Colorado has legalized marijuana, and I’m glad. We need to try some new approaches to drug policy in this country, and if Colorado is willing to be the guinea pig, we should be grateful.

But here at home, we need to be careful that Colorado’s experiment doesn’t blur one very important fact. Here, there and everywhere, teens should not be smoking marijuana.

Tina Clemmons is a prevention specialist for the Dallas Council on Alcohol and Drug Abuse. She has been hearing more and more parents dismiss concerns about their teens’ drug use.  “They say, ‘It’s just marijuana.’ ”

Dr. David Atkinson, a local professor of psychiatry and an addiction specialist, hears much the same thing from teens themselves. “ ‘It’s only pot,’ they say.”

But both Clemmons and Atkinson strongly reject the argument. “I’m frightened to death,” Clemmons said. “Parents and young people are not aware of the consequences.”

Now, please don’t confuse this with the “reefer madness” hysteria of old. This is about scientific evidence, not scare tactics.  And the science is clear that marijuana is not safe for the still-developing brains of teens and even young adults.

Susan Foster is vice president and director of policy research at Columbia University’s Center on Addiction and Substance Abuse. She put the matter in a way that jolted me.  “In most cases,” she said, “addiction is a pediatric disease.”

I think of runny noses and ear infections as the stuff of pediatrics. It’s painful to think of addiction as also part of childhood medicine.  But Foster said, “Adolescence is the critical period for onset of addiction. That’s because the brain is still developing and is more vulnerable to damage.”

CASAColumbia has studied the link between addiction and age at first use of addictive substances — alcohol, tobacco and drugs, both legal and illegal.

“We see some startling information,” Foster said. “Those who use addictive substances before age 15 are 6 1/2 times more likely to develop addiction than those who did not use until 21 or older.”

Brain chemistry is complicated, she said, but this risk factor is clear. “Early use hikes your risk of addiction,” she said. “The more time you can buy before first use, the lower the risk.”  And addiction is not the only risk of early use. Daily use of marijuana among young people produces an average drop in IQ of 6 to 8 points, said Atkinson, who is on the faculty at UT Southwestern Medical Center.  That’s about the same as for children exposed to elevated lead levels, he said.

All three experts I talked to say they believe that relaxing marijuana laws in Colorado and elsewhere is prompting more marijuana use among teens. “Legalization sends a tacit message of approval,” Atkinson said.  So it becomes more important than ever, they said, for parents to send a clear message of disapproval — for marijuana and all addictive substances. Clearly stating expectations actually works, studies show.

And though risk declines with age, Atkinson cautioned against framing the warning that way with teens. One of their greatest desires is to be treated as adults, he said, so a “You’re still too young” message is ineffective.

Instead, he said, parents should give a concise, straightforward explanation of the scientific evidence of damage to developing brains. “Adolescents often do well with that type of knowledge,” he said. “They feel they are being respected when they are taught the science.”

No matter what a parent’s history with marijuana may have been, that should not translate into acceptance with their own children, the experts said. “Kids will be kids” is not responsible parenting.   It will be interesting to see what Colorado’s experiment in drug policy brings. But let’s keep the experiment there, not in our homes.

Source:  www.dallasnews.com 26^th March 2014

CND 52^ND Session – Vienna International Centre

Side Event – 18^th March 2009

 

Effective Programmes for Drug Prevention in Youth

by Peter Stoker – Director, National Drug Prevention Alliance, UK.

This paper is written in the context of education for Universal Prevention, rather than for Indicated or Selective Prevention processes.

Drug education, as we on the prevention side of the house understand it, is part of the process of producing drug-free lifestyles for all. But our opponents characterise and condemn this as part of a so-called ‘war on drugs’.

Well, if what we have here is indeed a ‘war’, should Obama pull the troops out? More realistically, this is a ‘war’ that has never been fought for real. And sadly those whom you might think of as ‘our’ troops too often turn out to be collaborators. With the benefit of hindsight we can see that the term ‘war on drugs’ is a finely conceived and executed meme (Ref 1 – a paper by my NDPA colleague Brian Heywood – will tell you more about what a meme is) – this particular meme engenders a feeling that we who are opposed to drug abuse are aggressors, whilst our opponents, the libertarians, are cast as peace-seekers. Their high priests, such as Arnold Trebach, exploit this meme by pleading that ‘… we have had enough ‘drug war’ – what we want now is a little ‘drug peace’’. As Mel Brooks might have put it:

“A little piece of heroin, a little piece of dope,

A little piece of cocaine, brings us peace – we hope.”

Whether you seek a drug-free society, or the kind of drug-laden ‘peace’ Arnold Trebach proposes, both camps see a key role for drug education. Surely this means that if we serve up more education than they do, we will reach our goal – right? Wrong. This is the kind of over-simplifying that has typified too much of what has been done in the name of drug education in the past – it is like serving yourself chicken soup at home – it gives you a warm feeling, but nobody else notices.

After nearly twenty years of PRIDE conferences I can recall several drug education programmes which would have ‘warmed the soup’ for the teacher – but done little else.

Taking the title of this paper – ‘Effective Drug Education for Youth’ – let me start by de-constructing the title – in reverse order:

‘Youth …’

There are not a few people around – present company excepted – who see drug education with youth as the Silver Bullet. Get this youthful generation ‘educated’ and we are home and dry (and clean and sober). I take issue with this – youth are not an island, even though they are as vulnerable as any, and more vulnerable than many, to external influences – what the professionals call ‘mediating variables’. And youth have an inexhaustible knack of grabbing the wrong end of the stick; I still relish the words of one American mentor, several years ago:

‘There’s nothing wrong with a teenager that reasoning with him won’t aggravate’.

Just to remind us all that youth are not the be-all and end-all, I draw your attention to a report on evidence-based prevention with ‘older adults’ – published under the auspices of SAMHSA (Substance Abuse and Mental Health Services Administration) by the ‘Older Americans Substance Abuse and Mental Health Technical Assistance Center’. The problem of substance abuse amongst senior citizens is recognised to be such as to require prevention to be ‘a national priority’. (Ref 2)

‘Drug Education …’

I am astonished to note that there are still teachers around who think the transfer of factual knowledge is the key to drug prevention success. One may comfort oneself on the excellence of one’s knowledge transfer, and be warmed by a few positive feedbacks; the acid test is ‘have you influenced the majority?’ – the acid answer is ‘probably not’. Of course facts on their own will be seminal for a few receiving them – we have all, in our time, been touched by a single fact – but one cannot in all seriousness extend this to a generality.

We need to recognise that drug education is not an end in itself, it is a tool of prevention, and as such it must help must mediate behaviour. You can deliver a programme of education which satisfies process criteria within itself – but it has long been known that transmitting knowledge does not automatically change behaviour.

A valuable and occasionally seminal tool, maybe, but unless it is delivered skilfully, and in the right setting, unless it is properly sharpened, it won’t cut it.

‘Effective …’

My contention, from the review above, is that concentrating on ‘youth’ and ‘drug education’ in isolation cannot (for most recipients) be effective in terms of drug prevention. If we are looking for effective lifestyle change, then we have to look much wider and more rationally.

