DRUG addicts using the controversial Kings Cross injecting room are taking advantage of the safe environment to test their tolerance to higher doses of heroin and other cocktails of dangerous illicit drugs.
The claims were made during interviews with the peak body Drug Free Australia and were repeated in Parliament by Christian Democratic Party MLC Reverend Gordon Moyes late on Tuesday night during debate over a possible four-year extension of the injecting room.
Mr Moyes told the Upper House the injecting room “has encouraged (users) . . . to try wilder mixes of drugs” after he read aloud a transcript of a recorded conversation between Drug Free Australia secretary Gary Christian and a former injecting room client.
During the interview, the man claimed there was widespread dangerous mixing of heroin and pills including Benzodiazepene, Normasin, Oxycodone and Xanax.
“I have seen that they are going in for one thing but really they are going in for two (or three), with the heroin on top of the pills, but they won’t (tell anybody that),” he said.
“They feel a lot more safer, definitely because they know they can be brought back to life straight away. They know . . . they can, like some people go to the extent of even using more. So in a way they feel it is a comfort zone, and no matter how much they use if they drop (die) they (might) be brought back.”
Drug Free Australia had sought answers as to why the injecting room had “massive” numbers of heroin overdoses, measured between 36 and 42 times higher than normal rates of overdose in the community.
“In 2003 our expert committee analysing injecting room data found that clients of the injecting room were recording a prior history of one overdose for every 4380 injections on average in their intake questionnaire,” Mr Christian said.
“But inside the injecting room, there was an extraordinary one overdose for every 106 injections, 42 times higher than the client’s previous history.”
The former injecting room client said the rife experimentation was done behind workers’ backs.
“You can hide anything from everybody,” he said.
“It is not the workers’ (fault) . . . they try their best, it is just (that we) are (all) sneaky people.”
Mr Moyes told Parliament a second former client revealed users were using the safety of the room “to get the biggest rush they can, even if there is the risk of overdose”.
“Consequently, far from combating the problem and helping these people to stop harming themselves, the injecting facility has actually encouraged them to try harder, to try wilder mixes of drugs, and to push themselves right to the point of death,” Mr Moyes said.
“For six years the NSW Government has funded a drug experimentation laboratory where users can push their boundaries and where they have medical help immediately on hand from a nursing sister if they go too far.”

Source: The Daily Telegraph (Australia)June 28, 2007 12:00am

The federal government is stepping up its fight against tobacco, with a promise to cut smoking rates in Canada from 19 per cent last year to 12 per cent by 2011.
Health Minister Tony Clement, in Vancouver today for the Canadian Medical Association’s annual general meeting, said the target is ambitious but not unrealistic. “Seeing the great progress we have made over the past few years, I am confident . . . we can achieve this goal,” he said in a statement.
Clement also reiterated a promise to get tough on illicit drug use, saying mixed messages about the acceptability of drugs – including marijuana – must end.
“Canada has not run a serious or significant anti-drug campaign for almost 20 years, and the messages young people have received during the past several years have been confusing and conflicting, to say the least,” he told delegates.
“We are very concerned about the damage and pain that drugs cause families and we intend to reverse the trend toward vague, ambiguous messaging that has characterized Canadian attitudes in the recent past.”
He sidestepped questions about whether the anti-drug strategy would include harm-reduction measures such as Vancouver’s safe injection site, saying enforcement and prevention can also be considered harm reduction.
Furthermore, he said there is conflicting research about whether the safe injection site has been successful, adding that Ottawa will review all the data before making the long-awaited decision about whether the site can continue to operate.

Source: www.canada.com/vancouversun August 2007

OTTAWA — By the time they’re 14, many Canadian youth have done it all — cigarettes, drugs and alcohol — so a new report on substance abuse and addiction should serve as a “call to action” to change that, the organization behind the research says.
The Canadian Centre on Substance Abuse says Canadians need to pay closer attention to the facts that the average age when a child smokes a cigarette for the first time is about 12, 13 when he or she uses alcohol and gets drunk and 14 for first-time drug use.
In a report released Wednesday, titled Substance Abuse in Canada: Youth in Focus, the CCSA outlines gaps in Canada’s overall approach to dealing with these worrying statistics and it suggests several strategies to plug the holes.
The report paints an alarming portrait of drug and alcohol use by youth. By the time they are in their first year of high school, about two-thirds of students had consumed alcohol, according to one survey. Another survey of youth age 15-24 showed that 83% were currently drinking or had consumed alcohol within the past year. If it’s any comfort to parents, the students characterized their drinking as light to infrequent.
More than a third of students in grades 7 to 9 have binged on alcohol, meaning they consumed five or more drinks on a single occasion, researchers found. The same was true for 40% of 15- to 19-year-olds, while another survey showed that one-third of young drinkers drank at a hazardous level.
After alcohol, cannabis was the most commonly used illegal substance among youth. Cannabis use is reported by 17% of students in grades 7 to 9, about 29% of 15- to 17-year-olds, and almost half of 18- to 19-year-olds, the CCSA report said.
Pot smoking, in fact, now exceeds the rate of cigarette smoking among youth, the study found.
The statistics underline that new approaches are needed to prevent and treat substance abuse by youth, said Michel Perron, the CCSA’s chief executive officer.
In general, Mr. Perron said in an interview, there needs to be more funding for services, better co-ordination between all levels of government and non-governmental agencies, and better use of evidence-based research to evaluate which approaches are most effective. Specifically, Mr. Perron says, services need to be matched to the age and needs of certain kinds of youth, especially those at higher risk of substance abuse.
A universal prevention strategy that talks to youth about peer pressure, for example, can be effective up to about age 12, but beyond that, a one-size-fits-all approach won’t work, he said.
“We know that beyond 12 years old, and because the age of initiation is dropping consistently in Canada, which is a concern to us, we need to start matching our services to the age of youth,” he said.
Prevention strategies should target youth as early as possible, said Mr. Perron, ideally at around age 10.
“The longer we stave off a young person from trying illegal drugs or the like, the better it is, the less likely that they’ll carry on into the future,” he explained.
Canada also needs to “professionalize” addiction treatment services to make them more effective, said Perron. There’s a shortage of knowledgeable workers and no consistency in training, his organization says.
There’s also room for improvement in schools, the CCSA report said. Prevention strategies would be more effective, for example, if teachers had better training to recognize youth with substance abuse issues, it states.
Mr. Perron said he is optimistic about the ongoing challenges of curbing substance abuse among youth. While addiction was not on the political or public radar five or 10 years ago, said Mr. Perron, encouraging signs are now emerging.
He’s eagerly awaiting the anti-drug strategy promised by the federal government and expected this fall, and the recently established Canadian Mental Health Commission is another move in the right direction, he said. Good progress is being made at provincial levels too, Mr. Perron added.
The CCSA report is a call to action for both levels of government and the general public, he said.
“We’re very much looking to mobilize Canadian attention that we need to address substance use and addiction by youth in Canada,” he said. “We can’t do this with government alone; we have to be willing to work together.”

Source: CanWest News Service Wednesday, September 05, 2007

Vietnam has targeted to lower the number of drug addicts to below 0.1 percent of its population by 2010, Vietnam News Agency reported Wednesday.

Under the national anti-drug program by 2010 approved by Vietnamese Prime Minister Nguyen Tan Dung on Tuesday, the country has eyed to have 60 percent of its communes without drug addicts, and reduce the rate of people relapsing into addiction.

To this end, Vietnam, with population of over 84 million, will intensify surveillance on trading kinds of drugs from abroad into the country, eliminate growing trees providing materials for drug production, and tighten control over additive substances.

It will also complete law systems on drug prevention, improve public awareness and intensify international cooperation on the issue.

As of late 2006, Vietnam had a total of 160,226 drug addicts, over 70 percent of whom are in the age bracket of 18-35, according to statistics from the country’s Ministry of Public Security.

Source: Xinhua Peoples Daily Online 26.09.07

By: Ross Goodridge, Sydney, Australia
This year I published a paper entitled “The Methadone Conspiracy – Can Addicts Sue?”, highlighting the fact that Australia currently has approximately 24,000 people on long-term methadone maintenance programs. Patients receive daily methadone, which is ultimately supplied by the Federal Government of Australia. The methadone is often provided without any attempt to control long-term use or to restrict the addict’s use of other illicit drugs. Most methadone is provided by way of “take-away doses,” and thus an estimated 29 percent of methadone in Australia is re-sold on the black market. Methadone has become a substantial primary drug of addiction.
Methadone is a synthetic opiate, developed in Nazi Germany in 1941, in an attempt to replicate heroin for relief of pain. Methadone acts upon the body in a manner very similar to heroin, attaching to the same brain receptors and creating euphoria by the same chemical process.
In Australia, like most western countries, there are often many views expressed as to how society should deal with illicit drug users. There are those who promote a tougher on drugs policy, while others promote legalisation.
Since releasing “The Methadone Conspiracy,” I have personally attracted much criticism by those who promote legalisation. They believe that narcotics should be available either freely or by prescription. They already have one drug available on this basis – methadone.
On receipt of this criticism I posed the question for myself, “Can methadone maintenance be considered a successful drug treatment program?”
The starting point in answering this question is, “What is meant by success?”
If one starts with the position that no drug addict will ever be cured, and there is no point in trying, then I suppose it could be considered a success to provide clinically pure amounts of narcotic each day to that addict each day. This will provide lower risk of harm to the addict of HIV infection, criminal behaviour, etc.
From my prospective, I cannot, and do not, accept that the best outcome that can ever be achieved for any one addict is a lifetime of addiction.
Australia has a rapidly rising number of drug addicts, a rapidly rising number of methadone addicts, and rapidly rising crime. Australia’s prisons are over-flowing, and it is estimated that 80 percent of all prisoners have a drug addiction, which was a cause of their criminal behaviour. The direction must be changed.
Methadone programs do little to reduce the demand for heroin. An estimated 72 percent of people on long-term high dose methadone programs are also frequent heroin users.
Methadone addicts regularly sell part of their take-away doses in order to obtain money for heroin purchase.
Trading in methadone occurs directly outside of the methadone clinics in Australia.
Nobody involved in the field can be unaware of this fact; it is obvious and patent.
Heroin addicts buy methadone because one “done” (usually 20 or 40 millilitres), will help sustain a heroin addict until he or she can buy more heroin. Teenagers use methadone because of a perception that it is a “safe drug.” It is less daunting to take a sip than it is to inject, and teenagers experiment with methadone as a first drug.
Notwithstanding that there are now over 24,000 long-term methadone addicts in Australia, the Government does not offer any programs to help people overcome their methadone addiction. Drug addicts are placed in jail or given free drugs, and historically almost no funds are available to overcome drug addiction!
I am not opposed to methadone per se. I am opposed to methadone as the first and only option provided to people who would otherwise achieve abstinence.
Ross Goodridge is a senior Barrister-at-Law practising in Sydney, Australia. He is credited with the Australian introduction of Drug Courts and was responsible for the endorsement of Drug Courts by the AMA, most political parties and the broad community. Mr. Goodridge has been a keynote speaker at a number of conferences and an active supporter of the Australian Cities Against Drugs movement.

OTTAWA – Prime Minister Stephen Harper is set to announce a $64-million anti-drug strategy that cracks down on dealers and offers more help for users.Harper is to make the announcement Thursday in Winnipeg, casting his Conservative government’s approach as a balanced one that relies as heavily on prevention as it does on punishment. The new plan includes stricter penalties for drug-traffickers while spending millions on rehabilitation and public-awareness programs. The government wants to avoid having the plan portrayed as a Canadian version of the U.S. war on drugs. “There are two aspects to this,” said a source familiar with the announcement. “How can you help the user? And the other thing is punishing the dealer. Funding for the initiative was set out in the 2007 federal budget. The plan is expected to include: -A border crackdown on drug smuggling. -$32 million on treatments like detox and rehab centres.-About $10 million for an awareness campaign aimed at young people. One of the key goals of the awareness program is to alert kids to the dangers of marijuana and remind them that it remains illegal. Since the Conservatives took office, the number of people arrested for simple possession of marijuana has skyrocketed. Toronto, Vancouver, Ottawa and Halifax all reported increases of between 20 and 50 per cent in 2006 of arrests for possession of cannabis, compared with the previous year. As a result, thousands of people were charged with a criminal offence that, under the previous Liberal government, was on the verge of being decriminalized. Police say those Liberal efforts to decriminalize pot sent mixed messages to the public. They say many pot smokers have been emboldened by the talk of decriminalization and are more apt to smoke in public – all of which has resulted in more arrests. Proponents of more liberalized drug laws have ridiculed the Tory approach to marijuana, calling it a waste of taxpayers’ money to prosecute pot smokers. Drug-dependency experts have also challenged the common notion that pot is a so-called ‘gateway’ to other drugs, and argue that it actually keeps people from experimenting with more dangerous ones.Health Minister Tony Clement, who will be one of three cabinet ministers present at the announcement, has said his government wants to clear up the uncertainty about marijuana. “There’s been a lot of mixed messages going out about illicit drugs,” Clement said recently. “We’re going to be back in the business of an anti-drug strategy. . . In that sense, the party’s over.”

The policy on cannabis use in The Netherlands is substantially different from that in many other
countries. It is based on the idea that separating the markets for hard drugs and soft drugs prevents soft drug users to resort to hard drug use. Over the years so-called coffeeshops emerged.

Coffeeshops are alcohol free establishments where the selling and using of soft drugs is not prosecuted,provided certain conditions are met. Many of the cannabis products sold in these coffeeshops originate from Dutch-grown grass called ‘nederwiet’. Critics of the Dutch drug policy have claimed that the THC-content of nederwiet has increased drastically over the last decades.

However,the THC-content of cannabis products as sold in coffeeshops has not systematically been
tested. On request of the Ministries of Health and Justice, the potency of cannabis products as sold in coffeeshops in The Netherlands has been investigated since 1999.

Tetrahydrocannabinol (THC) is the main psychoactive compound in marihuana and hashish. The
aim of this study was to investigate the concentration of THC in marihuana and hash as sold in
Dutch coffeeshops. In addition we wanted to know whether there are differences between the cannabis products originating from Dutch grown hemp (nederwiet) and those derived from imported hemp. It is the eighth time that this study has been performed.

It might be that there are differences in potency of cannabis products in different seasons of the
year. For that reason, since 2001, every year extra samplings have been done in September. In
these extra studies only nederwiet was bought. The names and addresses of 50 Dutch coffeeshops were randomly selected. For the purpose of this study, 53 samples of nederwiet, 24 samples of foreign marihuana, 14 samples of Dutch hash and 42 samples of hash prepared from foreign hemp were anonymously bought in the selected coffeeshops.

In addition, 47 samples of the most potent marihuana product available in the coffeeshop,
were bought. As a rule samples of 1 gram were bought. The average THC-content of all the marihuana samples together13 was 14,2% and that of the hash-samples 17,2%. The average THC-content of nederwiet (16,0%) was significantly higher than that of foreign marihuana (6,0%). Hash derived from Dutch hemp contained more THC (29,1%) than hash originating from foreign hemp (13,3%). The average THC percentage of nederwiet was significantly lower than last year (16,9 vs. 17.5%).

Again, the THC-percentage in foreign marihuana did not differ from the previous samplings. The average THC-percentage of the marihuana samples that were bought as most potent (16,5%) did not differ from the average percentage of nederwiet. The potency of nederwiet bought in September 2006 was not significantly different from samples bought in December/January 2007. It was the first time that no seasonal influence in THC-levels was found. There seems to be a stabilization of the potency of nederwiet. Such stabilization was first seen in the cannabis samples bought in September. Most potent as indicated by the coffeeshop personnel. This is not corrected for in terms of relative contribution of number of foreign or Dutch samples.

Prices that had to be paid for foreign marihuana were lower than those for any of the other
cannabis products. The prices of nederwiet increased significantly the last year.
The most notable finding in the current investigation was a significant decrease in the potency
of imported hash (from 18,7% in 2006 to 13,3% in 2007). Climate factors in the countries
of origin seem to be the most logical explanation. Future monitoring has to show
whether this is an incident or a trend.

Source:THC-concentration in weed, netherweed and hasj in the Dutch coffeeshops (2006-2007)’, English summary.Trimbos Institute

For distribution to your contacts.
We are in agreement on the effects of ineffective international policies, political agendas and poor services.

We are requesting the Irish Government to take responsibility towards its Ministers as you will see from the article in our main National newspaper the Sunday Independent. [http://www.independent.ie/national-news/no-to-dail-coke-tests-minister-1
116996.html]
In the name of National security and especially as they are responsible
for national drug policy we feel it is imperative. This is similiar
for all other Governments.

If anyone is using it, means they are compromised in their position.
We did one hour on national radio yesterday discussing the effects of drug use on crime and the harm that our present national policy has
caused . Ireland has one of the highest rates of drug use in Europe.
When I work in Sweden we see the effects of a Drug Free Policy.
Less drug use, crime etc. Although they have a problem it is not in any way equal to that which we see under present ‘Harm Reduction’ – Harm Production policies internationally.

Source: Marie Byrne, Aisling Group International,Ireland. October 2007

The sale of hallucinogenic magic mushrooms is about to be banned by the Dutch Government in the latest sign of a conservative backlash against Amsterdam’s relaxed attitude towards sex and drugs.
A series of high-profile deaths and injuries linked to magic mushroom trips has proved too much for ministers, who are expected to discuss prohibition proposals from Ab Klink, the Health Secretary, at a Cabinet meeting today. The move follows growing official impatience with the unforeseen consequences of traditional Dutch tolerance, which instead of normalising drug taking and prostitution has drawn in people-traffickers, dealers and organised crime gangs from across Europe.
Mr Klink’s push for a ban on the mushrooms follows plans by the Mayor of Amsterdam for an upgrade of the city’s infamous red-light district, including the closure of many of its prostitute windows and coffee shops where cannabis is openly sold. Job Cohen, the mayor, has also proposed a three-day “cooling-off” period between ordering mushrooms and buying them, to put off Amsterdam’s many weekend tourists, but that did not go far enough for Mr Klink.
Fresh mushrooms — as opposed to dried fungi which are already banned — are legally on sale at so-called smart shops, about 40 of which have sprung up in the capital selling all manner of herbal and chemical compounds. The sale of hallucinogenic mushrooms is illegal in most other countries and the dramatic rethink in the Netherlands has followed a rise in medical emergencies in Amsterdam linked to mushroom use.
Ambulance call-outs rose from 70 in 2005 to 128 last year, with nine out of ten cases involving tourists. Britons were the largest group among them. In July an 18-year-old from Iceland threw himself out of a hotel window, breaking both his legs.
But what really caught the public imagination was the death of a 17-year-old French girl who jumped from a bridge over one of Amsterdam’s canals to her death in March, apparently under the influence of magic mushrooms. In May, Mr Klink ordered the national health institute to carry out a fresh study on the risks of mushrooms, following an earlier report that played down the health dangers and led to a continuation of the tolerant approach.
Magic mushrooms are not addictive, but can have severe psychological consequences. Over the past six years mushrooms in dried and fresh form have been banned in Britain, Denmark and Ireland. In Britain, freshly picked magic mushrooms have been classified as Class A drugs for two years. The Drugs Act 2005 brought the law on fresh mushrooms into line with dried specimens. Britain acted after a significant rise in the amount of imported magic mushrooms.

Source: Daily Dose 11th October 2007

Friday, October 19, 2007
Forensic psychiatrist Dr. Shabehram Lohrasbe, who has an office in the area, says the exchange is a neighbourhood nightmare of filth, confrontation and constant threats of violence.

I write out of concern that the desperation, exhaustion and fearfulness of the citizens who work and live near the Cormorant Street needle exchange has not come through clearly enough. Frustration can come across as insensitivity, a lack of compassion or a kind of NIMBY attitude, which would be very misleading.
Many of us who encounter the unhappy souls who struggle with addiction are not unsympathetic to their plight. I work regularly with the addicted, the homeless and the mentally ill in our province’s prisons.
For those of us who observe the devastation of a neighbourhood in the name of a social experiment, resentment is focused not on the unfortunates, but on those who planned and implemented this disaster, including our mayor and council. We are exhausted and outraged by their failure to deal with the unsurprising consequences of simply providing needles to a group of people who need much more.
It is the restraint of those who have tolerated this abandonment of civic responsibility that has kept things from getting out of control.
Let me provide one example, a mild one. Not long ago, a man barged into my office, demanding to use the washroom. Having been burned by acceding to a similar demand in the past that resulted in needles and blood in my washroom, I refused and asked him to leave. He did, walked outside and then urinated on my door, aiming at the door handle.
Consider my options. Should I call the police? Or physically push him off my property, risking being doused by urine or stabbed by a needle? Should I risk a shouting match and possible retaliation?
So he walked away smirking, with no fear of any consequences. I washed the door before my next patient arrived. This on a day that started with me scooping diarrhea embedded with needles off my front steps.
Used needles, human feces, discarded underwear, assorted condoms and other unsanitary byproducts of addiction are frequently deposited on properties in the neighbourhood. After earlier protests, the city installed a “porta-potty” outside the needle exchange. That lasted but a few days, apparently because of the refusal of those who have to clean the toilets to deal with the needles and other paraphernalia jammed into them.
Trained workers understandably refused to face the health risks, yet citizens are left to their own devices.
We have asked for toilets, increased policing, assistance in regular cleaning or tax relief so that we can hire our own crews and private security. Our pleas have gone nowhere and the mayor has not responded to my last letter.
In it, I have told him that if the lawsuit over the injection site fails, my neighbours and I will have no choice but to erect tall fences topped with barbed wire along our streets. This is what it has come to in our once-beautiful city; citizens are left to wall themselves off, prison-like, in a downtown area.
Since I spend a good part of my work week in prisons, it is not especially harsh for me, but for a 70-year-old pensioner who grew up in a city where she once walked fearlessly, it is utterly disheartening.
I am outraged by the complacency of those who seek power and responsibility and then do nothing when faced with a crisis.
I work here, but many senior citizens, some handicapped, live here. Many are unable to sleep at night, never mind take a walk. They are intimidated by the arguments and yelling, the confrontations and their increasing fears of violence.
The fears of those who bear the brunt of this disaster are not exaggerated or misplaced. The needle exchange is a gathering place for addicts and the predators that they inevitably attract. It is the latter group that is becoming increasingly prominent and more confrontational.
Drug dependence, especially on short-acting opiates, creates desperate cravings, often several times a day. There is a clear relationship between substance abuse and criminality, including acts of violence.
There are three broad ways in which alcohol and drugs influence crime and violence. The first is physiological, through a direct effect on mental functioning, when disinhibition of behaviour, including aggressive behaviour, is common. The second influence is due to the financial needs of the addict. Finally, there is the “business” aspect of addiction, the turf wars between dealers and others who prey on addiction.
By funnelling a large proportion of the city’s drug-related crime and disorder into a small neighbourhood, those responsible for this disaster have absconded from their responsibility for follow-through with services for the addicts, protection from the predators they attract and basic services for the citizens left to cope with the crime, filth and public disorder.
The “service” of providing needles ends before sundown when the needle exchange shuts down, leaving the addicted with no support, supervision, food or water, protection from predators, shelter or toilets.
Where do the politicians and planners think these people go to shoot up, steal money for their next hit or next meal, sleep, urinate, rant and rave, intimidate, vent their fury against the society they believe has abandoned them and destroy property and peace-of-mind?
Invited to bring their suffering and their rage to a particular spot, then left to their own devices, they inflict their despair and their frenzy on a small group of citizens who have been left to cope with the predictable consequences of “injecting” a crime-prone subculture into what was once a beautiful, pleasant and safe neighborhood.

Source: www.Canada.com 19th Oct.2007

Drug treatment works. How do we know? Today, there are millions of millions of Americans successfully recovering from drug and alcohol addiction. These courageous Americans are living proof that effective drug treatment can save lives and reduce our national drug problem.
That’s why it’s so troubling to see this:
“SAN FRANCISCO (AP) — City health officials took steps Thursday toward opening the nation’s first legal safe-injection room, where addicts could shoot up heroin, cocaine and other drugs under the supervision of nurses.
Hoping to reduce San Francisco’s high rate of fatal drug overdoses, the public health department co-sponsored a symposium on the only such facility in North America, a four-year-old Vancouver site where an estimated 700 intravenous users a day self-administer narcotics under the supervision of nurses…
… Bertha Madras, deputy director of demand reduction for the White House Office of National Drug Control Policy, called San Francisco’s consideration of such a facility “disconcerting” and “poor public policy.”
“The underlying philosophy is, ‘We accept drug addiction, we accept the state of affairs as acceptable,’ Madras said. “This is a form of giving up.” [AP]
Indeed, no one proposes aiding and sustaining an alcoholic by providing a supervised site for alcohol use. At best, so-called “harm reduction” is half-way measure; half-hearted approach that accepts defeat. Pretending harmful activity will be reduced if we condone it under the law is foolhardy and irresponsible.
Need more proof that treatment works? Consider this:
• Nearly 10,000 clients in community-based programs in 11 cities were compared before and after treatment on a number of key outcomes. Depending upon treatment modality, the data showed reductions in weekly use of heroin (between 44 and 69 percent), cocaine (between 56 and 69 percent), and marijuana (between 55 and 67 percent); reductions in illegal behavior (between 36 and 61 percent); and improvements in employment status (between 4 and 12 percent).
• One year following discharge from drug treatment, use of the primary drug of choice dropped 48 percent; arrests dropped 64 percent; self-reported illegal activity dropped 48 percent; and the number of health visits related to substance use declined by more than 50 percent.
• Five years after discharge, there was a 21 percent reduction in the use of any illegal drug—a 45 percent reduction in powder cocaine use, a 17 percent drop in crack cocaine use, a 14 percent decline in heroin use, and a 28 percent drop in marijuana use. Similar reductions were reported for criminal activity: a 30 percent reduction in selling drugs, a 23 percent decrease in victimizing others, and a 38 percent drop in breaking and entering, as well as a 56 percent drop in motor vehicle theft.

Sources: Drug Abuse Treatment Outcome Study, National Treatment Improvement Evaluation Study, and Services Research Outcomes Study.

Vancouver is a beautiful city – but they have a dreadful situation around Gas Town on the East side –
The needle exchange programme there attracts the most desperate of drug users. Now Victoria has very similar problems around their NEP.

