AN AUSTRALIAN trend for drug users to smoke rather than inject drugs like crack cocaine, methamphetamines and heroin will lead to serious lung damage, a UK expert warns.

Dr Alistair Story told the Thoracic Society of Australia and New Zealand meeting in Darwin yesterday that Australian data showed drug users were following overseas trends, using a ‘respiratory route’ rather than injecting drugs.

“In the United Kingdom, there is a trend among health care providers to describe smoking rather than injecting drugs as a harm reduction measure,” Dr Story, a respiratory specialist at University College Hospitals NHS Foundation Trust, said.

“However, I prefer to call this harm diversion. We know that injecting drugs is extremely damaging to health, but so is smoking drugs.”

He said there was a low awareness of the risks of smoking drugs in terms of lung damage among health care providers working with drug addicts.

Integrating respiratory health care into drug treatment services was a missed opportunity as a consequence, he said.

Dr Story, who pioneered outreach lung disease diagnosis and response programs among drug addicts, alcoholics and homeless people in London said drug users who choose to smoke the drug needed to understand the health consequences of chronic lung diseases.

“The lung is a non-regenerative organ and declining lung health is a one way ticket,” he said.

Source: www.medicalobserver.com.au 29th March 2013

Marijuana advertising is no longer an underground operation in Colorado but the latest trend is angering some parents- texts sent to children’s cell phones.

Medical marijuana ads are everywhere, from newspaper advertising to billboards. Now the advertising is branching into new territory, directly targeting consumers via cell phone texts.

“I really didn’t know what it was until I asked my mom,” said 10-year-old Trey Digby.Trey started getting texts from an unknown out-of-state number and showed his mother. “I couldn’t believe that a marijuana dispensary could come into my home and text my kids and expose them to this,” said Trey’s mother Kelley Digby. Digby said since Nov. 2012 her son has received about 25 text ads from the Urban Dispensary in Denver. Even after requesting the number be removed from their database, the texts keep coming.

The dispensary manager said the shop does not advertise to children, only to patients who provide their phone numbers on a membership form. Those phone numbers are manually entered into a group texting site out of California. Digby said that’s an imperfect and dangerous way to advertise. “There are so many numbers that can be easily transferred to children and avenues for error, numbers transposed and give kids access to these.”

The Colorado Drug Investigators Association said this new form of pot advertising is disturbing. “I’m a parent, so when I see something like this it makes me mad,” said Colorado Drug Investigators Assn. Sgt. Jim Gerhardt. “People that are proponents for it, you need to pay attention to how this might impact kids.”

Trey agrees. “Please stop sending these texts they’re bothering me and I’m kind of scared.”

Colorado’s Marijuana Task Force recommends prohibiting all mass marketing campaigns that have a likelihood of reaching minors. Another recommendation from the task force allows opt-in marketing on the web and mobile devices as long as there is an easy way to opt out.

Source: http://denver.cbslocal.com/2013/03/27

A new study suggests people with mental illness are more than seven times as likely to use marijuana weekly than people without a mental illness.

Although some research has found links between cannabis use and mental illness, until now, the exact numbers and prevalence of cannabis use had not been investigated.

Cannabis is the most widely used illicit substance globally, with an estimated 203 million people reporting use.

“We know that people with mental illness consume more cannabis, perhaps partially as a way to self- medicate psychiatric symptoms, but this data showed us the degree of the correlation between cannabis use, misuse, and mental illness,” said lead research Shaul Lev-ran, M.D.

“Based on the number individuals reporting weekly use, we see that people with mental illness use cannabis at high rates. This can be of concern because it could worsen the symptoms of their mental illness,” said Lev-ran.

Researchers also found that individuals with mental illness were 10 times more likely to have a cannabis use disorder.

In this new study, published in the journal Comprehensive Psychiatry, researchers at Toronto’s Centre for Addiction and Mental Health (CAMH) analyzed U.S. data from face-to-face interviews with over 43,000 respondents over the age of 18 from the National Epidemiologic Survey on Alcohol and Related Conditions.

Using structured questionnaires, the researchers assessed cannabis use as well as various mental illnesses including depression, anxiety, drug and alcohol use disorders and personality disorders, based on criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

Among those will mental illness reporting at least weekly cannabis use, rates of use were particularly elevated for those with bipolar disorder, personality disorders and other substance use disorders.

In total, 4.4 percent of individuals with a mental illness in the past 12 months reported using cannabis weekly, compared to 0.6 percent among individuals without any mental illness.

Cannabis use disorders occurred among 4 percent of those with mental illness versus 0.4 per cent among those without.

Researchers also noted that, although cannabis use is generally higher among younger people, the association between mental illness and cannabis use was pervasive across most age groups.

Experts believe the findings suggest those with mental illness may benefit from screening for frequent and problem cannabis use, so that targeted prevention and intervention may be employed as necessary.

Source: Centre for Addiction and Mental Health April 3, 2013

Bertha K. Madras, PhD

The United States is on the threshold of yet another national experiment, a human clinical trial, to test the health and safety of yet another drug, marijuana.

The first experimental trials with psychoactive drugs began in the late 19th century, following the extraction and proliferation of active compounds in opium and coca plants. Over-the-counter use of heroin, smoked opium, morphine and cocaine died within a few decades in the early 20th century, with an exponential and unacceptable rise in human behavioral and biological calamities that elicited an aggressive response from the medical, legal and legislative communities. The “War on Opium” led to a greater than 90% reduction in opium use internationally starting in the early 20th century and onward. Since then, the popularity of illegally obtained heroin and cocaine has risen and fallen with public perception, but the heroin excursions affect much smaller populations than at the turn of the 20th century. We will never have an accurate tally of the human, legal and economic costs that arose from the legal promotion and proliferation of heroin or cocaine in the few decades that these drugs were widely available. Populations currently addicted are relatively small, but the grim consequences persist and are visible.

The second experiment with another chemical class of psychoactive drugs, amphetamines, emerged in the 1930’s. This wave petered out by the late 1960’s, as data on its hazardous effects (e.g. addiction, psychosis) shifted public perception and led to legal constraints, especially with over-the-counter pills. Use of amphetamines (e.g. methamphetamine and ecstasy) once again rose in the 2000’s and then declined to current relatively low levels, partly because of supply reduction strategies (e.g. tightening of precursor availability, international cooperation) and increased perception of harm (addiction, brain toxicity).

The third experimental wave, hallucinogen use (e.g. LSD) in the 60’s, waned within two decades, conceivably as a result of “bad trip” publicity, enduring psychoactive effects, and restrictive legislation. The 1960’s also witnessed a surge in marijuana use in tandem with other drugs. Its use has fluctuated since then, rising and waning as perception of harm and cultural norms change.

Manifestly, the brain is the repository of our humanity. Drugs compromising brain function, cognition and behavior require a unique form of vigilance to protect public health and safety. The behavioral, psychiatric and biological outcomes of these naturalistic human experiments led to legislative actions embodied by the Controlled Substances Act (CSA) of 1970. The CSA regulated the manufacture, importation, possession, use and distribution of psychoactive substances. The Act assembled all psychoactive drugs under a single rubric and ranked them in five categories or Schedules on the basis of potential for abuse and medical use. Marijuana was placed in the most restrictive Schedule I category, as a substance with high abuse potential and no medical use.

Current Federal law prohibits the sale, distribution and possession of the hallucinogen-intoxicant-sedative marijuana, a decision driven by unacceptably high biological,

medical and behavioral risks (e.g. intoxication, cognitive impairment, sensory, auditory and temporal distortions/hallucinations, vehicular or workplace accidents, others). The status of marijuana has now entered a new, decentralized phase in American and international culture. Billionaire-funded, disingenuous, and proliferating state ballot initiatives are swelling legal access through the guise of medical marijuana laws, or decriminalization, or outright legalization. This accelerating access by the ballot box is associated with a tandem decline in public perception of harm and a rise in marijuana use and use disorders. The financially-endowed movement has catalyzed yet another naturalistic, uncontrolled, human experiment with the drug. This clinical trial requires no informed consent, no signatures approving human experimentation, no oversight from a professional Institutional Review Board, no protections of the Nuremberg Code, the Helsinki Declaration or the Belmont Report, and no legal or financial recourse for bad outcomes. No effective prevention strategy is in place for our most vulnerable population – youth. The experiment may last a few decades and the laws conceivably will be reversed, as even more data on human consequences pour in and society deems them too costly to bear. In the meanwhile, a generation of susceptible youth may be transformed by the drug’s consequences: addiction, IQ reduction, psychosis, cognitive impairment, educational underachievement. They will have no legal recourse with the perpetrators of this human biological experiment, as do participants in a clinical trial.

Source: Bertha K Madras, PhD Professor of Psychobiology Department of Psychiatry
Harvard Medical School bertha_madras@hms.harvard.edu April 201

By Peter Wehner,

Peter Wehner is a senior fellow at the Ethics and Public Policy Center. He was director of the White House Office of Strategic Initiatives in the George W. Bush administration and special assistant to the director of the Office of National Drug Control Policy during the George H.W. Bush administration.

Some say that the Republican Party needs to find new issues to champion if it hopes to become Americas majority party. There is something to this. But being a conservative party, the GOP should also look to the past, where wisdom often resides.

In that spirit, Republicans once again should take a strong stand against drug use and legalization. Virtually no lawmaker in either party is doing so.

For his part, President Obama has said more about the NCAA mens basketball bracket than he has about the dangers posed by illegal drugs. Gil Kerlikowske, the presidents drug czar, said last month that The administration has not done a particularly good job of, one, talking about marijuana as a public health issue, and number two, talking about what can be done and where we should be headed on our drug policy.

This is a startling admission, and there is a cost to abdication.

The drug-legalization movement is well-funded and making inroads. Voters in Washington state and Colorado passed ballot initiatives in November legalizing marijuana for recreational use. A bill to legalize marijuana was introduced in the Maryland House of Delegates last month. And Democrats in Congress have introduced legislation to end federal prohibitions on marijuana use.

This is the perfect time for Republicans to offer counterarguments grounded in medical science, common sense and human experience.

For example: One of the main deterrents to drug use is because it is illegal. If drugs become legal, their price will go down and use will go up. And marijuana is far more potent than in the past. Studies have shown that adolescents and young adults who are heavy users of marijuana suffer from disrupted brain development and cognitive processing problems.

Drug legalization will lead to more cases of addiction, which shatters lives. The vast majority of people who are addicted to harder drugs started by using marijuana. John P. Walters, the drug czar in the George W. Bush administration, noted last year, Legalization has been tried in various forms, and every nation that has tried it has reversed course sooner or later.

Strong, integrated anti-drug policies have had impressive success in the United States. Both marijuana and cocaine use are down significantly from their peak use in the 1970s and 80s.

So the policy arguments against drug legalization are all there; they simply need to be deployed.

But there is another, deeper set of arguments to be made.

In his dialogues, Plato taught that no man is a citizen alone. Individuals and families need support in society and the public arena. Today, many parents rightly believe the culture is against them. Government policies should stand with responsible parents and under no circumstances actively undermine them.

Drug legalization would do exactly that. It would send an unmistakable signal to everyone, including the young: Drug use is not a big deal. Were giving up. Have at it.

In taking a strong stand against drug use and legalization, Republicans would align themselves with parents, schools and communities in the great, urgent task of any civilization: protecting children and raising them to become responsible adults. But the argument against drug legalization can go even further. As the late social scientist James Q. Wilson noted, many people cite the costs of and socioeconomic factors behind drug use; rarely do people say that drug use is wrong because it is morally problematic, because of what it can do to mind and soul. Indeed, in some liberal and libertarian circles, the language of morality is ridiculed. It is considered unenlightened, benighted and simplistic. The role of the state is to maximize individual liberty and be indifferent to human character.

This is an impossible stance to sustain. The law is a moral teacher, for well or ill, and self-government depends on certain dispositions and civic habits. The shaping of human character is preeminently overwhelmingly the task of parents, schools, religious institutions and civic groups. But government can play a role. Republicans should prefer that it be a constructive one, which is why they should speak out forcefully and intelligently against drug legalization.

Source: The Washington Post Published: April 2nd 2013

Responding to Joe Klein on Drug Legalization

Earlier this week I wrote an op-ed in the Washington Post opposing drug legalization. In response, TIME magazine’s Joe Klein, who favors it, has written a dissent, critical but serious, which you can read here. Some responses to Klein follow:

1. “Most of [Wehner’s] arguments against dope come from a different era. He assumes a bright line between alcohol and ‘drugs.’ He assumes that marijuana is the entry drug on an inevitable path toward addiction. (He also seems to infer that marijuana is addictive.) Most of these arguments seem ridiculous to anyone who has inhaled.”

What I actually argue is a bit more nuanced and up-to-date than Klein’s characterization, and my claims happen to be true. Marijuana is much more potent than in the past. (In the 1970s, marijuana was at most 2-3 percent tetrahydrocanabinol, or THC. Recent Drug Enforcement Agency seizures were 7-10 percent. In Colorado and California, the marijuana dispensaries go as high as 15-20 percent or more.) Heavy use of marijuana does adversely affect brain development in the young. And the vast majority of people who are addicted to harder drugs start by using marijuana.

2. Does this mean that everyone who uses marijuana will become addicted to drugs like heroin and cocaine? Of course not. But it does mean that most of those who are addicted to cocaine and heroin started out by using marijuana. This hardly seems coincidental. Nor is there any credible evidence that I’m aware of that supports Klein’s sweeping claim that “Those who move on to harder drugs—and the infinitesimal minority who get hooked on harder drugs—would do so if marijuana were legal or not.”

Think about it like this: Some appreciable percentage of the population has a susceptibility to addiction (genetic factors account for between 40 and 60 percent of a person’s vulnerability to addiction). Under legalization, the pool of those exposed to marijuana will certainly increase by a significant factor; and the result will be that the number of those at considerable risk of moving to addiction on heroin or cocaine likewise grows.

