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

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

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

Source: Daily Telegraph,  London  reported Nov. 9.2004  

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

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

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

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

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

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

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

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

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

Source  IoS  Dec. 2008

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

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

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

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

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

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

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

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

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

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

Source  By Randy Dotinga
HealthDay Reporter    August  2004

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

About Providence Health Care

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

About the University of British Columbia

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Disengaged teenagers could then turn to cannabis.

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

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

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

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

Source: Sunday Tasmanian 30th January 2005

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

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

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

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

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

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

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

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

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

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

SOURCE: BMC Psychiatry, April 1,2005.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Source   www.partnershipatdrugfree.org  Nov. 2011

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

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

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

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

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

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

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

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

• Characteristics of the intervention (in this case, continuing care) such as the strength of the evidence for its effectiveness and how far it was adapted to fit the particular circumstances in which it was being implemented.

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

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

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

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

Outer Setting

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

Inner Setting

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

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

Implementation Process

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

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

Basic Continuing Care Implementation

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

Implementation Efforts Need to Address Multiple Domains

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Source: United Nations Office on Drugs and Crime

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

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

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

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

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

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

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

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

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

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

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

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

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

The attraction that the medical profession has for medical marihuana continues to mystify me. Many of the same physicians who will exercise exemplary caution in caring for their patients, will throw caution aside when it comes to pot. I know internists in private practice who refuse to accept new patients if they smoke tobacco. I often wonder if they would have the same reaction if the patients smoke pot! Yesterday, I entered an online discussion by a medical group on this subject and I’ve pasted my comment below.

The medical profession needs to apologize for letting the public down on this one – once again. In the early 1900s, although medical organizations like the AMA were against patent medicines and refused to post ads in JAMA that did not list the ingredients of the products being promoted, there were quite a few doctors who nonetheless sold and promoted the use of patent medicines, most of which were worthless elixirs of cocaine or morphine or heroin or cannabis or combinations thereof, laced with copious amounts of alcohol, coloring agents and flavorings. They were promoted as curing everything from the common cold to cancer. Although the docs knew better, they argued that they were giving their patients what they wanted and if they didn’t, the patients would buy them on the street from sidewalk vendors who were not trained healthcare professionals. Ethical?

As best we know, any “positive” effects of these nostrums came in the form of intoxication, a normal reaction to psychotropic substances, including alcohol. Therapeutic they were not. Even during alcohol prohibition (1919-1933), the federal government issued special prescriptions to physicians –only– that allowed them to prescribe “medicinal alcohol” in the form of wine, whiskey, and beer. Overnight, pharmacies became liquor stores. And doctors did, indeed, prescribe alcohol for medicinal purposes and plenty of it during Prohibition. Ethical?

Fast-forward to the 1980s and 1990s and along comes the return of “medical marihuana.” This time, however, it’s not in the form of a tincture but, instead, promoted for use in its crude form as smoked marihuana. Not surprisingly, smoked pot today is touted as a cure-all for anything that ails one, from stress, to headache, to multiple sclerosis, to cancer pain and even cancer itself. How could a drug that’s so great be overlooked for so long by so many? Moreover, as in the case of alcohol prohibition, only doctors in certain states can prescribe (or recommend) it for medicinal purposes only. Ethical?

What these brief histories have in common is the promotion and use of intoxicants for therapeutic purposes. In all three cases, doctors promoted the use of these substances knowing that the anecdotal evidence of efficacy was weak at best, unsupported by unbiased clinical trial data, and not likely to improve the patient’s condition but only mask symptoms temporarily through intoxication. Incidentally, we could add tobacco to this list, too. A favorite ad of mine comes from a 1950s magazine that shows a photo of a physician holding a cigarette with a caption proclaiming that in a national survey of physicians, more preferred Camels over any other brand of cigarette. Ethical?

Wake up, America, and realize that whatever therapeutic molecules we might be able to squeeze out of the pot plant must be synthesized, purified, and manufactured to measured standards and dosing units before being used in medical treatment. Consider morphine and codeine. We don’t recommend that people grow opium poppies, harvest them, extract and chew the gum to get pain relief. Instead, we have synthesized and standardized pharmaceutically pure opiate medicines. Current pot research is underway to isolate and restructure the genetic pathways that provide pot’s psychic effect. This, scientists say, will be accomplished without interfering or reducing in any way the therapeutic properties of the beneficial cannabinoids in the plant. The final product will be safe and effective – far more effective as a medicine than smoking pot because dosing will be concentrated and stronger – and not controlled because there will be no psychotropic response.

In effect, if pot truly has medicinal benefits independent of its intoxicating effects, they should be more readily available and useful in a finished pharmaceutical form. Also, users will be spared the toxic effects of inhaling smoke. Smoking anything — paper, tobacco, dry leaves, or pot — is not good for lung tissue of any living organism. Finally, the new pot without its psychic effect can be compared to decaffeinated coffee. It will have many of the same properties of the real thing except the kick. And, let’s face it, a good cup of Starbuck’s decaf can’t be distinguished from the regular stuff.
When all this happens in a few years, pot heads now desperately trying to promote pot for everything and anything will be left with nothing but the fact that their story of pot’s medicinal history will join the other historical artifacts described above. Someday, their kids and grand-kids will look back and say the same thing that we say now when we look at those old cigarette ads from the 1950s: What were you thinking?

Source: John Coleman Drug-Watch International Feb.2010

Jay’s story has a familiar ring. The pre-teen experimentation with cannabis after his father walked out on the family, followed by flirtation with ecstasy and cocaine. He had smoked his first wrap of heroin before he was old enough to buy a pint of beer. But it was only when he was off the street, safely incarcerated in a young offender institution, that methadone was added to Jay’s palate. As the gaunt teenager with grey skin shuffled from foot to foot in the West London drizzle, uncaringly dressed in a hooded tracksuit, his pin-pricked pupils scanned the streets.

“I was running wild with a raging [heroin] habit when they got me,” he said. “They tried to detox me inside but as soon as I complained they put my dose of methadone up again. I came out needing drugs as much as when I went in.”

His six-month stretch inside passed in a methadone-induced daze with, according to Jay, little attempt by prison staff to offer him a pathway to drug-free recovery. When he was released two years ago, Jay, whose only family contact is an elder brother he occasionally stays with, swiftly returned to the messy chaos of an opiate-obsessed existence. He thinks that he will be back in prison within weeks. “Most junkies I know want to be clean but if you can’t do it when you’re inside, when can you?” he says.

Methadone, a heroin substitute that is more addictive than heroin itself, has assumed a dominant position in the State’s drug-control armoury. It is given to half the country’s estimated 300,000 heroin addicts while parliamentary answers have revealed that 65,000 prisoners were prescribed it in the past year, including nearly 20,000 on a maintenance programme which can last years — an annual rise of 57 per cent. In some patches of “broken Britain” it is responsible for more fatal overdoses than any other substance.

Supporters say it stabilises addicts and protects society by removing the need for drug-financing crime sprees. Opponents argue that the State is happy to “park” people on methadone for years, giving up hope that addicts will ever lead a productive, drug-free life.

One aspect most agree on is that drug addiction is a lucrative business. Professor Neil McKeganey, a leading opponent of mass methadone medicating, said: “There’s considerable financial incentive that drug users remain drug dependent.” Drug companies make millions from producing methadone, GPs in many parts of the country get paid in the region of £220 per methadone patient per year, pharmacists can get £200 administration fees plus about £1.50 per administered dose, while more than 150,000 people are employed in drug-action teams funded largely from the public purse.
Mark Johnson, a former drug user who founded the charity Uservoice, said that although prisons are the ideal location for rehabilitation because they are “the only place that removes some people from dysfunction and gives them a respite”, the authorities are increasingly opting for the methadone route. “All we’re doing is containing the problem, not solving it,” he said.

Several studies have shown that a residential-based abstinence programme lasting at least a month has a roughly one in four success rate, while a recent study on addicts in society showed that after three years on methadone only 3 per cent are drug-free.

Despite this, however, the Government, backed by a cadre of policy experts and health professionals, is increasing its multi-million annual spend on methadone maintenance programmes. At the same time, at least 20 residential rehabilitation centres have closed in the past two years because primary care trusts have stopped referring clients. Last month Middlegate Lodge, the only residential rehab centre specifically for teenagers, closed.

Just 850 prisoners were put on the relatively succesful 12-step abstinence programme last year. No figures are available for how many young offenders are prescribed methadone.
Inspectors’ reports into young offenders’ institutions record that while alcohol and cannabis are the biggest substance problems, the use of methadone is being encouraged and is increasing.
Kathy Gyngell, a drugs policy analyst for the Centre for Policy Studies, said that prescribing methadone to young offenders had become routine. She added: “It might appear the easier option but it leads to longer term problems. Individuals who historically used their short sentences to gain clean time now feel the necessity to carry on using methadone, as it takes no effort other than presenting themselves at the healthcare door to get it.”

David Burrowes, a Tory justice spokesman, said that drug treatment was “characterised by methadone” and that a variety of treatment options needed to be available.

Katherine, a former addict, whose descent into heroin addiction began after she was raped as a teenager, said that after a decade ricocheting between methadone in prison and heroin outside, she had finally kicked her habit after becoming one of the few prisoners to be offered a place on a RAPt (Rehabilitation for Addicted Prisoners Trust) abstinence programme.

“Methadone is not a solution,” said Katherine, who left prison drug-free in 2008. “The message it gives is, ‘You come in with a habit and we’ll keep the habit and let you back out into society with no changes whatsoever.” She said that even in prison, addicts are able to exploit the system by using cotton wool to absorb the sickly-sweet green methadone linctus, before selling it on to other inmates and buying heroin with the proceeds.

Rosie, who started taking heroin at the age of 14, was prescribed methadone after leaving a young offenders’ institution and said that she had never seen a succesful methadone-led withdrawal from drug use. “It’s almost more of a poison than heroin, there doesn’t ever seem to be an end to it,” she said. She became drug-free after attending an abstinence-based treatment centre provided by the Nelson Trust.

To its advocates, though, methadone is a useful tool. At best, it stabilises addicts before they are weaned off; at worst, it can be used to maintain addicts long term, minimising the need for them to commit crime to pay for street heroin. Overall, drug-related crime is estimated to cost the country more than £13 billion a year.

There are also risks associated with forcing prisoners to go cold turkey. Cynics suggest the prison authorities’ increasing enthusiasm for methadone may have something to do with the £750,000 it was forced to pay out in 2006 after almost 200 drug-addicted prisoners sued the Government, claiming that their rights were infringed when they were forced to withdraw suddenly.

Even for those who claim to have benefited from it, methadone is at best a stopgap. James, 30, from Renfrewshire, had been a heroin user for nine years when he was given methadone in Barlinnie Prison, Glasgow. “Everything in prison was all about drugs,” he said. “Sometimes you couldn’t get any heroin and you couldn’t eat your dinner, you were in bed with all your clothes on, teeth rattling. They put me on 30ml of methadone, a low dose, and it settled me. I was a lot calmer; it was like a safety net.”

Roger Howard, the chief executive of the UK Drug Policy Commission, an advocate for methadone, admits that it could not alone cure drug addicts. “What everyone wants is to reduce deaths from dangerous street heroin and to reduce criminality,” he said. “Methadone is not the problem. These people come with a bucketful of problems: abuse, unemployment, homelessness, family.”

Professor McKeganey, who works at the Centre for Drug Misuse at the University of Glasgow, warned that Britain was sleepwalking into a situation similar to that in the Netherlands, where the Government provided places at old people’s homes for those with long-term methadone habits: the so-called “geriaddicts”. Mr Howard agreed: “There is a cohort who are probably so damaged and with such profound health problems that they will never get a job and will for ever rely on the State.”

As he prepared to pad the darkened streets of West London in shoes as punctured as his bony, needle-marked forearm in an all-consuming search for his next hit, Jay pondered a parting question: if you could survive in prison on methadone alone, why not, when outside, give your daily, drug-free urine sample, take the supervised dose of methadone and shun street drugs?

“But where would it get me? All right, the craving for smack’s not there but you soon get the craving for the meth. Nobody I know on a heroin ’script is getting any better. They’re just surviving.”

Source: Times Online 17th March 2010

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

Sources: NAO, Drugscope, Home Office

Whichever way you look at it, the Government’s increasing reliance on methadone to treat heroin addicts involves moral issues. Predominant among these is that the State is in effect cast in the role of drug dealer — conceivably for as long as the addicts live.

The uneasy relationship becomes especially problematic when users die of overdoses, having supplemented methadone with other street drugs.

Never forget how dangerous this is. When official figures show that in some areas a third of the people who die from drug-related causes have methadone in their bodies, put there by the taxpayer, and that this proportion doubled from 2006-08, we are on dodgy ethical ground.

Increasingly, it means the substance that is supposed to be a primary solution appears to be an intrinsic part of the problem. What methadone also represents is the transfer of personal responsibility for addiction away from the drug user. In this sense, the heroin substitute symbolises the cultural shift in modern drug policy: the addict is a victim who needs support and maintenance, rather than someone who should change their behaviour.

This official non-judgmentalism is interesting, especially when there is public debate about the resources devoted to the consequences of smoking, alcohol and overeating — which are not illegal. The merits of a humane approach to drug addiction are apparent. No one argues that methadone is not a useful part of the weaponry. It’s relatively cheap; it can stabilise the lives of addicts who shoplift or supply heroin to others; and of course, rather importantly, it allows the Government to say that it is doing something.

But what worries critics of methadone is not only its excessive use, but the lack of an exit strategy. In parts of the country there are addicts who have been taking it for decades. Even advocates concede that people are being kept on the drug for too long without any target to get them off.
All of which makes it troubling to hear that young offenders are being prescribed it, if only because, without any commitment to get them off drugs, they may end up “parked” for many years of dependency.

Professor Neil McKeganey, in his latest book, laments the lack of consensus about the goals of treatment, pointing out that although the majority of addicts want to be free of drugs, this is not facilitated by government policy. He wants to see a target limiting use to two years.

