of males, lacking the easily identifiable threshold and negative linear relationship .
Green and Ensminger examined the effects of marijuana use on a variety of social variables among a cohort of 530 African Americans. Frequent adolescent marijuana use was associated with poorer academic achievement, a lack of stable employment, and family dysfunction. These results suggested that using marijuana 20 or more times during adolescence was associated with being unemployed, unmarried, and becoming a parent while unmarried. Early marijuana use was also linked to dropping out of school and continued marijuana use as an adult . Although this study was specific to African Americans, when considered with other studies on occupational attainment and school performance, these results contribute to the body of literature indicating that marijuana use among young people can have a detrimental outcome on their future. However, these findings do not confirm a causal relationship between marijuana use and poor performance in school or life. Still, the evidence does suggest that, even in the absence of a direct causal link, the use of marijuana during adolescence, for many young people, is often accompanied by other factors, such as the development of delinquent peer associations or a general lack of commitment to pro-social activities and institutions, which can lead to problems with social development.
General Health Consequences of Marijuana Use
The use of marijuana introduces foreign substances into the body and produces a number of chemical changes in the user’s brain and body. Given this, there is a large amount of literature focusing on the physical effects of marijuana. To begin, there is little evidence to suggest that marijuana use poses a serious risk for an overdose death or its infrequent use is related to the development of long-term health problems . Given this research, the majority of health-related studies focused on the potential harmful health outcomes associated with long-term and heavy marijuana use. One of the most widely studied issues is the relationship between smoking marijuana and the development of respiratory ailments .
In addition, the short-term and long-term effects of marijuana use on the circulatory system have also been extensively studied . Other researchers have focused on potential reproductive harms , the effects of marijuana use on the immune system , and the risks for cancers . There is also a burgeoning research literature on the degree to which marijuana users can develop a dependency and experience withdrawal symptoms . The following section will review the research literature on these important issues.
Respiratory Ailments Related to Marijuana Use
The most common way of using marijuana is by smoking it. A direct consequence of this method of consumption is that smoke must enter the airways and lungs of the user. As a result, researchers are interested in the amount and type of harm that smoking marijuana has on the respiratory system of users. This is particularly important because marijuana smoke contains many of the same poisons found in tobacco smoke. Given this, research has focused on determining whether the respiratory outcomes of smoking marijuana are similar or worse than those associated with smoking tobacco . Taylor et al. reported that respiratory symptoms were significantly more prominent in marijuana-dependent users than in non-users. The sample consisted of 21 year old subjects from the 1970s who self-reported short histories of smoking marijuana . The associated self-reported respiratory problems included wheezing, shortness of breath after exercise, nocturnal chest tightness, and early morning phlegm and mucus. These symptoms, which are typically indicative of chronic bronchitis, were also found to be associated with smoking marijuana in other research .
In their review of the research literature, Taylor and Hall argued that marijuana should be considered as damaging to the airways as tobacco and that there was a strong possibility that smoking marijuana was a contributing factor to the development of chronic lung disease. Further research concluded that long-term marijuana smoking was also associated with an increase in airflow obstruction and obstructive lung disease. A comparison of the effects of marijuana cigarettes to tobacco cigarettes concluded that one marijuana cigarette can have the obstructing effects on the lungs equal to that of two to five tobacco cigarettes. Lower lung density and increased total lung capacity were also recorded for marijuana smokers, but macroscopic emphysema was not found to be a common symptom . These findings suggested that serious negative respiratory outcomes should be expected for regular marijuana smokers, regardless of the marijuana’s THC levels, even among youth or young adults.
Since many of the detrimental effects on the respiratory system are the direct result of smoking, there have been several studies examining whether vaporizers provide a less harmful way to consume marijuana . Based on self-reported respiratory symptoms after using vaporizers to inhale marijuana cannabinoids, Earleywine and Barnwell concluded that vaporizers did provide some measure of safety, especially as the amount of marijuana inhaled increased. Hazekamp et al. reached a similar conclusion.
While the use of vaporizers may reduce or eliminate some of the respiratory ailments for users, the THC in marijuana may pose a respiratory risk. In response to the presence of THC, human airways experience cellular changes, especially to mitochondrial energetics, which are responsible, in part, for the health of cells and their energy production . Sarafina et al. described these changes as deleterious effects, as changes to the mitochondria of lung cells affects the viability and functioning of those cells. These changes were more significant with higher concentrations of THC and longer exposure times . In effect, as a result of THC in the lungs and airways, the risk of adverse pulmonary conditions is substantially increased by the potential for damage to the airway epithelial cells .
Potential Harms of Marijuana Use on the Heart and Circulatory System
One direct outcome from using marijuana is an immediate increase in heart rate. It is estimated that marijuana use increases the heart rate 20% to 50% immediately following consumption . This has led researchers to examine the short and long-term implications of marijuana use on the heart and the circulatory system. The majority of research in this area relies on case studies . Although the conditions documented in the research literature may be serious, it must be kept in mind that there is little evidence to suggest that the outcomes discussed in the case studies are typical or the norm for marijuana users.
Based on their case study of a 34-year-old man who reported heart fluttering and near syncope after marijuana use, Rezkalla and coworkers suggested that marijuana was a likely contributor to the decrease in coronary blood flow and ventricular tachycardia experienced by their subject. Another study described two cases; one in which a man with a history of heart problems suffered arrhythmia precipitated by marijuana use, the second described a young patient who suffered an onset of myocardial infarction. The researchers concluded that marijuana was a serious concern for those who may be predisposed to heart-related illnesses. Similarly, Caldicott et al. documented the case of a young patient who suffered a heart attack after marijuana use, despite having no other identifiable risk factors for a cardiac event.
Findings may be more informative when referring to larger samples that identify cardiac risks associated with marijuana use. One study concluded that, although it was less common than other stressors, marijuana use was a trigger for myocardial infarction . In this study , the risk of onset of myocardial infarction increased approximately five-fold in the first hour after use.
The conclusion of existing research is that marijuana use may, in rare instances, trigger a heart attack. However, it is important to recognise that the evidence in support of this conclusion may be confounded by the subject’s participation in a wide range of other unhealthy habits that may also contribute to a greater or lesser degree to a heart attack. Still, there is some evidence to conclude that marijuana is harmful to the heart and researchers, such as Aryana and Williams (, have stated a belief that heart problems related to marijuana use may be more common than is currently recognized. In addition, they warned that as the population of marijuana users aged, continued use may increase the risk for a number of adverse cardiovascular issues, such as tachyarrhythmia, acute coronary syndrome, vascular complication, and congenital heart defects .
Consequences of Marijuana Use on Reproduction and Pregnancy
There is a growing body of literature on the effects of drug use on sperm and egg development and the short and long-term outcomes for the foetus. This literature focuses on the relationship between drug use and implications for fertility and healthy, successful pregnancy. For example, several studies have investigated the effects of marijuana use on male sperm fertility and female hormones . Scheul et al. found that the presence of THC in the reproductive fluids of both males and females could inhibit the ability of sperm to complete fertilization. Other research reported that THC inhibited male fertility by binding to sperm cells and impairing sperm functions. In females, marijuana was found to disrupt the endocrine system and produce an estrogenic effect, which can have detrimental effects on specific elements of the female reproductive system . It should be noted, however, that the effects were more the result of the contaminants of smoking the drug than the psychoactive chemicals . In addition, marijuana use negatively affected female reproductive hormones which could lead to delayed ovulation . In considering these studies, the conclusion is that marijuana use may have some negative effects on human reproduction and that these outcomes are increased for those already at risk for infertility or other reproductive conditions.
Research also examined the degree to which marijuana use by pregnant mothers affected the unborn foetus and whether maternal marijuana use led to negative outcomes for the child. Kuczkowski reported that THC crosses the placental barrier, but that there was no confirmation that it had a teratogenic effect. In other words, there is no evidence that marijuana use by a pregnant mother contributes or causes birth defects or malformations. However, research by Wang et al. determined that some impairment was present in foetuses exposed to marijuana. This finding led the researchers to conclude that some long-term emotional and behavioural implications existed for children exposed to marijuana while in the womb.
Fried and Smith’s review of literature concluded that the effects of prenatal exposure to marijuana were subtle, with little evidence supporting growth or behavioural effects prior to age three. Others concluded that there was a statistically significant association between prenatal exposure to marijuana and later use; however, they concluded that there were many other potential factors that could have contributed to later marijuana use among those exposed to the drug while in the womb. One common theme among the research conducted to date was that they all called for more study on this issue. Although further research is needed in this area, to date, no substantial dangers have been confirmed to be associated to smoking marijuana while pregnant. However, marijuana smoke contains hazardous chemicals and materials, many of which exist in tobacco smoke. Therefore, just as health providers caution that tobacco should not be used by pregnant mothers, the caution should extend to marijuana use.
Marijuana Use as a Potential Threat to the Immune System
THC from marijuana may act upon the immune system similarly to the way it does on cells in the reproductive system . If the immune system is compromised by the use of marijuana, there may be significant implications for health care systems around the world . The relationship between marijuana use and deficiencies of the immune system is based, in part, on the findings that THC inhibits the ability of T-cells and alveolar macrophages to protect the body from foreign pathogens . Alveolar macrophages are a main defence against infections in the lungs. A review of the research literature in this area by Copeland et al. suggested, however, that it might require high doses of THC to substantially impair immune system functioning. Still, when considering the number of respiratory problems associated with smoking marijuana, and the possibility of serious carcinogenic properties in the drug, compromising the immune system may further compound the harms of marijuana use, especially among those already suffering from weakened immune systems.
Cancer Causing Effects of Marijuana
Because marijuana smoke contains many of the same harmful carcinogens as tobacco smoke, there is a possibility that marijuana use may be associated with the onset of various types of cancers, especially lung cancer as the most common method of consuming marijuana is by smoking it . To date, however, the research does not support the association between marijuana use and cancer. In their study, Hashibe and colleagues failed to find substantial evidence for an association between marijuana use and lung or upper areodigestive tract cancers. A review of research on lung cancer and marijuana use by Mehra et al. revealed many of the methodological difficulties in attributing outcomes specifically to smoking marijuana. For example, in many instances, marijuana users also smoke tobacco, there is the challenge of determining proper thresholds for marijuana use, and the research has typically included only small sample sizes. Mehra et al. suggested that because the plausibility of an association between marijuana smoking and cancer is so apparent, improved studies are required to test this possible link. Other research has reached similar conclusions about the link between marijuana use and cancer . Although a 1999 study by Zhang and colleagues reported a potential for marijuana use to increase the risk of squamous cell carcinoma of the head and neck, the evidence for a link between marijuana use and head and neck cancers has been limited and conflicting . In a recent study, marijuana was not found to increase the risk of head and neck cancer, although the duration of use under study might have been too limited to rule out the possibility of a longer-term effect . Another large-sample study concluded that marijuana was not associated to oral squamous cell carcinoma. There was also no link between maternal or paternal marijuana use and risk of childhood acute myeloid leukaemia .
Although there is currently no evidence to confirm that marijuana use increases the risk for any type of cancer, there will likely be continued research. Already, there are many researchers who believe that the changes to a variety of cells in the body caused by marijuana use may contribute to the development of cancers including lung cancer, oral cancers, and breast cancer .
Marijuana Dependency and Withdrawal
Despite the commonly held belief that marijuana use does not lead to addiction, existing research has often referred to a dependency on the drug . Although many people use marijuana on a regular basis, Looby and Earleywine reported that fewer than half of all daily users exhibited the behaviours necessary to meet the established criteria for being classified as drug dependent. These criteria include tolerance, withdrawal, taking the drug for longer periods of time or larger doses than intended, inability to stop or reduce use, increasing the time spent obtaining the drug and recovering from its effects, ignoring other important activities, and continuing use despite undesirable consequences. The authors argued that frequent use does not necessarily result in dependence, but that it may be a contributing factor. Their research suggested that negative effects of marijuana use, such as dissatisfaction with life, low motivation, and unhappiness, were more related to dependence on the drug than regular use . When considering the results of this research with findings from Copersino et al. on withdrawal symptoms, strong support is established for the idea that a proportion of frequent marijuana users suffer negative effects resulting from a dependency.
In terms of factors that most likely contribute to the development of a marijuana dependency, Hall reported that initiation to drug use at an early age was the most significant. However, in terms of public policy, if THC levels are indeed increasing and continue to increase, there will likely be a growing number of users who find themselves dependent on marijuana. Furthermore, as the National Institute on Drug Abuse’s definition of addiction focuses on the “uncontrollable, compulsive craving, seeking and use of drugs”, the physical effects of dependency and withdrawal may be only part of the problem, as addiction can occur without physical signs of dependency. This may prove more problematic if future research establishes additional negative health consequences of long-term use as users may experience more difficulty abstaining from use even in the face of exacerbating social and health problems.
Marijuana Use and Mental Health
In addition to some potentially serious physical health problems, marijuana use has also been associated with mental health problems. The link between marijuana use and psychosis or later schizophrenia has possibly received the most attention in the research literature. This body of research focuses on the role of marijuana in triggering psychosis the risk of developing schizophrenia among those who suffered marijuana-induced psychoses, the dangers of marijuana use for those already suffering from psychosis , and a number of hypotheses on whether marijuana use contributes to the presence of psychoses or schizophrenia or whether mental health issues contribute to the onset of marijuana use To a lesser degree, researchers have also investigated the relationship between marijuana use and depression and anxiety .
Marijuana-Precipitated Psychosis and Schizophrenia
An association between marijuana use and the onset of psychosis recently emerged as a serious concern. Given this, it is necessary to understand the potential for marijuana to contribute to psychosis and what proportion of marijuana users are at risk for developing psychosis. Research suggests that 8% to 10% of all cases of psychosis may be triggered by the use of marijuana Others concluded that marijuana use was linked to psychosis independent of any previous mental pathology. Given this, there is a growing consensus that, although it is relatively rare, marijuana induced psychosis is a potential threat to users, specifically to those who are already vulnerable for this type of mental affliction In order to explain this relationship, Caspi et al. reported that there may be an interaction between the chemicals typically present in marijuana and a number of ‘susceptible’ genes in the user that contributes to the onset of marijuana-induced psychosis and schizophrenia.
Research findings suggested that if marijuana use triggered psychosis, it might be a risk factor for schizophrenia in determining whether those who suffered from an episode of marijuana-induced psychosis were at risk of developing later schizophrenia, a group of such individuals was compared to a group of people referred for schizophrenia-spectrum disorders for the first time who had no history of marijuana psychosis . Although suffering from some recognized methodological problems, this study found that marijuana-induced psychosis was an important risk factor for developing schizophrenia and that it often had an earlier age of onset compared to those who self-reported no marijuana use. In partial support, Solowij and Michie found similarities between the cognitive effects of marijuana use and the cognitive endophenotypes of schizophrenia. This suggested that there was little reason to believe that marijuana is a direct cause of schizophrenia, but that marijuana likely aggravates pre-existing susceptibilities to schizophrenia . This hypothesis may explain why those prone to suffering from marijuana-related psychosis are also more susceptible to later schizophrenia.
One of the complications for fully understanding marijuana’s association with psychosis and later schizophrenia is that people with mental illness may continue to use the drug. The effects of marijuana use in patients who had recently suffered from psychosis were studied to determine whether symptoms were prolonged and worsened by the drug . Findings suggested that those who continued to use marijuana were at a greater risk of having more symptoms and a continuous course of mental illness . It could not be confirmed from the study, however, if marijuana caused the symptoms to worsen or the degree to which marijuana directly contributed to the symptoms.
There were a number of relational hypotheses tested in the research literature . The most common hypotheses were that: marijuana use caused psychosis and schizophrenia without any existing predisposition; marijuana use triggered the onset of these symptoms in people who were previously vulnerable; marijuana use exacerbated the symptoms in those already suffering; and those already suffering from these symptoms were more likely to self-medicate with marijuana. Although the current state of the research does not support the hypothesis that the relationship between marijuana and psychotic symptoms is one of self-medication , other hypotheses found more support.
The strongest support was for the second and third hypotheses. However, the causal hypothesis remains debatable. Degenhardt and Hall found that cases of schizophrenia in the general population did not rise with an increase in reported marijuana use, thus weakening the case for the causal hypothesis. Although further research is needed to more fully understand the causal association between marijuana use and psychosis, based on the research to date, psychosis and later schizophrenia as a result of marijuana use is a risk for a small portion of the marijuana using population.
Depression and Anxiety Among Marijuana Users
Although psychosis and schizophrenia were researched more than other mental health issues associated with marijuana use, there is a body of research on other issues such as depression, anxiety, and violence. Research found that increased marijuana use among high school students was associated with increased self-reports of depression. However, others found that past-year marijuana use was not a significant predictor of future development of depression. Similarly, research by Bonn-Miller et al. found that marijuana use was a predictor of anxiety symptoms, but not of depression. Again, it remains a challenge to determine whether marijuana use is a cause of these symptoms or if the symptoms play a contributing role in marijuana use.
Marijuana’s Role in Continuing Drug Use
The discussion of potential harms of marijuana use presented thus far indicated that marijuana poses a number of potential risks to the general population of users and some specific negative outcomes for a relatively small subgroup. The risk or actual harms associated with marijuana use can be seriously compounded by the use of other drugs and can become overshadowed by the dangers associated with becoming addicted to ‘harder drugs’. Moreover, there has long been the suggestion that marijuana can act as a ‘gateway’ for much harder drug use. It would appear that the probability that marijuana acts as a gateway to other illicit drugs is much higher than the other way around . According to Fergusson and Horwood , when adjusting for other common covariate factors such as childhood, family, and life-style factors, regular marijuana use (fifty or more times in a year) was strongly related to the onset of further illicit drug use. However, others found that the opportunities presented by the lifestyle accompanying marijuana use were just as likely as the actual use of marijuana to predict the use of other illicit drugs. Currently, there is no evidence to prove or disprove that any biological effects of marijuana use increases the likelihood of using other illicit drugs, although researchers continue to test this hypothesis . Based on twin studies, it is well established that marijuana use is a strong predictor of future illicit drug use regardless of the familial and environmental similarities between twins .
Still, since the majority of marijuana users do not continue on to other illicit drugs , it is important to understand what factors distinguish between those who do and those who do not go on to use harder drugs. The appropriate policy and control responses may be very different depending on whether the relationship was based on the biological effects of marijuana use or on the lifestyles that accompanied marijuana and other illicit drug use. Currently, it can be concluded that, for those who use marijuana, there is a risk of using other illicit drugs. However, without a better understanding of what causes or correlates with an increased risk, it is impossible to determine what effects changes to marijuana’s current legal status would have on patterns and rates of drug use.
Conclusions
The debate over the most appropriate policy to have with respect to the personal use of marijuana has generally been polarized because of differing positions on the drug’s harms. In addition to the unknown extent of the potential for harm caused by existence and interaction of over 800 natural chemical components of marijuana, including 70 cannabinoids, it can be concluded that marijuana does pose some considerable confirmed risks to users. Some concern over marijuana is merited by findings regarding its ability to create short-term impairment, specifically on driving ability. Academic performance and social development appear to be negatively affected by marijuana use, but the causal role that the drug plays in the lack of future success of young people remains unconfirmed. As expected, smoking the drug contributes to considerable harm to the lungs and airways. Even though the use of vaporizers removes the contaminants of combustion and reduces some major respiratory problems, THC exposure to the lungs appears to be unhealthy. The immune system is also compromised by the use of marijuana, specifically the ability of the lungs to defend against foreign pathogens. Although cancers, heart problems, and threats to human reproduction are not common among marijuana users, most experts contend that further investigation is required, and the potential for risk should not be dismissed. The development of psychosis and later schizophrenia should also remain a concern for a small proportion of those who use marijuana. Dependency and regular, long-term use of the drug are also factors that likely exacerbate the potential for the majority of the harms previously identified in this review. Of course, these harms are often compounded by the fact the marijuana users have an increased likelihood of continuing on to other illicit drugs.
It is important to remain cognizant of the fact that the harms associated with marijuana use, though very serious in some cases, are not experienced by the majority of users, although prolonged regular use will generally put a person at a greater risk than occasional use. The debate over marijuana use requires advocates of both decriminalization and prohibition to concede that marijuana is neither harmless, nor is it particularly dangerous to the majority of users. It should be acknowledged by all that the lives of a small proportion of the population will be seriously disrupted by marijuana use.
With an understanding of the potential harms associated to marijuana use forming the basis of the debate, politicians, policymakers, and citizens can begin to answer the important questions that will form the basis for discussing policy options. For example, what can be learned from other jurisdictions about ways to respond to the social and personal harms associated with marijuana use? What lessons can be learned from the experiences with alcohol that might apply to marijuana? Are there other or better approaches than prohibition to manage the problems that marijuana use creates? Further research will also be required to better understand whether decriminalization promotes increased use. In other words, would the decriminalization of marijuana create better opportunities to regulate the drug, or would it result in greater social harm?
To date, the research evidence shows that marijuana has a number of associated harms. In some cases, these harms are worse than those associated with regulated substances such as alcohol or tobacco. Based on the course of research, it is likely that future studies will further refine our understanding of the harms of marijuana use. However, because marijuana continues to be a popular recreational drug, it is necessary that researchers disseminate their latest findings in a wide range of ways in order for the public to have the best information at their disposal about the harms and risks associated with using marijuana.

Source: Journal of Global Drug Policy and Practice Vol. 3. Issue 2 Summer 2009

William L. White

The difference between the right word and the almost right word is the difference between lightning and the lightning bug.—Mark Twain

At every word a reputation dies.—Alexander Pope

By our silence, we let others define us.—Susan Rook (Missouri Recovery Network campaign slogan)

Addiction treatment organizations and a variety of policy-making, planning, and funding authorities are changing their historical focus on acute biopsychosocial stabilization to a broader vision of sustained long-term recovery for individuals and families. This shift can be seen in widespread discussions and practices that embrace “recovery management” and “recovery-oriented systems of care.” This change in organizing concepts and service practices will not be possible without the meaningful involvement of individuals and families in or seeking recovery in the planning and decision-making processes.
The word “consumer” is cropping up more frequently, with references to “our consumers,” “consumer representation,” ”consumer councils,” and “consumer-based” or “consumer-directed” services. This latest term joins a long list of terms—patients, clients, service users/recipients/participants, alumni—that have described people needing, receiving, or completing addiction treatment and recovery support services.
Historically, language applied to and chosen by historically disenfranchised groups evolves over time. People who were recovering from severe mental illness began their own recovery revolution in the 1970s and 1980s and chose to self-designate themselves as “consumers” and “survivors” as a less stigmatizing alternative to “mental patient.” The surge in “consumer” language was a positive development within the history of the mental health recovery advocacy movement—one that at the time was experienced as personally empowering. It is likely that this language will continue to evolve as the mental health recovery advocacy movement continues to evolve.
With the growing integration of addiction treatment and mental health treatment services, the introduction of new medications for the treatment of addiction, and expanded efforts to include coverage for addiction treatment and recovery support services as part of comprehensive health care reform, the use of the word “consumer” is gaining prominence within the addiction treatment and recovery support communities. This brief essay describes why this “consumer” terminology is counterproductive and suggests other ways to describe the critical role that people seeking or in long-term recovery, their families, and friends play in the design, delivery, and evaluation of addiction treatment and recovery support services.

Rejecting the “Consumer” Designation
There are nine reasons to reject the spread of “consumer” language when talking about addiction treatment and recovery support services.

1. The term “consumer” is ill-defined and as such, may create further misunderstanding by the general public and policymakers about people experiencing addiction or who are in long-term addiction recovery. There is no generally understood meaning of what exactly is being consumed, and members of the public may well think the term refers to people who continue to consume excessive amounts of alcohol and/or drugs.
“The ‘consumer’ language suggests that the person in treatment is a social ‘taker,’ that they suck up community resources and give nothing in return—a parasitic relationship to others.”
People in active addiction are often involved in a parasitic process of using (in the manipulative sense) family, friends, and community resources to sustain their alcohol and drug use. “Consumer” is a more apt description of someone in active addiction than of a person in long-term recovery. Furthermore, the most cursory search of “consumer” on the internet reveals meanings that include a person who drinks alcohol to excess (See http://www.thefreedictionary.com/consumer). A person in recovery is more aptly described as a person who ceases being a consumer.

2. The term “consumer” fails to provide an alternative identity for persons attempting to disengage from alcohol/drug-saturated lifestyles and subcultures. Addiction treatment can be a transitional bridge from a culture of addiction to a culture of recovery or a revolving door within a person’s active addiction career. The “consumer” identity tends to reinforce the latter; focusing on the repeated “consumption” of services as well as the “consumption” of alcohol and other drugs. “Person in recovery,” in contrast, builds a new identity for an individual moving forward to a new life. “Consumer” defines a person in terms of a part of the self while ignoring the whole. Participating in addiction treatment is an activity, not who a person is.
The term “consumer” had value at a particular point in time for persons recovering from mental illness. New language that had value within a particular historical context can become old language and stand as an obstacle to progress as contexts change. We need a different term to describe people seeking and in long-term recovery from addiction and people who participate in addiction treatment as part of that long-term journey. Does that mean that any alternative language we embrace today may need to be given up in the future? We need to be open to that possibility.

3. The term “consumer” ties an individual’s identity to a service delivery system, be it a treatment provider or a physician prescribing medications, and can be paternalistic and disempowering. There are words other than “consumer” that can be used to describe a relationship between a person receiving professional care and the caregiver. For example, in the HIV/AIDS community, people who receive medications from a physician often describe themselves as patients when talking about their relationship with their doctor. Similarly, many people using medications in their recovery describe themselves as a “person in long-term recovery using medication,” as a “patient” when describing their relationship with their physician, or as a “client” when describing their relationship with a clinic.
The problem is that when “consumer” is juxtaposed against “professional” or “provider,” as it often is, “consumer” conveys a person of less value and authority and implies that the individual has value only to the extent to which they consume professional services or products. This juxtaposition further creates the delusion that the “provider” is whole/well and the consumer is “broken/sick.” Both are dehumanized by this process, with one denied of weakness and the other denied of strength. The “consumer” designation reflects a hierarchical relational model that rests on twin propositions: 1) “the professional knows best” and 2) the role of the “patient/consumer is to listen and comply.”
“Consumer” also defines a person in terms of his or her problems. It relegates the person to being one, albeit critical, component of a system of care, rather than as the driver of that care and the person around whom all care is to be organized so that the person is able to get well. There is nothing in the term that conveys autonomy (or even healthy interdependence), competence, responsibility, or describes the assets that the person brings to others and the community. “Consumer” does not convey the status of, or hope for, recovery and seems alien when linked to words like liberation, journey, transformation, Higher Power, redemption, spirituality, and service, to name just a few of the words and concepts that are associated with recovery. If we need a name, then let’s use words that convey wholeness and wellness, words like “citizen,” “person in long-term recovery,” or “person seeking recovery.”

4. Using the term “consumer” to convey the involvement of people in recovery and their families in advisement or decision-making roles narrowly restricts the pool of people considered for such participation. For example, the term “consumer” would not include individuals/families in need of recovery who have never sought professional help, individuals who did not complete and may have had a “bad” experience in treatment, and individuals and families who achieve long-term recovery without the aid of professional treatment. Referring to such people as “consumers” (of addiction treatment services) is simply inaccurate. Individuals in treatment constitute only a small, unrepresentative sample of those who have experienced and/or have resolved alcohol and other drug problems. Too often, “consumer” represents an even smaller sample: individuals who have successfully “graduated” from treatment and, out of deep gratitude for their personal recovery, can offer testimony to a particular program’s effectiveness.
“Consumer” councils that guide federal, state, or local recovery-focused initiatives must include a wide range of voices as part of the advisory process. The term “consumer” does not adequately describe the scope of needed representative. Voices must be heard who represent diverse levels of problem severity/complexity, recovery capital, and pathways and styles of long-term recovery. The homogenous designation “consumer” ignores the distinct cultural histories and the enormous diversity of needs and circumstances people bring to the experiences of recovery initiation and recovery maintenance.

5. The “consumer” designation inadvertently serves as a mechanism of “outing.” To routinely introduce someone as a “consumer representative” or a member of “our consumer council” discloses the person’s status as a former treatment recipient or person in recovery and places the institution rather than the individual in control of when, where, to whom, and under what circumstances his or her recovery status is disclosed. For professional treatment institutions, such communications often constitute an inadvertent breach of ethics (confidentiality) and etiquette (respect, privacy, discretion). For the people serving in this role, the “consumer representative” designation diminishes and restricts how they are perceived by others and how they perceive themselves.

6. Terms such as “consumer,” “client,” “patient,” and “previously incarcerated person (PIP)” are inappropriate in the context of peer-based recovery support services. These terms imply a hierarchical service relationship model that is incongruent with peer-based recovery support. For example, when a recovery coach commented to a treatment professional that they did not refer to the people they served as “clients” or “consumers,” the professional asked, “Well then, what do you call them?” The simple response was, “Collectively, we call them people; individually, we call them by their names.” This response indicates a different relationship—not only one of mutual respect, but one that embraces the reciprocity that is at the core of peer recovery support relationships. The term “consumer” reflects the role dichotomy of helper (a producer of services) and helpee (a user of services); in the world of peer recovery support services, each person both gives and receives.

As more people return to communities from prison in search of sustained recovery, new acronyms are popping up. Unfortunately, these names and acronyms continue to objectify and turn individuals into an aggregate object, e.g., previously incarcerated persons (PIPs) and formerly incarcerated persons (FIPs). Such names and acronyms have no place in the world of addiction treatment and recovery support services.
( Referrals from the criminal justice system increased from 38% of total referrals in 1990 to 59% of referrals in 2004. During this same time period, referrals from welfare and child protection systems increased from 8% to 16%. McLellan, A.T. (2006). Addiction is changing: How changes in systems and customers may affect the Betty Ford Institute. Presentation to Betty Ford Institute Executive Council, February, Rancho Mirage, CA)
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7. Embracing this term in the addiction treatment and addiction recovery support arenas may amplify stigma by pairing the stigma already attached to addiction with the stigma attached to mental illness.
Given the dominance of the term “consumer” within the mental health field over the past two decades and the existing Consumer Advisory Councils for people with mental illness in each state, “consumer” has become a code word for mental illness. Joint use of “consumer” by the two fields may compound social stigma by inadvertently signaling that all “consumers” have histories of both mental illness and alcohol/drug addiction.
The use of “consumer,” because of its association with the mental health field, may also reinforce the view that addiction is a symptom of mental illness and not a primary disorder. It is critical that people with co-occurring addiction and mental illness receive the specialized and integrated services that they need to achieve long-term recovery. However, it is imperative that addiction is recognized and treated as a primary disorder.

8. The term “consumer” used in the context of addiction treatment mistakenly conveys the image of a seller-buyer relationship, with an informed customer having substantial autonomy, power, and choice and rights of redress if the product or service is faulty. This is not an accurate depiction of most persons entering addiction treatment in the United States today. The growing percentages of people entering treatment via external coercion, the substantial power differential between addiction professionals and their “patients,” the limited choices available to those forced into treatment, the lack of knowledge about those choices, the absence of lobbyists and advocacy organizations representing individuals and families in addiction treatment, and the lack of any significant mechanisms of redress for ineffective or harmful treatment are all obscured by referring to those entering addiction treatment as “consumers.” The term “consumer” is used in few other contexts in which choice and redress are so limited.

9. The term “consumer” has a commercial/marketing/sales connotation that overemphasizes the business aspects of addiction treatment and is particularly ill-suited for people involved in volunteer, peer-based recovery support services provided by recovery community organizations.
The term “consumer,” perhaps not unexpectedly, came into prominence in the roaring “greed is good” days of the 1980s when addiction treatment organizations were told they needed to shift their identity from that of a service program to one of a business.
( Acker, C.J. (1993). Stigma or legitimation? A historical examination of the social potentials of addiction disease models. Journal of Psychoactive Drugs, 25(3), 193-205, quotation from page 203.
“Americans are urged through ubiquitous advertising to construct their identities through consumerism; they are expected to be positive economic actors through consumption.”)

The commodification of addiction treatment and its accompanying language has been a corrupting force within the treatment field and set the stage for calls to de-commercialize and re-humanize the service relationship. The “consumer” designation is incongruent with the sustained person-professional and peer-peer partnerships being advocated as the ideal models of long-term recovery support. The commercial/commodity aspects of the term “consumer” are also part of a value system that attributes personal value to the possession/consumption of goods and services. It conflicts with a recovery value system that defines personal identity in terms of humility, restitution (paying rather than incurring debt), service (an emphasis on giving rather than owning), and simplicity.

Final Reflection
The addictions field could learn much from the larger disabilities movement of recent decades. Some of the central ideas of this movement include the following:

• Language matters. It is far more than superficial concerns about political correctness.

• Language is imbedded with values and judgments of a culture; cultural change involves a transformation in language.

• The labels applied to individuals affect how they are perceived by others and how they perceive themselves.

• Language is a vehicle of social control and social isolation. Stigma and discrimination are couched in a language that reinforces stereotypes and elicits fear.

• Recovery and community integration require claiming one’s own language.

• Language that focuses on the person is more respectful and less stigmatizing than language that defines a person in terms of an illness.

It will be interesting to see how the language of addiction treatment and recovery evolves in tandem with the dramatic changes that are unfolding within these worlds. I hope we will not be talking much longer about “consumers” or “consumer councils” but will instead be talking about people in recovery and recovery (or citizen) advisory councils. I also hope that the paternalistic “our patients,” “our clients,” and “those we treat” will evolve in the near future to “people we serve.”

Words can elicit fear, contempt, anger, or pity, but they can also elicit understanding, compassion, and respect. Individuals and families in recovery are awakening culturally and politically. As they do, they will forge their own language to collectively convey their “experience, strength, and hope.” They will challenge the traditional language that has been used culturally and professionally to depict alcohol and other drug problems and their resolution. Most importantly, they will claim entitlement to select the words used to refer to those who have experienced addiction and recovery.

Source: Daily Dose 21st July 2009

The following paper consists of detailed extracts from a paper which analyses carefully the costs and benefits of effective drug prevention initiatives. I makes sobering reading when the costs to society of substance abuse are revealed. Good drug prevention clearly benefits the whole of society – and especially tax-payers – not just the individual.
Whilst this document relates to the United States there is no doubt that similar results would be attainable in the United Kingdom.

1. Executive Summary
Policymakers and other stakeholders can use cost-benefit analysis as an informative tool for decision making for substance abuse prevention. This report reveals the importance of supporting effective prevention programs as part of a comprehensive substance abuse prevention strategy. The following patterns of use, their attendant costs, and the potential cost savings are analyzed:
Extent of substance abuse among youth
• Costs of substance abuse to the Nation and to States
• Cost savings that could be gained if effective prevention policies, programs, and services were implemented nationwide
• Programs and policies that are most cost beneficial

1.1. Costs of Substance Abuse
Studies have shown the annual cost of substance abuse to the Nation to be $510.8 billion in 1999 (Harwood, 2000). More specifically,

• Alcohol abuse cost the Nation $191.6 billion.

• Tobacco use cost the Nation $167.8 billion.

• Drug abuse cost the Nation $151.4 billion.

Substance abuse clearly is among the most costly health problems in the United States. Among national estimates of the costs of illness for 33 diseases and conditions, alcohol ranked second, tobacco ranked sixth, and drug disorders ranked seventh (National Institutes of Health [NIH], 2000). This report shows that programs designed to prevent substance abuse can reduce these costs.

1.2. Savings From Effective School-Based Substance Abuse Prevention
If effective prevention programs were implemented nationwide, substance abuse initiation would decline for 1.5 million youth and be delayed for 2 years on average. It has been well established that a delay in onset reduces subsequent problems later in life (Grant & Dawson, 1997; Lynskey et al., 2003). In 2003, an estimated:
• 8 percent fewer youth ages 13 to 15 would not have engaged in binge drinking
• 11.5 percent fewer youth would not have used marijuana
• 45.8 percent fewer youth would not have used cocaine
• 10.7 percent fewer youth would not have smoked regularly

The average effective school-based program in 2002 costs $220 per pupil including materials and teacher training, and these programs could save an estimated $18 per $1 invested if implemented nationwide. Nationwide, full implementation of school-based effective programming in 2002 would have had the following fiscal impact:
• Saved State and local governments $1.3 billion, including $1.05 billion in educational costs within 2 years
• Reduced social costs of substance-abuse–related medical care, other resources, and lost productivity over a lifetime by an estimated $33.5 billion
• Preserved the quality of life over a lifetime valued at $65 billion

Although 80 percent of American youth reported participation in school-based prevention in 2005 (SAMHSA, 2004), only 20 percent were exposed to effective prevention programs (Flewelling et al., 2005). Given this level of participation, it is possible that some expected benefits already exist for these students, and the estimates in this paper are adjusted for these probable benefits. These cost-benefit estimates show that effective school-based programs could save $18 for every $1 spent on these programs.

Table A1 in the appendix lists 35 effective prevention programs and strategies and the estimated cost-benefit ratios for each program. The array of demonstrated effectiveness among prevention programs and strategies is impressive. Of the 35 substance abuse prevention programs, practices, or related interventions, 15 reduced medical, criminal justice, and other spending by more than the cost to implement the program.

1.3. Conclusion
The cost of substance abuse could be offset by a nationwide implementation of effective prevention policies and programs. SAMHSA’s Strategic Prevention Framework should include a planning step that considers cost-benefit ratios. Communities should consider a comprehensive prevention strategy based on their unique needs and characteristics and use cost-benefit ratios to help guide their decisions. Model programs should include data on costs and estimated cost-benefit ratios to help guide prevention planning.