The current US-based point of reference for effective processes of prevention is NIDA. (National Institute on Drug Abuse). Their most recent summary on the subject is ‘Preventing Drug Use – A Research Based Guide – second edition’ – 2003. (Ref 3) It is interesting to note that this reference work is now more than six years old. Does this mean it cannot yet be improved upon? Have fashions changed? Or is it simply a shortage of funding for prevention research?

The Guide starts by setting out the Principles of Prevention, under sixteen main headings. Of these, Principles 7 and 8 – reproduced here as Table 1 – focus on education, saying:

Principle 7- Elementary Schools – ‘… programs should target improving academic and social-emotional learning’.

Principle 8 – Middle, Junior and High schools – ‘…programs should increase academic and social competence’

The Guide does give a useful reference list of the components of effective preventive education, but this does not seem to take us much further than the earlier work (Ref 3) by Bonnie Benard, when she was a specialist with Illinois Teen Institute in the 1980s. Benards’ recommendations are shown in Table 2.

What neither NIDA nor Benard do not mention is the single factor which can be said to encompass all other factors in influencing (mediating) behaviour. That factor is culture.

This means the culture in which decisions about drugs are made; the culture in which teachers, police, media, legislators, governments, medics, youth workers, parents, partners (and many more besides) operate in this society of ours. The culture impinging on the decision-making person and their interaction with the culture of all other people around them is a major part of this. The age of all concerned is also relevant – as is the ‘education’ they have received. We sometimes forget that teachers in drug education have often received little or no education on the subject themselves, or in some cases, may have been exposed to influence from teacher trainers who have a drug education axe to grind. (Indeed some of these teachers may be current or past users of drugs themselves).

So, what influences the culture around decisions? It  includes, in no particular order:

– Peer Group Influence

– Personal perceptions

– Income v Cost of any action

– Health Issues

– Moral Structure

– Spiritual structure

– Family values

– The attraction of risk-taking

– The media, music, movies, tv, fashion, humour etc.

– Mental condition, – depressed, elated, in-between, and

– Legislation, including Conventions

This primacy of culture resonates with the work of one of my earliest mentors, Bill Lofquist, (Ref 5) who hails from Tucson, Arizona and who said:

“We need to get beyond the notion that prevention is stopping something happening, to a more positive approach which creates conditions which promote the well-being of people.”

Addressing culture through education is ‘creating conditions’ – no more and no less.

If you are going to tackle the culture in a community, you would do well to first measure whether your seeds will fall on stony ground, or will bear fruit. The NIDA Guide usefully assists this by giving a check list ‘Nine Stages of Readiness in a Community’ – reproduced here in Table 3.

Specifics of Effective Drug Education for Youth

Too often, it seems, the approach to drug education takes for granted that the educators understand and buy into the intended goals, know what they are doing, and will operate a Systems Approach – such as that described in another invaluable reference tool – ‘The Future by Design’. Published by the USDHHS, Department of Health and Human Services, in 1991. The core of a systemised approach is a ‘spiral’ of revisiting process stages – plan/implement/evaluate/decide/then plan again.

Another gem from this valuable reference work is a table showing a ‘Contrast of Paradigms’ in empowering a community – whether this be an education community or some other part of society. Reproduced herein as Table 4, it will almost certainly have a salutary effect on all of us, whatever our professional discipline !

As a very recent example of effective prevention programmes. I cite the ‘Good Behavior Game’ developed and tested in Baltimore City Public Schools, and reported in 2008 ( Ref 7 and Ref 8). Addressing multiple targets – anti-social disorders, violent and criminal behaviour, disruptiveness, as well as drug abuse and other factors, the ‘GBG’ program applied classroom management techniques with more than 2300 pupils, and helped them to significantly adjust to the role of successful student. A positive impact on drug/alcohol abuse was but one of the measured positive outcomes.

How Does Effective Education Fit In?

America’s CSAP (Centre for Substance Abuse Prevention) – was excited as long ago as 1991 (Ref 6 – see Chapter 1, Overview) by the finding that the best prevention results come through ‘….co-ordinated prevention efforts that offer multiple strategies, provide multiple points of access, and coordinate and expand citizen participation in community activity.’

Such an approach , whether in drug prevention or drug education, requires a certain relinquishing of self-authority; to get the best out of a wide range of disciplines and sectors, it is expedient to get on to their level – whatever that is. Prevention expert Bill Lofquist spells this out clearly by defining a spectrum of approaches – you can treat youth as dumb ‘Objects’, as ‘Recipients’ – albeit under your control, or as ‘Resources’ sharing the policy and practice. Hard way or easy way – your choice. It is also important to recognise that you cannot ‘do’ prevention ‘to’ people, you must rather engender a condition in which prevention will be the obvious choice for people.

This is also to a significant extent true of drug education – and certainly of affective education.

Equally important is an understanding of how the drug education which you are delivering interacts and harmonises with the whole societal system, and the goals of each sector. An example of this is given in Table 5 herein, which was presented by NDPA to the UK Shadow Home Secretary’s Office last November (2008) as part of a dialogue on national drug policy.

Specific examples of Effective Prevention

The technical references called up in this paper give several specific examples, covering various approaches. NDPA can give extended details (on request) on its own Peer-led drug education and prevention process – Teenex ( Ref 9 )– which was successfully adopted by other countries.

If you are looking for support for prevention, your first place to look would probably not be The Economist, and yet their issue on 5^th March this year gave just that. Their Article entitled ‘In America, lessons learned’ ( Ref 10) says:

‘By far the best way of reducing the harm that drugs do is to convince people not to use them’

The Economist article gives several further encouragements to preventive drug education. It takes the usual swipes at the DARE (Drug Abuse Resistance Education) programme, and does so on the usual incorrect and outdated basis, but it finds itself compelled to move to a more complimentary stance when it describes the latest remodelling, including DARE’s much wider scope of linked subjects – from drugs to internet bullying.

As the Economist observes, DARE (Drug Abuse Resistance Education) programme has learnt this lesson the hard way. DARE’s current strapline is ‘Dare to resist drugs, and violence’ and despite the hostile attitude of some on both sides of the drug education house towards it, DARE continues to succeed, witness the fact that it has been taken up by another 220 communities in the three years to its latest published report (2007).

Another project lauded by the Economist for a multi-topic motivational approach started in Montana and other western states in tackling the resurgent problem of methamphetamine abuse. Instead of trotting out the usual array of medical harm facts, the organisers elected to highlight that meth users often get rotten teeth. This turned out to be a very telling message.

The Economist concludes its article by referring to the anti-tobacco campaigns, which have made big inroads into prevalence. They suggest several reasons for this success; I would suggest they can all be grouped under the heading of culture change.

Elsewhere, an interestingly different example is given in the NIDA research-based guide. It is called PATHS – Promoting Alternative Thinking Strategies, and it is a programme for ‘promoting emotional, health and social competencies, and reducing aggression and behaviour problems in elementary school children, while enhancing the educational process in the classroom’. Although primarily targeted at school classrooms, it also includes information and activities for parents. I draw your attention to this programme not so much for its particular excellence as much as its example of how diverse one’s drug education approach can and should be. Diversity in a programme may produce vital dividends in this time of scarce funding. If the programme you intend using has other benefits over and above drug education, then this could open the door to other funding sources. Diverse outcomes equals diverse incomes!