Methadone is a smokescreen for the absence of alternatives when it comes to problem use. There appears to be no new thinking, no initiatives, few open minds; and indeed little political will.
In a sense, the ubiquity of the heroin substitute is an admission that not only have social policies failed, but that we have no solutions for the consequences.

Source: Times Online 17th March 2010

THE Conservative’s Holyrood justice spokesman Bill Aitken is no stranger to controversy and his plain-spoken attack on the methadone programme has re-ignited the debate about how best to tackle Scotland’s appalling epidemic of drug addiction.

The debate about the effectiveness of the methadone programme has raged since its inception and there has always been opposition to the principle of handing out free opium-based drugs like methadone to addicts. But there is much in the basis of the scheme to commend it, not least that it has the potential to place those on the programme outwith the reach of criminals. Something that means addicts no longer have to steal to manage their habit and keeps them out of the clutches of gangsters should be a good thing. However, too many just use the methadone as part of their daily drugs routine and find ways of selling it on, despite measures like forcing them to take it in front of the pharmacist.

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

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

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

Source: Edinburgh Evening News 17 March 2008

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

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

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

What Mr. Barnes failed to mention.

1. Drug related deaths in accordance with the UK official definition are at their highest for 5 years. (Health Statistics Quarterly 39. Office of National Statistics)

2. The level of HIV and other blood born diseases among Injecting Drug Users is higher now than at the start of the decade.

3 .In London where the prevalence of HIV is higher than anywhere else in England, 1 in 20 Injecting Drug Users is infected.

4 .In the remainder of England and Wales HIV among IDUs has risen from approximately one in 400 to 1 in 250 in 2006.

5 .The prevalence of hepatitis C among IDUs has increased from 33% in 2000 to 42% in 2006.

6. Approximately on in 5 IDUs has hepatitis B, which represents an increase of something like 200 per cent since 1997.

The foregoing is neither ‘uninformed’, or ‘unwarranted’ criticism, they are however the inescapable facts which Mr. Barnes seems either keen to suppress or is unaware of, In either event his opinion that “we should be justly proud of what has been achieved in drug treatment”, is hardly a balanced judgment of the escalation in both drug related deaths and disease which is being inflicted on our society. Nor the increasing level of drug offences and drug related crime.

Whether or not this catastrophic outcome of our drug treatment strategy can be wholly attributed to the harm reduction treatment protocols which has dominated it for so many years, and of which Mr. Barnes is an enthusiast, is the principle cause of the seemingly out of control increase in death, disease and crime, is debatable, what is not debatable is that we have no reason or justification to be proud that we have presided over an escalating and avoidable loss of life, death and criminal activity; nor is Mr. Barnes justified in claiming that we have.

Follow-Up Opinions

Failings Found In Needle Exchange Services.
posted by Mary Brett on 17 Mar 2009 at 1:49 pm
Among other failings found in a survey by the NTA of needle exchanges in England 2006, 50% of DATS had no access to virus testing on site, 40% no immunisation in place, about a third lacked hygiene and safer technique discussions.

Data collection was poor – DATS able to provide numbers of clients and visits, quantity of equipment distributed and returned were in the minority. Only 74% of DATS, 55% of needle exchange service providers and 48% of pharmacies provided information. There was a lack of training for co-ordinators and access to facilities was mostly limited to the working week. Very few operated at weekends or during the evening or night. Largely missing was any monitoring of discarded needles or injuries arising from them to the public.
Has anything been done to improve this situation? From the latest figures, quoted here, it would appear not to be the case.
|

Quantity V Quality
posted by Peter O’Loughlin on 18 Mar 2009 at 6:11 am
Thank you for your revealing and interesting contribution Mary.

It seems as if the NTA’s obsession with numbers treated, rather than treatment outcomes could be a contributory factor to the spread of blood born disease.

It is also depressing to learn that those hardy souls in the front line for whom I have considerable respect and admiration, are being deprived of the fundamental training and facilities needed to improve outcomes.

No doubt the apparent focus on numbers is to enable those responsible to issue gushing reports of achievement through the simplistic process of counting the numbers of needles issued, rather than positive outcomes of how those who use the facilities might be engaged in recovery.

A case of ‘never mind the quality, feel the width’.

If we add to that the seeming disregard of the danger to the public caused by discarded needles, then harm reduction as it is being practised in this country is creating more problems than it is resolving.

It seems to me that those people who sit in their ‘ivory towers’ dreaming up ‘harm reduction’ solutions have failed to realise that addiction is not confined to office hours and that when the addicted are craving for a fix, the lack of a clean needle will not prevent them from using.

Now exactly what is it that Mr Barnes of DrugScope feels we have reason to be ‘justly proud of’?

Is it the number of needles issued?

The injury to children and others arising from discarded needles?

The lack of training and supervision and hygiene facilities? Or the escalation, in avoidable deaths and disease?

The one thing I do agree with Mr. Barnes on is that more, much more is needed to reduce both drug related deaths and disease, and the most realistic way of achieving that is through abstinence focused recovery.

What Mr Barnes seems unable to grasp is that there is a world of difference between abstinence and recovery. Nor does he seem willing to acknowledge that the outcome of addiction is always abstinence. The latter is not an option as Mr Barnes appears to be suggesting. It is achieved either through premature death, a reality which is already occurring, or abstinence focused treatment followed by on going after care; realities that neither Mr. Barnes or the NTA seem willing or able, to confront.

Source:Posts between Peter O’Loughlin on 18 Mar 2009  and Mary Brett CSS after statement from Drugscope 

EACH year the Scottish Drug Misuse Database releases statistics laying bare the grim reality of drug addiction in Scotland. For a few days politician show angst at the tragedy that lies behind the statistics but somehow attention moves on as if this problem will resolve itself.

It is expected areas of high unemployment and poverty will feature prominently in the SDMD and yesterday’s figures offer little change. Glasgow, Dundee, Inverclyde and West Dunbartonshire all feature as areas showing significant levels of problematic drug abuse, though in truth all of Scotland is affected.

What continues to shock, however, is the numbers of young people under 15 years of age who present as problematic drug users and this year, as the figure records more than 100, that shock does not lessen.

Their first involvement is likely to occur as early as primary school but most often in first or second year secondary, their drug use developing usually from a habit of the illicit drinking of alcohol with school friends. Accessing of drugs builds from that background of irresponsible risk taking in public areas such as parks, isolated school play areas and the likes.

From my experience and talking to young people in prisons, it seems to me likely that school absenteeism arising from heavy drinking and the abuse of drugs (usually cannabis) created for these youngsters a self-imposed understanding of exclusion and thereafter educational failure that ensured that any chances they may have had of early success is denied.

Opportunities for gainful employment were also denied. It is in these circumstances that many turned to heroin, diazepam and cocaine – drugs identified in the most recent statistics as the source of much of the problematic drug misuse recorded. A spiralling downturn in life chances, an increased likelihood of arrest and incarceration and real possibility of drugs-related death beckons.

The latest figures reflect a 131 per cent increase in drugs-related deaths over the ten-year period to 2008 giving us a new yearly total of 574 deaths. 574 tragedies.

It is not the writing of new drugs strategies that will bring about a change in this situation. It’s government leadership to ensure that enforcement, health, education and prisons all work with the voluntary sector towards the sole outcome of reducing problematic drug abuse.

Source: http://news.scotsman.com 31st March 2010

Almost 30,000 prisoners are being kept dependent on drugs by the prison service rather than being put through detox programmes, according to a new report.

Methadone, along with similar drugs, is being prescribed too easily thanks to risk-averse clinical guidelines and inexperienced prescribers, concludes the Policy Exchange report, to be released on Monday.

“Perversely, the massive increase in opiate substitute medication has created a new kind of trade for drugs in prisons, as methadone and buprenorphine are readily traded among inmates,” said Max Chambers, author of the report, Coming Clean, Combating Drug Misuse in Prisons.
The report criticises clinical guidelines for not taking into account the length of sentence a prisoner is serving when prescribing treatment for drug addiction.

“Maintenance treatment, which is when a stable dose is prescribed often continued indefinitely, should only be given to prisoners serving 13 weeks or less and who don’t have time to complete a detoxification programme,” said Chamber. Under current practices, however, every prisoner who has been receiving methadone in the community will have their drug habit maintained in prison, regardless of the length of their sentence.

Almost 20,000 maintenance prescriptions were made in 2008 to 2009. By 2011, when the Integrated Drug Treatment System is rolled out to all prisons in England and Wales, an additional 8,788 prisoners a year will be receiving methadone maintenance treatment.

The report also cites research showing that around £100m of drugs are smuggled into prisons each year. The majority of drug-dealing in prison involves the collusion of about 1,000 corrupt members of staff – equating to seven prison officers per prison. “They are able to smuggle drugs due to lax security arrangements and, given the inflated value of drugs in prison, are able to make substantial profits without fear of detection,” said Chambers. “A prison officer bringing a gram of heroin into prison every week – about the size of two paracetamol tablets – could expect to more than double his basic salary.”

Chambers cites evidence that accusations of corruption by prison officers are not routinely investigated by the Serious Organised Crime Agency or the Prison Service. “Information on the number of officers accused, charged, prosecuted or convicted of smuggling drugsor other contraband is apparently not collected at all by central government,” he said.

The report reveals that the number of prisoners using drugs is hugely underestimated. Mandatory drug testing figures indicate 7.7% of prisoners are using drugs but in a survey of prisoners conducted for the new report, the figure was found to be 35%, with 16% using drugs at least once a week – equivalent to about 14,000 prisoners.

Harry Fletcher, assistant general secretary of probation union Napo, said officers who smuggled drugs into jail routinely avoided detection. “It’s a serious problem but the government doesn’t keep statistics on how many staff are caught, which is extraordinary,” he said. Fletcher said there were more than 6,000 prison officers convicted of disciplinary offences over the past four years, with 19 of them currently serving sentences. “Because there is no data on the extent of the problem we can’t devise solutions,” he said.

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

Dear  Friend,

They wait to welcome their child into the world. They wait in cars after the team practice. They wait in line to buy their family’s dinner. They wait for texts to pick up their child from birthday parties, sleepovers and play dates. Others wait for thick college acceptance envelopes. But imagine this: You are one of the millions of parents with a teen or young adult abusing drugs or alcohol. You? You wait for a phone call. You wonder if your child will come home. You worry she’s hurt.

Like so many others, you don’t know where to start to find the answers you need, let alone how you will confront your child, if she needs help, or if there are others like you, parents who have stood in your shoes, paced beside doors or waited for a call. Having a child with an alcohol or drug problem can be emotionally taxing and financially devastating for families.

Suddenly, a lifeline.

You are searching the Internet for help and find The Partnership at Drugfree.org. The website, created with and for parents, allows you to connect with others, tap into expert advice and find support as you find help for your child. You find insight and tools you can use. You find a community who understands. You find hope. That’s what The Partnership at Drugfree.org exists to do – be a partner to parents all along their journey of parenting a teen, whether that’s prevention, intervention or treatment.

The The Partnership at Drugfree.org is there, a steady, supportive hand, offering services to help parents and caring adults. Not a government agency, but a nonprofit made up of partners in science, parenting and communications, and one that relies on the generosity of individuals.

Right now…

• We are building support for You Are Not Alone… a campaign dedicated to letting families of teens and young adults who are struggling with addiction know that they are not alone. By enlisting and uniting the millions who have been affected by addiction, we are removing barriers to seeking treatment and creating a new dialogue around addiction.
• We are growing the staff and services of our Parents Toll-Free Hotline… 1-855-DRUGFREE… a new, nationwide support service that offers assistance to parents and other primary caregivers of children who want to talk to someone about their child’s drug use and drinking. Our trained and caring parent specialists will help parents plan a course of action for teens who are struggling with substance abuse and lead them to resources or treatment facilities in their area.
• We have downloadable e-books and kits available… which equip parents with conversation starters and step-by-step direction to talk to their kids or take action if they think or know their child is using. Kids who learn a lot about the risks of drugs from their parents are up to 50% less likely to use.

Meeting these specific needs of parents, in conjunction with the everyday services we provide to families, will take a huge effort, cost money, and stretch our resources to the limit.

Stephen J. Pasierb, President & CEO

Source: www.drugfree.org to learn more

 Q: How can I tell if my child has been using marijuana?

A: There are some signs you might be able to see. If someone is high on marijuana, he or she might:

 Seem dizzy and have trouble walking;

• Seem silly and giggly for no reason;
• Save very red, bloodshot eyes; and
• Have a hard time remembering things that just happened.

 When the early effects fade, the user can become very sleepy.

 Parents should be aware of changes in their child’s behavior, although this may be difficult with teens. Parents should look for withdrawal, depression, fatigue, carelessness with grooming, hostility and deteriorating relationships with family members and friends.

 In addition, changes in academic performance, increased absenteeism or truancy, lost interest in sports or other favourite activities, and changes in eating or sleeping habits could be related to drug use. However, these signs may also indicate problems other than using drugs.

In addition, parents should be aware of:

 Signs of drugs and drug paraphernalia, including pipes and rolling papers;

• Odour on clothes and in the bedroom;
• Use of incense and other deodorizers;
• Use of eye drops; and
• Clothing, posters, jewellery, etc., promoting drug use.

 Source: The National Institute on Drug Abuse  2010

Written by Bonnie Benard, NIDA, USA.(Originally in training manuals for Project Snowball, Illinois Teen Institutes, 1987)

Published in Britain in ‘Drug Prevention – Just say Now’ by Peter Stoker, pub. David Fulton Publishers,London, 1992.

Programme comprehensiveness/intensity

A.        Multiplicity: the causes of drug/alcohol abuse are multiple: personality, environmental, behavioural (Kandel, Logan, 1984; Hawkins et al, 1951).  Programmes tackling only one area usually fail.  You should target multiple systems (youth, families, schools, community, workplace, media, etc).  Also use multiple strategies (information, lifestyles, positive alternatives, community policies) (Botvin, 1982).