Mayor promises to find homes for 50 of the most troubled homeless people; plan expected have ‘enormous’ impact
Published: Wednesday, October 24, 2007
Victoria Mayor Alan Lowe promises the city will sweep off the streets 50 homeless people who are shooting up drugs and causing conflict downtown within four months.
The move, which makes good on recommendations contained in task force report released last week, should have an immediate and dramatic effect as the the group is one of the most visible symbols of the substance-abuse, mental-health and homelessness problems plaguing the city. Lowe said the first community outreach team called for in the report will be “up and running immediately,” and will find homes for the 50 “hardest to house” homeless people within 120 days.
One of the most visible examples of the city’s homelessness and addiction crisis is the needle exchange on Cormorant Street. Many of the most troublesome homeless people hang out there, leaving a trail of filth, faeces and needles.
Currently, the 50 people have nowhere to go, so often are sprawled outside the needle exchange on Cormorant Street or Streetlink on Store Street, amid feces, filth and scattered hypodermic needles.
The City of Victoria task force action plan unveiled last week aims to find 1,550 housing units over the next five years for the homeless. Within a year, the city plans to find accommodations, through rent subsidies, for 350 people.
The Vancouver Island Health Authority has kicked in $7.6 million toward the effort to deal with the homelessness and addiction crisis – more than $3 million of that going toward the creation of four outreach groups, dubbed “Assertive Community Teams,” to provide support to people on the streets, in shelters or supportive housing. Another $1.7 million is earmarked for adult detox treatment.
Victoria lawyer Stewart Johnston, who is leading a court action to shut down the needle exchange near his law office, said helping those individuals and finding them a place to live will change the entire look and feel of downtown Victoria. “If you take the worst 45 to 50 off streets, and then another 300, the difference would be enormous,” he said.
Police have estimated about 45 people are causing most of the problems around the needle exchange, Johnston said. Housing that group of people “would make all the sense in the world,” said Rev. Al Tysick of Our Place Society. A meeting on Friday should better clarify how the 50 people will be selected, he said.
Victoria police acting chief Bill Naughton agreed the plan will have an immediate and “very significant impact. It could also make easier the job of police, who continue to shuffle homeless residents from one doorway to another as business owners complain. Police can’t solve the housing piece of the puzzle but we recognize how important it is,” Naughton said.
Police estimate a group of 324 homeless, addicted and mentally-ill people were responsible for 23,033 police incidents over a period of 40 months, at a cost of $9 million. Some of the hardest to house will go to the soon-to-open Our Place Society drop-in street shelter and transitional housing complex, “but I don’t think it is a good idea to put them all in one location,” Lowe said. “They need to be dispersed, as long as there are support services available to follow the individuals.”
Victoria Coun. Charlayne Thornton-Joe said the plan is to use rent subsidies to place people throughout the region in existing housing. As long as there is “support wrapped around the individual,” and landlords have a housing team they can call around the clock, such placements are highly successful, she said.

Source Times Colonist Oct 2007
COMMENTS ON THIS STORY

Sylvia Oertel
Wed, Oct 24, 07 at 04:54 AM
There’s big talk about getting these poor souls off the street & I applaud that action. Now let’s not forget their greatest needs which are continuing health care, mental health care, rehabilitation programs, AA-NA,co-dependancy, abuse& anger mgmt programs ‘for all’ not just a chosen few & no endless wait lists! Then there’s self esteem courses, budgeting help, education & training… I could go on forever with the needs of these persons as they are obviously going to require a myriad of complex treatment to fully recover as it’s more than just addictions now….. There was a time when they thought “oh, I’ll never become an addict, I only do it when I party”, but that devils dust got hold of them and has had them in its grip for a decade or more! Maybe rather than a cheque each month (which at this date is generally being used to support addictiions),until they are stable they get Rent ‘paid direct’ & food credits, & laundry facilities, to assure that the $ are spent on essentials to help keep them healthy & clean…. After all the proof is in the pudding that so far the funds have been supporting habits. That wouldn’t change just because there’s a roof over their head. Not without some type of cautions in place. Maybe to encourage them to attend programs they could earn incentives… These ideas and insights come from the heart of a mother of 2 addicted daughters. Why do I care? Because I have a mother’s heart.When I counted their ten tiny little toes this wasn’t the dreams & hopes I had for my girls….. So when it comes to my girls I can only live 1 day at a time, no making plans with them for days ahead. I go to bed & wake up saying tpraying ‘ Serenity Prayer’, and dreading the knocks on my door or the calls that may be the time someone tells me they’re lost to me forever……….. Please just sign me :’Mom of 3 & Grandma of 6′

Nick
Wed, Oct 24, 07 at 03:57 PM
As a former long time Victoria resident, I think I should warn you that BC is THE destination for drug-loving lowlifes from the rest of the country. Build it and they will come, no sooner will you get rid of the current crop and the next batch will arrive from Ontario, Quebec, or other eastern provinces. BC should be petitioning the feds to make it possible to deport bad apples to their homes.

Nick 2.
Wed, Oct 24, 07 at 08:57 PM
Nick above has it right. Some people need to give their heads a good shake. Surely you must realise that if we citizens of Victoria start (continue) putting our taxes towards free needles, food, shelter etc for those who themselves put the needle in themselves, the flood gates will open. So let me see if I have the picture straight! If I shoot up, leave needles in the street, deficate publically, beg, sleep in someone elses doorway, or have a dog I don’t want to give up you are going to give me a place to live??? Sounds good to me, where do I start and can get a free dog please?

HEROIN is set for a devastating comeback on Sydney streets and could trigger a major surge in overdoses, drug experts warned yesterday.
While a recent heroin drought led to a drop in overdoses in Australia, an influx of pure heroin from East Asia is expected to flood the local market, sparking grave fears of more drug deaths.
The quantity of heroin imported to Australia has almost doubled in the past two years, jumping from 40kg in 2005-06 to about 70kg last financial year, the latest statistics show.
A dramatic increase in poppy production in Afghanistan and Burma due to favourable weather conditions has been blamed for the increased supply of pure heroin, which experts say is destined for Sydney, which is renowned as Australia’s heroin capital.
The Australian National Council on Drugs yesterday warned low grade heroin supplies were being supplemented by higher concentrations.
“The increase in purity has a potential problem for more overdoses,” the council’s executive director Gino Vumbaca said.
“Sydney is the market where it comes to and there’s an increase in usage patterns.”
The UN has recently confirmed Burma had dramatically increased poppy yields.
“They’re expecting a lot of heroin to be produced and sold and the destination will be Sydney and Melbourne,” Mr Vumbaca said.
The trend has angered Australia’s leading drug support group which held a memorial service in Canberra this week – attended by more than 100 people – to pay tribute to family members lost to drug overdoses.
“We haven’t solved the problem, we haven’t done anything to make long-term solutions,” a Families and Friends for Drug Law Reform spokesman said.
The heroin issue was also raised at a national drug strategy conference on the Gold Coast yesterday with experts saying supplies were certainly on the rise.
National Drug and Alcohol Research Council spokeswoman Louisa Degenhardt said internal research showed drug users confirmed that heroin supply was increasing.
“A greater proportion said it was very easy to get compared to last year,” she said.

Source www.news.com.au Oct 2007

DRUG deaths soared from 111 to 162 in the Greater Glasgow and Clyde Health Board area last year.
Heroin or morphine was the cause of 97 deaths and methadone was involved in 58 cases.
In Glasgow alone, there were 113 drug-related deaths, a sharp rise from 75 last year.
The rises in both areas were far higher than anywhere else in the country.
The figures, in a report from the General Register Office, revealed there were 421 drug-related deaths in Scotland, 85 more than last year.
They also show that there were 204,168 methadone prescriptions in the Greater Glasgow and Clyde Health Board area at a cost of almost £4.7million Glasgow Tory MSP Bill Aitken said: “These figures are so bad they point to a loss of control over an already desperate problem.
“The message has got to get across that dabbling with drugs then becomes a serious addiction and frequently ends with the loss of a life.
“We have to react to these tragic statistics. There must be a no-tolerance approach to drug taking, strict and punitive enforcement on drug dealers and better efforts to rehabilitate those who are willing address their demons.”
Minister for Community Safety Fergus Ewing said drug abuse was “one of the greatest problems facing us as a nation”.
He added: “It’s a long term problem, we need long-term solutions – not quick fixes. We will launch a new drugs strategy next year that will be focussed on using resources more effectively to get addicts drug-free.
“Connecting people to the right services and integrated care to help them lead drug free lives should be the norm across Scotland rather than the exception.”

Source: Evening Times. 19/12/07

IT IS clear for all to see that Ireland has a growing cocaine problem which we must face in a sensible and coherent manner. But in the process of tackling the problem, we must steer a careful path between two major mistakes that would make the situation worse.
The first mistake is that of normalising the problem by hyping its prevalence. The recent Prime Time Investigates programme grabbed the headlines with its findings that cocaine traces can be found in most pubs and nightclubs. But that is a long way from showing that most individuals take cocaine. If we create the impression that “everyone” takes cocaine when they clearly don’t, and if we communicate the idea that cocaine use is now the expected behaviour for young people, we can make the problem worse because of the powerful effect of social norm perceptions on human behaviour.
The second, and even greater, danger is to indulge in poorly thought-out policy reactions that will have the ultimate effect of making the problem worse. That’s why arguments about legalising cocaine and other drugs, must be rejected.
One of the arguments for legalisation is that state controls would put the crime lords out of business. But there is absolutely no evidence for this. Do we really believe that the gangs who have made millions, and who are prepared to kill to protect their narcotic empires, will simply walk away and retire?
At what age should children be allowed to buy legal cocaine? One study released earlier this year indicated that 40 per cent of Irish 15-year-olds have dabbled in illegal drugs. Should cocaine be legal for kids of this age? Unless we make cocaine more freely available than alcohol and tobacco, and place no age limits on it, a black market for underage cocaine will remain. In such a scenario, what’s to stop our drug lords killing each other to capture the teen coke market? And what if the cocaine magnates diversify into other banned substances, creating a new, expanded market where they won’t have to compete against the local cocaine-selling pharmacy? Do we really want expert drug pushers pursuing our teenagers in this way? What about the cost of legal cocaine? What’s to stop the criminal gangs from undercutting the price of legal cocaine?
But even if, in some alternative reality, the decriminalisation of cocaine would reduce crime, we still face a choice between two major evils and must ask ourselves which of them is the lesser: gangs wiping each other out or the prospect of even greater drug abuse and death in the rest of the population due to decriminalisation?
Legalising cocaine would inevitably increase drug consumption levels and with them, drug-related tragedies because the law plays a significant role in influencing human behaviour. Of course, it is peers that have the most intensely powerful impact on our behaviour, precisely because friends help to establish the social norms. But if this potent peer pressure has already led to a significant cocaine problem, how much greater would our problem be if the State endorsed cocaine?
Britain, in taking a softer approach to marijuana, has seen a 22 per cent increase in hospital admissions of cannabis users. The Netherlands, with its enlightened drugs policy, has seen a dramatic rise in heroin use since soft drugs were legalised. Meanwhile, Sweden, with some of the toughest drugs laws has Europe’s lowest consumption rate.
After the recent cocaine-related death of Kevin Doyle, 21, of Waterford, his family said that they “sincerely hope that no family has to suffer the pain that we are going through”. Can we really believe that a dangerous experiment with legalised cocaine would help their wish to come true?

Source: Independent i.e. Sunday December 23 2007
Patrick Kenny is a lecturer in marketing in the Dublin Institute of Technology.

Czech pot smokers have breathed a sigh of relief after the government clarified a law on drug use, turning the country into one of Europe’s safest havens for casual drug users.
Under the more transparent and liberal law in effect since January, people found in possession of up to 15 grammes (half an ounce) of marijuana or growing up to five cannabis plants no longer risk prison or a criminal record, but can only be fined if caught. The new law replaced an ambiguous one that made it a penalty to be in possession of “a larger than small amount” of marijuana.
But Karel Nespor, a doctor who heads the addiction treatment centre at Prague-Bohnice psychiatric hospital, is concerned about impact the eased law may have on health. “One study found that the risk of heart attack is four times higher in the hour after someone smokes a marijuana joint,” he recently told the Czech daily Dnes .”Marijuana use also risks provoking ‘cravings’ for the drug,” he said.
Adopted after years of wrangling, the new drug law also allows people to possess less than 1.5 grammes of heroin, a gramme of cocaine, up to five grammes of hashish, and five LSD blotter papers, pills, capsules or crystals.
Czechs can also legally grow up to five cannabis or coca plants or cacti containing mescaline, and possess up to 40 magic mushrooms. If growers comply with the legal limits, possession is treated as a minor offence, while the possession of bigger amounts may result in up to six months in prison for hemp and up to a year for magic mushrooms, plus a fine. In neighbouring Poland and Slovakia, people possessing any amount of marijuana risk ending up behind bars.

Source Daily Dose 18.03.10

On March 1, Ethan Nadelmann of the Drug Policy Alliance had expressed pleasure that “Obama and his Drug Czar, Gil, have made it clear that they don’t want to talk about marijuana at all.” Nadelmann considered the silence to mean assent to his agenda of marijuana decriminalization and legalization. But just three days later, in a dramatic development, Gil Kerlikowske, the director of the White House Office of National Drug Control Policy (ONDCP), came out in strong opposition to almost everything that Nadelmann and his “progressive” backers represent.

In a major speech on March 4, Kerlikowske denounced the use of marijuana, including its “medical” version, and cited facts and studies linking the weed to all kinds of health problems. “The concern with marijuana is not born out of any culture-war mentality, but out of what the science tells us about the drug’s effects,” he said. “And the science, though still evolving, is clear: marijuana use is harmful. It is associated with dependence, respiratory and mental illness, poor motor performance, and cognitive impairment, among other negative effects.”

This has to be perceived as a tremendous setback for Nadelmann and the rich liberals, led by George Soros and Peter Lewis, who have financed the drug legalization and “medical marijuana” movements. The Kerlikowske speech constitutes belated recognition that the drug wars south of the border are inexorably linked to the growing use of marijuana in California, where some of the same Mexican drug gangs are planting and harvesting their crop.
A report, Organized Crime in California Annual Report 2007-08, prepared by the California Department of Justice, states that “Mexican drug trafficking organizations [DTOs] command a large portion of the illegal drug trade in California.” Those DTOs, which “dominate the outdoor cultivation of marijuana in California,” are, in turn, linked to criminal street gangs and organized crime groups.

Maryland Considers Pro-pot Bill

Despite the wake-up call from Obama’s own Drug Czar, the well-financed movement to legalize dope continues on many fronts. On Thursday, March 18, Joyce Nalepka, former President of Nancy Reagan’s favorite charity, the National Federation of Parents for Drug-Free Youth, will testify in hearings before the Maryland State Legislature in Annapolis. She says that Maryland Senate Bill SB 627 would allow use of marijuana under the guise of “medicine.”
Thursday will mark the ninth time Nalepka has testified on this issue in Maryland. “There is nothing new to say, except the marijuana that kids are using today is so much more potent, they refer to it as ‘Skunk.’ Eighteen nations, including the U.S., now link ‘Skunk’ marijuana to depression, psychosis and schizophrenia,” she says.

On the national level, supported by Soros and Lewis, then-candidate Barack Obama adopted the soft-on-drugs approach. As President, his Attorney General Eric Holder decided to withhold federal resources from the war on drugs in California, at least as they apply to the growing “medical marijuana” program. But that was before a psychotic pothead named John Patrick Bedell came all the way from California with a “medical marijuana” card and opened fire on the entrance to the Pentagon, wounding two guards before getting killed himself.

Ironically, on the same day that Bedell was preparing his assault, Kerlikowske was getting ready to speak to the California Police Chiefs Association Conference in San Jose, California. His topic: “Why Marijuana Legalization Would Compromise Public Health and Public Safety.” The speech was so powerful, in terms of the facts he presented about the problems associated with marijuana, including “medical marijuana,” that it is somewhat shocking to consider that he has a job in the Obama Administration.

The editorial board of the Christian Science Monitor was pleasantly surprised, saying that “The Obama White House has finally laid out its most thorough, reasoned rebuttal to arguments for marijuana legalization—countering a campaign that is gaining alarming momentum at the state level.” Its editorial headline highlighted that this position had “finally” been articulated, reflecting frustration with the silence and confusion on the matter of drug legalization coming from the Obama Administration. The editorial referred to the “well-financed, well-organized pro-marijuana effort,” without noting that billionaires Soros and Lewis, major Democratic Party donors, are behind it. Obama should be asked at his next news conference, when and if he ever holds one, if he agrees with his Drug Czar about the dangers of dope, which he smoked as a young man, along with snorting cocaine. But the President has apparently been too busy with national health care legislation to take an interest in the health impact of illegal drugs and the drug wars that are resulting in part from its cultivation and use in the “Golden State.” Pot Linked to Mental Problems

In its editorial, “Marijuana legalization? A White House rebuttal, finally,” The Christian Science Monitor made prominent mention of John Patrick Bedell’s marijuana use and mental problems, which gave urgency to Kerlikowske’s remarks. It said, “The recent ‘Pentagon shooter,’ John Patrick Bedell, was a heavy marijuana user. The disturbed young man’s psychiatrist told the Associated Press that marijuana made the symptoms of his mental illness more pronounced.”
There is a contrast, as noted by the publication, between Kerlikowske’s tough talk to the California police chiefs and the Holder policy of withdrawing from a big part of the war on drugs in California. Attorney General Holder insists that the Department of Justice just doesn’t have the “resources” to do anything about the “medical marijuana” problem.

Kerlikowske alluded to “the problems associated with medical marijuana dispensaries,” where people get their dope with the simple approval of a pro-pot doctor, and said that “We’ve seen the problems of medical marijuana here in this state but also in places like Colorado, too, where kids are given the message that since marijuana is a medicine, it must be safe.” Although he failed to say anything about the Administration having basically given up on doing anything about those dispensaries, his comments have put him on a collision course with Holder and perhaps Obama himself. In California, anti-drug activists are examining what can be done about the pro-pot doctors behind the “medical marijuana” scam.

The Warning

As the Christian Science Monitor pointed out, some of the best material in the speech came in a jam-packed footnote. The paper said, “As Kerlikowske pointed out, marijuana is harmful—and he has the studies to back it up. Read the footnotes in his speech; they’re sobering, especially No. 8.” That footnote describes the scientific studies linking marijuana to respiratory illnesses, lung injury, and mental illness, including psychosis. Little did Kerlikowske know that, as he was speaking to the police chiefs, a crazed California pothead was on his way to try to kill people at the Pentagon because he thought the U.S. military was involved in a conspiracy of some sort. Of course, this is just one aspect of the mental problems associated with marijuana use. Simply put, the weed reduces the ability of people to think and act clearly.

On the matter of why drug legalization will increase and not solve any marijuana-related problems, Kerlikowske said that “it is clear that the social costs of legalizing marijuana would outweigh any possible tax that could be levied. In the United States, illegal drugs already cost $180 billion a year in health care, lost productivity, crime, and other expenditures. That number would only increase under legalization because of increased use.”
Regarding the claim that legalization would eliminate the black market, reduce crime and strike a blow against the drug trafficking organizations, he explained that the evidence indicates that there would still be a “profit motive for the existing black market providers to stay in the market, as they can still cover their costs of production and make a nice profit.” As a result, he noted, legalization would “saddle government with the dual burden of regulating a new legal market while continuing to pay for the negative side effects associated with an underground market whose providers have little economic incentive to disappear.”
In practical terms, he added, “Legalization means the price comes down, the number of users goes up, the underground market adapts, and the revenue gained through a regulated market will never keep pace with the financial and social cost of making this drug more accessible.”

Now Under Attack

Predictably, Kerlikowske is being attacked by the illegal drug lobby. The Peter Lewis-funded Marijuana Policy Project called his speech “supremely uneducated.” Like John Patrick Bedell, the potheads won’t rest until society recognizes their right to smoke, grow and even worship pot. Do they have an ally in President Obama? “Yes we Cannabis!” they say. But the public, concerned about a generation literally going to pot under a President who inhaled and liked it, may have something to say about that. With all the criticism of Obama’s various “Czars,” at least one of them, Gil Kerlikowske, has taken a bold stand that is out of step with what Obama’s “progressive” base has been demanding. It will be interesting to see how long he lasts.

Source Cliff Kincaid March 17 2010

Thank you for inviting me here today to address your conference. I especially want to thank Chief Rob Davis for that introduction.
Furthermore, I’d like to congratulate and thank your new President, Susan Manheimer.
I also want to acknowledge my friend, Barney Malekian, and congratulate him on his appointment as the COPS Director. I believe our appointments speak very clearly about the level of support and respect this Administration has for local law enforcement.
You have been at the forefront of some very controversial issues, and I appreciate your leadership. Other states look to California 2
for guidance, and your thoughtful and timely efforts on drug issues ranging from medical marijuana to pseudoephedrine are important for the health and safety of all Americans.
When President Obama asked me to serve as Director of National Drug Control Policy, he explained that one of my first duties would be drafting his Administration’s first National Drug Control Strategy, laying out the policies and programs best suited to curb drug use and its consequences.
But the President didn’t want a traditional policy paper, with a few people from Washington putting their ideas down and then submitting to Congress a plan that would be forgotten or disregarded by the field. Instead, he asked me to travel the country and sit down with people on every side of this issue.
Since my confirmation, I’ve visited 37 cities in 19 states, as well as 8 foreign countries, holding roundtable discussions and meeting with hundreds of drug prevention and treatment experts, local officials, law enforcement, parents, teachers, community groups, academics, and young people.
We also convened a working group made up of the 35 Federal agencies with a role in the anti-drug effort. The group’s task was to develop a coordinated approach at the Federal level.
These months of consultations across the country helped highlight an important truth – that public safety and public health are threatened by drug use and its consequences. Addressing these 3
challenges requires a balanced, comprehensive, and evidence-based approach.
The Administration’s Drug Control Strategy, which will be released soon, will build on the hard-won knowledge we already have, but it will also incorporate new information and new tools that experience in the trenches and our best research have provided us.
The scope of our country’s drug problem is disturbingly clear: drug overdoses outnumber gunshot deaths in America and are fast approaching motor vehicle crashes as the leading cause of accidental death. It’s hard to believe since we seem to hear much more about H1N1, the Toyota recall, and texting while driving.
We are also deeply concerned about two relatively recent threats to public safety and public health: prescription drug abuse and drugged driving.
Prescription drug abuse harms the people who take these pills and those close to them. While we must ensure access to medications that alleviate suffering, it is also vital that we do all we can to curtail diversion and abuse of pharmaceuticals.
Past-year initiation of non-medical prescription drug use has surpassed the rate for marijuana.1 Moreover, between 1997 and 2007, treatment admissions for prescription painkillers increased more than 400 percent. The latest data from the Monitoring the Future study show that seven out of the top ten drugs used by teens are prescription drugs
.
1 Results from the 2008 National Survey on Drug Use and Health: National Findings, Substance Abuse and Mental Health Services Administration (SAMHSA), 2009 4
2 Treatment Episode Data Set (TEDS) Highlights – 2007, SAMHSA: National Admissions to Substance Abuse Treatment Services.
3 Drug Abuse Warning Network (DAWN), SAMHSA, 2010. Found at https://dawninfo.samhsa.gov/
4 See Supra note 1.
And between 2004 and 2008, the number of visits to hospital emergency departments involving the non-medical use of narcotic painkillers increased 111 percent.3
Because prescription drugs are legal, they are easily accessible, often from a home medicine cabinet. Further, some individuals who misuse prescription drugs, particularly teens, believe these substances are safer than illicit drugs because they are prescribed by a healthcare professional and sold behind the counter. This is not the drug that people buy behind a gas station wrapped in tin foil, and so people think it is somehow safer.
We know from the latest National Survey on Drug Use and Health that most people who abuse these drugs are getting them from friends and family or from a doctor.4
As law enforcement professionals and community leaders, you can help spread an important message to parents and other adults: If you have unused prescription drugs in your home, dispose of them properly. I also know that many of you have initiated take-backs with the community to help this problem, and I applaud you for that. 5
Another priority for us this year is drugged driving.
A Department of Transportation study released in December showed that 16 percent of nighttime weekend drivers were under the influence of a licit or illicit drug.5

5 2007 National Roadside Survey of Alcohol and Drug Use by Drivers: Drug Results, U.S. Department of Transportation, National Highway Traffic Safety Administration, December 2009. Accessible at http://www.ondcp.gov/publications/pdf/07roadsidesurvey.pdf

This study highlighted the alarming prevalence of drugged driving, and I’ve made anti-drugged driving efforts a top priority.
We will be assessing how we can help states deal with this issue, and I will be meeting with leaders – from trainers of Drug Recognition Experts (DRE), to police chiefs, researchers, and policy makers –to see how the Administration can engage with them to reduce this threat.
This evening I’ll be in Sacramento, meeting with 30 officers currently undergoing DRE training. I will encourage them in their efforts and sit down with them to better understand the issues they face in this area.
I know it is impossible to talk about drug policy issues ranging from prevention to policing, from drugged driving to treatment, without mentioning the role of the most commonly used illicit drug today – marijuana.
You all know the impacts of marijuana in this state– from the proliferation of marijuana being grown on public lands and indoor grows, to the negative effects of marijuana use among youth, the 6
increasing influence of violent gangs on the marijuana trade, and the problems associated with medical marijuana dispensaries.
As I’ve said from the day I was sworn in, marijuana legalization – for any purpose – is a non-starter in the Obama Administration. I’d like to explain why we take this position.
First, on the medical marijuana issue, I believe that the science should determine what a medicine is, not popular vote.
We’ve seen the problems of medical marijuana here in this state but also in places like Colorado, too, where kids are given the message that since marijuana is a medicine, it must be safe.6

6 “Doctor says medical marijuana laws hurt teens,” NPR. Talk of the Nation, Feb, 10, 2010. Accessible at http://www.npr.org/templates/rundowns/rundown.php?prgId=5&prgDate=02-10-2010
7 “Government to scale down coffee shops,” Ministry of Health, Welfare, and Sport, Sept. 11, 2009. Accessible at http://www.minvws.nl/en/nieuwsberichten/vgp/2009/government-to-scale-down-coffee-shops.asp. Also see “Dutch border towns to close coffee-shops,” Expatica, October 24, 2008, http://www.expatica.com/fr/news/local_news/Dutch-border-towns-close-coffee_shops.html. It is also worth noting that research from MacCoun, R. and Reuter, P. (2001; Drug War Heresies, Cambridge University Press) shows that, despite traditionally higher rates of marijuana use in the U.S., there was a tripling in lifetime marijuana use and a more than doubling of past-month use among 18- to 20-year-olds in the Netherlands from 1984 to 1996 – a time when the commercialization of Dutch coffee shops was rapidly expanding

But we’ve also seen how localities are dealing with this, with success, through zoning, planning regulations, nuisance laws, and other mechanisms.
I recently met with officials from the Netherlands, they are closing down marijuana outlets – or “coffee shops” – because of the nuisance and crime risks associated with them. What used to be thousands of shops have now been reduced to a few hundred, and some cities are shutting them down completely.7 7
This brings me to the issue of outright legalization.
The concern with marijuana is not born out of any culture-war mentality, but out of what the science tells us about the drug’s effects.
And the science, though still evolving, is clear: marijuana use is harmful. It is associated with dependence, respiratory and mental illness, poor motor performance, and cognitive impairment, among other negative effects.8

8 Moore and colleagues (2005) summed up the literature on respiratory illnesses and marijuana in the Journal of General Internal Medicine by stating that “the current literature of case reports and clinical samples suggests that marijuana-related respiratory problems may constitute a significant public health burden.” See Moore, B.A., et al, Respiratory effects of marijuana and tobacco use in a U.S. sample, Journal of General Internal Medicine 20(1):33-37, 2005. Also see Tashkin, D.P., Smoked marijuana as a cause of lung injury, Monaldi Archives for Chest Disease 63(2):93-100, 2005. Other evidence on the effect of marijuana on lung function and the respiratory system, and the link with mental illness, can be found in expert reviews offered by Hall W.D, and Pacula R.L. (2003), Cannabis use and dependence: Public health and public policy. Cambridge, UK: Cambridge University Press., and Room, R., Fischer, B., Hall, W., Lenton, S., and Reuter, P. (2009), Cannabis Policy: Moving beyond stalemate, The Global Cannabis Commission Report, the Beckley Foundation. Room et al. write, “Cannabis use and psychotic symptoms are associated in general population surveys and the relationship persists after adjusting for confounders. The best evidence that these associations may be causal comes from longitudinal studies of large representative cohorts.” Also see Degenhardt, L. & Hall, W. (2006), Is cannabis a contributory cause of psychosis? Canadian Journal of Psychiatry, 51: 556-565. A major study examining young people and, importantly, a subset of sibling pairs was released in February 2010 and concluded that marijuana use at a young age significantly increased the risk of psychosis in young adulthood. See McGrath, J., et al. (2010), Association between cannabis use and psychosis-related outcomes using sibling pair analysis in a cohort of young adults, Archives of General Psychiatry.