Increasingly, the American public supports investment in prevention programs as a strategy for dealing with America’s substance abuse problems (Blendon & Young, 1998; Maguire & Pastore, 1996). Research demonstrates that substance abuse prevention programs work: they can reduce rates of substance use and can delay the age of first use. Studies also have shown that prevention programs not only prevent substance abuse; they can contribute to cost savings (Aos et al., 2004; Caulkins et al., 2002; Miller & Hendrie, 2005; Swisher et al., 2003).

As well as reporting the ratio of benefits to costs, a cost-benefit analysis typically provides a net benefits estimate, which is computed by subtracting the cost of intervention from the benefits of the intervention (Mishan, 1988). For example, the All Stars program has a cost-benefit ratio of 34:1 which means it returns $34 dollars in savings for every dollar invested, yielding net benefits of $4,670 per pupil ($4,810 in social cost savings minus $140 in program costs). By comparison, the Life Skills Training program has a cost-benefit ratio of 21:1 and yields net benefits of $4,380 per pupil.

Although the All Stars and Project Northland programs save more than it costs to develop and deliver them, the return on investment in All Stars is 34:1, and the return on Project Northland is just 17:1. However, other factors should be considered, e.g., the level of outcome and long-term effects. For example, Project Northland also involves developing a community coalition that remains after the program and can address related issues without additional costs. In allocating resources, analysts often trade off the most efficient investments—those with the highest cost-benefit ratios against those with a broader reach that can produce a larger total benefit.

Direct Economic Impact of Substance Abuse
NIH ranks alcohol second, tobacco sixth, and drug disorders seventh among estimated costs of illness for 33 diseases and conditions (NIH, 2000). The year 1999 is the most recent year, with estimates available for all three categories of substance abuse. Despite a smaller number of deaths from alcohol use, alcohol-related costs are greater than tobacco costs because alcohol-related mortality tends to occur at younger ages than smoking-related mortality.
The categories used to develop the alcohol and drug abuse estimates include specialty alcohol and drug services; medical consequences; lost earnings due to premature death; lost earnings due to substance-abuse–related illness; goods or services related to crashes, fires, criminal justice, other; and lost earnings resulting from crime. The categories used to develop the smoking estimates were medical consequences and lost earnings due to morbidity and premature death. Tobacco prevention costs are excluded; the largest share of these prevention costs, State spending, averages $600 million annually (Campaign for Tobacco-Free Kids, 2004).

The social cost of alcohol, tobacco, and drug abuse in the United States by substance are as follows:. Alcohol abuse was responsible for $191.6 billion (37.5 percent) of the $510.8 billion, tobacco use was responsible for $167.8 billion (32.9 percent), and drug abuse was responsible for $151.4 billion (29.6 percent).

Loss of potential productivity and earnings: Smoking accounted for almost 440,000 deaths in 1999 (Fellows et al., 2002), alcohol abuse accounted for 42,000 (Harwood, 2000) to 76,000 deaths (Midanik et al., 2004), and drug abuse accounted for an additional 23,000 deaths (Harwood & Bouchery, 2001). Additional productivity losses occurred when individuals who abused substance

Lost productivity makes up two-thirds of the costs of substance abuse. Lifetime wage and household work lost to premature death is the largest component of these costs, followed closely by work lost to acute and chronic illness and injury. Incarceration results in $32 billion in earnings losses. Almost $25 billion more is lost when people who abuse substances pursue criminal careers rather than enter the labor force.

These estimates are conservative; they omit some costs that result from substance abuse. Specifically, they exclude (1) the impact on the quality of life of those who abuse substances and the people they harm and (2) the health care costs and work losses of victims who were involved in alcohol-attributable crashes even though they had not been drinking. These estimates also exclude the impact on the quality of life.

Costs and Benefits of Preventing Substance Abuse
This section uses the percentage of youth who might have started using substances in the United States and published estimates of prevention effectiveness to analyze the probable impact of a nationwide implementation of effective school-based substance abuse prevention programming. The following were estimated:
• Potential reduction in substance use and abuse as a result of providing effective school-based prevention interventions to all U.S. youth ages 12–14 in middle school
• Potential social cost savings as a result of providing effective school-based prevention interventions to all U.S. youth ages 12–14
• Social return on investment in preventive intervention measured in terms of costs and benefits
• Potential State government savings in juvenile justice and education costs as a result of providing effective school-based prevention interventions to all U.S. youth ages 12–14

The analyses primarily draw on data from the following sources:
• A report by Caulkins and colleagues (1999) for RAND titled An Ounce of Prevention, a Pound of Uncertainty: The Cost-Effectiveness of School-Based Drug Prevention Programs
• The NCASA report titled Shoveling Up: The Impact of Substance Abuse on State Budgets (NCASA, 2001)
• National Survey on Drug Use and Health (NSDUH) (SAMHSA, 2004))
• Youth Risk Behavior Survey (YRBS) (Centers for Disease Control and Prevention, 2003)
Two meta-analyses on the effectiveness of school-based youth substance abuse prevention programs (Aos et al., 2004; Hansen et al., 2004)

4.1. Youth Delaying or Never Using Substances
Nearly every youth ages 12–14 is at risk for trying alcohol, tobacco, and drugs and may be aware of social norms and feel peer pressure to start using these substances. The initial analysis involved estimating the number of youth who would not have tried or would not regularly use these substances if effective school-based prevention programs were in place nationwide. To determine these estimates, the number of youth ages 12–14 was multiplied by three factors: the low, medium, and high estimates of the percentage of youth who would delay initiating use of each substance if they received effective school-based prevention programming. The effectiveness estimates were drawn from two meta-analyses on the effectiveness of school-based youth substance abuse prevention programs (Aos et al., 2004; Hansen et al., 2004

The midrange estimates of youth receiving effective school-based prevention services across intervention programs are as follows:
• 4.7 percent will delay using alcohol
• 4.1 percent will delay using marijuana
• 2.7 percent will delay using cocaine
• 4.7 percent will delay smoking

These estimates represent the mean values from an array of school-based prevention programs that evaluations found significantly (>.05) delayed or prevented initiation of youth substance use. The individual estimates of effectiveness were derived from meta-analyses that generally excluded evaluations that did not use some sort of comparison or control group. Prevention programs for cocaine use had the smallest range of effectiveness from 2.3 percent to 5.3 percent of youth delaying or never initiating use. Prevention programs that delayed or prevented initiation of alcohol use had the greatest range of 1 percent to 10.3 percent.

Table 4 shows a range of estimates of the number of youth who would delay substance use if they received effective school-based prevention programming. For all youth ages 12–14, universal prevention programming in 2002 would have delayed 1.5 million initiations of substance use, with a range from 0.7 to 3 million. The largest absolute impact would be on drinking, with 446,000 youth delaying their first drink, followed closely by smoking with 436,000 youth delaying their first smoke. (A youth who delays both smoking and drinking is counted in both categories.
For drug abuse, the corresponding estimates are 247,000 youth delaying their first cocaine use and 389,000 delaying their first use of marijuana.

The rationale for this analysis is that when youth delay onset of substance use, on average, two years less of lifetime use occurs. When prevention programs delay the onset of substance use, the number of future dependent users also decreases (Grant & Dawson, 1997), but the analysis does not estimate that further saving.

Effective nationwide school-based prevention programming for youth ages 12–14 in 2002 would have prevented 267,000 youth from drinking during 2003, 183,000 from using marijuana, 138,000 from using cocaine, and 205,000 from using tobacco . Prevention programming also would have prevented 169,000 youth from binge drinking in 2003, and 72,000 youth from smoking regularly.

Effective prevention programs would reduce binge drinking by 8 percent, marijuana use by 11.5 percent, cocaine use by 45.8 percent, and regular smoking by 10.7 percent

The impact of substance abuse prevention may extend over a lifetime and is most obvious when prevention fails to deter an individual from substance abuse, and the abuse results in premature death. Substance abuse may last many years and often entails periods of recovery and relapse. Furthermore, the effects of substance abuse may continue well beyond the period of time when an individual is actively abusing substances.

The following cost factors were considered:
• Medical costs
• Other resource costs, ranging from property damage to police, criminal justice, litigation, and insurance administration expenses
• Lost wage and household work
• Value of pain, suffering, and loss in quality of life

Cost-Benefit Ratios
To achieve these savings school-based prevention programming would cost an estimated $220 per pupil nationwide. This cost represents the average across the 11 school-based prevention programs analyzed in this section. Knowledge of program costs makes it possible to estimate the cost-benefit measures defined in Section 2. The return on investment in school-based prevention services would range between $7.40 and $36 per dollar invested, with a medium estimate of $18 The best estimate equates to a net saving of $3,740 per youth served, including a $74 net savings in medical and other resource costs ($294–$220). Since expected medical and other resource cost savings exceed program costs, the program would yield net cost savings to society. School-based substance abuse prevention programming that effectively addresses substance abuse appears to be an excellent investment and is likely to pay for itself in resource cost savings alone.

For every dollar spent per pupil, society would save $18.

SAMHSA’s continuum of care suggests some overlap in prevention programs (i.e., universal, selected, and indicated). For example, when the Strengthening Families Program prevents a youth from adopting multi-risk behavior, it clearly is prevention. Similarly, when Project Northland prevents a youth from ever trying cocaine or delays initiation of cocaine use, it unambiguously prevents illicit substance use. Indicated prevention programs can also work to prevent an increase or expansion of early experimental substance use behaviors. When the topic is preventing the costs of substance abuse, the distinction blurs between programs that prevent binge drinking per se and those that prevent costly adverse consequences attributable to substance abuse (e.g., programs to prevent drinking and driving).

Universal preventive interventions are targeted to the general public or a segment of the entire population with an average probability of developing a disorder, risk, or condition. Selected preventive interventions are targeted to specific populations whose risk of a disorder is significantly higher than average, either imminently or over a lifetime. Indicated preventive interventions are targeted to designated individuals who have minimal but detectable signs or symptoms suggesting a disorder or who carry biological markers for a disorder often referred to as high risk. Youth ages 12–17 who abuse substances constitute approximately 11 percent of people who engage in binge drinking and 15 percent of people involved in illicit drug use in the United States

Family-centered interventions with a school component generally are more costly than school-based life skills training, but they offer larger benefits per youth assisted. The most effective programs strengthen youth bonds to family, school, and community, increasing protective factors while reducing risk factors. These include Adolescent Transitions, Strengthening Families, Guiding Good Choices, Project Northland, and SOAR. Although family-centered programs achieve more in terms of bonding and protective factors, some narrower life skills programs offer larger returns per dollar invested. With a limited budget, life skills programs allow a school system to reach the most children. However, the same money probably would yield greater benefits per youth assisted if spent targeting the broader family-centered programs and related mentoring to the schools at highest risk.

As these findings indicate, the costs of substance abuse to society are significant, and cost savings may offset the cost of providing effective prevention

Substance abuse has a wide range of adverse consequences. In order to optimally reduce consumption and its adverse consequences, a comprehensive package of prevention programs and strategies is required. No single intervention will reduce the problem so dramatically that no further public action is desirable. Given the number and diversity of proven interventions, optimal resource allocation requires selecting the most complementary, politically feasible, and culturally and demographically appropriate set to maximize a return on investment within the available funding. Of critical concern is to identify a sensible package of interventions that complements existing interventions. Policymakers selecting substance abuse interventions can apply a series of filters. The estimates in this report provide the first filter: eliminating interventions that offer a questionable return on investment.

However, new and improved versions of the original DARE program, Here’s Looking At You (Farley & Associates 2002) and the Adolescent Substance Abuse Prevention Study (Sloboda & Hawthorne, 2003) have produced better results and consequently better cost-benefit ratios and should not be dismissed arbitrarily. This financial information should be used as only one of an array of measures in selecting effective programs. Additional filters that policymakers can use in selecting interventions are political feasibility, local priorities, appropriateness for the target population, cultural sensitivity, affordability, and the immediacy of the impact (weeks versus years). Political feasibility is especially important. A slightly less cost-beneficial program can be superior if the alternative with the higher return has a lower chance of widespread implementation or involves a long delay in implementation. As the subsections that follow describe, all things are not equal when selecting a package that yields the maximum gains at the lowest possible price. Other factors, such as aggregate benefits obtained, overlapping effects, spillover costs and benefits, and government cost can and should weigh into the decision process.

Conclusion
If effective prevention programs were implemented nationwide, substance abuse initiation would decline for 1.5 million youth and be delayed for 2 years on average. In 2003, an estimated:
• 8 percent fewer youth ages 13–15 would not have engaged in binge drinking
• 11.5 percent fewer youth would not have used marijuana
• 45.8 percent fewer youth would not have used cocaine
• 10.7 percent fewer youth would not have smoked regularly

The average effective school-based program costs $220 per pupil. It would save an estimated $18 per $1 invested if implemented nationwide. Nationwide school-based effective programming in 2002 would have had the following fiscal impact:
• Saved State and local governments $1.3 billion, including $1.05 billion in educational costs during 2003 and 2004
• Reduced social costs of substance-abuse–related medical care, other resources, and lost productivity over a lifetime by an estimated $33.5 billion
• Preserved the quality of life over a lifetime valued at $65 billion

These cost-benefit estimates show that effective school-based programs pay for themselves and more. For every dollar spent on these programs, an average of $18 dollars per student would be saved over their lifetime. Among 10 effective school-based life skills programs, the average return on investment exceeded $15 to 1. That is, every dollar spent on these programs returned an average of $15 dollars per student. The probable costs and cost savings involved in implementing a composite of these programs for middle school youth ages 12–14 nationwide were estimated. The average program would delay more than a million initiations of alcohol, cocaine, marijuana, or tobacco use by youth for an average of 2 years. Its cost would be $220 per pupil.29
The out-of-pocket expenses would be repaid by savings to the education system alone in less than 2 years. The program would offer additional savings to State and local governments by reducing spending on Medicaid, police, and other criminal justice services. School-based programs that offer a particularly large return on investment include All Stars, Family Matters, Keepin’ It Real, Life Skills Training, and Project Northland. Although Project TND and STARS for Families yielded lesser returns than competing NREPP programs, they still yielded $4 in savings per $1 invested. Programs designed to strengthen families generally cost more than the school-based life skills programs. Several of them also were highly cost-beneficial and offered much larger returns in the aggregate per youth served than the school-based life skills programs.
In a program targeting families with low income, intensive home visitation, coupled with preschool enrichment, reduced infant/toddler abuse (Aos et al., 1999; Karoly et al., 1998). As these toddlers reach adolescence and adulthood, visitation programs also can reduce a range of problems including substance abuse and violence. However, the net returns are often realized in the long term (for actual longitudinal cost-benefit results see Karoly, et al., 1998; Schweinhart, et al., 1993). The proven interventions often cover different aspects of the problem (such as youth drug use initiation, impaired driving, and violence), which make a complementary set of interventions more beneficial. Several interventions are best directed toward different aspects of the problem. If they are massed against the same aspect, the size of that aspect will shrink, and the return on added interventions will decline below the levels shown in this study. Taken as a whole, the benefits of substance abuse prevention well outweigh the costs of providing that service. Cost-benefit ratios can guide the selection of an optimal intervention package within the available resources. Political feasibility, cultural and demographic differences, and local priorities also must be considered.

Source: Miller, T. and Hendrie, D. Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis, DHHS Pub. No. (SMA) 07-4298. 2008

The PATS surveys also included questions related to a variety of factors associated with drug usage. We used responses to these questions as input to our model. Perceived susceptibility was measured by asking respondents to rate three items (on 4-point scales) indicating the degree to which people risk harming themselves by using drugs. Perceived severity was measured by having respondents rate four items (on 4-point scales) indicating the degree to which they would fear the consequences of being caught with drugs. Attitudes toward drugs were measured by having respondents indicate their level of agreement with 14 items (on 5-point scales) describing benefits of drug use. Attitudes toward drug users were measured by having respondents indicate whether each of 27 personality characteristics would describe a marijuana, cocaine, or crack user. Other factors measured included peer pressure, and how difficult it was to obtain drugs. Finally, respondents were asked to read a short description of six advertisements that were aired nationally, and to indicate how often they had seen each advertisement.

The probabilities of a respondent’s reporting use of marijuana and cocaine/crack over the previous 12 months were expressed in a standard “probit” formulation as a function of both the attributes of the individual (e.g., demographic characteristics) and his or her attitudes towards drugs and drug users, and perceptions of drug use itself (e.g., perceived severity). We considered three versions of this formulation, each of which involved a slightly different assumption about the relationship between the cocaine/crack and marijuana use decisions.

An Independent Choice?
First, we estimated the marijuana and cocaine/crack equations independently, assuming that the decision to try the two drugs is independent. (Empirical research suggests that the process may be sequential; that is, one first tries marijuana and then cocaine/crack.) Second, the common syndrome theory suggests that individuals have a “predisposition” to use drugs that manifests itself first in marijuana use. Third, certain factors associated with the experience of using marijuana could lead people to use harder drugs, such as cocaine/crack. This has been referred to as a “gateway” or “stepping stone” theory. These three alternatives resulted in different statistical specifications, which allowed us to test the hypotheses with the available data. In addition to the “use” choice, we investigated the decision regarding how much to use (the “volume” decision), given that an individual has reported using marijuana or cocaine/crack. For this analysis, individuals were categorized as “light” or “heavy” users.
The result is a classic sequential-choice decision: an individual uses the drug and then, on the basis of his or her experience and additional information (e.g., anti-drug advertising), decides whether or not to use the drug again. Accordingly, for each drug, we initially estimated stage one probability equations and then estimated the probability of a given individual’s being a light or heavy user conditional on previous use. Thus, including only those who had previously used drugs, we estimated each second-stage equation using a dichotomous dependent variable indicating heavy or light usage.
The first “wave” of PATS (conducted before the initiation of anti-drug advertising) provided us with the data necessary to assess the determinants of drug use in the absence of PDFA advertising. This was the “control” in our natural experiment. We were then able to assess the significance of recall of PDFA advertising in terms of use and volume decisions via a series of “treatment” groups consisting of each of the subsequent waves exposed to advertising.
We began by estimating the three sets of probability-of-use equations (“independent,” “gateway,” and “predisposition”) using the wave one data for marijuana and cocaine/crack. Then, on the basis of the best fitting of these equations, we estimated the second stage regressions for the probability of being a light vs. heavy user, also using the wave one data. This provided us with a detailed analysis of the factors influencing the decision to use and the volume of use for each drug before the commencement of PDFA advertising.
So what did we find? Using nested tests, we concluded that the “predisposition” formulation – i.e. that individuals have a “predisposition to use drugs” that manifests itself first in marijuana use – fit significantly better than the notion that the decision to try the two drugs is independent. Consequently, we used this formulation throughout. In addition, the data led us to reject the hypothesis that marijuana use increases the probability of cocaine/crack use. To be sure, individuals who have used marijuana in the past are indeed more likely to use cocaine/crack. But the reason is that – statistically speaking – individuals who are predisposed to try marijuana are also predisposed to try cocaine/crack.

Does Anti-Drug Advertising Work?
This analysis, conducted with the wave one “control” group, provided the basis for analyzing the significance of recall of PDFA advertising in waves two, three, and four. The findings demonstrate that recall of anti-drug advertising was associated with a decreased probability of marijuana use. The advertising coefficients in the marijuana use equation were all statistically significant and of the “correct” sign. In the case of cocaine/crack use, the advertising variables were also significant in waves two through four. The estimated advertising coefficients in the volume portion of our results were all statistically nonsignificant with the exception of the wave four marijuana volume-of-use equation. This suggests that recall of PDFA’s anti-drug advertising had little or no impact on the volume of use among existing users.

In England, the proportion of young people aged between 11-15 who reported having drunk alcohol decreased from 62% to 54%, between 1988 and 2007. However, the amount consumed by the young people who drink increased from 6.4 units per week in 1994 to 12.7 units per week in 2007 [1]. The largest increase was seen in 14 year olds who increased their alcohol consumption from 6.1 to 9.9 units per week over this period. Furthermore, this increase was not gender specific. For both boys and girls there was a substantial increase in
the amount of alcohol consumed [1]. Moreover, one in four young people aged 14 reported consuming over 10 units of alcohol on their last drinking occasion; this level of consumption increased to one in three by the age of 15 [2]. In 2001 it was reported that young people’s drinking tends to be confined to fewer days than adults, and in particular at weekends .

Thus young people (aged 11-15), who drink, tend to do less frequently but at a higher intensity than adults.

In young people (aged 16-24), the latest NHS Information Statistics on Alcohol (2008) reported that 26% of males and 24% of females drink over the recommended weekly limits for low risk drinking in adults, which are 21 units for men and 14 units for women. Moreover it is shown that 9% of young males and 6% of young females drank over 50 units per week which is indicative of high risk drinking in adults . It is not clear whether current adult guidance on low risk drinking is pertinent to young people or if specific recommendations are required for individuals who are in the midst of ongoing physiological and emotional
development.

During the last 30 years the number of deaths due to chronic liver disease and cirrhosis has risen steadily in England and this trend is particularly marked in the 25-34 year group with the number rising from 16 in 1970 to 68 in 2000 for men and from 7 in 1970 to 60 in 2000 for women . The majority of liver disease in this country is due to heavy drinking . However, the most significant physical health risks associated with alcohol consumption in young people at the present moment are those relating to accidents and injuries. The ESPAD study reported that 13% of all 15-16 year olds had been involved in an accident or had an injury as a result of drinking .

In Scotland, it has been reported that on a daily basis, 15 children under the age of 17 attend Emergency Departments, intoxicated and in need of medical assistance or treatment .Indeed an audit of 21 emergency departments over a 6 week period showed that 648 children and young people under the age of 17 required medical treatment; 15 of these cases were below the age of 12 and one was as young as 8 years old. On average these young people had consumed 13 units of alcohol within the 24 hours leading up to their attendance . If this number were to be extrapolated for England it would give an estimate of around 1245 young people per week requiring medical assistance or treatment in England (64,750 per year).

In England some 35,472 young people aged 16-24 were admitted to hospital in 2005 with alcohol-related conditions . The largest proportion (19,533) were male and the figures increased with increasing age. Whilst it is clear from these figures that excessive drinking by young people is a significant concern in the UK, it is not clear what impact this alcohol misuse has on their health and well-being beyond the immediate hospital episode.

Heavy drinking by young people is more pronounced in areas with high social deprivation. The highest levels of alcohol consumption are reported by young people in the North-East of England and Yorkshire and Humberside where they are 1.5 times more likely to have drunk alcohol during the last week than young people living in the rest of England . In 2008, a survey of 1,250 young people living in deprived communities in Britain found that over a third did not know what a unit of alcohol was and did not understand the term binge drinking. Of
these young people, 39% drank up to 20 units per week and 15% drank over 20 units per week . Thus the adverse effects of social deprivation on young people may be compounded by possible health and social problems related to heavy drinking.

In a survey of school children aged 15 and 16 from the North West of England, participants reported that being aged 16, receiving a greater amount of income per week and not having a hobby or being a member of a club or sports team was associated with higher levels of alcohol . In addition, a higher percentage of girls reported drinking in public places whilst a higher percentage of binge drinkers were male . The 2005/2006 Health Behaviour in School-aged Children (HBSC) Survey (on patterns of health among young people in 41 countries and regions across Europe and North America) provides an international comparison . Notably, findings suggest that young people in the UK have some of the
highest rates of drunkenness internationally. England had the highest proportion of girls (24%) that reported that they had first been drunk at the age of 13 or younger. Rates for English boys were also high 23% reported they had been drunk at age 13 or younger .

Thus there are clear grounds for concern about alcohol consumption in young people in England and it seems that many aspects of young people’s drinking may be situational or culturally determined. Moreover, whilst there is some evidence that parents’ attitudes about alcohol may shape their children’s views (particularly in younger children) about drinking, it seems that other direct mechanisms such as access to pocket money and involvement in diversionary activities (or not) may also determine if, when and how much their children
drink. However, it is currently not clear to parents what risks arise for their children from early exposure to, or different levels of, alcohol consumption. Many parents may feel that early introduction to alcohol by them is preferable to its use in unsupervised experimentation.

However, there is currently insufficient information to base such decisions on.
In adults there are some health and social benefits associated with alcohol consumption. However, the health benefits are linked to cardio-protective effects of low to moderate consumption of alcohol which have generally been identified in older adults, that is men aged over 40 and post-menopausal women . The positive social effects of drinking are well known to the majority of the adult population that chooses to drink alcohol, although these effects are rarely studied in research terms. In young people, it is not clear whether there is any health benefits associated with drinking in early life. It is likely that young people will
perceive positive social effects of drinking . However, it is possible that these may be tempered by adverse consequences that may arise from drinking at an age before alcohol is legal.

On the basis of current epidemiological evidence on adverse consequences of drinking, particularly in young people who become intoxicated, the alcohol harm reduction strategy for England has highlighted that underage drinking is a major public health priority and outlined three objectives for tackling it:

• 1.Delaying the onset of regular drinking, primarily by changing the attitudes of 11-15 year olds and their parents about alcohol.
• 2. Reducing harm to young people who have already started to drink.
• 3. Creating a culture in which young people feel they can have fun without needing to drink.

Recent NICE guidelines on alcohol interventions in schools and the Government’s recent Youth Alcohol Action Plan also set out clear priorities concerning alcohol and young people under the age of 18. One of the actions in the Action Plan is to issue advice to parents about young people and alcohol, which will include guidelines for low risk drinking

This ‘guidance will also offer wider information on the health and social impacts of
drinking at young ages, sources of help and support for parents including evidence-based approaches for them to use with their children. Furthermore, the 2007 Chief Medical Officers Report recognised that young people’s health is the key to the nation’s future. He identified six priority risk-taking areas of which one was alcohol and drugs . In order to inform the proposed guidelines on alcohol and young people, this review was commissioned to identify published evidence on both the harms and benefits of drinking in early life. Given that there was a limited time-frame available for the work, the commissioning brief asked for a focus on existing reviews in this field. The purpose of this work was to provide an assessment of this evidence to an expert group of clinicians/researchers
convened by the Department for Children, Families and Schools to enable them to make recommendations to parents about their children’s drinking.

The aim of the study were to:

• produce a thorough review of the most up-to-date, robust and reliable evidence on the harms and benefits of alcohol consumption for children and young people;
• undertake a systematic search of existing reviews and weigh-up the quality of the evidence base;
• communicate and discuss the findings with the expert panel on alcohol and young people;
• support the Department in accurately and appropriately interpreting and using the evidence;
• ensure the guidance for parents is based on a firm evidence base; and
• identify evidence gaps that longer term research needs to address.

The following electronic databases were searched for relevant reviews:

• ETOH Alcohol and Alcohol Problems Science database (1972-2003)
• TRIP (May 2008)
• MEDLINE (1950-May 2008)
• EMBASE (1980-May 2008)
• CINAHL (1982-May 2008)
• PsycINFO (1806-May 2008)
• Social Science Citation Index (1970-May 2008)
• Science Citation Index (1970-May 2008)
• Scopus (1996-May 2008)

We also used key words (see below) to search the following websites

• Institute http://www.intute.ac.uk/
• Department for Children, Schools and Families http://www.dcsf.gov.uk/
• Department of Health http://www.dh.gov.uk/en/Publicationsandstatistics/index.htm
• Home office http://www.homeoffice.gov.uk/rds/alcohol1.html
• UK Statistics Authority http://www.statistics.gov.uk
• EU Statistics UK http://www.eustatistics.gov.uk/
• NHS Information Centre http://www.ic.nhs.uk/
• UK Data Archive http://www.data-archive.ac.uk/
• NICE http://www.nice.org.uk/
• WHO http://www.who.int/topics/alcohol_drinking/en/
• Alcohol Concern http://www.alcoholconcern.org.uk/
• Alcohol Education and Research Council http://www.aerc.org.uk/
• National Center on Addiction and Substance Abuse http://www.casacolumbia.org/
• Alcohol and Drug Abuse Institute http://depts.washington.edu/adai/
• Australian Drug Information Network http://www.adin.com.au/
• SoRAD http://www.sorad.su.se/
• Diversity Health Institute Clearinghouse
http://www.dhi.gov.au/clearinghouse/default.htm
• European Alcohol Policy Alliance http://www.eurocare.org/
• ADCA library http://tinyurl.com/4t8ds2
• DrinkandDrugs.net http://www.drinkanddrugs.net/
• Daily Dose http://www.dailydose.net/
• Google and Google Scholar http://www.google.co.uk
• NIAAA: http://www.niaaa.nih.gov/

Just as in the 1970s, the drug legalization movement has received a great deal of media attention. Also just as in the 1970s, this movement, unfortunately, has contributed to the rise in drug use by painting the picture that drug laws – not drugs – are the villains. Legalization advocates attempt to support their position with faulty analogies, misrepresentations, and unsupported theories. This fact sheet will address the myths propagated by the pro-drug movement.

MYTH: Drug laws infringe on individual freedom and privacy as well as make criminals out of otherwise law-abiding citizens.

FACT: All laws, by their nature, restrict a certain degree of freedom – the freedom to do as one pleases, whenever one pleases, regardless of the harm or potential harm to oneself or others. Civilized society has the right and the responsibility to regulate behavior in order to protect individuals from their own poor decisions as well as others from the risks of certain behavior. Drunk driving, traffic regulations, possession of explosives and weapons, incest, and child labor are but a few examples.

Those who want to legalize drugs would have you believe that individuals who choose to engage in illegal behavior bear no responsibility; but, instead, the law is to blame, even though most of our citizens elect not to violate the law. The legalization advocates focus on the rights of drug users while ignoring the rights of the public. Based on their philosophy, it is acceptable to allow a very small segment of our society to get high with impunity while placing the majority in great jeopardy from their intoxicated state. Based on their theory, drunk driving should not be against the law. A drunk should only be punished after he or she has a traffic accident and kills or maims someone.

Additionally, the majority of our citizens do not fear law enforcement. It is those few who choose to violate the law who feel threatened by the police. They seek protection of their own freedom while they choose to violate the freedom of others.

MYTH: Drug use is a victimless crime.

FACT: There are actually four classes of drug use victims: the users themselves, the family and friends of users, the individuals who are victimized by the acts of those under the influence, and the taxpayers/consumers who are paying the price. Tell these people, who have had firsthand experience with drug abusers, that they are not victims. Tell the mother and father whose child was killed by a drugged driver, or the husband whose wife was raped by somebody loaded on cocaine, or the sister whose brother was brutally beaten by a “speed freak” that they are not victims of drug use. The nexus between violence and being under the influence is indisputable. Tragic stories of promising young adults dropping out or children beaten by their drug-using parents are all too common. How anyone, assuming that they truly understand the drug culture, can suggest a policy that would facilitate drug use is beyond comprehension.

MYTH: Alcohol and illicit drugs are no different; thus, it is hypocritical for society to allow alcohol use while outlawing other drugs.

FACT: Alcohol and illicit drugs have a major difference. Most people use alcohol as a beverage and don’t drink to become intoxicated; whereas, with drugs, intoxication is the sole purpose. That is why marijuana smokers seek the higher THC content in marijuana and why crack is so popular among cocaine users. A more factual analogy would be to compare drug use with drunkenness. In addition, illicit drugs are far more addicting than alcohol. Also, approximately one-half of our citizens use alcohol, whereas only approximately 6 percent use all of the illicit drugs combined – the simple reason being that alcohol is legal, relatively inexpensive, readily available, and socially acceptable, whereas illicit drugs are not.

MYTH: The legalization of illicit drugs should be based on the alcohol model.

FACT: Alcohol is hardly the model to use to justify legalizing illicit drugs. Legal alcohol has been consumed by a majority of our young people, whereas only a small percentage use illegal drugs. There are more people addicted to alcohol than use all the illicit drugs combined. Alcohol kills five times more people, the medical costs are triple, and economic costs are double those of all illicit drugs combined. There are also three times as many arrests for alcohol offenses as there are for drug offenses. The paradox is, while society is strengthening and demanding stricter enforcement of alcohol laws, there are those who want to decriminalize and even abolish drug laws.

MYTH: We tried alcohol prohibition, which was a failure, proving that prohibition against drugs does not work.

FACT: Alcohol prohibition, under quite different circumstances in the 1920s, was an attempt to pass laws that the majority of the people did not support. Even with that, there was an approximate 50 percent reduction in alcohol consumption, deaths from alcohol-related diseases, admissions to mental institutions, and alcohol-related psychosis. Unlike the legalizers would lead you to believe, crime did not skyrocket. Prior to enforcing drug laws and alcohol prohibition, from 1900 to 1920, the murder rate jumped 300% (1.5 to 8 per 100,000) from 1905 to 1919. During prohibition, the rate climbed only 30% (8 to 9.5 per 100,000). Rescinding prohibition after only 13 years was insufficient time to change society’s attitude following 2,000 years of acceptance. Regardless of whether you drink alcohol or not, you would probably agree that our society would be much better off if we didn’t have alcoholic beverages.

MYTH Elimination of drugs would reduce crime and free prison space for the more serious violent offenders.

FACT: Removal of laws would reduce incidents for those specific violations, but the behavior would not change. Lowering the age consent to 12 would reduce the number of child molestation crimes, but it would not change the fact that predators were molesting young children ages 12 to 18. The advocates fail to recognize what drug experts are well aware of: that a high percentage of drug dealers and addicts were criminals first and foremost. They would continue their criminal behavior in order to acquire sources of income. The Mafia did not disband after Prohibition nor would the Crips and Bloods become choirboys if drugs were legalized. The drug black market would continue unless all drugs for all ages were legalized, a proposal few support.

The nexus between being under the influence of alcohol and/or drugs and violence is well documented. Because drugs alter the mental state, drug users commit a disproportionate number of violent crimes. These acts of violence are often against family members and friends. Fifty percent of all child abuse cases are attributed to drug-using parents. Drug users are five to ten times more likely to be involved in fatal traffic accidents than drunk drivers. The perpetrator was under the influence in well over half of the violent crimes such as murder, rape, and serious assault. Only 5 percent of all murders are committed because of drug laws, whereas approximately 25 percent are committed because the murderer was under the influence of drugs.

There are three times as many arrests for alcohol violations as there are for drug violations. Legalizing substances such as alcohol was supposed to reduce crime, or is it that intoxication leads to more crime?

Ninety-three percent of all state prison inmates are violent and/or serious repeat offenders. Only 1.4 percent are first time, “non-violent” drug offenders. Keep in mind that “non-violent” only describes the act for which individuals are incarcerated and not their past history or previous behavior. If an organized crime “hit man” were convicted for income tax evasion, then he would be considered a non-violent inmate. In addition, only approximately 10 percent of those arrested for drug offenses actually end up in prison. The simple truth is that if we legalize or decriminalize drugs, the acts of violence against our citizens would skyrocket.

MYTH: Other countries have had successful experience with a more lenient and/or pseudo-legalized drug policy.

FACT: In the 1970s legalization advocates cited Great Britain’s decriminalization of heroin as a model drug policy. When Britain’s failed policy resulted in increased addiction, while the addict population remained stable in the United States, the advocates discontinued citing Britain. They then pointed to Platzspitz Park in Zurich, Switzerland, which essentially offered free drugs. This program was to prove all the so-called positive benefits of legalized drugs. The advocates expected less crime, more addicts accepting treatment, decreased AIDS, and the isolation of addicts. After five years, this experiment was abandoned because crime increased, drug-related deaths doubled, AIDS rose, and the health care system was overwhelmed. The very persistent advocates then began focusing on the Netherlands and its “enlightened” drug policy of not enforcing laws against selling and using marijuana in certain areas. After a number of years, the Netherlands began experiencing the consequences of lenient drug laws with increased drug use, unemployment, and crime. From 1984 to 1992, teenage drug use in the Netherlands increased 250 percent, while in the United States, at the same time, teenage drug use was reduced by 50 percent. Crimes of violence in the Netherlands – for instance, serious assault – increased 65 percent.

The advocates actually don’t have to look beyond this country to examine the results of legalization. The experience in Alaska with decriminalized marijuana resulted in twice as many Alaskan teenagers using the drug as those in the rest of the nation. Also, in the early 1900s, prior to legal sanctions, when drugs were inexpensive, available, and legal, the drug crisis per capita was triple today’s drug problem.

The advocates failed to examine the assertive drug policies of Japan and Singapore that resulted in the virtual elimination of the drug problem. Along with some Muslim countries, Japan and Singapore have proven that tough drug laws, coupled with aggressive enforcement, work.

MYTH: The cost of enforcing drug laws is too expensive, and the money could better be spent on social programs dealing with the root causes of drug abuse.

FACT: What the legalization advocates fail to address is the cost to this country if drug laws were not enforced. Making illicit drugs legal, inexpensive, and readily available would lead to a significant increase in the number of users and increased consumption among current users. Increased use and consumption would result in corresponding greater costs for homelessness, unemployment, welfare, lost productivity, disability payments, school dropouts, lawsuits, medical care, chronic mental illness, accidents, crime, and child neglect, to name a few.

Fifty to sixty percent of mental health care patients are substance abusers. Drug-using teens are three times more likely to commit suicide than their non-using peers. Seventy-five percent of teenage runaways are substance abusers. Hundreds of thousands of newborns are drug-exposed and impaired, costing taxpayers over $100,000 per child.

The current economic cost of illicit drug abuse is still half that of one legal drug – alcohol. The money raised in taxing alcohol covers less than 10 percent of all social and health expenditures due to that drug. Federal, state, and local government expenditures for drug law enforcement, which includes police, prosecutors, public defenders, courts, and prisons, is approximately $10 billion, which is less than 1 percent of total government expenditures. Relatively speaking, this is not a significant investment considering drug law enforcement, when compared to alcohol, helps save hundreds of thousands of lives and hundreds of billions of dollars.