B.         Target whole community.  School-based programmes achieve less than community-based approaches.

C.         Target all youth for prevention – not just “high risk”.  Adolescence is seen to be a high-risk time for all youth in terms of health-compromising behaviour.  Labelling “high risk” youth can provoke stigmatisation and lead to self-fulfilling prophecies.  There is however an argument for defining “high risk” communities where an additional resource over and above the general prevention effort could be justified.

D.        Build drug prevention into general health promotion.  Drug abuse has been found by several (Lofquist, 1993) to be part of a complex pattern of interrelated factors – e.g. delinquency, truancy, school failure, precocious sexuality, which share common antecedents.

E.         Start at an early age and keep going!  Even in infancy there are influences in later behaviour.  Developmental difficulties by age 3 are difficult to overcome (Burton, White).  Here, it is of course relevant to mention Trevor Williams, Noreen Wetton and Alysoun Moon of the Southampton University team who have demonstrated so graphically in their “Jugs and Herrings” research papers that primary age children are not blissfully ignorant of drugs and alcohol.  Prevention programmes starting from what children actually know are essential.  Many secondary schools still seem to regard years 11 and 12 as the age at which discussion of drugs (or indeed sexuality) should be facilitated.  Don’t wait until the horse has run away before you lock the stable doors!

F.         Adequate quantity.  ‘One-shot prevention efforts do not work” (Kumpfer, 1988) there must be a substantial number of interventions, each of a substantial duration.  Project D.A.R.E. (Drug Abuse Resistance Education) initiated by Los Angeles Police and now in several countries, delivers no less than seventeen one-hour lessons to any given year and this is only part of the school programme.

G.        Integrate family/classroom/school/community life.  This is easier to say than do, but where it has happened results have been enhanced.

H.        Supportive environment, empowerment.  Where young people are encouraged to participate and take responsibility their behavioural outcomes are improved.  In Britain now peer-education methods which have been proven elsewhere have been applied to good effect.

Programme strategies

J.          ‘KAB’ – Knowledge/Attitudes/Behaviour.  Address these as a set, i.e. each must be directly tackled rather than assuming one will flow from another.  The behavioural component is in part addressed by social skills development, but also supported by positive reinforcement activities – drug free social/sporting events, commendations (preferably with something for everyone), media coverage, etc.  Research suggests that social learning theory (Bandura, 1977) produces some of the most profound improvements.

K.         Drug specific curriculum.  Affective education programmes that had not specifically covered drugs (including alcohol) were found unsuccessful, even though they addressed knowledge, attitudes and lifeskills.

L.         Gateway drugs.  So-called because people now using heavy-end drugs almost always started on these.  Gateway drugs can be tobacco, alcohol and cannabis or, these days inBritain, even heroin!  Concentration on prevention of these is therefore likely to prevent all substances.  British research by PaT (Parents against Tobacco, 1990), showed that of youth who smoked tobacco 50% had also tried an illegal drug compared with only 2% of those who did not smoke tobacco.  It should be particularly noted that cannabis is far from harmless; physical, mental and social damage is now being increasingly accepted as a reality.

M.        Salient material.  Whatever is used needs to identify with the audience, including:

•          ethnic/cultural sensitivity

•          appeal to youth’s interests

•          short term outcomes to be emphasised as important to youth as well as long term

•          appropriate language, readability

•          appealing graphics

•          appropriate to real age/reading age – a key factor

In a survey of 3, 700, 000 young American children, 25% of 9 year olds felt “some” to “a lot” of peer pressure to try drugs or alcohol (Weekly Reader, 1987).

N.        Alternatives.  Activities have to be plausible, be more highly valued than the health-compromising behaviour.  Too often these alternatives are poorly thought through. ( ‘Ping-pong = prevention’? No!)

P.         Lifeskills.      Development of these will be of wider benefit than drug prevention.  Included will be

communication, problem solving, decision-making, critical thinking, assertiveness, peer pressure reversal, peer selection, low-risk choice making, self-improvement, stress reduction and consumer awareness (Botvin, 1985).

Choosing your friends has been found in some research to be more effective than resisting the peer pressure of said friends.  Consumer awareness is a “companion” to resisting peer pressure, i.e. resisting media pressure.

Q.        Training prevention workers.  For the school setting the greater emphasis on experiential and interactive work requires teacher training to extend into youth work skills.  Community development skills are valuable in taking school initiatives into the community.  Imported “prestige” role models are all very well, but good results have been achieved with parents, peers, teachers, or outside agency workers.

R.         Community norms.  Consistency of policies throughout schools, families and communities can greatly enhance impact.

S.         Alcohol norms.  Because of its dual status as a beverage and as a culturally accepted drug, alcohol is problematic for prevention.  However, heart disease and tobacco prevention programmes have shown that societal norms can be changed.

T.         Improve schooling!  Listed here as a target because of its important correlation with healthy lifestyle.  Within the current British economic and academic climate one realistic hope may lie with co-operative learning, see the ‘Tribes’ programme, for example.

U.        Change society.  Don’t just stop with improving schools; add your voices to pressure for improvement in employment, housing, recreation and self-development; it is naïve to suppose that prevention can take place in a political vacuum.  Jessor recognises that failing to acknowledge the need for macro-environmental improvement while at the same time placing the responsibility for health solely with the individual is tantamount to “blaming the victim”.

The planning process

V.         Design, implementation, evaluation.  Evaluations have generally concentrated on outcomes rather than the quality of design.  However, implementation is as much dependent on engaging all sectors of the community (be it a school, a workplace, or a town) as it is on quality of design.  Evaluation should therefore measure process as well as outcome.

W.        Goal-setting.  Unrealistic or immeasurable goals help no-one.  It is important to set not only long-term outcome goals (for prevention is long-term) but also “process goals” such as increased involvement of parents and community, academic success, increased student-teacher interaction, and so on.

X.         Evaluation and amendment.  Prevention workers have been criticized for giving too little attention to this area, the crushing shortage of funds has much to do with it (inAmerica the ratio of funding between interdiction-policy and prevention is about 200:1).  This lack of emphasis on evaluation has been the Achilles heel that pro-drug campaigners have gleefully attacked.  Effective evaluations have been those including longitudinal design, multiple measures of process as well as outcome (Tobler, 1986), and cost-benefit analysis (CBA).  CBA is perhaps the greatest marketing tool prevention has; where CBA has been applied substantial cost effectiveness has been demonstrated.

Source: Quoted in book Drug Prevention Just Say Now (1992) by Peter Stoker.  Contact NDPA

The number of Americans who died from overdoses of prescription painkillers more than tripled in the past decade, according to the Centers for Disease Control and Prevention (CDC). More people now die from painkillers than from heroin and cocaine combined.

An estimated 14,800 people died in the United States from painkiller overdoses in 2008, a more than threefold jump from the 4,000 deaths recorded in 1999, the CDC said in a new report. Prescription and illegal drugs caused 36,450 deaths in 2008, compared with 39,973 deaths from motor vehicle crashes, according to the Associated Press.

The CDC said painkiller abuse and deaths are rising because the drugs are easier than ever to obtain. They cited the growth of “pill mills,” clinics that prescribe opioids without first conducting medical exams, and “doctor shopping,” or receiving multiple prescriptions from different doctors.   According to the CDC, enough painkillers were prescribed in 2010 to medicate every American adult around the clock for a month. “Right now, the system is awash in opioids—dangerous drugs that got people hooked and keep them hooked,” said CDC Director Thomas Frieden.

“Prescription drug abuse is a silent epidemic that is stealing thousands of lives and tearing apart communities and families across America,” Gil Kerlikowske, Director of National Drug Control Policy, said in a CDC news release. He noted health care providers and patients should be educated on the risks of prescription painkillers. “Parents and grandparents should properly dispose of any unneeded or expired medications from the home and to talk to their kids about the misuse and abuse of prescription drugs,” he noted.

Source: ww.drugfree.org.  2nd Nov.2011

Nicotine appears to be a “gateway” drug that primes the brain to be susceptible to cocaine, according to a new study in mice.  The researchers say if further studies show the findings apply to humans, a decrease in smoking rates in young people would be expected to lead to a decrease in cocaine addiction, the Los Angeles Times reports.

The study found mice exposed to nicotine in drinking water for at least seven days showed an increased response to cocaine. The researchers also looked at data on cocaine use among a group of high school students, and found 81 percent of those who started using cocaine did so in a month when they were smoking tobacco.

The findings appear in the journal Science Translational Medicine.
Previous studies have shown that most illegal drug users report using tobacco products or alcohol before they started illicit drug use, according to a news release by the National Institute on Drug Abuse, which funded the study. Until now, studies have not shown a biological mechanism through which exposure to nicotine increases vulnerability to illegal drug use, the release notes.

“Now that we have a mouse model of the actions of nicotine as a gateway drug this will allow us to explore the molecular mechanisms by which alcohol and marijuana might act as gateway drugs,” lead author Eric Kandel, MD, of Columbia University Medical Center, said in the release. “In particular, we would be interested in knowing if there is a single, common mechanism for all gateway drugs or if each drug utilizes a distinct mechanism.”

Source:   www.drugfree.org.  4th Nov.

The headline below from the Daily Mail on the 18th October 2011, suggests that 50% of the population of America favour legalizing marijuana.   However  Jose Paulo Carneiro, a statistics expert from Brazil,  writes a critique of this survey and shows that the results issued by Gallup Poll are not what they seem to be suggesting.
The saying ‘Lies, Damn Lies and Statistics’ comes to mind.    NDPA
                                                                                      *  *  *  *  *  *
Record high: Gallup poll shows FIFTY per cent of Americans favour legalising marijuana    –    18th October 2011
• Up from 46 per cent last year
• Liberals and those 18 to 29 most in favour
• Americans 65 and older most oppose
Read more: http://www.dailymail.co.uk/news/article-2050348/Legalisation-marijuana-50-Americans-favour.html#ixzz1boJx8Vwj
*  *  *  *  *  *

“First of all, what is the methodology of this survey? What is the universe? Of course, it cannot be all the Americans.   Suppose it is the American population between 15 and 64 years (approximately 205.7 million).

If the sample were a simple random sample (that is, all the individuals have the same probability of being selected), the fact that the sample size is a tiny proportion of the population would not matter, because in the formula for the sample standard deviation (let us call it s) of a proportion to be estimated, the size N of the universe only appears in a factor, which, for a sample size of 1,005, equals 0.999995, which is practically 1. 

Then, the maximum value for s, which occurs precisely for the 50% proportion and is independent of N, reduces to 1.6%. This means (supposing, as usual, the normality of the sampling distribution) that there is a probability of 95% that a real proportion of 50% will appear in the sample between 46.8% and 53.2% (this is the meaning of the phrase “the survey error is 3.2%”), which is a very acceptable value.

The problem is not in the sample size. The problem is that a telephone survey is not a simple sample survey, because not all individuals have the same chance of being selected. If you don’t have a telephone number, your probability of being selected is zero. If you have three telephone numbers and your neighbor has only one, your probability of being selected is three times his. Moreover, even inside a specific household, the probabilities are different. In certain households (mine, for instance), the probability that the husband answers the phone is very small compared with the probability that the wife does it. And, what is worse: the sample is biased, because there may be – and usually there is – a specific profile of people who answer, opposed to that of people who don’t answer the call.

In summary, it is very surprising that an Institute so renowned as Gallup, in a country so developed in matters of survey and research, makes a telephone survey and draws a conclusion about the opinion of “half of the Americans”.

Jose Paulo Carneiro, Expert in Statistics and Surveys, Rio de Janeiro, Brazil. Oct.2011

Feinstein says the marijuana users performed significantly worse than the non-users on tests measuring attention, speed of thinking, visual perception, and cognition related to planning and organizing.  Scores on one test measuring speed of processing information were about a third lower among marijuana users compared to non-users.  Thirty-two percent of non-users and 64% of users met the definition of globally cognitively impaired, meaning that they had measurable impairments in two or more aspects of intellectual functioning.

Neurologist Lily Jung Hensen, MD, of Seattle’s Swedish Neurosciences Institute, tells WebMD that the findings make a strong argument that the cognitive risks associated with marijuana use outweigh potential benefits for MS patients.

Source: http://www.cbs47.tv/webmd/ms/story/Medical-Marijuana-May-Impair-Thinking-of-MS/FmQ00ndFKkKhQ199RrPTDQ.cspx  Oct.2011

A single cannabis joint has the same effect on the lungs as smoking up to five cigarettes in one go, indicates research published ahead of print in the journal Thorax.

The researchers base their findings on 339 adults up to the age of 70, selected from an ongoing study of respiratory health, and categorised into four different groups.

These comprised those who smoked only cannabis, equivalent to at least one joint a day for five years; those who smoked tobacco only, equivalent to a pack of cigarettes a day for at least a year; those who smoked both; and those who did not smoke either cannabis or tobacco.

All the participants had high definition x-ray scans (computed tomography) taken of their lungs and they took special breathing tests designed to assess how well their lungs worked.

They were also questioned about their smoking habits.
Seventy five people smoked only cannabis, and 91 smoked both. Eighty one people did not smoke either, and 92 smoked only tobacco.

Combined smokers tended to use less tobacco, the findings showed.
Cannabis smokers complained of wheeze, cough, chest tightness and phlegm. But emphysema, the progressive and crippling lung disease, was only seen in those who smoked tobacco, either alone or in combination.
But cannabis still damaged the lungs and stopped them from working properly.

It diminished the numbers of small fine airways, which are important for transporting oxygen and waste products to and from the blood vessels effectively.
And it damaged the large airways of the lung, blocking airflow, and forcing the lungs to work harder.
The extent of this damage was directly related to the number of joints smoked, with higher consumption linked to greater incapacity.