Conclusions

With the aim of ‘Effective Drug Education for Youth’ we need to understand that what makes a programme effective will range well beyond the programme itself. Taking an extreme example, if , as has been asserted, drug abuse is a reaction to an unsatisfactory society, then the solution is simple – improve society!

This paper has attempted to take drug education out of its comfort zone, and in the process, to identify ways of improving effectiveness.   One way to concentrate one’s thinking about drug education is to consider it as a business venture. Metaphorically speaking, what are the parameters we should address in this business?

– What is our product, our USP?

– What can we sell it for, and to whom?

– What can the competition sell theirs for and to whom?

– Where can we best sell it?

– Who, besides us, can influence the market?

– Who has the best toys? And can we partner with them?

– What is the shelf life of our product?

– What is our human resource? and

– How are we going to measure sales?

I wish you every good fortune, as you draw up your Business Plan!

**********

 

REFERENCES

1. Heywood, B. ‘Assaying Information in the Substance Misuse World’ Published NDPA, 2004

2. Blow, C. F. et al ‘Evidence-Based Practices for Preventing Substance Abuse and Mental Health Problems in Older Adults’ Published: Older American Substance Abuse & Mental Health Technical Assistance Center, 2005.

3. National Institute on Drug Abuse. ‘Preventing Drug Use Among Children and Adolescents – A Research- Based Guide’ Published NIDA, Second Edition 2003.

4. Benard, B. ‘Characteristics of Effective Prevention’ Published Project Snowball training manuals, Illinois Teen Institutes, 1987.

5. Lofquist, W.A. ‘Discovering the Meaning of Prevention – A Practical Approach to Positive Change’, Published: AYD Publications, Tucson, Arizona l983. Fifth Printing, 1991.

6. OSAP, DHHS. ‘The Future by Design – A Community Framework for Preventing Alcohol and Other Drug Problems Through a Systems Approach. Published: DHSS No. (ADM) 91-1760; l991

7. Petras, H. et al. ‘Developmental Epidemiological Courses Leading to Antisocial Personality Disorder and Violent and Criminal Behavior; Effects by Young Adulthood of a Universal Preventive Intervention in first-and second-grade Classrooms’ Published: Drug and Alcohol Dependency, 95S1 – pp.S45-S59, 2008

8. Poduska, J. et al. ‘Impact of the Good Behavior Game, A Universal Classroom-based Behavior Intervention, on Young Adult Service Users for Problems with Emotions, Behavior, or Drugs or Alcohol. Published: Drug and Alcohol Dependency, 95S1 – pp.S29-S44, 2008

9. Stoker, S. A. ‘Teenex – ‘A Peer Education and Drug Prevention Programme’ Published National Drug Prevention Alliance, 1988 and subsequent editions.

10. Economist,print edition. ‘In America, lessons learned – but efforts to warn people off drugs are still too timid’. – March 5^th 2009

 

Table 1.

NIDA: ‘Preventing Drug Use, Research-based Guide’ – 2^nd Edition, 2003.

Prevention Principles – Extract for Education

Principle 7:

Prevention programs for elementary school children should target improving academic and social-emotional learning to address risk factors for drug abuse, such as early aggression, academic failure, and school dropout. Education should focus on the following skills (Ialongo et al. 2001; Conduct Problems Prevention Work Group 2002b):

 

• Self-control
• Emotional awareness
• Communication
• Social problem-solving; and
• Academic support, especially in reading.

Principle 8:

Prevention programs for middle or junior high and high school students should increase academic and social competence with the following skills (Botvin et al. 1995; Scheier et al. 1999):

 

• Study habits and academic support;
• Communication;
• Peer relationships;
• Self-efficacy and assertiveness;
• Drug resistance skills;
• Reinforcement of anti-drug attitudes; and
• Strengthening of personal commitments against drug abuse.

NOTE: Principle 9 is also relevant, in encouraging programs aimed at transition points, such as the transition to middle school; these “…can produce beneficial effects even among high-risk families and children”.

(Botvin et al. 1995; Dishion et al. 2002).

 

————————————————————————————————

Source document full title:

‘Preventing Drug Abuse among Children and Adolescents – A Research-Based Guide for Parents, Educators, and Community Leaders’. Second Edition 2003.

National Institute on Drug Abuse/ US Department of Health and Human Services.

Available on line throughwww.drugabuse.gov  

Table 2

Characteristics Of Effective Prevention

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

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

Programme comprehensiveness/intensity

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

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

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

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

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

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

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

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

Programme strategies

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

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

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

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

• ethnic/cultural sensitivity

• appeal to youth’s interests

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

• appropriate language, readability

• appealing graphics

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

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

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

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

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

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

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

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

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

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

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

The planning process

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

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

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

 

Table 3                                                                     NIDA ‘Preventing Drug Use’ – A research-based guide Measuring Community Readiness for Prevention         AS SIMPLE AS A,B,C.        (A) ASSESSING READINESS        (B) COMMUNITY RESPONSE       (C) IDEAS 1. (A)No Awareness. (B) Relative tolerance of drug abuse. (C) Create motivation. Meet with community leaders involved with drug abuse Prevention.   2. (A) Denial. (B) “Not happening here – can’t do anything about it”. (C) Use the media to identify and talk about the problem.   3. (A) Vague Awareness. (B) Awareness but no motivation. (C) Encourage the community to see how it relates to community issues.   4. (A) Pre-planning. (B) Leadership aware, some motivation. (C) Begin pre-planning.   5. (A) Preparation. (B) Active, energetic leadership and decision-making. (C) Work together. Develop plans for Prevention planning through coalitions and other community groups.   6. (A) Initiation. (B) Data used to support Prevention actions. (C) Identify and implement research-based programs.   7. (A) Stabilisation. Community generally supports existing program. (C) Evaluate and improve ongoing programs.   8. (A) Confirmation/expansion. (B) Decision makers support improving or expanding programs. (C) Institutionalise and expand programs to reach more populations.   9. (A) Professionalisation. (B) Knowledgeable of community drug problem; expect effective solutions (C) Put multl-component programs in place for all audiences.   Source: Plested et al, 1999.

 

 

Table 4

DHHS – OSAP (CSAP) – ‘The Future by Design’

Community Action Alternatives

             Community Empowerment System:   a Contrast in Paradigms

How do you want this project or program to run ? You can choose either the paradigm of (A) Agency delivery of Services OR the paradigm of (B) Community Empowerment – Which is it to be ?

Here are the results you could encounter:

1. (A) Professionals are responsible (doing for the community) OR (B) Responsibility is shared (doing with the community)

2. (A) Power is vested in agencies OR (B) Power resides with the community

3. (A) Professionals are seen as experts OR (B) The community is the expert.