Putting drug law enforcement expenditures into perspective, our federal government spent ten times that amount paying the interest on the public debt, ten times that amount on the war on poverty, and more money on the Food Stamp Program alone than all federal, state, and local expenditures for drug law enforcement.

There is also an assumption that with legalization there would be no governmental costs to regulate and control the distribution, sale, and use of drugs similar to those we currently have with alcohol. In addition, drug law enforcement would still be required for those drugs that remain illegal or to police the sale to and use by those under age.

Most importantly, the cost-saving argument, referred to as “blind-side economics,” only addresses economic issues and not the more tragic costs in terms of loss of life, pain and suffering, broken families, child neglect, and the general poisoning of Americans.

MYTH: The answer to the drug problem is increased drug prevention and treatment and not law enforcement.

FACT: It is interesting to note that most drug treatment and prevention professionals are against legalizing drugs. They consider law enforcement an essential precursor to both successful prevention and treatment. Good drug policy requires all three disciplines. Drug treatment experts agree that law enforcement offers strong incentives not only to receive treatment, but once treatment has been completed, to stay off of drugs. Making drugs legal, inexpensive, and readily available would eliminate that important incentive. Drug prevention experts agree that legal sanctions and public attitude against drug use are essential for successful education and prevention programs.

MYTH: This country’s 80-year war on drugs has been a failure, proving that strict laws and enforcement do not work.

FACT: It should be noted that there is not actually a “war” on drugs, but a limited engagement. Even with that, drug sanctions and enforcement have been successful during this 80-year period. Experts estimate that in the early 1900s, prior to drug laws or enforcement, there were as many addicts in this country as there are today, even though the population was one-third smaller. Recognizing the tremendous costs and problems associated with drug use, citizens, through their government, elected to pass and strictly enforce drug laws. The drug problem was significantly reduced so that by the 1940s and ‘50s, it was relatively minor. Anyone attending high school during that period could testify that drugs were virtually non-existent for most people.

In the 1960s and 1970s, there was a major shift in attitude regarding drug use. Terms such as “recreational drug use” were coined; the legalization movement gained momentum; drug use was glorified; and drug law enforcement was de-emphasized. This resulted in a tremendous increase in drug use and related problems in America. In the 1980s, through a combination of increased law enforcement, highly publicized prevention messages, and more effective treatment, drug use was reduced by 50 percent in just twelve years. In 1979 there were 24 million drug users and by 1992 there were only 11.4 million. It was during that period that drug arrests and incarcerations doubled. High school seniors graduating in the class of 1992 were 50 percent less likely to use drugs than their counterparts in the class of 1979.

Studies and surveys show that while 70 percent of eighth graders had used alcohol, only 10 percent had tried marijuana, and only 2 percent cocaine. Additional studies demonstrate that a majority of students cite the fear of getting into trouble with the law as a major deterrent to drug use. Yet another study shows that 79 percent of those responding stated they had no chance to use cocaine. Of the 21 percent who did have a chance to use cocaine, over half did. The U.S. military’s tough drug policy dropped drug use from 28 percent in 1980 to 3 percent in 1992. Private industry has repeatedly proven that tough anti-drug sanctions are successful.

There have been few modern social problems in this country, such as welfare, teenage pregnancy, homelessness, high school dropouts, and test scores for American students that have shown the same degree of success as our country’s drug policy. If, for instance, teen pregnancies were reduced by 50 percent, homelessness reduced by 50 percent, or SAT scores raised by 50 percent, the successes would be applauded. Instead, a 50 percent reduction in the number of drug users is considered a failure.

Conclusion

You don’t have to be a drug-abuse expert, an intellectual, or hold a variety of degrees to understand that to make illicit drugs legal, readily available, relatively inexpensive, and reduce the risk would lead to increased numbers of drug users as well as increased consumption among current users. Likewise, common sense would dictate that with increased drug use and consumption, the problems affecting this country would be overwhelming. Drug abuse exacerbates most social problems facing this country and touches all segments of our population. There would be no greater threat to destroy our country from within than making drugs inexpensive, available, and legal. I don’t think this is a legacy that we want to leave our children or our grandchildren. Instead of repeating the mistake of the 1970s, we should build on the successes of the 1980s. It is a mystery as to what drug culture the legalization advocates are referencing. Drug abuse experts are positive it isn’t the one they deal with on a daily basis. Intellectual theory, although interesting, often has no basis in reality

Source: Executive Director Thomas J. Gorman The Rocky Mountain HIDTA (CO)

It’s not unusual any more to see people in Libertarian circles attacking the war on drugs as a waste of tax dollars and an infringement on personal liberties. In my opinion, that is misguided thinking that comes from trying to apply unworkable theoretical concepts in the real world.
For example, you often hear advocates of drug legalization say that we’re never going to win the war on drugs and that it would free up space in our prisons if we simply legalized drugs. While it’s true that we may not ever win the war against drugs, we’re not ever going to win the war against murder, robbery and rape either. Moreover, it’s true that it would free up lots of space in our prisons if we legalized drugs, but you could say the same thing about most crimes. In fact, we could reduce the crime rate to zero and save enormous amounts of money on police, lawyers, and courts if we simply made everything legal. But, that doesn’t mean it would be a net plus for society.
Another point that’s often brought up is that if we legalized drugs, we’d be able to tax them and bring in more revenue for the state. But, how is that working out with alcohol and cigarettes? In 2004 and 2005, 39% of all traffic-related deaths was related to alcohol consumption and 36% of convicted offenders “had been drinking alcohol when they committed their conviction offense.” When it comes to cigarettes, adult smokers “die 14 years earlier than nonsmokers.” But, will we ever get rid of tobacco or alcohol? No, both products are too societally accepted for that and perhaps more importantly, the government makes enormous amounts of revenue from their sale. Do we really want to get into that same position with Crack, Acid, or Meth? Do we really want to be sitting around 10 or 15 years from now saying, “Gee, we’d like to get rid of heroin, but how could we replace the revenue we make from taxing it at an exorbitant rate?”
Moreover, the drug legalization crowd claims that we can manufacture drugs here in the U.S., tax them heavily, thereby making money for the government, and yet still be able to sell the drugs cheaper than the dealers can. That would seem to be a dubious proposition. Drug dealers who pay no taxes, have no unions, and don’t have to pay their labor the minimum wage, may very well be able to produce drugs more cheaply than corporations in the U.S. that will be under strict FDA guidelines (It typically costs a billion dollars to bring a new drug to market), that will be faced with a never ending stream of lawsuits, that will have to pay taxes, and then, additionally, will have to sell a product that will be taxed to the high heavens. That means it’s entirely possible that the cost of illegal drugs could go up, not down, with the government running the show and that would be a problem in and of itself because currently, “16% of convicted jail inmates said that they committed their offense to get money for drugs.”
Of course, the number of people using what are currently illegal drugs would skyrocket if they were legalized, so we’d see a new wave of drug addled burglars if we “legalized it.” Now, maybe you think that’s not the case. Some people certainly argue that if illicit drugs were legalized, their usage would drop. However, the fact that drugs are illegal is certainly holding down their usage. Just look at what happened during prohibition if you want proof of that. Per Ann Coulter in her book, “How to Talk to a Liberal if you Must:”
“Prohibition resulted in startling reductions in alcohol consumption (over 50 percent), cirrhosis of the liver (63 percent), admissions to mental health clinics for alcohol psychosis (60 percent), and arrests for drunk and disorderly conduct (50 percent).” — P.311
That’s what happened when alcohol was made illegal. However, on the other hand, if we make drugs legal, safer, easier to obtain, more societally accepted, and some people say even cheaper as well, there would almost have to be an enormous spike in usage.
Certainly that’s what happened in the Netherlands where “consumption of marijuana…nearly tripled from 15 to 44% among 18-20 year olds” after the drug was legalized.
But, some people may say, “so what if drug usage does explode? They’re not hurting anyone but themselves.” That might be true in a purely capitalistic society, but in the sort of welfare state that we have in this country, the rest of us would end up paying a significant share of the bills of people who don’t hold jobs or end up strung out in the hospital without jobs — and that’s even if you forget about the thugs who’d end up robbing our houses to get things to pawn to buy more drugs. Even setting that aside, we make laws that prevent people from harming themselves all the time in our society. In many states there are helmet laws, laws that require us to wear seatbelts, laws against prostitution, and it’s even illegal to commit suicide. So banning harmful drugs is just par for the course.
And make no mistake about it, drugs do wreck a lot of lives. Of course drugs aren’t the only things that wreck lives and not every person who does drugs ends up as a crackhead burglar or a dirty bum living in an alley. Heck, Barack Obama, a man some people would like to see as our next President has used cocaine — and doesn’t it seem like every few weeks we read about another celebrity who comes out of rehab and goes on to have a successful career?
Sure, that’s true. But, every person who plays Russian Roulette doesn’t end up with a bullet in his head either. Look at the flip side of the equation. How many homeless people are drug addicts? How many women have had crack babies? How many people are in jail today because they got high and committed a crime? How many lives have been wrecked in some form or fashion by drug use? There’s probably not a person reading this column who doesn’t know someone who has faced terrible consequences in his life because of drug use.
That’s why once, way back when William Bennett was the drug czar, he responded like so to a caller on the Larry King show who told him that he should “behead the damn drug dealers.”
“I mean what the caller suggests is morally plausible. Legally, it’s difficult. But somebody selling drugs to a kid? Morally, I don’t have any problem with that at all.” — Bill Bennett
Bennett was right then, he’s right now, and my guess is that most parents, upon finding out that someone was peddling drugs to their kid, would agree with him. Since that’s the case, do we really want the federal government to take over the role of a pusher and get our kids hooked on drugs to make a profit? No, we don’t.
Source: www.rightwingnews.com Jan 2007

April 12, 2005
BY MARK HENDERSON, SCIENCE CORRESPONDENT

 ONE in four people carries genes that increases vulnerability to psychotic illnesses if he or she smokes cannabis as a teenager, scientists have found.
A common genetic profile that makes cannabis five times more likely to trigger schizophrenia and similar disorders has been identified, increasing pressure on the Government to reverse the drug’s reclassification from Class B to Class C.

The increased risk applies to people who inherit variants of a gene named COMT who also smoked cannabis as teenagers. About a quarter of the population have this genetic make-up, and up to 15 per cent of the group are likely to develop psychotic conditions if exposed to the drug early in life.
Neither the drug nor the gene raises the risk of psychosis by itself.
The study, led by Avshalom Caspi and Terrie Moffitt, of the Institute of Psychiatry at King’s College London, offers the best explanation yet for the way that cannabis has a devastating psychiatric impact on some users but leaves most unharmed. Scientists had suspected that genetic factors were responsible for this divide, but a gene had not been pinpointed.
The findings, to be published in Biological Psychiatry, also reinforce a growing consensus that nature and nurture are not mutually exclusive forces but combine to affect behaviour and health. The King’s team has previously identified genes that raise the risk of depression or aggression, but only in conjunction with environmental influences.
Mental health campaigners said that the results vindicated their concerns about the decision last year to downgrade cannabis to a Class C drug, which means that possession is no longer an arrestable offence.
Marjorie Wallace, chief executive of the mental health charity Sane, said that it was becoming clear that cannabis placed millions of users at risk of lasting mental illness. About fifteen million Britons have tried cannabis, and between two million and five million are regular users, according to the Home Office British Crime Survey. The research suggests that a quarter could be at risk.
The evidence will be considered by a review of the drug’s classification announced last month by the Home Secretary. It may be possible to develop a test for genetic susceptibility to cannabis. “If we were able genetically to identify the vulnerable individuals in advance, we would be able to save thousands of minds, if not lives,” Ms Wallace said.
Dr Caspi, however, rejected the idea of screening based on the COMT gene. “Such a test would be wrong more often than it is right. Cannabis has many other adverse effects, especially on developing teenagers, on respiratory health and possibly on cognitive function. Effects may be pronounced among a genetically vulnerable group but that doesn’t mean we should encourage others not genetically vulnerable to use cannabis.”
The King’s team tracked 803 men and women born in Dunedin, New Zealand, in 1972 and 1973, who were enrolled at birth in a research project. Each was interviewed at 13, 15 and 18 about cannabis use, tested to determine which type of COMT genes they had inherited, and followed up at 26 for signs of mental illness.
COMT was chosen as it is known to play a part in the production of dopamine, a brain-signalling chemical that is abnormal in schizophrenia. It comes in two variants, known as valine or methionine, and every person has two copies, one from each parent.
Among people with two methionine variants, the rate of psychotic illness was 3 per cent, the background rate for the general population, regardless of whether they had used cannabis as teenagers.
Among those with two valine variants the rate was 3 per cent for non-users but 15 per cent for those who had smoked cannabis in their teens.
Dr Caspi said research had shown that the valine gene variant and cannabis affect the brain’s dopamine system in similar fashion, suggesting that they deliver a “double dose” that can be damaging. The work needs to be replicated by others to confirm the findings, Dr Caspi said. It also is possible that the gene involved is not COMT but a neighbour.
THE DRUG OF CHOICE FOR MILLIONS
•  Cannabis was reclassified from a Class B to a Class C drug in January 2004. Possession remains illegal, but is not an arrestable offence. The Home Secretary has asked for a review by November
•  The Home Office estimates that fifteen million people have tried cannabis, two million to five million are regular users and reclassification has saved 199,000 hours’ police work
•  Liberalisation campaigners argue that millions smoke the drug with fewer ill-effects than others suffer from alcohol or tobacco
•  A recent study at Maastricht University found that cannabis doubles the risk of schizophrenia, hallucinations and paranoia among a genetically susceptible group

Source:  www.timesonline.co.uk  14 April 2005

The State Government figures show that out of 4619 drivers pulled over, one in 73 tested positive to either cannabis or methamphetamines. This compared to an average of one in 250 drivers testing positive for alcohol. The results surprised police.The  results come just two days after research by the National Drug and Alcohol Research Centre showed 57 per cent of clubbers admitted driving under the influence of alcohol and 52 per cent under the influence of cannabis. The VicRoads-commissioned study reported that just under half of those surveyed admitted driving soon after taking other drugs.

43% said they had taken ecstasy and 42 % speed.

Source:  Minister for Police & Emergency Services. Victoria. Australia. April 15 2005

While youth who had a history of abuse or mental health problems were more likely to become homeless, those same characteristics didn’t predict teens and young adults getting off the street six months later.

“It looks like the predictors of homelessness might be different than the predictors of exiting homelessness,” lead author Natasha Slesnick of Ohio State University said in a statement. “So that means prevention targets should be different from intervention targets.”

Dope smokers have a 40 per cent increased risk of developing schizophrenia, and taking it regularly drives the risk up two-fold, Australian research shows.
A new study by psychiatrists has reviewed the latest evidence of links between cannabis use and mental illness, concluding the association is “stronger and clearer than ever”.
A pot smoker is 40 per cent more likely to suffer a psychotic episode than a non-smoker, according to the review of major published international research.
And for people who smoke daily over long periods their risk is 200 per cent higher.
“On the world stage, Australians excel in smoking cannabis, so there are very many people who fit into this category,” said lead researcher Dr Martin Cohen, a psychiatrist at the Hunter New England Mental Health Service.
“In fact we’re number one in the world.
“We know now more than ever that this bodes badly for our mental health.”
The review, published in the latest Australian and New Zealand Journal of Psychiatry, calculates that about 14 per cent of all cases of psychosis would never have occurred had the patient not picked up a joint.
A third of all Australians have smoked at least once in their life, with about 300,000 using daily. And while all had increased their risk to some degree, there was growing evidence that genetics predisposed some people even more.
Scientists have found a gene called COMT that, when faulty, is unable to break down the brain chemical dopamine.
An overload of dopamine triggers psychosis and, as cannabis produces an excess of the chemical, people with this “fault” are vulnerable.
Between 10 and 25 per cent of the population are believed to have the faulty gene, but as yet there is no way to test for it.
The risk is also higher for people who start smoking young and those who use heavily.
A 1998 national drug survey of 14 to 19 year olds showed 20 per cent had smoked in the last week, and 20 per cent of these took their first puff before they turned 12.
“These teenagers are the ones we really need to worry about because their use is changing a developing brain,” Dr Cohen said.
Professor Jan Copeland, director of the National Cannabis Prevention and Information Centre, said the levels of cannabis use had declined significantly since the 1998 survey, especially among school-aged Australians.
“But while we’re deterring many from ever trying, established regular users are still finding it very difficult to give up, putting them at risk of not just psychosis but depression as well,” she said.
Source:  The West.com.au  21st May 2008

Ian Sample, science correspondent
The Guardian
Tuesday June 3 2008

Smoking cannabis for long periods of time may shrink parts of the brain that govern memory, emotion and aggression, according to researchers in Australia. Scientists used magnetic resonance imaging to scan the brains of people who admitted to smoking more than five joints a day for at least 10 years and compared them with brain images taken from non-drug users.

Those who smoked cannabis regularly had on average a 12% smaller hippocampus, the part of the brain which is thought to be involved with emotion and memory, and a 7% smaller amygdala, which plays a role in regulating fear and aggression.

For the study, researchers imaged the brains of 15 cannabis smokers and 16 individuals who did not use the drug. The scientists, led by Murat Yücel at the University of Melbourne and colleagues at the University of Wollongong, said scans on larger numbers of people were needed to confirm the extent of the effect.

“Although modest use may not lead to significant neurotoxic effects, these results suggest that heavy daily use might indeed be toxic to human brain tissue,” the scientists report in the journal Archives of General Psychiatry.

Cannabis users also fared worse in tests of verbal memory and were more likely to have low-level symptoms of psychotic disorders such as schizophrenia and mania.

Last month, a team at New York University scanned the brains of a group of 17- to 30-year-olds who had smoked cannabis two to three times a week for at least a year. In that study, the brains of drug users looked no different from those who had never taken cannabis.

In 2004, Cyril D’Souza, a professor of psychiatry at Yale University, reported that THC, the active ingredient in cannabis, caused fleeting schizophrenia-like symptoms in users, ranging from suspiciousness and delusions to poor memory and attention span.

Source: http://www.guardian.co.uk/science/2008/jun/03/drugs.drugsandalcohol

By Laura Clout
Telegraph News
06/02/2008

Researchers also found that those who took cannabis in adolescence had a greater risk of developing schizophrenia than older users of the drug.

The teenagers, aged 15 and 16, were asked about their drug use before their risk of developing a psychotic disorder was assessed by experts.

More than 5 per cent said they had used cannabis once or more, and one in 100 had used cannabis more than five times. Girls were more likely to take the drug than boys.

The study, carried out by a team at the University of Oulu in Finland, is published on Monday in the British Journal of Psychiatry.

Dr Jouko Miettunen, who led the research said: “These teenagers are likely to be vulnerable to the mental effects, which means they are probably vulnerable to developing psychosis at some point.”

Being a teenager isn’t as risky as it used to be, but too many teens still put their lives and their health at risk, a CDC survey shows.Every two years, the CDC conducts its huge Youth Risk Behavior Survey. It contains detailed data from more than 14,000 questionnaires anonymously completed by teens in grades 9 through 12.

Overall, the 2007 results suggest that teens are acting more responsibly. Fewer are sexually active, nearly all wear seat belts, drinking and drug use are down, 80% of kids don’t smoke, and there are fewer suicide attempts.

This is good news to Howell Wechsler, EdD, MPH, director of the CDC’s Division of Adolescent and School Health. In some cases, the new numbers begin to approach the CDC’s Healthy People 2010 objectives.   “What we are seeing is from the early to mid-1990s to now, on a large number of health risk behaviors, we are seeing very, very encouraging progress,” Wechsler tells WebMD.

Even so, the new numbers are enough to take a parent’s breath away:
• 7% of teens say they’ve attempted suicide (down from nearly 9% in
2001).
• 35% of teens say they’re sexually active (down from 37.5% in 2001).
• 18% of teens say they carry a gun, knife, or club (no significant change from 2001).
• 20% of teens say they smoke cigarettes (down from 36.4% in 1997).
• Nearly 45% of teens say they use alcohol (down from 50% in 1999).
• About 20% of teens say they use marijuana (down from nearly 27% in 1999).
• Only about 21% of kids eat five or more servings of fruits and vegetables (down from 24% in 1999).
• 25% of teens play video games or use the computer for three or more hours a day (up from 21% in 2005).
• More than 65% of kids don’t get enough exercise , and 25% of teens say they don’t even get an hour of exercise on any day of the week.

“We are gratified that there is progress being made,” Wechsler says. “But my take on it is this: I have a bunch of kids myself and I am not going to be satisfied until we meet our goals — and in most areas we are still not meeting our Healthy People 2010 objectives. So I see no cause to be overly
satisfied.”

(Which teens are most at risk? Find out from guest blogger Howell Wechsler on WebMD’s News Watch blog.)

Best States/Cities, Worst States/Cities

In some cases, the overall numbers conceal states and localities where teen behavior is much better — and much worse — than average:
• 62.2% of Kentucky kids have tried smoking cigarettes, compared with only 24.9% of Utah teens (national average: 50.3%).
• 34.5% of West Virginia teens use tobacco products, compared with only 8.9% of kids in Vermont (national average: 25.7%).
• 44.7% of Alaska teens have tried marijuana, compared with only 17.4% of Kentucky kids (national average: 38.1%)
• 90.8% of kids in New York attend physical education classes at least once a week vs. 28.4% of kids in South Dakota (national average: 53.6%).
• 49.7% of Baltimore teens are sexually active, compared with 17.5% of San Francisco teens (national average: 35%).
• 39.2% of ninth to 12th graders in Dallas have been offered, sold, or given an illegal drug, compared with 13.5% of teens in Baltimore (national average: 22.3%).

Wechsler says the survey data don’t show exactly why teens in some areas take fewer health risks than teens in other areas. But he says that state and local efforts to reduce specific risk behaviors pay off. He points to anti-tobacco efforts as an example.

“One thing that is instructive is the tremendous difference in resources different states put into this,” Wechsler says. “In some states, teen tobacco use is much lower than the national rate. And we see this in exactly those states where they have made substantial investments in tobacco
reduction.”

Even Good Teens Take Risks — What Parents Must Do

If none of this sounds like your teenager, listen to Nancy Cahir, PhD, a child/adolescent/adult psychologist in private practice in Atlanta.

“What I have seen in my practice is even parents who think it couldn’t happen to their child — well, it can,” Cahir tells WebMD. “Even with the ‘perfect child,’ there may be hidden issues; even in good families, bad things can happen. There is no discrimination when it comes to high-risk behavior for teens.”

Parents have a responsibility to involve themselves in their children’s lives, Cahir says. They cannot assume their teen is doing fine because they haven’t had calls from the school or because their teen’s grades are good.

“Parents, I say stay close to your children. Know your kids the way you know your best friend, and keep in touch with them,” she says. “Spend time with them, know their friends, and know the parents of the children your children hang out with. Say to them every day, ‘Did you have a difficult day? What’s going on with you? How are you doing?'”

It’s probably not news that teens can be moody, even surly at times. Your teen may respond to your inquiries with something like, “My life is none of your business.”

Not so, says Cahir.

“Every parent has the right to say, ‘It is too my business,'” she says. “Parents sometimes shy away from being more involved because they don’t want to seem intrusive. But it is their business to know whom their child hangs out with, to know whether the child is in distress, and to help their children through these difficult times. Sometimes kids don’t like hearing that, and may respond in defiant ways, but parents must toe the line and say, ‘We have a right to know.'”

But Wechsler agrees with Cahir that communication is not only what your children need, but what they truly want.

“As a parent of two teens myself, you tend to believe them when they walk out of the room and don’t express any interest in hearing from you,” Wechsler says. “But kids really do want that communication with parents. They really do want to hear their parents’ values. They really need their parents to monitor their whereabouts and stay in touch and stay a very strong part of their lives.”

Cahir says the key to communicating with teens is developing mutual respect.

“Each member of a family should treat the others members like a best friend or at least as a guest in the house,” she says. “If you are angry with your teen, or your teen is angry with you, you have to talk it out in a way that is not hostile or aggressive. I’ve seen some families go after each other tooth and nail and they end up really harming each other.”

If communication breaks down, it may be time for the family to sit down with a professional to learn how to express disagreements in a constructive way.

The full CDC report, “Youth Risk Behavior Surveillance — United States, 2007,” is available on the CDC’s web site. For comparison, earlier years’ reports are also available.

Source:CBS News Web 4 June 2008

More Author Affiliations: ORYGEN
Research Centre (Drs Yu¨ cel,
Whittle, and Lubman) and
Melbourne Neuropsychiatry
Centre, Department of
Psychiatry, The University of
Melbourne and Melbourne
Health (Drs Yu¨ cel, Whittle,
Fornito, and Pantelis),
Melbourne, Australia; School of
Psychology and Illawarra
Institute for Mental Health,
University of Wollongong,
Wollongong, Australia
(Dr Solowij and
Ms Respondek); and
Schizophrenia Research
Institute, Sydney, Australia
(Dr Solowij).
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©2008 American Medical Association. All rights reserved.
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recent structural magnetic resonance imaging (MRI) studies
have also reported contradictory findings, ranging from
no global or regional changes in brain tissue volume or
composition14-16 to gray and white matter density changes,
either globally17 or in focal regions, most notably in the
hippocampal and parahippocampal areas.18,19 However,
these previous studies used imaging techniques with relatively
coarse spatial and anatomical resolution and typically
focused on samples with multiple substance use or
comorbid psychiatric disorders and on only moderate levels
of cannabis use (ie, _2 joints per day). Indeed, despite
strong evidence of neurotoxicity in the animal literature,
6-9 to our knowledge, no neuroimaging study has
examined the neurobiologic sequelae of long-term heavy
cannabis use while controlling for the important confounds
of polydrug abuse and co-occurring psychiatric
disorders.
In this study, we used high-resolution 3-T MRI to assess
volumetric changes in 2 cannabinoid-rich regions
of the brain (the hippocampus and the amygdala) known
to be susceptible to the neurotoxic effects of cannabis exposure
in a sample of long-term heavy users carefully
screened for polysubstance abuse and mental disorders.
Given the growing literature regarding an association between
cannabis use and the development of psychosis20
and cognitive impairment,16,21 we also assessed for subthreshold
psychotic symptoms and verbal learning ability
in this otherwise psychologically healthy sample.
METHODS
PARTICIPANTS
Male cannabis users with long histories of regular and heavy
cannabis use (n=15) and nonusing healthy male volunteers
(n=16) matched on age, estimated premorbid intelligence (National
Adult Reading Test),22 years of education, and state and
trait anxiety (Spielberger State-Trait Anxiety Inventory)23 were
recruited from the general community via a variety of advertisements
(Table). Cannabis users had lower Global Assessment
of Functioning scale scores and greater depressive symptoms
(as measured using the Hamilton Depression Rating Scale)24
than the comparison group; however, there were no current
or lifetime histories of diagnosable medical, neurologic, or psychiatric
conditions as assessed using the Structured Clinical Interview
for DSM-IV Axis I Disorders, Patient Edition.25 All the
control subjects also underwent a Structured Clinical Interview
for DSM-IV Axis I Disorders, Non-Patient Edition.25 Subthreshold
psychotic symptoms were probed using the Scale for the
Assessment of Positive Symptoms26 and the Scale for the Assessment
of Negative Symptoms.27 Regarding alcohol use, the
groups did not differ in levels of current consumption, lifetime
use, or history of abuse or dependence; and no participant
drank more than 24 standard alcoholic drinks per week.
Significantly more cannabis users were also tobacco smokers
(_2=22.9, P_.001) (Table). For all users, cannabis was the primary
drug of abuse, with only limited experimental use of other
illicit drugs (generally _10 lifetime episodes).
PROCEDURE
Participants were assessed on 2 occasions, usually 1 week apart.
In the first test session, participants completed demographic,
clinical, and substance use history assessments. In the second
test session, they completed the Rey Auditory Verbal Learning
Test (RAVLT) and underwent structural MRI.
Participants were asked to abstain from using substances for
at least 12 hours before each test session, and cannabis users
reported abstaining from cannabis for a mean of 21.3 hours before
the first test session (median, 14 hours; range, 10-72 hours)
and a mean of 19.8 hours before the second test session (median,
17 hours; range, 12-48 hours). Urine samples were obtained
from users on 4 occasions and from controls on 2 occasions
to corroborate self-reported abstinence. Specifically, for
cannabis users, samples were obtained on the evening before
each test session and on the day of testing. For controls, samples
were collected only on the day of testing. Examination of these
samples demonstrated that all but 1 cannabis user had cannabinoid
metabolites (11-nor-_9-tetrahydrocannabinol-9-
carboxylic acid creatinine normalized) detected in urine samples
from the first test session, and levels were generally high
(evening: median, 467 ng/mg [range, 0-2320 ng/mg]; day of
testing: median, 447 ng/mg [range, 0-11 293 ng/mg]). From the
second test session, 2 users returned a 0 reading; otherwise,
cannabinoid metabolite levels were again high (evening: median,
456 ng/mg [range, 0-3511 ng/mg]; day of testing: median,
389 ng/mg [range, 0-4470 ng/mg]). The levels of urinary
cannabinoid metabolites generally corroborate the selfreported
patterns of heavy cannabis use in the sample. All but
2 control subjects returned a 0 reading for cannabinoid metabolites
across both test sessions. The 2 controls with positive
urine samples reported only minimal and very occasional
exposure to cannabis. The median level of cannabinoid metabolites
in controls at the first test session was 0 ng/mg (range,
0-184 ng/mg) and at the second test session was 0 ng/mg (range,
0-180 ng/mg).
STRUCTURAL MRI
The MRI data were obtained using a 3-T scanner (Intera; Phillips
Medical Systems NA, Bothell, Washington) at the Symbion
Clinical Research Imaging Centre, Prince of Wales Medical
Research Institute, Sydney. A 3-dimensional volumetric
spoiled gradient–recalled echo sequence generated 180 contiguous
coronal slices. The imaging parameters were as follows:
echo time, 2.9 milliseconds; repetition time, 6.4 milliseconds;
flip angle, 8°; matrix size, 256_256; and 1-mm3 voxels.
Hippocampal, amygdala, whole brain, and intracranial volumes
were measured using established reliable protocols28-31
and were delineated by a trained rater (S.W.) masked to group
information. Specifically, the hippocampal boundaries were as
follows: posterior, the slice with the greatest length of continuous
fornix; medial, the open end of the hippocampal fissure
posteriorly, the uncal fissure in the hippocampal body, and the
medial aspect of the ambient gyrus anteriorly; lateral, the temporal
horn of the lateral ventricle; inferior, the white matter inferior
to the hippocampus; superior, the superior border of the
hippocampus; and anterior, the alveus was used to differentiate
the hippocampal head from the amygdala. The anterior border
was the most difficult to identify consistently and was aided
by moving between slices before and after the index slice. The
amygdala boundaries were as follows: posterior, the appearance
of amygdala gray matter above the temporal horn; superolateral,
the thin strip of white matter that separates the amygdala
from the claustrum and the tail of the caudate; medial, the
angular bundle, which separates the amygdala from the entorhinal
cortex; superomedial, the semilunar gyrus; inferior, the
hippocampus; inferolateral, the temporal lobe white matter and
the extension of the temporal horn; and anterior, the slice anterior
to the appearance of the optic chiasm. Whole brain volumes
were estimated using the Brain Extraction Tool method32
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to separate brain from nonbrain tissue. After brain/nonbrain
segmentation, each voxel was classified into gray matter, white
matter, or cerebrospinal fluid using FAST Model statistical software.
33 Only gray and white matter were used in the estimate
of whole brain volumes. The intracranial cavity was delineated
from a sagittal reformat of the original 3-dimensional data
set. The major anatomical boundary was the dura mater below
the inner table, which was generally visible as a white line.
Where the dura mater was not visible, the cerebral contour was
outlined. Other landmarks included the undersurfaces of the
frontal lobes, the dorsum sellae, the clivus, and the posterior
arch of the craniovertebral junction.
Interrater and intrarater reliabilities were assessed by means
of the intraclass correlation coefficient (ICC) (absolute agreement)
using 15 brain images from a separate MRI database established
specifically for this purpose and that has previously
been delineated by another expert rater. For the hippocampus,
interrater ICC reliabilities were 0.92 (right) and 0.91 (left)
and intrarater ICC reliabilities were 0.98 (right) and 0.95 (left).
For the amygdala, interrater ICC reliabilities were 0.85 (right)
and 0.88 (left) and intrarater ICC reliabilities were 0.93 (right)
and 0.97 (left). Once reliability was established, the rater (S.W.)
delineated the regions of interest for the images acquired from
the present study.
STATISTICAL ANALYSES
Whole brain volume, age, educational level, and estimated IQ
were not significantly different between the 2 groups and were,
therefore, not used as covariates (Table). Regional gray matter
volumes for the hippocampus and amygdala were corrected for
the effect of the intracranial cavity using a previously described
formula34 and were analyzed using analyses of variance,
with hemisphere (left or right) and region (hippocampus
and amygdala) as within-subject factors and group as the
between-subject factor. Main effects and interactions were evalu-
Table. Demographic, Clinical, Drug Use, and MRI Volumetric Measures
Measure
Long-term Cannabis Users
(n=15)
Nonusing Control Subjects
(n=16) P Valuea
Age, mean (SD), y 39.8 (8.9) 36.4 (9.8) .31
IQ, mean (SD) 109.2 (6.3) 113.9 (8.1) .09
RAVLT score, mean (SD)
Sum of 5 learning trials 43.8 (8.8) 57.4 (10.1) _.001
20-min delay 8.9 (4.1) 12.3 (3.7) .009b
Educational level, mean (SD), y 13.4 (3.2) 14.8 (3.7) .28
GAF scale score, mean (SD) 72.0 (11.2) 80.8 (9.4) .02
HAM-D score, mean (SD) 5.87 (3.2) 2.56 (1.9) _.001b
STAI, mean (SD)
State anxiety 34.3 (9.8) 32.9 (9.4) .67
Trait anxiety 39.3 (9.7) 39.0 (8.2) .92
SAPS score, mean (SD) 8.1 (7.9) 0.6 (1.2) _.001b
SANS score, mean (SD) 11.7 (8.5) 1.4 (1.4) _.001b
Cannabis use
Duration of regular use, mean (SD) [range], yc 19.7 (7.3) [10-32] NA NA
Age started regular use, mean (SD) [range], yc 20.1 (6.9) [12-34] NA NA
Current use, mean (SD), d/mod 28 (4.6) NA NA
Current use, mean (SD), cones/mod,e 636 (565) NA NA
Cumulative exposure, past 10 y, mean (SD)f 77 816 (66 542) NA NA
Cumulative exposure, lifetime, mean (SD)f 186 184 (210 022) 12.7 (12.2) _.001
Estimated episodes of use, median (range) 62 000 (4600-288 000) 11 (0-30) _.001
Alcohol use, mean (SD), standard drinks/wk 9.6 (6.1) 6.8 (5.0) .19
Tobacco use, mean (SD), cigarettes/d 16.5 (8.9) 7.5 (9.2) .20
Brain volumes, mean (SD), mm3
Intracranial cavity 1 546 237 (94 018) 1 607 590 (136 386) .14
Whole brain 1 310 780 (90 778) 1 374 123 (105 673) .09
Hippocampus .002g
Left hemisphere 2849 (270) 3240 (423)
Right hemisphere 2949 (244) 3348 (400)
Amygdala .01g
Left hemisphere 1766 (98) 1878 (190)
Right hemisphere 1601 (143) 1744 (158)
Abbreviations: GAF, Global Assessment of Functioning; HAM-D, Hamilton Depression Rating Scale; MRI, magnetic resonance imaging; NA, not applicable;
RAVLT, Rey Auditory Verbal Learning Test; SAPS, Scale for the Assessment of Positive Symptoms; SANS, Scale for the Assessment of Negative Symptoms;
STAI, State-Trait Anxiety Inventory.
aTwo-tailed t test unless otherwise indicated.
bMann-Whitney test.
cRegular use was defined as at least twice a month.
dCannabis users had used at this level for most of their drug-using history.
eA cone is the small funnel into which cannabis is packed to consume through a water pipe in a single inhalation. Without the loss of sidestream smoke, the
quantity of tetrahydrocannabinol delivered by this method is estimated as equating 3 cones to 1 cigarette-sized joint. Thus, the cannabis users in this study
smoked the equivalent of 212 joints per month, or approximately 7 joints per day.
fExpressed as cones for users and as episodes for controls. Estimates of lifetime exposure beyond 10 years in these very long-term users became skewed and
unreliable; hence, the 10-year estimate was used in correlational analyses.
gRegion_group analysis of variance.
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ated using Greenhouse-Geisser–corrected degrees of freedom,
with _=.05. Effect sizes, expressed as Cohen d, are also reported
for pairwise contrasts. Only effects involving group (cannabis
users vs nonusers) and associations with cannabis use
parameters are reported because this was the primary focus of
the present study. Group comparisons of performance on the
RAVLT and measures of subthreshold psychotic symptoms
(using the Scale for the Assessment of Positive Symptoms and
the Scale for the Assessment of Negative Symptoms) were conducted
using independent-samples t tests or Mann-Whitney tests
for nonnormally distributed data. Pearson product moment correlational
analyses were conducted to examine the behavioral
(ie, symptom and cognitive) relevance of any identified group
differences in regional brain volumes and the association
between these brain changes and parameters of cannabis use.
These analyses were necessarily exploratory given the limited
sample size.
RESULTS
GROUP CONTRASTS
In the analysis of regional gray matter volumes, there
was a significant main effect of group (F1,29=12.98,
P=.001) and a region_group interaction (F1,29=6.25,
P=.02). This result and the post hoc pairwise analyses
demonstrated reduced hippocampal volumes in cannabis
users (F1,29=11.14, P=.002 corrected; a reduction of
12.1% in the left and 11.9% in the right hippocampus
relative to controls), with a very large effect size (Cohen
d: left hippocampus, 1.17; and right hippocampus,
1.27) (Figure 1). Cannabis users also had smaller
amygdala volumes (F1,29=7.31, P=.01 corrected; a
reduction of 6.0% in the left amygdala and 8.2% in the
right amygdala relative to controls), with large effect
sizes (Cohen d: left amygdala, 0.80; and right amygdala,
0.99). The region _ group interaction reflects that the
overall reduction in hippocampal volume was relatively
(and significantly) greater than the reduction in amygdala
volume (12.0% in the hippocampus vs 7.1% in the
amygdala). In the analysis of subthreshold psychotic
symptoms, cannabis users reported significantly higher
positive symptoms (Scale for the Assessment of Positive
Symptoms; z=−3.57, P_.001) and negative symptoms
(Scale for the Assessment of Negative Symptoms;
z=−3.66, P_.001) than nonusing controls. Regarding
verbal learning, cannabis users displayed significantly
poorer performance than controls on the RAVLT measures
(sum of words recalled across the 5 learning trials:
z=−3.97, P_.001; and free recall after a 20-minute
delay: z=−2.61, P=.009).
CORRELATIONAL ANALYSES
There was a significant inverse association between left
hippocampal volume and cumulative cannabis exposure
during the previous 10 years (r=−0.62, P=.01; accounting
for 38% of the variance in left hippocampal volume)
(Figure 2A). When 1 participant with relatively
higher cumulative cannabis exposure and small hippocampal
volume was excluded, 22% of the variance was
still accounted for despite falling short of significance in
the reduced sample (r=−0.47, P=.09). There was also an
association between left hippocampal volume and positive
symptoms (r=−0.77, P_.001) (Figure 2B) and between
positive symptoms and cumulative cannabis exposure
(r=0.52, P=.048) (Figure 2C). The associations
between left hippocampal volume and cumulative cannabis
exposure and between left hippocampal volume and
positive symptoms remained after controlling for the effects
of global functioning (Global Assessment of Functioning
scale) and depressive symptoms (Hamilton Depression
Rating Scale). No other associations were found
between other brain volumetric measures, cannabis use,
and psychotic symptoms, and they did not vary as a function
of alcohol or tobacco use. Measures of RAVLT performance
did not correlate with hippocampal or amygdala
volumes in either controls or cannabis users.
COMMENT
To our knowledge, this is the first human study of longterm
heavy cannabis users to demonstrate marked
exposure-related hippocampal volume reductions.
These findings corroborate previous animal research,6-9
suggesting that long-term heavy cannabis use is associated
with significant and localized hippocampal volume
reductions that relate to increasing cumulative cannabis
exposure. In addition, the present findings are consis-
tent with the view that cannabis use increases the risk
of psychotic symptoms and informs the debate concerning
the potential long-term hazardous effects of cannabis
in this regard. The bilateral reduction in amygdala
volume is a novel but not unexpected finding given the
dense concentration of cannabinoid receptors in this
region.35
Although these findings are consistent with those of
a previous study,18 it is difficult to directly compare these
results with those of other human studies given that past
work used MRI with lower magnetic field strength and
spatial resolution and did not conduct region-of-interest–
based analyses (eg, performed whole-brain voxel-based
analyses18). Tzilos et al14 conducted the only other study,
to our knowledge, that investigated cannabis users with
a relatively long history of use (specifically, an average
duration of use of 22.6 years, or 18.9 years of daily use)
and their study is, therefore, most comparable with the
present study. Although they found no effects of longterm
cannabis use on hippocampal volume, the authors
acquired their images at a lower field strength and with
a coarser spatial resolution (1.5 T with 3-mm-thick slices
vs 3 T with 1-mm-thick slices in the present study), an
important consideration given the size of the brain structures
investigated. Moreover, their region of interest was
less specific to the hippocampus relative to the present
measure because they also included the parahippocampal
gyrus. Furthermore, there was a relatively large age
discrepancy between their users and controls (38.1 vs 29.5
years), and the minimum duration of exposure to cannabis
was considerably lower in their sample (as little as
1 year of cannabis exposure), but, overall, their sample
reported an average of 20 100 lifetime episodes of use.
In contrast, the minimum duration of exposure to cannabis
in the present sample was 10 years, with an average
of 62 000 episodes of use. Thus, despite a similar mean
duration of use, the present sample used more than 3 times
as much cannabis, which may explain the finding of a
dose-response relationship between hippocampal volume
and cumulative cannabis use. Further highresolution
MRI work is necessary to characterize precisely
the dosage of cannabis required for significant brain
changes to occur.
The pattern of use in the present sample is consistent
with heavy cannabis use patterns that have previously
been reported in other Australian studies. For example,
Copeland and colleagues36 reported median daily intake
of 8 cones (the small funnel into which cannabis is packed
to consume through a water pipe in a single inhalation)
in an Australian sample of cannabis users seeking treatment
for cannabis dependence, ranging up to 125 cones
per day in the heaviest user, with 11% reporting cannabis
smoking throughout the day. The heaviest user herein
reported smoking 80 cones per day (approximately 25
joints smoked throughout the day). This pattern of cannabis
use is not dissimilar to the heaviest cannabis users
from other studies of non–treatment-seeking samples of
Australian cannabis users.37,38
Despite the large magnitude of effects observed, it remains
unclear whether these volumetric reductions
reflect neuronal or glial loss, a change in cell size, or a
reduction in synaptic density (eg, dendritic arborization),
all of which have been reported in rodent studies.
6-9 For example, Scallet and colleagues9 found striking
tetrahydrocannabinol-induced residual decreases in
the mean volume of hippocampal neurons and their nuclei
and a 44% reduction in the number of synapses up
to 7 months after the last exposure to tetrahydrocannabinol.
Moreover, Landfield and colleagues7 administered
tetrahydrocannabinol 5 times a week for 8 months
(approximately 30% of the rat lifespan, and comparable
in frequency and duration to the present sample) and
found significant tetrahydrocannabinol-induced decreases
in neuronal density in the hippocampus. Such
findings may help explain the mechanisms underlying
gross hippocampal and amygdala volume loss seen in this
sample of long-term heavy cannabis users.
Left Hippocampal Volume, mm3
In the present study, hippocampal volume in the cannabis-
using group was inversely correlated with cumulative
exposure to the drug in the left, but not right, hemisphere.
Previous functional imaging studies16,39 have found
reduced left hippocampal activation during cognitive performance
in cannabis users, and there is evidence to suggest
that hippocampal abnormalities in psychiatric disorders
such as schizophrenia are more prominent in the
left hemisphere.40 These findings converge to suggest that
the left hippocampus may be particularly vulnerable to
the effects of cannabis exposure and may be more closely
related to the emergence of psychotic symptoms. In this
context, it is interesting that we found a significant inverse
correlation between left hippocampal volume and
positive symptoms. Cannabis use was also positively correlated
with positive symptoms, suggesting that there are
complex associations among exposure to cannabis, hippocampal
volume reductions, and psychotic symptoms.
Given these relationships, it is possible that the exposurerelated
hippocampal reduction may reflect heavy cannabis
use in response to preexisting or developing psychotic
symptoms. However, there is limited empirical
support for long-term self-medication of subthreshold psychotic
symptoms with cannabis and stronger support for
the induction of psychotic symptoms subsequent to cannabis
exposure.20 As such, it seems more likely that prolonged
heavy use of cannabis induced subthreshold psychotic
symptoms and that both of these factors are
associated with hippocampal volume loss. These symptoms
were subthreshold because these cannabis-using participants
were carefully screened for current and past history
of mental disorders. Furthermore, the fact that the
mean age of the present cannabis-using sample was nearly
40 years suggests that these symptoms are unlikely to reflect
a prodrome. One speculation is that the present participants
were less genetically vulnerable to developing
a psychotic disorder subsequent to cannabis use,41,42 allowing
them to smoke heavily for many years. Future longitudinal
work assessing the emergence of hippocampal
reductions and psychotic symptoms with continued exposure
to cannabis, and how these are related to polymorphic
variations in susceptibility genes for psychotic
disorders, will prove useful in better characterizing these
relationships.
Given that cannabis users had significantly greater depressive
symptom scores than controls and that there is
an association between depression and hippocampal volume
reduction,43 it could also be argued that depressive
symptoms may be another mediating factor in the relationship
between cannabis use and hippocampal volume
reduction. However, there are a variety of important
considerations that make this unlikely. First, there
was no significant association between hippocampal volumes
and depressive symptom scores. Second, the relationship
between left hippocampal volume and quantity
of cannabis used was maintained after statistically
controlling for depressive symptoms. Finally, the overwhelming
evidence suggests that hippocampal reductions
in major depressive disorder tend to occur in the
more persistent forms of the disorder (eg, multiple episodes,
repeated relapses, or long illness duration).43,44 This
was not the case in the present sample of cannabis users,
who scored less than 6.0 on the Hamilton Depression
Rating Scale, had never been diagnosed as having
major depression, and did not seek treatment for any depressive
disorder.
Cannabis users showed poorer performance on measures
of verbal learning, consistent with previous findings.
Although some functional imaging studies have
found reduced left hippocampal blood flow and activation
during verbal (and visual) learning tasks in cannabis
users, we found no correlation between RAVLT
performance measures and hippocampal volume in either
controls or cannabis users. It is likely that anatomical volume
is a less sensitive measure than brain activation for
identifying correlations with behavioral performance. This
is a particularly pertinent consideration given that the
performance measures on the RAVLT are likely to reflect
the operation of numerous cognitive processes not
necessarily related to hippocampal function. Future work
using experimental tasks designed to more specifically
probe memory functions mediated by the hippocampus
may be useful in this regard.
The bilateral reduction in amygdala volume is a novel
but not unexpected finding given the dense concentration
of cannabinoid receptors in this region.35 There were
no cognitive, psychotic, or depressive symptom associations
with reduced volume in the amygdala. However,
this region has been significantly implicated in cannabinoid-
associated emotional and reward-related learning
and memory processes.47,48 Given that these aspects of
learning have not been examined in human cannabis users,
they would seem to serve as a potentially informative
avenue forward to help elucidate the functional relevance
of such volumetric reduction in the amygdala.
The relationship between long-term cannabis use and
brain abnormalities is complex. Although a limitation of
this study may be the residual effects of cannabis in light
of the fact that the cannabis users in this study were required
to be cannabis free for only 12 to 24 hours before
MRI, such issues are likely to be more pertinent for studies
examining more dynamic aspects of brain functioning
(eg, activations and cognition).49 The present structural
findings are unlikely to relate to the recent effects
of cannabis use because we are unaware of any evidence
that suggests that the hippocampus and amygdala can
change in volume by 6% to 12% in short periods. However,
although we maintain that the present results reflect
brain changes associated with long-term heavy cannabis
use rather than the consequences of recent exposure,
further longitudinal work is required to assess whether
such changes are reversible across more protracted periods
of abstinence.
Another limitation of this study is the relatively small
sample size, although the sample was exceptionally unique
in that participants were very long-term and heavy cannabis
users (mean of 5-7 joints per day for _10 years)
without polydrug use or co-occurring neurologic or diagnosable
mental disorders. As such, we conducted the
first, to our knowledge, “pure” examination of the effects
of heavy and protracted exposure to cannabis in humans.
The large effect sizes of the main findings suggest
that these results are robust and reproducible. These findings
are further strengthened by the observed dose-
response relationships between hippocampal volume reductions
and cumulative cannabis use.
There is ongoing controversy concerning the longterm
effects of cannabis on the brain.  These findings
challenge the widespread perception of cannabis as having
limited or no neuroanatomical sequelae. Although
modest use may not lead to significant neurotoxic effects,
these results suggest that heavy daily use might indeed
be toxic to human brain tissue. Further prospective,
longitudinal research is required to determine the
degree and mechanisms of long-term cannabis-related
harm and the time course of neuronal recovery after abstinence.
Correspondence: MuratYu¨ cel, PhD,MAPS,ORYGENResearch
Centre, 35 Poplar Rd (Locked Bag 10), Melbourne,