The effect on the lungs of each joint was equivalent to smoking between 2.5 and five cigarettes in one go.
The authors explain that the impact of cannabis is strongly associated with the way in which it is smoked. It is usually smoked without a filter, and at a higher temperature. Smokers tend to inhale more deeply and to hold their breath for longer.

Source:  Retrieved August 8, 2009, from http://www.sciencedaily.com

Abstract

Since 1996, 16 states and the District of Columbia in the United States have enacted legislation to decriminalize marijuana for medical use. Although marijuana is the most commonly detected non alcohol drug in drivers, its role in crash causation remains unsettled. To assess the association between marijuana use and crash risk, the authors performed a meta-analysis of 9 epidemiologic studies published in English in the past 2 decades identified through a systematic search of bibliographic databases. Estimated odds ratios relating marijuana use to crash risk reported in these studies ranged from 0.85 to 7.16. Pooled analysis based on the random-effects model yielded a summary odds ratio of 2.66 (95% confidence interval: 2.07, 3.41). Analysis of individual studies indicated that the heightened risk of crash involvement associated with marijuana use persisted after adjustment for confounding variables and that the risk of crash involvement increased in a dose-response fashion with the concentration of 11-nor-9-carboxy-delta-9-tetrahydrocannabinol detected in the urine and the frequency of self-reported marijuana use. The results of this meta-analysis suggest that marijuana use by drivers is associated with a significantly increased risk of being involved in motor vehicle crashes.

Source:  Epidemiology Rev (2011) doi: 10.1093/epirev/mxr017

1. Killian A. Welch, MD, MRCPsych  et al 

Correspondence:: kwelch1@staffmail.ed.ac.uk

Background
No longitudinal study has yet examined the association between substance use and brain volume changes in a population at high risk of schizophrenia.

Aims
To examine the effects of cannabis on longitudinal thalamus and amygdala-hippocampal complex volumes within a population at high risk of schizophrenia.

Method
Magnetic resonance imaging scans were obtained from individuals at high genetic risk of schizophrenia at the point of entry to the Edinburgh High-Risk Study (EHRS) and approximately 2 years later. Differential thalamic and amygdala-hippocampal complex volume change in high-risk individuals exposed (n = 25) and not exposed (n = 32) to cannabis in the intervening period was investigated using repeated-measures analysis of variance.

Results
Cannabis exposure was associated with bilateral thalamic volume loss. This effect was significant on the left (F = 4.47, P = 0.04) and highly significant on the right (F = 7.66, P = 0.008). These results remained significant when individuals using other illicit drugs were removed from the analysis.

Conclusions
These are the first longitudinal data to demonstrate an association between thalamic volume loss and exposure to cannabis in currently unaffected people at familial high risk of developing schizophrenia. This observation may be important in understanding the link between cannabis exposure and the subsequent development of schizophrenia.

Source:  bjp.rcpsych.org   Sept.2011

Important insights into the continued spread of hepatitis C among injecting drug users are provided by two studies published in the online edition of the Journal of Infectious Diseases. An international team of investigators showed that infectious quantities of hepatitis C could survive on inanimate surfaces for up to seven days. However, the virus can be rendered inactive by commercially available disinfectants, or heating to a temperature of 65-70° for approximately 90 seconds.

In a separate study, French investigators detected the virus on 80% of alcohol swabs obtained from injecting drug users. They suggest that the swabs may be shared by users, risking the transmission of hepatitis C.

Holly Hagan of the New York University College of Nursing in an accompanying editorial stated: “The studies contribute new knowledge to our understanding of the mechanisms by which HCV [hepatitis C virus] may be transmitted among PWID [people who inject drugs] via injection-related materials.”

There are an estimated 130 million hepatitis C infections worldwide. Hepatitis C is a blood-borne infection and a major mode of transmission is injecting drug use. Needle and syringe exchange programmes have been introduced in many countries to control the epidemic. The have been highly effective at preventing new HIV infections, but hepatitis C transmissions still continue. This is possibly because viral load tends to be high in individuals with chronic hepatitis C infection, and even small quantities of contaminated blood are potentially infectious.

A team of investigators led by Juliane Doerrbecker wished to establish a clearer understanding of the survival of the virus, and the effectiveness of disinfectants and heat at rendering the virus non-infectious. Steel discs were contaminated with infectious quantities of hepatitis C which were then allowed to dry. Reassuringly, commercially available disinfectants were also shown to have “a high virucidal efficacy against HCV.”

Tests also showed that infectious quantities of hepatitis C of approximately 30 TCID50/ml could still be detected on inanimate surfaces up to seven days after contamination. However, the investigators emphasised that “all tested biocides were able to inactivate HCV infectivity to undetectable levels.”

The investigators then examined the effect of heat on the virus. Spoons and/or cookers are used to heat diluted heroin into solutions. The liquid is then drawn into a syringe, potentially contaminating the spoon if hepatitis C-infected blood is present in the syringe. The investigators therefore contaminated spoons with the virus, which were then heated to various temperatures using tea candles.

Infectivity started to decrease at temperatures of approximately 50°. Levels of the virus fell below the limit of detection when temperatures reached 67-70°. It generally took between 80 to 95 seconds for heating to produce small bubbles in the spoon.

“Reusing HCV contaminated cookers could lead to infection even if using sterile syringes,” comment the investigators. Holly Hagan emphasised that injecting drug users rarely heat spoons for more than 15 seconds.

In separate research, Dr Vincent Thibault and his colleagues collected drug-using paraphernalia from individuals known to be infected with hepatitis C. The used paraphernalia included syringes, filters and water cups, swabs for cleaning of skin before injecting and pads employed to stop bleeding after withdrawal of needles. A total of 160 pieces of equipment were collected.

The virus was detected on 44% of the pooled materials. A further 620 items used by individuals of unknown infection status were also obtained. Approximately 83% of the pools obtained from swabs had detectable hepatitis C. Moreover, viral load was highest (above 3 log10 iu/ml) within these swab pools. Hepatitis C was also commonly detected in syringes, but viral load tended to be at low levels (12 to 890 iu/ml). The investigators therefore believe that there is “a higher chance for PWID to be contaminated though sharing of a tainted spoon rather than a tainted syringe.”

They note that blood was often visible on swabs. The researchers therefore suggest that transmission of the virus could occur if swabs were being used inappropriately. “The chaotic and rushed atmosphere of the injection setting, where swab sharing and mixing could take place, is…an important factor that should be considered.”

Holly Hagan believes the two studies have important implications for hepatitis C prevention programmes. “Cleaning cookers or perhaps impregnating injection equipment with safe biocides may help reduce the incidence of new infections. Promoting safe swab use to emphasize avoidance of reuse seems a prudent measure.”

Reference
Doerrbecker J et al. Inactivation and survival of hepatitis C virus on inanimate surfaces. J Infect Dis, online edition, doi: 101093/infdis/jir535 (click here for the abstract).

Thibault V et al. Hepatitis C transmission in injecting drug users: could swabs be the main culprit? J Infect Dis, online edition, doi: 101093/infdis/jir650 (click here for the abstract).

Source: www.aidsmap.com 4th Nov.2011

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

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

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

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

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

The ACMD called for a review on how those caught in possession of drugs are handled in a submission to the Sentencing Council, which is consulting on guidelines for courts on drug offences.

However, it is not in the remit of the Sentencing Council to consider what would effectively decriminalisation and the ACMD only included its comments in the final section asking for any further comments. It wrote: “There is an opportunity to be more creative in dealing with those who have committed an offence by possession of drugs.

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

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

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

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

The California Medical Association (CMA) took a major leap lacking science and common sense. With the issuance of a White Paper calling for the legalization of marijuana for medical and non-medial purposes, they have transitioned from a medical group into a lapdog of the drug legalization lobby.
“I am thoroughly appalled by the CMA’s decision to release this policy in an attempt to legalize a drug that we know causes so much harm to individuals and families,” said Eric Voth, M.D., F.A.C.P. and Chair of the Institute on Global Drug Policy. “The CMA has managed to single-handedly make a mockery of modern medicine and the ethical practices of physicians. There is nothing scientific about this White Paper – it is total politics.”

The White Paper just released contains a number of incorrect statements. Contrary to what the paper states:
• According to the National Household Survey on Drug Abuse, the rate of current, past 30-day use of marijuana by Americans aged 12 and older in 1979 was 13.2%. In 2008 that figure stood at 6.1%. This 54% reduction over that 29-year period is a major public health triumph, not a failure! Now, we must not only push back against the drugs but, the advocates who seek to normalize and legalize them.
• The Netherlands reclassified high potency marijuana as a “hard drug” because of the harms that have occurred from the drug and moved to shut down hundreds of “coffee shops” that serve marijuana. Their lenient policy caught up with them and they are moving back to more conservative actions.
• Portugal’s policy that decriminalized consumption and possession of illicit drugs in 2001 was a dismal failure. The 2007 national drug survey showed an increase in life-time prevalence of drug use in the general population, especially regarding cannabis use and use of cocaine has nearly doubled. Cocaine seizures increased seven-fold between 2001and 2006 and murders increased 40%.

“The CMA is dead wrong in asserting that the marijuana legalization movement is driven by the public. Instead it is driven by a group of well-financed legalization advocates. The ballot initiative to legalize pot was defeated in California and no other state has approved such an ill-advised policy, despite millions of dollars poured into this effort by ivory-tower elitists unaffected by the impact of drug use, like the rest of us. Even the issue of marijuana as medicine was rejected by two-thirds of the country,” stated Calvina Fay, Executive Director of Drug Free America Foundation.

“It is laudable that CMA supports more research and more education efforts to reduce marijuana use among children, adolescents, and young adults (although we believe it should include all adults). Ongoing research into potential medicines and cures is an important endeavor but, the solution should be to require marijuana to meet the standards of modern medicine, not by ballot initiatives or legislation and certainly not by legalizing it for recreational use” Fay concluded.
Drug Free America Foundation, Inc. is dedicated to fighting drug use, drug addiction and drug trafficking and to promoting effective sound drug policies, education and prevention.

Source: www.dfaf.org October 17, 2011

The price of cannabis has declined more than 40% (4.9% p.a.) in real terms during the 1990s, far greater than for most other agricultural products. Cannabis price may be declining because of increasing use of more efficient hydroponic cultivation techniques and also because decreasing law enforcement lowered the ‘full cost’ of cannabis. The number of national arrests and prosecutions per 100,000 population fell by almost one third between 1996 and 2001. Penalties also became less severe. If cannabis price had been constant, consumption of beer would have been 2.4% higher, wine 4.9% higher, spirits 9.8% higher and cannabis 10.4% lower.

Comment: As the health, social and economic costs of alcohol are greater than for cannabis, decreasing cannabis prices may have reduced harm from legal drugs.

Source: Clements KW. The Australian Journal of Agricultural and Resource Economics. 2004. 48:2; 271-300

University of Adelaide researchers have found that immune cells in your brain may contribute to how you respond to alcohol. Lead researcher Dr Mark Hutchinson, ARC Research Fellow with the University’s School of Medical Sciences, said his team’s research provided new evidence that an immune response in the brain was involved in behavioural responses to alcohol. This immune response lies behind some of the well-known alcohol-related behavioural changes, such as difficulty controlling the muscles involved in walking and talking.

“It’s amazing to think that despite 10,000 years of using alcohol, and several decades of investigation into the way that alcohol affects the nerve cells in our brain, we are still trying to figure out exactly how it works,” says lead researcher Dr Mark Hutchinson from the University’s School of Medical Sciences.
“Alcohol is consumed annually by two billion people world-wide with its abuse posing a significant health and social problem,” said Dr Hutchinson. “Over 76 million people are diagnosed with an alcohol abuse disorder. “This work has significant implications for our understanding of the way alcohol affects us, as it is both an immunological and neuronal response. Such a shift in mindset has significant implications for identifying individuals who may have bad outcomes after consuming alcohol, and it could lead to a way of detecting people who are at greater risk of developing brain damage after long-term drinking.”

The research is published in the latest edition of the British Journal of Pharmacology by PhD student Yue Wu, supervisor Dr Hutchinson, and others. Laboratory mice were given a single shot of alcohol and the researchers studied the effect of blocking toll-like receptors, a particular element of the immune system, on the behavioural changes induced by alcohol. The researchers studied the effects of blocking the receptors by drugs, and also the effects of giving alcohol to mice that had been genetically altered so that they were lacking the functions of the selected receptors.

“The results showed that blocking this part of the immune system, either with the drug or genetically, reduced the effects of alcohol,” Dr Hutchinson said. He believes similar treatment could work in humans. “Medications targeting this specific receptor ‒ toll-like receptor 4 ‒ may prove beneficial in treating alcohol dependence and acute overdoses,” Dr Hutchinson said.

Source: http://ahha.asn.au/news mark.hutchinson@adelaide. 29th Sept.2011

Killias M., Isenring G.L., Gilliéron G. et al.
European Journal of Criminology: 2011, 8(3), p. 171–186.

Studies of a ‘natural experiment’ in Switzerland in the 2000s suggested that the effective re-criminalisation of cannabis production and distribution did diminish availability and use of the drug. The results contradict other findings suggesting that national policies have little effect on cannabis use.

Summary
A ‘natural experiment’ in Switzerland in the 2000s revealed the impacts of changes in the enforcement of cannabis production and distribution laws. By 2001, in response to public sentiment Switzerland had already relaxed its enforcement of laws against the use and distribution of cannabis. At this time the government prepared reforms to enshrine this in law by officially tolerating the sale, possession and use of small amounts of cannabis (usually below 5g), and the production and sale of larger quantities as long as producers and retailers agreed to act under strict control by police and the Department of Agriculture. Though this change had yet to be implemented, in anticipation over the following years visible and quasi-official structures of production, distribution and sale emerged. Concerned over some of the consequences, in 2003 and again in 2004 the Swiss parliament rejected the proposed changes. Over the following months, police and prosecutors resumed former more repressive policies, especially in respect of production and distribution. As a result, shops and production centres were closed during 2005 and 2006. It was this reversal which offered the opportunity to evaluate the impact of tolerance of legal production and distribution versus lack of tolerance.