Government surveys found that of those age 12 and above, 22.5 million were current illicit drug users (18.1 million of whom used marijuana) and 133.4 million were current users of alcohol. More than 20 million of these people suffered from dependence or abuse: 14.1 million for alcohol alone, 3.9 million for drugs alone, and 2.6 million for drugs and alcohol.

What can we reasonably expect the drug problem to look like if we increase the number of illicit drug users to, say, 50-60 million? You will get significantly more addiction–and significantly more shattered lives.

3. We know from Monitoring the Future studies, conducted by the University of Michigan since 1975, that the rate of marijuana use in youths is inversely related to “perceived risk” and “perceived social disapproval.” Legalization would lead to decreased perceived risk and decreased perceived social disapproval; the result would almost certainly be greater drug use. (See Figure 1 from this article by Drs. Herb Kleber and Robert DuPont.) On the flip side, treating drugs as unlawful acts as a deterrent, which is one reason we criminalize behavior in the first place.

4. Many legalizers assume that past efforts to reduce drug use have been failures. But the assumption is flawed. For example, William Bennett was President George H.W. Bush’s director of the Office of National Drug Control Policy. Under his strong leadership, we saw substantial decreases in overall drug use, adolescent drug use, occasional and frequent cocaine use, and drug-related medical emergencies. Student attitudes toward drug use hardened. In fact, the two-year goals that were laid out in Bennett’s first ONDCP strategy were exceeded in every category.

John Walters, who was President George W. Bush’s “drug czar,” also experienced impressive success during his tenure. Anti-drug policies have shown far more success than, to take just one example, gun control laws. (Two different studies–this one by the Centers for Disease Control, which reviewed 51 published studies about the effectiveness of eight types of gun-control laws, and this one by the American Journal of Preventive Medicine–found that the evidence is insufficient to determine whether firearms laws are effective.)

5. Several times Klein compares marijuana to alcohol, arguing that “it is simply illogical for alcohol to be legal and pot not.” The rejoinder is fairly obvious, and it goes like this: Alcohol has deep roots in America in ways that marijuana and other illegal drugs do not. I readily conceded that alcohol abuse is problematic and destroys many lives (estimates are that there are 80,000 alcohol-related deaths each year). The question is whether we want to compound this damage by increasing marijuana use as well. And to throw the argument back at Klein: Would he favor legalizing cocaine and heroin based on the argument that alcohol kills many more people than those two drugs do? Alcohol kills many more people than automatic weapons would if they were legalized. Does Klein therefore, in the name of an allegiance to logic, believe we should legalize ownership of M-16s? I rather doubt it.

Governing involves making prudential judgments that take into account complexities, nuances, and even inconsistencies in a polity’s views and attitudes. Human actions cannot be reduced to mathematical formulations. Edmund Burke’s discussion of “prejudice” in the context of his concerns with the French Enlightenment and its devotion to Reason are apposite here.

Where Klein and I do agree is that, in his words:

legalization of marijuana would compound the cascade of society toward unlimited individual rights—a trend that can be catastrophic if there isn’t a countervailing social emphasis on personal and civic responsibility. It might well accelerate the trend toward the couchification of American life; it certainly would not be a step toward the social rigor we’re going to need to compete in a global economy… if, in the mad dash toward pleasure and passivity, we lose track of our citizenship and the rigorous demands of a true working democracy, we may lose the social webbing that makes the pursuit of happiness possible.

Having found common ground with Joe Klein, New Democrat, I will happily pitch my tent there.

Peter Wehner is a senior fellow at the Ethics and Public Policy Center.

Source: http://www.commentarymagazine.com/2013/04/04/responding-to-joe-klein-on-drug-legalization/

Research has suggested that people who use ecstasy develop significant memory problems, so the Dutch researchers wanted to find out if there was any clinical evidence of structural changes in the brain to back this up.

They focused on the hippocampus, which is the area of the brain responsible for long term memory. They measured the volume of the hippocampus using MRI scans in 10 young men in their mid 20s who were long term users of ecstasy and seven of their healthy peers in their early 20s with no history of ecstasy use.

Although the ecstasy group had used more amphetamine and cocaine than their peers, both sets of young men had used similar amounts of recreational drugs, bar ecstasy, and drank alcohol regularly. The ecstasy group had not been using on average for more than two months before the start of the study, but had taken an average of 281 ecstasy tablets over the preceding six and a half years.

The MRI scans showed that hippocampal volume in this group was 10.5% smaller than that of their peers, and the overall proportion of grey matter was on average 4.6% lower, after adjusting for total brain volume.

This indicates that the effects of ecstasy may not be restricted to the hippocampus alone, say the authors”Taken together, these data provide preliminary evidence suggesting that ecstasy users may be prone to incurring hippocampal damage, following chronic use of this drug,” they write.

They add that their findings echo those of other researchers who have reported acute swelling and subsequent atrophy of hippocampal tissue in long term ecstasy users. And they point out: “Hippocampal atrophy is a hallmark for diseases of progressive cognitive impairment in older patients, such as Alzheimer’s disease.”

Source: Journal of Neurology, Neurosurgery and Psychiatry Apr. 20 11

Dr Gregory K Pike
Director, Adelaide Centre for Bioethics and Culture
May, 2013

Introduction
As long as humans have suffered from ailments, medicine has sought treatments. To attempt to alleviate suffering is a mark of the better face of humanity, or at least recognition that we all, at one time or another, are subject to illnesses that need relief. Hence, maladies are markers of our shared condition and an opportunity for our better qualities to find expression.
The search for healing has taken many turns down the centuries, and along the way there have been good and bad treatments, effective ones, futile ones, burdensome ones, ‘miraculous’ ones, deceptive ones and downright dangerous ones. Just as humans can act wisely or foolishly, so treatments have been wisely or foolishly developed and employed. And noble motives are no guarantee that genuinely good treatments will be used.
As the scientific enterprise has grown and understanding of human biology advanced, so has our understanding of the biological basis of medicine. While our knowledge is far from complete, modern medicine now has an impressive array of treatments, and in many cases cures. There will always be mistakes, more inquiry, refinement, and new discoveries, but the general trend is moving forwards with hope for improvements and new ways of alleviating human suffering.
Modern medicine is not only built upon understanding human biology, but also upon an understanding of human nature itself. This is where a proper appreciation of human nature aligns with an ethical framework directed towards the good of the person receiving treatment. Hence, medicine has always developed codes of ethics that serve as a foundation or point of constant referral against which the discipline measures any new development. A sound ethical framework also recognizes the place of the patient within a community and also the unique nature of the relationship between patient and physician.
It is within this broad context that the question of medical marijuana needs to be considered.
At the outset an important distinction needs to be made, and that is between use and abuse. Health practitioners are aware of the abuse of legally available pharmaceuticals; for example, benzodiazepines like Xanax, opiates like Morphine and Oxycodone, antipsychotics like Seroquel, and amphetamines like Ritalin and Adderall. These are substances used for treatment of defined medical conditions that at the same time can be abused. Health practitioners are also aware of the abuse of illicit drugs like heroin, cocaine, cannabis and amphetamine. These substances have been deemed to have either no or limited medical application along with a high risk of abuse as ‘recreational’ drugs. Moreover, the link between such abuse and the phenomenon of addiction makes these substances especially problematic.

The term ‘medical marijuana’ has been used variably, but will be taken here to mean smoking the herbal product. This is to be distinguished from other means of delivery of the crude product, which could include tinctures, taking in an oral form, or vaporizing. The active ingredient(s) can also be isolated and taken orally or by nasal spray.

How does marijuana work?
The active ingredients in cannabis exert their effects by acting upon specific receptor sites in the brain and elsewhere. Much like the better understood endogenous opiate receptor system upon which drugs like morphine, codeine and heroin act, there is an endogenous cannabinoid receptor system upon which cannabis acts, or more correctly, upon which the active ingredients act, which are primarily tetrahydrocannabinol (THC) and cannabidiol (CBD). And just as there are naturally occurring substances within the brain that act upon opiate receptors, that is, the endorphins and enkephalins, there are naturally occurring substances which act upon cannabinoid receptors. The two identified so far are anandamide and 2-arachidonoylglycerol (2-AG).
The cannabinoid receptor system is widespread throughout the brain and serves a range of functions that are gradually becoming better understood. So far the system has been shown to be involved in motor control, cognition, emotional responses, motivated behaviour, learning and memory, appetite, pain and neuroprotection.
When cannabis is smoked and the active ingredients enter the bloodstream they are able to act upon these systems. Given that the systems are so widespread and complex, THC and CBD act upon many different processes that are involved in the functions listed above. Hence, it is not surprising that when someone smokes cannabis it affects their coordination, emotional responses, appetite, memory and ability to learn, ability to think clearly and rationally, and so on. Since the purpose of smoking cannabis ‘recreationally’ is to get high, the doses involved typically interfere with these systems in an adverse way and therefore the result of sustained exposure gives rise to the harms associated with cannabis. The endocannabinoid system is effectively swamped by THC, CBD and the other ingredients in marijuana at well beyond the natural physiological stimulation that occurs with anandamide and/or 2-AG.
The harms caused by cannabis are still being explored, but there is reasonable and growing evidence to indicate that the risks are significant, particularly with respect to mental health, where the results may be psychosis, depression, anxiety, memory deficits, impaired learning and motivation. These harms are of particular relevance for the developing brain and so all that can be done to protect young people from the harm of smoking cannabis should be a priority. Other harms include risks associated with immediate effects, for example due to impact upon motor control and decision-making, changes in perception and anxiety and possibly blacking out. Long term harms may also include risk of certain cancers and other respiratory diseases.
It is also important to note that the intrinsic harm of addiction makes all the difference. Substances with addictive potential are categorically unique and add a problematic dimension that must be taken into proper account when considering any possible therapeutic effect.
Human beings place a high value on freedom. To be free to act as an autonomous agent, to make real choices about how to live one’s life, is universally valued and desired. The essence of addiction is the loss of freedom, the substantial impairment of voluntary control over one’s behaviour … Addiction causes serious harm to individuals as well as to their friends, relatives and the community. It is the type of problem that varies not only in degree but also with considerable individual distinctiveness. It can be an intensely personal inner struggle that remains private, or a painfully public and alienating experience.1
It is estimated that approximately 10% of those who smoke cannabis will develop an addiction. The phenomenon of withdrawal should also be considered as one of the harmful effects of cannabis dependence. It includes, headaches, irritation, nausea, depression, insomnia, anxiety, poor appetite and restlessness. 2

Is Marijuana Medicine?
If marijuana has medicinal value, the first question to be asked is, “In what form might it have medicinal value?” Currently, many people claim that smoking marijuana treats a medical condition. Research directed towards this question will be considered shortly, along with a series of related questions about abuse, harm, and other social and legal issues that are largely prudential in nature – but are nonetheless important and with far-reaching implications.
The modern scientific approach to medicines typically follows a path of inquiry directed towards obtaining the most beneficial form of a medicine to treat a specified condition. For example, while opium has been recognised for its medicinal value for many centuries, the active ingredients codeine and morphine have now been extracted and subjected to extensive research and analysis over many years. We now have both in various formulations with known dosage and purity, a body of information on side-effects, known indications and contraindications, knowledge of therapeutic targets, patient populations for whom treatment is appropriate, and knowledge of abuse potential. No medical authority would ever prescribe or even recommend smoking opium, not only because of the availability of formulations of active ingredients which are superior, but also because of the harm of smoking as a delivery system.
Might not THC, CBD and other ingredients in marijuana likewise be useful medicines?
This is an important question in its own right regardless of the ‘recreational’ abuse of marijuana, and this area of research has gained considerable traction as discoveries about the endocannabinoid system in the brain have been made.
Currently there are 4 formulations of active ingredients, dronabinol (Marinol), nabilone, nabiximols (Sativex) and rimonabant. The first two are THC lookalikes, whereas Nabiximols is a marijuana extract containing both THC and CBD. Rimonabant is a cannabinoid receptor blocker which was initially marketed as an anti-obesity drug in Europe in 2006 before being withdrawn soon after when side effects including serious depression and suicidal ideation were found to be frequent.
Dronabinol was approved by the US Food and Drug Administration (FDA) in 1985 for treating chemotherapy-induced nausea and vomiting and AIDS-related wasting, and although proven effective, both dronabinol and nabilone have not become the mainstays of treatment mainly because of their side effects, which include sedation, anxiety, dizziness, euphoria/dysphoria and hypotension, as well as the presence of superior alternatives.
Dronabinol and nabilone have also been shown to produce symptomatic relief of neuropathic pain and the spasticity associated with multiple sclerosis. However, whilst patients report alleviation of spasticity, measures of objective changes are mixed. In a recent study by Kraft and co-workers, an orally administered extract of cannabis containing mainly THC was found to have no beneficial impact on acute pain and may possibly have enhanced pain sensation.3 This study highlights not only the complex nature of pain itself, but also the importance of identifying specific therapeutic contexts in which THC may or may not be useful.
It should be noted that while these studies are conducted much like other studies on medical agents, a particular problem arises because the psychoactive side effects of dronabinol and nabilone make it difficult to maintain appropriate blinding, which is a basic requirement of a randomized controlled trial. In other words, when the research subjects become aware that they are receiving the active ingredient and not the placebo, their perception of therapeutic value is potentially confounded and a study’s claim of therapeutic advantage over placebo may be compromised.
Nabiximols is an interesting example of a novel form of delivery by nasal spray that has the advantage of rapid absorption. By including both THC and CBD together, it may be that CBD limits some of the adverse side effects common with THC alone. It has been licensed for the treatment of cancer pain and neuropathic pain.
The role of CBD in potentially mitigating some of the adverse effects of THC may prove to be a valuable finding. It also highlights why use of the raw herbal product could be even more problematic than already thought, because as new strains have been developed, the amount of THC has risen at the same time as the amount of CBD has declined. In some strains, CBD is virtually absent. When production of cannabis is permitted by the public for medical use, there is no control over the levels of active ingredients and in particular the ratio of THC to CBD.
One final variation on delivery systems involves vaporization of the herbal product. This means of delivery is about as close as possible to smoked marijuana. Some clinical trials are currently underway.
It is important to note that with each of these formulations little is known about the medium to long term adverse effects. However, given that there is evidence for long-term harm arising from studies of those who smoke cannabis regularly, significant caution should be exercised about these formulations of active ingredients.
Research on smoked marijuana has occurred in parallel with research on the active ingredients. Smoked cannabis has been found to improve appetite and weight gain in HIV patients without adverse effect on viral load.4,5 However, again the validity of the results may be affected by poor blinding, and the effectiveness would of course need to be balanced against adverse effects.
Following the establishment of the Center for Medicinal Cannabis Research (CMCR) at the University of California in 1999, the number of research projects on smoked cannabis has increased. Several clinical studies have been published on neuropathic pain and experimentally induced pain. In general the results show a modest analgesic effect of smoked cannabis over placebo.6,7,8
It is important to note that most of the subjects in these studies were cannabis experienced, so the results may not be able to be extrapolated to cannabis naïve patients. Moreover, because the subjects were cannabis-experienced, it is likely that blinding was compromised and hence the findings should be interpreted with this in mind.
In 1999, the US Institute of Medicine (IOM) undertook an analysis of all the available evidence on the clinical utility of cannabis in its various forms. In its recommendations it made clear that,
The goal of clinical trials of smoked cannabis would not be to develop cannabis as a licensed drug, but rather to serve as a first step towards the possible development of non-smoked rapid-onset cannabinoid delivery systems.9
Similarly, the FDA has stated,
No sound scientific studies supported the medical use of marijuana for treatment in the United States and no animal or human data supported the safety or efficacy of marijuana for general medical use. There are alternative FDA-approved medications in existence for treatment of many of the proposed uses of smoked marijuana.10