Individual case reports have suggested a link between heart attack and amphetamine abuse, but this is believed to be the first epidemiological study of a large group of people on the issue, said Dr. Arthur Westover, assistant professor of psychiatry at
UT Southwestern and the study’s lead author.
  
“Most people aren’t surprised that methamphetamines and amphetamines are bad for your health,” Dr. Westover said. “But we are concerned because heart attacks in the young are rare and can be very debilitating or deadly.”

Amphetamines are stimulants that can be used to treat medical conditions such as attention-deficient disorder. They are illegally abused as recreational drugs or performance enhancers.

The researchers note that abuse of methamphetamine, a type of amphetamine often sold illegally, is increasing in most major U.S. cities.

In Texas, the researchers found greater amphetamine abuse in the north and Panhandle regions.

“This paper sounds a warning to amphetamine abusers, alerts emergency department personnel to look for amphetamine abuse in young heart attack patients, and it allows us to focus preventive efforts in geographical areas where the problems are greatest,” said Dr. Robert W. Haley, chief of epidemiology at UT Southwestern and senior author of the study. Dr. Haley holds the U.S. Armed Forces Veterans Distinguished Chair for Medical Research, Honoring America’s Gulf War Veterans.
“We’re also concerned that the number of amphetamine-related heart attacks could be increasing,” Dr. Westover said. “We’d rather raise the warning flag now than later. Hopefully, we can decrease the number of people who suffer heart attacks as the result of amphetamine abuse.”
Amphetamines may contribute to heart attacks by increasing heart rate and blood pressure and by causing inflammation and artery spasms that limit blood to the heart muscle. More research is needed to determine the exact mechanism of how amphetamines work on the heart, he said.
The current research could help doctors determine the cause of heart attacks in young adults, as well as treatment. Doctors recognizing an amphetamine-caused heart attack might choose not to administer a beta-blocker medication, a common treatment for heart attack, because it could interact with methamphetamine to make the heart attack worse.

The results could have broad implications in the general population, Dr. Westover said. Texas ranks 27th among all states in use of methamphetamine among 18- to 25-year-old adults, according to a 2006 government report.

“We’re talking about a state that is near the middle of prevalence of methamphetamine use in the United States, so it’s possible that the number of heart attacks in young adults in other states with a much higher prevalence of amphetamine abuse may be higher as well,” said Dr. Westover, who is a National Institutes of Health Multidisciplinary Clinical Research Scholar at UT Southwestern.
Dr. Paul Nakonezny, assistant professor of clinical sciences and psychiatry at
UT Southwestern, was also involved in the study.

The work was supported by a North and Central Texas Clinical and Translational Science Initiative grant from the National Center for Research Resources, a component of the National Institutes of Health.

WASHINGTON (CNN) — The earlier a young person uses marijuana the greater the risk for mental health problems later in life, the director of National Drug Control Policy said Tuesday, basing his conclusion on a survey of medical research.
 
“We’re trying to get out the word that the last 10 years of research have helped to alert us to the use of marijuana in particular is a very dangerous risk for the mental health of our young people,” John Walters said at a news conference.
He said the conclusion runs against popular culture that often considers marijuana a low-risk recreational drug.
Walters cited a government study that found a base rate of mental illness at between 8 percent and 9 percent among Americans 18 and older. For those who use marijuana, he said, “That increases to 12-and-a-half percent.”
And, he added, “For those who have used marijuana prior to age 12, the rate of mental illness jumps to 21 percent.”
The rate was half that, or 10.5 percent, for adults who first used marijuana at age 18 or older.
Those were the findings of the National Survey on Drug Use and Health, an annual survey sponsored by the Substance Abuse and Mental Health Services Administration.
Walters did not directly address the possibility of confusing cause and effect — that is, that people with mental problems might be more inclined to use drugs.
One study he cited was published last year in the Archives of General Psychiatry. It involved 600 pairs of same-sex twins, one of whom was dependent on marijuana and one of whom was not. The twin who was dependent was almost three times as likely to think about suicide and attempt suicide than his brother or sister, the study found.
Neil McKeganey, who heads the University of Glasgow’s Center for Drug Misuse Research, was at the press conference in support of Walters.
“It is leading us to look again at this so-called recreational drug,” he said. “Kids who start to use marijuana at a young age are much more likely to suffer serious, long-term mental health problems.”
The parents of a teenager who committed suicide last year were also at the news conference, and they linked their son’s death to his marijuana use.
Tanya Skaggs, of Colorado Springs, Colorado, said, “He had a severe lack of judgment that was because of the marijuana, this destructive behavior was continuing,” in the months leading up to his death.
The parents were unable to break his marijuana use, Skaggs said, despite counseling, searching his room for pot and random drug tests.
“We just never thought that something like this could happen to us. But it does, and it did,” she said. “We wish we could have helped.”
Agenda ‘detrimental to your children’
Walters downplayed whether the medical use of marijuana undercuts the impact of warnings to young people against pot use.
The question was tied to a decision by Canada last month to approve the prescription drug Sativex, an oral spray that contains the active ingredient of marijuana, to treat the symptoms of multiple sclerosis.
He responded, “We believe that there’s a clear distinction” between validated medical benefits and what he said could be “a bunch of ads where people testify that their mother, dying, smoked a joint and was saved, and that means marijuana is medicine.”
“Your children are being educated,” he said of such advertising. “But they’re being told lies. And they’re being told things that are designed to push a particular agenda which is detrimental to your children, and detrimental to the country.”
Group calls for national discussion
Meanwhile, a Washington-based nonprofit group released a report recommending changes in the way authorities handle drug offenses, citing a “disproportionate” focus on “low-level marijuana users.”
“The ‘war on drugs’ in the 1990s was, essentially, a ‘war on marijuana,’” said the report by the Sentencing Project, which was founded in 1986 to promote alternative sentencing programs.
A national analysis covering 1990 to 2002 found that, of a 450,000 rise in drug arrests during that period, 82 percent of the increase was for marijuana, and 79 percent was for marijuana possession alone.
Marijuana arrests now make up 45 percent of the nation’s 1.5 million drug arrests annually, the report said, and an estimated $4 billion is spent each year on marijuana offenders.
“The growth in marijuana arrests over the 1990s has not led to a decrease in use or availability, nor an increase in cost,” the group said. “Meanwhile, billions are being spent nationally.”
The report calls for “a national discussion regarding the zealous prosecution of marijuana use and its consequences for allocation of criminal justice resources and public safety.”
“Law enforcement has focused disproportionately on low-level possession charges as a result of the nation’s lack of a thoughtful strategy,” it said.Source:www.WordPress.com June 2008

While most university students tend to “mature out” of heavy drinking by the time they’re young adults, some develop alcohol-use disorders, or AUDs. Most genetic research on family history of alcoholism has focused on alcohol use by the parents, most often the father.
But this study found that the density of family history of alcoholism (FHA) is much more effective.
“Using a density measure of FHA can identify a greater number of individuals who may be at risk for developing an alcohol problem. The greater the number of affected relatives, the greater the potential risk of developing an AUD. Ours is the first published study to examine this measure among college students,” first author Christy Capone, a postdoctoral research fellow at Brown University’s Center for Alcohol and Addiction Studies, said in a prepared statement.
The study included 293 female and 115 male undergraduates from a northeastern U.S. university who completed an anonymous survey.
“Our use of a density measure identified a large proportion of students, about 29 percent, who are at potentially greater risk for development of AUDs based on their report of alcoholism among first- and second-degree relatives,” Capone said. “Our other key finding was the relationship between FHA and other potential risk factors — behavioral undercontrol, age of onset of drinking (AOD), and cigarette use.”
“Family density appears to be a promising method to identify a higher percentage of at-risk individuals,” John Hustad, a research associate at Brown University, said in a prepared statement. “For example, in this study, approximately 44 percent of the at-risk participants would have been missed if a typical family-history measure had been used instead of the family-history density approach.”
Capone said: “It is important to remember than not everyone with density of family alcoholism will go on to develop a long-term problem with alcohol themselves. Alcohol dependence is a very complex disorder, and FHA is but one influence on its development. However, college students who are heavy drinkers and have greater density of familial alcoholism are certainly at higher risk of continuing to drink in a problematic fashion after the college years.”
The study was published online in the journal Alcoholism: Clinical and Experimental Research and was expected to be in the August print issue.Source: (HealthDay News) June 4 2008

Context  While both environmental and genetic factors are important in the etiology of psychoactive substance use (PSU), we know little of how these influences differ through development.
Objective To clarify the changing role of genes and environment in PSU from early adolescence through middle adulthood.
Design  Retrospective assessment by life history calendar, with univariate and bivariate structural modeling.
Setting  General community.
Participants  A total of 1796 members of male-male pairs from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders.
Main Outcome Measures  Levels of use of alcohol, caffeine, cannabis, and nicotine recorded for every year of the respondent’s life.
Results  For nicotine, alcohol, and cannabis, familial environmental factors were critical in influencing use in early adolescence and gradually declined in importance through young adulthood. Genetic factors, by contrast, had little or no influence on PSU in early adolescence and gradually increased in their effect with increasing age. The sources of individual differences in caffeine use changed much more modestly over time. Substantial correlations were seen among levels of cannabis, nicotine, and alcohol use and specifically between caffeine and nicotine. In adolescence, those correlations were strongly influenced by shared effects from the familial environment. However, as individuals aged, more and more of the correlation in PSU resulted from genetic factors that influenced use of both substances.
Conclusions  These results support an etiologic model for individual differences in PSU in which initiation and early patterns of use are strongly influenced by social and familial environmental factors while later levels of use are strongly influenced by genetic factors. The substantial correlations seen in levels of PSU across substances are largely the result of social environmental factors in adolescence, with genetic factors becoming progressively more important through early and middle adulthood.Kenneth S. Kendler, MD; Eric Schmitt, BS; Steven H. Aggen, PhD; Carol A. Prescott, PhD

Source: Arch Gen Psychiatry. 2008;65(6):674-682.

It  was fascinating to note in the opening line of one of the recent papers on Alzheimer’s Disease that hippocampal atrophy (or wasting) is completely accepted as a hallmark feature!
 
You will recall the recent Australian Study (abstract below) which demonstrated unequivocally even in quite small samples (of 15 patients in control and THC groups) that cannabis atrophies the hippocampus!
 
Sounds like we need to tell the world!Dr.Stuart Reece, Australia.

 
Alzheimer’s disease (AD) is a genetically heterogeneous disorder characterized by early hippocampal atrophy and cerebral amyloid-β (Aβ) peptide deposition. Using TissueInfo to screen for genes preferentially expressed in the hippocampus and located in AD linkage regions, we identified a gene on 10q24.33 that we call CALHM1. We show that CALHM1 encodes a multipass transmembrane glycoprotein that controls cytosolic Ca2+ concentrations and Aβ levels. CALHM1 homomultimerizes, shares strong sequence similarities with the selectivity filter of the NMDA receptor, and generates a large Ca2+ conductance across the plasma membrane. Importantly, we determined that the CALHM1 P86L polymorphism (rs2986017) is significantly associated with AD in independent case-control studies of 3404 participants (allele-specific OR = 1.44, p = 2 × 10-10). We further found that the P86L polymorphism increases Aβ levels by interfering with CALHM1-mediated Ca2+ permeability. We propose that CALHM1 encodes an essential component of a previously uncharacterized cerebral Ca2+ channel that controls Aβ levels and susceptibility to late-onset AD.
Source: Cell, Vol 133, 1149-1161, 27 June 2008
 
Regional brain abnormalities associated with long-term heavy cannabis use.
CONTEXT: Cannabis is the most widely used illicit drug in the developed world. Despite this, there is a paucity of research examining its long-term effect on the human brain. OBJECTIVE: To determine whether long-term heavy cannabis use is associated with gross anatomical abnormalities in 2 cannabinoid receptor-rich regions of the brain, the hippocampus and the amygdala. DESIGN: Cross-sectional design using high-resolution (3-T) structural magnetic resonance imaging. SETTING: Participants were recruited from the general community and underwent imaging at a hospital research facility. PARTICIPANTS: Fifteen carefully selected long-term (>10 years) and heavy (>5 joints daily) cannabis-using men (mean age, 39.8 years; mean duration of regular use, 19.7 years) with no history of polydrug abuse or neurologic/mental disorder and 16 matched nonusing control subjects (mean age, 36.4 years). MAIN OUTCOME MEASURES: Volumetric measures of the hippocampus and the amygdala combined with measures of cannabis use. Subthreshold psychotic symptoms and verbal learning ability were also measured. RESULTS: Cannabis users had bilaterally reduced hippocampal and amygdala volumes (P = .001), with a relatively (and significantly [P = .02]) greater magnitude of reduction in the former (12.0% vs 7.1%). Left hemisphere hippocampal volume was inversely associated with cumulative exposure to cannabis during the previous 10 years (P = .01) and subthreshold positive psychotic symptoms (P < .001). Positive symptom scores were also associated with cumulative exposure to cannabis (P = .048). Although cannabis users performed significantly worse than controls on verbal learning (P < .001), this did not correlate with regional brain volumes in either group. CONCLUSIONS: These results provide new evidence of exposure-related structural abnormalities in the hippocampus and amygdala in long-term heavy cannabis users and corroborate similar findings in the animal literature. These findings indicate that heavy daily cannabis use across protracted periods exerts harmful effects on brain tissue and mental health.

Source:  Arch Gen Psychiatry. 2008 Jun;65(6):694-701

Alterations in a molecular brain pathway activated by marijuana may contribute to the cognitive symptoms of schizophrenia, according to a report in the July issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
Expression of the cannabinoid 1 receptor (CB1R), the site of action of the main chemical ingredient of marijuana, is significantly reduced in the brains of individuals with schizophrenia. Activation of CB1R impairs signaling by gamma-aminobutyric acid (GABA), an important neurotransmitter essential for core cognitive processes such as working memory. The use of marijuana in individuals with schizophrenia appears to worsen this deficit in GABA synthesis.
Since reduced GABA is known to be present in schizophrenia, these findings suggest possible new drug targets that could help to improve function in people with the mental illness, University of Pittsburgh School of Medicine researchers report.
“Heavy marijuana use, particularly in adolescence, appears to be associated with an increased risk for the later development of schizophrenia, and the course of illness is worse for people with schizophrenia who use marijuana,” said David A. Lewis, M.D., corresponding author of the study and UPMC Endowed Professor in Translational Neuroscience, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine. “We wanted to understand the biological mechanisms that could explain these observations, and with this study, I believe that we can narrow down at least part of the ‘why’ to CB1R, the receptor for both tetrahydrocannabinol (THC), the main psychoactive ingredient in marijuana, and the brains own cannabinoid chemical messengers.”
Dr. Lewis and his colleagues examined specimens of brain tissue collected after death from 23 people with schizophrenia and 23 normal comparison subjects matched for a number of factors, including age and sex. The researchers evaluated levels of CB1R messenger RNA and protein, and also measured levels of glutamic acid decarboxylase (GAD-67), an enzyme that makes GABA, and cholecystokinin (CCK), a neuropeptide released from GABA neurons that, among other actions, regulates the production of the brain’s own cannabinoids.
“CB1R levels were significantly 15 percent lower in the subjects with schizophrenia,” Dr. Lewis said. “We measured these biochemical messengers using three techniques, and each time got the same answer — less CB1R in people with schizophrenia.” This reduction, he noted, appears to be the brain’s way of compensating for lower levels of GABA, and the use of marijuana defeats this compensation.
“These findings may provide insight into the biological basis of why cannabis use worsens schizophrenia, and, as a result, identify a novel target for new drug development that could improve treatments available for schizophrenia,” said Dr. Lewis.
Other authors include Stephen M. Eggan, Ph.D., and Takanori Hashimoto, M.D., Ph.D., both of the Department of Psychiatry, University of Pittsburgh School of Medicine.
The study was funded by the National Institutes of Health. Additional funding support for Dr. Eggan came from the University of Pittsburgh’s Andrew Mellon Predoctoral and Scottish Rite fellowships.Source: University of Pittsburgh Schools of the Health Sciences (2008, July 8). Schizophrenia Linked To Dysfunction In Molecular Brain Pathway Activated By Marijuana. ScienceDaily. Retrieved July 18, 2008, from http://www.sciencedaily.com¬ /releases/2008/07/080707161411.htm

Scientists at the National Institute on Drug Abuse’s (NIDA) Intramural Research Program in Baltimore, MD, have confirmed for the first time in humans that chemically blocking the body’s cannabinoid receptors can significantly reduce the effects of smoked marijuana. The study appears in the April 14th issue of the Archives of General Psychiatry.Cannabinoid receptors – proteins on the surface of brain cells — are most dense in brain regions involved in thinking and memory, attention and control of movement. Their exact role in humans is not well understood, but animal studies have shown that cannabinoid receptor agonists – compounds that activate the receptor sites – impair learning and memory and increase appetite and food intake. Previous studies in animals have shown that the major effects of tetrahydrocannabinol (THC), the primary psychoactive compound in marijuana, are due to its binding to specific cannabinoid receptors located on the surface of brain cells. These effects appear to be lessened when cannabinoid receptors are blocked by an antagonist.
 
“This research helps point the way toward possible treatment for those addicted to marijuana and perhaps may be useful in finding effective treatments for other disorders related to the cannabinoid system, ” says NIDA director Dr. Alan I. Leshner.
In the study, Dr. Marilyn Huestis and her NIDA colleagues used a cannabinoid receptor antagonist – a compound that binds to the receptor and blocks agonist compounds from activating it. The antagonist, SR141716, was discovered by Sanofi-Synthelabo of Paris, France, and was used in this study with NIDA under a Cooperative Research and Development Agreement (CRADA).
Participants in the study were given either SR141716 or a placebo and two hours later smoked one marijuana cigarette. Those who received SR141716 showed significantly reduced marijuana effects, while those who received the placebo showed typical marijuana intoxication.
The results of the study are an important step in understanding the complex role of the cannabinoid receptor system in the human brain.
“Our findings of a significant blockade of marijuana’s effects after treatment with SR141716, which is highly selective for the CB1-cannabinoid receptor sites, demonstrates for the first time in humans that these receptors play a major role in mediating the effects of marijuana,” Dr. Huestis says.
In their investigation of the role of the cannabinoid system in humans, Dr. Huestis and her colleagues gave increasing doses of SR141716 or placebo to 63 adult men with histories of marijuana use. When individuals received SR141716 before smoking marijuana, there was a dose-dependent reduction in psychological and physical effects of marijuana. At the highest dose of SR141716 (90 mg), volunteers reported a 43% reduction in how “high” they felt, a 38% reduction in how “stoned” they were, and a 43% reduction in “drug effect” as compared to those who received active marijuana and no antagonist. In addition, they had a 59% less increase in heart rate, one of the primary physical effects of marijuana.
The National Institute on Drug Abuse is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports more than 85 percent of the world’s research on the health aspects of drug abuse and addiction. The Institute carries out a large variety of programs to ensure the rapid dissemination of research information and its implementation in policy and practice. Fact sheets on the health effects of drugs of abuse and other topics can be ordered free of charge in English and Spanish by calling NIDA Infofax at 1-888-NIH-NIDA (644-6432) or 1-888-TTY-NIDA (889-6432) for the deaf. These fact sheets and further information on NIDA research and other activities can be found on the NIDA home page at http://www.drugabuse.gov.

Source: . ScienceDaily. Retrieved July 23, 2008, from http://www.sciencedaily.com¬ /releases/2001/04/010413080431.htm

ScienceDaily (Aug. 16, 2008) — A possible future way to prevent relapses into drug dependence has been discovered by researchers at Linköping University and the German cancer research center DKFZ. The target is the dopamine-producing nerve cells in the midbrain.Earlier research has shown that these cells become more excitable when a person takes drugs. To find out the functional meaning of this, these researchers used a mouse model for cocaine dependence. When they blocked the cells’ receptors for glutamate ¬- the brain’s most important signal substance -¬ the risk of relapsing into addiction vanished. The findings are being published in Neuron.
Dopamine-producing nerve cells are central to the brain’s reward system. Dependence-inducing drugs cause concentrations of dopamine to rise in the surroundings, which in turn affects other nerve cells and brings about various physical and mental reactions.
Cocaine has a very rapid impact on dopamine levels, which explains why it is one of the most addictive drugs.
“When you take cocaine, the number of glutamate receptors increases, rendering the cell more excitable. When we block this process, we prevent relapses into addiction. This is interesting clinically since that is the phase when we can get hold of patients,” says David Engblom, a neurobiologist at Linköping University and the study’s lead author.
An addict who wants to give up drugs could thus be offered a ‘vaccination’ against relapsing. But much more research remains to be done before such treatment can become a reality.

Source: Vetenskapsrådet (The Swedish Research Council) (2008, August 16). Mechanism Behind Cocaine Craving Identified. ScienceDaily. Retrieved August 17, 2008, from http://www.sciencedaily.com¬ /releases/2008/08/080815073522.htm

Scientists at Oregon Health Sciences University have discovered that mice lacking a certain brain cell receptor for the chemical messenger dopamine are supersensitive to alcohol, cocaine and methamphetamine. Their findings appear in the September 19, 1997, issue of the journal Cell and detail the increased locomotor activity of mice who lack the D4 receptor.”Branching nerve cells communicate with each other by secreting chemical messengers like dopamine that bind to receptors on neighboring nerve cells in a lock-and-key fashion,” explains, David Grandy, Ph.D., OHSU scientist and senior author of the article. “Dopamine is one of the primary chemical messengers, or neurotransmitters, and plays numerous complex roles in both movement and emotional states. Disturbances in the dopamine system are known to be associated with human disorders such as Parkinson’s disease, schizophrenia and addiction. Dopamine producing neurons continue to be the focus of research because of their widespread importance in regulating complex locomotor, emotional and motivational states.”
Grandy further explains that dopamine producing neurons are involved in mediating some of the positive reinforcing properties shared by drugs of abuse such as alcohol, cocaine, methamphetamine and opiates.
“We examined mice that were genetically engineered to lack the D4 dopamine receptor to investigate the role of this receptor in mediating the effects of various drugs,” says Grandy. “We discovered that mice given either alcohol, cocaine or methamphetamine displayed a dramatic increase in locomotor activity compared to normal mice. Prior to their treatment with these drugs, the mutant mice tended to be less active than normal mice. Following treatment their activity level increased greatly compared to normal mice.
“Based on the observation that mice lacking the D4 receptor show a supersensitivity to certain drugs of abuse, we speculate that the D4 receptor is implicated in modulating the effects of such drugs,” says Grandy. “Consequently, the D4 receptor may be a new target for the treatment of drug abuse.”
Grandy explains that humans show a wide variability in the gene that encodes the D4 receptor, and there are reports that some forms of the D4 gene may predispose an individual to drug taking and novelty seeking behaviors. The D4 receptor has been the focus of intense interest since its discovery in 1990 because of its high affinity for the antipsychotic drug clozapine, which is used to treat schizophrenia. Recently, several new D4-selective drugs that are similar to clozapine have been developed and are currently undergoing clinical trials for the treatment of schizophrenia. In addition to shedding light on the role that the D4 receptor plays in an organism*s response to drugs like alcohol, cocaine and methamphetamine, the new research reported by Grandy and his colleagues underscores the relevance of this receptor to antipsychotic drug development.