Main findings
Early in 2004 shortly before most of their shops were closed, a survey of cannabis retailers suggested that competition between shops was quite stiff, particularly in respect of price. Nearly all felt they had to provide excellent products and service to keep their customers. Though many said they had never sold high strength and/or smokeable cannabis, this conflicted with the number of prosecutions for selling cannabis whose main active ingredient (THC) was above the legal limit.

In summer 2004 when many cannabis shops were still operating, two young men aged around 18 conducted ‘test purchase’ operations at 50 shops. Of these, 29 sold cannabis without reservation and 26 did so regardless of the young men’s age. Usually, the fake clients asked for 5g or the quantity available for about 50 Swiss francs. The quantities actually sold generally varied between 3.8g and 6.5g and THC levels between 8% and 28%, averaging 16%. Overall, the study confirmed that minors easily obtained high-strength cannabis. Most samples contained THC close to the average of 16% and prices varied little around 11 Swiss francs per gram. In short, quality and prices were fairly well standardised.
In 2009 when all known cannabis shops had closed, a second ‘test purchase’ operation was conducted, but this time to test the availability of supplies on the now fully illicit market. Two young men walked through inner-city areas where police said cannabis was most available, looking for potential dealers. Over 15 afternoons they made 29 relevant contacts; during 27 they were able to obtain cannabis. All the sales took place in streets and parks. Usually the fake clients were able to spot a dealer in under 20 minutes. The quantity purchased varied far more than in 2004, ranging from 0.38 to nearly 13 grams. Equally inconsistent were prices, varying greatly between 8 and 200 francs per gram. A typical price was 28 francs. The THC content varied between 4% and 18% and averaged 12%, lower than in 2004. At every transaction, the fake clients asked whether the dealer might be able or willing to supply other substances. Only one said they could.

Compared to 2004, typical prices paid per gram had increased from 11 to 28 francs and the variability in price and quantity was much greater and THC content lower. From the relatively standardised market of 2004, by 2009 the price structure was, from the clients’ point of view, relatively obscure and bore little relation to the origin or strength of the product.

The authors’ conclusions
The results of our studies suggest that legal policies can strongly affect production, supply, distribution and sale of cannabis. The switch from a liberal to a more repressive policy meant that large-scale agricultural was partly replaced by small-scale production on private premises, and sales moved back from shops to the streets. Formerly an export country, illegal import of cannabis in to Switzerland resumed, though probably not enough to compensate for lost local production. For users without links to home-based production networks, availability of cannabis may have decreased substantially, probably prompting decreased consumption. However, the market and its price structure became far more variable and obscure. Prices soared, possibly reflecting reduced supply and more marginal and criminal suppliers. Street sales favoured cheating because quantities cannot be accurately weighed and suppliers had little interest in repeat sales to unknown customers, feeling little need to gain their trust. On the other hand, and contrary to a widely held view, markets for cannabis and other substances seem to have remained separated.

Surveys in Switzerland and abroad suggest that policies making cannabis more easily available were followed by increasing rates of use, whereas Switzerland’s opposite policy after 2004 was associated with a drop in both the prevalence and frequency of cannabis use. Establishing to what extent policy changes caused changes in use is for the moment impossible, but data is consistent with the assumption that policies affect the availability and (indirectly) use of cannabis.

This draft entry is currently subject to consultation and correction by study authors.
Last revised 06 October 2011
Source : European Journal of Criminology: 2011, 8(3), p. 171–186.

ONE in four people carries genes that increases vulnerability to psychotic illnesses if he or she smokes cannabis as a teenager, scientists have found.

A common genetic profile that makes cannabis five times more likely to trigger schizophrenia and similar disorders has been identified, increasing pressure on the Government to reverse the drug’s reclassification from Class B to Class C.

The increased risk applies to people who inherit variants of a gene named COMT who also smoked cannabis as teenagers. About a quarter of the population have this genetic make-up, and up to 15 per cent of the group are likely to develop psychotic conditions if exposed to the drug early in life.

Neither the drug nor the gene raises the risk of psychosis by itself.

The study, led by Avshalom Caspi and Terrie Moffitt, of the Institute of Psychiatry at King’s College London, offers the best explanation yet for the way that cannabis has a devastating psychiatric impact on some users but leaves most unharmed. Scientists had suspected that genetic factors were responsible for this divide, but a gene had not been pinpointed.

The findings, to be published in Biological Psychiatry, also reinforce a growing consensus that nature and nurture are not mutually exclusive forces but combine to affect behaviour and health. The King’s team has previously identified genes that raise the risk of depression or aggression, but only in conjunction with environmental influences.

Mental health campaigners said that the results vindicated their concerns about the decision last year to downgrade cannabis to a Class C drug, which means that possession is no longer an arrestable offence.

Marjorie Wallace, chief executive of the mental health charity Sane, said that it was becoming clear that cannabis placed millions of users at risk of lasting mental illness. About fifteen million Britons have tried cannabis, and between two million and five million are regular users, according to the Home Office British Crime Survey. The research suggests that a quarter could be at risk.

The evidence will be considered by a review of the drug’s classification announced last month by the Home Secretary. It may be possible to develop a test for genetic susceptibility to cannabis. “If we were able genetically to identify the vulnerable individuals in advance, we would be able to save thousands of minds, if not lives,” Ms Wallace said.

Dr Caspi, however, rejected the idea of screening based on the COMT gene. “Such a test would be wrong more often than it is right. Cannabis has many other adverse effects, especially on developing teenagers, on respiratory health and possibly on cognitive function. Effects may be pronounced among a genetically vulnerable group but that doesn’t mean we should encourage others not genetically vulnerable to use cannabis.”

The King’s team tracked 803 men and women born in Dunedin, New Zealand, in 1972 and 1973, who were enrolled at birth in a research project. Each was interviewed at 13, 15 and 18 about cannabis use, tested to determine which type of COMT genes they had inherited, and followed up at 26 for signs of mental illness.

COMT was chosen as it is known to play a part in the production of dopamine, a brain-signalling chemical that is abnormal in schizophrenia. It comes in two variants, known as valine or methionine, and every person has two copies, one from each parent.

Among people with two methionine variants, the rate of psychotic illness was 3 per cent, the background rate for the general population, regardless of whether they had used cannabis as teenagers.

Among those with two valine variants the rate was 3 per cent for non-users but 15 per cent for those who had smoked cannabis in their teens.

Dr Caspi said research had shown that the valine gene variant and cannabis affect the brain’s dopamine system in similar fashion, suggesting that they deliver a “double dose” that can be damaging. The work needs to be replicated by others to confirm the findings, Dr Caspi said. It also is possible that the gene involved is not COMT but a neighbour.

THE DRUG OF CHOICE FOR MILLIONS

• Cannabis was reclassified from a Class B to a Class C drug in January 2004. Possession remains illegal, but is not an arrestable offence. The Home Secretary has asked for a review by November
• The Home Office estimates that fifteen million people have tried cannabis, two million to five million are regular users and reclassification has saved 199,000 hours’ police work
• Liberalisation campaigners argue that millions smoke the drug with fewer ill-effects than others suffer from alcohol or tobacco
• A recent study at Maastricht University found that cannabis doubles the risk of schizophrenia, hallucinations and paranoia among a genetically susceptible group

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

Children of drug addicts are suffering in desperation as shame and secrecy shroud the substance misuse in families, it was claimed today.

Youngsters whose parents take drugs are also more likely to have problems with substances, as well as their mental health, social skills and academically, a seminar heard. Joan O’Flynn, director of the National Advisory Committee on Drugs (NACD), said there is a need for more integration between addiction services, children’s services and medical professionals.

“Alcohol and drugs misuse by parents can impact negatively on a child’s experience of positive parenting and can create stressful family circumstances that impact on child development,” she said. “For many of the affected children, the effect of their parents’ substance misuse continues into their adult lives.

“For some, the impact can be multifaceted and persist not only into adult life but even into the lives of the next generation.” She added that stress, combined with the increased likelihood of the child being in care or homeless, leaves young people at a high risk of emotional isolation or social marginalisation.

Alcohol Action Ireland estimates between 61,000 and 104,000 children aged under 15 are living with parents who misuse alcohol. Director Fiona Ryan said: “Shame and secrecy shroud the issue of substance misuse in families with children living lives of quiet desperation.

“Alcohol Action Ireland has spent the past three years campaigning for children affected by parental alcohol problems to be seen and heard.” An NACD report – ‘Parental Substance Misuse: Addressing its Impact on Children’ – was launched at a seminar it jointly hosted with the Health Service Executive (HSE) and Alcohol Action Ireland, the national charity for alcohol-related issues.

The report reviewed all major international research on the impact of parental substance misuse on children and identified what steps can be taken in Ireland to reduce its impact.

It recommended additional research and data be collected to properly estimate the number of children whose parents have substance misuse problems. It also wants an assessment of which adult alcohol and drug treatment services are supporting parents and liaising with child support services. Women should also be educated on the adverse effects of consuming alcohol and drugs during pregnancy, it added.

Source: www.IrishExaminer.com 26th October 2011

Irish research shows addicts on methadone programme still abusing crack cocaine and other substances. The Irish Government drugs policy needs to change
There has been an apparent levelling off of the need for opiate centred drug treatment. However the researchers believe their findings show that this is misleading. Their evidence suggests that multiple drug use is the norm among many addicts.

Realities of Drug Misuse Investigated

The study was led by Dr A. Jamie Saris (Principal Investigator) and Fiona O’Reilly (Primary Field Researcher), Dept of Anthropology at NUI Maynooth and is the result of a long-term study which closely examined the realities of drug misuse in three adjacent neighbourhoods.
Of 92 abusers surveyed, 98% were on a methadone drugs treatment programme yet almost two thirds claimed to have used heroin within the past 3 months. Whilst over half were on prescription tranquilisers almost as many had used illegally obtained tranquilisers. Nearly one third had used crack cocaine and more than one in five powder cocaine. “Multiple drug use is the reality for nearly all users, and official policy needs to have this understanding at its centre”, claims Dr Saris.

Stigma Against Heroin Among the Young

A surprising finding was that there is a stigma against heroin among many of the younger users (aged 16 to 25). But these individuals still abuse what the study team describe as a “dizzying array” of other substances. The established approach to treatment, being so heavily focused on heroin, means that the issues faced by such people are not being addressed.
Another problem with the focus on crack and heroin is that it sets the users of those drugs apart from society when, in fact, such people are rarely defined solely by their addiction. A lot of local community activities aimed at assisting users recognise that they often lead lives that are not so very different from everyone else.
Drug Treatment Services Should Focus on Individuals
However it is often difficult to justify such activities to official funders under the rubric of ‘treatment’, as currently understood. Dr Saris believes that it is important to understand who users are, what they are taking and why, so that the authorities can assign the appropriate resources, treatments or management systems.
Tony MacCarrthaigh chairs the Local Drugs Task Force that covers the area of the study and he agrees with Dr Saris. “Individuals and not chemicals, need to become the focal point of treatment, and that treatment needs to assist individuals in developing another orientation not just to drugs, but to life,” he said. (A Dizzying Array of Substances; An Ethnographic Study of Drug Use in the Canal Communities, Department of Anthropology, NUI Maynooth, 2010.)

Source: Apparent Success of Drug Treatment Aimed at Heroin is Misleading

http://news.suite101.com/article.cfm/apparent-success-of-drug-treatment-aimed-at-heroin-is-misleading-a259572#ixzz0tO3OAGXw

“Methadone prescriptions for heroin addicts would be cut and the National Treatment Agency that runs the programme scrapped under plans from the Tories favourite think-tank,” reports Rosemary Bennett, social affairs correspondent of The Times newspaper.

“The Centre for Social Justice, set up by Iain Duncan Smith, the Work and Pensions Secretary, said it was unacceptable that only 4% of addicts in treatment ever get “clean” and accused the agency of “pushing aside” proper rehabilitation. The Times has also learnt that the highly influential think-tank will use a report on Monday to throw its weight behind Ken Clarke, the Justice Secretary, who called for short prison sentences to be scrapped.The report will state that the CSJ agrees with him that short sentences of two months do nothing to help to rehabilitate offenders and should be replaced by community orders.”

The CSJ’s Green Paper on Criminal Justice and Addiction comes as the government considers major changes to drug policy and the future of the National Treatment Agency. Set up in 2001, the NTA oversees the controversial “harm reduction” strategy – most recent NTA treatment statistics show that of the 207,000 addicts a year who use ‘treatment’ services, only 8,980 completed their treatment drug free.4,600 addicts have access to residential rehabilitation.Numerous residential drug rehabilitation centres have closed because of lack of patients, despite no sharp fall in the number of addicts.

The CSJ said that the NTA, the running costs of which have spiralled to £18million a year, merely processes addicts with a “fatalistic” belief that they can never get clean. It wants it scrapped and replaced by an Addiction Recovery Board, chaired by a minister and charged with getting addicts off drugs altogether, using the best local private sector and charity programmes, or “recovery communities”.

The report says there is a role for methadone, but it should be used only as part of a wider treatment programme, with abstinence the goal.

“There is no strategy or incentive to reduce the numbers on maintenance treatment and move people into recovery,” the CSJ said. The report is also highly critical of how drug use is tolerated in prison: 55% of prisoners received into custody each year are classified as problematic drug users. According to the Ministry of Justice, one in five men who reports using mainstream drugs first used them in prison.