Why did the FDA come to this conclusion?
Their position is grounded in an approach to the development of medicines that must take into consideration a range of factors. To be accepted as a medicine, the following criteria must be met,

The drug’s chemistry must be known and reproducible
There must be adequate safety studies
There must be adequate and well-controlled studies proving efficacy
The drug must be accepted by qualified experts
The scientific evidence must be widely available 11

Smoked marijuana does not meet these criteria and hence the FDA has not approved its use as a medicine.
Of additional concern is the fact that the herbal product is produced with little or no quality assurance and may therefore be contaminated by microbes, other pathogens, heavy metals and pesticides. This would not be tolerated for other medicines over which the FDA has regulatory control.
It is not surprising that other peak organisations like the American Medical Association, the American College of Physicians, the American Nurses Association, the American Cancer Society, the American Glaucoma Foundation, the National Multiple Sclerosis Society, the American Academy of Pediatrics and the American Society of Addiction Medicine all support the FDA approval process and have expressed either opposition to or concern over the use of smoked marijuana as a therapeutic product.12
It is important that peak bodies like the FDA in the US and the Therapeutic Goods Administration (TGA) in Australia are able to maintain their position as the gatekeepers of the regulatory process by which new medicines become available to the public. They are undermined when, by alternate regulatory means, medicines are made available. This is the case in the US where States have enacted legislation that makes smoked marijuana available for medical purposes without FDA approval.
A dangerous precedent is set by approval processes that are effectively achieved by popular vote of citizens who are not expert judges of medical efficacy, side-effects, abuse potential, or ethics of the doctor-patient relationship. Popular vote is also risky because the public is then at the mercy of pressure from groups who are using medical marijuana as a beachhead for generalised legal access to marijuana.
Medical Marijuana in the US and elsewhere
Smoked marijuana for medical purposes is now legal in 18 US States. The first was California in 1996 when the citizen referendum Proposition 215 was passed by a majority of 56% to 44%. Most of the medical marijuana in the US is grown and utilized in California and Colorado.
In California it is estimated that there are between 250,000 and 300,000 people who have physician approval for their use of marijuana.13 This number is so large that it clearly serves those who are not only within the category of the seriously ill and dying, which were the grounds upon which many campaigns were argued. In Colorado, which has twice as many medical marijuana users per capita as California, 2% of the population is registered.14 This yields approximately 100,000 people.
Whilst there is limited data, some aspects of the demographic profile of medical marijuana registrants appears to be similar in the different States. The average age of registrants in Colorado is 40 years of age and 69% are male.15 Even so, there are 40 under the age of 18. In a UK study, users were predominantly young, male and recreationally familiar with cannabis.16 A Californian study revealed users to be approximately 75% male, 60% white, and mostly from a background of recreational use.17 In a separate study, 89% had started using before the age of 19, and 90% were daily smokers.18 In another recent Californian study, it was found that applicants to the medical marijuana program self-reported their use of marijuana for pain relief (82.6%), improved sleep (70.6%), relaxation (55.6%), muscle spasms (41.3%), headache (40.8%), relief of anxiety (38.1%), improved appetite (38.0%), relief of nausea and vomiting (27.7%), and relief of depression (26.1%).19
These observations are consistent with the specified conditions for which marijuana can be used in California, along with those covered by the catchall phrase, ‘or any other illness for which marijuana provides relief’. The conditions vary in each of the States, but by and large, the breadth of conditions for which marijuana can be used is relatively expansive.
In Nevada, the majority of marijuana is used for generalised conditions; for example, 53% for severe pain, 29% for muscle spasms, and 11% for severe nausea.20 There is no straightforward way to assess each of these conditions objectively. The remaining 7% are for glaucoma, HIV+/AIDS, cancer and cachexia (wasting).
The demographic data and usage data reveal that most registrants have come from a background of recreational use and are smoking marijuana for conditions which cannot be easily objectively verified. This is not to necessarily argue that registrants do not have medical conditions which they believe may be treated by marijuana, but simply to note that this mode of drug delivery and means of treatment are not subject to the usual controls put in place for ensuring the good of the patient. There is also no straightforward way to assess whether someone might simply be seeking marijuana for ‘recreational’ use under the guise of medical treatment, and thereby exposing themselves to a litany of avoidable harms.
In most of the States, marijuana can be grown by registrants or by a caregiver, and often the amounts involved allow for considerable excess beyond use for medical reasons. For example, in Oregon, registrants can possess 6 mature plants and 24 ounces of usable cannabis. Morgan has calculated that 24 ounces of cannabis can be rolled into 1896 joints.21
Despite the fact that most States permit users to grow their own marijuana, but do not permit dispensaries, they are nevertheless proliferating. In the city of Denver in Colorado, there are “more dispensaries than public schools, liquor stores, or even Starbucks coffee shops”.22 The incentive for owners is considerable. Average monthly cost for consumers has been estimated to be between $562 and $2250. Moreover, as there is no FDA approval, no insurer will contribute.23
In Colorado, dispensaries advertise a variety of products and offer free samples.24 In Nevada tourists are greeted with large billboards advertising medical marijuana.25 This is an industry that is growing and operates in a fashion unlike other providers of medical products.
A particular problem arises in contexts where cannabis can be legally provided by a cooperative, which must source their product from the black market, as in California. The result of this is stimulation of the illegal production of cannabis. In their submission to the NSW inquiry into medical marijuana, Hall & Farrell comment:
The effect of these forms of liberalization has been to create a quasi-legal system of cannabis production and distribution in many parts of California and some of this cannabis is sold to recreational users.26
There seems little doubt that marijuana is being diverted from medical programs for ‘recreational’ purposes. The Las Vegas Metropolitan Police Department recorded an enormous 1200 percent increase in grow site seizures between 2006 and 2010.27
In Colorado, 48.8 percent of adolescents admitted to substance abuse treatment obtained their marijuana from someone registered to use medically.28 The authors conclude:
Diversion of medical marijuana is common among adolescents in substance treatment. These data support a relationship between medical marijuana exposure and marijuana availability, social norms, frequency of use, substance-related problems and general problems among teens in substance treatment.
In a recent study by Cerda and co-workers, it was found that states with medical marijuana laws had higher rates of use, abuse and dependence.29 The authors are careful not to assume a causal link, and acknowledge that there are several possible mechanisms by which medical marijuana laws could lead to increased abuse. Harper and coworkers suggest that there is unlikely to be a causal link.30
In a retrospective case study series of marijuana exposure in children under 5 years of age presenting to emergency hospital departments in Colorado, it was found that children had been exposed over a 6 month period. Importantly, 4 of the 5 children came from home environments where medical marijuana cards were present.31
One of the complications of States enacting laws such as these is that cannabis remains a schedule 1 drug and hence possession and use is a federal offence. The laws therefore represent a strange and messy juxtaposition between State and Federal legislation. This is not only a difficult and inconsistent regulatory environment but also one in which there is potential for laws to come into disrepute. This is especially the case since the Obama administration issued a statement in 2009 indicating it would give low priority to the prosecution of individuals in those states with medical marijuana laws.32 Thus a deterrent for dispensaries to provide a federally prohibited substance was removed.

What is the impact on the medical profession?
It has long been recognised that the relationship between patient and physician is a unique one. It is unlike the relationship between consumer and service provider in many other professions, largely because of the vulnerability of the patient, but also because the physician is entrusted with direct engagement with diagnosis and treatment that deals closely with the person’s body and its integrity. It has an intimacy that calls forth particular ethical reflection and guidance.
Codes of ethics have been developed to govern the relationship, the oldest being the Hippocratic Oath. Even older is the basic requirement primum non nocere, ‘do no harm’. More recently, the Declaration of Geneva states, “The health of my patient will be my first consideration.” All of these are designed to protect the patient and ensure that care is directed towards their well-being, recovery, and ultimately, flourishing. Hence, physicians have a duty of care and a fiduciary responsibility to their patients. They should also be aware of potential conflicts of interest.
In the modern context, the standard of care typically requires the physician to perform an examination, and if necessary implement appropriate diagnostic tests, take a patient’s history to check for possible contraindications, check for the failure of other treatments, communicate with the person’s other health professionals, and assess response to treatment and monitor adverse effects.
Medical marijuana programs generally fail in some or all of these normal requirements, compromising the doctor-patient relationship and potentially putting the patient at risk. Doctors are placed in a difficult position when asked to provide a substance that is federally controlled, is of unknown purity, potentially contaminated, and about which there is limited evidence on indications, contraindications, adverse effects and dosage.
It is not surprising that many physicians are unwilling to recommend marijuana to their patients. In Colorado, for example, 10% of recommendations were made by one physician and 49% by just 15.33 Some doctors may also be concerned about their legal liability if harm were to come to a patient. In one case, a physician recommended
marijuana to a 20 year old pregnant woman without examining her or documenting her pregnancy. The child was born and tested positive for marijuana.34
In some contexts there are clearly conflicts of interest. Some physicians are employees of dispensaries and therefore have personal interest in recommending cannabis.35
In a recent letter to the American Journal of Psychiatry, a medical practitioner described a case where a young man with a history of psychiatric problems was recommended medical marijuana. His problems were exacerbated, eventually resulting in hospitalization for psychosis. He eventually withdrew from marijuana and recovered.36 This case highlights not only the risk of psychosis with marijuana, but also the failure of a duty of care by a recommending physician.

Who is driving medical marijuana initiatives?
The impetus behind legislative changes for medical marijuana comes from several different sources.
Those who have been using marijuana in the belief that it is treating their medical condition are often strong advocates for legal change. As we have seen, there is therapeutic potential in cannabis, so there is some rationale behind pressure from those who find relief for their symptoms. However, not only is anecdotal evidence alone an unreliable path to new medicines, but the complications with ‘recreational’ use make it very difficult to sift out a real benefit from a sense of ‘feeling better’.
There are also individual health practitioners who may believe that some of their patients could benefit from medical marijuana, and hence they may advocate for legislative change.
However, by far the most active players are those who would like to see marijuana legally available for ‘recreational’ purposes. Some of these groups as well as individuals have been pressing for change for decades and with medical marijuana, they see the opportunity for a beachhead. The rationale is based upon the idea that the image of marijuana will be considerably softened by its use as a medicine. They would also likely be aware that medical marijuana constitutes such a regulatory mess that as more people use medical marijuana, policing of ‘recreational’ use becomes more difficult. To some in authority it may appear simpler to accede to pressure for full legalization.
Groups like the National Organisation for the Reform of Marijuana Laws (NORML) have been agitating for medical marijuana for a long time, as has the Drug Policy Alliance. However, particular individuals have also put in considerable funds. These include billionaire financier George Soros and insurance magnate Peter Lewis. It is estimated that Lewis alone has spent between $40 and $60 million on medical marijuana initiatives since the early 80s.37

Soros-watcher Rachel Ehrenfeld has described the Soros strategy as set forth to pro-legalisation group Drug Policy Foundation in the early nineties:
… in 1993 Soros gave DPF a “set of suggestions to follow if they wanted his assistance: Come up with an approach that emphasizes `treatment and humanitarian endeavors,’ he said … target a few winnable issues, like medical marijuana and the repeal of mandatory minimums.” Apparently, they took his advice.38