Source: Oregon Health Sciences University (1997, September 23). OHSU Scientists Discover Mice Lacking Dopamine Receptor Are Supersensitive To Alcohol, Cocaine And Methamphetamine. ScienceDaily. Retrieved August 17, 2008, from http://www.sciencedaily.com¬ /releases/1997/09/970923034045.htm

As a follow up to previous work showing that gene therapy can reduce drinking in rats trained to prefer alcohol, scientists at the U.S. Department of Energy’s Brookhaven National Laboratory have used the same technique to cut drinking in rats with a genetic predisposition for heavy alcohol consumption. The findings, along with additional results on the effects of long-term ethanol consumption on certain aspects of brain chemistry, are published in the May 2004 issue of Alcoholism Clinical and Experimental Research.”Though we are still early in the process, these results improve our understanding of the mechanism or mechanisms of alcohol addiction and strengthen our hope that this treatment approach might one day help people addicted to alcohol,” said Panayotis (Peter) Thanos, who lead the study in Brookhaven Lab’s medical department.
Genetically predisposed alcohol-preferring rats are a much better model for human alcoholism than the rats used previously, which the scientists had to train to prefer alcohol. Without any training, the genetic alcohol-preferring rats drink, on average, more than five grams of ethanol per kilogram of body weight per day when given a free choice between alcohol and plain water. Genetically non-preferring rats, in contrast, typically consume less than one gram of ethanol per kilogram of body weight per day.
In this study, both groups were treated with gene transfer to increase the level of a brain receptor for dopamine, a chemical important for transmitting feelings of pleasure and reward and known to play a role in addiction. After the gene treatment, the alcohol-preferring rats exhibited a 37 percent reduction in their preference for alcohol and cut their total alcohol consumption in half — from 2.7 grams per kilogram of body weight before treatment to 1.3g/kg after. Non-preferring rats also reduced their drinking preference and intake after gene treatment, but not in nearly as dramatic a fashion. The greatest reductions in alcohol preference and consumption were observed within the first few days after gene treatment, and both preference and consumption returned to pre-treatment levels by day 20.
The gene administered was for the dopamine D2 receptor, a protein shown in various studies to be relevant to alcohol and drug abuse. For example, low levels of dopamine D2 receptors in the brain have been postulated to lead to a reward deficiency syndrome that predisposes certain people to addictive behaviors, including drug and alcohol abuse. The alcohol-preferring rats used in this study have about 20-25 percent lower levels of dopamine D2 receptors when compared to the non-preferring rats, which may, in part, explain their tendency toward heavy drinking.
The scientists delivered the gene by first inserting it into a virus that had been rendered harmless. They then injected the virus directly into the rats’ nucleus accumbens, the brain’s pleasure center. The idea behind this type of gene therapy is to use the virus as a vector to carry the gene to the brain cells, which can then use the genetic instructions to make the D2 receptor protein themselves.
As an additional measure in this study, the scientists used micro-positron emission tomography (microPET) imaging to non-invasively assess the effects of chronic alcohol consumption on D2 receptor levels in alcohol-preferring and non-preferring rats. They measured D2 levels seven weeks after the gene therapy treatment (well after the effects of gene therapy had worn off). D2 receptor levels in alcohol-preferring rats were significantly lower (about 16 percent) compared to that in non-preferring rats. These levels were similar to previous data in naïve preferring and non-preferring rats.
In future studies, the D2 connection to alcoholism will be examined in transgenic mice that are totally depleted of D2. In addition, the scientists plan to develop a second generation D2 vector approach that will provide a longer period of treatment.
“These findings further support our hypothesis that high levels of D2 are causally associated with a reduction in alcohol drinking and may serve as a protective factor against alcoholism,” Thanos said.
###
This study was funded by the Office of Biological and Environmental Research within the Department of Energy’s Office of Science and by the National Institute of Alcohol Abuse and Alcoholism within the National Institutes of Health.
One of the ten national laboratories overseen and primarily funded by the Office of Science of the U.S. Department of Energy (DOE), Brookhaven National Laboratory conducts research in the physical, biomedical, and environmental sciences, as well as in energy technologies and national security. Brookhaven Lab also builds and operates major scientific facilities available to university, industry and government researchers. Brookhaven is operated and managed for DOE’s Office of Science by Brookhaven Science Associates, a limited-liability company founded by Stony Brook University, the largest academic user of Laboratory facilities, and Battelle, a nonprofit, applied science and technology organization. Visit Brookhaven Lab’s electronic newsroom for links, news archives, graphics, and more: http://www.bnl.gov/newsroom
Previous related study: http://www.bnl.gov/bnlweb/pubaf/pr/2001/bnlpr090501.htm

Source: Brookhaven National Laboratory (2004, May 6). Gene Therapy Reduces Drinking In Rats With Genetic Predisposition To ‘Alcoholism’. ScienceDaily. Retrieved August 17, 2008, from http://www.sciencedaily.com¬ /releases/2004/05/040506070752.htm

Scientists have identified a brain mechanism in rats that may play a central role in regulating anxiety and alcohol-drinking. The finding, by researchers supported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health (NIH), could provide important clues about the neurobiology of alcohol-drinking behaviors in humans..”This is an intriguing finding,” notes NIAAA Director Ting-Kai Li, M.D. “These experiments, conducted in rats selectively bred to have a high affinity for alcohol, help us address questions about the potential role that anxiety might play in human alcoholism. These molecular studies also may reveal potential targets for therapy of anxiety and alcoholism.”
Some researchers have suggested that high levels of anxiety may predispose some individuals to becoming alcoholic.
Researchers led by Subhash C. Pandey, Ph.D., Associate Professor and director of neuroscience alcoholism research in the Department of Psychiatry at the University of Illinois and Jesse Brown VA Medical Center in Chicago, found that “P” rats, a strain bred to prefer alcohol, showed more anxiety-like behaviors and drank more alcohol, than non alcohol-preferring “NP” rats. They measured anxiety in the rats with an apparatus known as an elevated plus-maze, which consists of two open arms and two closed arms connected to a central platform. Anxiety is gauged as a function of the amount of time a rat spends in the closed versus the open arms of the maze during a 5-minute testing period — the greater an animal’s level of anxiety, the less open-arm activity it displays.
Dr. Pandey and his colleagues also found that levels of CREB, a protein involved in a variety of brain functions, were lower in certain brain areas of P rats compared with NP rats. Levels of neuropeptide Y (NPY), a molecule that regulates the function of several neurotransmitters and is known to play a role in anxiety and alcohol-drinking behaviors, also were lower in P rats. One function of CREB is to regulate the production of NPY.
“Compared to NP rats, levels of CREB and NPY were innately lower in the central amygdala and medial amygdala of P rats,” explains Dr. Pandey, “brain areas which play a crucial role in anxiety behaviors and which have been shown previously to be involved in rewarding, reinforcing, and motivational aspects of alcohol drinking behaviors. And turning off CREB function in the central amygdala of NP rats makes them look like P rats — more anxious and thus more likely to drink.”
Alcohol intake reduced anxiety-like behaviors in the P rats, an effect that was associated with increased CREB function and NPY production in the central and medial amygdala. And by administering compounds that promote CREB function and NPY production in the central amygdala, researchers were able to reduce anxiety — and alcohol intake — in P rats. On the other hand, by disrupting CREB function (and the concomitant NPY production) in the central amygdala of NP rats, the researchers were able to provoke anxiety-like behavior and promote alcohol intake in those animals.
Dr. Pandey and his colleagues proposed that decreased CREB-dependent NPY production in the central amygdala might be a pre-existing condition for anxiety and alcohol-drinking behaviors.
“Our findings implicate this pathway in genetic predisposition to high anxiety and alcohol-drinking behaviors of P rats,” says Dr. Pandey. “Future studies should explore the relationship of other CREB-related compounds to these phenomena in P rats or other animal models.”

Source: NIH/National Institute on Alcohol Abuse and Alcoholism (2005, October 5). Researchers Shed Light On Anxiety And Alcohol Intake. ScienceDaily. Retrieved August 17, 2008, from http://www.sciencedaily.com¬ /releases/2005/10/051005080853.htm

Reshaping of the DNA scaffolding that supports and controls the expression of genes in the brain may play a major role in the alcohol withdrawal symptoms, particularly anxiety, that make it so difficult for alcoholics to stop using alcohol.The finding is reported by researchers at the University of Illinois at Chicago and the Jesse Brown VA Medical Center in the April 2 issue of the Journal of Neuroscience.
DNA can undergo changes in function without any changes in inheritance or coded sequence. These “epigenetic” changes are minor chemical modifications of chromatin — dense bundles of DNA and proteins called histones.
“This is the first time anyone has looked for epigenetic changes related to chromatin remodeling in the brain during alcohol addiction,” said Dr. Subhash C. Pandey, professor and director of neuroscience alcoholism research at the UIC College of Medicine and the Jesse Brown VA Medical Center in Chicago, the lead author of the study.
Chemical modification of histones can change the way DNA and histones are wound up together. Histone acetyltransferases (HATs) are enzymes that add acetyl groups to histones and loosen the packing, promoting gene expression. On the other hand, histone deacetylases (HDACs) remove acetyl groups from histones, causing them to wrap with DNA more tightly, decreasing gene expression.
The UIC researchers had previously shown in an animal model that levels of neuropeptide Y in the amygdala modulate anxiety and alcohol-drinking behavior. In the new study, they looked at the HDAC activity, acetylation of histones, and expression of the genes for NPY in the amygdala and the anxiety-like behaviors associated with withdrawal from chronic alcohol use.
Pandey and his colleagues found that acute exposure to alcohol decreases HDAC activity; increases the acetylation histones; increases levels of NPY — and reduced anxiety in the animals.
Conversely, anxiety-like behaviors during withdrawal in animals with chronic alcohol exposure was associated with an increase in HDAC activity and decrease in histones acetylation and NPY levels.
Importantly, blocking the observed increase in HDAC activity using an HDAC inhibitor during alcohol withdrawal brought up histone acetylation and NPY expression levels in the amygdala and prevented the development of anxiety-like behaviors.
“Our findings suggest that HDAC inhibitors may have potential as therapeutic agents in treating alcoholism,” Pandey said.
The researchers also found that levels of a protein known as CREB binding protein, which has HAT enzymatic activity, were increased by acute alcohol but were decreased during ethanol withdrawal.
They concluded that the enzymes that are involved in remodeling of chromatin play an important role in the anxiety that accompanies alcohol withdrawal as well as in the anti-anxiety effects of acute alcohol use.
“We need new strategies to treat alcoholism that are directed toward the prevention of withdrawal symptoms,” Pandey said. “Anxiety associated with withdrawal from alcohol abuse is a key factor in the maintenance of alcohol addiction.”

Source: University of Illinois at Chicago (2008, April 4). Brain DNA ‘Remodeled’ In Alcoholism. ScienceDaily. Retrieved August 17, 2008, from http://www.sciencedaily.com¬ /releases/2008/04/080402084340.htm

Doctors may one day be able to control alcohol addiction by manipulating the molecular events in the brain that underlie anxiety associated with alcohol withdrawal, researchers at the University of Illinois at Chicago College of Medicine and the Jesse Brown VA Medical Center report in the March 5 issue of the Journal of Neuroscience.”The association of anxiety with increased alcohol use is a key factor in the initiation and maintenance of alcohol addition,” says Dr. Subhash Pandey, UIC professor of psychiatry and director of neuroscience alcoholism research, the lead author of the study.
Previous research has shown that people with inherently high levels of anxiety are at an increased risk of becoming alcoholics. In addition, withdrawal of alcohol in chronic users is often accompanied by extreme anxiety.
“Alcoholics may feel a need to continue to drink alcohol in an attempt to self-medicate to reduce their anxiety and other unpleasant withdrawal symptoms,” said Pandey.
Pandey and his colleagues have discovered the molecular basis for the link between anxiety and alcohol addiction, which may help in identifying new therapeutic strategies for the treatment of alcohol addiction.
The researchers found that a protein within neurons in the amygdala — the area of the brain associated with emotion and anxiety — controls the development of alcohol withdrawal symptoms and drinking behaviors in laboratory animals by changing the shape of the neurons. This change in shape affects the communication between neurons, leading to changes in behavior.
Neurons communicate by sending signals through branches called dendritic spines. The researchers found that short-term alcohol exposure increased the number of dendritic spines in certain regions of the amygdala, producing anti-anxiety effects. Alcohol-dependent animals eventually developed a tolerance to the anxiety-lowering effects of alcohol.
The researchers traced the anti-anxiety effect to the production of a particular protein, Arc, in response to a nerve growth factor called BDNF that is stimulated by alcohol exposure. BDNF is vital in the functioning and maintenance of neurons.
When alcohol was withheld from animals that had been chronically exposed, they developed high anxiety. Levels of BDNF and Arc — and the number of dendritic spines — were decreased in the amygdala. But the researchers were able to eliminate the anxiety in the alcohol-dependent animals by restoring BDNF and Arc to normal levels.
Pandey suggested that an initial easing of anxiety may encourage people to begin to use alcohol, while for chronic users, a lack of alcohol provokes high anxiety, creating a need to continue drinking to feel normal.
The researchers blocked Arc production in normal rats by injecting a complementary sequence to Arc gene DNA into the central amygdala. They found that when levels of Arc in the central amygdala were lowered, the spines decreased and anxiety and alcohol consumption increased. When levels of Arc were returned to normal three days post-injection, anxiety and alcohol consumption also returned to normal. In a previous study, researchers found that lowering BDNF in amygdala promoted anxiety and alcohol drinking.
“This is the first direct evidence of the molecular processes occurring in the neurons that is responsible for the co-morbidity of anxiety and alcoholism, which we believe plays a major role in the addictive nature of alcohol,” said Pandey.
“This offers the possibility of new therapeutic target — BDNF-Arc signaling and associated dendritic spines in the amygdala — or new drug development.”
“These observations by Dr. Pandey’s research group provide an insight into the link between alcohol and anxiety and could be used to identify new targets for developing medications that alleviate withdrawal-induced anxiety and potentially modify a motivation for drinking,” said Antonio Noronha, director of neuroscience and behavior research at the National Institute on Alcohol Abuse and Alcoholism.
The work was supported by grants from the National Institute on Alcohol Abuse and Alcoholism and the Department of Veterans Affairs. Huaibo Zhang, Rajesh Ugale, Anand Prakash, Tiejun Xu and Kaushik Misra of the UIC College of Medicine and the Jesse Brown VA Medical Center also contributed to the study.

Source: University of Illinois at Chicago (2008, March 5). Brain Chemistry Ties Anxiety And Alcoholism. ScienceDaily. Retrieved August 17, 2008, from http://www.sciencedaily.com¬ /releases/2008/03/080304173356.htm

Naltrexone is one of four oral medications approved by the U.S. Food and Drug Administration (FDA) for the treatment of alcoholism. A recent large multicenter research study of alcohol dependence supported by the National Institute of Alcoholism and Alcohol Abuse (NIAAA), the COMBINE Study, suggested that naltrexone produced a modest but significant benefit but another FDA-approved medication, acamprosate, was ineffective.   Perhaps consistent with its modest effects in COMBINE, naltrexone is not widely prescribed in the treatment of alcoholism. Yet, clinicians report that naltrexone may have significant benefits for individual patients. To make naltrexone a more useful medication, it would be important to begin to identify groups of patients who might be more or less likely to show a significant clinical benefit from naltrexone prescription and to understand the causes of differential naltrexone efficacy.
A new study that will appear in the September 15th issue of Biological Psychiatry suggests that alcohol dependent individuals with a family history of alcohol dependence may be more likely than alcohol dependent individuals without a family history of alcohol dependence to reduce their drinking in the laboratory when prescribed naltrexone.
Krishnan-Sarin and colleagues at the NIAAA Center for the Translational Neuroscience of Alcoholism studied alcohol consumption in the laboratory by alcohol-dependent individuals who were not seeking treatment. The participants were studied in the laboratory after 6 days of treatment with 0 mg (placebo), 50 mg, or 100 mg of naltrexone. The authors discovered that naltrexone decreased drinking in those with a family history of alcoholism and this effect was greatest with the highest naltrexone dose. However, it increased drinking in those without a family history of alcoholism and this effect was greatest at the highest naltrexone dose.
John H. Krystal, M.D., one of the authors, notes that “When studied in large groups, naltrexone appears to have a rather small effect upon the ability to reduce drinking or remain abstinent from alcohol. However, there is growing evidence that there are subgroups of patients who show substantial benefit from naltrexone, even when naltrexone fails to work in the overall trial.*
“According to Suchitra Krishnan-Sarin, Ph.D., the lead author, “The results suggest that family history of alcoholism may be an important predictor of clinical response to naltrexone and could potentially be used to guide clinical practice.” Dr. Krystal agrees, “These data suggest that family history might influence the optimal dosing of naltrexone and the nature of the clinical response.” Their hope is that these findings ultimately can contribute to a better treatment experience for some who are seeking to end their battle with alcohol.
This research article: “Family History of Alcoholism Influences Naltrexone-Induced Reduction in Alcohol Drinking” by Suchitra Krishnan-Sarin, John H. Krystal, Julia Shi, Brian Pittman and Stephanie S. O’Malley. All authors are affiliated with the Department of Psychiatry at Yale University School of Medicine in New Haven, Connecticut. Dr. Krystal is also affiliated with the VA Connecticut Healthcare System in West Haven, Connecticut and he serves as the Editor of Biological Psychiatry. This article appears in Biological Psychiatry, Volume 62, Issue 6 (September 15, 2007), published by Elsevier.

Source: Elsevier (2007, September 24). Family History Of Alcoholism Affects Response To Drug Used To Treat Heavy Drinking. ScienceDaily. Retrieved August 17, 2008, from http://www.sciencedaily.com¬ /releases/2007/09/070919101735.htm

Long-acting injections of the drug naltrexone, combined with psychotherapy, significantly reduced heavy drinking in patients being treated for alcohol dependence, according to a study in the Journal of the American Medical Association by a Yale School of Medicine researcher.
“The decision to take medication can wane over time,” said Stephanie O’Malley, professor of psychiatry and director of the Division of Substance Abuse Research at the Connecticut Mental Health Center at Yale. “This provides coverage for an entire month.”
Acohol dependence ranks as the fourth leading cause of disability worldwide, as reported by the World Health Organization’s Global Burden of Disease project. Nationwide, it is believed to contribute to more than 100,000 preventable deaths a year.
Naltrexone belongs to a class of drugs called opioid antagonists. Although many clinical trials have shown that oral naltrexone can be effective in treating alcohol dependence, its use in clinical practice has been limited, in part patients have to take the pill daily.
In this trial conducted at 24 sites, 627 alcohol dependent patients were randomly assigned to receive either an injection of long-acting naltrexone or a placebo injection; 624 ultimately received at least one injection. All participants received 12 counseling sessions during the six-month study in addition to the medication. Long-acting naltrexone was associated with a reduction in heavy drinking within the first month of treatment, and this response was maintained over the six month treatment period.Source: Yale University (2005, May 17). Once-a-month Naltrexone Successfully Used To Treat Alcohol Dependence. ScienceDaily. Retrieved August 17, 2008, from http://www.sciencedaily.com¬ /releases/2005/05/050517094735.htm

Patients with a certain gene variant drank less and experienced better overall clinical outcomes than patients without the variant while taking the medication naltrexone, according to an analysis of participants in the National Institutes of Health’s 2001-2004 COMBINE (Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence) Study. About 87 percent of patients with the variant who received naltrexone experienced good outcomes, compared with about 49 percent of those who received a placebo. About 55 percent of patients without the variant experienced a good outcome regardless of whether they received naltrexone or placebo. Good outcome was defined as abstinence or moderate drinking without related problems, according to an article in the Feb. 4 issue of the Archives of General Psychiatry.Drinking alcohol increases the release of endogenous opioids, compounds that originate in the body and promote a sense of pleasure or well-being. An opioid antagonist, naltrexone blocks brain receptors for endogenous opioids, making it easier for patients to remain abstinent or stop quickly in the event of a slip. In clinical studies, naltrexone has been shown to reduce relapse and craving for alcohol in some but not all treated patients. Earlier studies had suggested that a specific DNA variant of the opioid receptor gene (OPRM1) might have role in patients’ response to naltrexone.
“Analysis of the large COMBINE patient population increases confidence that the OPRM1 variant is in part responsible for positive responses to naltrexone. This study points to the promise of research on gene-medication interactions to refine treatment selection, improve clinical results, and inform ongoing medications development,” said National Institute on Alcohol Abuse and Alcoholism (NIAAA) director Ting-Kai Li, M.D.
Of the original 1383 COMBINE Study participants, 1013 were available to be genotyped for the current study, conducted by Raymond F. Anton, M.D., Medical University of South Carolina, and other COMBINE Study principal investigators in collaboration with David Goldman, M.D., and his colleagues in NIAAA’s Laboratory of Neurogenetics. The researchers successfully genotyped 911 of the available patients and conducted their initial analysis in 604 who are white, 135 of whom were found to carry the genetic variant. Approximately 15 to 25 percent of humans carry the variant, with considerable variation among ethnicities.
As in the COMBINE clinical trial, drinking variables evaluated in the pharmacogenetic study included the percentage of days abstinent from alcohol, the percentage of heavy drinking days, and clinical outcome during 16 weeks of active treatment. In addition to naltrexone or placebo, all patients received medical management (nine brief, structured outpatient sessions delivered by a health professional) and some also received a combined behavioral intervention (integrated cognitive-behavioral and motivational enhancement therapies, together with techniques to enhance mutual-help participation).
The researchers found that, compared with patients who do not carry the variant, white variant carriers who received naltrexone fared substantially better than other groups on all measures, including almost a 6 times greater likelihood of good clinical outcome. Extending the clinical outcome measure to variant carriers of all ethnicities reduced the benefit to just over a 3 times greater likelihood of good outcome. The researchers found no gene-medication interaction in patients who received specialized alcohol counseling, leading to them to conclude that genotyping for the variant may be most useful when naltrexone is used without intensive counseling.
Approved by the U.S. Food and Drug Administration in 1994, naltrexone is one of three indicated medications* shown to help patients reduce drinking, avoid relapse to heavy drinking, achieve and maintain abstinence, or gain a combination of these effects. The COMBINE trial showed either specialized counseling or naltrexone–each delivered with medications management–to be effective options for treating alcohol dependence. “Given that alternative treatments such as combined behavioral interventions, acamprosate, and topiramate can be offered, one could make the case that naltrexone should be used first or used primarily in carriers of the OPRM1 [variant],” state the authors.
“Research studies designed to ensure appropriate medication targeting are critical, especially as treatment for alcohol use disorders increasingly involves primary care physicians as well as specialists,” notes Mark L. Willenbring, M.D., director of NIAAA’s Division of Treatment and Recovery Research. “Without the ability to predict response for a specific patient, we must use trial-and-error to determine the correct medication–a process that may prolong illness and lead to more side effects. This study highlights the promise of truly personalized medicine and could help to move treatment of alcohol dependence into the medical mainstream.”

Source: NIH/National Institute on Alcohol Abuse and Alcoholism (2008, February 12). Gene Variant Predicts Medication Response In Patients With Alcohol Dependence. ScienceDaily. Retrieved August 17, 2008, from http://www.sciencedaily.com¬ /releases/2008/02/080207172332.htm

The National Cancer Institute (NCI) released a report today, co-edited by University of Minnesota professor Barbara Loken, that reaches the government’s strongest conclusion to date that tobacco marketing and depictions of smoking in movies promote youth smoking. “There is now incontrovertible evidence that marketing of tobacco, and the depiction of smoking in the movies, promote youth smoking and can cause young people to begin smoking,” said Loken, professor of marketing at the Carlson School of Management and one of the report’s five scientific editors.
The 684-page monograph, “The Role of the Media in Promoting and Reducing Tobacco Use,” presents definitive conclusions that a) tobacco advertising and promotion are causally related to increased tobacco use, and b) exposure to depictions of smoking in movies causes youth smoking initiation. The report also concludes that while mass media campaigns can reduce tobacco use, youth smoking prevention campaigns sponsored by the tobacco industry are generally ineffective and may even increase youth smoking.
“The role of marketing in the success of the tobacco companies is conclusive,” according to Loken. “The report’s recommendations offer the best approach to employ marketing techniques and the media to help prevent a further increase in youth smoking.”
The NCI report reaches six major conclusions:
1. Cigarettes are one of the most heavily marketed products in the United States.
2. Tobacco advertising targets psychological needs of adolescents, such as popularity and peer acceptance. Advertising creates the perception that smoking satisfies these needs.
3. Even brief exposure to tobacco advertising influences adolescents’ perceptions about smoking, smokers, and adolescents’ intentions to smoke.
4. The depiction of cigarette smoking is pervasive in movies, occurring in 75 percent or more of contemporary box-office hits, with identifiable brands in about one-third of movies.
5. A comprehensive ban on tobacco advertising and promotion is an effective policy intervention that prevents tobacco companies from shifting marketing expenditures to permitted media.
6. The tobacco industry works hard to impede tobacco control media campaigns, including attempts to prevent or reduce their funding.
“This direct link between marketing and tobacco use is very powerful.” Loken said, “Anti-tobacco ads before films and a comprehensive ban on tobacco advertising are two effective strategies found to curb effects of tobacco images on youth. Now we need to use marketing to steer youth and others away from tobacco.”
The report provides the most current and comprehensive analysis of more than 1,000 scientific studies on the role of the media in encouraging and discouraging tobacco use. The report is Monograph 19 in the NCI’s Tobacco Control Monograph series examining critical issues in tobacco prevention and control. Research included in the review comes from the disciplines of marketing, psychology, communications, statistics, epidemiology and public health.Source: National Cancer Institute Report. National Press Club Release 21 August

Twiggs County school system will receive a $62,724 federal grant to help students say no to gangs, according to a legislative news release    The grant from the Department of Justice will develop a Gang Resistance and Education Training program for Twiggs elementary and middle school students.
 Known as G.R.E.A.T, it’s a violence prevention curriculum that helps students develop values and practice behaviors to help them avoid destructive activities. It will help pay for a summer program and activities afterschool.
“This funding will go a long way to help ensure that Twiggs County has the resources necessary to help prevent young people from getting involved in dangerous activities,” Sen. Isakson said.
“G.R.E.A.T is an important resource for Georgia’s youth and I’m pleased to see Twiggs County receive this funding which will help keep our communities safe,” Chambliss said.Source: www.macon.com August 2008

Wednesday, September 10, 2008NEW YORK (Reuters Health) – Researchers from Spain have found a strong and independent link between cannabis use and the onset of psychosis at a younger age. The association, they say, cannot be explained by chance, and is not related to gender or the use of other drugs. It is, however, related to the amount of cannabis used.

“The clinical importance of this finding is potentially high,” Dr. Ana Gonzalez-Pinto from Santiago Apostol Hospital in Vitoria, and colleagues write in the Journal of Clinical Psychiatry, given that cannabis use is extremely prevalent among young people.”

The researchers also report that “estimates of the attributable risk suggest that the use of cannabis accounts for about 10 percent of cases of psychosis.”

The findings are based on 131 patients ages 15 to 65 years who needed inpatient care for a first psychotic episode during a 2-year period. The subjects were evaluated using the Structured Clinical Interview for DSM-IV Axis I Disorders, and clinical and demographic data were also collected.

The results showed a significant gradual reduction in the age at which psychosis began that correlated with an increased dependence on cannabis. Compared with nonusers, age at onset was reduced by 7, 8.5, and 12 years among users, abusers and dependents, respectively, the researchers report.

In further analysis, the effect of cannabis on age at onset “was not explained by the use of other drugs or by gender,” they also note. The finding was similar in the youngest patients, suggesting that this effect was not due to chance.

These results “point to cannabis as a dangerous drug in young people at risk of developing psychosis,” Gonzalez-Pinto and colleagues conclude.

SOURCE: Journal of Clinical Psychiatry, August 2008.

Gamma butyrolactone (GBL), an industrial solvent commonly used to clean graffiti, also has a darker purpose: the liquid can cause a euphoric high — or death — when ingested.
that GBL has become a popular intoxicant on the gay club scene, with sometimes deadly consequences. The drug can cause nausea and unconsciousness if too much is consumed. Users also risk damage to their stomachs, liver, and kidneys from ingesting the toxic solvent.
“This is vastly more dangerous than ecstasy,” says Sean Cummings, who runs the Freedom Health clinic in London. “I personally know of two deaths this year alone, and the numbers using it are much smaller than ecstasy. The penetration into the [straight clubbing] mainstream is relatively small at the moment and if it spreads, the number of deaths associated with it is going to increase.”
Even now, it is fairly common for gay clubbers to collapse from GBL use; one ambulance service alone answered 16 GBL-related calls on one recent Saturday night. “One minute I was dancing, the next I woke up in hospital and the nurse said I had been resuscitated,” said GBL user Sergio, 33. “I got such a shock. My friend told me I had collapsed and security staff at the club were reluctant to call an ambulance. But another guy was monitoring my pulse and said it was dropping so my friend called an ambulance himself, and I’m forever in his debt that he did.
“I had taken G before, but that night I had drunk alcohol earlier and I think that’s what made me overdose. It’s a great high, but never again.”Source: The BBC reported Oct. 7 2008

Research SummaryA brain imaging study conducted by researchers at Massachusetts General Hospital revealed that abnormalities appearing in the cerebral cortex of cocaine addicts correlate with dysfunction in regions of the brain responsible for attention and reward-based decision-making. 
While some of these abnormalities may reflect a predisposition to drug use, others may result from long-term cocaine exposure. “These data point to a mixture of both drug effects and predisposition underlying the structural alterations we observed,” said Hans Breiter principal investigator of the Phenotype Genotype Project in Addiction and Mood Disorder.
Magnetic resonance imaging studies of 20 cocaine addicts and 20 control participants were used to determine variations in cortical thickness. Compared to the healthy controls, the cocaine addicts had significantly less overall cortical volume. The difference was markedly apparent in areas that control reward functioning and decision-making. In addition, typical differences in thickness in the frontal regions of the cortex was reversed for the addicts compared to non-addicts.
“The severity of these cortical alterations point to the potential importance of prevention efforts to keep susceptible individuals from beginning to use cocaine,” Breiter said. He suggested that further large-scale testing of individuals with different addictions is needed “to see if these findings are limited to cocaine users.”

Source The report appears in the Oct. 9, 2008 issue of the journal Neuron.

New research suggests that it takes less exposure to tobacco to increase the risk of colorectal cancer among women than men.
Researchers Joseph C. Anderson, M.D., of the University of Connecticut and Zvi A. Alpern, M.D. of Stony Brook University conducted a large cross-sectional study, analyzing data on patients who underwent colonoscopies. Utilizing a measurement called “pack years” — determined by multiplying the number of cigarettes smoked per day by the number of years smoked — researchers compared the amount of tobacco exposure in men and women to increased colorectal cancer risk.
The analysis, controlling for age, body mass index and family history, showed that women who smoked up to 30 pack-years had an 82 percent greater risk for significant colorectal neoplasia than nonsmoking women, while men who smoked up to 30 pack-years showed 21 percent greater risk than nonsmoking men. Female smokers faced double the risk or more of colorectal cancer if they smoked less than 30 pack years, while men achieved the same level of risk only when they smoked more than 30 pack years.
The study was presented at the American College of Gastroenterology’s annual scientific meeting.
 
Source: Reported in Join Together Oct. 7 2008

Research SummaryJust as smoking causes hardening of the arteries, quitting smoking can improve arterial health, although recovery from arterial stiffness may take up to a decade, Reuters reported March 19.
Researcher Noor Ahmed Jatoi and colleagues compared current smokers, ex-smokers and people who never had smoked. “We categorized ex-smokers according to how long they were off cigarettes — under one year, more than one but less than 10 years and more than 10 years,” said Jatoi.
The researchers found that arterial health improved over with time once smokers quit, but only reached normal levels after more than a decade of abstinence.
The study was published in the journal Hypertension.

Source: Reported in Join Together March 23 2007

Source:Reported in Join Together April 2006

Conclusion:  Awareness of the risks of inhaling the smoke directly from burning cannabis has led to the development of a number of alternative methods of delivery [water bongs, low temperature vaporizers, etc.], which are claimed to be safer than direct smoking.  Ammonia at toxic levels is produced from heating ‘street’ cannabis in these commercially available devices.  Thus, the use of these devices to deliver ‘street’ cannabis is now open to question and further research is needed to investigate their safety.”
Source:  Addiction, October 2008
(Addiction, 103, 1671-1677) Bloor, Want, Spanel & Smith, UK and Czech Republic

 
Morbidity – Causes and Manners of Death Among Users of heroin, Methadone, Amphetamine, and Cannabis in Relation to Postmortem Chemical Tests for Illegal Drugs

This is the result of a 12-year medicolegal investigation of deceased illegal drug users (ILDU) in Stockholm, Sweden, classified on the basis of postmortem chemical tests.  The study “showed noticeable variations in causes and manners of death as well as the distribution of suicide methods.”

The authors noted:  “We did not anticipate the large relative proportion for fatal traffic crashes among the ‘cannabis only’ users…the relative proportion of fatal traffic crashes was 57% among the 30 cannabis only users as compared to all decedents with evidence of recent cannabis use, for whom the relative proportion was 16%. . . This study also revealed differences among the suicide methods chosen in relation to results of postmortem drug tests.  Non-violent suicide methods most often were chosen by heroin and methadone users (84% and 62%, respectively); this was the only choice for suicide when one of these drugs was the only illegal drug detected….However, it is of note that…the choice of extremely violent suicide methods was quite substantial among cannabis users, 45% (54% for cannabis only users).

Source: Substance Use & Misuse,  2008(Substance Use & Misuse, 43:1326-1339)  Staffan Eksborg and Jovan Rajs; Sweden

Pain Medicine
(a double-blind, crossover study in 18 healthy female volunteers)

Lack of Analgesia by Oral Standardized Cannabis Extract on Acute Inflammatory Pain and Hyperalgesia in Volunteers.

“Besides studies with smoked cannabis, no controlled experimental clinical trials on the analgesic (pain relieving) efficacy of oral cannabis extract or THC on acute inflammatory pain and hyperalgesia in humans have been published to date.  Therefore, the current study was designed to detect a potential analgesic activity of oral THC-standardized cannabis extract by two different and well-established human models of acute inflammatory pain and hyperalgesia, i.e., the sunburn model and the intradermal injection of capsaicin.”

Conclusion:  “No analgesic or antihyperalgesic activity of cannabis extract was found in the experiments.  Moreover, the results even point to the development of a hyperalgesic (more painful) state under cannabinoids.  Together with previous data, the current results suggest that cannabinoids are not effective analgesics for the treatment of acute nociceptive (inflammatory) pain in humans.

Source: Anesthesiology 2008; 109:101-10, Kraft, Frickey et al, Austria

 So much for harm reduction techniques reducing drug deaths.

An ageing population of heroin users does not fully explain the five year peak in deaths from drug poisoning in English and Welsh men. The increase is attributable to heroin, methadone, and morphine, and death rates were highest in young adults.
The UK has the highest prevalence of drug misuse in Europe.  The social laboratory of harm reduction as practised in the UK does not focus on prevention by creating and implementing drug use prevention activities and increasing drug free recovery facilities. Substitute prescribing protocols and needle exchange facilities have an important role in preventing further harm being incurred by users, but they cannot reduce the mental, physical, spiritual, and social harms caused by continued use or the severity of addiction with continued use.

Methadone maintenance, the flagship of drug treatment in the UK, needle exchange facilities, and drug consumption rooms have all failed to reduce or prevent the increasing use of addictive substances, as well as the associated deaths and bloodborne diseases.

The action plan on reducing drug related deaths referred to by the Department of Health spokesperson proposes more of the same. Abstinence is mentioned twice in the eight page plan, but there is no mention of increasing drug free recovery protocols or programmes.

Peter O’Loughlin principal, Eden Lodge Practice, Beckenham BR3 3AT peteroloughlin5@hotmail.com

Competing interests: PO’Lis an addictions counsellor and psychotherapist who is principal of a practice offering a non-residential service to those seeking to become free of alcohol, addictive psychoactive substance disorder, or addiction.
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Bargagli AM, Hickman M, Davoli M, Perucci CA, Schifano 4 P, Buster M. Drug related mortality and its impact on adult mortality in eight European countries. Eur J Public Health 2005;79:191-9.
Department of Health. Reducing drug-related 5 harm: an action plan. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_074850
Cite this as: BMJ 2008;337:a1671

The new report also found that around one quarter of IDUs reported sharing of needles and syringes and almost half have been infected with hepatitis C, with one fifth becoming infected within three years of starting to inject.

There is significant new research concerning adolescent brain development and the effects of alcohol and other drug use on the developing brain. This emerging science is providing new insights about how teenagers make critical and life influencing decisions, including their decisions about drug use. Brain imaging studies suggest that the brain continues to develop through adolescence and into young adulthood (age 25 years). During adolescence, the parts of the brain that are responsible for expressing emotions and for seeking gratification tend to mature sooner than the regions of the brain that control impulses and that oversees careful decision making. As one expert puts it the teenage brain”has a well-developed accelerator but only a partly developed brake.”

The maturing brain of the adolescent may also pose a particular risk toward drug abuse. There is some evidence that the developing brain is prone to the deleterious effects of alcohol. One study showed that memory ability may be negatively affected by about 10% as a result of alcohol abuse.

Source   Mentor Foundation  17th Dec. 2008

Scientists have been studying cannabinoids, substances that are chemically related to the ingredients found in marijuana, for more than two decades, hoping to learn more about how the drug produces its effects–both therapeutic and harmful. Marijuana has been reported effective in the treatment of multiple sclerosis, glaucoma, nausea caused by chemotherapy and wasting caused by AIDS. However, like all drugs, it also causes numerous unwanted side effects, including hypothermia, sedation, memory impairment, motor impairment and anxiety. Research on cannabinoids could someday yield new, more effective drugs or drug combinations.At Temple University’s School of Pharmacy and Center for Substance Abuse Research (CSAR), one of only a few centers in the nation focused on the basic science of substance abuse, several researchers are investigating how cannabinoids produce pharmacological effects in rats.
One such study, “L-NAME, a nitric oxide synthase inhibitor, and WIN 55212-2, a cannabinoid agonist, interact to evoke synergistic hypothermia,” published in the February issue of the Journal of Pharmacology and Experimental Therapeutics, reveals how cannabinoids produce one of the drug’s most robust actions, hypothermia, or decreased body temperature.
According to lead author Scott Rawls, Ph.D., assistant professor of pharmacodynamics at Temple’s School of Pharmacy, “To operate at maximum efficiency, the body needs to maintain a stable, normal temperature. When the body’s temperature is altered, as in hypothermia, normal body functions, such as blood pressure and circulation, are impaired.”
Marijuana operates via two receptors in the body. One receptor, called CB1, is located in the brain and produces the drug’s psychoactive effects, including euphoria and dizziness. The other receptor, CB2, is found throughout the body and impacts the immune system. Substances in marijuana bind to one of these receptors and set off a chemical process that leads to an effect, such as hypothermia. Scientists have focused on this chemical process at the molecular level to pinpoint the exact molecules involved.
Knowing that the molecule nitric oxide (NO) plays an important role in the regulation of body temperature, the Temple researchers set out to determine what role it might play in cannabinoid-induced hypothermia. By combining a cannabinoid with a substance that blocked NO synthesis, they found that cannabinoid-induced hypothermia increased more than two-fold.
“This demonstrates the possibility that NO plays a part in regulating the impact of cannabinoids on body temperature and other cannabinoid-mediated actions,” said Rawls. “These findings could be helpful in determining the mechanisms that underlie some of the pharmacological actions of marijuana,” he added.
Rawls’ research team is currently investigating the impact of cannabinoids on other physiological systems, such as analgesia and movement, and the brain neurotransmitters that mediate those systems.