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

On Tuesday, July 20th 2010, internationally recognized anti-drug experts from every region of the world united to oppose a set of dangerous unproven global strategies recommended in the Vienna Declaration. The declaration is based on three false premises: 1) that the criminalization of illegal drug use fuels the HIV/AIDS epidemic, 2) that criminal justice and health promotion are conflicting approaches to drug policy, and 3) that the major costs of illegal drug use are those generated by the criminal justice system.
This document was released in anticipation of the 18th International AIDS Conference and has been under scrutiny by several non-governmental organizations. Calvina Fay, Executive Director of Drug Free America Foundation says, “There is no ‘reasonable evidence’ that supports the strategies outlined in the Vienna Declaration. Further, we should reject ineffective harm reduction tactics that are not based on scientific evidence while accepting drug use and creating an illusion that drugs can be used safely or responsibly. Such ill-conceived schemes foster the misunderstanding that drug use itself is not harmful and increases addiction.”
Many of the experts who opposed the Vienna Declaration know from research and practical experience that the optimal way to truly beat addiction, prevent the spread of AIDS and other sexually transmitted diseases, and prevent drug-related harm are effective strategies that target drug use and include prevention, education, treatment and law enforcement efforts and do not trade one for the other.
“The best foundation for prevention is policy. We know from experience that a balanced and restrictive drug policy is effective in keeping drug use at low levels. Since drug utilization in itself is an important risk factor for being infected by HIV, it is good AIDS-prevention to preclude illicit drug use. We must always strive to protect young people from getting involved with illegal drugs,” says Sven-Olov Carlsson, International President, World Federation Against Drugs.

To view the full joint statement issued opposing the Vienna Declaration, please visit www.wfad.se. If you would like to conduct an interview with Ms. Fay, Mr. Carlsson and/or other drug policy and prevention experts on this statement, please contact Lana Beck, Director of Communications with Drug Free America Foundation, Inc. at 727-828-0211 or 727-403-7571.

The World Federation Against Drugs (www.wfad.se) is a multilateral community of non-governmental organizations and individuals. Founded in 2009, the aim of WFAD is to work for a drug-free world. Drug Free America Foundation (www.dfaf.org) is a national and international nonprofit organization dedicated to fighting drug use, drug addiction and drug trafficking and to promoting effective sound drug policies, education and prevention. Drug Free America Foundation is a Non-Governmental Organization (NGO) in Special Consultative Status with the Economic and Social Council of the United Nations.

For More Info Contact Lana Beck 727-828-0211 or 727-403-7571 after hours

Source: Joint Press Release from www.wfad.se and www.wfad.se July 2010

The criminalization of illicit drug use provides positive health and social benefits by deterring nonmedical use of substances that cause great harm to HIV/AIDS-affected individuals. Incarceration that respects human rights and provides drug treatment services can accelerate an individual’s recovery from drug dependence and prevent drug-related harms to HIV/AIDS-affected individuals and prevent further proliferation of both diseases – HIV/AIDS and substance abuse.
In anticipation of the International AIDS Conference (AIDS 2010) from July 18-23, 2010,i the Vienna Declaration was released by a group of non-governmental organizations (NGOs) and signed by private individuals to outline a global strategy to deal with the modern drug epidemic. The Vienna Declaration is based on three false premises:
1) that the criminalization of illegal drug use fuels the HIV/AIDS epidemic,
2) that criminal justice and health promotion are conflicting approaches to drug
policy, and
3) that the major costs of illegal drug use are those generated by the criminal justice system.

The prohibition of illegal drug use does not encourage the spread of HIV/AIDS, but rather it reduces illegal drug use among HIV/AIDS patients, as well as the non-infected population and thereby reduces the population vulnerable to HIV/AIDS infection by contaminated needles. Illegal drug use exacerbates weaknesses of the immune system, making individuals with AIDS more susceptible to infection and death. iii Marijuana use causes impaired immunity,iv v vi vii and opens the door for the virus that causes Kaposi’s Sarcoma,viii life-threatening for individuals with HIV/AIDS. Marijuana also contains bacteria and fungi that put users at risk for infection. ix x xi Illegal drug use among AIDS patients is life-threatening because these drugs lessen the effectiveness of anti-retroviral (ARV) medications.xii Nonmedical drug use is associated with increased risky sexual behaviors which promote transmission of HIV/AIDS in a way that needle exchange cannot prevent. xiii xiv
Illegal drug use also increases sexual violence which in turn results in more HIV infections, particularly among the most vulnerable members of society including womenxv as well as children. Mother-to-child transmission of HIV/AIDS now can be largely prevented by medical intervention; however, there is no protection for unborn fetuses from the adverse effects of a drug-using mother. xvi Joint Statement in Opposition to the Vienna Declaration Released July 20, 2010 Page 2

There are 200 million illegal drug users globally, making up 5% of the world population aged 16-64,xvii and an estimated 33.4 million people living with HIV/AIDS.xviii Since the emergence of the HIV/AIDS epidemic in 1981, an estimated 25 million people have died of HIV/AIDS-related causes and two million people die each year from this disease.xix These numbers are tragically high, but so is the number of global drug-related deaths, estimated at 223,000 each year. xx As previously noted, illegal drug use increases the risks associated with both contracting and treating HIV/AIDS. Reducing drug use must be part of the solution to curb the distressingly high HIV/AIDS death toll
.
The Vienna Declaration concludes that “reorienting drug policies towards evidence-based approaches that respect, protect and fulfill human rights has the potential to reduce harms deriving from current policies and would allow for the redirection of the vast financial resources towards where they are needed most: implementing and evaluating evidence-based prevention, regulatory, treatment and harm reduction interventions.” Prevention and treatment are admirable goals which aim to reduce illegal drug use; however many so-called “harm reduction” interventions normalize illegal drug use and inevitably lead to more nonmedical use of drugs, leading to more drug-caused harm. Real harm reduction is achieved by rejecting illegal drug use to improve the health and safety of would-be drug users.

To promote public health and public safety, and to reduce both illegal drug use and HIV/AIDS, the World Federation Against Drugs (WFAD), Drug Free America Foundation, Inc. (DFAF), Institute for Behavior and Health, Inc. (IBH) and numerous other organizations and individuals support a balanced restrictive drug policy that uses the criminal justice system, and the illegal status of nonmedical drug use, to reinforce both prevention and treatment. The current globally-endorsed balanced drug abuse prevention policy can be improved. Treatment systems can work together with the criminal justice system by incorporating new, effective and evidence-based strategies to reduce illegal drug use among criminal offenders. These approaches also reduce the commission of new crimes and associated incarceration.
The greatest costs of illegal drug use are not generated by the criminal justice system but by the nonmedical drug use itself. These costs include not only sickness and death but reduced productivity and the high healthcare costs generated by illegal drug use.

We are committed to efforts to improve current drug policy to further reduce illegal drug use by building on a balanced strategy that includes the criminal justice system. Rather than choosing between prevention and treatment on the one hand, and the criminal justice system on the other, it is important to find better ways for them to work together to achieve vital public health and public safety goals that neither can achieve alone. We know that the prevention of illegal drug use and HIV/AIDS prevention must go hand-in-hand; they are not in conflict with one another.

Organizations:
Sven-Olov Carlsson, International President, World Federation Against Drugs, www.wfad.se
Robert L. DuPont, M.D., President, Institute for Behavior and Health, Inc., www.ibhinc.org
David Evans, Esq., Executive Director, Drug Free Projects Coalition,
www.studentdrugtesting.org/
Calvina Fay, Executive Director, Drug Free America Foundation, Inc., www.dfaf.org
Members, International Task Force on Strategic Drug Policy, www.itfsdp.org Joint Statement in Opposition to the Vienna Declaration Released July 20, 2010 Page 3

Source: Joint Press Release www.dfaf.org and www.wfad.se July 20 2010

REFERENCES: XVIII International AIDS Conference. (2010). Retrieved July 12, 2010 from http://www.aids2010.org/
ii The Vienna Declaration. (2010). Retrieved June 30, 2010 from http://www.viennadeclaration.com/the-declaration.html
iii Antoniou, T., & Tseng, L. (2002). Interactions between recreational drugs and antiretroviral agents. Annual of Pharmacotherapy, 36, 1598-1613.
iv Cabral, G.A., & Vasquez, R. (1992). Delta-9-Tetrahydrocannabinol suppresses macrophage extrinsic anti-herpes virus activity, Proceedings of the Society for Experimental Biology and Medicine, 199(2), 255-63.
v American College of Allergy, Asthma and Immunology. (2004, November 17). Immunological changes associated with prolonged marijuana smoking.
vi Tashkin, D.P., Baldwin, G.C., Sarafian, T., Dubinett, S., & Roth, M.D. (2002). Respiratory and immunologic consequences of marijuana smoking. Journal of Clinical Pharmacology, 42(11 Suppl), 71S-81S.
vii Wu, T.C., Tashkin, D.P., Djahed, B., & Rose, J.E. (1988). Pulmonary hazards of smoking marijuana as compared with tobacco. New England Journal of Medicine, 318(6), 347-351.
viii American Association for Cancer Research. (2007, August 2). Marijuana component opens the door for virus that causes Kaposi’s sarcoma. ScienceDaily. Retrieved July 7, 2010 from http://www.sciencedaily.com/releases/2007/08/070801112156.htm
ix Fleisher, M., Winawer, S.J., & Zauber, A.G. (1991). Aspergillosis and marijuana. [Letter]. Annals of Internal Medicine, 115, 578-579.
x Ramirez, J. (1990). Acute pulmonary histoplasmosis: newly recognized hazard of marijuana plant hunters. American Journal of Medicine, 88(5), 60N-62N.
xi Taylor, D.N., Wachsmuth, I.K., Shangkuan, Y.H., Schmidt, E.V., Barrett, T.J., et al. (1982). Salmonellosis associated with marijuana: A multi state outbreak traced by plasmid fingerprinting. New England Journal of Medicine, 306(21), 1249-1253.
xii Ghaziani, A. (2005, October). Crystal methamphetamine use and antiretroviral drug resistance: A pilot study of behavioral and clinical correlates. International Association of Physicians in AIDS Care. IAPAC Monthly, 297-299. Retrieved July 9, 2010 from http://img.thebody.com/legacyAssets/22/36/meth.pdf
xiii Wechsberg, W.M., Parry, C.D.H., & Jewkes, R.K. (2010, May). Drugs, sex, gender-based violence, and the intersection of the HIV/AIDS epidemic with vulnerable women in South Africa. RTI Press. Retrieved July 9, 2010 from http://www.rti.org/pubs/pb-0001-1005-wechsberg.pdf
xiv Colfax, G., Coates, T.J., Husnik, M.J., Huang, Y., Buchbinder, S., Koblin, B., et al. (2005). Longitudinal patterns of methamphetamine, popper (amyl nitrite), and cocaine use and high-risk sexual behavior among a cohort of San Francisco men who have sex with men. Journal of Urban Health, 82(1 Suppl 1), i62-i70.
xv Wechsberg, W.M., Parry, C.D.H., & Jewkes, R.K. (2010, May). Drugs, sex, gender-based violence, and the intersection of the HIV/AIDS epidemic with vulnerable women in South Africa. RTI Press. Retrieved July 9, 2010 from http://www.rti.org/pubs/pb-0001-1005-wechsberg.pdf
xvi World Health Organization. (2010). PMTCT strategic vision 2010-2015: Preventing mother-to-child transmission of HIV to reach the UNGASS and millennium development goals. Retrieved July 9, 2010 from http://www.who.int/hiv/pub/mtct/strategic_vision.pdf
xvii United Nations Office on Drugs and Crime. (2010). World Drug Report 2010. New York: United Nations. Retrieved July 7, 2010 from http://www.unodc.org/documents/wdr/WDR_2010/World_Drug_Report_2010_lo-res.pdf
xviiiUNAIDS. (2009, December). Global facts & figures. Retrieved July 7, 2010 from http://data.unaids.org/pub/FactSheet/2009/20091124_FS_global_en.pdf
xixUNAIDS. (2009, December). Global facts & figures. Retrieved July 7, 2010 from http://data.unaids.org/pub/FactSheet/2009/20091124_FS_global_en.pdf
xx National Drug Research Institute. (2003, February 25). Tobacco, alcohol and illicit drugs responsible for seven million preventable deaths worldwide. Media release. Retrieved July 7, 2010 from http://db.ndri.curtin.edu.au/media.asp?mediarelid=40

President joins calls for debate after figures reveal extent of violence since launch of military offensive against cartels in 2006.

Murders in Mexico’s drug wars are becoming increasingly gruesome.

Mexico’s president, Felipe Calderón, has joined calls for a debate on the legalisation of drugs as new figures show thousands of Mexicans every year being slaughtered in cartel wars.
“It is a fundamental debate,” the president said, belying his traditional reluctance to accept any questioning of the military-focused offensive against the country’s drug cartels that he launched in late 2006. “You have to analyse carefully the pros and cons and key arguments on both sides.” The president said he personally opposes the idea of legalisation.
Calderón’s new openness comes amid tremendous pressure to justify a strategy that has been accompanied by the spiralling of horrific violence around the country as the cartels fight each other and the government crack down. Official figures released this week put the number of drug war related murders at 28,000.