4. (A) Planning and services are responsive to each agency’s mission OR (B)Services and activities are planned and implemented on the basis of community needs and priorities

5. Planning and service delivery are fragmented OR Planning and service delivery are interdependent and integrated.

6. Leadership is external and based on authority, position and title OR Leadership is from within the community, based on ability to develop a shared vision, maintain a broad base of support, and manage community problem solving.

7. Ethnic and cultural differences are denied OR Ethnic diversity and special populations are valued.

8. External linkages are limited to networking and co-ordination OR Co-operation and collaboration are emphasized.

9. The decision making process is closed OR Decision making is inclusive.

10. Accountability is to the agency OR Accountability is to the community.

11. The primary purpose of evaluation is to determine funding OR Evaluation is used to check program development and decision making.

12. Funding is categorical OR Funding is based on critical health issues.

13. Community participation is limited to providing input and feedback OR Community is maximally involved at all levels.

 

 

 

 

 

Table 5

Submission to UK Shadow Home Office Drugs Minister   by NDPA

An Idealised UK Drug Strategy should contain:

          Culture change: – Cross-society measures coordinated to produce a result, as has been done with tobacco.

          Information: – Improve quality, age-appropriateness, root out hidden messages.

         Prevention: – Few know what it is, fewer practice it. Study it. Apply it.

         Show its cost-benefit to society as a whole.

         Education: – Abstinence goal. Check materials before allowing them into schools. Develop         random drug testing

 

         Intervention, Treatment, Rehab, After-care, All should be abstinence-oriented

         Justice system: – Apply proven systems such as Drug Courts. Work towards drug-free prisons.    Apply mandatory education courses to any person cautioned or convicted.

       Policing: – Should include referral to education courses

      Customs:- Address serious concerns about SOCA

      NICE – Should embrace an abstinence focus

      Harm Reduction: – Should apply to whole society, not just users

      Human Rights: – Should apply to whole society, not just users

      Policy reviews: – Should proceed in line with the above goals.

 

———————————————————————————————-

 

Guide to acronyms:

NICE National Institute on Clinical Excellence

SOCA Serious and Organised Crime Authority

 

 

CND 52^ND Session – Vienna International Centre

Side Event – 18^th March 2009

 

Effective Programmes for Drug Prevention in Youth

by Peter Stoker – Director, National Drug Prevention Alliance, UK.

This paper is written in the context of education for Universal Prevention, rather than for Indicated or Selective Prevention processes.

 Drug education, as we on the prevention side of the house understand it, is part of the process of producing drug-free lifestyles for all.  But our opponents characterise and condemn this as part of a so-called ‘war on drugs’.

Well, if what we have here is indeed a ‘war’, should Obama pull the troops out?  More realistically, this is a ‘war’ that has never been fought for real.   And sadly those whom you might think of as ‘our’ troops too often turn out to be collaborators.  With the benefit of hindsight we can see that the term ‘war on drugs’ is a finely conceived and executed meme (Ref 1 – a paper by my NDPA colleague Brian Heywood – will tell you more about what a meme is) – this particular meme engenders a feeling that we who are opposed to drug abuse are aggressors, whilst our opponents, the libertarians, are cast as peace-seekers.  Their high priests, such as Arnold Trebach, exploit this meme by pleading that ‘… we have had enough ‘drug war’ – what we want now is a little ‘drug peace’’. As Mel Brooks might have put it:

“A little piece of heroin, a little piece of dope,

            A little piece of cocaine, brings us peace – we hope.”

 Whether you seek a drug-free society, or the kind of drug-laden ‘peace’ Arnold Trebach proposes, both camps see a key role for drug education.  Surely this means that if we serve up more education than they do, we will reach our goal – right?  Wrong.   This is the kind of over-simplifying that has typified too much of what has been done in the name of drug education in the past – it is like serving yourself chicken soup at home – it gives you a warm feeling, but nobody else notices.

After nearly twenty years of PRIDE  conferences I can recall several drug education programmes which would have ‘warmed the soup’ for the teacher – but done little else.

Taking the title of this paper – ‘Effective Drug Education for Youth’ – let me start by de-constructing the title – in reverse order:

‘Youth …’

 There are not a few people around – present company excepted – who see drug education with youth as the Silver Bullet.  Get this youthful generation ‘educated’ and we are home and dry (and clean and sober).  I take issue with this – youth are not an island, even though they are as vulnerable as any, and more vulnerable than many, to external influences – what the professionals call ‘mediating variables’.  And youth have an inexhaustible knack of grabbing the wrong end of the stick; I still relish the words of one American mentor, several years ago:

          ‘There’s nothing wrong with a teenager that reasoning with him

           won’t aggravate’.

 Just to remind us all that youth are not the be-all and end-all, I draw your attention to a report on evidence-based prevention with ‘older adults’ – published under the auspices of SAMHSA (Substance Abuse and Mental Health Services Administration) by the ‘Older Americans Substance Abuse and Mental Health Technical Assistance Center’. The problem of substance abuse amongst senior citizens is recognised to be such as to require prevention to be ‘a national priority’. (Ref 2)

‘Drug Education …’

 I am astonished to note that there are still teachers around who think the transfer of factual knowledge is the key to drug prevention success.  One may comfort oneself on the excellence of one’s knowledge transfer, and be warmed by a few positive feedbacks; the acid test is ‘have you influenced the majority?’ – the acid answer is ‘probably not’.  Of course facts on their own will be seminal for a few receiving them – we have all, in our time, been touched by a single fact – but one cannot in all seriousness extend this to a generality.

We need to recognise that drug education is not an end in itself, it is a tool of prevention, and as such it must help must mediate behaviour.  You can deliver a programme of education which satisfies process criteria within itself – but it has long been known that transmitting knowledge does not automatically change behaviour.

A valuable and occasionally seminal tool, maybe, but unless it is delivered skilfully, and in the right setting, unless it is properly sharpened, it won’t cut it.

‘Effective …’

 My contention, from the review above, is that concentrating on ‘youth’ and ‘drug education’ in isolation cannot (for most recipients) be effective in terms of drug prevention.  If we are looking for effective lifestyle change, then we have to look much wider and more rationally.

The current US-based point of reference for effective processes of prevention is NIDA.  (National Institute on Drug Abuse).   Their most recent summary on the subject is ‘Preventing Drug Use – A Research Based Guide – second edition’ – 2003. (Ref 3) It is interesting to note that this reference work is now more than six years old.  Does this mean it cannot yet be improved upon?  Have fashions changed? Or is it simply a shortage of funding for prevention research?

The Guide starts by setting out the Principles of Prevention, under sixteen main headings.  Of these, Principles 7 and 8 – reproduced here as Table 1 –  focus on education, saying:

Principle 7- Elementary Schools – ‘… programs should target improving academic and social-emotional learning’.

 Principle 8 – Middle, Junior and High schools – ‘…programs should increase academic and social competence’

 The Guide does give a useful reference list of the components of effective preventive education, but this does not seem to take us much further than the earlier work (Ref 3) by Bonnie Benard, when she was a specialist with Illinois Teen Institute in the 1980s. Benards’ recommendations are shown in Table 2.

What neither NIDA nor Benard do not mention is the single factor which can be said to encompass all other factors in influencing (mediating) behaviour.  That factor is culture.