We know that over 110,000 people who showed up voluntarily at treatment facilities in 2007 reported marijuana as their primary substance of abuse.9 Additionally, in 2008 marijuana was involved in 375,000 emergency visits nationwide.10 8
Several studies have shown that marijuana dependence is real and causes harm. We know that more than 30 percent of past-year marijuana users age 18 and older are classified as dependent on the drug,11 and that the lifetime prevalence of marijuana dependence in the US population is higher than that for any other illicit drug. Those dependent on marijuana often show signs of withdrawal and compulsive behavior.12

11 Compton, W., Grant, B., Colliver, J., Glantz; M., Stinson, F. (2004), Prevalence of Marijuana Use Disorders in the United States: 1991-1992 and 2001-2002, Journal of the American Medical Association, 291:2114-2121.
12 Budney, A.J. & Hughes, J.R. (2006), The cannabis withdrawal syndrome, Current Opinion in Psychiatry, 19: 233-238.; Budney, A.J., Hughes, J.R., Moore, B.A. & Vandrey, R. (2004), Review of the validity and significance of cannabis withdrawal syndrome. American Journal of Psychiatry, 161: 1967-1977.; Budney, A.J.,Vandrey, R.G., Hughes, J.R., Moore, B.A. & Bahrenburg, B. (2007), Oral delta-9-tetrahydrocannabinol suppresses cannabis withdrawal symptoms, Drug and Alcohol Dependence, 86: 22-29.; Kouri, E.M. & Pope, H.G. (2000), Abstinence symptoms during withdrawal from chronic marijuana use, Experimental and Clinical Psychopharmacology, 8: 483-492.; Jones, R.T., Benowitz, N. & Herning, R.I. (1976), The 30-day trip: clinical studies of cannabis use, tolerance and dependence. In Braude, M. & Szara, S. (eds.), The Pharmacology of Marijuana. New York: Academic Press, Vol. 2, pp. 627-642.
13 For a review of the evidence on marijuana and educational attainment, see: Lynskey, M.T. & Hall, W.D. (2000), The effects of adolescent cannabis use on educational attainment: a review, Addiction, 96: 433-443.

Travelling the country, I’ve often heard from local treatment specialists that marijuana dependence is as a major problem at call-in centers offering help for people using drugs.
Marijuana negatively affects users in other ways, too. For example, prolonged use is associated with lower test scores and lower educational attainment because during periods of intoxication the drug affects the ability to learn and process information, thus influencing attention, concentration, and short-term memory.13 9
Advocates of legalization say the costs of prohibition – mainly through the criminal justice system – place a great burden on taxpayers and governments.
While there are certainly costs to current prohibitions, legalizing drugs would not cut the costs of the criminal justice system. Arrests for alcohol-related crimes such as violations of liquor laws and driving under the influence totaled nearly 2.7 million in 2008. Marijuana-related arrests totaled around 750,000 in 2008. 14

14 Federal Bureau of Investigation (2008) Uniform crime reports, Washington, DC. Available at: http://www.fbi.gov/ucr/ucr.htm
15 Heron M., Hoyert D., Murphy S., et al. Deaths: Final data for 2006. National vital statistics reports; vol 57 no 14. Hyattsville, MD, National Center for Health Statistics, 2009. See http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_14.pdf
16 For example, see: Williams, J., Pacula, R., Chaloupka, F., and Wechsler, H. (2004), “Alcohol and Marijuana Use Among College Students: Economic Complements or Substitutes?” Health Economics 13(9): 825-843.; Pacula R., Ringel, J., Suttorp, M. and Truong, K. (2008), An Examination of the Nature and Cost of Marijuana Treatment Episodes. RAND Working Paper presented at the American Society for Health Economics Annual Meeting, Durham, NC, June 2008. Jacobson, M. (2004), “Baby Booms and Drug Busts: Trends in Youth Drug Use in the United States, 1975-2000,” Quarterly Journal of Economics 119(4): 1481-1512.

Our current experience with legal, regulated prescription drugs like Oxycontin shows that legalizing drugs is not a panacea. In fact, its legalization widens its availability and misuse, no matter what controls are in place. In 2006, drug-induced deaths reached a high of over 38,000, according to the Centers for Disease Control – an increase driven primarily by the non-medical use of pharmaceutical drugs.15
Controls and prohibitions help to keep prices higher, and higher prices help keep use rates relatively low, since drug use, especially among young people, is known to be sensitive to price.16
The relationship between pricing and rates of youth substance use is well-established with respect to alcohol and cigarette taxes. 10 There is literature showing that increases in the price of cigarettes triggers declines in use.17

17 See, for example, Chaloupka, F., “Macro-Social Influences: Effects of Prices and Tobacco Control Policies on the Demand for Tobacco Products,” Nicotine & Tobacco Research, 1999, and other price studies at http://tigger.uic.edu/~fjc and www.uic.edu/orgs/impacteen. Orzechowski & Walker, Tax Burden on Tobacco, 2006. USDA Economic Research Service, www.ers.usda.gov/Briefing/tobacco. Farelly, M., et al., State Cigarette Excise Taxes: Implications for Revenue and Tax Evasion, RTI International, May, 2003, http://www.rti.org/pubs/8742_Excise_Taxes_FR_5-03.pdf. Country tax offices. CDC, Data Highlights 2006 [and underlying CDC data/estimates]. Miller, P., et al, “Birth and First-Year Costs for Mothers and Infants Attributable to Maternal Smoking,” Nicotine & Tobacco Research 3(1):25-35, February 2001. Lightwood, J. & Glantz, S., “Short-Term Economic and Health Benefits of Smoking Cessation – Myocardial Infarction and Stroke,” Circulation 96(4):1089-1096, August 19, 1997, http://circ.ahajournals.org/cgi/content/full/96/4/1089. Hodgson, T., “Cigarette Smoking and Lifetime Medical Expenditures,” The Millbank Quarterly 70(1), 1992. U.S. Census. National Center for Health Statistics.
18 See http://www.taxpolicycenter.org/taxfacts/displayafact.cfm?Docid=399
19 Harwood, H. (2000), Updating Estimates of the Economic Costs of Alcohol Abuse in the United States: Estimates, Update Methods and Data. Report prepared for the National Institute on Alcoholism and Alcohol Abuse.

Marijuana has also been touted as a cure-all for disease and black market violence – and for California’s budget woes. Once again, however, there are important facts that are rarely discussed in the public square.
The tax revenue collected from alcohol pales in comparison to the costs associated with it. Federal excise taxes collected on alcohol in 2007 totaled around $9 billion; states collected around $5.5 billion.18
Taken together, this is less than 10 percent of the over $185 billion in alcohol-related costs from health care, lost productivity, and criminal justice.19
Alcohol use by underage drinkers results in $3.7 billion a year in medical costs due to traffic crashes, violent crime, suicide attempts, and other related consequences.20 11

20 See Pacific Institute for Research and Evaluation (PIRE), 2009, Underage Drinking Costs. Accessed on March, 1, 2010. Available at http://www.udetc.org/UnderageDrinkingCosts.asp
21 State estimates found at supra note 27. Federal estimates found at https://www.policyarchive.org/bitstream/handle/10207/3314/RS20343_20020110.pdf, Also see http://www.nytimes.com/2008/08/31/weekinreview/31saul.html?em and http://www.tobaccofreekids.org/research/factsheets/pdf/0072.pdf; Campaign for Tobacco Free Kids, see “Smoking-caused costs” on p.2.
22 The Economic Costs of Drug Abuse in the United States, 1992-2002, Office of National Drug Control Policy, Executive Office of the President, Washington, DC: (Publication No. 207303), 2004.
23 Pacula, R. (2009). Legalizing Marijuana: Issues to Consider Before Reforming California State Law. Accessed at www.rand.org

Tobacco also does not carry its economic weight when we tax it; each year we spend more than $200 billion and collect only about $25 billion in taxes.21
Though I sympathize with the current budget predicament – and acknowledge that we must find innovative solutions to get us on a path to financial stability – it is clear that the social costs of legalizing marijuana would outweigh any possible tax that could be levied. In the United States, illegal drugs already cost $180 billion a year in health care, lost productivity, crime, and other expenditures.22 That number would only increase under legalization because of increased use.
Rosy evaluations of the potential economic savings from legalization have been criticized by many in the economic community. For example, the California Board of Equalization estimated that $1.4 billion of potential revenue could arise from legalization. This assessment, according to a researcher out of the independent RAND Corporation is, and I quote, “based on a series of assumptions that are in some instances subject to tremendous uncertainty and in other cases not valid.”23 12
Recent testimony from a RAND researcher concluded that “There is a tremendous profit motive for the existing black market providers to stay in the market, as they can still cover their costs of production and make a nice profit.”24

24 Ibid.
25 Gruber J., Sen, A. & Stabile, M. (2003), “Estimating Price Elasticities When There is Smuggling:
The Sensitivity of Smoking to Price in Canada,” Journal of Health Economics 22(5): 821-842.
26 See Supra note 23.

Canada’s experience with taxing cigarettes showed that a $2 tax differential per pack versus the United States created such a huge black market smuggling problem that Canada repealed its tax increases.25
Legalizing marijuana would also saddle government with the dual burden of regulating a new legal market while continuing to pay for the negative side effects associated with an underground market whose providers have little economic incentive to disappear.26
Now that I’ve told you what the research says, let me tell you what this means in practical terms. Legalization means the price comes down, the number of users goes up, the underground market adapts, and the revenue gained through a regulated market will never keep pace with the financial and social cost of making this drug more accessible.
Now let’s talk about what will work to reduce drug use. 13

The Office of National Drug Control Policy is pursuing a combined, coordinated public health and public safety strategy.
This strategy recognizes that the most promising drug policy is one that prevents drug use in the first place.
We have many proven methods for reducing the demand for drugs. The demand can be decreased with comprehensive, evidence-based prevention programs focused on adolescence, which science confirms is the peak period for drug-use initiation and the potential for addiction.
Our young people must be made aware of the risks of drug use – at home, in school, in sports leagues, in faith communities, in places of work, and in other settings and activities that attract youth.
This is vital because an individual who reaches age 21 without smoking, using drugs or abusing alcohol is virtually certain never to do so.
ONDCP’s National Youth Anti-Drug Media Campaign can reinforce these efforts by connecting with youth through popular television shows, Internet sites, magazines, and films. Community anti-drug coalitions can provide an environment conducive to remaining drug-free. Expanding early intervention services for drug users and treatment options for the addicted will also be major components of our effort to reduce demand for drugs in this country. 14
Surveys of prevalence show that these efforts work. Drug use today remains comparatively low. Annual marijuana prevalence peaked among 12th graders in 1979 at 51 percent. By 2009, annual prevalence had fallen by about one-third. Similar statistics can be found for other age groups. However, we are seeing some troubling signs that have bubbled up in the last year or two. The perception that drugs are dangerous is dropping, and that usually predicts imminent increases in use.
At the same time, we’ve learned that trying to manage drug-addicted criminal offenders entirely through the criminal justice system results in a costly, destructive cycle of arrest, incarceration, release, and re-arrest.
Together, we can transform this situation through new collaborations between the criminal justice system and the treatment system. Drug courts are just one example of how these systems can work together.
Re-entry programs that provide addiction treatment, combined with intensive monitoring and swift and certain sanctions for violations – as evidenced by Hawaii’s HOPE program – are another example of the kind of scientifically supported cross-system initiatives we seek to expand, especially in the probation system, which represents a highly important but often under-utilized and forgotten role in drug and crime control.
We advocate further research on pre-arrest diversion programs like the one piloted in High Point, North Carolina. These programs threaten dealers in a community with credible sanctions, but also 15
offer them other resources to change their lives. Research on these kinds of pre-arrest diversion programs is just emerging, but preliminary results have been positive.
We are also firm believers in the law enforcement techniques you employ every day, based on local assessments of needs and available resources.
A balanced approach based on a combination of public health and public safety strategies is the surest route to reducing drug use and its consequences. This approach employs best practices in prevention, treatment, and law enforcement with community partners. We know that working together has resulted in lowering crime and drug use.
Thank you for being on the front line of these issues. I look forward to supporting you to reduce drug use and its consequences.

Source: Statement from ONDCP Director R. Gil Kerlikowske
Delivered at the California Police Chiefs Association Conference
March 4th, 2010 San Jose, CA

UN-commissioned guidance from international experts on how to mount prevention programmes based on family skills training involving parents and children in a joint effort to improve family dynamics and child development. Engaging parents seems the major barrier.

Abstract
This review and guidance initiated by the UN Office on Drugs and Crime concerned the role of family skills training programmes in the prevention of substance use problems among children in families across the board (‘universal’), or families whose children are particularly at risk (‘selective’). Unless integrated with these types of interventions, the document did not include programmes aimed at individuals identified as at high risk or as already experiencing substance use problems (‘indicated’). A literature and website review identified 130 universal and selective programmes. Research articles and programme descriptions were solicited from the developers. Practitioners, managers, researchers and developers from these programmes throughout the world were invited to a technical consultation meeting. The guide was drafted on the basis of the discussions and the literature review. This account largely relies on its final chapter, which summarised the major points.
Families can act as powerful protective forces in healthy child development, in particular with regard to substance use. To bolster this process, universal and selective family skills training programmes generally aim at strengthening the protective factors in families, equipping parents with the skills to provide supportive parenting, supervision, monitoring and effective discipline, and giving entire families opportunities and skills to strengthen attachment between parents and children. These approaches are more intensive and differ from parent education, which typically limits itself to providing parents with information about substances and their effects and does not involve the children.
Such programmes have been extensively evaluated and found effective in preventing substance abuse and other risky behaviours – about three times more effective than life skills education programmes aimed only at children and young people, and with more long-lasting benefits. Conservative estimates indicate that for each pound spent, over the long term these programmes return a saving of nine pounds. They also form part of effective multi-component programmes which offer other interventions in other settings (such as schools, media and the community), and of tiered programmes which operate across several levels of prevention simultaneously according to the needs of the families (universal, selective and indicated).
Although the evidence is limited to few programmes in high-income countries, recommended principles for family skills training programmes can be identified. These include a solid theory of how the training will affect risk and protective factors based on research on factors related to substance abuse which can be addressed at the family level. Programmes should be matched to the target population, especially the age and developmental stage of the children and the level of risk or problems in the families. This makes accurate needs assessment vital. Programmes must be of sufficient intensity and duration to address the targeted outcomes. In general, universal programmes extend over four to eight sessions, selective programmes for higher risk families, 10 to 15. Sessions last about two to three hours and should be based on interactive techniques implemented in small groups of eight to 12 families. A typical and effective programme will provide parents with the skills and opportunities to strengthen positive family relationships, family supervision and monitoring, and improve the communication of family values and expectations.
Recruitment and retention of parents are significant barriers to the dissemination of such programmes. However, retention rates of over 80% can be achieved by addressing the practical (transportation, childcare) and psychological (fear of stigmatisation, feelings of hopelessness) barriers. Interventions are most effective if participants are ready for change, such as at major transition points like children starting school or a new school phase.
Often it most feasible and/or cost-effective to base a project on an evidence-based programme developed elsewhere for a similar target group, preferably one with the best prevention record. In this case, it is important to carefully and systematically adapt the programme to the cultural and socioeconomic needs of the target population. Such adaptations enhance recruitment and retention of families. However, during its initial use the programme should be implemented with only minimal local adaptations or changes. Feedback from participants and group facilitators on what worked or did not work so well can be used as the basis for further refinements. Experience with these and outcome evaluations should be used to assess whether a deeper adaptation is required.
As with other types of programmes, adequate training and ongoing support must be provided to carefully selected staff. Most evidence-based programmes require two to three days of training for 10 to 30 future group leaders. Training should give them the opportunity to practise their skills, but also discuss the theoretical foundations, evidence of effectiveness, and the values of the programme. Ongoing support by programme managers and supervisors (and, if possible and appropriate, from programme developers) is important, especially in the form of e-mail contacts and web-based networking of group facilitators across agencies. Site visits and debriefing sessions also enhance quality and fidelity of implementation, as well as the collection of monitoring data.
Programmes should include strong and systematic monitoring and evaluation components. This work contributes to the understanding of prevention strategies, indicating which programmes are effective, under which circumstances, and for which populations, and provides evidence of effectiveness which can be used to lobby policymakers and donors, potentially helping to sustain the programme.
There is no question that the family is a powerful influence on child development and on substance use and problems in particular, nor that interventions with families and parents can (see for example this demonstration from Sweden) help prevent substance use in various forms. What is questionable is whether the research, though sometimes promising, is sufficiently extensive and sound to warrant widespread implementation of these programmes. Searching for practical guidance, British reviewers found that research deficiencies mean that no clear choice could be made about what works best either for marginalised and vulnerable groups, or for families in general. The background notes focus on two of the best researched family skills interventions (the Strengthening Families Programme and the Family Check-Up) as a way of testing the adequacy of the evidence overall, and address the issue of engaging families of early adolescent children. For other relevant evidence run this search for pre-school and parenting interventions on the Findings site.
When in 2008 the US government analysed the costs and benefits of substance use prevention programmes, family skills training programmes were among those with the highest benefit to cost ratio, though they lagged behind some other school/community/family programmes, and also well behind some entirely different kinds of initiatives like enforcing laws on serving drunk customers in licensed premises. Estimates for the two relatively well researched family skills interventions focused on in the background notes rested on one or two studies, which in both cases provided a narrow and at best tentative basis for the calculations, casting doubt over the degree to which they can be relied on to guide prevention programme planning. Nevertheless, the same may be said of some of the other programmes included in the analysis. For the analysts, the major drawback of family training as a universal prevention modality was its higher cost relative to other types of initiatives, leading them to suggest that this approach be reserved for high risk schools, areas or families
A particular issue is whether by the time family skills training comes in to its own – from age six to 11, and in major studies not until the early years of secondary schooling – enough families can be involved to make these strategies a viable way of curbing youth substance use problems across the population as a whole. British experience so far suggests this is not the case, though high-risk families under pressure to attend and/or energetically and sensitively targeted can be engaged in and benefit from family skills training. As the featured review comments, one way cost and accessibility barriers are being addressed is through computerisation of such programmes so families can go though them at times convenient to them and in their own homes, a tactic trialled for example with some success among mothers and daughters in New Jersey.
Based on UK experience and the adequacy of the international evidence, family skills training programmes of the kind reviewed can be recommended for consideration for families who have come to attention because their children (age six upwards) are at risk of behavioural problems which may include risky substance use. Sensitive personal approaches from programme staff, perhaps preferably from the same communities, can recruit many to participate, stay in and benefit from the programmes. Universal application to all families seems at the moment to lack sufficient evidence (especially in the UK) to warrant the considerable investment required, a situation which may change if low-cost, accessible computer-based alternatives prove feasible, effective and capable of widespread implementation.

Source: K. Kumfer www.findings.org.uk 09 March 2010

One of the questions that comes up time and again is how do we safeguard our children from being exposed to drugs and pro drug use content on the Internet?
Most parents are already attuned to risks on the web like online predators and sexual content. Increasingly, sites that promote illicit drug use — actually explaining which drugs to use and how to do it — are coming to the attention of parents as their children are exposed.  What’s more, rogue online pharmacies and their e-mail spam promote painkillers and other drugs to teens with “no prescription needed” while blogs and teen content portray drug and alcohol abuse as no big deal.
Our colleagues at the Treatment Research Institute in Philadelphia have been studying the growth of these sites.  They came away so worried about the scale and scope that they’ve invited us to partner with them and an Internet developer to launch a new online platform called WebSafe Parent available at www.websafeparent.com
WebSafe will be an online community educating adults about this content and how their children are exposed to it.  WebSafe will also provide Community Alerts that regularly notify registered “WebSafe Parents” about new and potentially harmful websites and other threats.  Parents who want to go a step further can purchase state-of-the-art software that can monitor and control how long, when and what sites children are visiting — and even block children from giving out personal information.  Longer term, members will be invited to join local “WebSafe Communities” where they can exchange information about threats with other adults in their area.
This is an increasingly digital world where teens surf freely and much of the time profit greatly from the experience.  Our goal through this latest partnership is to enlighten and empower parents to protect their kids when they get into situations that can ultimately prove dangerous.  It’s also a prime opportunity to remind parents and caregivers of the immense power and influence you have to help your kids make the right choices for themselves!
What are your thoughts on the content kids are exposed to on the web?  Do you think your kids have discovered pro drug, sexual or other content?

Source www.timetotalk.org.

Research Summary

The more parents expect their teens to engage in risky behaviors such as drinking and using drugs, the more likely their teens are to follow through with those behaviors, Reuters reported Oct. 16.
Researchers found that adolescents with mothers who expected them to be more rebellious and take greater risks reported higher levels of risky behavior than other adolescents during follow-up surveys.
On the other hand, parents may lower the rate of risky behavior among their adolescent children by expecting that they can resist negative peer pressure and instead engage in positive behavior, according to the study. 
“Parents who believe they are simply being realistic might actually contribute to a self-fulfilling prophecy,” said study author and Wake Forest University psychology professor Christy Buchanan. “By thinking risk-taking or rebelliousness is normal for teenagers and conveying that to their children, parents might add to other messages from society that make teenagers feel abnormal if they are not willing to take risks or break laws.”
The study’s recommendations for parents included modeling good behavior for their teens, exposing them to examples of positive things that other teens are doing, and making sure their teens know there are consequences to risky behavior. 
The study was based on surveys of more than 200 6th- and 7th-graders and their mothers.

Source: Journal of Research on Adolescence. June 2009

John, an engineer in his fifties, lives in Scotland with his wife. One of their two sons, Simon, became a heroin addict.
I have huge sympathy for Amy Winehouse’s parents, I know exactly what they are going through.
We had high hopes for Simon. He was highly intelligent and had a natural ability with computers. We first realised something was wrong when he started having rapid mood swings, from happy to extremely angry. He also went from having glowing school reports to not doing well at school. He seemed to have got in with the wrong crowd.
Simon had started using drugs when he was 13 but we didn’t realise it until a couple of years later. I found cannabis in his bedroom and didn’t know what it was, but I flushed it down the lavatory. He said he was looking after it for a friend and, foolishly, I believed him.
We moved to the north of Scotland, in the hope of removing him from the bad influences, but again he got in with the wrong crowd. At 16, he was excluded from school for generally bad behaviour. We put him into a private college and he then took a string of manual jobs, but they didn’t last. He would just sit up all night watching television and then sleep through the day. And he would disappear for days at a time, leaving his mother and me tearing our hair out.
Simon left home when he was around 18 – a mutual decision. It had been like living in a war zone. There were lots of confrontations, occasionally violent, and he stole from us to the point where we never left money lying around at home, and put a lock on our bedroom door.
He denied taking drugs other than cannabis. He told me I was imagining things. I felt sad and disappointed, watching someone with a lot of potential and ability throwing it all away.
After leaving home, he still lived in our city. I continued to subsidise him, thinking that I was helping with his rent and not realising that he spent the money on drugs. I’m not sure when he progressed to heroin. But from the moment he started using it, it controlled him.
We would get calls from the police, who had him in custody for possession or whatever, or we would get calls from him in winter, saying he had no money for gas and electricity. At first I gave him money, but that meant that he could spend his benefit money on drugs. Eventually, I told him where to get emergency loans and free food parcels.
My younger son’s friends would see his brother begging. It hurt us terribly. At least the papers weren’t printing pictures of my son, apart from when he was in court, like they do with Amy Winehouse. Addiction affects the whole family – it’s a family illness – but a lot of statutory bodies forget this and focus on the addict alone.
There is still a huge stigma attached to drug addiction, which makes it even harder for addicts’ parents, because they are so isolated. A lot of my own family didn’t know about Simon’s problem – it’s something you don’t discuss.
Nine years ago, a friend of my wife’s suggested that we went to Families Anonymous meetings, and we’ve been going ever since. They allowed us to realise that we had no control over our son and that only he could change himself. The meetings also allowed me to get my life back. Before, it had been out of control, even though I was still going to work. They made me realise that I had to practice tough love toward my son. I would never presume to give advice to Amy’s parents because everyone’s situation is different, but the one thing I would suggest is to give Families Anonymous a try.
In 2006, Simon went to the Cenacolo rehabilitation centre in Ireland. He was expected to remain there for a year. We were told he was doing well but he decided to leave after four months. He returned to his flat that summer, and died in December of a drug overdose, aged 26.
• Names have been changed to protect anonymity. Families Anonymous helpline 0845 1200 660.

Source: The Observer 28th Jan 2008

CASA REPORT FINDS TEENS WHO HAVE INFREQUENT FAMILY DINNERS LIKELIER TO DRINK, SMOKE, USE MARIJUANA
Compared to teens who have frequent family dinners (five or more per week), those who have infrequent family dinners (fewer than three per week) are twice as likely to use tobacco or marijuana; more than one and a half times likelier to use alcohol; and twice as likely to expect to try drugs in the future, according to The Importance of Family Dinners V, a new report by The National Center on Addiction and Substance Abuse (CASA) at Columbia University.
The CASA report also found that compared to teens who have frequent family dinners, those who have infrequent family dinners are more than twice as likely to be able to get marijuana in an hour and one and a half times likelier to be able to get prescription drugs to get high within an hour.
The report reveals that compared to teens who have frequent family dinners without distractions at the table (talking or texting on a cell phone, using a Blackberry, laptop or Game Boy), those who have infrequent family dinners and say there are distractions at the table, are three times likelier to use marijuana and tobacco, and two and a half times likelier to use alcohol.
The report also found that compared to teens who have five to seven family dinners per week, those who have fewer than three family dinners per week are:
• Twice as likely to have friends who use marijuana and Ecstasy;
• More than one and a half times likelier to have friends who drink, abuse prescription drugs, and use Meth; and
• Almost one and a half times likelier to have friends who use illegal drugs like cocaine, acid and heroin.
“The magic of the family dinner comes not from the food on the plate but from who’s at the table and what’s happening there.  The emotional and social benefits that come from family dinners are priceless,” said Elizabeth Planet, CASA’s Vice President and Director of Special Projects.  “We know that teens who have frequent family dinners are likelier to get A’s and B’s in school and have excellent relationships with their parents.  Having dinner as a family is one of the easiest ways to create routine opportunities for parental engagement and communication, two keys to raising drug-free children.”
Family Dinners and Parental Attitudes and Behaviors on Alcohol
The report found that compared to teens who have five to seven family dinners per week, those who have fewer than three family dinners per week are more than one and a half times likelier to have seen their parent(s) drunk and to think their father is okay with them drinking.
Teens who think their fathers are okay with their drinking are likelier to drink and get drunk than teens who believe their fathers are against their drinking.  Teens who have seen their parent(s) drunk are likelier to drink, get drunk, and try cigarettes and marijuana, compared to teens who have not seen their parent(s) drunk. 
The Family Dinner
“Over the past decade and a half of surveying thousands of American teens and their parents, we’ve learned that the more often children have dinner with their parents, the less likely they are to smoke, drink or use drugs.  I urge parents to arrange their schedules and the outside activities so that they can have frequent family dinners.  If they do so, they’ll discover what a difference dinner makes.”  Says Joseph Califano.
Other Notable Findings
• Compared to 12- and 13-year olds who have frequent family dinners, those who have infrequent family dinners are six times likelier to use marijuana, four times likelier to use tobacco, and three times likelier to use alcohol.
• Compared to teens who attend religious services at least weekly, those who never attend services are more than twice as likely to try cigarettes, and twice as likely to try marijuana and alcohol.
• Compared to teens who have frequent family dinners, those who have infrequent family dinners are one and a half times likelier to report getting grades of C or lower in school. 