Conclusion
Medical marijuana is an example of a complex blurring of the lines between use and abuse, between potential medical utility and ‘recreational’ use. Concern about the use of smoked marijuana being made publically available has been vindicated by the spread of medical marijuana legislation throughout the US and the proliferation of dispensaries providing marijuana for dubious purposes including ‘recreational’ use.
The situation has made it difficult for policing and compromised the medical profession. It undermines the FDA process of approval of medicines and complicates State-Federal relations. By doing so it has the potential to bring the regulatory process as well as the law itself into disrepute.
The active ingredients in cannabis are showing promise for therapeutic use and may prove to be useful for the treatment of various ailments. Ironically, permission to smoke marijuana for medical purposes may delay the development of cannabinoid medicines by ‘muddying the waters’ and drawing valuable resources away from genuine research.
Colorado psychiatrist Christian Thurstone puts it well:
In the absence of credible data, this debate is being dominated by bad science and misinformation from people interested in using medical marijuana as a step to legalization for recreational use. Bypassing the FDA’s well-established approval process has created a mess that especially affects children and adolescents. Young people, who are clearly being targeted with medical marijuana advertising and diversion, are most vulnerable to developing marijuana addiction and suffering from its lasting effects.”39
When reflected upon years from now, how will medical marijuana be viewed?
With the advent of treatments designed to work with the body’s own cannabinoid system, the medical use of marijuana should fade as a topic of heated debate to a footnote in the history of medicine.40

1 Pike, GK, The Debate on Drug Law Reform, paper delivered at the Catholic Bioethics Colloquium, Melbourne, January 2013.
2 NSW Government Health Department fact sheet on Cannabis, May 2011.
3 Kraft B et al., Lack of analgesia by oral standardized cannabis extract on acute inflammatory pain and hyperalgesia in volunteers. Anesthesiology 109(1):101-10, 2008
4 Abrams DI et al., Short-term effects of cannabinoids in patients with HIV-1 infection: a randomized, placebo-controlled clinical trial. Annals of Internal Medicine 139(4): 258-266, 2003
5 Haney M et al., Dronabinol and Marijuana in HIV(+) marijuana smokers: acute effects on caloric intake and mood. Psychopharmacology(Berl) 181(1): 170-178, 2005
6 Abrams DI et al., Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial. Neurology 68(7): 515-521, 2007
7 Ellis RJ et al., Smoked medicinal cannabis for neuropathic pain in HIV: a randomized, crossover clinical trial. Neuropsychopharmacology 34(3):672-680, 2009
8 Wilsey B et al., A randomized, placebo-controlled, crossover trial of cannabis cigarettes in neuropathic pain. Journal of Neurology 253(10): 1337-1341, 2006
9 Joy JE et al., Marijuana and Medicine: Assessing the Science Base. Division of Neuroscience and Behavioral Health. Institute of Medicine. Washington DC, National Academy Press, 1999,
10 See DOJ, DEA, “Lyle E. Craker; Denial of Application,” 74 Fed. Reg. 2101, 2104 (Jan. 14, 2009).
11 Barthwell AG, Early findings in Controlled Studies of Herbal Cannabis: A Review. The Journal of Global Drug Policy and Practice, June 24, 2010
12 Barthwell, Op. Cit. See also http://nrfocus.org/latest_topics/is-marijuana-medicine/
13 Bostwick JM, Blurred Boundaries: The Therapeutics and Politics of Medical marijuana. Mayo Clinic Proceedings 87(2): 172-186, 2012
14 Nussbaum AM & Thurstone C, Mile High Macaroons: The Medicalization of Marijuana in Colorado. The Journal of Global Drug Policy and Practice 5: 5-15, 2011
15 Medical Marijuana registry program update [Internet]. Denver CO: Colorado Department of Public Health and environment, c2011 Mar 31
See www.cdphe.state.co.us/hs/medicalmarijuana/statistics.html
16 Ware MS et al., The medicinal use of cannabis in the UK: results of a nationwide survey. Int J Clin Pract. 59(3): 291-295, 2005
17 Reinarman C et al., Who are medical marijuana patients? Population characteristics from nine California assessment clinics. J Psychoactive Drugs 43(2): 128-135, 2011
18 O’Connell TJ & Bou-Matar CB, Long term marijuana users seeking medical cannabis in California (2001-2007): demographics, social characteristics, patterns of cannabis and other drug use of 4117 applicants. Harm Reduction Journal 4:16, 2007
19 Nunberg H et al., An Analysis of Applicants Presenting to a Medical Marijuana Specialty Practice in California. Journal of Drug Policy Analysis 4(1): Article 1, 2011
20 Raybuck T, Medical Marijuana, Nevada’s Big Gamble. The Journal of Global Drug Policy and Practice 5(2), 2011
21 Morgan S, The Impact of Oregon’s Marijuana Program, The Journal of Global Drug Policy and Practice
22 Nussbaum & Thurstone, Op. Cit., 2011
23 Barthwell, AG, Marijuana Dispensaries and the Federal Government: Recommendations to the Obama Administration 2009: Part 1, The Journal of Global Drug Policy and Practice
24 Nussbaum & Thurstone, Op. Cit., 2011
25 Raybuck, Op. Cit., 2011
26 Hall W & Farrell M, Submission No 46 to the New South Wales Inquiry into use of cannabis for medical purposes, 13 Feb 2013
27 Raybuck, Op. Cit., 2011
28 Thurstone C, Lieberman SA & Schmiege SJ, Medical marijuana diversion and associated problems in adolescent substance treatment. Drug Alcohol Dependence 118(2-3):489-492, 2011
29 Cerda M et al., Medical marijuana laws in 50 states: investigating the relationship between state legalization of medical marijuana and marijuana use, abuse and dependence, Drug Alcohol Depend. 120(1-3): 22-27, 2012
30 Harper S et al., Do medical marijuana laws increase marijuana use? Replication study and extension, Ann Epidemiol 22: 207-212, 2012
31 Wang GS et al., A case series of marijuana exposures in pediatric patients less than 5 years of age, Child Abuse & Neglect: The International Journal 35(7): 563-565, 2011
32 Johnston D & Lewise NA, Obama administration to stop raids on medical marijuana dispensers. The New York Times Mar 19 2009
See http://www.nytimes.com/2009/03/19/us/19holder.html?_r=0
33 Nussbaum & Thurstone, Op. Cit., 2011
34 Nussbaum AM et al., “But my Doctor Recommended Pot”: Medical Marijuana and the Patient-Physician Relationship, J Gen Intern Med 26(11): 1364-7, 2011
35 Nussbaum AM et al., Op. Cit., 2011
36 Pierre JM, Psychosis associated with medical marijuana: risk vs. benefits of medicinal cannabis use. Am J Psychiatry 167(5): 598-9, 2010
37 O’Connor C, High Roller: How Billionaire Peter Lewis Is Bankrolling Marijuana Legalization, Forbes Magazine, April 2012 See http://www.forbes.com/sites/clareoconnor/2012/04/20/high-roller-how-billionaire-peter-lewis-is-bankrolling-marijuana-legalization/
38 Rachel Ehrenfeld, May 1996, The Movement to Legalize Drugs in the United States: Who’s Behind It? Downloaded from the Capital Research website (www.capitalresearch.com).
39 http://nrfocus.org/latest_topics/is-marijuana-medicine/
40 Mack A & Joy J, Marijuana as Medicine? The science beyond the controversy. 2001

DALGARNO INSTITUTE

The real subtext of the decriminalisation push

Shane Varcoe

5/22/2012

Author: Mr. S.W.Varcoe May 2012 www.dalgarnoinstitute.org.au

There is a maxim that remains constant in our consumerist culture and that is ‘availability, accessibility and of course the key component permissibility all increase consumption’.
I was speaking with a close friend who spent years in the horse racing industry and he told me the story about the advent of TAB betting outlets and the reason why such measures were introduced. One of the key motivators was the desire to diminish, if not eradicate the underground ‘S.P (Starting Price) bookies’ who would ‘assist’ punters who couldn’t get to the race track to make a wager on the ponies!
The strategy was to set up government controlled facilities that would enable people to gamble on the horse races in a more ‘scrutinized’ and accountable manner. Sounds fair? So to introduce state sponsored gambling they most certainly had to have ‘safe-guards’ in place; the following are just some of the caveats that must be adhered to in the setting up of government licensed TAB’s
a) Must not be within 200 metres of a hotel
b) Must not be within 200 metres of a church
c) Automatic Teller Machines or other money distribution mechanisms not permitted at race tracks.
Sounds wise, reasonable, especially to ensure some modicum of ‘harm minimisation’ was in place. For those at all familiar with this race betting industry, you will have no doubt raised your eyebrows to the clear fact that all of these ‘harm minimising’ measures have long since fallen by the wayside. Consumer demand insisted on it, didn’t it? The thin end of the wedge went deep and went fast!
Now we see….
a) Rows of ATM’s at racetracks
b) Gambling facilities and hotels merged into an indistinguishable melting pot of ‘alcohol enhanced’ entertainment
c) Churches… sorry what about them?
Now in this scenario, permission to gamble already existed, but it was access and availability that changed to increase its incidence.
What of other ‘permission’ increasing exercises? Let’s look at the legalisation of brothels in the State of Victoria; from 1984, when Victoria first legalised brothels, to 2004, the number of licensed ‘sexual services providers’ increased from 40 to 184 (Business Licensing Authority 2004a, p.1). Significantly, these figures do not include the growth in illegal prostitution, estimated to be four to five times the size of the regulated sector. The legalization of a once illegal industry has only seen an increase, not only in the spread of this ‘service’, but an exponential increase in those workers operating ‘outside the law’, to avoid regulatory processes and accountability. I’ll state it again… “Operating outside the law to avoid regulatory processes and accountability” Now, we have two tiers to contend with and still with no more, and one could argue, even less management of this dehumanising ‘industry’.

So, will this increase in both use and uptake happen with decriminalizing drugs? Of course not! Is the pro-drug lobby cry, but why would this arena be any different to the above mentioned?
The emergence of a new drug genre, ‘Novel Psychoactive Substances’ (NPS) gives us a clear indicator as to whether decriminalizing current illicit drugs will promote usage; the colloquial ‘tag’ given to these ever morphing chemical cocktails is the giveaway –‘Legal Highs’. The idea that one may be able to get a ‘buzz’ without breaking the law is a ‘permission slip’ for, if nothing else, a ‘guilt free’ try. Social prohibitions that are informed by not merely health and safety, but economic/productivity values do influence decision making. However, once these are viewed by the egocentric and ‘care-less’ social isolationist, as arbitrary, and personal ‘taste, mood and urge’ become the informing agents of policy, then removing illegality gives a further ‘push’ toward use.
If you think this is mere social theory, then think again. A very recent (and first of its kind for Australia) survey/study conducted by Dr Monica Barratt from National Drug Research Institute (Curtin University in Melbourne) reveals some, albeit unintentional, findings. The research, published in Australasian Professional Society on Alcohol and other Drugs, ‘Drug and Alcohol Review’ revealed not only the impact of Synthetic Cannabinoids, but the reasons for uptake. Not surprisingly the top reason for trying this substance was ‘Curiosity’ which 50% of those surveyed admitted as the motivation for engagement with the substance. However, it is reason two and three that reinforce what we here at The Dalgarno Institute have always known, and that is – ‘permissibility, accessibility and availability, all increase consumption.’
The research revealed that 39% of these first time users did so because of its perceived ‘legality’ and 23% took it up because it was ‘available’.1
Let’s turn this axiomatic formula to the legal drug of tobacco. Certainly more than permission for use of this substance has existed for over a century. More than permission was a sociable ‘insist-ability’ to partake – it was high fashion. At one point some medical doctors were prescribing cigarette smoking as a stress management tool, as mind-boggling as that is to contemplate in today’s social climate.
The growing and relentless assault against tobacco via the QUIT campaign in Australia is something only ‘mushrooms’ would know little of. This vital and effective demand-reduction and education ‘crusade’ that is raging against tobacco has been clear from its inception, and has continued to burgeon, evermore aggressively to the veritable ‘war’ we now see today.
The message is at the very least unambiguous, at times, bombastic! There is no guessing what the outcome of this assault on this ‘legal’ drug is to be. The message and mandate, at least in Australia, is not ‘slow down’, it is not ‘moderate’ it is QUIT. The end game is the only game. Sure, there are no illusions about the time it may take for many to reach that goal, but that goal is the only target to aim at and as a consequence measures and outcomes are effective – more and more Australians are quitting!
In 1945 approximately 72% of Australian men smoked. The rate has been dropping ever since then. In 2007 only 18% of Australian males were daily smokers. In 1945 26% of Australian women smoked…In 2007 women were smoking at a lower rate than men with 15.2% still smoking daily. 2