This means the culture in which decisions about drugs are made; the culture in which teachers, police, media,  legislators, governments, medics, youth workers, parents, partners (and many more besides) operate in this society of ours. The culture impinging on the decision-making person and their interaction with the culture of all other people around them is a major part of this.   The age of all concerned is also relevant – as is the ‘education’ they have received.  We sometimes forget that teachers in drug education have often received little or no education on the subject themselves, or in some cases, may have been exposed to influence from teacher trainers who have a drug education axe to grind. (Indeed some of these teachers may be current or past users of drugs themselves).

So, what influences the culture around decisions?  Ii includes, in no particular order:

–                  Peer Group Influence

–                  Personal perceptions

–                  Income v Cost of any action

–                  Health Issues

–                  Moral Structure

–                  Spiritual structure

–                  Family values

–                  The attraction of risk-taking

–                  The media, music, movies, tv, fashion, humour etc.

–                  Mental condition,  –  depressed, elated, in-between, and

–                  Legislation, including Conventions

This primacy of culture resonates with the work of one of my earliest mentors, Bill Lofquist, (Ref 5) who hails from Tucson, Arizona and who said:

          “We need to get beyond the notion that prevention is stopping

            something happening, to a more positive approach which

            creates conditions which promote the well-being of people.”

 Addressing culture through education is ‘creating conditions’ – no more and no less.

If you are going to tackle the culture in a community, you would do well to first measure whether your seeds will fall on stony ground, or will bear fruit.  The NIDA Guide usefully assists this by giving a check list ‘Nine Stages of Readiness in a Community’ – reproduced here in Table 3.

Specifics of Effective Drug Education for Youth

 Too often, it seems, the approach to drug education takes for granted that the educators understand and buy into the intended goals, know what they are doing, and will operate a Systems Approach – such as that described in another invaluable reference tool – ‘The Future by Design’.   Published by the USDHHS, Department of Health and Human Services, in 1991.  The core of a systemised approach is a ‘spiral’ of revisiting process stages – plan/implement/evaluate/decide/then plan again.

Another gem from this valuable reference work is a table showing a ‘Contrast of Paradigms’ in empowering a community – whether this be an education community or some other part of society.  Reproduced herein as Table 4, it will almost certainly have a salutary effect on all of us, whatever our professional discipline !

As a very recent example of effective prevention programmes. I cite the ‘Good Behavior Game’ developed and tested in Baltimore City Public Schools, and reported in 2008 ( Ref 7 and Ref 8). Addressing multiple targets – anti-social disorders, violent and criminal behaviour, disruptiveness, as well as drug abuse and other factors, the ‘GBG’ program applied classroom management techniques with more than 2300 pupils, and helped them to significantly adjust to the role of successful student. A positive impact on drug/alcohol abuse was but one of the measured positive outcomes.

How Does Effective Education Fit In?

America’s CSAP (Centre for Substance Abuse Prevention) – was excited as long ago as 1991 (Ref 6 – see Chapter 1, Overview)  by the finding that the best prevention results come through ‘….co-ordinated prevention efforts that offer multiple strategies, provide multiple points of access, and coordinate and expand citizen participation in community activity.’

Such an approach , whether in drug prevention or drug education, requires a certain relinquishing of self-authority;  to get the best out of a wide range of disciplines and sectors, it is expedient to get on to their level – whatever that is.  Prevention expert Bill Lofquist spells this out clearly by defining a spectrum of approaches – you can treat youth as dumb ‘Objects’, as ‘Recipients’ – albeit under your control, or as ‘Resources’ sharing the policy and practice.  Hard way or easy way – your choice. It is also important to recognise that you cannot ‘do’ prevention ‘to’ people, you must rather engender a condition in which prevention will be the obvious choice for people.

This is also to a significant extent true of drug education – and certainly of affective education.

Equally important is an understanding of how the drug education which you are delivering interacts and harmonises with the whole societal system, and the goals of each sector.  An example of this is given in Table 5 herein, which was presented by NDPA to the UK Shadow Home Secretary’s Office last November (2008) as part of a dialogue on national drug policy.

Specific examples of Effective Prevention

The technical references called up in this paper give several specific examples, covering various approaches.  NDPA can give extended details (on request) on its own Peer-led drug education and prevention process – Teenex ( Ref 9 )– which was successfully adopted by other countries.

If you are looking for support for prevention, your first place to look would probably not be The Economist, and yet their issue on 5^th March this year gave just that. Their Article entitled ‘In America, lessons learned’ ( Ref 10) says:

‘By far the best way of reducing the harm that drugs do is to convince

 people not to use them’

The Economist article gives several further encouragements to preventive drug education. It takes the usual swipes at the DARE (Drug Abuse Resistance Education) programme, and does so on the usual incorrect and outdated basis, but it finds itself compelled to move to a more complimentary stance when it describes the latest remodelling, including DARE’s much wider scope of linked subjects – from drugs to internet bullying.

As the Economist observes, DARE   (Drug Abuse Resistance Education) programme has learnt this lesson the hard way.  DARE’s current strapline is ‘Dare to resist drugs, and violence’ and despite the hostile attitude of some on both sides of the drug education house towards it, DARE continues to succeed, witness the fact that it has been taken up by another 220 communities in the three years to its latest published report (2007).

Another project lauded by the Economist for a multi-topic motivational approach started in Montana and other western states in tackling the resurgent problem of methamphetamine abuse. Instead of trotting out the usual array of medical harm facts, the organisers elected to highlight that meth users often get rotten teeth. This turned out to be a very telling message.

The Economist concludes its article by referring to the anti-tobacco campaigns, which have made big inroads into prevalence. They suggest several reasons for this success; I would suggest they can all be grouped under the heading of culture change.

Elsewhere, an interestingly different example is given in the NIDA research-based guide.  It is called PATHS – Promoting Alternative Thinking Strategies, and it is a programme for ‘promoting emotional, health and social competencies, and reducing aggression and behaviour problems in elementary school children, while enhancing the educational process in the classroom’.   Although primarily targeted at school classrooms, it also includes information and activities for parents.  I draw your attention to this programme not so much for its particular excellence as much as its example of how diverse one’s drug education approach can and should be.  Diversity in a programme may produce vital dividends in this time of scarce funding.  If the programme you intend using has other benefits over and above drug education, then this could open the door to other funding sources.  Diverse outcomes equals diverse incomes!

Conclusions

With the aim of ‘Effective Drug Education for Youth’ we need to understand that what makes a programme effective will range well beyond the programme itself.  Taking an extreme example, if , as has been asserted, drug abuse is a reaction to an unsatisfactory society, then the solution is simple – improve society!

This paper has attempted to take drug education out of its comfort zone, and in the process, to identify ways of improving effectiveness.

One way to concentrate one’s thinking about drug education is to consider it as a business venture.  Metaphorically speaking, what are the parameters we should address in this business?

–                  What is our product, our USP?

–                  What can we sell it for, and to whom?

–                  What can the competition sell theirs for and to whom?

–                  Where can we best sell it?

–                  Who, besides us, can influence the market?