Source: ScienceDaily. Retrieved July 18, 2008, from http://www.sciencedaily.com¬ /releases/2004/03/040309071927.htm

The latest Drug Abuse Warning Network (DAWN) report—drawn from a sample of hospital emergency departments across the Nation—indicates that more than 1.7 million visits to emergency departments (ED) were associated with some form of substance misuse or abuse. The 2006 DAWN report, developed by the Substance Abuse and Mental Health Services Administration (SAMHSA), provides the latest estimates on how substance use affects this critical part of the Nation´s healthcare system.

Of the of 113 million ED visits in the United States, DAWN estimates that 1,742,887 were associated with drug misuse or abuse, with illicit drugs responsible for 31 percent of the cases and prescription drugs for 28 percent of the cases.

Among the report’s more notable findings:

• Cocaine was involved in 548,608 emergency department visits.
• Marijuana was involved in 290,563 emergency department visits. The rates were highest among those aged 18-24.
• Heroin was involved in 189,780 emergency department visits.
• There were 126,704 emergency department visits by patients under age 21 where alcohol was the only substance involved in the visit.
• Stimulants, including amphetamines and methamphetamines, were involved in 107,575 emergency department visits.

Prescription and over-the-counter drugs were responsible for 741,425 of the ED visits and the majority of these visits (54 percent) involved multiple drugs.

While most of the data was similar to previous years, there was a notable increase in the number of ED visits related to prescription drugs, with a 44 percent increase from 2004 to 2006.

Source:  CADCA Coalitions OnLine  11th Dec. 2008

A drug used to tranquillize horses, called ketamine, is gaining popularity within the dance scene in a number of countries throughout the world. That´s according to a recent report by the United Nations Office of Drugs and Crime, which warned that long-term use of ketamine use can have serious effects on the brain, the kidneys and internal organs.

Now the most abused drug by so called “clubbers” in Hong Kong, ketamine is gaining popularity across southern China. Its use is spreading throughout East Asia as well as Australia, Europe and North America. But because ketamine is a legal substance – and therefore not controlled – the true extent of its use is unclear and probably underestimated.

Nicknamed ‘Special K’, ketamine can be taken in powder, liquid or tablet form but is often mixed with other drugs or alcohol. Sometimes ketamine is laced with synthetic drugs such as methamphetamine and then sold as ecstasy because it commands a higher price than straight ketamine.

“It is a new candy for the youth “, explains UNODC expert Jeremy Douglas, who cautioned that people can be easily fooled. “Sometimes they know they’re using ketamine, sometimes they don’t”. Uncertainty about the content of tablets sold as “ecstasy” is of concern and poses particular risk.

The effect of the drug depends on the dose. With low doses, party-goers may feel euphoric, have psychedelic experiences and high levels of energy, but high doses might plunge the user into an out-of-body or near-death experience known as the “K-hole.” “It’s an anaesthetic so it can put someone in a catatonic state, a different state of being. Perception of the body, time and reality is severely altered,” Douglas said.

Long-term use may impair the memory and cognitive functions, and damage the kidneys and internal organs.

The emergence of ketamine on the synthetic drug scene has gone unnoticed in many parts of the world. Unlike illicit drugs, the trade in ketamine is not internationally controlled. This makes it hard to get a clear picture of how the drug is being diverted for illicit purposes. “We’re seeing the use of ketamine taking off, but it’s up to Member States and national governments to control it. Anyway, it seems that the use is growing both in developing countries and in the west”, Douglas says.

Source: CADCA Coalitions Online 13th Nov.2008

Recovery coaches’ effective in reducing number of babies exposed to drugs

CHAMPAIGN, Ill. — About 11 percent of the 4 million babies born in the U.S. each year have been exposed to alcohol or illicit drugs in the womb, according to a June 2006 report by the National Center on Substance Abuse and Child Welfare. If removed from the home by child protection, these children tend to remain in foster care longer, and chances are very low that they will be reunited with their parents.

However, a groundbreaking study led by Joseph P. Ryan, a faculty member in the School of Social Work at the University of Illinois, indicates that recovery coaches can significantly reduce the number of substance-exposed births as well as help reunite substance-involved families, saving state child-welfare systems millions of dollars in foster-care and other placement costs.

The study, part of a larger collaboration among the U. of I., the Department of Children and Family Services, and Treatment Alternatives for Safe Communities, appeared in the journal Child Abuse and Neglect. The sample included 931 women in Chicago and suburban Cook County who had lost temporary custody of their children to DCFS, and who were chronic substance abusers referred for alcohol and drug assessments. Sixty-nine percent of the women had given birth to at least one substance-exposed infant prior to enrollment in the study.

Although several characteristics – age, race, and cocaine or heroin use among them – place certain women at higher risk for giving birth to a substance exposed infant, mothers who have at least one prior substance-exposed infant are significantly more likely to deliver additional substance-exposed infants.
The study made use of an experimental design: Families were randomly assigned to one of two treatment conditions. The mothers assigned to the control group during the five-year study received traditional child-welfare and substance-abuse services; the mothers assigned to the experimental group received traditional services plus the services of a recovery coach. The coaches – caseworkers with special training in addiction, relapse prevention, case management and counseling – focused on getting the mothers into substance-abuse treatment and keeping them there by engaging in face-to-face contacts in the family home and with treatment-provider agencies. If a mother suffered a relapse – a common event in the recovery process – or dropped out of the program, the recovery coach helped re-engage her with treatment, and helped her meet the legal and other requirements associated with regaining custody of her children.

At the study’s conclusion, 15 percent of mothers assigned to the recovery-coach group had given birth to a subsequent substance-exposed infant compared with 21 percent of mothers assigned to the control group. Overall, mothers assigned to the recovery-coach group were more likely to access substance-abuse services, and were more likely to achieve family reunification, saving the state of Illinois $5.5 million in foster-care and other placement costs.

Reunification rates for substance-involved families typically are the lowest of all families involved with the child-welfare system. “One reason that they don’t achieve reunification is that they are unable to address the core problem of substance abuse, and that really presents an obstacle toward judges making decisions to have the children return home,” Ryan said. “A recovery coach increases the reunification rate by about 6 percent, which is a small but significant gain.”

Often, substance-involved families are grappling with several major problems – such as mental illness, inadequate housing, domestic violence and unemployment – “so it’s somewhat unrealistic to think that one case worker can effectively manage all those types of problems,” Ryan said. “No single intervention is going to solve the complex array of problems that these families encounter. But if we chip away at it – increase reunification rates, close out foster-care placements at a higher rate, decrease the likelihood of additional substance-exposed infants – it produces gains for families and for the state.”
It is important to note that one obstacle to identifying substance exposure at birth is the lack of federal or state laws that mandate testing newborns for drug exposure. A recent nationwide study found that there are no standardized testing practices or criteria for testing infants in most hospitals, and the decision to test a newborn is left to the discretion of the attending physician or the hospital.

Co-authors of the study, which appeared in the November issue of the journal, were professor Christopher R. Larrison, research specialist Pedro Hernandez and graduate student Jun Sung Hong at the U. of I., and Sam Choi, a postdoctoral scholar in the School of Social Service of Administration at the University of Chicago.

Source:  News Bureau, University of Illinois  7th Jan 2009

DAZED AND CONFUSED: Marijuana muddles memory, and it may be because THC disrupts the synchronous firing of brain cells.
Marijuana–and its active ingredient, Δ9-tetrahydrocannabinol (THC)–has muddled memories for millennia. But how exactly the wacky weed interferes with remembrance of things past–as well as attention span and speech, among other things–has never been clear. Now neuroscientists have discovered that cannabinoids diminish the brain waves of rats–and disrupt the symphony of synchronous brain cell firing that may be essential for memory.
Neuroscientist David Robbe of Rutgers University and his colleagues tested the impact of THC and a synthetic cannabinoid on rats that had their heads restrained. The drugs affected certain brain waves: the theta (four to 12 hertz) and fast ripple (100 to 200 hertz) waves diminished significantly, whereas the drug had a slightly lesser impact on gamma (30 to 80 hertz) waves. Because theta and gamma oscillations are thought to play a critical role in creating and storing short-term memories–and fast ripple oscillations may allow such short-term memories to be moved into long-term storage–this suppression could mean missing memories for the rats.
In fact, rats that had been trained to follow a specific series of turns to get water–and did fine on the test before being intravenously injected with the drug–found themselves wandering in a daze under its influence. And when the researchers injected the synthetic cannabinoid directly into three rats’ brains, it completely disrupted the otherwise synchronized pattern of the firing of their neurons: they fired as much as before, but in a more random pattern. And other types of brain cells, such as interneurons and pyramidal cells, fell out of step as well, although, interestingly, their overall activity actually increased (perhaps an explanation for the random nature of thoughts generated by use of the drug).
The finding suggests that this disruption of synchronized brain cell firing might be responsible for marijuana’s memory distortions. “Overall, our findings indicate that under the influence of cannabinoids, neurons are liberated from population control,” the researchers write in the paper presenting the finding published in the December issue of Nature Neuroscience. This, they argue, is the direct cause of memory impairment. But the research also reveals that at the highest doses of synthetic cannabinoid, the rats failed to discover the right sequence of turns altogether. In other words, there may be a threshold level of the drug that entirely prohibits learning, and that is something worth remembering very clearly.
Source:  Scientific American. Nov.2006

PURPOSE: To determine the risk for malignant primary adult-onset glioma (MPAG) associated with cigarette smoking and other lifestyle behaviors in a large, multiethnic, managed-care cohort. METHODS: The study population included a cohort of 133,811 subscribers to the Kaiser Permanente Medical Care Program of Northern California who had received a multiphasic health checkup and questionnaire between 1977 and 1985, were at least 25 years old at their start of follow-up, and had no prior history of benign or malignant brain tumors. In this cohort, patients were followed for up to 21 years for the development of MPAG. RESULTS: Risk for MPAG among women increased with increasing packs of cigarettes smoked per day (p-for-trend = 0.04), adjusting for cigar and pipe smoking, patient age, sex, race, education, alcohol use and coffee consumption. A similar pattern was not observed for men. Individuals who smoked marijuana at least once a month, adjusting for cigarette smoking (packs smoked per day) and for the factors noted above, had a 2.8-fold (CI = 1.3-6.2) increased risk for MPAG. Relative risk for MPAG increased with increasing consumption of coffee (p-for-trend = 0.05). CONCLUSIONS: Cigarette smoking was associated with an increased risk for MPAG among women but not among men. Individuals who smoked marijuana at least once a month had an increased risk for MPAG, although no dose-response relation was observed. Drinkers of >7 cups of coffee per day had a 70% increased risk for MPAG and smaller risk elevation for lower consumption. Alcohol usage was not associated with an increased risk for MPAG.
Source:   J Neurooncol. 2004 May;68(1):57-69

OBJECTIVE: To evaluate whether maternal use of recreational drugs around conception and pregnancy influences the risk of childhood neuroblastoma.
METHODS: Self-reported use of recreational drugs from one month prior to pregnancy until diagnosis was assessed among mothers of 538 children with neuroblastoma (diagnosed 1992-1994 and identified through the Children’s Cancer Group and Pediatric Oncology Group) and 504 age-matched controls (identified by random-digit dialing). Odds ratios (OR) and 95% confidence intervals (CI) were estimated using unconditional logistic regression, adjusting for age at diagnosis and household income. RESULTS: Maternal use of any illicit or recreational drug around pregnancy was associated with an increased risk of neuroblastoma in offspring (OR = 1.82, 95% CI: 1.13, 3.00), particularly use of marijuana in the first trimester of pregnancy (OR = 4.75, 95% CI: 1.55, 16.48). Marijuana use in the month before pregnancy did not increase risk. The effect of gestational marijuana exposure was strongest in subjects diagnosed before age one. Evaluation of recreational drugs other than marijuana was limited by infrequent use, and analyses of drug use by fathers were not carried out due to missing data.
 CONCLUSIONS: Maternal recreational drug use and marijuana use during pregnancy were associated with increased risk of neuroblastoma in offspring. Further examination of these drugs and the risk of childhood cancer is warranted.
Source  Cancer Causes Control. 2006 Jun;17(5):663-9.

Two recently published research papers have used functional MRI (fMRI) to show how the two main constituents of cannabis Tetrahydrocannabinol (THC) and Cannabidiol (CBD) act on the brain to modulate cognitive function and psychiatric  symptoms.
Cannabis is the world’s most widely used illicit drug and has a wide range of psychological and symptomatic effects.  In the short term cannabis can induce psychotic symptoms and anxiety, while regular use is associated with cognitive impairments and an increased risk of schizophrenia.  
Talking about the latest research published by the Institute of Psychiatry at King’s College London, into the effects of cannabis, Professor Philip McGuire one of the authors said: “The Institute has been at the forefront of research into the adverse psychiatric effects of cannabis use.  These new findings further develop scientific understanding in this area by indicating how the two main psychoactive constituents of cannabis act on the brain to alter cognitive function and induce psychiatric symptoms.
The studies were initiated by Philip McGuire and Zerrin Atakan from the Institute of Psychiatry at King’s, Jose Crippa from Ribeirão Preto, Brazil and Rocio Martin-Santos in Barcelona, Spain.   They and a team of researchers at the Institute used functional magnetic resonance imaging and behavioural measures to assess the impact on brain function in healthy male volunteers.  Each subject was scanned on three occasions at monthly intervals, with each scan preceded by the administration of either THC, CBD or a placebo.
In the first paper published in Biological Psychiatry in December 2008, ‘Neural Basis of Δ-9-Tetrahydrocannabinol and Cannabidiol: Effects During Response Inhibition’ the researchers considered the effects of THC and CBD on brain function during a Go/No Go task which requires subjects to over-ride a regular button pressing response.  They found that THC reduced activation in the part of the prefrontal cortex that is normally critical for this ‘response inhibition’ process.  Please refer to the journal for a full copy of the paper. (Biological Psychiatry 64 (11), pp. 966-973) doi:10.1016/j.biopsych.2008.05.011)
In the second paper published in the Archives of General Psychiatry (12 January 2009) ‘Distinct Effects of _9-Tetrahydrocannabinol and Cannabidiol on Neural Activation During Emotional Processing’  the researchers investigated the neurophysiological basis of the effects of cannabis on anxiety, using faces that had fearful expressions.  Normally viewing fearful faces provokes anxiety, activates the amygdala, and increases skin conductance (a measure of autonomic arounsal).  Administration of CBD reduced the response of the amygdale to fearful faces, and this effect was correlated with its effect on skin conductance.  Please refer to the Archives of General Psychiatry, January 2009 issues for full copies of this paper.  (Arch Gen Psychiatry, 2009;66 (1): 95-105.)
Professor Philip McGuire concludes, “These studies show that THC and CBD have distinct effects on brain function in humans, and these may underlie their correspondingly different effects on cognition and psychiatric symptoms.  Determining how the constituents of cannabis act on the brain is fundamental to understanding the role of cannabis use in the aetiology of psychiatric disorders.”
Source:  Institute of Psychiatry  20th Jan 2009 

A new study from the Telethon Institute for Child Health Research has revealed the consequences of heavy and binge drinking on pregnancy even after these drinking patterns have stopped.
 
The study, to be published in BJOG: An International Journal of Obstetrics and Gynaecology, investigated the relationship between prenatal exposure to alcohol and the effects on fetal growth and preterm birth. 
 
A random sample of 4,719 women who gave birth in Western Australia between 1995 and 1997 took part in a survey.  Data such as how often participants drank alcohol, the amount of alcohol consumed in each occasion and the types of alcoholic beverage consumed were collated.    
 
The researcher team from the Institute with the National Perinatal Epidemiology Unit at the University of Oxford found that, on average, levels of alcohol intake decreased from the pre-pregnancy period to the second and third trimester.  There was no difference in outcomes for women who drank low levels of alcohol during their pregnancy and those that abstained. 
 
The incidence of preterm birth was highest amongst women who binged (9.5%) or drank heavily, even if the mother stopped drinking prior to the second trimester (13.6%), compared with less than 6% in women who did not drink during pregnancy.  There was a 2.3-fold increased odds of preterm birth in women who drank heavily in early pregnancy but then stopped (CI 0.7, 7.7) after taking into account maternal smoking, drug use, socioeconomic status and maternal health. Researchers suggest that a possible reason why this occurs is because the cessation of alcohol consumption before the second trimester may trigger a metabolic or inflammatory response resulting in preterm birth.  There was no evidence of an increased likelihood of preterm birth at low levels of alcohol consumption. 
 
Prenatal alcohol exposure did not increase the risk of babies being born small for gestational age once maternal smoking was accounted for.
 
Researchers noted a link between smoking and alcohol consumption – they found women who smoked during pregnancy were less likely to abstain from alcohol at any time during their pregnancy than non-smokers.  Over one quarter (27.7%) of women who drank in late pregnancy also smoked, compared with 19% of women who had abstained from alcohol during pregnancy.  Other factors associated with late term pregnancy drinking include: a maternal age of 30 years and above, higher income, use of illicit drugs.
 
Institute researcher Colleen O’Leary said “Our research shows pregnant women who drink more than one to two standard drinks per occasion and more than six standard drinks per week increase their risk of having a premature baby, even if they stop drinking before the second trimester.
 
“The risk of preterm birth is highest for pregnant women who drink heavily or at binge levels, meaning drinking more than seven standard drinks per week, or more than five drinks on any one occasion.
 
“Health professionals should routinely screen pregnant women and all women of child bearing age for alcohol use/misuse.  It’s important that women should be given information about the possible risks to the baby from alcohol exposure during pregnancy.
 
“Women should be advised that during pregnancy, drinking alcohol above low levels increases the risk to the baby and that the safest choice is not to drink alcohol during pregnancy.  If pregnant women cannot stop or reduce their drinking, they should seek medical advice.”
 
[A standard drink in this analysis is the Australian standard10gm of alcohol, eg 100ml of wine]
 
Professor Philip Steer, BJOG editor-in-chief said, “This study provides useful insight into the drinking habits of a representative group of women.  It is very telling how the combination of smoking and heavy drinking can mean double trouble for pregnant mothers and their babies.      
 
“It shows the effects of high alcohol use and demonstrates that heavy and binge levels of alcohol during pregnancy increases the risk to the baby, even if drinking is stopped in the first three months of pregnancy. These findings are sobering and should act as a deterrent to heavy or binge drinking during pregnancy. However, the results also show that low levels of alcohol consumption (less than 7 standard drinks per week and no more than two on any one occasion) appeared not to constitute a significant risk of preterm birth provided all other forms of unhealthy behaviour were avoided.”  
 
Source: Telethon Institute for Child Health Research  21st Jan.2009

Middle-class women are in the grip of an alarming epidemic in cocaine use.
The number seeking NHS help for addiction to the Class A drug has leapt by 50 per cent in two years.   Last year, some 2,923 women and girls sought help, according to the National Drug Treatment Monitoring System – the equivalent of eight every day.
Meanwhile, statistics released by the Ministry of Justice show that, since 2002, there has been an almost five-fold increase in the number of women cautioned by police for possession of cocaine.   Outside of London, the affluent home counties of the Thames Valley, Hertfordshire and Sussex are the places where officers issue the most cautions for cocaine possession to women.   
It will fuel fears the drug, in combination with alcohol, is taking a firm hold on the social lives of professional women who see it as ‘glamorous’.
DrugScope chief executive Martin Barnes said: ‘Cocaine was traditionally seen as a glamorous drug, usually associated with a wealthy or jet-set lifestyle. ‘While the drug has become cheaper and more available in the last decade, it has unfortunately kept some of this so-called glamorous image. ‘Cocaine is far from a safe or risk-free drug. Users can experience anxiety, insomnia and heart problems and the risks increase when the drug is combined with alcohol.’
Drug treatment experts said those seeking help for addiction to cocaine were professionals with well-paid jobs.  Critics claim use of the drug has been promoted by high-profile celebrities who confess to taking it but avoid prosecution.
Kate Moss and Jodie Kidd have been exposed as users, while classical singer Katherine Jenkins and Amy Winehouse have confessed to taking the drug.
Adrian Rides, a drug addiction recovery expert for New Choices, said: ‘It is only in the last five years that cocaine has become as popular as it is and people are starting to get into trouble with it. Most of the people I work with are entrepreneurs, bankers, musicians – basically successful and dynamic people. ‘The people who get into trouble with cocaine are often successful small business managers and the drug taps into that drive.’
Figures obtained by the Mail under Freedom of Information laws show the number of women needing treatment for all drug addiction has risen from 50,462 in 2005/06 to almost 57,000 in 2007/08.   This included 3,282 who were addicted to crack. The number of cautions given to women for cocaine offences has surged from 153 in 2002, to 542 in 2006, and 740 in 2007.
Among men the problems associated with cocaine are similarly bad. The number of NHS addicts needing treatment has soared from 6,371 in 2005/06 to 9,690 in 2007/08, an increase of 52 per cent.
Men being cautioned for possession of cocaine has also leapt – from 2,104 in 2004 to 6,634 in 2007. Cocaine was also the most commonly seized class A drug in 2006/07, with 16,079 seizures, up 35 per cent since 2005. It is the first year since records began in 1973 where cocaine seizures have totalled more than those of heroin.
Almost two in every three of the cocaine seizures were for amounts under one gram – indicating they were for use by the individual who had been caught rather than a dealer.    Last year, it was estimated that 750,000 in the country had snorted cocaine in the previous 12 months. A report by the European Monitoring Centre for Drugs and Drug Addiction said young people in the UK were more likely to take cocaine than those in any other country on the continent.
One in 20 children of 15 and 16 have used the drug, it said.
The rise in use comes in the wake of evidence of increased binge-drinking among women, allied with a surge in their involvement in violent attacks.
Source:  Mail Online 26th Jan. 2009

WASHINGTON (Reuters) – About a fifth of people with tuberculosis in the United States report abusing drugs or alcohol, and the figure is even higher when only U.S.-born patients are included, government researchers said on Monday.
The substance abusers were more contagious than others with the disease and remained contagious longer, the U.S. Centers for Disease Control and Prevention researchers wrote in the journal Archives of Internal Medicine.
About a third of people worldwide are infected with the bacterium that causes TB. Only a small percentage of people ever develop the disease. But the effect of substance abuse on the body may raise the chances that the latent infection turns into active disease, and substance abusers may be less likely to be screened for TB, the researchers said.
The researchers tracked 153,268 people with TB in the United States from 1997 to 2006, accounting for nearly everyone age 15 and older with the disease during that span.  Overall, 19 percent of them reported that they abused drugs and/or alcohol, according to the study. Among the 76,816 U.S.-born people with TB, 29 percent reported substance abuse.
The United States has very low rates of TB compared to many other parts of the world, and about half of the people with TB were born elsewhere.
“The most commonly reported risk factor for TB was substance abuse,” CDC epidemiologist Eric Pevzner, one of the researchers, said in a telephone interview. It was greater than are other leading risk factors such as HIV infection or homelessness, the researchers said.
TB is an infectious bacterial disease typically attacking the lungs. It can be spread by breathing in droplets from a cough or sneeze of an infected person.
Pevzner said the findings had important public health implications as the United States attempts to lower its TB rates even further, Pevzner said.  “We can’t treat the TB in isolation,” Pevzner said. “We have to bring in people who are experts in substance abuse and also treat the life circumstances that people are facing so that we can help cure this disease and help end a chain of transmission.”
Substance abusers are less likely to complete TB treatment, the researchers said. They also may have TB diagnosed later and have less access to routine medical care.

Source:  Reuters  16th January 2009

AUSTRALIANS who have more than four drinks on any one occasion sharply increase their risk of serious harm, the Federal Government’s new alcohol guidelines state.And people who regularly consume more than two drinks a day seriously heighten their risk of death from alcohol-related disease or injuries.
The National Health and Medical Research Council’s guidelines also express concerns about youth binge drinking, stating there is no safe level of alcohol consumption for people under 18, and warning parents against giving older children small amounts of alcohol.
The guidelines, obtained by The Sunday Age, have been softened since a controversial October 2007 draft stated that two drinks a day constituted an immediate health risk.   But the new guidelines reverse the advice in the draft that 15-to-17-year-olds could consume some alcohol under parental supervision. Parents are also warned that alcohol is particularly dangerous for under 15s and they should try to delay drinking by their teenagers for as long as possible.
The new four-drink guideline for a one-off celebration has been added in response to public angst about youth binge drinking and violence, and refers to risk of injury due to drunkenness as well as long-term health damage.   The document, which will be released on February 26, almost a year overdue, states: “In view of growing community concern about harm arising from single occasions of drinking, particularly among young people, the NHMRC undertook to also set a guideline on reducing the risk of injury on single occasions of drinking.”
Sectors of the alcohol industry, which vigorously opposed the first draft, welcomed the new guidelines. Steve Riden from the Distilled Spirits Industry Council of Australia said the guidelines “have improved significantly from those originally proposed”.
Evidence presented in the guidelines state that regularly having two drinks a day puts the lifetime risk of death from alcohol-related disease at about 0.4 in 100. Above that level the risk rises to one in 100 and continues to escalate with every drink. It also states having four drinks in one sitting more than doubles the chance of injury in the six hours afterwards.
A senior NHMRC source said: “These are not insignificant risks. This is injury sufficient enough to cause hospitalisation or death; we’re not talking about stubbing your toe as you leave the pub.”
Completion of the guidelines had been delayed as the committee tried to make the advice easier to understand. “Essentially, what the guidelines say is that if you try and aim for two drinks a day, then as a pattern over a lifetime you keep your risk relatively low. Above that, your risk rises.
“If you drink more than four on any one occasion, your risk starts to rise on that occasion … no one is saying this is what you have to do; it’s just trying to get health information out to the public in the same way as we do with blood pressure, weight or exercise.”

Source:  TheAge.com.au  1st Feb. 2009

Drug addicts find it harder than non-addicts to derive pleasure from everyday life, new Australian research shows.
The study took in 33 heroin addicts on opiate replacement, whose brain activity was measured as they looked at pictures of drug and non-drug related scenes.
Associate Professor Dan Lubman said the addicts showed elevated responses to drug-related images compared with a control group of non-drug users, but the key finding was their disinterest in otherwise pleasurable non-drug scenes.  “Looking at pictures of heroin, needles, people injecting heroin, and social drug use … the heroin group found the drug pictures much more pleasant and rewarding, it lit up the brain activity,” said Dr Lubman, of Melbourne University’s Orygen Youth Health Research Centre.  “Whereas they were under-responsive and found the emotionally pleasant pictures much less pleasant.”
Dr Lubman said the alternative images included attractive people engaged in fun activities, delicious food, and “things that people normally rank as being quite pleasurable … there were also a few puppy dogs in there”.
The same drug addicts were assessed again six months later to see who had kicked their habit, with surprising results as the critical factor was not those who enjoyed drug-related pictures the most.  “It was actually the under-responsiveness to emotional positive pleasurable stimulus that predicted who was using the most heroin,” Dr Lubman said.
He said the findings held implications for drug treatment programs and the public, who often grappled with an addict’s inability to stop using.  Dr Lubman said the results suggested drug users had a reduced ability to enjoy everyday pleasures, and their brains remained excited by the prospect of continued drug use.
It also showed why threats of punishment, which Dr Lubman calls the “big stick” approach, may not work in discouraging addicts. “They haven’t got anything else in their lives to turn to,” he said.
“Our research shows the focus should be not only just the drugs but getting them (addicts) to be passionate about something else in some way, because that’s the best predictor about whether they will stop using.”
Dr Lubman said he expected similar results to be associated with all drugs of addiction, including alcohol, and further research was needed to explain a possible “chicken and egg” problem.  Which came first, addiction leading to less pleasure in life or drug taking to overcome a pre-existing lack of enjoyment?
“There is evidence to suggest that people who are vulnerable to addictions already have an underlying emotional problem,” Dr Lubman said.
The research findings were published in the journal Archives of General Psychiatry.

Source:  www.theage.com.au  Feb. 3rd 2009

Kids on both sides of the Atlantic are smoking less pot and going out less often with friends at night, a study of 15-year-olds in 30 countries found. The double declines occurred in the United States, Canada and mostly European countries from 2002 to 2006. The trends are likely related, since other research has found that kids who spend many evenings out are more likely to smoke dope than homebodies.
Since few parents approve of marijuana use, teens are most likely to use the drug secretly away from home, said lead author Emmanuel Kuntsche of the Swiss Institute for the Prevention of Alcohol and Drug Problems.
Reasons for the declines are unclear. But the researchers said drug prevention efforts and technology may have contributed.   Instant messaging, e-mail and cell phones “may have partly replaced face-to-face contacts, leading to fewer social contacts in the evenings,” Kuntsche said.
The study appears in February’s Archives of Pediatrics and Adolescent Medicine, released Monday.  The researchers analyzed data on 93,297 15-year-olds from periodic health surveys in dozens of countries conducted in collaboration with the World Health Organization.
Survey questionnaires were distributed to entire classrooms at various schools, asking various health-related questions including about marijuana use and evenings out with friends in the past year. Responses to 2006 surveys were compared with those in 2002.   Users were kids who’d tried marijuana at least once in the past year.  Marijuana use increased only in Estonia, Lithuania and Malta, and among Russian girls.
While rates varied widely among countries, prevalence was highest both years in Canada, where 30 percent of boys and almost 28 percent of girls used marijuana in 2006. That was down 13 percent among boys and almost 10 percent among girls.
The United States ranked third in 2006, with 24 percent of boys and girls each reporting marijuana use. That was down almost 12 percent among boys and 2 percent among girls, echoing previous reports of declining pot use among U.S. teens.
Switzerland ranked second in prevalence among boys, and Wales was second among girls. Greece, Macedonia and Sweden were at the bottom of the list — with fewer than 5 percent of boys and girls reporting marijuana use in 2006.
Average number of evenings out also decreased in most countries. In the United States, nights out fell slightly to about twice a week in 2006 for boys and girls.
An Archives editorial ( http://www.archpediatrics.com) said that while evenings out may increase chances for marijuana use, parents shouldn’t discourage socializing since teens need time away from home to gain independence. Instead, the editorial advises, parents should help steer kids to activities that don’t encourage drug use.

Source: Associated Press Feb. 2009

Two Iowa State University researchers have given communities worldwide good reason to implement substance abuse prevention programs. They’re economically beneficial, with a nearly $10 return for every dollar invested in prevention.
Richard Spoth, director of the (PPSI) at Iowa State, and Max Guyll, ISU assistant professor of psychology, presented that message to substance abuse experts representing approximately 100 countries at a conference in Vienna, Austria, co-sponsored by the United Nations Office on Drugs and Crime and the World Health Organization back in December.
“We showed how prevention can be particularly economically beneficial,” Spoth said. “The presentation began by reviewing the evidence on the cost effectiveness and the return on the investment — or cost benefits — of prevention programs. I also did a second presentation on the scientific advances and positive outcomes of family-focused prevention, illustrated by our own research.”
The ISU researchers applied their own and national data to calculate both the cost effectiveness and cost benefit for two of PPSI’s intervention programs — Iowa Strengthening Families Program (ISFP), which works on the family level to prevent substance abuse; and the Life Skills Training Program (LST), which was designed for school-based implementation. Spoth defines cost effectiveness as the cost to achieve a particular outcome — such as the prevention of an alcohol use disorder — while the cost benefit assesses whether savings generated by prevention are greater than costs spent on prevention.
The longitudinal “Project Family” study recruited 667 families through 33 Iowa school districts. The researchers calculated that the ISFP intervention cost $12,459 per disorder prevented, but resulted in a $119,633 benefit to communities per alcohol disorder prevented — a $9.60 return on each dollar invested. The “Capable Families and Youth” trial recruited 679 families through 36 Iowa school districts. Researchers found that life skills training intervention cost $4,921 per methamphetamine use case prevented, but produced a $130,013 employer benefit per methamphetamine user prevented — a $9.98 return on each dollar invested.
“Effective and efficient prevention promises to save possibly billions of dollars per year, provided we can learn how to effectively implement it on a larger scale,” Spoth told the conference.
Iowa State was the only American university that had a presenter invited to speak on the topic of prevention. Spoth, who received a commendation from the director of the National Institute on Alcohol Abuse and Alcoholism last year for his prevention work, was also the only expert asked to present twice at the conference.
“I spoke with people there who were very interested in doing family-focused prevention programming, which is evidence-based, in their countries,” Spoth said. “Some of them are developing these vast infrastructures, devoting extensive resources. I received a number of requests where they wanted me to get involved in some way with a group that was working on a large scale implementation of prevention programming in their country.”
Spoth reports that his conference appearance generated requests from Chile, India, Indonesia, Senegal and a number of other countries for consulting assistance as they implement intervention programs — possibly modeled after the ones he’s successfully implemented through PPSI.
He’s also been asked to participate in the meetings by the International Narcotics Control Board, located in Vienna, to work with them to produce their annual report.”They evaluate international substance issues in depth,” Spoth said. “What they would want me to address is the state of the art in effective prevention worldwide.”
The complete ISU reports “Prevention’s Cost Effectiveness — Illustrative Economic Benefits of General Population Interventions,” and “Prevention of Substance-related Problems: Effectiveness of Family-focused Prevention” are available online at: http://www.ppsi.iastate.edu/press/vienna.htm.

Source www.newswise.com  Feb 2009

Doctors and drug workers in Bristol have established a link between the use of Class C drug ketamine and severe bladder and kidney problems.
A BBC investigation for Inside Out West found a rising number of ketamine users in their teens and 20s were admitted to Southmead Hospital over the past year.
Many had to undergo operations – two even needed their bladders removing. Doctors at the hospital conducted further research and discovered a similar pattern across the UK.  Ketamine is a short-acting but powerful general anaesthetic which depresses the nervous system and causes a temporary loss of body sensation.
Kidney pains
In the early 1990s the drug started becoming popular on the UK club scene as people bought it in the mistaken belief it was ecstasy. It was made illegal in January 2006 when the government classified it as a Class C drug.
 
 
The drug comes in various forms, most commonly as a powder, but also as a liquid and a tablet.   The British Crime Survey for 2008 revealed its use was up 10% on the previous year.
The BBC researchers found many users were unaware of the long-term effects of the drug on their health.  Symptoms include pains in the stomach and kidneys, wanting to go to the toilet all the time, often getting up in the night as many as 30 times, and finding the process agonising.
‘Physically shrivelled’
During 2008 the Bristol Drugs Project said there had been a noticeable increase in the number of ketamine users asking for help.   One anonymous user, who is now waiting for bladder reconstruction surgery, told a BBC researcher: “Doctors told me the capacity of my bladder had shrunk.
“It was actually physically shrivelled and scarred, there was an awful lot of scar tissue.  “A lot of the muscle around the outside, which obviously helps your bladder contract and which is what makes you go, a lot of that had been eaten away by the ketamine.”   The programme found there are other similar cases on waiting lists in Bristol. Operations have also been carried out in London and Liverpool.
David Gillatt, a consultant urologist at Southmead Hospital, said: “This is a worrying development as major bladder operations, such as the ones they’re now carrying out, are normally performed on a much older age group.  “We have got cases who’ve had to go as far as major surgery to remove the bladder and that’s a fairly big step.  “These people are often in their teens through to 20s, maybe 30s at the oldest, and that’s something they’ll have to live with for the rest of their days.” Professor David Nutt, who chairs the government’s drug advisory panel, is being kept regularly updated on the latest developments in the research in Bristol.
 Source:  BBC News Channel  4th Feb.2009

Specialist liver services are already at full capacity and demand is growing as increasing numbers of younger people fall ill due to their drinking, according to doctors writing in the journal Clinical Medicine.
A questionnaire of gastroenterologists revealed that the majority of hospitals have only have the number of specialist doctors needed for the expected workload of an average local hospital. There is also shortages of specialist nurses, radiologists, pathologists and psychiatrists, the study said.
Author of the study Dr Michael Williams, Specialist Registrar at Derby Digestive Diseases Centre, Derby City General Hospital said the shortages will affect patient care and hospitals should be organised into networks as recommended by the National Plan for Liver Services.   Professor Ian Gilmore, President of the Royal College of Physicians, Professor of Medicine and consultant gastroenterologist at Royal Liverpool University Hospitals said: “Liver disease is increasing and the majority of the increase is alcohol-related.
“Deaths from alcohol-related liver disease are continuing to rise and across all liver disease deaths have gone up ten fold since the 1970s.  Liver disease stands out starkly as an increasingly common cause of death at a time when improvements in health are being seen in other areas. Many deaths are avoidable with specialist care but our hospitals services have not kept pace with this rising tide of liver disease.
“We need to urgently implement the national plan to remedy this.”
Prof Gilmore said the Government was taking action on alcohol labelling and selling at discounts but more needed to be done as drink has never been more available or cheaper than it is now.
He said the best way to bring down harmful alcohol consumption would be to introduce a minimum price per unit as this would not affect the middle market wines but would hit the cheap strong ciders and lagers which are often drunk to excess.