• increases in getting help to quit smoking, especially use of the Quitline (2% to 4%) and nicotine replacement therapy (7% to 10%);
• increase in one year quit rate from 8% to 11% among smokers and recent quitters;
• a statistically significant reduction of about 1.5% in the estimated adult prevalence of smoking. 3
However, as successful as this message has been, the fight is not over yet, as the following excerpt so irrefutably affirms…
“ANTI-SMOKING campaigners have far from finished their battle with the tobacco industry, with some pushing for a ”license to smoke” and many predicting that cigarettes could be outlawed within a decade.” 4(emphasis added)
Well, so was the bold opening statement in recent article ‘Now butt out: new push seeks to outlaw cigarettes’ in The Age Newspaper.
Fascinating! Outlawing cigarettes, even though around 17% of Australians are still smoking – outrageous! The article went on to note that if such a ban were to take place the government would stand to lose around $6 billion dollars in tax revenue, but save an estimated $31 billion dollars currently spent per annum on smoking related health problems.
No doubt to everyone who is not a smoker this makes good health and fiscal sense – maybe even to some smokers too?
So how is that we have managed to convince a society that a ban could actually be possible on a legal drug – tobacco, that in its boom era (during the 40’s, 50’s and 60’s) was a key social accessory? A quick inventory of the processes engaged may give us some insight:
? A clear and uncompromising acknowledgement from health, government and fiscal sectors that cigarette smoking was damaging our community.
? The ensuing resolve that this must change for both fiscal, but more importantly, health reasons.
? The continuing single voice of disapproval of cigarettes from academics, politicians and health professionals. (Stopped the propaganda of the pro-smoking academics/doctors and started the recognition of the undeniable facts that ‘every cigarette is doing you damage’.)
? The sustained political will to create and implement policies to bring about change, including increased taxation, total advertising ‘blackouts’ and bans – that’s right, ‘prohibition’ on smoking in defined places.
? These have been followed by the creation and implementation of Demand Reduction strategies that only grow in number and intensity; including health warnings and plain packaging on cigarette packets; and the relentless public education campaign on the dangers of smoking.
Author: Mr. S.W.Varcoe May 2012 www.dalgarnoinstitute.org.au
It would appear from both anecdotal and empirical data that such resolute policies work, even with a once widely accepted and socially palatable ‘legal drug’ like tobacco.
But I’m confused! How can such a relentlessness, ‘war’ on this ‘legal’ drug – tobacco, of which some 17% of Australians still use, be not only waged, but affirmed; while at the same time an apparent ‘war’ on illicit drugs be waged, declared ‘lost’ by noisy protagonists and discounted as no longer a worthy strategy? Especially when statistically less than 6% of the world’s 16-65 y.o. olds have tried or may be using some illicit drug intermittently, why would one give up on changing that statistic?
Why is a ‘war’ being fought so assiduously against tobacco and given up on against illicit drugs and the human cost they incur? Wouldn’t a war to reduce the now less 6% statistic be worth fighting to do all it can to prevent it increasing? Yet instead we hear, from a very small, but noisy minority, a call to not only stop the all but non-existent war on drugs and instead let them off the leash through decriminalisation or legalisation.
You, the reader, must understand something here and make no mistake; this call is a key component to the greatest drug pushing measure to ever be foisted on a culture – the push of permission! And timing for such a push is everything.
If you are an architect of such a blatant drug ‘push’ exercise, you must…
a) Cultivate the message that drug use is ‘normal’, everybody is trying it!
b) Cultivate a notion that some drugs are harmless and drug use is manageable, no different to alcohol or cigarettes.
c) Set up the ‘couch of credibility’ for some drugs by declaring them ‘medicine’. For example push the following specious logic; Cannabis can be used for some medical purposes, therefore marijuana is medicine, therefore marijuana is healthy, therefore marijuana is ok to use!
d) Have ‘celebrities’ and ‘doctors’ come out with claims of functional drug use giving credibility to the ‘product’.
e) However, the real key, if these elements are going to get real traction, is you must have an easily to manipulate demographic. To do that you have to ‘set people up’, particularly the young who have never really been taught how to think in any anthropological context of sustainable ‘why’ on life, rather only being told that what they think they want to right and good or bad, right or wrong, no longer come into it.
In our current confused culture, the plumbline for right and wrong has been ostensibly removed. There is no one unified ‘moral code’ to keep other than ‘one’s own’. It is Generation Y and the emerging generation who are best set up for this manipulation. Add to that the attentive issues of a ‘fun focused’ pop-culture, ruled by and ever distracting technocracy and you have a demographic easy to ‘play’ in a well-pitched market scenario.
When ‘selfist’ relativism erodes all sense of the ‘common’ good and any version of collective morality banned. When anchorless, rudderless and directionless ‘ethics’ are wielded by the manipulative apologists of chaos, thinly cloaked in ‘progressive spin’, we are left with only one vehicle by which to somewhat order society and prevent descent into anarchy, that vehicle is the rule of law.
Author: Mr. S.W.Varcoe May 2012 www.dalgarnoinstitute.org.au
The prominent Statesman Edmund Burke made this clear…
“Human Beings are qualified for liberty in exact proportion to their disposition to put moral chains upon their own appetites… Society cannot exist, unless a controlling power upon will and appetite be placed somewhere; and the less of it there is within, the more there must be without. It is ordained in the eternal constitution of things, that men of intemperate minds cannot be free. Their passions forge their fetters.”
Of course then comes the next question; what law and who gets to make it? This now becomes the arena of debate.
I want to present a couple key scenarios in this brief treatise that leave us little ‘wiggle-room’ for the idea of abandoning criminal sanctions on drug use, let alone the unthinkable society wide and ultimate ‘drug pushing’ scenario of legalisation.
A basic principle of good democratic and functional communities is to do with foundational governance issues. When it comes to legislation, what principle/s should it be founded on, or at least informed by?
Gus Jaspert the Deputy Director of UK Home Office speaking at the 3rd World Forum Against Drugs, declared…
Governments should aim to…
a) Protect their citizens from harm.
b) Provide environments that enable its citizens to reach their full productive potential.
Any legislation must be filtered through these two foundational principles and the tough questions asked of any proposed introductions or amendments that may breach these principles.
So follow the questions…
a) Does illicit drug use cause harm to citizens?
b) Does illicit drug use impede/diminish the productive potential of a nation’s citizens?
Subsequent to these basic questions one then must also ask…
? Will widening illicit drug accessibility, permissibility and availability, improve the safety, amenity and wellbeing of any or all of a nations’ citizens?
? Will widening illicit drug accessibility, permissibility and availability, improve familial and community functionality, harmony and cohesiveness?
? Will widening illicit drug use improve or put greater burden on the physical, emotional and mental health of our community?
? And last, but by no means least, will widening illicit drug accessibility, permissibility and availability improve or diminish the well-being and safety of our nation’s children?
These last two of these questions are most important to answer, not only on their own merit, but also within the context of other social justice and social responsibility charters, being a) Good professional health care/management and b) nothing less than the United Nation’s Convention of the Rights of the Child.
A précised, but lucid look at professional health management strategies of functional societies reveals that all measures and means be taken to maximise community health for one primary reason (other than well-being of its citizens) and that is good fiscal policy. Healthy people not only save any society immense amounts of money, but contribute more productively to its growth and improvement.
In answering above questions a) and b) just the following pieces of data is evidence enough for governments to move against illicit drugs to protect its citizens against such harms:
‘‘Illicit drug use shaves approximately 13 million years off the world’s collective drug users lives.” 5
“Americans spend approximately $65 billion per year on illicit drugs,6 but the costs to society from drug consumption far exceed this amount. Illegal drugs cost the U.S. economy $98.5 billion in lost earnings, $12.9 billion in health care costs, and $32.1 billion in other costs, including social welfare costs and the cost of goods and services lost to crime.”7
“Principle 16 – Research-based prevention programs can be cost-effective. Similar to earlier research, recent research shows that for each dollar invested in prevention, a savings of up to $10 in treatment for alcohol or other substance abuse can be seen (Aos et al. 2001; Hawkins et al. 1999; Pentz 1998; Spoth et al. 2002a; Jones et al. 2008; Foster et al. 2007; Miller and Hendrie 2009).”8
“The success of demand reduction in the US is reflected in long-term decreases in rates of illegal drug use. The percentage of persons aged 12 and older in the US who used an illegal drug in the past 30 days has decreased 38% from its peak in 1979 (14.1%) to 2009 (8.7%). Equally impressive are statistics from the United Nations Office on Drugs and Crime (UNODC), which has documented a greater than 80% reduction in annual opioid use over the past century!”9,10,11
Yet, there is more to professional health management strategies than economic rationalism. Disease control is a primary goal of good health management policy/strategies. Eradication of any disease is the ultimate goal, but in the interim, management practices can be used with an attempt to alleviate symptoms and to improve health status, enabling best opportunities to work toward recovery and wellness. When there is any option for recovery/wholeness then that becomes the goal.
No good health professional will refuse or omit such options when they are available.
For instance, when it comes to the epidemiology of a disease, treating physicians look to a number of factors, including the agent of contagion. They look to manage, negate and prevent these agents from spreading.
Illicit drug use dependency has now been widely touted as a ‘disease’ and as such the term ‘disease’ has an ever morphing definition in various diagnostic manuals. Regardless of the definition, treatment principles still remain the same – the containment, cessation and future prevention of this disease. Two key factors must be addressed if any sort of positive health outcome is going to be achieved…
a) Susceptibility factors of the patient
b) Exposure factors to the patient
So in treating the disease of drug dependency/addiction one must address both of these factors to have best hope of the drug user becoming healthy again – The health that a) saves money b) keeps you from harm c) enables your full productive potential d) adds to your and the communities general well-being.
The question we now have to ask of any measure that will increase accessibility, permissibility and availability of illicit drugs is, will it exacerbate or alleviate a) susceptibility factors and b) exposure factors? If it does the former, then we have breached good, professional and fiscally responsible health care practice. Any action/method/process that enables the increase or worsening of these two factors is at best reprehensible and at worse culpable and worthy of malpractice suites and license revocation.
When it comes to the mental, physical and emotional health of society’s citizens and particularly its children, any measure that increases the exposure or susceptibility to a disease must be, if not eradicated, utterly contained. To do less is to collapse the very core of what good governance and good health care strategy is for a nation.
When the already available, well managed and effectively deployed ‘exposure’ preventing tool of criminality is employed, we are half way to achieving best potential for full recovery. Removing this proactively used mechanism will only see the opposite be true in a community.
In summary, when it comes to the notion of drug decriminalisation or legislation and the key issues that we have looked briefly at here, we need to ask….
a) Will decriminalisation/legalisation of currently illicit drugs increase the harms to citizens, the children and their productivity/potential?
b) Will decriminalisation/legalisation of currently illicit drugs make for better health care policy/practice and outcomes?
c) Can criminal sanctions be used effectively, not as a punitive sanction, but as a collaborative vehicle to enable both unwitting causalities or even recalcitrant purveyors of drug disease to not only diminish harms to the wider society and themselves, but more importantly to discover the potential and productivity that both functional society and good government endeavour to promote?
It is clear that when societal expectations and conventions of protection, safety, productivity, health and wellbeing are breached by its citizens, then sanctions are not only expected, but demanded. However, the caring use of these sanctions and prohibitions is not about what is ‘put down’, but much more about what can be ‘taken up’. Why remove a mechanism (criminality) that has the proven potential (when used proactively for care i.e. diversion/rehabilitation) to provide safety, promote recovery and more importantly promote wholeness?

I think it is time we stopped the ‘war’ on good drug policy and start to take up the fight for a better society for all our citizens and not just the one dimensional demands of disease promulgating and society damaging minority; the careless minority who seek to avoid, not only the consequences of their bad choices, but more callously, demand the rest of the community to pay for their ongoing bad choices.
I will conclude with a quote from one of the ‘fathers’ of modern libertine ideology, John Stuart Mills; A caveat even the most self-absorbed, ‘rights’ demanding drug user cannot easily dismiss…
No person is an entirely isolated being; it is impossible for a person to do anything seriously or permanently hurtful to himself without mischief reaching at least to his near connections, and often far beyond them…If he deteriorates his bodily or mental faculties, he not only brings evil upon all who depended upon him for any portion of their happiness, but disqualifies himself for rendering the services which he owes to his fellow creatures generally, perhaps becomes a burden on their affection or benevolence; and if such conduct were very frequent hardly any offense that is committed would detract more from the general sum of good.

Endnotes
1. Barratt,1 Monica J* Patterns of synthetic cannabinoid use in Australia, Drug and Alcohol Review: Volume 32, Issue 2, pages 141–146, March 2013
2 http://www.cancercouncil.com.au/editorial.asp?pageid=371
3 CHANGES ASSOCIATED WITH THE NATIONAL TOBACCO CAMPAIGN PRE AND POST CAMPAIGN SURVEYS COMPARED by Melanie Wakefield http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-publicat-document-metadata-tobccamp.htm/$FILE/tobccamp_c.pdf
4 Stark , Jill The Age, 22.5. 2011 http://www.theage.com.au/victoria/now-butt-out-new-push-seeks-to-outlaw-cigarettes-20110521-1ey2s.html#ixzz1OBTg5SRQ
5 http://gma.yahoo.com/blogs/abc-blogs/200-million-people-illicit-drugs-study-finds-120123343–abc-news.html
6Executive Office of the President, Office of National Drug Control Policy. What America’s Users Spend on Illegal Drugs. December 2001.
7 Executive Office of the President, Office of National Drug Control Policy. The Economic Costs of Drug Abuse in the United States, 1992-1998. September 2001.
8 NIDA: Lessons from Prevention Research, August 2011 http://www.drugabuse.gov/publications/drugfacts/lessons-prevention-research
9Substance Abuse and Mental Health Services Administration. (1999). National household Survey on Drug Abuse: Main Findings, 1997 (Office of Applied Sciences). Rockville, MD.
10 Substance Abuse and Mental Health Services Administration. (2010). Results from the 2009 National Survey on Drug Use and Health: Volume I. Summary of National Findings (Office of Applied Studies, NSDUH Series H-38A,HHS Publication No. SMA 10-4856Findings). Rockville, MD.
11United Nations Office on Drugs and Crime. (2007). World Drug Report 2008. Vienna: United Nations Office on Drugs and Crime. Retrieved June 23, 2011 from http://www.unodc.org/documents/wdr/WDR_2008/WDR_2008_eng_web.pdf

Mr. Shane W. Varcoe – Executive Director, Dalgarno Institute May 2012

Source: Shane W. Varcoe www.dalgaroinstitute.org.au May 2012

A new study suggests people with mental illness are more than seven times as likely to use marijuana weekly than people without a mental illness.

Although some research has found links between cannabis use and mental illness, until now, the exact numbers and prevalence of cannabis use had not been investigated. Cannabis is the most widely used illicit substance globally, with an estimated 203 million people reporting use.

“We know that people with mental illness consume more cannabis, perhaps partially as a way to self- medicate psychiatric symptoms, but this data showed us the degree of the correlation between cannabis use, misuse, and mental illness,” said lead research Shaul Lev-ran, M.D. “Based on the number individuals reporting weekly use, we see that people with mental illness use cannabis at high rates. This can be of concern because it could worsen the symptoms of their mental illness,” said Lev-ran.

Researchers also found that individuals with mental illness were 10 times more likely to have a cannabis use disorder. In this new study, published in the journal Comprehensive Psychiatry, researchers at Toronto’s Centre for Addiction and Mental Health (CAMH) analyzed U.S. data from face-to-face interviews with over 43,000 respondents over the age of 18 from the National Epidemiologic Survey on Alcohol and Related Conditions.