Source:www.casacolumbia.org New York, NY, September 23, 2009 –

Admitting an absence of credible data affording an insight into the drug abuse situation in the country, Union Minister of Social Justice and Empowerment Mukul Wasnik said he has suggested setting up of more drug de-addiction centres across India.

Wasnik said he has suggested to the union health ministry to consider setting up of centers, like “national drugs dependent treatment centre, which is functioning at All India Institute of Medical Sciences”, in different parts of India as it would be a big step in dealing with drug abuse.

He was speaking after releasing the International Narcotic Control Board ’ s (INCB) 2009 annual report here.

“I would have to admit that data available on drug abuse has not been of such a nature that can give us a total insight into the entire situation,” Wasnik said.

He added that his ministry has been coordinating with other ministries on the issue and a big network of about 350 voluntary organisations is involved in dealing with the situation.   The INCB report highlights that rates of drug abuse tend to be higher among teenagers and young adults.   Another new trend noted by the report is increase in young women using drugs – the gap with the level of drug use by young men has narrowed substantially.

It said: “Primary prevention strategies need to focus on the whole population, as such strategies can reduce demands for drugs as well as identify gaps or population that is not sufficiently served.”   “Primary prevention needs to begin with prospective parents, by raising their awareness of the harms caused by drug, alcohol or tobacco abuse during pregnancy,” it added.

“Drug education is an important prevention component in early adolescence. Nightclubs, discotheques, bars and music festivals are key locations for getting messages about drug abuse across the older adolescents and young adults, as well as colleges and universities,” the report said.

It said that besides other steps, there needs to be collaboration with NGOs and others to tackle drug abuse.

Source:Times of India 25th Feb 2010

Needle-exchange programmes designed to cut injection drug users’ risk of HIV, the virus that causes AIDS, and other infections do seem to reduce needle sharing, but there is only limited evidence that they lower disease transmission, a new research review concludes.
Reporting in the journal Addiction, researchers say that based on their study — an analysis of five previous reviews of needle-exchange programs — the evidence for the programs’ effectiveness is weaker than generally thought.
However, they also stress that their review did not find needle-exchange programs to be ineffective either.  “The findings of this review should not be used as a justification to close NSPs (needle and syringe programs) or hinder their introduction,” write the researchers, led by Norah Palmateer, of Health Protection Scotland, part of the UK National Health Service.
“Insufficient or weak evidence of an effect is not evidence of no effect,” Palmateer told Reuters Health in an email. “It is more a reflection of the studies and evidence available.”   It is not that studies on needle-exchange programs have been “poor,” Palmateer said,  but they are limited by the nature of their design.
Studies looking at needle-exchange programs have been observational, rather than controlled clinical trials where researchers would, for example, randomly assign some communities to start a program, and then compare them over time with program-free communities.   Observational studies, Palmateer noted, are subject to limitations like “selection bias.” For example, if those injection drug users at greatest risk of HIV are most likely to use the programs, then a study may find that program attendees have a higher rate of infection than drug users not involved in needle-exchange.
Needle-exchange programs have always been controversial, with opponents arguing that they sustain people’s addictions and send the wrong message about drug use. The U.S. just recently repealed a ban on federal funding for needle-exchange programs, though some cities have long had their own programs.
Advocates of the programs, including many public-health and HIV experts, point to studies showing that needle and syringe exchange can cut HIV transmission — such as a 2004 review by the World Health Organization (WHO) that concluded there is “compelling evidence” that the programs reduce HIV infections.  However, individual studies have come to mixed conclusions, including those covered by the WHO review, according to the current study.
Palmateer and her colleagues found that of the 10 studies in the WHO review focusing on HIV transmission, five had positive findings; of those five, four had weaknesses in their design that limit the conclusions that can be drawn.
Palmateer’s team also looked at two other reviews that covered many of the same studies as the WHO review. One research team came to similar conclusions as the WHO, while the other was more guarded — saying that the evidence that needle-exchange programs reduce HIV transmission is “modest.”  Overall, Palmateer and her colleagues conclude, there appears to be “tentative” evidence that needle-exchange programs reduce HIV transmission among injection-drug users.
When it came to hepatitis C, a liver infection usually spread through infected blood, there was insufficient evidence to say whether the programs are effective or not, according to Palmateer’s team. Of the five reviews she and her colleagues analyzed, the three major ones did not examine hepatitis C “in any depth,” the researchers write.
There was also insufficient evidence of the effectiveness of alternatives to standard needle-exchange programs — including vending machines that sell syringes and needles, and outreach programs that go to drug users rather than having them come to a clinic.   On the other hand, there was “strong” evidence across the reviews that needle-exchange programs reduce the sharing or reuse of dirty needles, and no evidence of harmful effects, according to Palmateer’s team.
Exactly why the evidence for disease prevention is not as strong is not entirely clear. Studies may have failed to detect an impact, but limitations of the programs themselves may also be at work.  For example, many of the needle-exchange programs studied in these reviews had strict limits on the number of syringes and needles they could give clients, Palmateer and her colleagues note. So while they might have reduced users’ needle sharing and reuse, it might not have been adequate.
It is not known what “level of coverage” — that is, the amount of injecting equipment given to clients — is needed to lower HIV and hepatitis C rates, according to Palmateer’s team. And at any rate, the optimal level will vary from one locale to another.  “The main public health implications of the findings are that a higher level of coverage of interventions, including (needle and syringe programs), is likely required to reduce blood-borne virus transmission,” Palmateer said.
She noted that this may be especially true of hepatitis C, which is most commonly transmitted through drug-equipment sharing. In the U.S., injection drug use is believed to account for most new cases of hepatitis C and about one-fifth of new HIV cases.

SOURCE: Addiction, online March 2, 2010.

Smoking marijuana as a teenager could raise the risk of developing schizophrenia and psychotic symptoms as a young adult, according to a new study that compared the prevalence of mental illness among marijuana users and non-users.
Bloomberg News reported March 2 that researcher John McGrath of the University of Queensland, Australia, and colleagues studied 3,801 young-adult sibling pairs and concluded that those who used marijuana the longest (six or more years) were twice as likely to develop schizophrenia or delusional disorders. They also were four times more likely than non-users to score highly on a test gauging psychotic-like experiences.
Higher scores on the test also were seen among those who used marijuana for less than three years.

Source: www.jointogether.org March 2010

In a study published today in the journal Addiction, researchers in the United States have discovered that accidental overdose deaths involving cocaine rise when the average weekly ambient temperature passes 24 degrees Celsius (75 degrees Fahrenheit).  Using mortality data from New York City’s Office of the Chief Medical Examiner for 1990 through 2006, and temperature data from the National Oceanic and Atmospheric Association, researchers found that accidental overdose deaths that were wholly or partly attributable to cocaine use rose significantly as the weekly ambient temperature passed 24 degrees Celsius.  The number of cocaine-related overdose deaths continued to rise as temperatures continued to climb. 
Cocaine-related overdose deaths increase as the ambient temperature rises because cocaine increases the core body temperature, impairs the cardiovascular system’s ability to cool the body, and decreases the sense of heat-related discomfort that ordinarily motivates people to avoid becoming overheated.  Cocaine users who become overheated (hyperthermic) can overdose on lower amounts of cocaine because their bodies are under more stress. 
The study’s findings correct previous research that associated an increase in cocaine-related mortality with much higher temperatures (31.1 degrees Celsius, or 87.9 degrees Fahrenheit).  Because cocaine-related overdose fatalities begin to rise at lower ambient temperatures than was previously thought, it is now apparent that cocaine users are at risk for longer periods of each year.  Between 1990 and 2006, the average weekly temperature in New York City rose above 24 degrees Celsius for about seven weeks per year.
The study showed no difference in the number of drug overdoses in New York City among those weeks where the average temperature was between -10 and 24 degrees Celsius. Above 24 degrees Celsius, however, there were 0.25 more drug overdoses per 1,000,000 residents per week for every two degrees increase in weekly average temperature.  Given that over 8.2 million people live in New York City, the study’s findings predict that at least two more people per week will die of a drug overdose in the city for each two degree rise in temperature above 24 degrees Celsius, compared to weeks with average temperatures of 24 degrees and below.
The authors of this study point out the need for public health interventions in warm weather, such as delivering health-related warnings to high-risk groups.  Prevention efforts could also include making air conditioning available in locations where cocaine use is common such as urban areas with a known high prevalence of cocaine use, and within those urban areas, particular neighbourhoods with elevated numbers of cocaine-related deaths or arrests.  As lead author Dr. Amy Bohnert explains, “Cocaine users are at a high risk for a number of negative health outcomes and need public health attention, particularly when the weather is warm.”

Source: Bohnert A., Prescott M., Vlahov D., Tardiff K., and Galea S. Ambient temperature and risk of death from accidental drug overdose in New York City, 1990-2006. Addiction 2010; 105: doi:10.1111/j.1360-0443.2009.02887.x

 Marijuana use at a young age significantly increased the risk of psychosis in young adulthood, Australian investigators reported.

Young adults who reported a longer duration since first exposure to marijuana had a two- to fourfold greater prevalence of three different psychosis-related outcomes, John McGrath, MD, PhD, of the Queensland Center for Mental Health Research in Wacol, and colleagues concluded in an article published online in Archives of General Psychiatry.

Apart from the implications for policy makers and health planners, we hope our findings will encourage further clinical and animal model-based research to unravel the mechanisms linking cannabis use and psychosis, the researchers concluded.

Several prospective-cohort studies have demonstrated an association between early marijuana use and an increased risk of psychosis. On the basis of such studies, reviews of the issue have generally concluded that early use of marijuana, or cannabis, is a modifiable risk factor for psychosis-related outcomes, the authors wrote.

However, some concern has persisted about potential methodologic biases and unmeasured confounders in the cohort studies. In an effort to address the concern, McGrath and colleagues examined the association between cannabis use and psychosis in 3,800 participants in a long-term evaluation of pregnancy and outcomes. In contrast to prior cohort studies, the authors incorporated a subset analysis involving 228 sibling pairs.

“If a significant association between cannabis use and psychosis-related outcomes was not detected in sibling pairs, it would seriously weaken the argument that cannabis use was a risk-modifying factor for psychosis-related outcomes,” they wrote.

Participants were born between 1981 and 1984 at a single hospital in Brisbane. Mothers and their offspring were followed up at five, 14, and 21 years after birth. At the 21-year follow-up, McGrath and colleagues retrospectively assessed cannabis use among the offspring, whose age averaged 20 and ranged from 18 to 23.

Cannabis use was assessed by means of the young adults’ responses to two questions: In the last month, how often did you use cannabis, marijuana, pot, etc.? At what age did you first use cannabis?
Possible responses to the first question were never, every day, every few days, once or so, and not in the past month.

Investigators separated the cohort into four groups on the basis of self-reported cannabis use. One group included never-users, and the remaining three groups were categorized by duration since first use of cannabis: three years or less, four to five years, six years or more.

Investigators compared participants’ history of cannabis use with three psychosis-related outcomes: non-affective psychosis, hallucinations (assessed by the Computerized International Diagnostic Interview), and the Peters et al Delusions Inventory (PDI) score (Schizophr Bull 2004; 30: 1005-1022).

The authors found that 65 participants met criteria for a diagnosis of non-affective psychosis, and 233 reported at least one hallucination-related incident. The PDI has a score range of 0-21, and participants were grouped into PDI quartiles representing scores of =2, 3 or 4, 5 to 7, and =8.

The authors analyzed the results by means of two statistical models, one adjusted for participant sex and age at testing and the other adjusted for sex, age at testing, presence of hallucinations at the 14-year follow-up, and parental history of mental illness.

Using never-users as the reference, the odds ratio for non-affective psychosis increased from 1.5 to 2.1 or 2.2 in the two models as duration of first cannabis use increased. The odds for hallucinations increased from 1.4 to 2.5 and 1.5 to 2.8.

Comparing the lowest and highest quartiles of PDI scores, the authors found that the odds of a higher score increased from 1.6 to 4.0 or 4.3 as duration since first cannabis use increased.  Associations for all three psychosis-related outcomes were statistically significant in both models (P=0.001 to P<0.001).

The sibling analysis was limited to the PDI scores. For each pair, the authors calculated difference scores for duration since first cannabis use and PDI total score. The association between time since first cannabis use and PDI score remained statistically significant in the sibling subset analysis.

Limitations of the study included: retrospective self-reporting of time since first cannabis use, lack of data on cumulative exposure to cannabis, no clinical validation of non-affective psychosis diagnosis and lack of use of the instrument at the 14-year follow up, and loss of participants at the 21-year mark with significant differences in the group lost to follow up compared with those retained.

Source:. “Association between cannabis use and psychosis-related outcomes using sibling pair analysis in a cohort of young adults” Arch Gen Psychiatry 2010; DOI: 10.1001/archgenpsychiatry.2010.6.

TESTIMONY OF DAVID G. EVANS, ESQ.
EXECUTIVE DIRECTOR, DRUG-FREE SCHOOLS COALITION
BEFORE THE HEALTH AND HUMAN SERVICES
COMMITTEE OF THE NEW JERSEY ASSEMBLY
SEPTEMBER 20, 2004
TRENTON, NJ

IN OPPOSITION TO A-3256

SUMMARY OF THE TESTIMONY:

THE PUBLIC HEALTH BENEFITS AND SOCIAL EFFECTS OF NEEDLE EXCHANGE PROGRAMS ARE AT BEST UNCERTAIN, AND AT WORST ARE DEVASTATING TO BOTH ADDICTS AND THEIR COMMUNITIES

A.   NEEDLE EXCHANGE PROGRAMS ARE NOT SCIENTIFICALLY
       PROVEN TO REDUCE THE EPIDEMIC OF HIV OR HCV INFECTION
       AMONG INJECTION DRUG USERS

B.   NEEDLE EXCHANGE PROGRAMS DO NOT REDUCE SUBSTANCE
       ABUSE, BUT IN FACT FACILITATE AND ENCOURAGE SUBSTANCE
       ABUSE

C.   NEEDLE EXCHANGE PROGRAMS ARE DESTRUCTIVE TO THE
       COMMUNITIES IN WHICH THEY ARE USED

D.  NEEDLE EXCHANGE SENDS A BAD MESSAGE TO SCHOOL CHILDREN.
      PROVISION OF NEEDLES TO ADDICTS WILL ENCOURAGE DRUG USE.
      THE MESSAGE IS INCONSISTENT WITH THE GOALS OF OUR
      NATIONAL YOUTH-ORIENTED ANTI-DRUG CAMPAIGN.
 
A. NEEDLE EXCHANGE PROGRAMS ARE NOT SCIENTIFICALLY PROVEN TO REDUCE THE EPIDEMIC OF HIV OR HCV INFECTION AMONG INJECTION DRUG USERS 
 
(i) The New Haven Study

NEP activists frequently cite the results of a New Haven, Conn., study, published in the American Journal of Medicine, which reported a one-third reduction of HIV among NEP participants. However, the New Haven researchers tested needles from anonymous users, rather than the addicts themselves, for HIV.  They never measured “seroconversion rates,” which determine the portion of participants who become HIV positive during the study.  Also, sixty percent of the New Haven study participants dropped out; those who remained were presumably more motivated to protect themselves, while the dropouts likely continued their high risk behavior.

 Essentially, the New Haven study merely reported a one-third decrease in HIV-infected needles themselves, which, considering the fact that the NEP flooded the sampling pool with a huge number of new needles, is hardly surprising.  Even Peter Lurie, a University of Michigan researcher and avid NEP advocate, admits that “the validity of testing syringes is limited.”

Furthermore, the New Haven study was based on a mathematical model of anonymous needles using six independent variables to predict the rate of infection. The unreliability of any of the variables invalidates the result. The New Haven study also assumed that any needle returned by a participant other than the one to whom it had been given had been shared, and that any needle returned by the original recipient had not been shared. Both assumptions are suspect.   Also, the role of HIV transmission through sexual activity is downplayed. Prostitution often finances a drug habit. Non-needle using crack addicts have high incidence of HIV. Recent studies reveal that the greatest HIV threat among heterosexuals is from sexual conduct, not from dirty needles.   Less than one-third of the New Haven subjects practiced safe sex. In the New Haven study, sampling error alone could account for the 30 percent decline.
(ii) The HHS / NAS Study

In 1992, Congress directed the U.S. Department of Health and Human Services (HHS) to study NEPs. HHS in turn commissioned the National Academy of Sciences (NAS), an independent, congressionally chartered, non-government research center, to conduct the study.  According to the Congressional directive, if the NAS could show that NEPs worked and did not increase drug use, the Surgeon General could lift the ban on federal funding. The study was completed in 1995, and it concluded that well run NEPs could be effective in preventing the spread of HIV, and do not increase the use of illegal drugs. The NAS panel further recommended lifting the ban on federal funding for NEPs and legalization of injection paraphernalia. Now, seven years after the NAS study, Congress has yet to lift the NEP funding ban, clearly indicating that Congress maintains serious doubts as to the validity of the NAS/HHS conclusions regarding NEPs.  Of note is that study chairman Dr. Lincoln E. Moses cites the dubious New Haven study as a basis for the NAS findings.   The NAS panel admitted that its conclusions were not based on reviews of well-designed studies, and the authors admitted that no such studies exist.  Incredibly, the panel reported that “the limitations of individual studies do not necessarily preclude us from being able to reach scientifically valid conclusions.”

Two of the physicians on the NAS panel, Herbert D. Kleber, M.D. and Lawrence S. Brown, M.D., say the news media exaggerated the NAS’s findings. “NEPs are not the panacea their supporters hope for…We personally believe that the spread of HIV is better combated by the expansion and improvement of drug abuse treatment rather than NEPs, and any government funds should be used instead for that purpose.”   Dr. Kleber, executive vice president for medical research at Columbia University, added: “The existing data is flawed.  NEPs may, in theory, be effective, but the data doesn’t prove that they are.”  

This questionable NAS study represents the cornerstone research data used by the notoriously-politicized U.S. Department of Health and Human Services.  The pro-NEP advocacy of HHS, and its supporting data, has yet to convince Congress that NEPs are scientifically proven to reduce HIV infection while not increasing drug usage.

6 Id.
7  See Loconte, Joe, Policy Review, supra, note 2.
8  See New Jersey Family Policy Council, ANeedle Exchange Programs – Panacea or Peril, supra, note 1 
9    See Loconte, Joe, Policy Review, supra, note 2.
   (iii) The CDC Study

The Centers for Disease Control (CDC) conducted a study whose chief architect, Dr. Peter Lurie, recommended NEPs.  The CDC report calls for federal funds for NEPs and the repeal of drug paraphernalia laws
 
However, although the CDC study endorses NEPs, Dr. Lurie, the study’s author, acknowledges numerous problems:  None of the studies were randomized, and self reported behavior was often the basis for outcomes. Poor follow up and rough measurement of risk behavior also present problems, and he notes that syringe studies have limited validity. The report concludes: “Studies of needle exchange programs on HIV infection rates do not, and in part due to the need for large sample sizes and the multiple impediments to randomization, probably cannot provide clear evidence that needle exchange programs decrease HIV infection rates.”

(iv) The Montreal Study

A 1995 Montreal study, published in the American Journal of epidemiology, showed that IDUs who used the NEP were more than twice as likely to become infected with HIV as IDUs who did not use the NEP. Thirty three percent of NEP users and 13 percent of nonuser became infected.  There was an HIV seroconversion rate of 7.9 per 100 person years among NEP participants, and a rate of 3.1 per 100 person years among non-participants. 

A high percentage of both groups shared intravenous equipment in the last six months: 78 percent of NEP users and 72 percent of non-NEP users. Risk factors identified as predictors of HIV infection included previous imprisonment, needle sharing and attending an exchange in the last six months. The study authors stated: “We caution against trying to prove directly the causal relation between NEP use and reduction in HIV incidence. Evaluating the effect of NEPs per se without accounting for other interventions and changes over time in the dynamics of the epidemic may prove to be a perilous exercise.”  The study concluded:  “Observational epidemiological studies…are yet to provide unequivocal evidence of benefit for NEPs.” 
(v) The Vancouver Study
Vancouver has the largest NEP in North America, and was praised in the 1993 CDC report. It is financed by public funds, and by 1996 was distributing over 2 million needles per year.  A 1997 evaluation of the needle exchange program in Vancouver showed that since the program began in 1988, AIDS prevalence in intravenous users rose from approximately 2% to 27%.  This occurred despite the fact that 92% of the intravenous addicts in that jurisdiction participated in the needle exchange program.
 
The Vancouver study also found that 40% of the HIV-positive addicts who participated in the program had lent a used syringe in the previous six months, and that 60% of HIV-negative addicts had borrowed a used syringe in the previous six months.  Despite the enormous number of clean needles provided free of charge, active needle sharing continued at an alarming rate.  After only eight months, 18.6 percent of those initially HIV negative became HIV positive. 

The Vancouver study corroborates a previous Chicago study which also demonstrated that its NEP did not reduce needle-sharing and other risky injecting behavior among participants. The Chicago study found that 39% of program participants shared syringes, compared to 38% of non-participants; 39% of program participants, and 38% of  non-participants “handed off” dirty needles; and 68% of program participants displayed injecting risks vs. 66% of non-participants.
 
The Vancouver report noted that “it is particularly striking that 23 of the 24 seroconverters reported NEP as their most frequent source of sterile syringes, and only five reported having any difficulty accessing sterile syringes.”
The authors continue: “Our data are particularly disturbing in light of two facts:  first, Vancouver has the highest volume NEP in North America; second, HIV prevalence among this city’s IDU population was relatively low until recent years.  The fact that sharing of
injection equipment is normative, and HIV prevalence and incidence are high in a community where there is an established and remarkably active NEP is alarming.”  

What should be obvious from all of the studies above is that there is no conclusive scientific evidence that NEP’s arrest HIV infection.  Indeed, there is evidence that NEP’s breed HIV infection.

Some claim that the federal government supports NEPs. While the previous administration’s Department of Health and Human Services actively favored NEPs, those who were actually in charge of our national drug policy do not. General Barry McCaffrey, then director of the Office of National Drug Control Policy (ONDCP), when addressing the issue of NEPS stated “we have a responsibility to protect our children from ever falling victim to the false allure of drugs. We do this, first and foremost, by making sure that we send them one clear, straightforward message about drugs: They are wrong and they can kill you.” McCaffrey’s strong views influenced President Clinton not to approve federal aid money for NEPs.
A further elaboration of the ONDCP’s policy was provided by James R. McDonough, Director of Strategic Planning for ONDCP, who wrote:

       ‘  The science is uncertain. Supporters of needle exchange frequently gloss over gaping holes in the data — holes which leave significant doubt regarding whether needle exchanges exacerbate drug use and whether they uniformly lead to decreases in HIV transmission. It would be imprudent to take a key policy step on the basis of yet uncertain and insufficient evidence.

     The public health risks may outweigh potential benefits. Each day, over 8,000 young people will try an illegal drug for the first time. Heroin use rates are up among youth. While perhaps eight persons contract HIV directly or indirectly from dirty needles, 352 start using heroin each day, and more than 4,000 die each
     year from heroin/morphine-related causes (the number one drug-related cause of death).Even assuming that NEWS can further accelerate the already declining rate

  of  HIV transmission, the risk that such programs might encourage a higher rate of heroin use clearly outweighs any potential benefit.

    Treatment should be our priority. Treatment has a documented record of reducing drug use as well as HIV transmission. Our fundamental obligation is to provide treatment for those addicted to drugs. NEPS should not be funded at the expense of treatment.

Supporting NEPS will send the wrong message to our children. Government provision of needles to addicts may encourage drug use. The message sent by such government action would be inconsistent with the goals of our national youth-oriented anti-drug campaign.

NEPS do nothing to ameliorate the impact of drug use on disadvantaged neighborhoods. NEPS are normally located in impoverished neighborhoods. These programs attract addicts from surrounding areas and concentrate the negative consequences of drug use, including of criminal activity. 

 (vi) Among IV drug users, HIV is transmitted primarily through high-risk sexual      contact
 
Another reason why NEPs may not retard the spread of HIV is that HIV is transmitted primarily through high-risk sexual contact, even among IV drug users.  Contrary to prior assumptions, recent studies on the efficacy of NEPs have discovered that it is not needle exchange, but instead, high-risk sexual behavior which is the main factor in HIV infection for men and women who inject drugs, and for NEP participants. A recently released 10-year study has found that the biggest predictor of HIV infection for both male and female injecting drug users (IDUs) is high-risk sexual behavior and not sharing needles. High-risk homosexual activity was the most significant factor in HIV transmission for men and high-risk heterosexual activity the most
significant for women.  The study noted that in the past the assumption was that IDUs who were HIV positive had been infected with the virus through needle sharing.

The researchers collected data every 6 months from 1,800 IDUs in Baltimore from 1988 to 1998. Study participants were at least 18 years of age when they entered the study, had a history of injection drug use within the previous 10 years, and did not have HIV infection or AIDS. More than 90 percent of them said they had injected drugs in the 6 months prior to enrolling in the study. In their interviews, the participants reported their recent drug use and sexual behavior and submitted blood samples to determine if they had become HIV POSITIVE since their last visit. The study showed that sexual behaviors, which were thought to be less important among IDUs, are the major risk for HIV seroconversion for  both men and women. 

If the above conclusions are correct, the very presumption of NEP efficacy becomes suspect.  Indeed, the use of needle exchange programs to address a problem which is caused primarily by high-risk sexual behavior would seem to be highly misguided.

Another reason that Needle Exchange Programs do not effectively address the issue of “saving lives” is that HIV (regardless of how it is contracted) is not the primary cause of death for IVUs.  A study conducted at the University of Pennsylvania followed 415 IV drug users in Philadelphia over four years.  Twenty eight died during the study.  Only five died from causes associated with HIV.  Most died of overdose, homicide, suicide, heart or liver disease, or kidney failure.