–                  Who has the best toys? And can we partner with them?

–                  What is the shelf life of our product?

–                  What is our human resource? and

–                  How are we going to measure sales?

I wish you every good fortune, as you draw up your Business Plan!

********** 

 

REFERENCES

1.       Heywood, B. ‘Assaying Information in the Substance Misuse World’ Published NDPA, 2004

2.       Blow, C. F. et al  ‘Evidence-Based Practices for Preventing Substance Abuse and Mental Health Problems in Older Adults’   Published:  Older American Substance Abuse & Mental Health Technical Assistance Center, 2005.

3.       National Institute on Drug Abuse. ‘Preventing Drug Use Among Children and Adolescents – A Research- Based Guide’    Published NIDA, Second Edition 2003.

4.       Benard, B.  ‘Characteristics of Effective Prevention’  Published Project Snowball training manuals, Illinois Teen Institutes, 1987.

5.       Lofquist, W.A.  ‘Discovering the Meaning of Prevention – A Practical Approach to Positive Change’,  Published:  AYD Publications, Tucson, Arizona l983.   Fifth Printing, 1991.

6.       OSAP,  DHHS.  ‘The Future by Design – A Community Framework for Preventing Alcohol and Other Drug Problems Through a Systems Approach.   Published:  DHSS  No. (ADM) 91-1760;  l991

7.       Petras, H. et al. ‘Developmental Epidemiological Courses Leading to Antisocial Personality Disorder and Violent and Criminal Behavior; Effects by Young Adulthood of a Universal Preventive Intervention in first-and second-grade Classrooms’  Published: Drug and Alcohol Dependency, 95S1 – pp.S45-S59, 2008

8.       Poduska, J. et al. ‘Impact of the Good Behavior Game,  A Universal Classroom-based Behavior Intervention, on Young Adult Service Users for Problems with Emotions, Behavior, or Drugs or Alcohol. Published: Drug and Alcohol Dependency, 95S1 – pp.S29-S44, 2008

9.       Stoker, S. A. ‘Teenex  – ‘A Peer Education and Drug Prevention Programme’ Published National Drug Prevention Alliance, 1988 and subsequent editions.

10.     Economist,print edition. ‘In America, lessons learned – but efforts to warn people off drugs are still too timid’.         – March 5^th 2009

 

Table 1.

NIDA: ‘Preventing Drug Use, Research-based Guide’ – 2^nd Edition, 2003.

                             Prevention Principles – Extract for Education

Principle 7:

Prevention programs for elementary school children should target improving academic and social-emotional learning to address risk factors for drug abuse, such as early aggression, academic failure, and school dropout. Education should focus on the following skills (Ialongo et al. 2001; Conduct Problems Prevention Work Group 2002b):

 

• Self-control
• Emotional awareness
• Communication
• Social problem-solving; and
• Academic support, especially in reading.

 Principle 8:

 Prevention programs for middle or junior high and high school students should increase academic and social competence with the following skills (Botvin et al. 1995; Scheier et al. 1999):

 

• Study habits and academic support;
• Communication;
• Peer relationships;
• Self-efficacy and assertiveness;
• Drug resistance skills;
• Reinforcement of anti-drug attitudes; and
• Strengthening of personal commitments against drug abuse.

 NOTE: Principle 9 is also relevant, in encouraging programs aimed at transition points, such as the transition to middle school; these  “…can produce beneficial effects even among high-risk families and children”.

(Botvin et al. 1995; Dishion et al. 2002).

 

————————————————————————————————

Source document full title:

‘Preventing Drug Abuse among Children and Adolescents – A Research-Based Guide for Parents, Educators, and Community Leaders’.         Second Edition 2003.

 National Institute on Drug Abuse/ US Department of Health and Human Services.

 Available on line throughwww.drugabuse.gov

Table  2

 Characteristics Of Effective Prevention

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

 

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

Programme comprehensiveness/intensity

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

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

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

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

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

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

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

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

Programme strategies

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

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

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

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

•         ethnic/cultural sensitivity

•         appeal to youth’s interests

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

•         appropriate language, readability

•         appealing graphics

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

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

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

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

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

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

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

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

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

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

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

The planning process

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

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

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

 

 

 

Table 3   NIDA ‘Preventing Drug Use’ – A research-based guide Measuring Community Readiness for Prevention                                AS SIMPLE AS A,B,C.   (A)    ASSESSING READINESS                                             (B)      COMMUNITY RESPONSE                                                                                                 (C)     IDEAS     1.      (A)No Awareness. (B) Relative tolerance of drug abuse. (C) Create motivation. Meet with community leaders involved with drug abuse Prevention.   2.      (A) Denial.  (B) “Not happening here – can’t do anything about it”.  (C)  Use the media to identify and talk about the problem.   3.      (A)  Vague Awareness.  (B)  Awareness but no motivation. (C)    Encourage the community to see how it relates to community issues.   4.      (A)  Pre-planning.  (B)  Leadership aware, some motivation. (C)  Begin pre-planning.   5.      (A)  Preparation.  (B)  Active, energetic leadership and decision-making.  (C)  Work together. Develop plans for Prevention planning through coalitions and other community groups.   6.      (A)  Initiation.  (B)  Data used to support Prevention actions.  (C)  Identify and implement research-based programs.   7.      (A)  Stabilisation.  Community generally supports existing program.  (C)  Evaluate and improve ongoing programs.   8.      (A)  Confirmation/expansion.  (B)  Decision makers support improving or expanding programs.  (C)  Insitutionalise and expand programs to reach more populations.   9.      (A)  Professionalisation.  (B)  Knowledgeable of community drug problem; expect effective solutions  (C)  Put multl-component programs in place for all audiences.   Source: Plested et al, 1999.

 

 

Table 4

DHHS – OSAP (CSAP) – ‘The Future by Design’

Community Action Alternatives

Community Empowerment System:

a Contrast in Paradigms

 

How do you want this project or program to run ? You can choose either the paradigm of (A) Agency delivery of Services   OR   the paradigm of (B) Community Empowerment  – Which is it to be ?

 

Here are the results you could encounter:

1.  (A) Professionals are responsible (doing for the community) OR (B) Responsibility is  shared (doing with the community)

2.  (A) Power is vested in agencies OR (B) Power resides with the community

3.  (A) Professionals are seen as experts OR (B) The community is the expert.

4.  (A) Planning and services are responsive to each agency’s mission OR       (B)Services and activities are planned and implemented on the basis of community needs and priorities

5.  Planning and service delivery   are fragmented  OR Planning and service delivery are interdependent and integrated.

6.  Leadership is external and based on authority, position and title OR Leadership is from within the community, based on ability to develop a shared vision, maintain a broad base of support, and manage community problem solving.

7.  Ethnic and cultural differences are denied  OR Ethnic diversity and special populations are valued.

8.  External linkages are limited to networking and co-ordination OR Co-operation and collaboration are emphasized.

9.  The decision making process is closed  OR  Decision making is inclusive.

10. Accountability is to the agency  OR  Accountability is to the community.

11.  The primary purpose of evaluation is to determine funding  OR  Evaluation is used to check program development and decision making.