Using structured questionnaires, the researchers assessed cannabis use as well as various mental illnesses including depression, anxiety, drug and alcohol use disorders and personality disorders, based on criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Among those will mental illness reporting at least weekly cannabis use, rates of use were particularly elevated for those with bipolar disorder, personality disorders and other substance use disorders.

In total, 4.4 percent of individuals with a mental illness in the past 12 months reported using cannabis weekly, compared to 0.6 percent among individuals without any mental illness. Cannabis use disorders occurred among 4 percent of those with mental illness versus 0.4 per cent among those without.

Researchers also noted that, although cannabis use is generally higher among younger people, the association between mental illness and cannabis use was pervasive across most age groups. Experts believe the findings suggest those with mental illness may benefit from screening for frequent and problem cannabis use, so that targeted prevention and intervention may be employed as necessary.

Source: Centre for Addiction and Mental Health April 2013

The letter below was written by a Portuguese doctor to a Journalist from Der Spiegel who had printed an article about how successful Portuguese drug policy was. Dr.Coelho shows how the journalist clearly had pre-conceived ideas about the article he was writing and how he totally ignored evidence disputing many of his assumptions. Readers in Germany will not have been able to decide for themselves on evidence, having only read a biased and one sided version of events. The media worldwide have powerful influences on the public and we should, wherever possible, call them to task over inaccurate or downright untruthful reporting. Whether they would publish is another story……

Dear Wiebke,

Reading your article was, surprisingly, a disappointment. I´m sorry to say. You´ve come to Portugal to independently investigate and write a piece on the Portuguese drug policy experiment, but actually, after reading your article, one thing has become clear to me – impartiality is not your game.

What does one do when writing an impartial depiction on a given situation? One listens to every intervening party and to what they have to say and, then translate that to contextualized writing, allowing the essential juicy content about each party to surface in rigorous replication. And that…you did not do.

You have created a skewed depiction on this reality. If on one side of the scale you have placed a fairly detailed description about the official decriminalization policy, its origins, it´s protagonists, it´s numbers and statistics, it´s routines and philosophy; on the other side you were exceedingly scarce and vague with presenting information, the real objective information that contradicts the established thought current.

You´ve limited your words to just saying that there is an opposing character, me, who´s against it all. You say I´m against decriminalization. You say I´m at odds with former colleagues and with “the system”. You say my greatest concern is that my country has given up on the idea of a drug-free world. You say I´m fighting the extensive methadone program (which is actually an incorrect statement). You say that my critical perspective has made me an outsider in my own country. And you say that I don´t agree with Goulão about drug users not being criminals and being sick. And that is, unfortunately, how you´ve summarized my words. Other than that, there´s only you characterizing me with romanticized redundancies that, although perhaps entertaining for the reader, share absolutely NO real information about the issue at hand. And don´t get me wrong – I do not mind being shaped into a character, I get it, it´s more entertaining to read and it´s just a matter of style. What I do mind is when that is done at the expenses of vital core information not appearing. Because ultimately, that is what serving the public is all about, providing information so they can think and decide for themselves. And my filtered and randomly picked phrases or my persona are, absolutely not the point. They are secondary to the technical information I provide, So, where is it?

You see, I did not pick this side of the coin just because I like to contradict and annoy people. I simply cannot ignore the contradicting evidence that presents itself before my eyes and, I feel obligated to contribute with my accumulated knowledge because I feel my help can prevent a whole number of painful situations, which I see are being neglected. I feel it is my duty to act and inform. And I think that that should just as well be yours.

And then you do worse. The ONLY reference that you make to any documentation provided by me is in a description of me showing you a “brief and skeptically worded fact sheet”, “as if” I were “offering proof”, so you say. So, once again, absolutely no concrete data, no content whatsoever is being conveyed to the reader. Just a description of me

handing you sheets of paper. Is that an honest representation of what happened? Far from it. Is that valuing my contribution? Absolutely not. Misleading? Yes indeed.

You were at my house interviewing me for about 3 to 4 hours. I provided you with a whole amount of technical and statistical information, and plenty of documentation based on official sources. After that, you continued to ask questions by email, and I continued to provide you with answers and more documentation. And, of all that documentation and data, what was the only thing that you´ve found worthy of reference? That I have shown you a brief and skeptically worded fact sheet, “as if offering proof”. And let me tell you that I love your subtle vote of distrust in these words – “as if offering proof”. So, what you are saying is, that I might not be showing any proof after all, I´m just acting “as if” I were. Lovely.

A few further inaccuracies to be corrected: you say I fight the extensive methadone program. Not quite true. As I´ve told you before, I believe methadone to be useful in a whole variety of situations. What I absolutely cannot agree with is the decision of making it solely the only practice, applied to every opioid dependent. Making it close to impossible for full remissions and recoveries to happen. Do you realize what that means in someone´s life? It means they´ll be a dependent forever. They´ve changed drugs, but they continue being dependents. And that is a huge heavy burden to carry. They´re self-confidence is always shattered even if they don´t show it. They carry the stigma with them permanently in self-corroding secrecy, always self-conscious about it. Their functioning in the world is always compromised by that. It is quite ludicrous that something as simple as allowing a dependent to have a full drugless recovery, should be eradicated, just because it means more state money spent. In my opinion, the toll is much higher for everybody when such a large part of the population is being maintained in a state of numbness – an opioid is an opioid…

And when I say drugless recovery, I don´t mean “cold turkey” remission, which was another inaccuracy of yours. There is absolutely no need for the recovering dependent to experience the agony and pain of the chemical physical dependence during the remissive process, they already have them in large amounts in their “lives”, and I never did recommend it. So, once again, “cold turkey withdrawals” are not something I would recommend as being the best treatment.

So, to conclude, your article is biased, clearly favoring decriminalization and the Portuguese policy´s point of view. And that was something that you had already established long before meeting me. But just as basic academic rules dictate, you had to have a pinch of contradictory salt – the opposing character. Just a slight colorful adornment to the text to make it seem better founded. But my foundations were overlooked and disregarded, avoided. They were never your focus.

But I understand your context now. You have an agenda, just like Der Spiegel probably does. I noticed in another recent issue of the magazine, an article about how the German state spends 4 billion euros in fighting drugs, and mentioning how a lot of people now believe that decriminalization drug consumption is the way. I don´t condemn your points of view, it´s a current attractive trend, I´m aware of that, and everyone´s entitled to believe whatever seems better to their eyes. I just think that rigor and honesty should not be compromised when it comes to allowing different voices to be heard.

Having said that, if Der Spiegel should be interested in portraying the both sides of the coin more consistently, you are welcome to attend the “I International Congress on Drugs & Dependencies: Recovery is possible”, in Lisbon, next May 23, 24 and 25.

Sincerely at your disposal, Manuel Pinto Coelho

Peter Bensinger is former administrator, of the U.S. Drug Enforcement Administration and former director of the Illinois Department of Corrections. Andrea Barthwell is former deputy director of the Office of National Drug Control Policy.

The marijuana bill the Illinois legislature is considering does away with the Food and Drug Administration process, and the legislature assumes the role of the FDA.

The FDA has concluded that marijuana has a high potential for abuse, has no accepted medical use and lacks an acceptable level of safety even under medical supervision. The FDA has approved Marinol, which is not smoked, but is marijuana in pill form.

Over a century ago, people bought all sorts of stuff from salesmen selling heroin, cocaine, marijuana — out of the back of a wagon. Often called Snake Oil Salesmen, they sold products touted as painkillers.

We had almost 3 million heroin addicts in the early 1900s. The Harrison Narcotics Act passed in 1914, then the Food, Drug and Cosmetic Act, the FDA was established and Charles Walgreen opened a drugstore.

Today people know where they can get medicine approved by the FDA as safe and effective — at drugstores — and manufacturers list the ingredients, directions, side effects and warnings. This bill would make medical marijuana available to 18 year olds, but it won’t be with a prescription or at a drugstore.

Marijuana as medicine means more use and more abuse. Each cardholder can get 2.5 ounces of marijuana every 14 days (2.5 ounces makes 183 joints). Medical marijuana cardholders will either sell their marijuana or give it to others. This is not debatable; this will happen. Based upon Michigan’s experience, Illinois could expect more than 270,000 medical marijuana cardholders.

Research documents that regular users of marijuana have twice the motor vehicle crashes as non-users. In Colorado, since medical marijuana was introduced, the number of drivers causing fatal motor vehicle crashes testing positive for marijuana has more than tripled.

Substance Abuse Treatment centers for children report marijuana as the leading cause for admission. Marijuana is second only to alcohol at adult substance abuse treatment centers.

Illinois employers responsible for a safe work environment prohibit employees from coming to work under the influence of alcohol or illegal drugs. Employers would now have new problems dealing with employees and applicants using marijuana. Can employers maintain a safe work environment when people with marijuana in their system come to work under the influence or stoned, threatening the safety of the workplace and co-workers?

Since when is smoking good for your health? Marijuana is fat soluble and stays in the fatty tissues and the brain 75 times longer than a drink of alcohol.

If smoked marijuana is good for cancer, glaucoma and multiple sclerosis patients, why do national associations representing these patients oppose marijuana as medicine? The legislation sponsors argue that marijuana can provide relief from those suffering untreatable pain, but as the U.S. Court of Appeals ruled on January 22 “no adequate and well controlled studies exist on marijuana’s medical efficacy.”

This is about whether Illinois citizens want the legislature to decide on how to approve and dispense medicine instead of the FDA. The medical marijuana lobby has put together myths and money that will not make for a safe or healthier Illinois. The proposal endangers our youth, our highways and our workplaces and increases costs for employers and taxpayers. It is bad medicine.

Source: Springfield, Illinois, State Journal-Register April 12, 2013

Legal marijuana may not bring in enough money to cover the societal costs of legalization, a new study from a Colorado State University think tank concludes.

The analysis was conducted by the university’s Colorado Futures Center in response to Colorado passing an amendment back in November . The study argues that revenue from marijuana taxes won’t do much to help Colorado’s budget and that money generated for new school construction won’t reach the $40 million annual target that supporters of marijuana legalization set when campaigning for legalization.

“These questions are of even more concern in light of our expectation that the most productive marijuana tax years will be the years just after legalization,” the center wrote in its report.

The study is one of several seeking to predict the unpredictable: What will the state look like with legal marijuana.

“[T]he future holds more unknowns than knowns,” four national marijuana-policy experts wrote in a recent editorial examining the implications of legalization votes in Colorado and Washington.

The predictions largely hinge on how much legal marijuana people will buy and smoke in Colorado. The Colorado Futures Center, citing federal studies on drug use and other references, estimates that demand for pot in Colorado will hit 2,268,985 ounces a year — more than 70 tons.

Using a retail price of $157 per ounce before taxes — and assuming that proposals for a 15 percent excise tax and a 15 percent special marijuana sales tax pass with both lawmakers and voters — the center estimates annual tax revenues starting in 2014 at about $130 million.

That is well above what the state’s nonpartisan Legislative Council found in its voter-guide analysis of Amendment 64, although its $5 million to $22 million annual estimate didn’t include an excise or a special sales tax. The center’s estimate also is above the $60 million annually in savings and extra revenue that the Colorado Center on Law and Policy predicted initially for Amendment 64 — although it, too, didn’t consider revenue from a special sales tax.

The Colorado Futures Center concludes in its report that the costs of regulating recreational marijuana — plus possible extra costs for law enforcement, public health and human services — may exceed the tax revenue from the recreational marijuana industry. The center also estimates that tax revenue from the industry will level off or fall, “as the ‘wow’ factor erodes over time and any marijuana tourism begins to decline, particularly if other states follow Colorado and Washington and legalize marijuana.”

Smart Colorado, a group opposed to all but the most limited implementation of legal marijuana, jumped on the analysis as proof that Amendment 64 was a bad deal.

“The latest research just confirms that marijuana proponents’ promises to Colorado voters that Amendment 64 would be a financial gain to the state were empty,” Diane Carlson, one of the group’s leaders, said in a statement. “Even if voters approve the recreational-marijuana tax, the new pot market could be a net drain on the state’s budget, the study indicates. That means funds for education, roads and other top priorities could be diverted to marijuana regulation.”

Department of Revenue officials, who would regulate recreational marijuana businesses under a proposal before the legislature, have pushed for the special sales and excise taxes — arguing the regulations must be funded if they are to be effective. Still, they told lawmakers Wednesday during a hearing for a bill on proposed regulations that they still don’t have a handle on how much money they will need.

“The challenge that we have,” said Ron Kammerzell, the Revenue Department’s enforcement director, “is that it is very difficult to predict demand.”

jingold@denverpost.com 23.04.13

Prevention is often the best medicine, and that is not only true when it comes to physical health, but also public health. Case in point – young adults reduce their overall prescription drug misuse up to 65 percent if they are part of a community-based prevention effort while still in middle school, according to researchers at Iowa State University.

The reduced substance use is significant considering the dramatic increase in prescription drug abuse, said Richard Spoth, director of the Partnerships in Prevention Science Institute at Iowa State. The research published in the American Journal of Public Health focused on programs designed to reduce the risk for substance misuse. In a related study, featured in the March-April 2013 issue of Preventive Medicine, researchers found significant reduction rates for methamphetamine, marijuana, alcohol, cigarette and inhalant use.

Additionally, teens and young adults had better relationships with parents, improved life skills and few problem behaviors in general. The research is part of a partnership between Iowa State and Penn State known as PROSPER, which stands for Promoting School-Community-University Partnerships to Enhance Resilience. PROSPER administers scientifically proven prevention programs in a community-based setting with the help of the Extension system in land grant universities. The results are based on follow-up surveys Spoth and his colleagues conducted with families and teens for six years after completing PROSPER. Researchers developed the prevention programs in the 1980s and 1990s to target specific age groups.