Until recently the government regularly played down the general impact of the violence by claiming that 90% of the victims were associated with the cartels, with the remainder largely from the security forces. In recent months it has started to acknowledge a growing number of “civilian victims” ranging from toddlers caught in the cross fire to students massacred at parties.
Momentum behind the idea that legalisation could be part of the solution has been growing since three prominent former Latin American presidents signed a document last year arguing the case.
César Gaviria of Colombia, Fernando Cardoso of Brazil and Ernesto Zedillo of Mexico urged existing governments to consider legalising marijuana as a way of slashing cartel profits.
This year Mexico’s national congress began a debate on the possibility that resurfaced again this week during a series of round table discussions between the Calderón, security experts, business leaders and civic groups.
The “Dialogue for Security: Evaluation and Strengthening” is part of a new government effort to counter the growing perception in Mexico that the president’s drug war strategy is a disaster.
“I’m not talking just about legalizing marijuana,” analyst and write Hector Aguilar Camin said during the Tuesday session, “rather all drugs in general.”
After accepting the need to directly address the proposal, Calderón made it clear he did not support it. “It requires a country to take a decision to put several generations of young people at risk,” he said, citing a likely increase in consumption triggered by lower prices, greater availability and social acceptability.
He added that the predicted “important economic effects by reducing income for criminal groups” would be limited by the integration of Mexican drug trafficking into international markets where drugs remain largely underground.  Calderón did not mention current moves to soften drug laws in the US, including a planned vote in California in November on an initiative that would allow marijuana to be sold and taxed. Nor did he address the home grown argument that legalisation would remove the roots of the violence raging in the country.
“Legalisation would render the war pointless as drugs would become just another product like tobacco or alcohol,” Jorge Castañeda, a legalisation advocate and former foreign minister, told W Radio. He added that even if it did prompt an increase in drug use. “It is worth considering whether this is preferable to having 28,000 deaths.”
The new death toll, which was not broken down, is significantly higher than the informal counts kept by newspapers. Milenio newspaper put the number of drug-related deaths in July at 1,234.
Some leading critics of Calderón’s strategy, however, do not believe legalisation is the key to reining in the cartels and the violence, preferring to emphasize the need to increase efforts to go after money laundering and political corruption.
Edgardo Buscaglia, and expert in organised crime around the world, argues that the recent diversification of the Mexican cartels into other criminal activities ranging from systematic extortion to people trafficking would give them ample reason to keep fighting each other, even if drugs were legal. “Legalising drugs would be good public policy,” he said, “but it would not be a tool with which to combat organized crime.”

Source: guardian.co.uk, Wednesday 4 August 2010 20.13 BST

The following is an interesting article about Drug Courts in the USA and how successful they are. It is in response to criticisms by the NACDL about drug courts.
Setting the Record Straight: Criticisms Answered

The National Association of Drug Court Professionals (NADCP) Board of Directors has unanimously approved an official position statement regarding the 2009 report by the National Association of Criminal Defense Lawyers (NACDL) purporting to identify deficiencies in the practices of Drug Courts. Following the release of their report last September, NACDL used attacks on Drug Courts to launch an aggressive media campaign. Each attack on Drug Courts was met with a thorough and factual response from NADCP. These responses, and others, are listed below.

NADCP CEO West Huddleston and NADCP Chief of Science, Law, and Policy Doug Marlowe authored the official position statement to correct assertions made in the NACDL report that are unsupported by research, as well as address some areas of common concern. NADCP encourages Drug Court professionals to use the statement as a tool for answering these criticisms and concerns should they arise.

Missouri Law Quarterly
April, 2010

Drug Courts Save Lives and Money: So Why the Criticisms?
by Dr. Douglas Marlowe, Chief of Science, Law and Policy, NADCP

More research has been published on the effects of Drug Courts than on virtually all other criminal justice programs combined. By 2006, the scientific community had concluded beyond a reasonable doubt from what are called meta-analyses (highly advanced statistical procedures) that Drug Courts reduce crime and return financial benefits to society which are several times the initial investments. A large-scale study funded by the National Institute of Justice and recently completed in 2009—called the Multi-Site Adult Drug Court Evaluation, or MADCE— has confirmed, once again, that Drug Courts reduce crime, reduce substance abuse, improve family relationships, and increase employment and school enrollment.

Yet, just as the scientific evidence is coming in decidedly in favor of Drug Courts, criticisms of Drug Courts appear to be reaching a surprising crescendo in opinion editorials and non-scientific law journals. How can we explain this seeming paradox? If the criminal justice system endorses evidence-based practices, why should negative sentiments be rising alongside favorable research findings?

The answer is at least two-fold. One group of critics appears to be turning an intentionally blind eye to the research evidence to serve a drug-decriminalization policy agenda. Although they may use scientific language to defend their objections, no amount of data could ever dissuade them from their position. A second group of critics, however, recognizes the proven efficacy of Drug Courts, but worries that some Drug Courts might produce other negative side-effects which should also be taken into account, such as impeding zealous representation by defense counsel. Because these latter critics are swayed by data, their concerns are capable of being empirically tested; and if confirmed, can point the way toward corrective measures that will advance the field rather than move it further and further behind.

One would be hard-pressed to point to a negative commentary on Drug Courts that does not, within the same pages, endorse a drug-decriminalization or legalization agenda. For decades, drug legalizers could take steady aim at the so-called “War on Drugs” with its undue emphasis on mandatory sentencing and incarceration. Such criticisms were easy to level, because the War on Drugs has been both prohibitively costly and largely ineffective at reducing drug abuse or crime.

But Drug Courts throw a potential curve ball to these arguments. Drug Courts prove that drug abuse can remain illicit without necessitating a costly and draconian punitive response. We can hold people accountable for their dangerous behavior, while at the same time supervising them in the community and providing them with needed treatment and other services. This finding could be seen by some as sweeping the legs out from under the strongest rationale for drug decriminalization. And for this reason, it has elicited a steady stream of vehement antagonism framed in the guise of an objective scientific analysis.

Other critics, however, recognize that even beneficial treatments have the potential to cause unwanted side-effects. For example, aspirin is proven to reduce pain but in some cases can cause unintended ulcers or blood thinning. This has required the medical field to take remedial measures to reduce the likelihood that such side-effects will occur and to treat any negative symptoms that do emerge. By analogy, there is always the possibility that some Drug Courts might misapply their authority or mishandle their operations to the detriment of their participants. Moreover, there is the possibility that some types of addicted offenders might not respond well to the Drug Court model and should be treated in other ways.

There are two problems, however, with how these arguments have typically been framed by critics of Drug Courts. First, they assume facts not in evidence, and second, they often seek the wrong remedy. A review of the research literature through February of 2010 failed to uncover a single empirical study confirming any of the untoward effects that have been attributed by critics to Drug Courts. For example there is no reliable evidence (apart from some critics’ personal anecdotes) that Drug Courts impede adequate evidentiary discovery by defense counsel or sentence terminated defendants more harshly than if they had never entered the Drug Court.

It would not be a difficult matter, however, to study these questions in a scientifically defensible manner. If such negative effects do exist, then corrective measures can be developed and tested to address them. And finally, practice guidelines can be developed to ensure that all Drug Courts adhere to best practices and take reasonable efforts to avoid foreseeable injuries. There is no need to “throw out the baby with the bath water.” The indicated remedy is not to abandon the most successful program we have in the criminal justice system. The appropriate course of action is to conduct more sophisticated research to improve the intervention and to develop standards to guide the actions of Drug Court professionals.

Drug Courts are here to stay not because they are politically palatable, but because they have withstood, time and again, rigorous empirical scrutiny. They work where few other programs have. The time has come for the Drug Court field to reach full maturity. And like other mature disciplines, such as medicine or psychology, this means developing guidelines for effective and ethical practices.

The time has come for serious-minded constituencies to cease taking blind swipes at Drug Courts and vying for attention and limited resources. We need to come together to determine who should be treated in Drug Courts, how to optimize Drug Court operations, and how to avoid or redress any potential harms. This is what is meant by rational drug policy.

Governing Magazine
January, 2010
by West Huddleston, Chief Executive Officer, NADCP

John Buntin’s recent profile of Judge Stephen Alm and Hawaii’s promising H.O.P.E program is an encouraging sign that our nation’s probation system is ready for change (Swift and Certain, Hawaii’s Probation Experiment – November, 2009). In highlighting the development of the H.O.P.E. program, Mr. Buntin correctly identified systemic changes to our criminal justice system brought about by the growth and widespread success of Drug Courts, which now exceed 2,300 nationwide. In doing so, however, Mr. Buntin also raised serious questions about Drug Courts that rigorous research has already answered.

In the twenty years since the first Drug Court was founded there has been more research published on its effects than virtually all other criminal justice programs combined. The verdict? Drug Courts significantly reduce substance abuse and crime at less expense than any other justice strategy.

Mr. Buntin inferred that little is known about Drug Court participants once they leave the program. Here are the facts. Research demonstrates that nationwide, 70% percent of the 120,000 annual participants in Drug Court complete the program and 75% remain arrest-free. The longest study on Drug Courts to date shows that community reductions in drug abuse and improved employment and family functioning outcomes can last as long as 14 years.

Judge Alm suggested that most Drug Courts employ an “ineffective” reliance on future punishment. This is not the case. Drug Courts utilize close supervision, urine monitoring, and a system of graduated sanctions to ensure participants are immediately held accountable for not living up to their obligations. The approach is a vast improvement over traditional criminal justice responses, which are often applied inconsistently and in an all or nothing manner which emphasizes the draconian response of incarceration. This is just part of the reason why Drug Courts work better than probation, jails or prison and better than treatment alone.

The Sacramento Bee
October 16, 2010

Drug courts unfairly attacked
by West Huddleston, Chief Executive Officer, NADCP

Re “Fresh look at drug courts could also ease prison crisis” (Viewpoints, Nov. 9): In its latest attack on drug courts, the National Association of Criminal Defense Lawyers reveals a startling comfort with distorting facts and ignoring the truth. In misrepresenting its recent anecdotal report as a “study,” the NACDL chooses to ignore two decades of conclusive research, including hundreds of studies that prove drug courts reduce crime, reduce drug abuse, reunite families and save considerable money for taxpayers.

Here are the facts. Nationwide, 70 percent of the approximately 120,000 seriously addicted individuals who voluntarily enter drug courts with the assistance of their defense attorney complete it a year or more later and 75 percent of them remain arrest-free. A drug court participant is more than twice as likely to stay clean and remain arrest-free than is a newly released state inmate. Research also concludes that drug courts reduce drug abuse and improve employment and family functioning.

These effects are not short-lived. The longest study on drug courts to date shows these outcomes last as long as 14 years. Clearly, drug courts are not an experiment. They must be expanded to serve the 1.2 million substance-abusing arrestees before the courts. That is the real issue.

With every blind attack on drug courts, the National Association of Criminal Defense Lawyers calls into question only its own credibility.

The Miami Herald
October 13, 2009

Keep drug courts — they’re effective
by Dr. Douglas Marlowe, Chief of Science, Law and Policy, NADCP

The National Association of Criminal Defense Lawyers chooses to attack our nation’s most successful justice intervention for substance abusing offenders: drug courts (Cynthia Orr, Sept. 29 Other Views column, Rethink how we fight drugs).

It minimizes the impact of drug courts like the one in Miami-Dade, which has restored more than 12,000 lives and reunited tens of thousands of family members. NACDL only begrudgingly accepts drug courts as an interim improvement over the war on drugs until decriminalization is accomplished.

Two decades of research have proven that drug courts reduce crime, reduce drug abuse and save considerable money for taxpayers. The most conservative estimate is that every $1 invested in drug courts reaps between $2 to $3 in direct cost-savings to society.

Between 50 percent and 80 percent of all crimes are committed by substance abusers. NACDL’S assertion that drug courts are only treating low-level offenders is patently false. The majority of drug courts now treat serious offenders who have failed repeatedly in treatment and other dispositions.

NACDL recommends that drug courts treat high-risk offenders who would otherwise be in jail or prison bound in programs that do not require a guilty plea for entry.

But this would mean that serious and potentially violent offenders would face no legal repercussions whatsoever if they failed to complete treatment or even to attend it. When we consider the safety of our communities such recommendations cannot be taken seriously.

The Philadelphia Inquirer
October 24, 2009

Drug courts are needed; New Jersey shows why
by Yvonne Smith Segars, New Jersey Public Defender (As New Jersey Public Defender, Yvonne Smith Segars is the head of the New Jersey Office of the Public Defender, an agency overseeing the Public Defender offices throughout state.)

Last Saturday’s editorial, “Who needs drug courts?,” asks a simple question. In reality, the answer is far more complex. Drug courts are certainly not for everybody, and they were never intended to solve all of the problems plaguing the criminal-justice system.

In New Jersey, with all major stakeholders having a voice at the table, the judiciary, law enforcement, the defense bar, and the addiction-services community worked diligently to create a successful model. Nonviolent offenders clinically addicted to alcohol and drugs are given an opportunity to receive effective treatment.

The New Jersey Office of the Public Defender represents more than 90 percent of drug court participants, undermining the claim that drug courts favor a more privileged socioeconomic group. Of the 8,004 people who, with the advice of lawyers at their sides, participated in New Jersey’s drug-court program, 1,577 successfully graduated. While 61 percent of those entering the program complete it, the employment rate at the time of graduation is 90 percent and the percentage of negative drug tests is 96 percent. Within three years of graduating, only 3 percent return to prison for a new crime, compared with a 60 percent rate of recidivism for inmates who do not receive treatment.

Although there are serious concerns raised by the National Association of Criminal Defense Lawyers that need attention, we should not be dismayed nor distracted. Funding should continue for easily accessible substance-abuse education, prevention, and treatment. As a community, we all benefit each and every time a person triumphs over his addiction to alcohol or other drugs and becomes a law-abiding, tax-paying citizen. Who needs drug court? We all do.

Los Angeles Daily Journal
October 22, 2009

Drug Courts Are the Most Sensible and Proven Alternative to Incarceration: So What’s the Problem?
by West Huddleston, Chief Executive Officer, National Association of Drug Court Professionals

The National Association of Criminal Defense Lawyers recently released a report criticizing 2,100 (there are actually 2,369) Drug Courts that offer effective treatment instead of incarceration for drug addicted offenders. Instead, the NACDL calls for the decriminalization of highly addictive drugs such as methamphetamine, heroin and crack cocaine as the solution to the drug problem. According to Cynthia Orr, President of the NACDL, “Drug Courts have not stymied the rise in both drug abuse or exponentially increasing prison costs to taxpayers” because, according to the NACDL report, “Drug Courts focus on first-time or nonviolent offenders.” The evidence says differently.

It is now 20 years since the first Drug Court was initiated and there has been more research published on its effects than on virtually all other criminal justice programs combined. The scientific community has put Drug Courts under a microscope and concluded that Drug Courts work better than jail or prison, better than probation, and better than treatment alone. Most medications have less scientific evidence supporting their safety and benefit to the public. The research is unequivocal: Drug Courts significantly reduce drug abuse and crime and do so at less expense than any other justice strategy; and according to rigorous and replicated studies conducted by the University of Pennsylvania, the more serious the offender’s drug addiction and length of criminal record, the better Drug Courts work. Drug Courts are not for the fist time or the non-addicted offender. Those individuals will do just as well by diverting them to a disposition that leads to record expungement upon successful completion of court conditions. Drug Courts focus on high-value offenders; those who have the highest need for treatment and other wrap-around services, and who have the highest risk of failing out of those services without support and structure.