Clean needles, even if they in fact prevent HIV, will do nothing to protect the addict from numerous more imminent fatal consequences of his addiction.  It is both misleading and unethical to give addicts the idea that they can live safely as IV drug abusers.  Only treatment
and recovery will save the addict.  The myth of “safe IV drug use” is a lie which is perpetuated by NEPs, and it is a lie which will tend to kill the addict, although his corpse may be free of HIV, for whatever consolation that will provide to the NEP proponent.  
B. NEEDLE EXCHANGE PROGRAMS DO NOT REDUCE SUBSTANCE ABUSE, BUT IN FACT FACILITATE AND ENCOURAGE SUBSTANCE ABUSE.

The rise of NEPs, with their inherent facilitation of drug use (coupled with the provision of needles in large quantities), may also explain the rapid rise in binge cocaine injection which may be injected up to 40 times a day. Some NEPs encourage cocaine and crack injection by providing “safe crack kits” with instructions on how to inject crack intravenously.  Crack cocaine can be, and generally had been, ingested through smoking.  But the easy and plentiful availability of needles facilitates crack injection, creating a new segment of IV drug users, subject to health dangers they would otherwise have been spared exposure to.  In some NEPS, needles are provided in huge batches of 1000, and although there is supposed to be a one-for-one exchange, the reality is that more needles are put out on the street than are taken in.

NEPs also facilitate drug use through lax law enforcement policies.  Police are instructed not to harass addicts in areas surrounding NEPs. Addicts are exempted from arrest because they are given an anonymous identification code number. Since police in these areas must ignore drug use, and obvious and formidable disincentive to drug use disappears.  As the presence of law enforcement declines in these areas, the supply of drugs rises, with increased purity and lower prices, attracting new and younger consumers. 

Many drug prevention experts have warned that the proliferation of NEPS would result in a rise in heroin use, and indeed, this has come to pass. (However, the increase in drug use was ignored by the federally-funded studies which recommended federally funding NEPS). The National Center on Addiction and Substance Abuse at Columbia University reported August 14, 1997 that heroin use by American teens doubled from 1991 to 1996.  In the past decade, experts
estimate that the number of US heroin addicts has risen from 550,000 to 700,000. 
In 1994, a San Francisco study regarding a local NEP falsely concluded that there was no increase in community heroin use because there was no increase in young users frequenting the NEP.  The actual rate of heroin use in the community was not measured, and the lead author, needle provider John Watters, was found dead of an IV heroin overdose in November 1995. According to the Public Statistics Institute, hospital admissions for heroin in San Francisco increased 66% from 1986 to 1995.

In Vancouver, site of the largest NEP in North America, heroin use has risen sharply.  In 1988 when the NEP started, 18 deaths were attributed to drugs.  In 1993, 200 deaths were attributed to drugs. A 1998 report notes that drug deaths were averaging 10 per week.  Now Vancouver has the highest heroin death rate in North America, and is referred to as Canada’s “drug and crime capital.”

The 1997 National Institutes of Health Consensus Panel Report on HIV Prevention praised the NEP in Glasgow, Scotland, but the report failed to note Glasgow=s massive resultant heroin epidemic. Subsequently, as revealed in an article entitled “Rethinking Harm Reduction for Glasgow Addicts,” Glasgow took the lead in the United Kingdom in deaths from heroin overdose, and its incidence of AIDS continues to rise. 

Boston’s NEP opened in July 1993, and the city became a magnet for heroin. Logan Airport has been branded the country’s “heroin port.”  Boston soon led the nation in heroin purity (average 81%), and heroin samples of 99.9% are found on Boston streets. Subsequently, Boston developed the cheapest, purest heroin in the world and a serious heroin epidemic among the youth.  The Boston NEP was supposed to be a “pilot study,” but there was no evaluation of seroconversion rates in the addicts nor of the rising level of heroin use in the Boston area.

Similarly, the Baltimore NEP is praised by those who run it, but the massive drug epidemic in the city is overlooked.  The National Institute of Health reports that heroin treatment and ER admission rates in Baltimore have increased steadily from 1991 to 1995. At one open-air drug supermarket (open 9 a.m. to 9 p.m.) customers were herded into lines  sometimes 20 or 30 people deep. Guarded by persons armed with guns and baseball bats, customers are frisked for weapons, and then allowed to purchase $10 capsules of heroin.
One thing should be clear from the foregoing: since the implementation of NEPs, heroin use in our country has boomed.  It is obvious:  a public policy of giving needles to heroin addicts facilitates and encourages heroin use. 
C. NEEDLE EXCHANGE PROGRAMS ARE DESTRUCTIVE TO THE COMMUNITIES IN WHICH THEY ARE USED.

Most citizens oppose NEPs in their communities, and are concerned about the prospect of dirty needles being discarded in public places.  These fears are not without merit.  NEPs distribute millions of needles every year, and there is little or no accountability for needles once they have been distributed.  A survey conducted in 1998 revealed that in that year 19,397,527 needles handed out, and at best 62% were exchanged, leaving 7-8 million needles unaccounted for.   Carelessly discarded needles create a well-documented public hazard:

* On February 11, 2001, a six-year old from Glade View, Florida, stabbed five children with a discarded syringe. (Kellie Patrick/Scott Davis, “Playground Attack Raises Health Worries,” Sun Sentinal, 2/9/00, p 1B).

* On February 2, 2001, a nine year old from the Bronx stabbed four children with a discarded needle. (Diane Cardwell, “Boy Accused of Needle Attack,” The New York Times, 2/2/01, p. A17.)

* On February 13, 2001, a syringe left at a bus station stuck a four year old boy. (Mike Hast, “Big Fines for Syringe Litterers,” Frankson & Hastings Independent, February 13, 2001,www.mapinc.org/drugnews/v01/n304/ a08.html.)

Besides the physical hazard created by discarded needles, there is a commonsense perception that NEPs bring an air of decay to the communities that host them.  After several years of operation, 343 Massachusetts towns and cities (out of a total of 347) continue to decline the option of approving a local NEP, although of the 10 available slots, only 4 are taken.
31  Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, HHS,       Washington, DC 2001;50:384-388. 
32  Maginnis, Robert L., 2001 Update On The Drug Needle Debate, Insight, Number 235, July 16, 2001, Family Research Council, 801 G. St. NW, Washington, DC 2001.
In March 1997, accompanied by a New York Times reporter, a member of the Coalition for a Better Community, a New York City group opposed to NEPs, visited the Lower East Side Needle Exchange. She was not asked for identification and was promptly given 40 syringes (without having to produce any to exchange).  She was also given alcohol wipes and “cookers” for mixing the drugs, and she was given an exchange ID card that would exempt her from arrest for possession of drug paraphernalia. She was then shown how to inject herself. 

Community opposition to the Lower East Side Needle Exchange arose soon after implementation of the local NEP due to an increase in dirty syringes on neighborhood streets, in school yards and in parks. There was observed to be a dramatic increase in the public display of injecting drugs.  NEP users were seen selling their syringes to buy more drugs. Exchange workers themselves were photographed selling needles offsite.  Neighbors perceived the Lower East Side NEP as little more than a wholesale distribution center for clean needles and a social club for addicts. 

Pro-needle activist Donald Grove concurred: “Most needle exchange programs actually provide a valuable service to users beyond sterile injection equipment. They serve as sites of informal organizing and coming together. A user might be able to do the networking to find good drugs in the half an hour he spends at the street based needle exchange site networking that might otherwise have taken half a day. [Grove, D. The Harm Reduction Coalition, N.Y.C., Harm Reduction Communication, Spring 1996].

In 1998, a U.S. Government official was sent to Vancouver, site of the largest NEP in North America, to assess the high incidence of HIV among NEP participants, and the skyrocketing death rate due to drug overdose.  He reported that the highest rates of property crime in Vancouver were within two blocks of the needle exchange.  He also observed, pursuant to a tour with the Vancouver Police, that there was a 24 hour drug market and plain view injection activity in the area immediately adjacent to the needle exchange.  Most poignantly, he was told, in a private interview with an elementary school teacher, that the children at area schools are not allowed outside at recess for fear of needles. 
CONCLUSION

There is ample evidence to suggest that very fundamental premises used to justify and support NEPs are seriously flawed.  First, NEP participants routinely continue to share needles and large percentages of the NEP participants are HIV positive, meaning that NEPs do nothing more than continue the spread of HIV (and HCV).  Significantly, no one has been able to explain satisfactorily why enhanced needle availability in and of itself would discourage needle sharing: needle sharing is an intrinsic aspect of IV drug use, and a NEP-issued needle will transmit HIV as well as any other needle.

Second, NEP studies have discovered (inadvertently) that needle sharing is not even the primary cause of HIV infection for IVUs.  It is primarily through high-risk sexual behavior that IVUs contract HIV; free needles do nothing to prevent sexually transmitted disease.  Furthermore, HIV (regardless of how it is contracted) is not even the primary cause of death for IVUs.  Most die of overdose, homicide, suicide, heart or liver disease, or kidney failure.  Clean needles may protect an addict from HIV, but they do nothing to protect him from the more numerous, and more imminent fatal threats of his addiction.  Several key NEP proponents have died of heroin overdose; no doubt their needles were very clean.

Third, the science is inconclusive.  Although the proponents of NEPs uniformly aver that the scientific debate regarding the efficacy of NEPs is over, in truth, even the reports favoring NEPs are burdened with imprecise methodology, and many of the authors of those reports caution that their results should not be deemed conclusive. Today, there is still no conclusive scientific evidence: (1) that NEPs reduce the spread of HIV and HCV, or (2) that NEPs do not encourage IV drug use.  Indeed, the correlation between the rise of NEPs and the explosion of IV drug use, if it is a coincidence, is a remarkable one.  Dispassionate observers will look at the current epidemic of heroin and IV cocaine use as a tragedy which might have been averted, or mitigated, but for the misguided mercies of the NEP concept.
 
Fourth, while the benefits of NEPs may be in doubt, the costs to the surrounding communities are very real.  The overwhelming majority of communities dread the prospect of a local NEP, for self-evident and well-documented reasons.

 34  D.B. Des Roches, Information, Memorandum for the Director, Through: the Deputy Director, Subject: Vancouver Needle Exchange Trip Report, Executive Office of the President, Office of National Drug Control Policy, Washington, D.C. 20503, April 6, 1998.

 Peer-based addiction recovery support: history, theory, practice, and scientific evaluation.
White W.L.
Chicago, IL: Great Lakes Addiction Technology Transfer Center and Philadelphia Department of Behavioral Health and Mental Retardation Services, 2009.
This monograph is likely to become the handbook for the growing peer-based recovery movement in the UK. For administrators, the approaches it reviews offer a way to reconcile decreasing per-patient resources with a policy agenda now focused on reintegration and recovery.
Abstract This seventh monograph* in a series on recovery management and recovery-oriented systems of care synthesises knowledge about the history, theoretical foundations, methods, and scientific status of peer-based recovery support for individuals with the most severe and complex alcohol and other drug problems. It was written primarily for people directly involved in planning, funding, delivering, supervising, and evaluating peer-based recovery support services, but will also be of interest to policymakers, purchasers of care, treatment programme administrators, and addiction counsellors and other service professionals. Though rigorously researched, information is presented in a clear and accessible language.
The report focuses on:
• Peer-based recovery support in general, meaning any form of mutual assistance aiming for long-term recovery from alcohol and other drug problems. Such assistance can and often does occur informally. The focus here is primarily on recovery support provided through recovery mutual aid societies and abstinence-based religious and cultural revitalisation movements by people whose credentials rest on personal experience.
• Peer-based recovery support services, a narrower term for assistance directed toward the same goal but delivered through more specialised roles with more formal resources, service protocols and safeguards. The key distinction is the term ‘services’, which implies a more formal structure though which recovery support is delivered. Here the focus is on recovery community organisations other than mutual aid societies, and on peer-based services provided through addiction treatment programmes and allied health and human service agencies. These services are distinguished from other programmes by their: mobilisation of personal, family, and community recovery capital to support long-term recovery; respect for diverse pathways and styles of recovery; focus on immediate recovery-linked needs; use of self as a helping instrument; and their emphasis on continuity of recovery support over time.
After comprehensively reviewing the literature and profiling peer-based recovery support initiatives, the author reached (among others) the following conclusions:

• Peer-based recovery support services are today growing out of the failure of addiction treatment to provide a continuum of care that is accessible, affordable, and capable of helping people with the most severe and complex problems move beyond brief episodes of recovery initiation to stable long-term recovery.

• Their distinctive strategy is to improve linkage to recovery mutual aid groups and other recovery support institutions, and their value is founded in what specifically those in recovery bring to the helping process. As with any effective helpers, those in recovery relate not primarily through techniques, but through humanness. They are able to do so, not because they once experienced addiction, but because they completed their own recovery experiences and emerged as men and women committed to this demanding way of life.

• Peer-based models of care can have a transforming effect on larger systems of care and on our society, but can also be corrupted and devoured when integration in to these systems leads to pressure to emulate the ethos of current professional treatment models. Care must be taken not to over-professionalise the roles of peer helpers, but training, guidelines, supervision and recognising the limits of one’s competence and role, are as important for services based on the power of mutual identification as for professional services.

• Rather than view peer-based and professional-based styles of knowing and doing as antagonistic models rivalling for superiority, it is more helpful to view these approaches as complementary. We need a community in which both professional and peer-based services are available as needed, and are supported and integrated into a seamless system of long-term recovery support.

• One unique quality separates the addictions field from peer models in allied fields: the growth of spiritual, secular, and religious recovery mutual aid groups, and new recovery support institutions, has gifted it the oldest and largest recovery mutual aid network in the world. New peer-based models must capitalise on these strengths rather than undermining or replacing them. The long-term goal is not to create a larger treatment system or new profession, but the establishment of recovery support relationships that are non-hierarchical, non-commercialised, and enduring in recovery-friendly communities.

• The question, ‘Who is most qualified to treat the alcoholic?’ is ill-framed because it assumes a homogeneity within the label ‘alcoholic’ and within the boundaries of particular helping roles or categories of helpers. In terms of recovery status, the question is not whether professional and peer helpers with or without a history of addiction recovery are most effective, but which helper is most effective with which person or family at a particular point in time. There are so many kinds of alcoholics and so many different kinds of alcoholism that a therapist eminently qualified to treat one type may fail completely with another.

• Recovery stages might be broadly conceived in terms of:
• 1 a sudden or unfolding opportunity for change;
• 2 a commitment to recovery experimentation;
• 3 recovery initiation and stabilisation;
• 4 recovery consolidation and maintenance; and
• 5 enhanced quality and meaning of life in long-term recovery.
 Peer-based recovery support services will probably be found most critical in stages 1, 2, and 4. Traditional professionals may be most effective in stages 3 and 5.
Every effort has been made to meticulously document sources, but many critical research questions about peer recovery support have yet to be studied and many studies suffer from methodological problems, so these findings are best viewed as probationary, pending new studies of greater methodological sophistication.
Though written by an advocate of peer-based recovery, this monograph is careful to adhere to the research (more comprehensively reviewed here than in any other publication) and to point out the limitations and risks involved in this route to recovery and the continuing role of professional treatment and other formal services. In it the British reader will find unfamiliar but potentially promising manifestations of mutual aid such as recovery social clubs, recovery community centres, and recovery homes, with profiles of how these have worked in practice and relevant research. Attention is not limited to 12-step based approaches, but extends to mutual aid based on other philosophies and understandings of addiction and recovery. For the growing peer-based recovery movement in the UK, it is likely to become an essential handbook to clarify thinking, offer practical ways forward, identify pitfalls and risks, and to encourage further research.
As the author comments, most of the reviewed research lacks the methodological safeguards of a randomised trial or some other research design capable of eliminating influences on outcomes other than mutual aid or peer support. Typically studies have recorded the degree to which substance dependent individuals participated in mutual aid activities and groups, and then assessed how closely this was associated with substance use and related problems. Such designs leave open the possibility that good outcomes encourage increased mutual aid participation rather than the reverse, or that people who are in any event going to do well also tend to participate in whatever in that society is the accepted route to doing well in terms of recovery from addiction. In the USA, where most studies originate, that route entails 12-step mutual aid.
When (as in a review for the Cochrane Collaboration) the focus is limited to the few randomised or other well controlled trials, there is no convincing advantage for 12-step mutual aid or allied services over other approaches. This review was unable to take in to account an influential later study which randomly assigned patients in formal treatment to standard versus intensive referral to 12-step groups. As intended, intensive referral improved 12-step mutual aid participation and this in turn improved substance use outcomes, confirming that participation was indeed an active ingredient. However, the effects on both participation and substance use were not great. While such studies can demonstrate the value of the extra element of mutual aid participation they ‘artificially’ generate, they say nothing about the value of the bulk of mutual aid participation as it naturally occurs. For this we must turn to the less well controlled studies excluded from the Cochrane review but included in the featured report, yet these are not capable of delivering convincing answers. This bind arises from the fact that mutual aid cannot be imposed or withheld by researchers and the results observed. Rather, it is generated (or not) organically by the nature of the society and of the individuals who choose (or not) to participate. It makes little sense to ask what the recovery chances of that society or those individuals would be if they did not generate or participate in mutual aid, because then they would not be the same societies or individuals. Another limitation of the controlled research is that typically it has studied mutual aid as an add-on to current treatment models, not the thoroughgoing systemic transformation called for in the featured report.
Even if given these difficulties, peer support and mutual aid struggle to demonstrate a superiority, where they can have a distinct advantage is in accessibility and (by reducing resort to public services) cost to society. For administrators in the UK, such approaches offer a way to reconcile increasing numbers in treatment, decreasing per-patient resources, increasing pressure to move patients through and out of treatment, and a policy agenda now focused on secure reintegration and recovery. Formal services seem unlikely to be able to make major advances in the availability to dependent substance users of (among other supports to reintegration and recovery) supported housing, suitable training and education opportunities, sheltered, graduated and attractive employment, and satisfying non-drug focused social and lifestyle options. Within available resources and political and public willingness to redirect these, transformations of the kind described in the featured report may be the only feasible way to create a more recovery-friendly environment which can protect greater numbers of people leaving treatment from repeated relapse.
However, risks of the kind warned about in the report are already apparent in parts of Britain where services concerned to safeguard vulnerable adults and who have clinical responsibility for patients seem reluctant to refer those patients to untried and unqualified mutual aid organisations, leading to pressure for those organisations to implement safeguards and protocols potentially antithetical to their self-help ethos. Such pressures have also been apparent in the UK mental health service-user/survivor movement. There is also a tendency for mutual aid recovery enthusiasts to see formal treatment services and their workers as ‘part of the problem’ rather than collaborators. The result is an imperfect interface between mutual aid and formal services which impedes beneficial complementarity and movement between them. As with other collaborations between organisations with different traditions and agendas, these difficulties will need to be carefully and respectfully worked through if patients are to benefit maximally from the potentially huge reservoir of voluntary effort represented by current and former problem substance users.
In the UK employment of current or former problem substance users in drug and alcohol services may be seriously impeded by the new requirements and powers associated with the advent in 2009 of the Independent Safeguarding Authority and of a similar scheme in Scotland. Among the criteria for banning people working with vulnerable adults (which would embrace many attending drug and alcohol services) are a history of acquisitive crime or fraud, addictive behaviour, or persistent offending. Such histories are common among drug addicted populations who have recovered through treatment and who might be employed as a paid employee or volunteer to offer peer-based support to substance users in contact with services. These problems have been recognised and representations are being made to the authority.
SOURCE: Peer-based addiction recovery support: history, theory, practice, and scientific evaluation.
White W.L.
Chicago, IL: Great Lakes Addiction Technology Transfer Center and Philadelphia Department of Behavioral Health and Mental Retardation Services, 2009.

There has been a considerable scientific effort over the past three decades in to identifying and understanding the core features of alcohol and drug dependence. This work really began in 1976 when the British psychiatrist Griffith Edwards and his American colleague Milton M. Gross collaborated to produce a formulation of what had previously been understood as ‘alcoholism’ – the alcohol dependence syndrome.
The alcohol dependence syndrome was seen as a cluster of seven elements that concur. It was argued that not all elements may be present in every case, but the picture is sufficiently regular and coherent to permit clinical recognition.   The syndrome was also considered to exist in degrees of severity rather than as a categorical absolute. Thus, the proper question is not ‘whether a person is dependent on alcohol’, but ‘how far along the path of dependence has a person progressed’.   The following elements are the template for which the degree of dependence is judged:

Narrowing of the drinking repertoire

A normal drinker’s consumption and choice of drink varies from day to day and week to week, with the drinking being patterned by varying internal cues and external circumstances.   The dependent person may drink to the same extent whether it is workday, weekend or holiday, irrespective of whether he is alone or in company, and whatever his mood. With advanced dependency, the drinking may become timetabled to maintain high alcohol levels.
Increased salience of the need for alcohol over competing needs and responsibilities
As dependence advances, the person gives priority to maintaining their intake. Their partner’s distressed complaints are ignored, income is used to support their drinking rather than provide for the family, and the need for drink may become more important for the person with liver damage than consideration of survival. A person who used to have moral standards now begs, borrows and steals to pay for drinking.

An acquired tolerance of alcohol

A given amount of alcohol will have a smaller effect on the dependent person than on a naïve drinker due to changes in brain function arising from repeated consumption of alcohol. Tolerance is also shown by the dependent person being able to sustain an alcohol intake and go about their business at blood alcohol levels that would incapacitate the non-tolerant individual.   However, in later stages of dependence this tolerance declines and the drinker is incapacitated by quantities of alcohol that he would previously hold easily.

Withdrawal symptoms

These vary from a mild shaking of the hands in the morning through to convulsions and the life-threatening illness of delirium tremens (confusion, hallucinations, tremor). As dependence increases, so does the frequency and severity of the symptoms. Symptoms of withdrawal may occur during the day as blood alcohol levels drop.    The four key symptoms are tremor, nausea, sweating and mood disturbance. A person may wake in the morning with soaking sweats, or they may vomit in the morning. In the early stages, a person may feel a ‘bit edgy’, but as dependence develops, they may experience terrible agitation and depression, or may show phobic reactions. Other symptoms include muscle cramps, sleep disturbance, hallucinations and grand mal seizures.

Relief or avoidance of withdrawal symptoms by further drinking

In the earlier stages of dependence, the person may feel at lunchtime that the first drink of the day ‘will help me straighten up a bit’.   At the other extreme, a person may require a drink every morning before they can get out of bed. They may try to maintain steady alcohol levels which they may have learnt to recognise as being comfortable above the danger level for withdrawal.

Subjective awareness of compulsion to drink

The person may become aware of their ability to lose control: ‘If I have one or two, I won’t stop’. They may start to experience and express their craving for alcohol. Cues for craving include the feeling of intoxication, incipient withdrawal, mood or situational cues (e.g. seeing a drinking friend). They may constantly think about alcohol when experiencing withdrawal.

Reinstatement after abstinence

If a severely dependent drinker is abstinent for a year and then attempts to return to social drinking, it is likely that within a few days they will be back to an intensity of withdrawal experience which had previously taken many years of drinking to develop. Dependence has memory.
There is no signpost to a person becoming dependent. Whilst a severely dependent person is easy to recognise, it can be difficult to detect a problem in the early stages.    Clearly, it is essential to be able to diagnose early problems, before drinking gets out of hand and there is a precipitous decline in the quality of life that accompanies increasing dependence.
In the latter stages of dependence, there may be rapidly mounting intensity of morning distress, appalling shakes and suicidal thoughts and delirium tremens. Gross and incapacitating intoxication becomes common.
The person is intoxicated after a couple of drinks, there is a gross and repeated amnesia (they may disappear for several days but not remember where), and there are desperate attempts to avoid withdrawal by topping up.   Drinking makes the person very ill – this is partly due to mounting intensity of morning distress, but also due to various alcohol-induced physical problems (e.g. liver disease). Psychiatric disorders may become common at this stage

Source: www.wiredin.org.uk 2009

The latest scientific conclusions — which are causal, not merely correlative — show that pot use significantly increases the likelihood of mental illness.
Back in the 1970s, when I was first exposed to the idea of decriminalizing illegal drugs, it seemed like a good idea. My interest was abstract: I didn’t smoke pot. My wife and I signed a marijuana decriminalization petition one evening around 1980 for a group that acted like they had fallen out of a Cheech and Chong movie. They asked if we could contribute a joint or two to the cause. They were utterly shocked when we told them: “We don’t smoke pot.” They just could not imagine that anyone would support decriminalization without a more personal interest.
There’s no question that making drugs illegal creates serious problems for our criminal justice system. It clogs the courts, it corrupts police officers and government officials, and it funds some really sleazy people. All of this is true — but it turns out that there are some substantial social costs on the other side that simply don’t get any attention. While it may sound like I have been watching Reefer Madness (1936) – a tragically overwrought portrayal of the dangers of marijuana — it turns out that mental illness is one of those social costs.
A surprising number of scholarly studies in the last 25 years have demonstrated that marijuana use seems to cause an increase in psychoses such as schizophrenia, and somewhat less dramatic mental illnesses such as bipolar disorder.
Let me emphasize: This isn’t just correlation analysis — finding that people with a current mental illness are disproportionately potheads. I am well aware that people with significant mental illness problems tend to “self-medicate” using various psychoactive drugs (including alcohol). No, these are longitudinal studies that show the marijuana use comes first, with the mental illness later in life.
The first of these, involving Swedish conscripts, was published in the Lancet in 1987. Those who had used marijuana heavily by age 18 were six times more likely to develop schizophrenia. A British medical journal paper published in 2002 performed a longitudinal study in New Zealand and found that:
Firstly, cannabis use is associated with an increased risk of experiencing schizophrenia symptoms, even after psychotic symptoms preceding the onset of cannabis use are controlled for. … Secondly, early cannabis use (by age 15) confers greater risk for schizophrenia outcomes than later cannabis use (by age 18). The youngest cannabis users may be most at risk because their cannabis use becomes longstanding.
This paper, from the British Journal of Psychiatry in 2004, should also make you a bit concerned. From the abstract:
On an individual level, cannabis use confers an overall twofold increase in the relative risk for later schizophrenia. At the population level, elimination of cannabis use would reduce the incidence of schizophrenia by approximately 8%, assuming a causal relationship. Cannabis use appears to be neither a sufficient nor a necessary cause for psychosis. It is a component cause, part of a complex constellation of factors leading to psychosis.
There’s unquestionably a genetic component. This Schizophrenia Bulletin (2008) paper tells us:
Cannabis use is considered a contributory cause of schizophrenia and psychotic illness. However, only a small proportion of cannabis users develop psychosis. This can partly be explained by the amount and duration of the consumption of cannabis and by its strength, but also by the age at which individuals are first exposed to cannabis. Genetic factors, in particular, are likely to play a role in the short- and the long-term effects cannabis may have on psychosis outcome. … Evidence suggests that mechanisms of gene-environment interaction are likely to underlie the association between cannabis and psychosis.
Obviously, only a fraction of pot smokers are going to go crazy and join the 1-3% of Americans who are psychotic. Think of smoking marijuana on a regular basis as playing Russian roulette once with a 50-shot cylinder, one of which has a live round. (Of course, now that you know that, maybe you do have to be crazy to smoke marijuana.)
At this point, you may be saying: “Big deal! It’s my life! If I want to smoke pot and risk going crazy, that’s my choice!” I would concede that point, except that as of 2002, schizophrenia alone of the mental disorders was costing the United States $63 billion a year in medical costs and in disability payments. Much of that cost is directly governmental, since schizophrenics usually aren’t able to work and thus are reliant on the government.
You might also argue: “What about alcohol? Doesn’t it have risks?” No question — and these risks have been recognized for a long time. Arguing for decriminalization of marijuana because alcohol is a big problem is like arguing that because one of your feet is gangrenous the doctor should also amputate the healthy foot just to be even-handed. (Or even-footed, I suppose.) If anything, instead of decriminalizing marijuana, we should be looking at discouraging alcohol — and recognizing that while Prohibition didn’t work, there may be approaches more educational, and less drastic, that can.