Spoth said understanding when and why adolescents experiment with drugs is a key to PROSPER’s success. “We think the programs work well because they reduce behaviors that place youth at higher risk for substance misuse and conduct problems,” Spoth said. “We time the implementation of these interventions so they’re developmentally appropriate. That’s not too early, not too late; about the time when they’re beginning to try out these new risky behaviors that ultimately can get them in trouble.”

PROSPER administers a combination of family-focused and school-based programs. The study involved 28 communities, evenly split between Iowa and Pennsylvania. The programs start with students in the sixth grade. The goal is to teach parents and children the skills they need to build better relationships and limit exposure to substance use. “One of the skills students are taught through the school-based program is assertiveness, so that they feel comfortable refusing to do something that might lead to them getting in trouble,” Spoth said. “We try to help parents be more attuned to what their children are doing, who they’re with, where they’re going, effectively monitoring, supervising and communicating with their children.”

Parents say the program works. Michelle Woodruff will admit that being a parent is hard work. “Absolutely, underline and capital letters – it is hard,” said Woodruff, a mother of four sons who range in age from 13-21 years old. But the lessons learned through the PROSPER program, she believes, made her and her husband better parents and also brought out the best in their children. “It was a lot of little things that made us re-evaluate how we parented,” Woodruff said. “I think it makes children more responsible not only to themselves, but their parents and the community. They want to represent their families well, their schools well, their churches; I think it just makes them want to be a better person.” Woodruff is now a member of the PROSPER team in Fort Dodge, where she encourages and supports other parents who participate in the program. Facilitators of the family-focused program use games and role-playing to help parents and children improve communication and set expectations for behavior. Woodruff would like to see more families take advantage of the opportunity. “Do it, not only for the one-on-one time with your child, but also to meet other like-minded parents,” Woodruff said.

“We’re just trying to come together as a community to raise the best kids that we can possibly raise so that they’re successful members of society as adults.”

Community benefits . The ongoing community partnerships are evidence of the PROSPER program’s sustainability, Spoth said. The results extend beyond a reduction in prescription drug or marijuana use. Researchers know that substance abuse often leads to other problem behaviors, so prevention can have a ripple effect and cut down on problems in school and violent behaviors in general. The benefits are measured in economic terms as well as the overall health and outlook of the community. “There are things that can only happen over time if you have sustained programming, because more and more parents are exposed to programs that help them address all of the challenges in parenting,” Spoth said. “As a result, people feel like they’re making connections, their community is a better place to live, and they are positive about the leadership in their community.”

Read more at: http://medicalxpress.com/news/2013-04-prosper-substance-abuse-teens.html#jCp

Source: American Journal of Public Health Preventive Medicine April 25, 2013 in Addiction (Medical Xpress)

The NDPA has often spoken of the need to change the culture around illegal drug use. Young people are being bombarded with mixed messages and find it hard to know who to trust. Parents, quite rightly, want to protect their children and don’t want them using drugs which have addiction potential. More and more research is proving that even cannabis is not the harmless substance once thought and the risk to mental health of users is considerable. And yet the media, via tv, newspapers, music and clothing normalise and glamourise drug taking. The letter below was sent to the CEO of a chain of youth clothing shops.

Letter sent to CEO of Urban Outfitters USA May 2012

Subject: Glasses made to look like pill bottles

I am a parent and grandmother, and one of the thousands of dedicated volunteers who work worldwide to prevent our children from using drugs. I am shocked to learn that your company is selling products made to look like prescription pill bottles. Have you not read about the deaths and health harms from young people using prescription pills ? They think the pills must be safe if prescribed by a doctor – not realising that they are only safe for the patient -not for others using them to get high ?

Is there nothing that companies like yours won’t do to make a profit – even at the risk of death and health to young vulnerable teenagers ?

Shame on you.

A Whangarei man says smoking synthetic cannabis caused seizures that led to his losing his job and left him unable to drive for 12 months. Hugh Van Harlingen, aged in his 50s, is urging others not to experiment with the “dangerous substances.”

He says smoking synthetic cannabis product K2 was the biggest mistake he ever made. Mr Van Harlingen decided to go public after reading in Wednesday’s Northern Advocate that Whangarei lawyer Dave Sayes had written to the Government urging an immediate ban on synthetic cannabis products.

“I saw that article and just had to speak out … I had to let others know what I have been through after smoking K2. K2 ruined my life and I don’t want others to go through it,” he said. Mr Van Harlingen said he had been a cannabis smoker, but gave the habit up before trying K2 about five months ago after friends said he might enjoy it.

But two months later his life was in tatters after he lost his job due to getting seizures in the workplace, fits that also led to his being banned from driving until he had been seizure-free for 12 months, because medical experts could not be sure they would not happen again.

“I wasn’t a heavy user of K2, just a couple of nights a week to help me relax after work, and I thought that because it was legal it must be safe. But boy was I wrong. It’s caused me major problems.” About two months after starting smoking K2 he had had a seizure at work, the morning after having a toke at home.

“It was the first time I ever had anything like that happen to me. I just completely blacked out and can’t remember anything about it, but I was fitting, and my arms and legs were jerking about and I was foaming at the mouth,” he said.

“All I can remember is waking up in the ambulance on the way to hospital wondering what the hell was going on, but I didn’t link it to K2 at that stage.”

He was taken to hospital, but doctors were unable to find out what was wrong. His workplace stuck by him, but said he would not be able to drive any of its vehicles. Then a short time later he had another seizure at work and he had to be let go because of his inability to drive and concerns over workplace safety.

Mr Van Harlingen admits he didn’t read the instructions on the K2 closely, but assumed it would be like cannabis, given that it was marketed as synthetic cannabis. “But it was different from cannabis and much worse. There was something odd about the feeling it gave.”

While the doctors were struggling to find out what was wrong with him, the seizures ceased within days of quitting K2 and now, three months later, he has not had another.

“Now I’m on a sickness benefit and nobody will employ me because I can’t drive for 12 months and because I’ve had seizures at work. It’s messed my life up big time,” Mr Van Harlingen said.

A Psychoactive Substances Bill has been tabled in Parliament by Associate Health Minister Peter Dunne and is expected to pass by August 1. The bill will restrict the importation, manufacture, and supply of psychoactive substances and only allow the sale of psychoactive substances that can meet safety and manufacturing requirements.

But Mr Van Harlingen said August was too long to wait: “It needs to happen now. This stuff is just too dangerous.” –

Source: NORTHERN ADVOCATE New Zealand 29th April 2013

Smoking prevention in schools reduces the number of young people who will later become smokers, according to a new review published in The Cochrane Library. World-wide, smoking causes five million preventable deaths every year, a number predicted to rise to eight million by 2030. The researchers analyzed data from 134 studies, in 25 different countries, which involved a total of 428,293 young people aged 5-18. Of these, 49 studies reported smoking behavior in those who had never previously smoked. The researchers focused on this group because it offered the clearest indication of whether smoking interventions prevent smoking. Although there were no significant effects within the first year, in studies with longer follow up the number of smokers was significantly lower in the groups targeted by smoking interventions than in the control group. In 15 studies which reported on changes in smoking behavior in a mixed group of never smokers, previous experimenters and quitters, there was no overall long term effect, but within the first year the number smoking was slightly lower in the control group. The analysis revealed two key points: • School programs designed to discourage young people from smoking appear to be effective at least one year after their use. • Programs that included social skills training were more effective than those that just provided information or training on resisting peer pressure. “This review is important because there are no other comprehensive reviews of world literature on school-based smoking prevention programs,” Julie McLellan, one of the authors of the review based at the Department of Primary Care Health Sciences at the University of Oxford in the United Kingdom, wrote in the journal. “The main strength of the review is that it includes a large number of trials and participants. However, over half were from the United States, so we need to see studies across all areas of the world, as well as further studies analyzing the effects of interventions by gender.”

Source: ‘Smoking’ reported in www.cadca.org 2nd May 2013

—Substances previously unknown to most psychiatrists, synthetic cathinones (SCs)—commonly referred to as bath salts—have catapulted to the front line of substance abuse in the past 2 years. In 2010, there were 302 Poison Control calls related to the SC 3,4-methylenedioxypyrovalerone (MDPV). For the first 11 months of 2011, this number increased to 5625.1

SCs are sold online, in “head shops,” and in convenience stores. These substances have been marketed as bath salts, plant food, and other seemingly benign compounds in order to be sold over the counter and avoid FDA regulations. Most packages include the warning, “not for human consumption.”

Naturally occurring cathinones are derived from the khat plant (Catha edulis). Active ingredients in SCs include MDPV; 4-methylmethcathinone (mephedrone); and 3,4-methylenedioxy-N-methylcathinone (methylone). The structure is similar to that of amphetamines. The Table lists some aliases of bath salts.

Sometimes viewed as “legal cocaine,” the over-the-counter status of SCs gives the illusion that they are safe. These substances produce sought-after effects (eg, euphoria, elevated mood, increased alertness, aphrodisiac). The most common method of ingestion is injection, followed by snorting and oral ingestion, but they are also taken rectally. Typical dosages range from 3 to 20 mg, with peak absorption within 1.5 hours.2 Effects can last for 3 to 4 hours, followed by a crash period of 2 to 4 hours. With mephedrone, effects may last more than 24 hours.3

Common physical signs of use and intoxication include the following:
• Tachycardia
• Hypertension
• Hyperthermia
• Diaphoresis • Seizures
• Tremors • Motor automatisms
• Mydriasis • Paranoia • Irritability
• Anxiety
• Psychosis

Bath salt use can mimic other medical problems when it results in seizures, hyperthermia, or cardiovascular issues. Concurrent use of serotonergic drugs and SCs may increase the risk of serotonergic syndrome. Kidney damage from rhabdomyolysis, ischemia, and hypoperfusion has also been reported.4

An investigation of 35 emergency department patients who used bath salts in Michigan from November 2010 to March 2011 noted diffuse organ system involvement.5 This report found that 91% of patients had neurological involvement, 77% had cardiovascular involvement, and 49% had psychological involvement. Liver failure developed in one patient 12 days after initial presentation. In addition to reports of hyperthermia and multiorgan failure, deaths have occurred. One death was a result of acute intoxication. Another reported death by suicide was thought to be from the direct psychological effect of MDPV.6

Legal regulation of SCs is difficult because each compound, as opposed to the class, must be individually banned. The Drug Enforcement Administration (DEA), and not the FDA, regulates the products because they are “not intended for consumption.” On October 21, 2011, the DEA exercised its emergency scheduling authority to ban the 3 most common SCs: mephedrone, MDPV, and methylone. In July 2012, President Barack Obama signed into law a federal ban of 31 synthetic substances, 10 of which were bath salts.7 This law also inhibited the sale of synthetic drugs and placed mephedrone and MDPV on the FDA list of substances that cannot be sold for any reason. As a result of this action, these 3 compounds became Schedule I substances, making possession illegal.

The challenge continues as new synthetic compounds emerge, including a-pyrrolidinovalerophenone (a-PVP) and pentedrone, among others. Many of these substances are first seen in Europe before they appear in the US.

Although not revealed via routine drug screens, SCs are detectable by mass spectroscopy. This laboratory test should be obtained on patients with symptoms of ingestion, as well as chemistry panels to test for renal function and liver function. Because of the cardiac effects and the propensity to cause a myocardial infarction, an ECG should also be obtained.5

Treatment of cathinone use is symptomatic. The mainstay of acute intoxication treatment is benzodiazepines. The administration of lorazepam(Drug information on lorazepam) allows for a more careful titration of dose based on symptoms compared with a longer-acting benzodiazepine. Psychotic symptoms can persist after autonomic symptoms have abated and may necessitate antipsychotic medication and psychiatric hospitalization. Antipsychotics may lower the seizure threshold. Psychosis usually resolves within 4 days, but there are reports of psychosis lasting for weeks.8 There have been several reports of violence and suicide after SC ingestion.6,9 All individuals with known or suspected SC use should have thorough violence and suicide risk assessments. When evaluating for violence risk, physicians should look for the presence of delusions, specifically persecutory delusions. A history of violence and of mental illness increases the risk of violence in an intoxicated individual.

The suicide risk assessment should focus not only on thoughts of the patient but also on intent. Attention should be placed on actions taken during the time of intoxication. One should not assume that suicide risk is completely tied to SC intoxication; risk should also be assessed outside of intoxication. Once brought to the attention of the health care provider, the intoxicated individual should be monitored until no longer symptomatic, even if this requires hospitalization.

Conclusion SCs are marketed under several different names and product classes. Symptoms of intoxication mimic those of cocaine and amphetamines. Intoxication can involve most organ systems. Some symptoms of use are serious, and death has been reported. Treatment is symptomatic and should include suicide and violence risk assessments. The 3 most common compounds have been made illegal—but new synthetic compounds are already appearing and are likely to come to light for the psychiatric practitioner.

Source: www.psychiatrictimes.com 30th April 2013 Jason Beaman, DO and Erin E. Hayes, Dr Beaman is a Fellow in Forensic Psychiatry at Case Western Reserve University in Cleveland

‘‘One drink’s too many and a thousand’s never enough.’’

This has been the mantra for people struggling with alcoholism, warning them against the dangers of having ‘‘just one’’. But what if you had a drink problem and could still have the occasional beer? Could a heroin addict continue to shoot up and consider themselves on the road to recovery?

As Australia grapples with the rise in illicit drug use and a binge drinking culture that shows no signs of abating, a new breed of addiction specialists are reshaping the way we view this complex and insidious problem. Born out of the United States, and also burgeoning in Britain, the ‘‘recovery’’ movement aims to challenge community perceptions of addiction by not only publicly celebrating those working their way out of it, but by redefining what it means to be substance dependent. While still in the fledgling stages in Australia, it’s already causing division within the drug and alcohol treatment sector.