Source: www.Telegraph.co.uk  4rh Feb.2009

Adolescents and young adults who are heavy users of marijuana are more likely than non-users to have disrupted brain development, according to a new study. Pediatric researchers found abnormalities in areas of the brain that interconnect brain regions involved in memory, attention, decision-making, language and executive functioning skills. The findings are of particular concern because adolescence is a crucial period for brain development and maturation.
The researchers caution that the study is preliminary and does not demonstrate that marijuana use causes the brain abnormalities. However, “Studies of normal brain development reveal critical areas of the brain that develop during late adolescence, and our study shows that heavy cannabis use is associated with damage in those brain regions,” said study leader Manzar Ashtari, Ph.D., director of the Diffusion Image Analysis and Brain Morphometry Laboratory in the Radiology Department of The Children’s Hospital of Philadelphia.  The study appeared early last month in the Journal of Psychiatric Research. The current research builds on previous work by Ashtari and colleagues, who used the same imaging technology to analyze normal brain development in adolescent subjects.
In the current study, working with child psychiatrist Sanjiv Kumra, M.D., now at the University of Minnesota, Ashtari and colleagues performed imaging studies on 14 young men from a residential drug treatment center in New York State, as well as 14 age-matched healthy controls. All the study subjects were males, with an average age of 19. The researchers performed the imaging studies at Long Island Jewish Medical Center.  The 14 subjects from the drug treatment center all had a history of heavy cannabis use during adolescence. On average, they had smoked marijuana from age 13 till age 18 or 19, and reported smoking nearly 6 marijuana joints daily in the final year before they stopped using the drug.
The study team performed a type of magnetic resonance imaging scan called diffusion tensor imaging (DTI) that measures water movement through brain tissues. “The abnormal patterns of water diffusion that we found among the young men with histories of marijuana use suggest damage or an arrest in development of the myelin sheath that surrounds brain cells,” said Ashtari. Myelin provides a coating around brain cells similar to insulation covering an electrical wire. If myelin does not function properly, signaling within the brain may be slower.
Myelin gives its color to the white matter of the brain, and covers the nerve fibers that connect different brain regions. “Our results suggest that early-onset substance use may alter the development of white matter circuits, especially those connections among the frontal, parietal and temporal regions of the brain,” said Ashtari. “Abnormal white matter development could slow information transfer in the brain and affect cognitive functions.”
Ashtari added that the findings are preliminary. Among other limitations of the study, such as a small sample size, five of the 14 subjects with heavy cannabis use also had a history of alcohol abuse, which may have contributed an effect. Also, it is possible that the brain abnormalities may have predisposed the subjects to drug dependence, rather than drug usage causing the brain abnormalities.
“Further research should be done to investigate the relation between repeated marijuana use and white matter development,” said Ashtari. “However, our work reinforces the idea that the adolescent brain may be especially vulnerable to risky behaviors such as substance abuse, because of crucial neural development that occurs.
Source: Science Daily 5th Feb 2009

People with mental illness alone are no more likely than anyone else to commit acts of violence, a new study by UNC researchers concludes. But mental illness combined with substance abuse or dependence elevates the risk for future violence.
“Our study shows that a link between mental illness and violence does exist, but it’s not as strong as most people think,” said Eric B. Elbogen, Ph.D., lead author of the study and assistant professor in the forensic psychiatry program at the University of North Carolina at Chapel Hill School of Medicine.
“We found that several other factors – such as a history of past violence or substance abuse or a recent divorce or loss of one’s job – are much more predictive of future violence than mental illness alone,” Elbogen said. “Only when a person has both mental illness and substance abuse at the same time does that person’s risk of future violence outweigh anyone else’s.”
UNC co-author Sally C. Johnson, M.D. added, “These findings challenge the perception some people have, and which you often see reflected in media coverage, that mental illness alone makes someone more dangerous. Our study shows that this perception is just not correct.”  Elbogen and Johnson’s study is published in the February 2009 issue of Archives of General Psychiatry. To arrive at their findings, they conducted statistical analyses of data collected previously as part of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) conducted by the National Institute of Alcohol Abuse and Alcoholism.
A total of 34,653 people completed interviews during the two separate waves of NESARC. Wave 1 took place from 2001-2002 while wave 2 was from 2004-2005. Wave 1 data on severe mental illness – including schizophrenia, bipolar disorder and major depression – were analyzed to predict wave 2 data on violent behavior.
The results show “that if a person has severe mental illness without substance abuse and history of violence, he or she has the same chances of being violent during the next 3 years as any other person in the general population,” Elbogen and Johnson wrote. 
When mental illness is combined with substance abuse, the risk for future violence reaches the level of statistical significance. However, even mental illness combined with substance abuse ranks only ninth on the study’s list of the top 10 predictors of future violence. The higher ranking predictors, listed in order of their predictive value, are age (younger people are more likely to commit acts of violence), history of violence, sex (males are more prone to violence), history of juvenile detention, divorce or separation in the past year, history of physical abuse, parental criminal history and unemployment for the past year. Victimization in the past year was the tenth predictor.
“The data shows it is simplistic as well as inaccurate to say the cause of violence among mentally ill individuals is the mental illness itself … the current study finds that mental illness is clearly relevant to violence risk but that its causal roles are complex, indirect, and embedded in a web of other (and arguably more) important individual and situational cofactors to consider,” the study concludes.
Source:   ScienceDaily (Feb. 3, 2009)

There is growing evidence suggesting that
adolescence is a key period for neuronal maturation. The
results of the current study support that heavy cannabis
use during adolescence is related to brain damage in areas
known to be involved in ongoing development during late
adolescence, particularly in the fronto-temporal connection
via arcuate fasciculus. These results suggest that earlyonset
substance use may affect the development of fronto-
temporal white matter circuits, potentially resulting in
disturbed memory, and deficits in executive and affective
functioning (Lubman et al., 2007). Since five of the HCU
subjects were alcohol abusers, conclusions from our report
should be considered preliminary as the DTI findings
reported here may be due to combination of alcohol and
marijuana use. Adolescence, however, being marked as a
critical time for brain maturation and development, may
be a vulnerable period to partake in risky behaviors, such
as marijuana or alcohol use, for both physiological

Source: extract from  Journal of Psychiatric Research 43 (2009) 189–204

Young men who smoke marijuana are more likely to develop an aggressive form of testicular cancer than those who have never tried the drug, a study has found.

Smoking the drug at least once a week, or using it regularly from adolescence, doubled the risk of a fast-growing form of the disease called nonseminoma, which tends to strike men in their 20s and 30s, researchers said.

The US study is the first to find evidence of a link between cannabis and testicular cancer, which is the most common type of cancer among British men aged 20 to 44. More than 1,900 new cases of the disease are diagnosed in the UK each year, but it responds well to treatment, with nine in 10 men surviving.

The findings suggest that smoking the drug before the age of 18 raises the cancer risk by coaxing immature cells in the testes to become tumours later in life.

Scientists at the Fred Hutchinson Cancer Research Centre in Seattle investigated the possibility of a link after learning that the testes were one of the few organs in the body to contain receptors for the main psychoactive substance in the drug, tetrahydrocannabinol (THC). There has also been a rise in testicular cancer cases that has mirrored the rise in marijuana use since the 1950s, they said.

“Our study is not the first to suggest that some aspect of a man’s lifestyle or environment is a risk factor for testicular cancer, but it is the first that has looked at marijuana use,” said Stephen Schwartz, an epidemiologist and author on the study.

The researchers asked 369 testicular cancer patients if they had any history of marijuana use. A further 979 healthy men were asked about their use of the drug.

After accounting for any family history of the cancer and lifestyle factors, such as smoking and drinking alcohol, the study found cannabis use emerged as a significant, separate risk factor for the disease.

Being an existing cannabis user raised the risk of cancer by 70%, while men who had used the drug regularly from puberty were twice as likely to develop the disease than those who had not used the drug.

Men naturally produce a cannabinoid-like substance that is thought to protect the testes against tumours. But smoking cannabis may disrupt this and so raise the risk of cancer, the study speculates.

Source:  www.guardian.co.uk   9th Feb. 2009

The United Kingdom has one of the highest rates of illicit drug use in the developed world.In 2007, it was estimated that more than eleven million adults aged between 16 and 59 in England and Wales had taken illegal drugs in their lifetime, including over three million who had taken an illicit drug in the past year. Many drug users have taken cannabis only a few times in their lives and no other drugs. For a minority, drug use becomes regular and prolonged, and is associated with a high degree of harm to themselves and others.

Drug misuse is defined by the World Health Organisation as the use of a substance for a purpose not consistent with legal or medical guidelines, for example the non-medical use of prescription medications or the recreational use of illegal drugs. Drug misuse is not necessarily problematic, though it can never be considered risk-free.

 More people take cannabis than any other drug, but problematic drug use, particularly dependence, is most frequently associated with opiates. For example, the National Treatment Agency for Substance Misuse report that heroin is the main drug misused by 66%of their clients aged 18 or over, with a further 8%naming other opiates as their main drug of misuse. The annual
social and economic cost of Class A drug use has been estimated at £15.4 billion a year; 99%of this is accounted for by problem drug users.

A number of adverse health outcomes have been associated with drug misuse. Injecting drug users are vulnerable to thrombosis, abscesses, blood-borne diseases (particularly hepatitis B and C and HIV), and respiratory problems. Frequent cannabis use has also been associated with respiratory problems.
There is significant co-morbidity between drug misuse and poor mental health. Problematic use of one drug often co-occurs with misuse of or dependence on other drugs and alcohol.

Drug misuse and drug dependence are more prevalent in adults with various psychiatric problems, from common mental disorders to personality disorders and severe psychotic illness. For example, cannabis use has been linked to the development of acute and long term psychotic symptoms, though the causal pathways for the latter remain unclear. In prisoners in England and Wales, severe dependence on cannabis or stimulants, such as amphetamines or cocaine, was associated with an increased risk of psychosis. Significant proportions of those being treated as inpatients or in the community for severe mental illness have substance misuse problems, and this has treatment implications that are not
always satisfactorily addressed. ( Psychiatric comorbidity, including with drug
dependence, is considered in Chapter 12 of this report.)

The number of admissions to NHS hospitals with a primary or secondary diagnosis of drug related mental health or behavioural disorder has risen from 19,018 episodes in 1996/97 to 38,170 in 2006/07.15 In the same period, the number of admissions with a primary diagnosis of poisoning by drugs rose from 7057 to 10,047. Between 1993 and 1999, deaths in England attributable to drug misuse rose from 786 to 1538.16 Since then the level has remained constant; in 2006, 1469 deaths were attributable to drug misuse.

 In 2007/08, 202,666 individuals were in contact with structured drug treatment services in England. Though the health impacts of drug dependence are significant, the harm to society of drug related crime is also great. It has been estimated that between a third and a quarter of acquisitive crime – including burglary, theft, fraud and the sale of sex – is drug-related. Surveys of offenders have shown high rates of recent heroin and cocaine use, and made explicit the link between criminal behaviour and the need to get money to buy drugs. Other types of crime are less strongly linked to drug use, although drug dealing may be linked to high levels of community violence.

The risk factors for drug use are similar to those for criminal behaviour, including social and economic deprivation and family breakdown. In young people, truancy, exclusion from school, serious or frequent offending and homelessness are linked to an increased risk of frequent drug use and the use of Class A drugs.  The harm caused by problem drug use also extends to the families of drug users and to the communities in which they live. The children of people with problematic drug use have been described as being at risk from conception to adulthood, from multiple and cumulative harms to their mental and physical health, and to their social, emotional and educational development. Already-deprived communities are most at risk of drug-related harm, through the direct effect on users, as well as increased rates of crime and antisocial behaviour.

Increasing concern about the harm caused by drug misuse and dependence during the 1990s led to the publication of the first ten-year drugs strategy in 1998, updated in 2002.  Its overall aim was to ‘reduce the harm caused by illegal drugs’, with objectives relating to four themes: preventing young people from becoming drug users, treatment of problem drug users, reducing the supply of drugs, and reducing drug-related crime.

The first drug strategy could claim some successes, including a reduction in the prevalence of lifetime drug use, a doubling between 1998 and 2008 of the numbers of drug users receiving treatment, and a reduction in recorded acquisitive crime. In 2008 the second ten year drug strategy was published. This strategy focused on:

• Protecting communities through tackling drug supply, drug-related crime     and anti-social behaviour;
• Preventing harm to children, young people and families affected by drug misuse;
• Delivering new approaches to drug treatment and social re-integration; and
• Public information campaigns, communications and community engagement.

The major source of data on the prevalence of drug use by adults aged 16 and over in England is the annual British Crime Survey (BCS). The 2006/07 BCS estimated that 35.5% of adults in England and Wales aged between 16 and 59 had taken illegal drugs at some time, including 13.8%of adults who had taken one or more Class A drugs.

10.0%of adults had taken drugs in the past year. Cannabis was the most commonly used drug; 8.2% of adults had taken cannabis in the past year. 3.4%of adults had taken a Class A drug in the past year.

Men were more likely than women to have taken drugs. Drug use in the past year was most common in 16 to 19 year olds (23.3%) and 20 to 24 year olds (24.8%), but declined sharply with age thereafter. Around half of adults in their twenties had taken drugs at some time in their lives. This was increasingly less likely in older adults; among 55 to 59 year olds, the oldest age group for whom data were available, 18.1%had taken drugs at least once.

It is acknowledged that using a household survey of this kind to measure drug use may underestimate several key groups whose patterns and levels of drug use may be atypical. These include students in halls of residence, the homeless, and those in institutions, including hospitals and prisons. Additionally, drug dependent people living in private households may be relatively less likely to participate in surveys, given that they may lead chaotic lives which make them less available, able or willing to answer survey questions. Comparisons of the BCS with the numbers of drug users in treatment confirm that surveys significantly underestimate the number of dependent drug users.

Source:  Adult Psychiatic Morbidity in England. Report for NHS Information Centre Feb. 2009 National Centre for Social Research morbidity in England.

A Cognitive and Psychiatric Study

Originally, those asserting that crude marijuana should be approved for medical use claimed that it should be available for the terminally ill or those suffering from intractable pain. The scope of projected uses rapidly expanded to include “debilitating” conditions, which might be anything that the user perceived was a handicap or impairment. 

Marijuana contains numerous unique compounds known as cannabinoids.  Several of these have been synthesized and developed into useful drugs for specific medical use but these drugs are devoid of the more than 2000 impurities found in smoked cannabis, and the potency and dose of these manufactured drugs can be carefully adjusted to the patient.

In a recent study by Drs. Ghaffar and Feinstein, in the journal Neurology, 2008:71:164-169,(Multiple sclerosis and cannabis: a cognitive and psychiatric study),  found that patients with multiple sclerosis (MS) who were regular smoking of street cannabis had more extensive cognitive abnormalities compared to patients with MS who don’t use cannabis.  The study did not note this disparity in the controlled pharmaceutical use of cannabis-based medicinal extracts (CBMEs).  The authors, in response to an inquiry in the January 6, 2009 issue of Neurology, stated that “Based on the existing literature, it seems unlikely that the cognitive problems identified in our cannabis smokers are a function of a withdrawal syndrome, but we cannot be certain this given the limitations in our data.”   This statement acknowledges that there is a “withdrawal syndrome” for cannabis and that “cognitive problems” are associated with withdrawal from cannabis. 
Source:  Journal Neurology, 2008:71:164-169

This case-control study investigated cannabis use as a possible cause for the increase in testicular tumours in recent decades. Testicular tumours typically affect men in their 20s, 30s and 40s. There are two main types of testicular cancer: seminomas and nonseminomas. They are both types of germ (seed) cell tumours. The peak age for developing these types of tumour is between 20 and 35 years for nonseminomas and between 30 and 45 years for seminomas. The aim of this study was to compare previous cannabis use in men who had developed testicular cancer with a group of matched controls who had not.
The ATLAS study recruited men between 18 and 44 years living in three counties of Washington State who had been diagnosed with invasive testicular cancer between January 1999 and January 2006. Of the possible 550 cancer cases, the researchers interviewed and enrolled 369 men in their study.
Men who did not have testicular cancer were identified for the control group by a technique called random digit dialling. This involves calling random phone numbers and establishing if there is somebody matching certain criteria living at that address. In this case, the controls were male, matched to the cases by age and had to have been living in the same area during the diagnosis period. The researchers interviewed 979 of 1,875 eligible controls.
All cases and controls were interviewed using a questionnaire asking about demographics, cigarette smoking, alcohol use, recreational drug use, family history and other known risk factors for testicular cancer. The cases were asked to give their exposure to these risks for the time before they were diagnosed with cancer. The controls were then asked about their behaviour from that same date. Each man who reported marijuana use was asked to recall the times in his life when he used marijuana or hashish (or both), the age at which he first and last used it, and the frequency (times per day, week, month or year).
The researchers carried out statistical analyses for all testicular cancers combined, and then separately for type of cancer: seminomas, nonseminomas and each particular subtype of nonseminomas. They looked at risk of cancer according to marijuana use, while adjusting for (taking into account) confounders such as smoking and alcohol use.
What were the results of the study?
Compared with controls, cases were more likely to be from a lower socioeconomic background and to have less than college education. There were also no men of African-American origin in the cases. Cases were also more likely to have a first-degree relative with testicular cancer and to have a history of cryptorchidism (undescended testis/testes).
A slightly higher proportion of men with testicular cancer had ever smoked marijuana (72.6%) compared to the controls (68.0%). However, from this, the calculated risk of testicular cancer with ever having used marijuana was only borderline significant (OR, 1.3; 95% CI, 1.0-1.8). A higher proportion of cases reported being current marijuana users (26% versus 20%), and to have started using marijuana below the age of 18 years (21% versus 15%). How many years the men had used marijuana did not significantly affect the risk of testicular cancer.
Men with testicular cancer more commonly used marijuana once or more times per week (15% versus 10% of the control group). Using marijuana once or more times per week doubled the risk of testicular cancer (OR, 2.0; 95% CI, 1.3-3.2) compared with never using it. Using marijuana less than once a week was not associated with a significantly increased risk.
When the researchers carried out subgroup analyses by type of testicular cancer they found that the increased risk of seminoma from current marijuana use was non-significant, but the increased risk for nonseminoma was significant (OR, 2.3; 95% CI, 1.3-4.0).
What interpretations did the researchers draw from these results?
The researchers conclude that they found a link between marijuana use and the occurrence of nonseminomas. They say that additional studies are needed to test further the theory of a link between marijuana use and testicular cancer, and to explore the possible biological reasons for this.

Source:  medical journal Cancer Feb 2009

Marijuana use appears to have decreased among most European and North American adolescents between 2002 and 2006, and those who went out with friends on fewer evenings of the week were less likely to report using the drug, according to a report in the February issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
“Cannabis [marijuana] use among young people is a serious public health concern,” the authors write as background information in the article. Recent evidence links marijuana use to motor vehicle accidents, injuries, inflammatory and cancerous changes in the airways and mental health problems, including depression. Long-term detrimental effects include poor academic performance and failure to complete schooling, impeding development and hampering future career opportunities.
“One factor that may help explain why adolescents engage in cannabis use is association with cannabis-using peers, which can increase the availability of cannabis and socially influence use,” the authors write. To investigate this link and also trends in marijuana use over time, Emmanuel Kuntsche, Ph.D., of the Swiss Institute for the Prevention of Alcohol and Drugs Problems, Lausanne, and colleagues analyzed data from 93,297 15-year-old students who participated in the Health Behavior in School-Aged Children study. Participants in 31 countries (mostly in Europe and North America) were surveyed in 2002 and again in 2006 about marijuana use and the number of evenings per week they usually spend out with their friends, among other topics.
During the four-year study period, marijuana use decreased in most of the countries, with the most significant declines in England, Portugal, Switzerland, Slovenia and Canada. Increases were observed in Estonia, Lithuania, and Malta and among Russian girls. The number of evenings out with friends also declined in most countries during the same time period, although there was a wide range in averages, from about one evening per week for Portuguese girls to more than three evenings per week among boys and girls in the Ukraine, Russia, Scotland, Estonia and Spain.
“The more frequently adolescents reported going out with their friends in the evenings, the more likely they were to report using cannabis,” the authors write. “This link was consistent for boys and girls and across survey years. Across countries, changes in the mean [average] frequency of evenings spent out were strongly linked to changes in cannabis use.”
Besides a decline in evenings out with friends, potential reasons for the decline in marijuana use include prevention efforts, availability or changes in teen preferences. It is more difficult to pinpoint factors behind the decline in evenings out, the authors note. New forms of communication, such as e-mail and text messaging, may have replaced some face-to-face interactions, or that the high rate of marijuana use in 2002 may have increased parental concerns about substance use and made access to the drug and evenings out more difficult.
“This overview of trends in 31 countries and regions provides policy makers with important information on the prevalence and amount of change in cannabis use among boys and girls in their countries,” the authors write. “There is a great need to learn more about the nature of evenings out with friends and related factors that might explain changes in adolescent cannabis use over time. Because there are many benefits to adolescent social interaction, it is important to determine how best to foster it without unduly increasing exposure opportunities for cannabis use.”
(Arch Pediatr Adolesc Med. 2009;163[2]:119-125. Available pre-embargo to the media at www.jamamedia.org.)
________________________________________
Editorial: Reducing Social Time for Teens Not an Ideal Prevention Method
“What we have gained from this well-designed international study is further convincing evidence that unsupervised social time is a critical ingredient for cannabis use for many young people,” write John E. Schulenberg, Ph.D., and Patrick M. O’Malley, Ph.D., of the University of Michigan, Ann Arbor, in an accompanying editorial.
“This might lead some to suggest a simple intervention of reducing unsupervised time with friends by, for example, increasing structured time with friends, increasing school and work time or increasing alone time,” the authors write. “However, this strategy may have unintended consequences for many adolescents. An important part of adolescence is exploring and forming friendships, having bonding experiences and finding a safe haven with friends away from adult supervision.”
“Thus, rather than trying to reduce socializing with friends, a more complicated but possibly more successful approach to intervention would help young people find activities together that do not promote marijuana use,” they conclude.

Source: Arch Pediatr Adolesc Med. 2009;163[2]:183-184

Scientists at Stanford University School of Medicine have discovered that a commonly available non-addictive drug can prevent symptoms of withdrawal from opioids with little likelihood of serious side effects.
The drug, ondansetron, which is already approved to treat nausea and vomiting, appears to avoid some of the problems that accompany existing treatments for addiction to these powerful painkillers, the scientists said.
Opioids encompass a diverse array of prescription and illegal drugs, including codeine, morphine and heroin. In 2007, about 12.5 million Americans aged 12 and older used prescription pain medications for non-medical purposes, according to the National Survey on Drug Use and Health, administered by the federal government’s Substance Abuse and Mental Health Services Administration.
“Opioid abuse is rising at a faster rate than any other type of illicit drug use, yet only about a quarter of those dependent on opioids seek treatment,” said Larry F. Chu, MD, assistant professor of anesthesia at the School of Medicine and lead author of the study that will be published online Feb. 17 in the Journal of Pharmacogenetics and Genomics. “One barrier to treatment is that when you abruptly stop taking the drugs, there is a constellation of symptoms associated with withdrawal.” Chu described opioid withdrawal as a “bad flu,” characterized by agitation, insomnia, diarrhea, nausea and vomiting.
Current methods of treatment are not completely effective, according to Chu. One drug used for withdrawal, clonidine, requires close medical supervision as it can cause severe side effects, while two others, methadone and buprenorphine, don’t provide a satisfactory solution because they act through the same mechanism as the abused drugs. “It’s like replacing one drug with another,” said co-investigator Gary Peltz, MD, PhD, professor of anesthesia.  “What we need is a magic bullet,” said Chu. “Something that treats the symptoms of withdrawal, does not lead to addiction and can be taken at home.”
The researchers’ investigation led them to the drug ondansetron, after they determined that it would block certain receptors involved in withdrawal symptoms.
The scientists were able to make this connection thanks to their having a good animal model for opioid dependence. Mice given morphine for several days develop the mouse equivalent of addiction. Researchers then stop providing morphine to trigger withdrawal symptoms. Strikingly, these mice, when placed into a plastic cylinder, will start to jump into the air. One can measure how dependent these mice are by counting how many times they jump. Like humans, dependent mice also become very sensitive to pain when they stop receiving morphine.
But the responses vary among the laboratory animals. There are “different flavors of mice,” explained Peltz. “Some strains of mice are more likely to become dependent on opioids.” By comparing the withdrawal symptoms and genomes of these different strains, it’s possible to figure out which genes play a major role in addiction.
To accomplish this feat, Peltz and his colleagues used a powerful computational “haplotype-based” genetic mapping method that he had recently developed, which can sample a large portion of the genome within just a few hours. This method pinpoints genes responsible for the variation in withdrawal symptoms across these strains of mice.
The analysis revealed an unambiguous result: One particular gene determined the severity of withdrawal. That gene codes for the 5-HT3 receptor, a protein that responds to the brain-signaling chemical serotonin.   To confirm these results, the researchers injected the dependent mice with ondansetron, a drug that specifically blocks 5-HT3 receptors. The drug significantly reduced the jumping behavior of mice as well as pain sensitivity – two signs of addiction.
The scientists were able to jump from “from mouse to man” by sheer luck: It turns out that ondansetron is already on the market for the treatment of pain and nausea. As a result, they were able to immediately use this drug, approved by the Food and Drug Administration, in eight healthy, non-opioid-dependent humans. In one session, they received only a single large dose of morphine, and in another session that was separated by at least week, they took ondansetron in combination with morphine. They were then given questionnaires to assess their withdrawal symptoms.
Similar to mice, humans treated with ondansetron before or while receiving morphine showed a significant reduction in withdrawal signs compared with when they received morphine but not ondansetron. “A major accomplishment of this study was to take lab findings and translate them to humans,” said principal investigator J. David Clark, MD, PhD, professor of anesthesia at Stanford University School of Medicine and the Palo Alto Veterans Affairs Health Care System.
Chu plans on conducting a clinical study to confirm the effectiveness of another ondansetron-like drug in treating opioid withdrawal symptoms in a larger group of healthy humans. And the research team will continue to test the effectiveness of ondansetron in treating opioid addiction.
The scientists warned that ondansetron will not by itself resolve the problems that arise with continued use of these painkillers. Addiction is a long-term, complex process, involving both physical and psychological factors that lead to compulsive drug use. “This is not a cure for addiction,” said Clark. “It’s (wrong) to think that any one receptor is a panacea for treatment. Treating the withdrawal component is only one way of alleviating the suffering. With luck and determination, we can identify additional targets and put together a comprehensive treatment program.”
Collaborators on this study included De-Yong Liang, PhD, the study’s co-lead author, previously a research associate in the Department of Anesthesia and currently a research associate at the Palo Alto Institute for Research and Education; Xiangqi Li, MD, a life science research assistant in the department; Nicole D’Arcy, a medical student: Peyman Sahbaie, MD, a research associate at the institute; and Guochun Liao, PhD, of the pharmaceutical company Hoffman-La Roche. This work was supported by grants to Clark from the National Institutes of Health and the National Institute on Drug Abuse, and grants to Chu from the NIH and the National Institute of General Medical Sciences.
The researchers are working with the Stanford University Office of Technology Licensing to seek a patent for the use of ondansetron and related medicines in the treatment of drug addiction.
Source:  http://med-www.stanford.edu/   18-Feb-2009

ScienceDaily (Feb. 20, 2009) — An ingredient in licorice shows promise as an antidote for the toxic effects of cocaine abuse, including deadly overdoses of the highly addictive drug, researchers in Korea and Pennsylvania are reporting.
In the new study, Meeyul Hwang, Chae Ha Yang, and colleagues note that there is currently no effective medicine for treating cocaine abuse or addiction. Recent animal studies conducted by the researchers show that a licorice ingredient called isoliquiritigenin (ISL) can block the nervous system’s production of dopamine. That neurotransmitter is involved in emotion, movement, and other brain activities.
Cocaine and other addictive drugs stimulate dopamine and help produce the pleasurable and addictive effects. Drugs that block dopamine block this response. The scientists used rats as model animals to show that rats injected with ISL just prior to cocaine-administration showed 50 percent less of the behavioral effects associated with the illicit drug.
They also showed that ISL injections protected nerve cells in the brain from cocaine-associated damage.

Source: ScienceDaily. http://www.sciencedaily.com¬ /releases/2009 February 22, 2009

ScienceDaily (Feb. 19, 2009) — Scientists at Stanford University School of Medicine have discovered that a commonly available non-addictive drug can prevent symptoms of withdrawal from opioids with little likelihood of serious side effects. The drug, ondansetron, which is already approved to treat nausea and vomiting, appears to avoid some of the problems that accompany existing treatments for addiction to these powerful painkillers, the scientists said.

Opioids encompass a diverse array of prescription and illegal drugs, including codeine, morphine and heroin. In 2007, about 12.5 million Americans aged 12 and older used prescription pain medications for non-medical purposes, according to the National Survey on Drug Use and Health, administered by the federal government’s Substance Abuse and Mental Health Services Administration.
“Opioid abuse is rising at a faster rate than any other type of illicit drug use, yet only about a quarter of those dependent on opioids seek treatment,” said Larry F. Chu, MD, assistant professor of anesthesia at the School of Medicine and lead author of the study that will be published online Feb. 17 in the Journal of Pharmacogenetics and Genomics. “One barrier to treatment is that when you abruptly stop taking the drugs, there is a constellation of symptoms associated with withdrawal.” Chu described opioid withdrawal as a “bad flu,” characterized by agitation, insomnia, diarrhea, nausea and vomiting.
Current methods of treatment are not completely effective, according to Chu. One drug used for withdrawal, clonidine, requires close medical supervision as it can cause severe side effects, while two others, methadone and buprenorphine, don’t provide a satisfactory solution because they act through the same mechanism as the abused drugs. “It’s like replacing one drug with another,” said co-investigator Gary Peltz, MD, PhD, professor of anesthesia.
“What we need is a magic bullet,” said Chu. “Something that treats the symptoms of withdrawal, does not lead to addiction and can be taken at home.”
The researchers’ investigation led them to the drug ondansetron, after they determined that it would block certain receptors involved in withdrawal symptoms.
The scientists were able to make this connection thanks to their having a good animal model for opioid dependence. Mice given morphine for several days develop the mouse equivalent of addiction. Researchers then stop providing morphine to trigger withdrawal symptoms. Strikingly, these mice, when placed into a plastic cylinder, will start to jump into the air. One can measure how dependent these mice are by counting how many times they jump. Like humans, dependent mice also become very sensitive to pain when they stop receiving morphine.
But the responses vary among the laboratory animals. There are “different flavors of mice,” explained Peltz. “Some strains of mice are more likely to become dependent on opioids.” By comparing the withdrawal symptoms and genomes of these different strains, it’s possible to figure out which genes play a major role in addiction.
To accomplish this feat, Peltz and his colleagues used a powerful computational “haplotype-based” genetic mapping method that he had recently developed, which can sample a large portion of the genome within just a few hours. This method pinpoints genes responsible for the variation in withdrawal symptoms across these strains of mice.
The analysis revealed an unambiguous result: One particular gene determined the severity of withdrawal. That gene codes for the 5-HT3 receptor, a protein that responds to the brain-signaling chemical serotonin.
To confirm these results, the researchers injected the dependent mice with ondansetron, a drug that specifically blocks 5-HT3 receptors. The drug significantly reduced the jumping behavior of mice as well as pain sensitivity — two signs of addiction.
The scientists were able to jump from “from mouse to man” by sheer luck: It turns out that ondansetron is already on the market for the treatment of pain and nausea. As a result, they were able to immediately use this drug, approved by the Food and Drug Administration, in eight healthy, non-opioid-dependent humans. In one session, they received only a single large dose of morphine, and in another session that was separated by at least week, they took ondansetron in combination with morphine. They were then given questionnaires to assess their withdrawal symptoms.
Similar to mice, humans treated with ondansetron before or while receiving morphine showed a significant reduction in withdrawal signs compared with when they received morphine but not ondansetron. “A major accomplishment of this study was to take lab findings and translate them to humans,” said principal investigator J. David Clark, MD, PhD, professor of anesthesia at Stanford University School of Medicine and the Palo Alto Veterans Affairs Health Care System.
Chu plans on conducting a clinical study to confirm the effectiveness of another ondansetron-like drug in treating opioid withdrawal symptoms in a larger group of healthy humans. And the research team will continue to test the effectiveness of ondansetron in treating opioid addiction.
The scientists warned that ondansetron will not by itself resolve the problems that arise with continued use of these painkillers. Addiction is a long-term, complex process, involving both physical and psychological factors that lead to compulsive drug use. “This is not a cure for addiction,” said Clark. “It’s naïve to think that any one receptor is a panacea for treatment. Treating the withdrawal component is only one way of alleviating the suffering. With luck and determination, we can identify additional targets and put together a comprehensive treatment program.”
Collaborators on this study included De-Yong Liang, PhD, the study’s co-lead author, previously a research associate in the Department of Anesthesia and currently a research associate at the Palo Alto Institute for Research and Education; Xiangqi Li, MD, a life science research assistant in the department; Nicole D’Arcy, a medical student: Peyman Sahbaie, MD, a research associate at the institute; and Guochun Liao, PhD, of the pharmaceutical company Hoffman-La Roche. This work was supported by grants to Clark from the National Institutes of Health and the National Institute on Drug Abuse, and grants to Chu from the NIH and the National Institute of General Medical Sciences.
The researchers are working with the Stanford University Office of Technology Licensing to seek a patent for the use of ondansetron and related medicines in the treatment of drug addiction.

Source:  Science Daily 19th Feb 2009

Researchers at Brigham and Women’s Hospital found that patients taking cannabinoid medicines for pain may be getting “high,” but these effects were unrelated to relief from their pain symptoms. Results of their study, one of the first to examine the addictive potential of this class of pain medicine, were presented today at the American Academy of Pain Medicine’s 25th Annual Meeting.
In the study, Ajay Wasan, MD MSc and colleagues found that when used for non-cancer pain management, the cannabinoid class of medicines (such as dronabinol), got patients “high,” but the majority of subjects experienced significant pain relief independent of these psychoactive effects. Results indicate that these medicines have the likelihood of an addiction similar to smoking marijuana, leading researchers to conclude the abuse potential of this class should be studied further.
Using the Addiction Research Center Inventory (ARCI), the gold-standard for determining the abuse liability of substances, Dr. Wasan and colleagues at McLean Hospital looked at two different patient populations to compare the effects of medicinal, synthetic cannabinoid and marijuana. The first population was suffering from pain, and took each of the following at separate visits where they were observed for eight hours: placebo, 10mg, or 20 mg of dronabinol. The second population was not suffering from pain, but they were monitored every 30 minutes after smoking a high and low strength marijuana cigarette. Participants in both populations were given the ARCI every hour. After two hours, patients in the first population (synthetic cannabinoid medicine) were found to have the same psychoactive effects that patients from the second population (smoked marijuana) did after 30 minutes.
“Based on our study we believe the addictive qualities of this class of medicines need more investigation. In our study, patients taking the medicine, like the patients smoking the marijuana, were, essentially, stoned. However, they didn’t report less pain, indicating the pain relief properties were independent of the psychoactive effects,” said Dr. Wasan, lead author of the study, and director of clinical pain research at Brigham and Women’s Hospital. “We discovered that both the synthetic cannabinoid medicines we studied and marijuana have similar psychoactive properties and suggestive of an addiction potential.”
Source:  http://www.painmed.org/

The damage caused by expectant mothers who drink during pregnancy is costing Canada more than $5 billion a year, a report says.
Fetal Alcohol Spectrum Disorder (FASD) impacts one in 100 children, or almost 243,000 Canadians, causing low birth weight, restricted growth, physical and mental disability and, in some cases, heart problems.
Doctors dealing with the disorder say there is a dire need for more diagnostic services and warn that even with government intervention, FASD will carry a high price tag for generations.
“We all know one drink is not going to cause FASD,” says Dr. Brenda Stade, the head of the FASD clinic at Toronto’s St. Michael’s Hospital who co-wrote the paper, published in the January edition of the Canadian Journal of Clinical Pharmacology. “Bottom line, you should abstain if you can. If you can’t, you should go to your family doctor and try to cut down.”
Eight-year-old Caitlyn Nugent was born addicted to alcohol after her mother sipped vodka coolers throughout her pregnancy. Her 10-year-old sister Chrystal isn’t as badly affected but has also been diagnosed with conditions classified under FASD, an umbrella term for a variety of mental, physical and behavioural problems linked to drinking during pregnancy, including Fetal Alcohol Syndrome.
“The children do look normal, but they don’t act normal,” says their grandfather, Doug Nugent, who with his wife Larraine have raised the girls since they were babies in Toronto. Their son is the girls’ father. “There is a lot of confusion about their behaviour … they are not spoiled brats. It’s just brain damage.”
Some FASD children bear hallmark facial features, including smaller and wide-set eyes, a thin upper lip and no groove between the nose and lip. But many don’t, which is why their behaviour is often misunderstood well into adulthood. “These people have been struggling for years and nobody can really recognize their disability,” says Stade, who has adopted a child with the disorder. The clinic opened six years ago and diagnoses about 400 patients every year, of all ages. They are expanding to meet demand.
The report by the Hospital for Sick Children, the Public Health Agency of Canada and St. Mike’s, involved interviews with 250 caregivers of children and adults with FASD on the costs of emergency medical care, health services, education and out-of-pocket spending, including medication and recreational activities. FASD is a recognized disability so the costs of the Ontario Disability Support Program were included. No one knows exactly how much alcohol causes the disorder. To prevent confusion over what could be safe, most experts advise pregnant women not to drink at all.
Every child’s condition and needs are different and complicated, Stade says. Mental impairment includes behavioural issues, problems learning and impaired social skills and judgment.
But many children with the disorder, she says, are socially adept, using small talk to fit in and, given the proper support, can function well in certain positions, including some trades. But getting to that point requires a tremendous amount of support.
Doug and his wife are both 57. But, he says, “my retirement started six years ago, once the kids came. I couldn’t go out and work full-time.”
Caitlyn and Chrystal have serious dental problems and “their immune system is zilch,” says their grandfather. They both require inhalers and are constantly battling infections. They have had speech and physical therapy and need sensory integration therapy – essentially exposing them to a barrage of sensations to teach them to respond properly to stimuli.
FASD children have trouble focusing, says Doug.
“The teachers, they can’t understand why the kids are not capable of doing work … the signal doesn’t get through properly.”
It’s easy, Doug says, for outsiders to find fault with a child affected by FASD. Caitlyn and Chrystal have difficulty understanding social cues, it’s hard for them to play with other children and they are prone to severe mood swings. “I’m a little bit scared for the girls when they start the next level of school. The social aspects of the higher-level schools scare me, because these children are so vulnerable,” he says.
Of their teenage years, Larraine says: “I’m really dreading them because they are such followers … it doesn’t matter how much you try to streetwise them. It is going to be hard.” She and her husband’s main goal is to raise awareness and get the government to provide funding for early services and therapies for kids with FASD and their families.
That is why they invited the Star into their home to speak about the girls. They have applied twice to the province’s Family Responsibility Office to get coverage for dental care and prescription medication. They were rejected both times, told incorrectly that FASD is not a recognized disability and that being grandparents disqualifies them.
“I would love to tell the government to live with these children themselves,” says their grandfather. “It’s banging your head up against a brick wall, trying to get acceptance for these children … they need assistance.”