Source: http://pajamasmedia.com/blog/author/claytonecramer/ March 3, 2010

Adaptation and Testing of the Strengthening Families Programme 10-14 (SFP10-14) for use in the United Kingdom

Summary
Introduction
Numerous studies in Europe report high rates of alcohol use among young people. A European School Project on Alcohol and Drugs (Hibbell 1999) reported that the UK had among the highest rates of drunkenness and binge drinking and alcohol consumption in Europe. Participants reported that 75% had had one episode of drunkenness, while nearly one third had 20 or more episodes in their lives or 10 or more episodes in the last year. Half had been intoxicated in the last month and a quarter intoxicated at least three times in the same period. The trends of the last decade are: more young people are drinking regularly (at least once a week); weekly drinkers are drinking more; regular young drinkers are drinking more alcohol per session; there are changes in the types of alcohol consumed (alcopops/designer drinks) (Alcohol Concern 2005).

The Strengthening Families Programme 10-14 (SFP10-14) is a seven session video based family skills training programme designed to increase resilience and reduce risk factors for alcohol and substance misuse, depression, violence and aggression, delinquency and school failure in The SFP10-14 has been evaluated for primary prevention effectiveness with young people and their parents living in mainly rural areas in Iowa, U.S.A. (Spoth et al 2001a; Spoth et al 2001b).
 
Whilst initial reports of implementation of the SFP10-14 in the UK are valuable it has been recognised that the US SFP10-14 programme materials and approach might need to be adapted to meet the needs of a UK audience and that a more systematic approach to evaluation of SFP10-14 in the UK was needed (Coombes et al 2006).
This report presents the results of the adaptation process and exploratory pilot study of the adapted SFP10-14 materials and approach in the UK.
Aims of the study
1. To adapt the US SFP10-14 materials and approach for the primary prevention of alcohol and drugs misuse in the U.K.
2. To model and explore the adapted SFP10-14 (UK) materials and approach with young people in the UK.
3. To develop a protocol for a large-scale evaluation study of the SFP10-14 (UK) including a cost-effectiveness assessment.

Method
Adaptation of US SFP10-14 materials
A small number of professionals and participants who had facilitated/attended SFP10–14 programmes in the United Kingdom using the United States programme materials was recruited and an advisory group formed. Four professionals, four mothers, two fathers and five young people agreed to join the advisory group. The advisory group was established with the remit to meet on one occasion only, with any further contact being by correspondence. The advisory group reviewed the original SFP10-14 materials and made recommendations about how the original programme should be adapted for a UK audience, using a nominal group technique to collect data. The advisory group was asked to review the US SFP10–14 materials and generate an individual list of positive features, and areas for improvement. A ‘round robin’ recording of individuals’ ideas into a single list was undertaken until all ideas were exhausted, and duplicates eliminated. The advisory group was then asked to discuss each item of the final list and to reach a consensus on the areas for improvement. The final list was the pooled results of individual opinions. The process of the nominal group’s work was recorded and the completed list of suggested improvements was then sent to all participants at a later date to check for accuracy
and agreement. The US SFP10–14 materials were then revised according to the agreed lists of improvements to produce the SFP10-14 (UK) materials.

Modelling of revised SFP10-14 materials
Focus group meetings involving parents/guardians and children were held in schools in four different geographical locations in the United Kingdom: Barnsley, Chester, Oxford and Peterborough (see Table 1). The sites and participants were selected purposively guided by time and resources. The focus groups critically reviewed the revised SFP10-14 (UK) materials, identifying what they felt were their strengths and weaknesses.
At the start of each focus group, short extracts from the original US SFP10–14 materials were shown. This was done to enable participants to provide a reference point for discussion of the adapted SFP10-14 (UK) materials. Participants were then asked for their opinions about the US SFP10–14 materials. This process was repeated for the SFP10-14 (UK) materials.

All focus group interviews were audiotape recorded and transcribed. The transcripts were coded and the codes were then aggregated to form larger conceptual categories. Conceptually meaningful themes were constructed from categories of the data. Validation of the thematic analysis was achieved through the use of independent individuals to check the analysis and interpretation of data; external checks on the inquiry process and debriefing with informants.

Exploratory pilot study of SFP10-14 (UK)
The SFP10-14 (UK) materials produced from the adaptation and modelling stages were field tested in three different geographical locations. In each of the three sites sufficient families were recruited to participate in the SFP10-14 (UK) delivery sessions. Subsequently, in each of the three sites a similar number of families were non-randomly selected into a comparison group. The comparison group children received the standard alcohol and drugs education delivered as part of the school curriculum. The SFP10-14 (UK) group received the standard alcohol and drugs education delivered as part of the school curriculum plus the SFP10-14 (UK) intervention.

Study self-report questionnaires were completed by youth and their parents/carers pre- and post- intervention, and at 3 months after completion of the programme. The study questionnaires were adapted from validated tools used in previous SFP10-14 evaluations in the US (Spoth et al 2001a; Spoth et al 2001b) and those used in ESPAD (European School Survey Project on Alcohol and Drugs) research studies. To supplement and enrich the quantitative data, focus groups were held to gain feedback from participating families. Two tape-recorded, focus group interviews lasting approximately 60 minutes were undertaken with the parents/caregivers and young people in Barnsley and Chester who had completed the SFP10-14 (UK) programme. Interviews focused on the parent’s/caregiver’s and young people’s experience of the SFP10-14 materials and approach. All interviews were tape recorded and transcribed and a content analysis of transcripts undertaken. The transcripts were coded and codes aggregated to form larger conceptual categories. Conceptually meaningful themes were constructed from categories of the data. Validation of the thematic analysis was achieved through the use of independent researchers to analyse and interpret single sets of data, external checks on the inquiry process and debriefing with informants.
Findings
Adaptation & Modelling of revised SFP10-14 materials
The results from the nominal group meeting and subsequent focus group meetings provided useful information on whether and how the original US SFP10–14 materials could be adapted for use in the United Kingdom, while at the same time retaining essential ingredients of the effective US programme. Twenty-one parents/caregivers and sixteen young people participated in the focus groups. The nominal and focus group study led to the development of newly revised programme materials, now referred to as SFP10–14 (UK), that were used in the subsequent exploratory pilot study.
Exploratory pilot study of SFP10-14 (UK)

There were 23 parent/caregivers and 24 young people from 3 sites in the SFP10-14 (UK) intervention group. There were 24 parent/caregivers and 22 young people from 3 sites in the non-random comparison group.
The study questionnaires were completed by all participants without difficulty, and analysis and interpretation was straightforward. Given the small sample size and short-term follow-up in this pilot study no statistically significant effects were predicted or found, though data are summarized here for completeness: overall, there were no clear or consistent outcomes associated with the SFP10-14 programme in terms of alcohol use, substance use, parenting behaviour, general child management, parent-child affective quality, or measures of supportive and controlling family environment.
16 adults and 14 young people participated in the focus groups. Feedback from parents, carers and young people was overwhelmingly positive. The following key themes have been selected for the summary:

Expectations and reasons for attending the SFP10-14: some participants commented that they did not have any idea what to expect before attending the programme, while others identified a particular aspect of the programme that they had come to find out about. What became clear during analysis of the focus group data was that the important aspect of the programme for many parents/guardians was not necessarily to do with drug and alcohol prevention, but more to do with strengthening family functioning.

Involving youth in the programme: participants acknowledged that in some cases it had not been easy to persuade their youth to attend the first group meeting. There were examples given that showed some youths were quite determined not to go with their parents at first. However, after participating in the first group, barriers and obstacles to attendance were overcome.

What worked well for participants: participants identified that the SFP10-14 (UK) had helped strengthen the family unit and had also helped them identify different strategies to manage situations. Their responses indicated that they felt that the SFP10-14 (UK) provided parents with a range of strategies (or ‘tools’) which they can draw on to help manage different situations. Some of these strategies involved a change in the adults’ behaviour and how they responded to challenging situations.
Some participants also observed that by working with a group that were all there to learn about parenting and improving their skills helped them to be open about their problems. The sessions that focused on peer pressure were identified as being particularly helpful by participants.
When speaking about the parent sessions of the programme, the group spoke positively about the support they felt they had from one another. They felt that everyone had participated and contributed to the sessions and therefore the group had gained from that.

Use of DVDs, actors and scenario: generally, participants found the DVDs useful to illustrate particular potentially problematic aspects of family life, and felt they could identify with the families (actors) homes and the locations that were used. Some participants felt the approach taken in the DVDs was patronising when they first saw it, but generally, they developed a more positive perception as they became more engaged with the programme. Participants felt that the actors and scenarios helped get discussion going in sessions by encouraging people to reflect on their own situations and how they dealt with these.

Exercises and activities in the programme: participants were very positive about the activities and family exercises to help families have fun and learn about each other, particularly enjoying activities such as creating the family tree and the family shield. However not all comments about this aspect of the course were entirely positive. Some participants found some of the exercises or games rather frivolous, although they did understand that there was a purpose behind the group activities.

What did not work so well for participants: participants were asked if they could identify aspects of the SFP10-14 (UK) that they felt did not work so well for them or for the group as a whole. One of the issues that was identified related to the tight control of time. The delivery of the SFP10-14 (UK) relies on strict time keeping within a two hour time frame: in the first hour parents and youth work separately, in the second hour they work together. It is critical that both sessions end together, on time, or the following family session will over-run and participants will be late leaving for home. Participants felt they were sometimes rushed with not enough time being available for discussion. However they also acknowledged that there is a need for some time limits.
 
Timing of the programme: the SFP10-14 (UK) is generally facilitated in the evening as this suits most families. The timing of the programme had been negotiated with parents and carers at the information evening held prior to the programme. Participants felt that this had worked well for most members of the group.
Crèche: the programme also offered a crèche for families who had younger siblings. This was viewed very positively by both the parents and the children who attended the crèche.
 
Positive outcomes:
 throughout the focus group sessions parents and carers spoke of what they had learned and how their parenting had changed since attending the programme. The following are a selection of some of the comments made:

• “What I’ve learnt is to really, really listen to my kids feelings. Even if the answer is going to be no to whatever the request is, because some have to be no, but they need to air their feelings”
• “It changed my behaviour towards my children, I listen to what they say, I don’t lose my temper so much”
• “I used to confront him and the situation would get worse and worse and it could spoil a whole evening…but by walking away its much better, it’s a really calm approach” 
• “We have definitely got closer since doing the course, I think what they (youth) have done in combination with what we have done – I think its made her think a bit more about her behaviour at home and I’m certainly thinking about my behaviour more”
• “I’m a single parent I’m on my own, it’s very hard to be a mum and a dad, but the tools gained from the course have been extremely beneficial”
• “I feel that you have never got enough skills as a parent, I’ve learned a lot from this course, my son’s learned a lot from this course and its brought us closer together and I think it would bring any family closer together”
• “I’ve got nothing but praise for what has happened, it’s a transformation. Getting called into school and they asked ‘what has changed in ****, what have you done that is different? There is a noticeable and marked difference in the way **** has adopted a more mature attitude’ and that, that’s the proof of the pudding isn’t it? As they say”
• 
Youth Feedback: the young people who had participated in the programme were equally enthusiastic in their evaluation of their experience. They enjoyed the companionship, the role play, games and exercises. They also commented that some of the tools and strategies used in the programme had worked for them in their family setting. One example of comments from one young person is:

• “I was like a bit nervous when I first came – but then enjoyed it. I liked the first week, especially the treasure map, and the fifth week with the shield. The last week was good with the role models. I liked working with mum and dad. I enjoyed the DVDs and having the family meetings. The role play and acting was good especially ‘setting up situations’. The games were good I liked the three legged game”
• “I liked it all – no negatives”
• “I learned about drugs and keeping out of trouble. And about rules – in the driving game”
• “It has been better at home. We use the points and I earned 8 points and that meant a meal in the pizza hut. 10 points and we have an Indian meal. I get the points when I clean my room, putting my shoes away. For cleaning the car or cutting the grass”

Conclusions
Although there were no clear or consistent outcomes associated with the SFP10-14 programme on examination of the quantitative data, we need to be cautious about our interpretation of these data. The purpose of this pilot study was primarily to test the adapted materials and the evaluation tools in a “live” programme delivery setting in the UK. Further research based on a randomised controlled trial design, with adequate sample size, is required to fully evaluate the potential of the programme in the UK.
The qualitative data that were obtained allow us to draw some conclusions about the perceived benefits of the SFP10-14 (UK) from the participant’s perspective. These results suggest that parents, carers and young people enjoyed and felt that they benefited from the intervention. Parents/caregivers and young people reported that 
the SFP10-14 (UK) had played a part in improving family functioning through: strengthening the family unit, improving parent/caregiver communication, using a more consistent approach, increasing the repertoire for dealing with situations, developing better positive and negative feedback, working more together as a team, identifying family strengths, strengthening family bonds, receiving group support, working more closely with mum and dad, learning to listen more, learning to get along with each other better, helping parents/caregivers more, better understanding of what parents/caregivers/young people are saying, changing the code of behaviour and developing more interaction among the family.
A protocol for a large-scale trial of the SFP10-14 in the UK has been developed and is being submitted to various funding agencies.

Source: Research Report No. 28 ISBN: 1-902606-25-6
www.brookes.ac.uk/schools/shsc/4

In Sweden routine parent-school meetings incorporating parenting advice and encouraging commitment to take a strong stand against underage drinking had a remarkable impact on adolescent drunkenness – but would this simple, low-cost tactic work as well in the UK? 

Abstract
The Örebro Prevention Programme built on the fact that Swedish schools start each term with a parent information meeting. A survey of pupils in the final grade of compulsory schooling (roughly age 16) in the county of Örebro in central Sweden was used to select schools for the project in communities typified as inner cities, public housing areas, or small towns. Within each type of community, pairs of matched schools were selected, one of which carried on as normal, the other of which was assigned to test the prevention programme. None of the schools refused to participate in the study.
The programme was implemented across the final three years (grades seven to nine) of compulsory schooling when pupils were aged 13 to 16. Before the programme started, a survey of pupils in grade seven formed the baseline against which to assess impacts in this and the following two years. In each succeeding year the next higher grade was surveyed, meaning that largely the same pupils were followed up each year. In each year roughly 900 pupils evenly split between both sets of schools were asked to participate in the study.
Rather than through classroom lessons, the programme worked via the parents. At a seventh-grade parent information meeting, project staff gave a presentation describing the programme and advising parents to maintain a zero-tolerance stance towards youth drinking and to communicate clear rules to their children. This was reinforced by inviting attending parents to sign agreements about their positions on (among other issues) youth drinking; most did so. The agreement was mailed to all parents including those who had not been at the meeting. In each of the next two years project staff attended two further parent meetings to emphasise the key message of strict rules. Reports on the meetings were one of at least three mailings each term to parents. Mailings included letters (most co-signed by project workers and teachers) which stressed the importance of communicating family rules against alcohol and drug use and of promoting organised leisure activities.
 
The key question in the pupil surveys asked how often pupils had been drunk in the past four weeks. From virtually no times at age 13, in the control schools not participating in the programme the average rose to nearly once in four weeks at age 16  chart. From a similar starting point, it rose just half as much in programme schools, a medium to large programme impact as represented by the effect size metric. Also the proportion of pupils who had been drunk more than once during this period was twice as high (27% versus 13%) in non-programme schools.
At age 13 just under a fifth of the pupils said they had already been drunk. Among these high risk pupils the programme was just as, if not more, effective, halving the increase in the frequency of drunkenness; by age 16, without the programme these children were getting drunk on average twice a month compared to less than once a month in programme schools  chart. On all these measures for both full and high risk samples, there were statistically significant differences between programme and non-programme schools, and no indication that the programme was any less effective with boys than with girls or vice versa.
Pupils were also asked how often they had committed criminal or antisocial acts over the past year. Though the intervention had focused on drinking, here too there were statistically significant and medium to large programme benefits across the entire samples and among pupils in the top fifth of delinquency before the programme started. In respect both of drunkenness and delinquency, the there were no major differences between the three types of communities in the effectiveness of the programme.
One mechanism underlying these benefits was expected to be an extension of the parents’ strict anti-drinking norms in respect of their 13-year-old children to older ages. Based on the parents’ own accounts, the programme did significantly maintain these norms. However, there was no evidence from the children that involvement in adult-led organised group activities – another supposed means by which the programme would affect drinking – had in fact been enhanced by the intervention.
For the authors their study demonstrated that the parent programme had successfully influenced parental attitudes against underage drinking, resulting in (compared to most other prevention programmes) relatively large reductions three years later in drunkenness and delinquency across both boys and girls, among high risk pupils as well as the entire school year, and in different types of communities. It achieved these impacts despite being easily administered through existing parent–teacher meetings, costing very little to implement, and requiring just a two-day course for the people delivering the programme, who need not be specialist professionals. In the Swedish context they believed these attributes meant the programme could be implemented widely and largely within existing resources.
 In the Swedish context this was a convincing demonstration of the power of harnessing the parent involvement mechanisms and influence of the school to reinforce parental responsibility in respect of their children’s drinking. It is also a testimony to the potential power of unambiguous and simple messages congruent with the culture and to the strong influence exerted by parental attitudes and behaviours on when and then how young people drink. Whether it would work in drinking cultures like that of the UK is questionable. However, ease of implementation, low cost, the fact that no classroom time is involved, and the potential for substantial impacts, may be seen as making it worth a try, probably not as a standalone intervention, but to supplement whole school programmes, the promotion of activities which give young people a sense of achievement and belonging, and perhaps above all, cultural change which makes parents more willing and able to control drinking among underage children.
Though not clear in the featured report, it seems that parents at the initial meeting jointly develop an agreement concerning their stance on youth drinking, possibly adding group solidarity and continuing parent-to-parent reinforcement to the mix of influences leading to impacts  several times greater and more consistent than typical of alcohol prevention programmes applied universally to the entire youth population. This is the case even in respect of programmes recognised as effective and usually far more costly and difficult to implement. Confidence in the validity of these findings is weakened slightly by methodological issues; in particular, the failure to account for the grouping of children and parents within schools could have falsely magnified the apparent impacts. More in background notes.
Efforts to involve parents have generally been more elaborate but less successful than the one trialled in the featured study. A meta-analysis combining findings from randomised studies of parent-focused substance use prevention programmes found modest effects in the form of fewer adolescent children starting to drink and a lower frequency of drinking. This was particularly the case when whole schools were engaged in the intervention, offering an opportunity for pupils and parents who participated in the programme to influence those who did not. However, the findings were undermined by a general failure to account for families which were unable to be followed up.
A common practical problem is getting parents to participate in face-to-face substance use prevention programmes. Typically in Britain (see for example 1 2 3) and elsewhere in Europe, attendance is very low, especially among parents most in need of parenting support and with lenient attitudes to substance use. Generally in these studies the attempt was to encourage attendance at special add-on events. On this count the featured study’s strategy of incorporating prevention in to the school’s core parent involvement programme has a distinct advantage. The downside is that at these events schools have a limited time in which communicate with parents; educational and other social issues (such as knife-carrying, guns, bullying, illegal drugs, teenage pregnancy) are likely to be seen as higher priorities both by the school and by the parents. Other solutions tried in Australia and the USA involve mailings to parents from the school or parent-child homework assignments; more in background notes.
An obvious risk of encouraging parents to make their strictness about underage drinking known to their children, is that the children will respond by hiding their drinking, depriving parents of awareness and the opportunity to intervene. In Sweden but perhaps less so in Britain, voluntary self-disclosure is an important way parents learn about their children’s leisure-time activities. More in background notes.
As the authors acknowledged, the main question mark for readers outside Sweden will be the programme’s applicability to their cultures. Rather than having to create this, it merely had to extend the strict anti-underage drinking norms held by parents and communicated to their children when they were 13 years of age to later ages, when legal purchase was still many years away for their children. Such attitudes reflect national policy. For a European nation, Sweden has unusually restrictive alcohol laws, allowing legal purchase only at age 20 and confining the sale of anything other than low-content beverages to state-run stores, restrictions which make it clear that drinking is not mainstream and accepted.
As in Sweden, in Britain too parents seem influential in their children’s drinking, but as much in the direction of condoning as outright opposition. It would be a far bigger task to persuade the majority of British parents to harden their attitudes and keep them hardened as their child approaches the lower legal alcohol purchase age in the UK, where full-strength drinks are available in virtually every supermarket. In drinking cultures like Britain, advice originating from the school about the parent’s responsibility to communicate an unambiguous stance on drinking risks being seen as unwelcome meddling, especially by the heavy drinking parents whose children could most benefit from stronger parenting. See background notes for some relevant studies. A trial in the Netherlands of a Dutch version of the Örebro programme may be a better pointer to how it would perform in a drinking culture more like that of the UK. If so, it suggests that it would be a worthwhile addition to alcohol use prevention lessons, but not the standalone success it was in Sweden. More in background notes.
Attempts are however being made in Britain to harden parental attitudes to youth drinking. Aided perhaps by media coverage highlighting the risks of youth drinking, the relevant English national policy aims to develop a national consensus on young people and drinking. At the sharp end of the policy are court orders requiring parents whose children persistently drink in public to exercise greater control. Further down the scale are support for parents whose children are at risk of problems such as drinking, and the attempt to establish a partnership with parents based on a clear understanding of acceptable and unacceptable levels and patterns of youth drinking. So far however the message received by parents from other aspects of alcohol policy – alcohol’s mainstream position in society, and particularly the recent extension of opening hours – is that the government is not taking a stand to manage the issue of alcohol in society, undermining the credibility of calls for parents themselves to shoulder that responsibility.

Source: Koutakis N., Stattin H., Kerr M. Request reprint
Addiction: 2008, 103, p. 1629–1637.

Journalist Nick Davies has  written  about legalising Heroin before and more recently. This is a rebuttal by an Australian professor and researcher. 

Nick Davies is right about one thing; drug policy is typically surrounded by an absurd amount of disinformation and misinformation. The truth is not always easy to find.  Governments the world over are perennially advised by experts of the day and the scientific establishment. Science, like most human activities, has within it schools of different thought and is very subject to the winds of its own internal fashions.  Phrenology in the 1930’s was one glaring example and the recent man made global warming debate is another. Many of my friends in the UK and on the East coast of the US are desperate for a good dose of global warming to thaw out their cars, homes and driveways.  The dearth of quality information in this field, and in many cases its deliberate suppression implies that, to borrow another of Davies’ metaphors, the policy debate continues to impersonate a drunken man on a dark night.  The main thing I learnt from Davies’ polemic was that the political and social left dislike Margaret Thatcher – who would have guessed?

Davies dutifully recites the many alibis and mantras of the liberal drug left including principally that heroin itself is intrinsically benign, and it is the illegal status of the drug along with the high cost, the impurities with which it is mixed and injected, and the unknown purity of the drug which are responsible for its toxicity. 

Astonishingly Davies even manages to trivialize heroin overdose, and claims it is relatively rare.  Perhaps this extraordinary claim is due to the fact that his references are mainly to Wikipedia, advised by a few drug liberalization sites or other journalists.

It is well known that the rate of death amongst heroin addicts is about 16 times higher than that of non-addicts, with some estimates from Sweden placing it 55 times higher, and others 70 times higher.  Overdose is not rare amongst heroin addicts, and many studies show that it is a common feature of people who have been injecting it for several years, and more have overdosed than have not.  In some Australian studies about half overdose several times annually.  Rather than heroin being safe as suggested, the levels of opiates in the blood are often relatively low or in the therapeutic range at post-mortem.  Therefore the reason some addicts die is often not well understood, although in the overdose situation it may be mixed with other drugs.  This does not exonerate heroin as it is a depressant drug, and obviously depressant drugs can sum together, or even potentiate the effects of each other to have a super-additive effect to halt breathing.  Moreover opiate addiction, which includes methadone and heroin, likely changes the central appetite mechanism deep in the hypothalamus of the forebrain, so that the appetite for other drugs is increased.  Davies also fails to mention that many heroin programs are actually heroin and methadone programs.  Heroin works for such a short time, that the overnight doses have to be of methadone to keep patients comfortable during the night.  So heroin programs are more properly thought of as “heroin top up programs.”

Rather than heroin being benign for the brain, the scientific literature is replete with studies and claims that long term opiate use causes damage to the mood centres in the limbic system, and the extended limbic system which includes the hippocampus and hypothalamus, which it turns out are also responsible for memory formation, learning and hormone control.  There is no such thing as a drug addict with a good memory and this is not related to the legal status of the drug.  Similarly the majority of opiate addicted patients have psychological disorders with rates in various studies particularly of depression and anxiety at over 70-90%.  Similarly epilepsy is far more common in opiate dependent patients, and there are several reasons for this.  Opiates have been shown to impair the renewal of brain stem cells, particularly in the hippocampus.  As this area is in charge of memory formation and emotionality, and is frequently the site of origin of fits, disturbances in these functions are to be expected, and are in fact commonly observed.  Indeed opiates have been shown to impair the growth of all organs, likely by impairing stem cell growth and activity.  This likely accounts for the evidence of disease and dysfunction in virtually every organ system of the body in long term users.  Opiates have actually been shown to impair the ability of cells to divide by blocking the normal progression of stem cells through the cell cycle, right at the very beginning of these transitions.  This effect is exacerbated by the action of morphine and its derivates including heroin to trigger programmed cell death, which researchers refer to as “apoptosis”.  Clearly the increased cell death, and the relative inability to replace the lost cells can hardly be good either for the health of the body’s cells and organs individually, or the patient as a whole.