Its most controversial tenet is that abstinence is a personal choice not a necessity. What it means to be recovering from drug or alcohol abuse is, according to the movement’s guiding principles, ‘‘experienced and defined by the individual’’. In essence, recovery is a journey not a destination.

Proponents say it’s a fresh, non-proscriptive approach that takes addiction out of the shadows and offers more chance of success through empowerment and self-determination. But some addiction doctors are concerned that this ‘‘recovery is what you want it to be’’ notion is an ill defined philosophy that undermines traditional medical treatment by letting addicts set their own recovery agenda.

‘‘A big risk of this approach is that the patient no longer becomes a patient, they become a willing servant of their own outcome and therefore if they don’t do well it’s their fault and so you then have a situation where you blame the victim,’’ says Professor Jon Currie, one of Australia’s most prominent drug and alcohol specialists, who is the former head of addiction medicine at St Vincent’s in Melbourne, and now works in private practice. ‘‘It moves away from a medical health model and towards an idea that everyone can do this if they try hard enough. But addiction has complex neurobiology behind it, so for a lot of people if they could have stopped using they would, but they have a brain structure that doesn’t allow them to do this.’’

David Best, a recently emigrated Scottish addiction specialist now working with Turning Point Drug and Alcohol Centre in Melbourne, is leading the recovery movement here. He says critics misunderstand the model and place too much focus on the abstinence-as choice ethos. ‘‘We still say that your best bet is to be abstinent from your primary drug of choice, and if you possibly can be completely sober from psychoactive substances apart from medications, but it’s a personal journey so everyone will be different,’’ Associate Professor Best said. ‘‘The best evidence we have is the length of an addiction career is typically around 27 years from age of first use of psychoactive substance to five years in stable or sober recovery, so it’s a long journey and it’s really more about the journey and the quality of life than whether you happen to be abstinent at a particular time.’’

Kim Riley’s path out of addiction was a long and arduous one that she traces all the way back to that first sip of alcohol, aged 10. At her lowest point she was waking up in the middle of the night for a fix. The three bottles of wine she’d start drinking from breakfast time were never enough. Now a drug and alcohol counsellor, the 40-year-old from Parkdale has been sober for 3 1/2 years, and is an advocate of the recovery approach.

After trying moderate drinking following stints in rehab she ultimately decided abstinence was her best option, although she says she respects those who take a different path. ‘‘I still had in the back of my mind that I would have a champagne on New Year’s Eve. Some people might be able to be that social drinker but I couldn’t,’’ she says.

One of the approach’s other key principles is encouraging those who have struggled with addiction to go public with their experiences. Advocates believe that while traditional Alcoholics/Narcotics/Gamblers Anonymous 12-step programs have helped countless people, the insistence on anonymity may also have inadvertently exacerbated the shame and silence surrounding addiction.

Indeed, when Fairfax Media approached Alcoholics Anonymous Australia’s general services officer for an interview, he agreed but only if his name was not published. ‘‘We don’t want to be known as some secret, unknown society that doesn’t celebrate that we’ve found a solution that works, but we do ask that members don’t get in front of a television camera recognisable or nominate their name in a radio or newspaper interview. AA has a spiritual approach and we don’t want to big note ourselves,’’ he said.

Ms Riley believes sharing her story has played a key part in her conquering her addiction. ‘‘Not only does it make your own recovery stronger but it instils within other people the idea of hope, and as you watch them get better it reinforces the belief that your life is just going to continue to get better,’’ she says.

Recovery proponents say secrecy surrounding drink and drug problems, while arguably vital in the early stages of treatment to build trust among members at ‘‘tell-all’’ support group meetings, has also helped entrench stereotypes.

“The old guy on the park bench drinking whisky from a paper bag is the visible alcoholic, everybody sees him. The guy who’s a professional and living in Toorak is invisible but there are just as many of them, they’re just being hidden by their families,’’ says George Thompson, program director of Recovery Foundation, a Melbourne addiction treatment program that embraces aspects of the recovery approach. ‘‘The AA model works and it has helped millions of people, but one of the biggest drawbacks of those 12-step groups has been anonymity. Alcoholism and addiction in general is an illness. It’s a serious mental disease. Why are we anonymous about somebody who has a mental health problem?’’

The success of organisations such as beyond blue and headspace in de-stigmatising depression and mental illness has largely been driven by their ability to put people with lived experience in front of journalists and TV cameras. The subsequent shift in public consciousness has inspired those in the addiction space.

David Best hopes to have a similar effect with Recovery Academy Australia – an organisation he set up to support and celebrate people dealing with addiction. Based on events he staged in Glasgow, he started an annual ‘‘recovery walk’’ in Melbourne last year to publicly celebrate the journeys of those navigating the addiction pathway, and the friends and family who support them. The inaugural event attracted 400 people, and today the second walk from Federation Square is expected to draw an even bigger crowd.

This public affirmation is part of the recovery movement’s core belief that messages of hope have a social contagion effect. The visible presence of recovering alcoholics, gamblers and drug users coming together in a major city centre also challenges stigma and discrimination, he said. ‘‘It makes it apparent that yeah, addiction is a terrible blight but people do overcome it, they do get on with their lives. . .The notion of it somehow being this chronic relapsing condition that leads to degradation and death is unhelpful, for family members, and for the people who are going through it.’’

Another concern in the treatment sector is that governments will capitalise on the recovery model’s growing popularity by cutting back on addiction services in favour of cheaper recovery-based approaches. Already, there are signs that the Victorian government has been captivated by the approach. In its recently released four year plan to tackle the state’s alcohol and drug toll it promised to deliver a ‘‘redeveloped, recovery-oriented alcohol and drug treatment system’’. ‘‘So you get a relatively cheap service which provides some support and the rest is up to the family and the person and their support group,’’ Professor Currie says.

For Kim Riley, recovery is, above all, about hope. ‘‘It’s time to break that stigma and this is an opportunity for people to say you don’t have to keep going down that same path, you can turn things around and find success. I feel just really a part of life now, which is a feeling that I’ve not ever experienced before.’’

Source: jstark@fairfaxmedia.com ? Melbourne Age May 2013

This study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal. This case report suggests that chronic marijuana use may cause clinical signs and symptoms as well as laboratory studies consistent with hypopituitarism.

Chronic, daily pot smoking over 15 years may be draining on pituitary hormones, and may explain the “pot-head” image popularized in movies and TV, according to a case report presented here.

A hormonal evaluation of a patient with symptoms of loss of libido, fatigue, and dyspnea showed luteinizing hormone concentration of 0.2 mIU/mL, follicle-stimulating hormone concentrations of 1.8 mIU/mL, and testosterone concentrations of 22 ng/dL, according to Richard Pinsker of Jamaica Hospital Medical Center in Queens, N.Y., and colleagues.

The patient also showed deficiencies in thyroxine and cortisol production, Pinsker said during an oral presentation at the meeting of the American Association of Clinical Endocrinologists.

Tetrahydrocannabinol (THC), the psychoactive ingredient in marijuana, can impair gonadotropin-releasing hormone, as well as affecting other neural transmitters in the hypothalamus, which can result in clinical hypopituitarism, the researchers noted.

“This is a single case, but an interesting case and a hypothesis-generating case,” noted R. Mack Harrell, MD, FACP, vice president of the AACE and who was not involved in the study.

He added that this case “takes it to a whole other level — all of the pituitary hormones were out in this patient.”

The study followed a 37 year-old patient who reported daily marijuana use for 15 years and presented to the Jamaica Hospital Medical Center emergency department with symptoms of increasing fatigue, loss of libido, and dyspnea on exertion.

The patient had no history of radiation exposure or head trauma and normal iron and echocardiography, but had significant symptoms of bibasilar rales, gynecomastia, and bilateral atrophied testis on physical examination.

In addition, tests for commonly prescribed opioids turned up negative.

The patient’s hormones were measured and, in addition to lower levels of testosterone, follicle-stimulating hormone, and luteinizing hormone, the patient presented with elevated levels of prolactin (53.3 ng/mL), low total T3 (30 ng/dL), high T3 resin reuptake (49%), low total T4 (3.94 ug/dL), normal free T4 (0.97 ng/dL), and low thyroid-stimulating hormone (0.22 uLU/mL).

A subsequent MRI of the patient’s head showed an enlarged protuberant pituitary gland without an identified mass lesion.

The patient received a morning dose of 25 mg cortisone, 12.6 mg bedtime cortisone, and daily 25 mcg levothyroxine treatment, which improved his fatigue
and edema “dramatically.”

Pinsker noted that this issue may be under-addressed, in part because cannabis is not frequently tested for as part of screening for hypopituitarism and due to an increasing political climate supporting marijuana legalization.

“The whole trick was to identify [the patient’s marijuana use], and I think we’re missing a tremendous amount of people in the United States who have had damage to their pituitary from the use of marijuana,” Pinsker told MedPage Today, cautioning that “patients have to be aware and give doctors the scoop on what’s going on in their outside lives.”

He added that follow-up studies should look at more subjects or individual cases to see if the problem is more wide spread. Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine,University of Pennsylvania

Source reference: Pinsker R, et al “Chronic marijuana use as a potential cause of hypopituitarism” American Association of Clinical Endocrinologists 2013; Abstract 825. May 2013

Written by Sheila Polk and Carolyn Short

Marijuana brings dangerous consequences.

If you weren’t afraid to share the road before, a recent survey result should send chills up your spine: most teenagers who drive under the influence of marijuana said the drug either improves their performance behind the wheel or is no hindrance at all.

The survey, by insurer Liberty Mutual Holding Co. and Students against Destructive Decisions, reveals that teens aren’t just saying that – they believe it, and they’re driving while stoned.

Ironically, a leading cause of death for teens is the car crash; and marijuana use, even in small amounts, significantly increases that risk.

Who – or what – is responsible for this incredible ignorance? In perhaps another chilling development, we are seeing the social norming of pot through the medical marijuana movement: “It can’t be harmful; it’s medicine!” Call something medicine and its perceived risks decline while its acceptance spreads.

Political rhetoric on the legalization of marijuana is highly charged. Meanwhile, nobody is hearing the truth: Marijuana is harmful for both the user and society.

Marijuana contains more than 400 chemicals. The primary psychoactive chemical is delta-9-tetrahydrocannabinol (THC) and is the component of marijuana principally responsible for the “high” experienced by pot smokers. Along with the high, users exhibit slower reflexes and decreased coordination. Marijuana also impairs judgment.

Slower reaction times, impaired judgment, and problems responding to signals and sounds equal dangerous drivers. No wonder those who drive within three hours of smoking marijuana are twice as likely to be involved in a major car crash.

The THC content of marijuana varies widely depending on the strain of plant, how grown, and the part of the plant that is used. The pot of the 60’s had an average THC content of .5 to 3%. Today’s pot is much more potent. As the THC content increases, so do the potential adverse effects.

This is one of several reasons why the FDA and medical associations say smoked marijuana isn’t “medicine.” It can’t be delivered in discreet, consistent and measurable doses. It also has a high potential for dependence and abuse.

Smoked marijuana use is also associated with respiratory ailments, mental illness, impaired cognitive and immune functioning, and poor academic performance. Recent studies show teen pot smokers do worse in school, can have lower IQs as adults and are more likely to develop serious mental health issues.

Pot use harms society as well. Increased costs of substance abuse treatment, health care, high school and college drop-outs, and decreased productivity typically are borne by the public.

It should come as no surprise that the idea for “medical” marijuana came from the pot lobby, not from medical doctors. Medical doctors already have access to prescription Marinol which accesses the effective aspects of THC in a controlled dose and has

withstood the rigorous approval process by the FDA. Pot is big business, promoted by a well-funded, well organized and politically influential pot lobby.

Meanwhile, our teens have heard adults declare via the ballot box that marijuana is medicine and so they conclude that its use is not risky. And now we learn that most teens who drive stoned actually think they are safe.

How dangerous. How frightening. How sad.

Source:http://www.prescottenews.com/index.php/news/current-news/item/21636-marijuana-is-not-harmless

Sizzurp, purple drank, lean — that cough-syrup-laced concoction of many names — has been gaining popularity in hip hop culture and notoriety as more celebrities fall prey to its effects. Rapper Lil Wayne was hospitalized at Cedars-Sinai last week, reportedly linked to use of the prescription-strength medication.

The codeine in the medicine serves as a pain reliever and also suppresses coughing, said Dr. George Fallieras, an emergency room physician and hospitalist at Good Samaritan Hospital. A second drug in the cough syrup, known as promethazine, is used as an antihistamine and commonly used to treat motion sickness and nausea. It’s also a bit of a sedative — employed partly to keep people from drinking too much of the stuff. “This is a very common cough syrup that, when taken in appropriately prescribed quantities, is quite safe,” Fallieras said.

But promethazine is a depressant of the central nervous system, Fallieras said. More importantly, codeine is a respiratory depressant, he added — and when taken in very large amounts, it can cause people to stop breathing. “A lot of times these guys are not just drinking the purple drink, they’re also drinking alcohol,” Fallieras said. “And potentially in combination with alcohol and other drugs — all of these together can be a lethal cocktail.” Lil Wayne reportedly suffered seizures as well, but Fallieras said that high doses of the drink would probably precipitate seizures only in patients who were already prone to them.

The so-called purple drank gains its name from the dyes in the cough syrup, which is mixed with a soft drink and perhaps a sugary candy for sweetness. It has become very popular, spreading through rap lyrics, and across state lines through Texas and Louisiana (where Lil Wayne hails from).

But codeine is an opiate – the same family of drugs as heroin and morphine — and can be very addictive in high doses, Fallieras said. And promethazine has at least anecdotally been noted to intensify the euphoric effects of codeine in the brain. “There’s a misconception that codeine is a weaker formula of the same class of medicine [as heroin],” Fallieras said. “But the amount of codeine these guys ingest with the syrup is massive … it’s just the same as someone being addicted to heroin, except they’re not using needles.”

Source: Los Angeles Times 19th March 2013