12.  Funding is categorical  OR  Funding is based on critical health issues.

13. Community participation is limited to providing input and feedback  OR  Community is maximally involved at all levels.

 

 

 

 

 

 

 

Table 5

Submission to UK Shadow Home Office Drugs Minister

by NDPA

 

An Idealised UK Drug Strategy should contain:

 

Culture change: – Cross-society measures coordinated to produce a

result, as has been done with tobacco.

 

Information: – Improve quality, age-appropriateness, root out hidden messages. 

 

Prevention:  –   Few know what it is, fewer practice it. Study it. Apply it.

Show its cost-benefit to society as a whole.

 

Education: –  Abstinence goal. Check materials before allowing them into schools. Develop random drug testing

.

 

Intervention, Treatment,   Rehab,   After-care,     All should be abstinence-oriented

 

Justice system: – Apply proven systems such as Drug Courts. Work towards drug-free prisons. Apply mandatory education courses to any person cautioned or convicted.

 

Policing: – Should include referral to education courses

 

Customs:- Address serious concerns about SOCA

 

NICE – Should embrace an abstinence focus

 

Harm Reduction: – Should apply to whole society, not just users

 

Human Rights: – Should apply to whole society, not just users

 

Policy reviews: – Should proceed in line with the above goals.

 

———————————————————————————————-

 

Guide to acronyms:

 

NICE          National Institute on Clinical Excellence

 

SOCA         Serious and Organised Crime Authority

 

 

Marijuana legalization may be the same-sex marriage of 2014 — a trend that reveals itself in the course of the year as obvious and inexorable. At the risk of exposing myself as the fuddy-duddy I seem to have become, I hope not.  This is, I confess, not entirely logical and a tad hypocritical. At the risk of exposing myself as not the total fuddy-duddy of my children’s dismissive imaginings, I have done my share of inhaling, though back in the age of bell-bottoms and polyester.

Next time I’m in Colorado, I expect, I’ll check out some Bubba Kush. Why not? They used to warn about pot being a gateway drug, but the only gateway I’m apt to be heading through at this stage is the one to Lipitor.

Still, widespread legalization is a bad idea, if an inevitable development. Washington state will be the next to light up, in a few months. A measure is heading to the ballot in Alaska this year, along with measures in Oregon and California. As with gambling — also a bad idea, by the way — more states are certain to feel the peer pressure for tax dollars and tourist revenue.  I’m not arguing that marijuana is riskier than other, already legal substances, namely alcohol and tobacco. Indeed, pot is less addictive; an occasional joint strikes me as no worse than an occasional drink. If you had a choice of which of the three substances to ban, tobacco would have to top the list. Unlike pot and alcohol, tobacco has no socially redeeming value; used properly, it is a killer.

So the reason to single out marijuana is the simple fact of its current (semi-)illegality. On balance, society will not be better off with another legal mind-altering substance. In particular, our kids will not be better off with another legal mind-altering substance. As the American Medical Association concluded in recommending against legalization in November, “Cannabis is a dangerous drug and as such is a public health concern.” It added: “It is the most common illicit drug involved in drugged driving, particularly in drivers under the age of 21. Early cannabis use is related to later substance use disorders.”     And this point, for me, is the most convincing: “Heavy cannabis use in adolescence causes persistent impairments in neurocognitive performance and IQ, and use is associated with increased rates of anxiety, mood, and psychotic thought disorders.” A 2012 study of more than 1,000 New Zealanders from birth to age 38 found that “persistent cannabis use was associated with neuropsychological decline broadly across

domains of functioning, even after controlling for years of education.” Long-term users saw an average decline of eight IQ points.   Once again, teenage toking was the problem. The decrease in IQ was linked only to those with adolescent marijuana use, not those who started in adulthood.

“Impairment was concentrated among adolescent-onset cannabis users, with more persistent use associated with greater decline,” the study reported. For those who started as teens, stopping didn’t fully restore functioning. The results, the study concluded, “are suggestive of a neurotoxic effect of cannabis on the adolescent brain.” Please do not argue that Colorado’s law, like those proposed elsewhere, bans sales to those under 21. Ha! I have teenage children. The laws against underage drinking represent more challenge to overcome than barrier to access.  And although alcohol seems to be the teen drug of choice among the adolescents I know, the more widely available marijuana becomes, the more minors will use it. If seniors in fraternities can legally buy pot, more freshmen and sophomores will be smoking more of it.

And it’s not as if the kids need encouragement. By the time they have graduated from high school, nearly half have tried smoking pot; 16.5 percent of eighth-graders have. More alarming, the number who perceive great risk from regular use has been plummeting, from 58 percent to 40 percent among 12th-graders, according to a study funded by the National Institute on Drug Abuse.   And, that study says, for those who trumpet tight controls on sales to minors, a third of 12th-graders who live in states with medical marijuana and who have used the drug in the past year report that one source is another person’s prescription. Another 6 percent have their own Rx.

Throwing people in jail for smoking pot is dumb and wasteful. Given changing public attitudes — for the first time last year, a majority of Americans supported legalization — Colorado and Washington are apt to be the vanguard states, not the outliers.

If this doesn’t make you nervous, you are smoking something.   Maybe even legally.

Source:  www.washingtonpost.com  3rd Jan.2014

January 30, 2014

Summary:

The prevalence of non-alcohol drugs detected in fatally injured drivers in the US steadily rose from 1999 to 2010 and especially for drivers who tested positive for marijuana. Researchers found that of 23,591 drivers who were killed within one hour of a crash, 39.7 percent tested positive for alcohol and 24.8 percent for other drugs. The prevalence of non-alcohol drugs rose from 16.6 percent in 1999 to 28.3 percent in 2010; for marijuana, rates rose from 4.2 percent to 12.2 percent.

Columbia University’s Mailman School of Public Health

Source: www.sciencedaily.com 30th Jan 2014  

January 19, 2014:  President Obama opines that marijuana is “not very different from cigarettes” and no more “dangerous” than alcohol, just “a waste of time” and “not very healthy.” Maybe like super-sized drinks?

January 23:  Attorney General (AG) Holder says marijuana money should have legal access to the American banking system, and that he would make way for regulations to protect what is, under federal law, illegal money laundering.  Arrival of the Mad Hatter?

January 25:  The “Maryland Mall shooter” kills three, and police soon discover he was using marijuana and needed mental health support, by his own admission. Shadows of Columbine?

January 29:  The AG testifies before the U.S. Senate, refusing to condemn pot legalization and adding that “all drugs are dangerous,” lumping alcohol in with Schedule One narcotics. Curiouser and curiouser …

Here are the incontrovertible facts:  Marijuana is a Schedule One narcotic, meaning a drug assessed as possessing “high potential for abuse,” based on science.  The drug has put hundreds of thousands in treatment over the past ten years, accelerated emergency room incidents according to the Centers for Disease Control, and raised levels of drugged driving, domestic abuse and marijuana-associated crime, according to State and Federal criminal justice databases.