It has also been shown that – pure – opiates both suppress and stimulate the immune system.  Whilst some may find this dual action confusing, it is reminiscent of an old car struggling to keep up with the speed limit with a dying engine.  As the car goes up the highway it blows smoke everywhere, and gets pulled over by the police for failing to keep up to the speed limit!  It is also very noisy, as its engine rev’s hard to do its best.  It is clearly working both hard and weakly at the same time.  This seems to be the picture of the opiates saturated immune system.  It parallels other clinical disorders such as rheumatoid arthritis and lupus, where patients with an overactive immune system also display evidence of generalized immunosuppression.  This immune stimulation is particularly damaging for the body, and likely takes a big toll of all organ systems.  Such immunity has been found to be important in many diseases including dementia, atherosclerosis, diabetes, obesity, osteoporosis, chronic periodontitis, cancer development and the ageing process itself.  Opiates have been shown to directly stimulate many aspects of the innate immune system, an evolutionarily ancient and very powerful arm of the immune response which acts quickly and promptly to alert the body to danger signals, and to summon other yet more powerful components of the truly matching adaptive immune response.  Moreover components of the innate immune system have now been shown to be also involved in controlling brain formation, synapse formation between nerve cells, brain stem cell generation and differentiation, and controlling neuronal and dendrite growth in the brain.  The immunosuppressive action of opiates increases the infectivity of, and damage caused by HIV in the immune system and brain, and Hepatitis C damage in the liver.

In particular one of the most sensitive tissues are actually stem cells, as these fragile baby cells, which all carry opiate receptors, are unusually sensitive to the noxious effects both of opiate agents and immunity.  This means that opiates actually pack a triple punch on cells throughout the organism:  there is the devastating effect of opiates on cell growth, and particularly stem cell growth; there is the stimulating effects of opiates on the immune system which leads to damage to the body as a whole; and then there is the compounded interactive effect of the immune effects of opiates particularly on the stem cells, which is likely more severe than the effect of either action working alone. 

Evidence of damage to the vascular system has also been published, which has been linked with stroke and heart attack.  Evidence of widespread hormonal disruption has also been shown.  The dental disease is well known, and this in its turn has been shown to be linked with higher rates of systemic pathology including hardening of the arteries and the development of dementia, probably by further stimulating the immune system.  Opiates disrupt cellular barriers both in the gut, allowing increased access of highly toxic germs to the blood stream, and in the brain where the immune system gains increased access to the nerve cells of the critical centres of the brain through a leaky blood brain barrier.  Similarly bone healing and formation is disturbed by opiates, likely by both stem cell and immune stimulatory mechanisms.  90% of an American study of opiate dependent males, with a mean age of about 40 years, had evidence of measurable and clinically significant bone loss, called osteopaenia or osteoporosis.  This is very important as it integrates the effects of addiction over significant time.  The liberalists argue that opiates are without intrinsic harm themselves, whilst conservatives argue the obvious denigration of virtually all drug users with time.  In one sense both might be true.  If the net defect suffered is only minor – say 5% annually, then over 20 years, the total deficit suffered is 64%!  Over 40 years this is 87%!  This implies that studies which demonstrate short term efficacy, typically over 6-12 months, really have essentially nothing to say about the long term toxicity of the drugs, as none of them have the necessary sensitivity to assess damage at this high degree of precision.

In fact there are very few published studies which examine the effect on physiology over the very long term.  Those which are available all paint a very bleak picture, with one major American study recently calling for geriatricians to be appointed to those addicts who survive to the age of 50 years, as their health was essentially falling apart in many body systems with evidence of widespread physical and mental disease, disability, misery and – of course – death in those who had not survived to complete the survey.

As for giving heroin out, one must be very careful.  The recent report of the Canadian heroin trial showed that it had a primary failure rate over one year of 40%.  This makes it far from the panacea depicted in its marketing blurb.  Data from the Sydney injecting groom, a room where illegal heroin can be taken under the supervision of Government employed nurses, showed that the rate of overdose was over 30 times higher than that in the general community.  In other words, in the presence of support staff clients were more than happy to “go for the magic big hit”, with near fatal overdoses on many occasions only averted by prompt action from the attending professional staff.

Davies mentions the disrupted social networks characteristic of heroin users.  It is sad that people who are dearly loved by their families die alone.  The utter chaos surrounding the heroin addicts life is legendary.  So many patients have told me that while they are using they think they are only hurting themselves; however when they get clean they realize how destructive their drug abuse is on all their family, friends and social relationships.  Most of these patients tell me that the best thing they could do is to come upon a bag of free heroin, and when they are sick many admit praying for a free hit.  However they freely and universally admit that this is also the worst thing that could happen to their own children.  When I ask them which view is correct, their view for themselves or their view for their children, they start to see that they have been badly deceived, and wickedly seduced.  It also becomes very obvious to them that they will not be truly free from their addiction in their mind until the way they think about heroin for themselves is the same as the way they think about heroin for their children.  As much is likely also true of societies.

As to heroin use being normalized in Switzerland and Zurich, that is not what the many refugees from that city who have fled all the way to Australia have told me on many occasions, nor is it the story which is in the published medical press.  Many have fled the gross social degradation which have taken over the forced closure of the Swiss “Needlepark” [ “Platzspitz”], and the criminal explosion which accompanied it.  According to published reports the top 1 meter of soil had to be bulldozed out of the park to clean it up.  Its closure only saw it move over the road to the abandoned railway station. 

Davies’ claim that the introduction of methadone was a cunning move to push up the price of black market heroin betrays his obvious agenda.  The simple fact is that a wave of heroin abuse has taken the world since the 1960’s which the various programs were designed to allay.  I found his figures for the majority of property crime in the UK being related to heroin use interesting in that they are virtually identical to those from Australia. 

The arguments of the left are seductively simple, but they are best addressed by stating the obvious from everyday life, the social, physical and psychological nightmare of active addiction.  These are the hard lessons learnt in places such as Sweden in 1968 and in Zurich where liberal policies such as those presently advocated were tried on the basis of seductive supposedly compassionate advice such as that which Davies and his ideological colleagues presently so eloquently argue.  Whilst there is a superfluity of robust evidence available in the scientific literature to refute such claims, it is also clear that much more work in this area could be done.  Nor is it relevant only to addiction medicine.

The fact that opiate addicts notoriously suffer from exorbitant rates of atherosclerosis, dementia, psychological disorders, osteoporosis, dental disease, immune dysfunction, hormonal disturbances and disruption of their sleep-wake cycles and appetite drives, and a very high rate of some cancers, implies that if we understood more of this process we could treat these major disorders much better.  Moreover, collectively they demonstrate an acceleration of the ageing process, so we would likely begin to understand the ageing process much better, potentially developing treatments which might increase the human “healthspan”, or our number of disability free years, minimizing our risk of long term disablement and years spent in a nursing home.  And the deficit of detailed long term studies of these important issues is clearly a major gap in our understanding, which urgently needs to be addressed.  Whilst it is true that there exists enough data in the published science to effectively refute the raucous arguments for legalization of all presently proscribed drugs, it is equally true that much more could be done in the toxicological sciences to explore these issues in more detail.  That western societies allow mainstream science to continue to overlook such areas, whilst drugs pose so present and imminent a major social threat, is an international disgrace, and one which can only be overcome by the will of the people being felt by the policy makers, to properly protect the coming generations. 

For example cannabis has been shown to be linked with eight cancers, including congenital leukaemia and brain cancer, and has been shown to be mutagenic.  This may be related to its genotoxic effects mediated via AP-1 and MAP kinase pathway activation.  Opiates also stimulate these same pathways, and have also been shown to be linked with carcinogenesis.  Environment has been shown to impact gene regulation through epigenetic regulation including chromatin methylation confirming the Barker hypothesis that in utero and neonatal influences can permanently affect gene expression for decades to come.  There is no liberalization argument to address genotoxicity in this generation, and no liberalist defence of genetic mutagenicity in the next generation.  The demonstration in many studies that parental opiate use produces body and organ growth retardation, impairs brain growth, induces organ structural abnormalities, and intellectual and behavioural disabilities in affected offspring into their teenage years has no liberalist defence, and is in fact egregariously indefensible.  As developed nations we have much more to learn and much more to do

The author runs the largest heroin detox clinic in Queensland Australia, and has published many papers on heroin and drug addiction and its treatment.

Source: Stuart Reece Feb.2010

A synthetic drug that is up to five times as powerful as cannabis is being sold legally in Britain, as incense.
It has already been made illegal in Germany and is also banned in the Netherlands.
The drug is based on the chemical JWH018 which mimics the effects of tetra hydra cannabinol or THC, the main active ingredient of cannabis. Drugs watchdogs are currently investigating the sale of the substance in the UK. JWH018, was first synthesised in a US lab in 1995. It was originally developed for scientific experiments on chemical receptors in the brain. However, it is now being manufactured in China, and is being sold at UK events like rock festivals as part of the growing “legal high” industry.

The UK drugs regulator, the Medicine and Healthcare products Regulatory Agency (MHRA), is understood to have identified JWH018 in products available in the UK. It is currently in order to determine whether or not it should be classified as a medicinal product – which would mean it should only be available from a doctor.

The UK Advisory Council on the Misuse of Drugs, which advises the government on whether a drug should be made illegal, is also aware of the substance, and is investigating it.  In addition to being illegal in Germany, it has been banned in the Netherlands and its legality is under review in Austria. But scientists do not know what side effects the drug could have, as no tests have been done on its toxicity either in the lab or on animals.

Toxicologist Dr John Ramsey, who runs the Tic Tac Communications drugs database at St George’s Medical School in London, said: “It’s not a problem at the moment, in that we’re not aware of casualties appearing in A&E, but there’s an underlying potential for a problem.”
He added that there were between 20 and 30 other similar substances that could be added to the incense mixtures.

Source:www.drugsproject.co.uk  19^th Feb.2009

Smoking marijuana as a teenager could raise the risk of developing schizophrenia and psychotic symptoms as a young adult, according to a new study that compared the prevalence of mental illness among marijuana users and non-users.

Bloomberg News reported March 2 that researcher John McGrath of the University of Queensland, Australia, and colleagues studied 3,801 young-adult sibling pairs and concluded that those who used marijuana the longest (six or more years) were twice as likely to develop schizophrenia or delusional disorders. They also were four times more likely than non-users to score highly on a test gauging psychotic-like experiences.

Higher scores on the test also were seen among those who used marijuana for less than three years.

Source: www.jointogether.org  March 2010

Two NIDA-funded studies identify health risks that  underscore the importance of curbing marijuana abuse.

BY PATRICK ZICKLER, NIDA Notes Contributing Writer                             

A large new epidemiological study suggests that marijuana smoke can cause the same types of respiratory damage as tobacco smoke. Significant associations between marijuana smoking and a variety of respiratory diseases also have been confirmed by an extensive review of clinical literature.

MONITORING THE EFFECTS OF TOBACCO AND MARIJUANA

Dr. Brent Moore and colleagues at Yale University, the National Cancer Institute, and the University of Vermont evaluated data from a nationally representative sample of 6,728 adults. Their analysis indicated that a history of more than 100 lifetime episodes of smoking marijuana, with at least one episode in the past month, increased an individual’s risk of chronic bronchitis, coughing on most days, wheezing, chest sounds without a cold, and increased phlegm.

“The most significant difference between tobacco smoke and marijuana smoke is their principal active ingredients—nicotine in tobacco and delta-9-tetrahydrocannabinol (THC) in marijuana. Beyond that, marijuana contains at least as much tar and half again as many carcinogens as smoke from conventional tobacco,” says Dr. Moore. “Quitting marijuana smoking may benefit respiratory health as much as quitting cigarettes, in addition to the clear and considerable health, psychological, and social benefits of no longer abusing an illicit drug.”

The information Dr. Moore and his colleagues analyzed was gathered through the third National Health and Nutrition Examination Survey (NHANES III), conducted between 1988 and 1994. Participants included 4,789 nonsmokers of either tobacco or marijuana; 1,525 smokers of tobacco but not marijuana; 320 smokers of both marijuana and tobacco; and 94 who smoked marijuana only. On average, marijuana abusers had smoked the drug on 10 of the preceding 30 days, with 16 percent reporting daily or almost daily smoking. Tobacco smokers consumed roughly the same number of cigarettes—averaging 19.2 per day—whether or not they also smoked marijuana. Survey participants answered questions about their experiences of a range of respiratory symptoms and were examined for signs of respiratory abnormalities.

The researchers concluded that tobacco smokers who also smoked marijuana had a higher prevalence of most respiratory symptoms than tobacco-only smokers. Compared with tobacco-only smokers, however, those who also smoked marijuana were less likely to have had pneumonia during the previous year or to show spirometric evidence of obstructive pulmonary disorder. Commenting on this finding, Dr. Moore says that it is important to note that the marijuana smokers in the sample were significantly younger (average age 31.2 years) than the tobacco smokers (average age 41.5 years). “The marijuana-related respiratory effects correspond to a relatively young population, and NHANES III did not ask participants older than age 59 about drug use,” he adds. “It is likely that respiratory effects will be higher in older marijuana smokers, and, because of the high prevalence of tobacco use among marijuana smokers, there appears to be an increased risk for illness due to cumulative effects of smoking both drugs.”

MARIJUANA’S LONG-TERM PULMONARY EFFECTS

Further evidence of marijuana’s respiratory toxicity emerged from a study conducted by Dr. Donald Tashkin at the University of California, Los Angeles. Dr. Tashkin conducted an extensive review of clinical and epidemiological research to determine the extent to which chronic marijuana smoking might lead to long-term pulmonary effects and diseases similar to those caused by tobacco. Unlike the NHANES III data examined by Dr. Moore, the studies evaluated by Dr. Tashkin made it possible to assess a possible association between marijuana smoking and respiratory cancers.

The results of animal and cell culture studies are mixed with respect to the carcinogenic effects of THC, some studies showing that THC promotes lung cancer growth and others showing an anti-tumoral effect on a variety of malignancies. Although the results of epidemiological studies are also mixed, a large, recently completed case-control study has failed to find a direct link between marijuana use (including heavy use) and lung, throat, or other head and neck cancers. “Nevertheless, there is evidence that suggests precarcinogenic effects in respiratory tissue,” Dr. Tashkin says. “Biopsies of bronchial tissue provide evidence that regular marijuana smoking injures airway epithelial cells, leading to dysregulation of bronchial epithelial cell growth and eventually to possible malignant changes.” Moreover, he adds, because marijuana smokers typically hold their breath four times as long as tobacco smokers after inhaling, marijuana smoking deposits significantly more tar and known carcinogens within the tar, such as polycyclic aromatic hydrocarbons, in the airways. In addition to precancerous changes, Dr. Tashkin found that marijuana smoking is associated with a range of damaging pulmonary effects, including inhibition of the tumor-killing and bactericidal activity of alveolar macrophages, the primary immune cells within the lung.

Taken together, Dr. Tashkin’s survey of clinical and epidemiological studies and Dr. Moore’s assessment of self-reported and clinically observed effects provide an extensive catalog of respiratory and pulmonary damage associated with marijuana smoking. Smokers are subject to:

·         Coughing and phlegm production on most days;

·         Wheezing and other chest sounds;

·         Acute and chronic bronchitis;

·         Injury to airway tissue, including edema (swelling), increased vascularity, and increased mucus secretion;    

·         Impaired function of immune system components (alveolar macrophages) in the lungs.

Moore, B.A., et al. Respiratory effects of marijuana and tobacco use in a U.S. sample. Journal of General Internal Medicine 20(1):33-37, 2005. [Full Text]

Tashkin, D.P. Smoked marijuana as a cause of lung injury. Monaldi Archives for Chest Disease 63(2):93-100, 2005. [Abstract]

Hashibe, M., et al. Marijuana use and aerodigestive tract cancers: a population-based case control study. Cancer Epidemiology, Biomarkers & Prevention (In Press).

Source:NIDA Notes > Vol. 21, No. 1  Oct.2006

There were 897 deaths involving heroin or morphine in 2008, an 8 per cent rise compared with 2007 and the highest number since 2001. The number of deaths involving methadone rose throughout 2004 to 2008, to 378 in the latest year, an increase of 16 per cent compared with 2007 (and 73 per cent higher than in 2004). There were 235 deaths involving cocaine in 2008, continuing the long-term upward trend.

There were 99 deaths involving amphetamines in 2008, with nearly half of these being accounted for by deaths mentioning ecstasy. Cannabis was mentioned in 19 deaths in 2008, while the number of deaths mentioning GHB rose to 20 in 2008 from 9 in 2007. The number of deaths that mentioned benzodiazepines rose to 230 in 2008, an increase of 11.

Source: Office for National Statistics  26 August 2009

Last week, it was announced that the Conservative government will soon unveil a new national anti-drug strategy. The plan is said to feature a get-tough approach to illegal drugs, including a crackdown on grow-ops and drug gangs. And while it will also (wisely) include tens of millions for rehabilitation of addicts and for a national drug prevention campaign, it is said to retreat from safe-injection sites and other fashionable “harm-reduction” strategies introduced by the previous Liberal government. To which we say: Good. This editorial column has long urged a softening of drug policy on marijuana and other non-addictive recreational substances. But heroin and similarly addictive drugs are a different story. Moreover, safe injection sites don’t work. And they send the wrong message, too, promoting disrespect for the rule of law by having government facilitating the consumption of illegal substances.

 Too bad most of the proof to back these positive claims come from SIS proponents or the academics who devise harm-reduction theories. Police here, and in Europe (where they have lots of experience with SISs) tell a very different tale.

 When Insite applied to have its three-year licence renewed last fall, the RCMP told Health Canada it had “concerns regarding any initiative that lowers the perceived risks associated with drug use. There is considerable evidence to show that, when the perceived risks associated to drug use decreases, there is a corresponding increase in number of people using drugs.”

Reports that the Harper government is preparing to announce changes to Canada’s outdated 20-year-old national strategy on illicit drug use should be reason for optimism.Source:Addiction & Recovery News May 2007

Source:Addiction & Recovery News May 2007

My first appointment was with Dr Diana Fishbein, a Senior Fellow in behavioral neuroscience at the Research Triangle Institute (RTI) which is an international not-for-profit research organisation .

Diana is the Director of the Transdisciplinary Behavioural Science Program at RTI. In this role she focuses on bringing interdisciplinary teams of researchers together to try to answer some of the big questions that need to be asked in the behavioural sciences. Her overarching goal is to focus on the nexus between research and practice and to facilitate the “Translation of Research into Evidence Based Practice”. In fact RTI International organisational by line is Turning Knowledge into Practice.    

Diana’s personal research career has been in the area of criminology and drug abuse taking a prevention science approach.  She is particularly interested in why some young people respond well to a prevention approach while others don’t, and ultimately in determining “who responds to what treatment at what time point and why”?

To explore these questions she uses interdisciplinary methods and a developmental approach and sees the plasticity of neurobiological systems as one of the keys to finding the answer. Dr. Fishbein  pointed out that neuroplasticity enables neurobiological systems to be shaped by inputs from the environment and so can be altered for better or worse depending on the nature of these inputs. This is highly relevant to a prevention or early intervention approach and can guide the development of interventions. Research in this area is now beginning to focus on the mechanisms through which developmental risk factors impact on the developing systems and also on the type of interventions which have the most impact, how they are affecting neuroplastic change and when they are having the most effect.  

For instance there is evidence that the neurobiological functions underlying drug misuse and aggression are quite complex and include executive functioning, coping skills and affect regulation. The part of the brain associated with these functions (prefrontal-limbic brain networks) is not consolidated until early adulthood. Therefore is we can understand the type, effect and developmental timing of environmental impact on this brain function we may be able to plan intervention programs that alter negative impact and increase positive impact.  We may also need to tailor interventions to particular risk factors in the young person’s environment. Diana is confident this translational approach promises to eventually offer some direction for the design of effective interventions to prevent drug misuse and associated aggression.

This cutting-edge evidence-based research with the capacity to not only make a difference but to provide us with the scientific evidence to show how change has come about.  The message that again seems to be coming through to me is that one size is not likely to fit all. The other message is one that Professor Alan Hayes a member of the external advisory group for this project has written about in his chapter entitled Why early in life is not enough! (Hayes, 2007. In France, A & Homel, R (Eds) Pathways and crime prevention: Theory policies and practice  Willian (pps 202-225)

Dr Fishbein and I also talked about the need for parent and community involvement in interventions.  She also indicated to me that she and her organisation are very interested in innovative collaborative international research. Perhaps this is something to think about for the future.

Source: http://shapingbrains.wordpress.com  3^rd March 2010

BABIES born to mothers who take methadone during pregnancy have developed a range of visual problems, according to a report by medical experts in Glasgow.

The study discovered that the mothers of all 20 infants referred to a specialist clinic for vision defects had taken opiates during pregnancy.  The problems included blurred vision, nystagmus (rapid and involuntary eye movement from side to side), squints, short-sightedness and cerebral visual impairment – signs that the brain was not processing the signals from the eyes correctly.  The results of the study are likely to add to the controversy surrounding the prescription of the heroin substitute methadone to drug users.The latest official statistics show that 572 babies were born to drug misusers in 2006-7, including 370 births to users of opiates such as methadone and heroin. The study, published in the Scottish Medical Journal, was carried out by doctors at the Royal Hospital for Sick Children at Yorkhill and Princess Royal Maternity. It is the first major investigation into how the use of opiates during pregnancy affects the development of vision in babies.

Researchers said there were “growing concerns” about the scale of the vision problems being picked up by eye examinations and about how long they would persist.

Neonatal consultant Helen Mactier said: “We were seeing a disproportionate number of babies who had visual difficulties whose mothers had a history of drug abuse.”
Ruth Hamilton, a consultant clinical scientist and an expert in vision who is involved in the research project, said: “This is about the long-term outcomes for these children. It may be that these babies will go on to develop problems later in life, and it is very important that we discover if there is something we can do.”

In the study, 19 babies had blurred vision, 14 nystagmus, six had squints, six were short-sighted and five had cerebral visual impairment.

A preliminary summary of the research has been presented to the Scottish Paediatric Society. It suggests routine eye examinations for children who were exposed to methadone in the womb, saying: “Children with a history of in-utero opiate exposure may benefit from a vision screening programme.”

Mactier said: “We deliver 150 babies a year to drug-using women and around 45 per cent of them are treated for withdrawal. These babies stay in hospital for a longer period, they are often sick and small. Their mothers are often heavy smokers, they may be from very socially deprived backgrounds, they have a high risk of depression.

“There is an increasing amount of evidence that babies born to drug-addicted mothers have a whole range of health problems.”  She said that, because of the often chaotic lifestyle of drug users, it was hard to single out methadone or any other factor as the principal cause of eye problems.

“Between two-thirds and four-fifths of women on prescribed methadone are also using illicit opiates, valium or similar drugs.” A secondary study will try to pinpoint which factors were most likely to cause of eye problems in the babies of drug-abusing mothers.

There are now 22,000 addicts in Scotland on a methadone programme. A study by Glasgow University’s Centre for Drug Misuse Research found that people on methadone programmes still take heroin. There are concerns the programme replaces one addictive drug with another, and that people are “parked” on methadone for years. There have also been cases of addicts’ children gaining access to methadone.

Earlier this month, the £50 million policy was criticised when an addict’s free supply was cut after almost 20 years.  A Scottish Government spokesman said official policy was to recommend methadone treatment for pregnant drug users on the grounds that prescribed drugs carried a lower risk than continuing to use illegal drugs.  He said: “Pregnant women who misuse drugs receive extra support and care suited to their personal needs.”

Source: ScotlandonSunday  28^th Feb 2010

●● At the national level, 20,934 Class A drug-misusing individuals in England and Wales were identified between 1 January 2008 and 31 March 2008 to form the national cohort.

●● During the 12 months following identification, individuals in the cohort were

convicted of a total of 54,462 proven offences. This equates to a baseline rate of

offending of 2.60 offences per individual.

●● Sixty-one per cent of the national cohort were convicted of at least one offence in the 12 months following identification. Twenty-five per cent were convicted of either one or two offences, while 16 per cent were convicted of more than five offences.

●● Comparing proven offending rates by different ways in which drug-misusing

offenders were initially identified reveals that those individuals identified as drug

misusers on release from prison and who also tested positive for Class A drugs on

arrest, had a rate of proven offending that was markedly higher than any other group of offenders in the cohort (5.59 proven offences per individual).

Source: Home Office ‘Drug Misusing Offenders Cohort 2008’  published March 2010

Research Summary

The more parents expect their teens to engage in risky behaviors such as drinking and using drugs, the more likely their teens are to follow through with those behaviors, Reuters reported Oct. 16.
Researchers found that adolescents with mothers who expected them to be more rebellious and take greater risks reported higher levels of risky behavior than other adolescents during follow-up surveys.
On the other hand, parents may lower the rate of risky behavior among their adolescent children by expecting that they can resist negative peer pressure and instead engage in positive behavior, according to the study.
“Parents who believe they are simply being realistic might actually contribute to a self-fulfilling prophecy,” said study author and Wake Forest University psychology professor Christy Buchanan. “By thinking risk-taking or rebelliousness is normal for teenagers and conveying that to their children, parents might add to other messages from society that make teenagers feel abnormal if they are not willing to take risks or break laws.”
The study’s recommendations for parents included modeling good behavior for their teens, exposing them to examples of positive things that other teens are doing, and making sure their teens know there are consequences to risky behavior.
The study was based on surveys of more than 200 6th- and 7th-graders and their mothers.
Source: Journal of Research on Adolescence. June 2009

The truth youth anti-smoking campaign has the power to save hundreds of thousands of lives and billions of dollars in smoking related health care costs and productivity losses, according to the Citizens’ Commission to Protect the Truth, a group composed of every former U.S. Secretary of Health, Education and Welfare and Health and Human Services with the exception of Michael Leavitt; every former U.S. Surgeon General; and every former Director of the Centers for Disease Control and Prevention.
A recent study published in the American Journal of Preventive Medicine indicated that the medical care costs averted by the truth® campaign – due to prevention of smoking – were far greater than the costs of the campaign itself and found that for every dollar invested in truth®, it is estimated that society saved over $6.80. The study focused on the period of 2000–2002. During this period of time, the truth® campaign has been credited with reducing the number of children and teen smokers by 300,000.
We believe that if the truth® campaign continues for another five years (2009-2014) with similar effectiveness, there will be up to 500,000 fewer youth smokers with savings of up to $9.0 billion in future medical costs.
The Commission based its analysis on the findings of the study presented in the May 2009 issue of the American Journal of Preventive Medicine, which found that the decrease in the number of youth who initiated smoking as a result of truth® during the period of 2000–2002 may result in averting up to $5.4 billion in future medical costs.
According to the U.S. Centers for Disease Control and Prevention, one-third of young smokers will die prematurely from smoking-related diseases. Since 80% of adult smokers began using tobacco products before the age of 18, the hundreds of thousands of children who opt not to smoke because of their exposure to truth® will almost certainly not become adult smokers.
“Ending smoking by American children and teens is crucial to the health and cost of healthcare to our nation. The truth® campaign provides a return on investment that would make the greediest corporate CEOs salivate. The truth® campaign is one of the most effective investments in the history of public health,” said Joseph A. Califano, Jr., Commission Chairman and former U.S. Secretary of Health, Education, and Welfare who started the national anti-smoking campaign in 1978. “truth® is the only national smoking prevention campaign not directed by the tobacco industry which exposes the tactics of the tobacco industry, the truth about addiction, and the health effects and social consequences of smoking.”
The American Legacy Foundation’s life-saving truth® campaign is the largest national youth smoking prevention campaign and an extraordinary public health story. The campaign is a national peer-to-peer intervention that works. In its first two years, truth® was responsible for 22% of the overall decline in youth smoking—a decrease which represents approximately 300,000 fewer smokers. Peer reviewed studies, both old and new, underscore that truth® can inoculate teens against tobacco addiction. The truth® campaign’s successes are unassailable.
Source : Citizens Commission to Protect the Truth April 19, 2009

According to details given by the NHS, there has been a 65 per cent increase in people receiving treatment for cocaine addiction in UK. These are teenagers which is cause of concern.
These figures correspond to the announcement by the Advisory Council on the Misuse of Drugs (ACMD) earlier. It was found by an NHS study, conducted by the National Treatment Agency for Substance Misuse, that the number these teenagers has doubled since 2005.
It was reported that users were combining cocaine with alcohol that causes more damage to the heart and makes users more violent. It was noticed that a six-month treatment treated four in 10 people and they were no longer addicted, but several left the treatment midway.
In England, about 12,354 people were treated for cocaine addiction last year. Between 2005-06 and 2008-09 a rise was seen in the number of people coming for treatment and the figures increased from 453 to 745, and the number of 18- to 24-year-olds doubled from 1,586 to 3,005.
The chairman of the ACMD, Professor Les Iversen stated, “The figures were deeply concerning.”
The Conservatives and Liberal Democrats both stated that a change was needed in the government’s approach to tackling addiction.