Research demonstrates that nationwide, 70% of the approximately 120,000 seriously addicted individuals who voluntarily enter Drug Court with the assistance of their defense attorney complete it a year or more later and 75% of them remain arrest-free. A Drug Court participant is over twice as likely to stay clean and remain arrest-free as a newly released state inmate. Research also concludes that Drug Courts reduce drug abuse and improve employment and family functioning. These effects are not short-lived. The longest study on Drug Court to date shows these outcomes last as much as14 years. And more research is coming out every day.

Still, no one would argue that Drug Courts have realized their full potential. Drug Courts have not been made available to everyone who needs them. Half of U.S. counties do not have a Drug Court and the Drug Courts that do exist only have capacity to serve 10% of the serious drug-abusing and addicted offenders estimated to be in need. That’s the real issue.

New York has implemented a Drug Court in every county in the state. In a three year study, the New York State Court System estimates that $254 million in incarceration costs were saved by diverting 18,000 drug offenders into Drug Court. During the entire fifteen-year time period Drug Courts have been in operation throughout the state, New York has witnessed historic reductions in crime. And through the first half of this year, crime has fallen another 4.7 percent. According to a recent Northwestern University report, alternatives to incarceration like Drug Courts could lead to the closing of four half-empty adult prisons in New York. And a number of states such as Alabama, Missouri, New Jersey and Texas, among others, are following suit. In fact, in 2008, 44 state budgets included a specific appropriation for Drug Courts, totaling $208,000,000 nationwide. The Obama Administration and Congress is also investing in new Drug Courts and increasing the capacity of the 2,369 Drug Court already in existence in all fifty states and U.S. territories with a 250% increase in federal appropriations from the year before. That’s a great start, but far from what we need to reach the 1.2 million seriously drug abusing or addicted offenders who need treatment.

If no other sentencing option can compare with its success, shouldn’t we finish the job and give everyone who needs it access to these life-saving courts? It’s simple really. Drug Courts remain constrained by limited resources and by the more popular thinking that an alcoholic or addict can be punished out of their dependence.

It is no secret that prison has accomplished little to stem the tide of crime or drug abuse. Upon their release from prison, between 60% and 80% of drug abusers commit a new crime (typically a drug-related crime) and 85% to 95% relapse quickly to drug abuse. In some states, such as California, more than 75% will be returned to prison. And amazingly, these disappointing figures have done little to curb prison spending. National expenditures on corrections well exceed $60 billion annually. On average, states spend $65,000 per bed, per year to build new prisons and $23,876 per bed, per year to operate them

Unfortunately, it is also not sufficient to simply offer more treatment. Left to their own devices without intensive supervision by a judge, approximately 25% of offenders never arrive for a single treatment session. And among those who do show for treatment, most drop out prematurely before receiving any benefits. The power and authority of the Court is necessary to keep them engaged in treatment long enough to experience any lasting gains.

Drug Courts are judicially supervised court dockets that strike the proper balance between the need to help addicted offenders get free from the gasp of drugs and the need to protect community safety; between the need for effective treatment and the need to hold people accountable for their actions; between hope and redemption on the one hand and productive citizenship on the other. Drug Courts keep drug-addicted individuals engaged in treatment for long periods of time, while supervising them closely and holding them accountable for their obligations to society, their families and themselves. Participants are regularly and randomly tested for drug use, required to appear frequently in court for the judge to review their progress, and immediately receive rewards for doing well and sanctions for not living up to their obligations. All of this with one simple goal; get the addict clean and sober.

And everybody benefits when an addict gets clean and sober in Drug Court. The most conservative estimates by researchers show that for every 1.00 invested in Drug Court, $3.36 are saved by the justice system and up to $12.00 (per $1 investment) are saved by the community on reduced emergency room visits and other medical care, foster care, and property loss.

In Drug Court, we have an effective intervention that is not being fully implemented. Now is not the time to change course. It is our hope that a drug-addicted citizen should not need to be arrested in order to receive the help they require. But for the 1.2 million drug-addicted arrestees currently involved in the adult criminal justice system, the verdict is in: Drug Court is the solution and the passport to a new way of life. Now we must make the investment and finish the job.

Source: http://www.nadcp.org/setting-the-record-straight 2010

RESPONSE TO THE NTA BUSINESS PLAN 2010/2011

Deirdre Boyd, CEO of the Addiction Recovery Foundation
Kathy Gyngell, chair of the Centre for Policy Studies’ Addictions working group

With the threat of abolition hanging over its head, the National Treatment Agency has cleverly extended its longevity by promising to mend its ways. It will, it announced on Friday, use the final two years of its now-extended life to change the policy it has promulgated over the past nine years.
“We’ve got to get rid of the centralised bureaucracy that wasteS money and undermines morale,” prime minister David Cameron stated in July. But the NTA would seem to have got the last laugh, with over £42.8million of taxpayer‘s money now allocated to it for two more years to change the disastrous system it created and has so steadfastly defended even in face of the indefensible.
The NTA will, it promises, help people get off the methadone dependency, tier 2/3 organisation dependency and state dependency which it created via its performance-managed targets. Its new Business Plan 2010/11, in a truly Orwellian “four legs bad, two legs good” style, now seemingly advocates the very abstinence approach its spokespeople have repeatedly declared to be unviable.
It will even consult rehabs, the NTA graciously announced – those very rehabs it has ignored for almost a decade and of whose success in getting addicts into drug-free and rewarding recovery Paul Hayes (yes, still the NTA’s CEO) has publicly belittled, scorned or downright denied. Could it be less than two years ago that the NTA’s ‘first point-of-contact’ told BBC Home Affairs editor Mark Easton that “rehab doesn’t work”? (see Comment 5th from bottom here for more derogatory comments from NTA senior managers).
But maybe this was not such a hard promise for the NTA top brass to make, as they look forward to their ‘brobdingnagian’ pension pots in two years’ time. After all, there are fewer rehabs to consult… For under the NTA regime, only 2-4% of addicts seeking help to quit drugs were actually referred to them. The result? Financial hardship, redundancies, the closure of over 20 specialist rehabs, more wing and bed closures and a loss of the real expertise required to rehabilitate addicts. And with their own personal futures well secured, would success of change be in their interest?
There isn’t any evidence for abstinence or for rehab, they have repeated declared. This is despite two national treatment outcomes surveys – Ntors and Doris – which indicate strongly to the contrary. It is also in face of experience. As Sir Ian Gilmore said yesterday, the “absence of evidence” about school milk for under fives is only that; it does not mean that it is not a good thing and has not helped children’s health. All experience suggests it certainly has, he insisted. Similarly with rehab: a joint report in 2008 by the Commission for Social Care Inspectorate with the NTA itself that “residential rehabs outstrip other sectors in every outcome group we measure”.
The NTA seems to have bamboozled the Department of Health and a too readily believing government. For who have they tasked to change their policy and now shift people into ‘recovery’? Brazenly, it has appointed as one of the duo the addiction psychiatrist most closely associated with the failed medico-clinical treatment approach of the past 20 years years, one of the the proponents and instigators of the last government’s failed treating-drugs-with-drugs approach so loved by the NTA, key lobbyist for counterintuitive, expensive and ethically questionable prescribing programmes: John Strang of the National Addiction Centre.
In his capacity as a director of the UKDPC – recipient of millions of charitable funds to, among other briefs, redefine for the nation the notion of (addiction) recovery – Strang chose to use this remit to ensure that any new official definition of recovery excluded full abstinence, ignoring all expert advice to the contrary.
Nor did he stop there. His UKDPC’s plan was to use this new definition of “recovery” to replace real total drug-free outcomes as the measure for the NTA’s Treatment Outomes Profile forms, meaning that their targets could be easily be hit. Very convenient. For, in one Orwellian sleight of hand, the NTA could claim a recovery outcome when no such thing had been achieved. A reduction in injection frequency would suffice. This would be the basis of NTA’s (aspirationless) claims of treatment success. In face of the derision this deserved, the NTA has gone on record saying it does not define recovery at all now – despite the fact that “recovery” is the raison d’etre of its Janus-faced Business Plan 2010/2011. That all the goals and actions therein are meaningless can thus be taken as read.
For example, there is apparently no plan to replace the discredited and bureaucratically heavy Top form. It will be forced on ever more people. The NTA states, too, that it has looked at the ASAM patient placement criteria. Yet instead of contacting the creators of this highly-researched method, it plans to reinvent the wheel and spend taxpayer money developing a version for its own purposes. It also plans to spend more taxpayer money on a mutual aid directory. Yet this is already provided free by Addiction Today. Under Championing abstinence-focussed treatment in the business plan… well, for further help interpreting the Business Plan’s double speak, read our glossary.
It is, however, commendable that Dr David Best, who has wriiten so cogently and expertly on abstinence-based recovery in the pages of Addiction Today and other professional journals, has been appointed as the other half of the recovery duo. We wish him the very best of luck in counterbalancing his former mentors, and getting them on the true road to recovery with a Damascene conversion. They should heed him, for he is the only person giving this exercise any credibility.
As David Cameron said in June,“There is a problem in our national health service, in that we spend too much time treating the symptoms rather than necessarily dealing with the causes… All addictions need proper attention, and proper treatment and therapy, to rid people of their addictions”.
We really would love to believe, as he and many in government must wish to believe, that we will witness the NTA’s respecting the trust that has been placed in it and seeking the rehab expertise that actually helps people to get off life-destroying drugs and rebuild their lives and their families’ lives. But the serious worry is that this initiative for change get will be lost in adherence to disinformation and blowback, and submerged in intransigent ideology about the non-recoverability from addiction. Of even more concern, will its lack of understanding continue to marginalise the expertise necessary to help the 330,000 or so addicts desperate for the sobriety which is the basis for them to get back, or get for the first time, their self esteem and their lives?
We will be happy to be proved wrong. But we are not holding our breath.

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

CALLS have been made for a rethink on the use of methadone in Scotland after official figures revealed the number of deaths in which it was implicated reached a ten-year high last year.
Amid a general fall in people being killed by drugs, fatalities in which the heroin substitute was cited as a contributory factor rose to 173 in 2009, up from 169 in 2008 and a surge of 51 per cent since 2007 when it was associated with 114 deaths. The controversial drug treatment was found to be at least partly responsible for more than a third (32 per cent) of all of the 545 drug-related fatalities in Scotland last year, and was associated with the second-highest number of drug-addict deaths after heroin or morphine, which contributed to 322 losses of life – 59 per cent of the total.

The 2009 methadone figure also equates to roughly one death every 48 hours.

The rising number of deaths linked to methadone led to calls for the policy of wide prescription of the treatment to addicts to be reviewed, with one drug-misuse expert describing the current situation as being of “enormous concern”.

Professor Neil McKeganey, the director of the Centre for Drug Misuse Research at Glasgow University, said: “The situation in relation to methadone – where it appears we have around a third of addict deaths associated with the drug we are prescribing most widely to treat drug addiction – is of enormous concern. We really ought to be looking again at this policy of widespread methadone prescribing. The statistics are inescapable – we ought to be looking at why we are doing it and whether all of those to whom it is being prescribed are deriving benefit from it.”

Peter McCann, the chairman of the Castle Craig Hospital for alcoholism and drug addiction, lent his weight to the calls, adding: “Today’s drug-death figures would have been described as totally catastrophic just a few years ago. There must now be a total rethink in Scotland along the lines of the National Treatment Agency in England which totally reversed its policy earlier this month. “They will be limiting the use of methadone with strict multi-disciplinary assessments at regular intervals. The policies prescribing methadone in Scotland have obviously failed and must be revised.”

Murdo Fraser, Scottish Conservative health spokesman, said the focus of the Scottish drugs strategy should be on recovery and abstinence. He said: “The attempts of the last decade to merely manage the problem, based on harm reduction and an over-reliance on methadone, just have not worked. The challenge now is to expand the range of rehabilitation services on offer and move to abstinence and recovery.”

But the treatment was defended by Biba Brand of the Scottish Drugs Forum: “We know from research that staying on methadone tends to prolong their life by about 13 per cent. “We also know that of those deaths that are occurring (overall], two-thirds are outwith treatment, so being in treatment – and generally that involves methadone – is helping people stay alive. Methadone can help save lives, but we need to help people progress through treatment.”

A Scottish Government spokesman added: “We do not favour one form of treatment over any other. Decisions on the most appropriate treatment to prescribe an individual are for clinicians, in discussion with their patients and in line with national guidelines.”

Overall, the number of people killed by drugs in Scotland fell by 5 per cent since 2008, but the 545 drug-related deaths during 2009 equated to the second-highest total ever recorded; an increase of 20 per cent since 2007 and a rise of 87 per cent since 1999.

A wider analysis, using figures recorded by the Office for National Statistics, showed the number of deaths related to drugs in Scotland last year was 716, down from 737 in 2008, but a rise from the 2007 total of 630.

This figure included people killed by solvent abuse, legal highs and through overdoses of prescription medication. It also included people dying with mental-health problems linked to drug abuse, as well as those killed by the health complications allied to contaminated drugs. More than a third of all deaths in Scotland, some 200, were in the Greater Glasgow and Clyde NHS board area, and this represented the highest total on record. Deaths in Lothian dropped, by 13 to 81, as did fatalities in Fife (37 to 32) and Forth Valley (23 to 14).

There was also a rise in the number of older people dying from drugs, with deaths among those aged 35 and over rising from 271 in 2008 to 296 in 2009, while at the same time deaths among users under 35 dropped from 303 to 249.

Source: News.Scotsman.com 18th Augutst 2010