Source: TheStar.com  3rd March 2009

Down in your cups? … researchers find a link between alcohol dependency and depression.
Excessive alcohol drinking may increase the risk of depression, a long-term study conducted over 25 years in New Zealand has found.
The study, published in the Archives of General Psychiatry, involved a group of 1,055 children who were monitored and interviewed at various times over 25 years.
“At all ages, there were clear and statistically significant trends for alcohol abuse or dependency to be associated with increased risk of major depression,” wrote the researchers, led by David Fergusson at the University of Otago’s department of psychological medicine.
The study found 19.4 percent of the participants between 17 and 18 were either abusing or dependent on alcohol, and 18.2 percent were diagnosed with depression.
“Individuals who fulfilled the criteria for alcohol abuse or dependency were 1.9 times more likely to also fulfill the criteria for major depression,” the researchers wrote.
The link between the two was significant even after factoring in other possible causes, such as use of cannabis and other illegal drugs, affiliation with “deviant peers,” unemployment and a partner who committed crimes.
“It has been proposed that this link may arise from genetic processes in which the use of alcohol acts to trigger genetic markers that increase the risk of major depression,” the researchers said.
“Further research suggests that alcohol’s depressant characteristics may lead to periods of depressed effect among those with alcohol abuse or dependency.”

Source:  theAge.com.au  3rd March 2009

All those T-shirts, hats and other items promoting alcoholic beverages that young people wear may be more than just a fashion statement.   Teens who own such merchandise are more likely to start drinking and become binge drinkers, a new study contends.
The Dartmouth scientists who did the research said this is the first study directly linking alcohol-branded merchandise to adolescent drinking and outcomes such as binge drinking that can result in illness and death. In addition, the data provide evidence that this merchandise promotes teen drinking and could be a basis for enacting policies to restrict this alcohol-marketing practice, the researchers said.
“About 3 million adolescents in the United States own alcohol-branded merchandise,” said lead researcher Dr. Auden C. McClure, a pediatrician at Dartmouth Hitchcock Medical Center in Hanover, N.H. “Ownership of these items is associated with susceptibility to alcohol use and binge drinking,” she added.
These items serve as a marker for adolescents who drink, McClure said. “But it is also a direct link with susceptibility and initiation to drinking,” she said. “You can’t say any longer that these items are just a marker of kids who drink.”

Source:Archives of Pediatrics & Adolescent Medicine.  arch 2009

JUST two alcoholic drinks a day can increase the risk of pancreatic cancer, a study has shown.
Consuming 30g or more of alcohol a day raises the likelihood of developing the disease by 22 per cent, scientists found.

That is the equivalent of roughly two drinks, according to the US researchers. They defined “a drink” as 12 fluid ounces of  beer, four fluid ounces of wine or 1.5 fluid ounces of spirits.

The investigation was one of the largest ever to examine dietary factors influencing pancreatic cancer.   Scientists analysed data from 14 studies looking at the food and drink consumption of more than 860,000 men and women.

Of these, 2,187 were diagnosed with pancreatic cancer.

Dr Jeanine Genkinger, from Georgetown University in Washington DC, said: “Our findings support multiple nutrition recommendations that men should limit intake to no more than two alcoholic beverages a day and women to one.”

Previous studies had been unable to confirm an association between alcohol consumption and pancreatic cancer risk.

The link was suspected because drinking is associated with pancreatitis, inflammation of the pancreas and diabetes. Both conditions are known risk factors for pancreatic cancer.

Source:  News.Scotsman.com  4th March 2009

Adolescents and young adults who are heavy users of marijuana are more likely than non-users to have disrupted brain development, according to a new study. Pediatric researchers found abnormalities in areas of the brain that interconnect brain regions involved in memory, attention, decision-making, language and executive functioning skills. The findings are of particular concern because adolescence is a crucial period for brain development and maturation.
The researchers caution that the study is preliminary and does not demonstrate that marijuana use causes the brain abnormalities. However, “Studies of normal brain development reveal critical areas of the brain that develop during late adolescence, and our study shows that heavy cannabis use is associated with damage in those brain regions,” said study leader Manzar Ashtari, Ph.D., director of the Diffusion Image Analysis and Brain Morphometry Laboratory in the Radiology Department of The Children’s Hospital of Philadelphia.
The study appeared early last month in the Journal of Psychiatric Research. The current research builds on previous work by Ashtari and colleagues, who used the same imaging technology to analyze normal brain development in adolescent subjects.
In the current study, working with child psychiatrist Sanjiv Kumra, M.D., now at the University of Minnesota, Ashtari and colleagues performed imaging studies on 14 young men from a residential drug treatment center in New York State, as well as 14 age-matched healthy controls. All the study subjects were males, with an average age of 19. The researchers performed the imaging studies at Long Island Jewish Medical Center.
The 14 subjects from the drug treatment center all had a history of heavy cannabis use during adolescence. On average, they had smoked marijuana from age 13 till age 18 or 19, and reported smoking nearly 6 marijuana joints daily in the final year before they stopped using the drug.
The study team performed a type of magnetic resonance imaging scan called diffusion tensor imaging (DTI) that measures water movement through brain tissues. “The abnormal patterns of water diffusion that we found among the young men with histories of marijuana use suggest damage or an arrest in development of the myelin sheath that surrounds brain cells,” said Ashtari. Myelin provides a coating around brain cells similar to insulation covering an electrical wire. If myelin does not function properly, signaling within the brain may be slower.
Myelin gives its color to the white matter of the brain, and covers the nerve fibers that connect different brain regions. “Our results suggest that early-onset substance use may alter the development of white matter circuits, especially those connections among the frontal, parietal and temporal regions of the brain,” said Ashtari. “Abnormal white matter development could slow information transfer in the brain and affect cognitive functions.”
Ashtari added that the findings are preliminary. Among other limitations of the study, such as a small sample size, five of the 14 subjects with heavy cannabis use also had a history of alcohol abuse, which may have contributed an effect. Also, it is possible that the brain abnormalities may have predisposed the subjects to drug dependence, rather than drug usage causing the brain abnormalities.
“Further research should be done to investigate the relation between repeated marijuana use and white matter development,” said Ashtari. “However, our work reinforces the idea that the adolescent brain may be especially vulnerable to risky behaviors such as substance abuse, because of crucial neural development that occurs during those years.”
Source:  www.ScienceDaily.com  3rd Feb 2009

ScienceDaily (Mar. 8, 2009) — New findings may significantly improve the safety of methadone, a drug widely used to treat cancer pain and addiction to heroin and other opioid drugs, according to researchers at Washington University School of Medicine in St. Louis and the University of Washington in Seattle.
The researchers discovered that the body processes methadone differently than previously believed. Those incorrect assumptions about methadone have been making it difficult for physicians to understand how and when the drug is cleared from the body and may be responsible for unintentional under- or overdosing, inadequate pain relief, side effects and even death.
For many years, methadone has been a mainstay in the treatment of opioid addiction. Taken orally, it suppresses withdrawal and reduces cravings. In recent years, doctors have prescribed methadone more frequently as an effective treatment for acute, chronic and cancer pain. Use of the drug for pain treatment rose 1,300 percent between 1997 and 2006. As more methadone was prescribed, however, adverse events increased by approximately 1,800 percent, and fatalities were up more than 400 percent (from 786 to 3,849) between the years 1999 and 2004.
“Unfortunately, increased methadone use for pain has coincided with a significant increase in adverse events and fatalities related to methadone,” says principal investigator Evan D. Kharasch, M.D., Ph.D., an anesthesiologist and clinical pharmacologist at Washington University School of Medicine and Barnes-Jewish Hospital in St. Louis. “The important message is that guidelines used by clinicians to direct methadone therapy may be incorrect.”
Kharasch, the Russell D. and Mary B. Shelden Professor and director of the Division of Clinical and Translational Research in Anesthesiology at the School of Medicine, and his colleagues report the findings in the March issue of the journal Anesthesiology and online in the journal Drug and Alcohol Dependence.
The investigators wanted to understand how protease inhibitors, drugs that keep the immune system functioning in patients with HIV, interact with methadone. For years, the enzyme P4503A was believed to be responsible for clearing methadone from the body. But when healthy volunteers were given a low dose of methadone together with protease inhibitors that caused profound decreases in the activity of P4503A, there was no reduction in the clearance of methadone.
There were two reasons to study what happened to methadone when taken together with those drugs: First, HIV-AIDS patients may receive methadone for pain and, in some cases, for accompanying substance abuse problems, along with one or more protease inhibitors. In addition, many protease inhibitors interact with the P4503A enzyme that traditionally was thought to be important to methadone clearance. In these studies, Kharasch and his team looked at interactions among methadone, the P4503A enzyme in the intestine and liver and the protease inhibitors nelfinavir, indinavir and ritonavir.
They gave study volunteers a combination of the protease inhibitors ritonavir and indinavir. Both drugs profoundly inhibited the actions of the enzyme. If that enzyme were responsible for methadone clearance, then inhibiting it should have caused methadone to build up in the body. But the researchers found that it had no effect on methadone levels.
Volunteers in the second study received the protease inhibitor nelfinavir. Again, the drug inhibited the action of the P4503A enzyme. That should have meant methadone concentrations would rise, but they actually decreased by half.
“For more than a decade, practitioners have been warned about drug interactions involving the enzyme P4503A that might alter methadone metabolism,” Kharasch says. “The package insert says inhibiting the enzyme may cause decreased clearance of methadone, but our research demonstrates that P4503A has no effect on clearing methadone from the body. So the package insert appears to be incorrect, or certainly needs to be reevaluated, as do guidelines that explain methadone dosing and potential drug interactions.”
That can be dangerous, Kharasch explains, because a clinician may prescribe too much or too little methadone for patients taking drugs that interact with P4503A, having been informed that they also would influence methadone clearance. Too little methadone will not relieve pain. Too much can contribute to the unintentional build-up of methadone in the system, which can cause slow or shallow breathing and dangerous changes in heartbeat. Physicians could be unintentionally prescribing methadone incorrectly.
“The highest risk period for inadequate pain therapy or adverse side effects is during the first two weeks a patient takes methadone,” Kharasch says. “If we can provide clinicians with better dosing guidelines, then I believe we will be able to better treat pain and limit deaths and other adverse events.”
About a dozen related liver enzymes are part of the P450 family, and Kharasch believes another enzyme from that family may be the one actually involved in methadone metabolism and clearance. His laboratory is determined to identify the correct enzyme to limit over-and under-dosing of patients taking methadone to improve addiction and pain treatment as well as patient safety. Currently, he’s testing the related enzyme P4502B. Laboratory studies and preliminary clinical results indicate that P4502B may be involved, but he says more clinical research is needed.
“The research also is important for the treatment of HIV-AIDS,” Kharasch says. “Protease inhibitors can interfere with the activity of P4503A but increase the activity of P4502B. This paradox is highly unusual, and because these two enzymes metabolize so many prescription drugs, there are many potential drug interactions that we’ll be able to understand better if we can get a better handle on how these pathways absorb drugs into the system and clear them from the body.”
This research was supported by grants from the National Institute on Drug Abuse of the National Institute of Health and by an NIH grant to the University of Washington General Clinical Research Center.
Source: ScienceDaily 8 March 2009. 11 March 2009 <http://www.sciencedaily.com¬ /releases/2009/03/090303102736.htm>.

Researchers in the Discipline of Pharmacology have discovered a genetic variation that may help determine the most effective methadone dosage levels for individual heroin addicts.
The genetic discovery reveals why some people are either less efficient or more effective in distributing drugs throughout their body to the central nervous system.
Lead researcher Dr Janet Coller says accurate dosing of methadone is essential to successfully treat drug addicts because up to 62% fail to remain in the methadone program due to the severe withdrawal symptoms.
“Individualised dosing may decrease the incidence of withdrawal symptoms in some people and therefore encourage them to continue with the methadone treatment.”
An estimated 10 million people worldwide are heroin dependent, including 74,000 Australians, incurring enormous health, social and economic costs.
“More than 40,000 people are undergoing methadone treatment in Australia and only 38% of them are staying in the program at the moment. Most drop out at the start of the treatment when the withdrawal effects are severe,” Dr Coller says.
This breakthrough will allow individuals undergoing the methadone treatment program to be tested for the genetic variation to determine optimal treatment doses.
The pharmacology study was conducted collaboratively as part of Dr Coller’s postdoctoral and Daniel Barratt’s PhD studies, supervised by Professor Andrew Somogyi, with the assistance of Karianne Dahlen and Morten Loennechen, Masters of Science students from Denmark. The results have been published in the December issue of the journal Clinical Pharmacology and Therapeutics.
Source: University Of Adelaide (2007, January 29). Breakthrough For Heroin Addiction Treatment. ScienceDaily. Retrieved March 11, 2009, from http://www.sciencedaily.com¬ /releases/2007/01/070128135642.htm

Sometimes, small changes do add up. In the case of addictive diseases, tiny variations in a few genes can increase or decrease the likelihood of some people developing a dependency on heroin. Now, by examining a select group of genetic variants in more than 400 former severe heroin addicts, Rockefeller University researchers have identified several genetic variations in American and Israeli Caucasians that influence the risk for becoming addicted to one of the world’s most powerful substances.
In a collaborative effort with statistical geneticists and several methadone clinics, scientists led by Mary Jeanne Kreek, head of the Laboratory of the Biology of Addictive Diseases, analyzed 1,350 variations in 130 genes and found nine, from six genes, that were either more or less common in recovering heroin addicts when compared to Caucasians with no history of drug abuse. These small changes in the gene sequences can cause significant changes in protein function that can influence addictive behavior — changes that may affect people of different ethnic background differently.
“The idea of ‘personalized medicine’ makes this field really exciting but also very complicated,” says Orna Levran, a senior research associate in the Kreek laboratory and first author of the study. “Although seven of these variants increase the risk for developing heroin addiction in Caucasians, the same seven may not have the same effect in other populations. So ethnicity and, more precisely, genetic information in each individual may become important factors for treating and diagnosing addictions to different drugs.”
In their analysis, Kreek, Levran and their colleagues looked at a string of letters called nucleotides, the building blocks that make up genes. In each of the six genes, at least one letter is replaced by another, a genetic variation known as a single nucleotide polymorphism, or SNP. The researchers found that all of the single-letter variations exist in parts of the genes that do not translate into proteins but instead may have a regulatory or a structural effect.
Out of the nine SNPs, the group found six in the μ, δ and κ opioid receptors, a finding that reinforces the idea, and many other findings of the Kreek laboratory, that opiate receptors play a major role in severe heroin addiction. The remaining three SNPs were found in genes coding for the serotonin receptor 3B, casein kinase 1 epsilon, which acts as a regulator of the circadian clock genes, and galanin, which modulates appetite and alcohol consumption. This is the first study to show that specific variants in these genes are associated with heroin addiction, explains Levran.
The SNPs in the κ opioid receptor and casein kinase 1 genes were found more in the control group than the heroin addicts’ group, suggesting that they conferred protection from heroin addiction — not vulnerability to develop addiction.
“Individually, these SNPs probably have a small effect,” explains Levran, “but collectively, we are seeing that they could have a larger effect. One of the goals now is to find all of these gene variants and assess how they influence people of different ethnic backgound.”

Source: Rockefeller University (2008, October 5). Variations In Key Genes Increase Caucasians’ Risk Of Heroin Addiction. ScienceDaily. Retrieved March 11, 2009, from http://www.sciencedaily.com¬ /releases/2008/10/081002211720.htm

Abstract Achieving abstinence in the treatment of cannabis dependence has been difficult. To date the most successful treatments have included combinations of motivational enhancement treatment plus cognitive–behavioural coping skills training and/or contingency management approaches rewarding abstinence. Although these approaches are theoretically based, their mechanisms of action have not been explored fully. The purpose of the present study was to explore mechanisms of behaviour change from a cannabis treatment trial in which cognitive–behavioural and contingency management approaches were evaluated separately and in combination. A ‘dismantling’ design was used in the context of a randomised clinical trial. 240 dependent adult cannabis smokers who responded to advertisements attended an out-patient treatment research facility located in a university medical centre. They were randomly assigned to one of four nine-week treatment conditions:
• supportive case management, the control condition used as a benchmark for the other treatments;
• motivational enhancement therapy plus cognitive–behavioural coping skills training;
• standalone contingency management procedures rewarding cannabis abstinence with vouchers for retail goods or services, with no other therapeutic inputs;
• and a combination of contingency management with the motivational and cognitive–behavioural therapies.
The main outcome measure was total abstinence over the past 90 days based on the patients’ own accounts and verified by urinalysis. These measures were recorded every 90 days for the 12 months after treatment ended. Standalone contingency management led to the highest in-treatment abstinence rate, but the lowest in the last six months of the follow-up. Regardless of the treatment, abstinence in near-term follow-ups was predicted most clearly by abstinence during treatment, but long-term abstinence was predicted by use of coping skills and especially by post-treatment self-efficacy for abstinence.
 Though an exploration of the mechanisms of change in cannabis treatment in general, the study’s innovation This seems the first study to establish how contingency management works by linking it to psychological and behavioural changes, and then linking these to abstinence outcomes using a methodology which can tease out potential causal mechanisms. Inclusion of motivational and cognitive–behavioural approaches in the same study makes it possible to compare these mechanisms against those of probably the most influential and widespread structured therapies for substance use problems. (and the focus for this commentary) was to probe the psychological processes underlying contingency management, building on previously reported abstinence outcomes from the same study. The key message is that these procedures do not produce lasting change simply by mechanically reinforcing the habit of non-use. More important is whether the experience fosters confidence that one can resist relapse, along with the motivation to transform ‘can’ in to ‘will’, and strategies to effectively implement this resolution. In other words, what the patient makes of their spell on the contingencies and how they interpret it determines whether it will result in a transient, reward-driven spell of reduced substance use, or more lasting change. What the patient makes of the contingencies can in turn be influenced by integrating test results and rewards in to accompanying therapy, leading to greater longer term success than either on its own.
On the basis of the study, this message can only be considered a tentative working hypothesis. But it is consistent with other studies (1 2 3 4 5) which also found that the in-treatment boost Interestingly, in several studies this boost was deflated somewhat when contingency management was combined with cognitive-behavioural therapy, yet once the rewards ended this combination was at least as or more effective. to abstinence provided by rewards does not persist, leaving contingency management with longer term outcomes at best equivalent to cognitive-behavioural approaches, and sometimes slightly worse. More generally, when rewards end, patients often quickly revert to their previous behaviours. Even during the rewards period, typically impacts are limited to the targeted behaviours and/or the targeted drugs. This is what would be expected if patients interpret the procedures as a chance to do what it takes (and no more) to make some money or win some prizes. In particular, the authors suggest that lasting change is less likely if patients see abstinence as foisted on/enticed out of them by the rewards, rather than something they have shown they can achieve by their own efforts.
Within the study, this hypothesis emerged from an analysis which showed that the way contingency management enhanced cannabis abstinence after treatment, was by having enhanced it during treatment. However, when other variables were taken in to account, the distinct contribution of in-treatment abstinence was relatively weak. More significant were variables contingency management did not directly affect – the individual’s growing confidence in their ability to resist cannabis use and their deployment of strategies to help them do so. Each bolstered the other, especially when growing motivation to change gave impetus to the process. These variables were directly impacted by the treatments which included motivational and cognitive–behavioural elements, especially when combined with contingency management.
The upshot it seems was that though it led to the highest abstinence rates Both in terms of the average number of days abstinent and the number of patients who remained completely abstinent. during treatment, by the final follow-up a year later patients subject only to the rewards were least likely to have sustained abstinence over the past three months. After the other three This applied even to the case management option, one deliberately devoid of structured therapeutic content. treatments, abstinence rates improved, culminating in a final rate of around 20% or more. After standalone contingency management ended, the abstinence rate rapidly fell to barely more than half the level during treatment.
This transience did not apply when contingency management was combined with motivational/cognitive-behavioural therapy – in the longer term, the most effective of the options. Contingency management brought these patients in to contact with qualified and specially trained and supervised therapists who melded the urinalysis results and the rewards in to the therapeutic encounter, and who were in a position to influence the patient’s interpretation of and response to the contingencies. In contrast, standalone contingency management involved relatively fleeting contact with a research assistant who administered tests and rewards.
When contingency management and cognitive-behavioural therapy have merely run in parallel no longer term advantage from combining the two has materialised. But when, as in the featured study, therapists have integrated the contingency programme in to their sessions, the combination has proved the most powerful intervention in the longer term.
Though this study breaks new ground, others have also indicated that contingency management may not work in the same way as other therapies. Most relevant is a study which used vouchers to reward drug-free urine tests and consumption of the opiate blocking medication naltrexone to maintain abstinence from opiates after detoxification. As expected, during the 12 weeks of treatment the rewards encouraged patients to take their medication The difference was substantial but fell just short of statistical significance. and stay free of opiate drugs. But this did not presage lasting change. Within 12 weeks of the rewards ending, there was little difference between these patients and those not offered vouchers, by another 12 weeks, virtually none. A clue to the reason came in the observation that across the 12 weeks of treatment, motivation and readiness to change drug use behaviour increased slightly among patients not offered vouchers, but were significantly eroded Tests showed that this was not due to patients who had attained abstinence no longer feeling the need to change. among those rewarded for abstinence.
In other studies, motivation has not been eroded relative to other treatments, but neither has it been enhanced by reinforcing abstinence, indicating that the greater abstinence rates ‘bought’ by the rewards do not reflect increased motivation to remain abstinent. In one, supplementing motivational and coping skills therapy with rewards actually halved what without the rewards was a substantial increase in confidence in ability to refrain from smoking cannabis.
The potential for contingency management type rewards to erode motivation is well recognised outside the substance misuse sector. An analysis aggregating results from 128 studies found that tangible rewards offered for engaging in, completing, or doing well at a task undermined intrinsic motivation. The effect was greatest when represented by what people actually did after the rewards ended, the equivalent of post-treatment substance use in contingency management studies. However, the same analysis found that it is possible for rewards – and especially verbal recognition – to be given in such a way that they acknowledge the individual’s achievements and bolster feelings of mastery rather than of being controlled. In these cases the undermining effect can be reversed and intrinsic motivation enhanced.
Such findings help explain why in several studies contingent rewards or punishments for engaging in treatment did improve attendance and compliance, but, contrary to the usual pattern, ‘engagement’ elicited in this way did not improve substance use or other outcomes. It also helps explain why occasionally this does not happen, for example, when rewards are experienced as a non-controlling signal of the individual’s own achievements, and are embedded in a caring therapeutic environment which accompanies them with verbal and public recognition. Another exception is a study which achieved greater and more lasting abstinence by rewarding recovery-oriented activities rather than directly rewarding abstinence. In this case the rewards were delivered within a collaborative therapeutic relationship and empowered rather than controlled the patient. With their therapist, they could select activities to be rewarded in line with their own recovery plan and ability to complete the task. The broader findings referred to above also help us understand the oft-reported power of the verbal praise delivered by drug court judges to offenders, precisely the sort of unexpected, non-controlling verbal recognition which the analysts would expect to enhance motivation by reinforcing the offender’s sense of control.
Current British trials have absorbed the lessons of this US research and at least one Personal communication from Dr John Marsden of the National Addiction Centre, March 2008. is attempting to extend the substance use reductions gained by contingency management by exploring this experience in accompanying therapy. The trial is also using a newly developed questionnaire Marsden J., Mitcheson L., Stillwell G., Litt M., Shoptaw S. Treatment Incentives Experiences Scale. 2008. to track how patients interpret the contingencies, including whether they attribute their successes to the rewards or to themselves, and impacts on their confidence in their recovery.

Source: Litt M.D., Kadden R.M., Kabela-Cormier E. et al. Request reprint
Addiction: 2008, 103(4), p. 638–648

Evidence has emerged which points to a link between cocaine use and violent behaviour in Britain’s city centres.
Figures from Greater Manchester Police suggest that 41% of people arrested for violence had taken cocaine or crack cocaine, by itself or with other drugs.
The force took samples from 1,000 people arrested for offences such as assault, wounding and affray in the seven months to March last year.   The charity DrugScope revealed the results in its magazine, DrugLink.
The survey was part of an article which considered whether mixing alcohol and cocaine was a recipe for disaster.Similar findings had been reported in the Liverpool area after a separate study, run last summer by John Moores University.
Aggressive behaviour
Chief Inspector Dave Boon, who leads Greater Manchester Police’s drug intervention programme, said while only a small number of offenders had been tested so far, the statistics were important.
 

“We cannot afford to ignore the link between violence, drugs and alcohol that is apparent in city centres all over the UK every weekend,” he said.
“What this survey is doing is trying to prove that link and developing ways to manage the problem.”
DrugScope chief executive Martin Barnes said: “The investigation carried out by our magazine does suggest some link between powder cocaine use and violent and aggressive behaviour.
“However, because the drug is so often taken in combination with alcohol we need to be cautious about claims that cocaine alone can lead to violent offending.”
Cocaine is more widely used in Britain than ever, while the average price has halved in a decade. A wrap can cost as little as £25.
Further research will be conducted this year, with police keen to establish whether there is a link between alcohol, cocaine and domestic violence.  

Source:  BBC News Channel 13th March 2009

The number of 11 to 18 years old in London admitted to hospital for alcohol-related illnesses has risen.
Admissions increased from 1,171 in 2002/03, to 1,769 in 2006/07, according to figures obtained for a report.
The ‘Highs and Lows’ report by the Greater London Alcohol and Drug Alliance said less young Londoners are using drugs, particularly cocaine.
London Mayor Boris Johnson said the fall in cocaine use over the last couple of years was encouraging.
The report said the proportion of young Londoners between 16 and 24 who reported using any drug use during the last year decreased between 2005/06 and 2007/08 – from 20.3% to 17.8%.
And the proportion of young Londoners who reported using cocaine is down from 7.1% in 2005-06 to 4.7% in 2007-08.
Widespread problems
The report also said the estimated numbers of problem drug users – those whose drug use has taken over their lives – in this age group dropped from 14,068 in 2004/05 to 11,750 in 2005/06.
Mr Johnson said: “It is encouraging to see a noticeable reduction in cocaine use among young people over the last couple of years.
“Fewer young Londoners are using drugs but we can’t be complacent. Substance abuse causes widespread problems across the city.”
The Greater London Alcohol and Drug Alliance is a partnership bringing key agencies together to analyse trends and share information reducing alcohol and drug related harm in London, and is supported by the Greater London Authority.

Source: http://news.bbc.co.uk/go/pr/fr/-/1/hi/england/london/7939368.stm  2009/03

In a new study, researchers have determined that prenatal exposure to cigarette smoking, when combined with a specific genetic variant, places children at increased risk for aggressive behavior and other behavioral problems.
The study, led by scientists at the Institute for Juvenile Research at the University of Illinois at Chicago, identified a long-lasting influence on a child’s behavior precipitated by the monoamine oxidase A (MAOA) gene variant in conjunction with prenatal exposure to tobacco. MAOA is an enzyme which regulates key neurotransmitters in the brain. 
The genetic variant responsible for increased risk of behavioral problems differs between boys and girls, researchers said. In boys exposed to tobacco smoke prenatally, the low-activity MAOA (MAOA-L) gene variant was associated with increased disruptive social interactions, aggressive behavior, and serious rule-violating.
Among girls, the high-activity MAOA (MAOA-H) gene variant was associated with increased disruptive behavior. In addition, girls with both the MAOA-H variant and prenatal exposure to cigarette smoke had an increased “hostile attribution bias” — a tendency to perceive anger in a range of facial expressions — that was not seen among boys.
There was a higher risk of disruptive behavior for both boys and girls the more their mother smoked during pregnancy, according to the study.
“The tendency to over-perceive anger suggests the possibility that the combination of prenatal tobacco exposure and the MAOA risk variant affects the brain’s processing of emotional cues,” said Lauren Wakschlag, the study’s principal investigator. “Clearly, close attention to sex differences in these patterns will be critical for future studies,” she said.

Source:Join Together. March 16th 2009

Cannabis is a common drug of abuse that is associated with various long-term and short-term adverse effects. The nature of its association with vomiting after chronic abuse is obscure and is underrecognised by clinicians. In some patients this vomiting can take on a pattern similar to cyclic vomiting syndrome with a peculiar compulsive hot bathing pattern, which relieves intense feelings of nausea and accompanying symptoms. In this case report, we describe a twenty-two year-old-male with a history of chronic cannabis abuse presenting with recurrent vomiting, intense nausea and abdominal pain. In addition, the patient reported that the hot baths improved his symptoms during these episodes. Abstinence from cannabis led to resolution of the vomiting symptoms and abdominal pain. We conclude that in the setting of chronic cannabis abuse, patients presenting with chronic severe nausea and vomiting that can sometimes be accompanied by abdominal pain and compulsive hot bathing behaviour, in the absence of other obvious causes, a diagnosis of cannabinoid hyperemesis syndrome should be considered.

Source:  Cannabinoid hyperemesis syndrome: Clinical diagnosis of an underrecognised manifestation of chronic cannabis abuse. Sontineni SP et al
World J Gastroenterol 2009 March;15(10):1264-1266

Students who regularly combine ecstasy and cannabis may harm their academic results, a recent research project has shown. The research was conducted in Barcelona and followed 120 cannabis and ecstasy users for three years. The results suggested that regular poly-drug users obtained half the marks of the non-user control group, writes Ruth Evans.
Scientists are divided over the effects of ecstasy, but there is general agreement that regular use can negatively affect long-term memory. The Spanish study contradicts previous research which suggested that people who took ecstasy alone had worse memory problems.
Dr de la Torre, who conducted the study, said that the risk of affecting their degrees should deter students from mixing drugs.
Source:  www.Nouse.co.uk    February 12, 2005

A literature review
Results
The most extensive and consistent evidence relates to young people’s interaction with their
families. The key predictors of drug use are parental discipline, family cohesion and parental
monitoring. Some aspects of family structure such as large family size and low parental age
are linked to adolescent drug use. There is also consistent evidence linking peer drug use
and drug availability to adolescent drug use. There is extensive evidence on parental
substance use, although some studies report no association while others indicate that the
association is attenuated by strong family cohesion. Age is strongly associated with
prevalence of drug use among young people reflecting a range of factors including drug
availability, peer relationships and reduced parental monitoring. There is limited evidence
suggesting that genetic factors account for a significant proportion of the variance in liability to
use cannabis, however this interpretation has been criticised by other writers. There is a
similar level of evidence linking self-esteem and hedonism to drug use. The available
evidence indicates that higher levels of drug use are strongly associated with young people’s
reasons for using drugs after controlling for risk factors.
Categories where evidence linking specific factors is mixed include: mental health, Attention
Deficit Hyperactivity Disorder (ADHD), stimulant therapy, religious involvement, sport, health
educator interventions, school performance, early onset of substance use and socioeconomic
status. For some of these categories there is evidence of indirect effects; for
example, socio-economic status may influence parental monitoring which in turn influences
drug use. The review did not consider any studies relating to previously identified risk and
protective factors such as ethnicity or impulsivity.
For young drug users in treatment, psychosocial risk predicts drug abuse at treatment entry
but not follow up. In contrast, protective factors are of increased importance during recovery
The overall ratio of risk to protection may be more important than any individual factor. These
results, although supported by a relatively small body of research, support the concept of
resilience to drug use. According to this view resilience to drug use is enhanced by increasing
social skills, social attachments and material resources despite constant exposure to known
risk factors.
Whereas risk and resilience are, to a large extent, independent of individuals’ motives, there
is evidence that the latter are just as important as the former in determining drug use. Young
drug users consistently report getting intoxicated and relief from negative mood states as
reasons for their drug use. Qualitative research shows that the context in which young people
experience drugs is crucial for understanding how risk and protective factors operate in
relation to experimental and sustained drug use.
Risk factors have differential predictive values throughout adolescence. Some factors may
occur at birth (or before) while others occur at varying times throughout adolescence. Some
factors may persist for long periods of time while others are transitory. The distinction
between early and late onset risk factors is important as preventive measures need to focus
on particular age groups.
Conclusion
This review was pragmatic because it was time constrained and not all the studies identified
could be reviewed in detail. From the studies reviewed, the evidence relating to factors
associated with increased (or decreased) risk of drug use is described. Further analysis would
require a detailed assessment of individual studies, with clear specification of exposures (risk
and protective factors), outcomes (type and level of drug use) and study design (i.e. did
exposure precede the outcome).
Much of the current knowledge about risk and protective factors is not yet available in a form
that would permit the calculation of the effect of reducing exposure to risk (or enhancing
protective factors), even if was possible to modify the exposure. The evidence indicates that
risk and protective factors are context dependent and operate on people taking drugs for
disparate reasons. With these caveats, improving the general social environment of children
and supporting parents will probably be the most effective strategies for primary prevention of
drug use. Studies indicating that risk and resilience can be successfully altered include
interventions for parental monitoring and enhancement of social attachments and skills.
These interventions show promise but have rarely been implemented or evaluated in the UK.

Source:   Home Office OnLine report 05/07 Martin Frisher et al

Drinking heavy amounts of alcohol over a long period of time may decrease brain volume, according to research that was presented at the American Academy of Neurology’s 59th Annual Meeting in Boston, April 28 — May 5, 2007. The study found the more alcohol people drink on a regular basis, the lower their brain volume.
The study involved MRI scans of 1,839 people from the Framingham Offspring study, ages 34 to 88, who were classified as non-drinkers, former drinkers, low drinkers (one to seven drinks per week), moderate drinkers (eight to 14 drinks per week), or high drinkers (more than 14 drinks per week). MRI scans were performed and used to measure brain volume, which can be thought of as a measure of brain aging.
“Research has shown that there is a beneficial effect of alcohol in reducing incidence of cardiovascular disease in people who consume low to moderate amounts of alcohol. However, this study found that greater alcohol consumption was negatively correlated with brain volume,” said study author Carol Ann Paul, MS, of Wellesley College in Wellesley, MA.
This cross-sectional study found people who had more than 14 drinks per week had an average 1.6 percent reduction in the ratio of brain volume to skull size compared to people who didn’t drink. In other words, brain volume decreased .25 percent on average for every increase in drinking category (i.e. non-drinkers, former drinkers, low drinkers, moderate drinkers, or high drinkers).
In addition, Paul reported the inverse relationship between drinking and brain volume was slightly larger in women than in men. Also, drinking heavy amounts of alcohol seemed to have the biggest negative impact on brain volume for women in their 70s.
In looking at the longitudinal effects of drinking, people who had a 12-year history of heavy drinking had less brain volume than those who changed into the high drinking group during those 12 years. Researchers are following up on these findings to make sure these differences hold up.

Source: ScienceDaily (May 3, 2007)

The body of evidence linking alcohol consumption with increased cancer risk has been added to by a study recently published in Cancer Epidemiology, Biomarkers and Prevention, which found that drinking two alcoholic drinks every day can increase one’s risk of getting pancreatic cancer.

Details and Findings of Study

The study team, led by Jeanine M Genkinger, an assistant professor of oncology at the Lombardi Comprehensive Cancer Center at Georgetown University, Washington, DC, had examined the findings of 14 studies previously conducted on the subject of alcohol consumption and pancreatic cancer. The 14 studies covered a total of almost 863,000 men and women. Of the group, 2,187 persons were diagnosed with the disease.

Based on available information on the study subjects’ dietary habits, the researchers found that persons who consumed two or more alcoholic drinks per day had 22% increased risk of pancreatic cancer, as compared to those who stayed off such beverages. Here, one drink was defined by 4 ounces of wine, 12 ounces of beer or 1.5 ounces of 80-proof liquor.

Zooming in, the study team discovered that two or more drinks a day raised women’s risk by 41%, while only elevating men’s risk by 12%, the latter figure not having statistical significance. When the bar for men was raised to more than three drinks, their increased risk for a particular type of pancreatic cancer, adenocarcinoma, was found to be 60%, a figure which had become statistically significant; adenocarcinomas are the most common type of pancreatic cancer. This suggests that men have a higher tolerance for alcohol.

One interesting finding was that the effect of alcohol on pancreatic cancer was more pronounced among persons in the healthy weight range. However, before those who are overweight or obese rejoice, this, according to the researchers, is likely down to the fact that obesity is already a strong risk factor for the disease, and that could have masked the effects of alcohol on pancreatic cancer risk for the overweight subjects.

Another interesting finding was that the effects of alcohol were the same regardless of the type which was consumed.

Source:  http://www.naturalnews.com/025884.html Saturday, March 21, 2009