Source: www.topnews.net.nz 3rdMarch 2010

The recreational use of cocaine has rapidly increased in many European countries over the past few years. One cause of this is the fall in the price of the drug on the street from 100 Euros for one gram (about 5 lines) in 2000 to 50 Euros in the Netherlands today. One line of cocaine is, thus, now as cheap as a tablet of ecstasy. This means cocaine is no longer considered an “elite” drug but is affordable for all, especially for recreational use. It is therefore likely that the recreational use of cocaine will become a public health issue in the next few years, which is already the case for the recreational use of ecstasy.
In a study in PLoS One, researchers at Leiden University and the University of Amsterdam, led by Lorenza Colzato, employed the “stop-signal paradigm” to measure the length of time taken by subjects to initiate and suppress a prepared reaction.
The stop-signal task requires participants to react quickly and accurately by pressing a left or right key in response to the direction of a left- or right-pointing green arrow. In 30% of the trials, the green arrow turned red, in which case participants had to abort the go response. The results show that while both recreational users of cocaine and non-users performed similarly in terms of response initiation, users needed significantly more time to inhibit their responses.
The study is the first of its kind to investigate systematically action control, and the inhibitory control of unwanted response tendencies in particular, in recreational users, i.e. those who don’t meet the criteria for abuse or dependency but who take cocaine (usually by snorting) on a monthly basis (1 to 4 grams). The researchers found that the magnitude of the inhibitory deficit in recreational users was smaller than previously observed in chronic users, suggesting that the degree of the impairment is proportional to the level of cocaine use.
Given the seemingly small quantities of cocaine involved, the findings of this study are rather worrying. Many real-life situations require the active inhibition of pre-potent actions, as in the case of traffic lights turning red or of criminal actions. This impairment of inhibitory control has serious implications for personal or societal functioning. This reduced level of inhibitory control may even be involved in the emergence of addiction: the more a drug is used, the less able users are to prevent themselves from using it.

Source: Public Library of Science PLoS One 2(11): e1143.doi:10.1371/journal.pone.0001143 2007, November 7.

Researchers have discovered that even a small amount of MDMA, better known as ecstasy, can be harmful to the brain, according to the first study to look at the neurotoxic effects of low doses of the recreational drug in new ecstasy users. The findings were presented today at the annual meeting of the Radiological Society of North America (RSNA).

“We found a decrease in blood circulation in some areas of the brain in young adults who just started to use ecstasy,” said Maartje de Win, M.D., radiology resident at the Academic Medical Center at the University of Amsterdam in the Netherlands. “In addition, we found a relative decrease in verbal memory performance in ecstasy users compared to non-users.”
Ecstasy is an illegal drug that acts as a stimulant and psychedelic. A 2004 survey by the National Institute on Drug Abuse (NIDA) found that 450,000 people in the United States age 12 and over had used ecstasy in the past 30 days. In 2005, NIDA estimated that 5.4 percent of all American 12th graders had taken the drug at least once.
Ecstasy targets neurons in the brain that use the chemical serotonin to communicate. Serotonin plays an important role in regulating a number of mental processes including mood and memory.
Research has shown that long-term or heavy ecstasy use can damage these neurons and cause depression, anxiety, confusion, difficulty sleeping and decrease in memory. However, no previous studies have looked at the effects of low doses of the drug on first-time users.
Dr. de Win and colleagues examined 188 volunteers with no history of ecstasy use but at high-risk for first-time ecstasy use in the near future. The examinations included neuroimaging techniques to measure the integrity of cells and blood flow in different areas of the brain and various psychological tests. After 18 months, 59 first-time ecstasy users who had taken six tablets on average and 56 non-users were re-examined with the same techniques and tests.
The study found that low doses of ecstasy did not severely damage the serotonergic neurons or affect mood. However, there were indications of subtle changes in cell architecture and decreased blood flow in some brain regions, suggesting prolonged effects from the drug, including some cell damage. In addition, the results showed a decrease in verbal memory performance among low-dose ecstasy users compared to non-users.
“We do not know if these effects are transient or permanent,” Dr. de Win said. “Therefore, we cannot conclude that ecstasy, even in small doses, is safe for the brain, and people should be informed of this risk.”
This research is part of the Netherlands XTC Toxicity (NeXT) study, which also looks at high-dose ecstasy users and aims to provide information on long-term effects of ecstasy use in the general population.

Source: Radiological Society of North America (2006, November 28).

Professor Fabrizio Schifano at the University’s School of Pharmacy, is lead author of the paper which will be published online in Neuropsychobiology.

Professor Schifano and his colleagues at St George’s, University of London’s International Centre for Drug Policy, which runs the National Programme on Substance Abuse Deaths (np-SAD), reviewed stimulant-related deaths from the np-SAD database and from the British Crime Survey 2001-2007 results and found that identified 832 amphetamine and methylamphetamine-related deaths and 605 ecstasy-related deaths. What was of more concern to Professor Fabrizio and the researchers was the fact that the fatalities from ecstasy during that period were typically identified in victims who were young and healthy.

The report, which covered an 11-year, UK-wide analysis of mortality from these drugs, noted that deaths seemed to have dropped in 2000 to peak once again over the following years and then after a drop again in 2003, it increased again over the following years.
Commenting on the findings, Professor Schifano said: “These data seem to support the hypothesis that young individuals seem to suffer extreme consequences after excessive intake of ecstasy. This is an issue of public health concern which deserves further studies.”

Source: ScienceDaily (Feb. 1, 2010

According to a new report from the National Treatment Agency for Substance Misuse (NTA), people aged 18 to 24 now account for a third of all those in England seeking treatment for cocaine addiction.
Last year, over 3,000 18 to 24-year-olds sought treatment for cocaine use, with another 745 users under the age of 18.
This is nearly double the number who sought treatment in 2005-2006.

Over 60% of all cocaine users seeking treatment remain abstinent six months after completing their treatment, the NTA says.
However, the most recent British Crime Survey estimates there are 437,000 people aged 16 to 24 in England and Wales who have used cocaine in the past year.
The survey says the number of 16 to 24-year-olds to have used cocaine in the past year rose from 5.1% to 6.6% – the highest percentage of users yet.
The Class A drug is no longer seen as the preserve of the celebrity classes and can be brought on most city streets for “pocket money” prices, starting as little as £15 a bag.
Only cannabis and alcohol are more popular, while the use of designer dance drugs like ecstasy is falling.
Tumbling prices and the lack of stigma attached to powder cocaine have also led to increasing use at every level of British society. The number of cocaine dealers is also mushrooming, with a proliferation of younger street-level dealers who are known in urban slang as “shottas”.
Drugs education charities are warning that urgent action is needed so that recreational users are made aware of the dangers.
Cocaine is a class A drug that can cause anxiety, a rise in blood pressure and heart problems, as well as long-term addiction.
Statistics in a recent NTA report show that over 50% of cocaine users will also drink alcohol while using cocaine – a particular concern, as this creates a third highly toxic chemical in the body called cocaethylene, which can cause severe harm to the liver.
The potential health hazards are exacerbated by the fact that a lot of the cocaine sold on the streets is heavily adulterated, or “bashed”, as dealers refer to it, with various substances like crushed painkiller tablets and other stimulants.

Source: The Donal MacIntyre Show, BBC Radio 5 live

Teens who smoke marijuana are at a greater risk of developing schizophrenia and psychotic symptoms in the future, a new study has found.
After observing more than 3800 youngsters, researchers learnt that people who used the drug for six or more years were twice as likely to suffer from delusional disorders than those who never used it. Researchers from Queensland Brain Institute, at the University of Queensland, quizzed 3801 young adults who were born in Brisbane between 1981 and 1984.
Among the 1272 participants who had never used marijuana, 26 (2 per cent) were diagnosed with psychosis, while the 322 people who had used marijuana for six or more years, 12 (3.7 per cent) were diagnosed with the illness. The average age of the participants was about 20. According to the authors, the study was the first to look at sibling pairs to discount genetic or environmental influence.
“This is the most convincing evidence yet that the earlier you use cannabis, the more likely you are to have symptoms of a psychotic illness,” the Sydney Morning Herald quoted Dr McGrath, a professor at the institute, as saying in a statement.
McGrath added: “The message for teenagers is: if they choose to use cannabis they have to understand there’s a risk involved.” The study noted: “Apart from the implications for policy makers and health planners, we hope our findings will encourage further clinical and animal-model research to unravel the mechanisms linking cannabis use and psychosis.”
The research has been published online by the Archives of General Psychiatry.

Source: Health Wise Feb 28 2009

A new American study suggests that parental monitoring can help bring down the cases of marijuana use by adolescents.
Psychologists Andrew Lac and William Crano of the Claremont Graduate University examined various studies to find the connection between parental monitoring (when parents know where their children are, what company are they in and what they are doing) and adolescent marijuana use.
Lac and Crano selected 17 studies containing data on over 35,000 participants. They assessed parental monitoring on the basis of admissions made by adolescent themselves and not their parents’ reports of keeping an eye on their children. The researchers found a strong link between parental monitoring and the decreased use of marijuana by adolescents.
The authors write: “Our review suggests that parents are far from irrelevant, even when it comes to an illegal and often secretive behavior on the part of their children.” They also believe that their analysis might come in handy for marijuana-prevention programs that are aimed at parents.
The findings of the review have been published in the latest issue of Perspectives on Psychological Science, a journal of the Association for Psychological Science. (ANI)

Source: Health Wise November 17th, 2009

A new Australian study suggests that parental encouragement leads to alcoholism in teenagers. The latest MBF Healthwatch survey found that 63percent of Aussies in the higher income bracket approve of alcohol consumption by 15 to 17 year olds at home under the eyes of parents.
“Our survey suggests many Australians believe it’s acceptable to buy alcohol for teenagers and allow them to drink under parental supervision at home,” Bupa Australia Chief Medical Officer, Dr Christine Bennett, said.
Dr Bennett continued: “Some parents may think this is harmless; some may see this approach as a way to teach their teenage children about socially responsible drinking. But we want parents to understand that early exposure may actually be doing them damage. “Evidence suggests that the earlier the age that alcohol is introduced, the greater the risk of long-term alcohol related health problems.
“Binge drinking in young people is on the rise. Too much alcohol impairs young people’s judgement, which can lead to violence, injury and build a pattern of use that leads to lifetime dependence. “It’s shocking to think that one teenager a week dies of alcohol abuse. We teach children about the harmful effects of smoking, unsafe sex and taking illicit drugs, but we also need to teach them about the damage that alcohol can do.”
The survey also found that people’s acceptance of supervised underage drinking was closely related to their income levels. Nearly 63percent people earning over 100,000 dollars approved supervised drinking; 53percent people with incomes between 70,001 to 100,000 dollars were comfortable with the idea followed by 48percent people getting paychecks ranging from 40,001 to 70,000 dollars.
Dr Bennett added: “Given that social drinking is a common part of the Australian culture, our challenge is to help our young people learn how to enjoy alcohol in a socially responsible way and protect them from harm now and in the long-term.
“That will mean educating young people about the risks of underage drinking and, as parents and a community, being good role models.”

Source: Health News Dec. 3rd 2009

Children, whose parents allow them to have alcohol at home in a bid to teach responsible drinking, drink even more outside of home, a new study claims.
A study of 428 Dutch families has found that teens who drank under their parents’ watch or on their own were at a greater risk of developing alcohol-related problems. The researchers insists that the study puts into question the advice of some experts who recommend that parents drink with their teenage children with the aim of limiting their drinking outside of the home.
Dr. Haske van der Vorst, the lead researcher on the study, said: “The idea is generally based on common sense. For example, the thinking is that if parents show good behavior-here, modest drinking-then the child will copy it. Another assumption is that parents can control their child’s drinking by drinking with the child.” Every family, which was quizzed, had two children between the ages of 13 and 15. Parents and teens completed questionnaires on drinking habits at the outset and again one and two years later.
The researchers found that, in general, the more teens drank at home, the more they tended to drink elsewhere; the reverse was also true, with out-of-home drinking leading to more drinking at home.
In addition, teens who drank more often, whether in or out of the home, tended to score higher on a measure of problem drinking two years later.
Haske van der Vorst, of Radboud University Nijmegen in the Netherlands concluded: “I would advise parents to prohibit their child from drinking, in any setting or on any occasion. “If parents want to reduce the risk that their child will become a heavy drinker or problem drinker in adolescence, they should try to postpone the age at which their child starts drinking.” (ANI)

Source: Health News. Jan 28th 2010

Teens and young adults who are heavy marijuana users are more likely than non-users to have disrupted brain development, according to a new study that appeared last month in the Journal of Psychiatric Research.

Pediatric researchers found abnormalities in areas of the brain that interconnect 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 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.

Working with child psychiatrist Sanjiv Kumra, M.D., Ashtari and colleagues performed imaging studies on 14 young men from a residential drug treatment center in New York, 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. Most had smoked marijuana from age 13 till age 18 or 19, and reported smoking nearly six 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 were found among the young adults with histories of marijuana use suggest damage or an arrest in development of the myelin sheath that surrounds brain cells, Ashtari said. 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. The study’s results suggest 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. Abnormal white matter development could slow information transfer in the brain and affect cognitive functions

Source: the Journal of Psychiatric Research. Reported in CADCA Coalitions online Feb 24 2010

Abstract
The impact of ecstasy/polydrug use on real-world memory (i.e. everyday memory, cognitive failures and prospective memory [PM]) was investigated in a
sample of 42 ecstasy/polydrug users and 31 non-ecstasy users. Laboratory-based PM tasks were administered along with self-reported measures of PM to
test whether any ecstasy/polydrug-related impairment on the different aspects of PM was present. Self-reported measures of everyday memory and
cognitive failures were also administered. Ecstasy/polydrug associated deficits were observed on both laboratory and self-reported measures of PM and
everyday memory. The present study extends previous research by demonstrating that deficits in PM are real and cannot be simply attributed to
self-misperceptions. The deficits observed reflect some general capacity underpinning both time- and event-based PM contexts and are not task
specific. Among this group of ecstasy/polydrug users recreational use of cocaine was also prominently associated with PM deficits. Further research
might explore the differential effects of individual illicit drugs on real-world memory.

Source: Journal of Psychopharmacology 0(00) 1–12 2010

Alcohol-related death rates by sex, United Kingdom, 1991-2008

The number of alcohol-related deaths in the United Kingdom has consistently increased since the early 1990s, rising from the lowest figure of 4,023 (6.7 per 100,000) in 1992 to the highest of 9,031 (13.6 per 100,000) in 2008. Although figures in recent years suggested that the trend was levelling out, alcohol-related deaths in males increased further in 2008. Female rates have remained stable.

There are more alcohol-related deaths in men than in women. The rate of male deaths has more than doubled over the period from 9.1 per 100,000 in 1991 to 18.7 per 100,000 in 2008. There have been steadier increases in female rates, rising from 5.0 per 100,000 in 1991 to 8.7 in 2008, less than half the rate for males. In 2008, males accounted for approximately two-thirds of the total number of alcohol-related deaths. There were 5,999 deaths in men and 3,032 in women.

Source: Office of National Statistics 29th January 2010

Methadone withdrawal helps many people to withdraw from damaging heroin use. Methadone maintenance however keeps a person addicted …

I’ve been told that methampethamine addicts who binge use the drug can go on a tweaking stage and its dangerous. Can some explain this “tweaking phase” or provide a nice reference site that discusses this.

Response: cotton mouth, anxiety, paranoia, restlessness

I went to the doctor for help to get through a moderate heroin addiction back in 1976. The doctor put me on 40mg of Methadone per day and referred me to a Psychiatrist who continued this dosage until he lost his licence to prescribe methadone and had to send me and his other methadone patients to the government run methadone clinic. I think that methadone exacerbated my moderate heroin addiction culminating in over 30 years of daily pharmacy attendance and now 120mg per/day dependence.

Source: Drug Rehabilitation that works Blog Archives 28.01.10

What does it take to get a wave of energy to a point where it takes on its own momentum, swelling and ploughing across a rough ocean, gathering dynamism and visibility? I’m thinking the recovery movement here and I’m watching the wave as it grows. My surfboard is getting a dusting down.
‘Tipping points’ are, according to Malcolm Gladwell, ‘the levels at which the momentum for change becomes unstoppable’. It seems to me that we’re moving toward critical mass in the UK with regard to recovery. With Government supporting recovery and a late conversion to the cause by the NTA, it would look like the environment is favourable. That’s not where I see the head of steam though. The kettle is on the boil from the grassroots up.

What can Gladwell teach us about this from his book ‘The Tipping Point’?

Well, “The success of any kind of social epidemic is heavily dependent on the involvement of people with a particular and rare set of social gifts”. I think we have these kinds of people. He also says that 80% of the work will be done by 20% of the people. Sound familiar?
That’s why I think we need to support all the initiatives that bring the emergent recovery movement together. I see a little cynicism around some of this and a suspicion about motives and who has the ‘right’ to represent who.

We need to resist cynicism and stay positive. Wise, and careful and observant of course, there will be teething problems, but where recovering people and their supporters come together to spread the message of recovery (“We do recover; here’s how we did it; we’ll support you to do it too!”) then exciting things will happen.

Gladwell also says: “Epidemics are sensitive to the conditions and circumstances of the times and places in which they occur.” It’s my impression that the conditions, the circumstances and the times are perfect for the recovery epidemic to take hold in the UK. Of course the analogy to a pandemic has been made before. Take a look here. That recovery wave, fanned by the enthusiasm and energy of recovering people is gathering momentum. It’s time to go surfing.

Comments
Thanks for this Peapod. Massively timely and very, very important. If recovery is about getting there in a way that works for you, then surely we should be applying this to our own movement. Whether or not I agree with a,b and c, doing x, y and z is not relevant. Surely if they are pushing things along as best they can, we should – not only respect – but applaud! Not that I do this all the time – so note to self, must do better!
By Michaela on 31/01/2010 at 2:11 PM –

Pucker blog, I like your quotes. I just hope things will change for the better, I like the way you say 80% of the work is done by 20% of the people. Sort of gave me a guilt trip as i know my limits and have to keep my life as simple as possible. Envy those who have the commitment and energy to do all this, like Michaela on this site, and Anne Marie up in Scotland. Pucker like I said.
By MartinBailey on 31/01/2010 at 5:32 PM

Bill White once told me that they were doing some very interesting research on the prevalence of recovery in Philadelphia, PA. They were doing a survey of the city and using postal codes to map neighborhoods by the prevalence of recovery and the prevalence of drug problems. He said that they planned to use this information to identify the areas richest in recovery support and target other areas for the cultivation of a recovering community.
By Jason Schwartz on 31/01/2010 at 6:38 PM –

lol riding the waves Peapod, love it. Martin thanks for your support and questions, and Jason we have the means to map this in the UK also….. and to watch it grow.
By Annemarie W on 31/01/2010 at 9:37 PM –

The tipping point is one of my favourite books, It’s inspirational in how it shows that small things really CAN make a big difference.
I think that we (the recovery advocates, if you will) are probably still the 20% at the moment. Indeed, sometimes it can feel like you are fighting a loosing battle. One thing I am growing to understand though, the minute you become despondent and ready to give up YOU BECOME ONE OF THEM. I have seen this in many walks of life, not just in this field. Note to self: Must remain positive For everyone else, a word or 3 from Martin Luther King: “Keep hope alive” Matt

Source: Community Blog Wired-In Feb 2 2010

The truly alarming statistic that at least 900 children in Scotland are suffering severe damage caused to the brain and organs before birth by foetal alcohol syndrome (FAS) and that thousands of others have learning and behavioural difficulties as a result of their mothers’ drinking during pregnancy must concern us all.

The report by Dr Jonathan Sher, director of research, policy and programmes at Children in Scotland, should act as a warning that policy on alcohol in both Scotland and the UK has largely ignored the dangers to unborn children.

The Scottish Government’s Alcohol Bill has produced extensive lobbying of MSPs, mainly on the contentious proposal to set a minimum price at which a unit of alcohol can be sold.
At present, this is unlikely to become law because it does not have the support of the opposition parties at Holyrood. Nevertheless there is concern across all parties at the mounting alcohol-related damage in Scotland to both individuals and society in terms of ill-health and criminal activity.
Both of these can apply to children and adults affected by FAS and the wide-ranging foetal alcohol syndrome disorder (FASD) which can include congenital heart problems and attention deficit disorder.

Once the damage has been caused to developing brains and organs in the womb it cannot be reversed. Yet the lifelong effects are completely avoidable by not drinking alcohol during pregnancy. The most critical time is the first three months of gestation, so a foetus can be harmed even before a woman knows she is pregnant.

Changing behaviour to prevent the growing toll of damage, therefore, requires education rather than regulation.
Forrester Cockburn, Emeritus Professor of Child Health at Glasgow University, believes that young women are not sufficiently aware of the dangers of consuming alcohol during pregnancy, although such is the range of potential problems that it is not possible to specify a safe limit for expectant mothers.
Scotland’s chief medical officer, Dr Harry Burns, has said that he believes the incidence of FASD in Scotland has been significantly underestimated and that it is directly linked to anti-social behaviour.
Dr Sher’s report coincides with a joint statement to MSPs by eight major children’s charities warning that excessive parental drinking is seriously damaging many children’s lives.

Their lobbying for minimum pricing ought to carry as much weight as that of the drinks industry.
Nevertheless while the arguments continue over the effectiveness of minimum pricing, in the light Dr Sher’s report on FAS, the call by the charities to include harm caused to other people when measuring the damage from alcohol should be accepted by MSPs. The despairing calls to ChildLine are the unassailable evidence that the extent of alcohol abuse goes far beyond the health and crime statistics.

Source:www.Heraldscotland.com March 1 2010

Teachers UK-wide given emergency training after some as young as 12 fall victim to £3-a-go ‘plant food’ drug linked to two deaths.

Teachers are dealing with the behavioural consequences in their classrooms of a new “legal high” – known as “meow meow” or “plant food” – which is being taken by pupils as young as 12 or 13.
Classroom staff are now receiving training in the dangers of the new craze after an explosion in its use and recent cases of children falling seriously ill after taking the drug, which is believed to have similar effects to ecstasy. While the drug is not illegal, its abuse in the hands of pupils has prompted officials around the country to add warnings about the substance to PSHE lessons. It has been linked to the deaths of Swedish teenagers and 14-year-old Gabi Price from Worthing last November.
“Meow meow”, or mephedrone as it is formally named, is marketed by suppliers as plant food to avoid detection and can be acquired for as little as £3 a hit (a gram, containing four capsules, costs £12).

In Brighton there are reports of children as young as 12 and 13 taking the drug on school buses. College students have even started a trend of trying to drive home after taking legal high drugs, with five teenage boys in County Durham taken to hospital after indulging – with one suffering a drug-induced high for 36 hours.
Police around the country worried about the trend have now started taking action. Pupils at Brighton schools have already begun learning about the dangers of the drugs in assemblies and through the PSHE curriculum, while children in Teesdale have been given information leaflets. Police are also working with Harrogate headteachers after a growth in legal-high use among the town’s young people.

“It’s clear that increased numbers of 14- and 15-year-olds started using ‘meow meow’ at the end of last summer and we have big concerns about this,” said Sam Beal, acting healthy schools team leader for Brighton and Hove City Council. “Teachers hear about this more and more and they are concerned that the drugs are being brought into schools.”
The symptoms of using meow meow can include nosebleeds, headaches and breathing problems. Limbs can also turn purple and the user may have trouble urinating, leading to stomach cramps.
“It seems when bought over the internet you get discounts for buying larger quantities,” said Sgt Geoff Crocker, safer neighbourhoods officer for Harrogate. “It’s easily available and cheap and we’ve seen enterprising pupils start selling it in school. Staff in our pupil referral unit service have noticed a very rapid physical and mental decline in pupils using legal high drugs – and some just aren’t there any more. One young girl we know is addicted to mephedrone and she is active sexually with a number of men for money to pay for it. I know our schools are concerned about this, and are working hard to deal with it.”

In County Durham, drug workers have been warning pupils that legal does not mean safe following the incident when five boys fell ill last August. This has also meant an increased local police interest in the issue. “We’ve mostly seen it used as part of a ‘risk-taking’ culture among young people, particularly in colleges,” said Darren Archer, manager of the County Durham drugs and alcohol action team. We’ve had anecdotal reports of it causing bad behaviour and now we are trying to offer comprehensive support to teachers and children.” It scared the life out of us, seeing him like that’
It was the wake-up call no teacher wants – but witnessing the distressing effects of legal high drugs has revolutionised one school’s drug education programme. Horrified teachers at Woldgate College, near York, watched as a sixth-form student became seriously ill after taking mephedrone off-site during lunchtime earlier this month. He was taken to hospital suffering from an irregular heart beat, chest pains and breathing problems. Headteacher Jeff Bower (pictured) is now calling for the drug to be made illegal.
“You can’t think anything else after seeing that young man struggling like that, it scared the life out of everyone here,” he said. We are not extremely receptive to this problem – it’s been a big wake-up call. It was the first time he had taken it and he admits it was because of peer pressure. This has just hit us completely between the eyes. We held a special assembly about the situation and built it into our drugs education programme. We have also been in contact with parents. This goes on out of school hours so it’s vitally important they know about the dangers.”
A correction to the above story:

The only link between the death of Gabi Price and mephedrone was made by some ill informed reporting in the Daily Mail, and the Sun and the Telegraph that reported that this was a drug death before the coroners report was published. The coroner in reality found no drugs in her body and that she died of broncho-pneumonia following a streptococcal A infection (see here http://bit.ly/7td8FN ). Such is the nature of drug story reporting that none of the newspapers that ran the original story printed a correction or follow up.

It is also the case that the unregulated vendors of this drug reported a leap in sales when the (false) Gabi Price death story received free advertising (it works, its legal, its cheap, you can buy online) from the massive national tabloid coverage (and the broadcast coverage that followed).

This is undoubtedly a dangerous drug, and serious public health and regulation policy concern – particularly regarding young people, but that does not excuse
Steve Rolles 28th Jan 2010-01-29
Source: www.tes.co.uk Jan 2010