Since the early 1980s, forward thinking policy makers, parents, teachers, doctors, nurses and caring experts have pointed out, in hundreds of studies, how devastating marijuana addiction is. Nor have we rounded some new corner, where the danger is falling.  According to the Columbia University Center on Addiction and Substance Abuse (CASA), marijuana potency jumped 175 percent since 2006.  The jump has accelerated both marijuana use and addiction, together with hospital Emergency Room (ER) incidents and voluntary treatment admissions.  And CASA has long observed that the ratio of addicts to first users is roughly one in eight.  So, a little math:  If the President’s and AG’s remarks have encouraged only eight million young Americans in our 315 million-person Nation to try pot, they have just condemned another million young Americans to addiction.  Nor is this addiction easy to shake off.  Those addicted are trapped, which – at best – produces a costly new stream of treatment cases, at worst a rise in overdoses and grieving parents.

The rise in marijuana addiction correlates with other trends.  Friends of the President’s are among the wealthy promoters of this drug’s abuse.  Billionaire financier George Soros, a friend of this White House, has contributed millions to marijuana legalization.  Meantime, other trends demonstrate where this rabbit hole really leads.  Over the past seven years, America has witnessed a 492 percent increase in the proportion of teen medical admissions for marijuana addiction, according to CASA.  The President ignores these numbers, and the devastation they portend, while pouring billions into public messaging against obesity and cigarette companies.

How about a few more trends?  The marijuana spike has led to rising medical and social costs, challenging families and professionals with disinformation as they battle associated domestic abuse, mental health issues and drug-influenced crimes.   The Justice Department has linked poly-drug use to four in five domestic abuse cases, while the President’s own Drug Czar released a 2013 nationwide study showing that “80 percent of adult males [incarcerated for non-drug crimes] tested positive for at least one illegal drug, [and] marijuana was the most commonly detected drug.”  It was “found in 54 percent of those arrested.”

Between 2009 and 2011, there was a shocking 19 percent rise in ER visits tied to marijuana according to the Centers for Disease Control (CDC), while related overall drug overdose rates – with marijuana a major accelerant – rose for the eleventh straight year to more than 38,000.  Against this backdrop, how can anyone justify indifference?  How can the President speak of compassion and leadership to those 72,000 heartbroken parents, many of whom lost a child that began their drug addiction with marijuana?  Or think about it this way:  The annual numbers of children who die from drug abuse in one year is now five times the Nation’s total losses in both Afghanistan and Iraq.  We pulled out of both those wars, but our kids still die of drug addiction in combat numbers.

Another CDC fact:  The nearly 500-percent increase in marijuana treatment cases is in stark contrast to a more than 50-percent reduction of admissions for other abused substances.  In other words, pot is now outpacing all other addictions.

Finally, peripheral impacts from increased social passivity include reduced test scores and graduation rates for marijuana users, increased family dissolution for adult users, increases non-overdose medical incidents  (e.g. lung, heart and brain issues), and birth defects associated with  pot addiction.  Are these not reason enough to throw the brakes on, Mr. President?  The addiction curve for marijuana is already steep and dangerous.  How about a public correction of the record?  How about siding with us – just everyday Americans who think addiction, overdoses, drugged driving and drug-related crime are bad things?  How about siding with the country’s parents, kids, doctors, nurses, social workers, law enforcement officers and “the average folks” you so often talk about?  How about public opposition to pot, instead of validating illegal narcotics abuse?  In short:  Why don’t you help us, Mr. President, instead of working against us?

Charles, former assistant secretary of State for International Narcotics and Law Enforcement for Secretary of State Colin Powell, has worked for more than 20 years on drug prevention, addiction treatment and criminal justice issues.  He now heads The Charles Group LLC in Washington D.C.

Source http://thehill.com/blogs/congress-blog/healthcare/197776-presidential-disconnect-on-pot#ixzz2slGnWusO      8th Feb 2014

(Note the date on this study – 1997.)

 Substance Abuse in Home Is a Risk Factor

People who do not use illegal drugs but live in households where such drugs are used are 11 times as likely to be killed as those living in drug free homes according to a study reported today in the Journal of the American Medical Association.

Killings were also 70 percent more likely among non-drinkers in households where alcoholism exists, according to the study, which examined. the effect of substance abuse on homicides and suicides in the three counties that include Seattle, Memphis and Cleveland.

“Our concept Of the individual at risk for violent death should be broadened to include not only the substance abuser, but also those who may be at risk because of the presence of others within the household who are substance abusers,” the researchers said.

The study, by researchers at the University of Washington, the University of Tennessee, Case Western Reserve University and Emory University, found that people who mix alcohol with drugs were 16.6 times more at risk for suicide and 12 times more at risk for homicide then those who abuse neither. Not only were alcoholism and drug abuse associated with more frequent suicide, the researchers reported, but homicides also increased among people who did not consume drugs or alcohol but lived with others who did.

Dr. Frederick P. Rivara the lead researcher said the study underscored the need to confront the abuse of alcohol and drugs on many levels, including basic medical care.

“Physicians don’t usually screen for substance abuse, and substance abuse has many implications, including violence.” Dr Rivara said in a telephone interview from Seattle.  He said the study documented that alcohol and drug abusers posed a risk not just to themselves but also to others in their household.  Alcohol is generally recognized as a factor in killings and suicides.  The researchers alluded to previous studies showing that 40 percent to 70 percent of homicide victims were found during autopsies to have had alcohol in their blood.

But the potentially fatal impact of chronic substance abuse on other household members was often overlooked the researchers said.  They studied reports by medical examiners on 438 suicides and 388 homicides occurring at home in Shelby County, Tenn., King County, Washington, and Cuyahoga County, Ohio, during a three- to five-year period beginning in August 1987.  The victims’ proximity to alcohol or drugs was compared with that of a control group of residents of the same or similar neighborhoods.

Alcohol abuse increased the risk of suicide three-fold, whether or not the subject lived alone, the study said, but “non-drinking individuals who lived with others who drank were not at increased risk of suicide.”

The study said,  “Alcohol impairs judgment, possibly causing individuals to place themselves in situations at high risk of violence.”  But the use of illegal drugs by those younger than 50, it found, was associated with a higher incidence of suicide both among drug users and those who lived with them. Drug use was too infrequent to be measured in those over 50.

The link between violence and drug use, the researchers suggested, may result from “drug-seeking activities, such as interaction with drug dealers and theft to obtain resources for drug purchase.”  The study reported that drug abuse in a home increased a woman’s risk of being killed by a spouse, lover, or close relative by 28 times.  “That the true risk factor may be the drug culture environment is supported by our finding that even non-drug users who lived in households where illicit-drug use occurred were at greatly increased risk of homicide,” it said.

Commenting on the study, Susan Ohanesian of Project Return, an organization in New York that helps people overcome problems resulting from substance abuse. said there was a broader pattern of violence in homes where drugs and alcohol were used to excess. “You see high levels of depression and very low levels of self esteem as the abused person comes to believe they deserve the abuse,” Ms. Ohanesian said.

Ms. Ohanesian, the senior director of substance abuse services at the organization, said the risk of violence was there whether a domestic partner abstained from drugs and alcohol or not,  In addition to Dr. Rivara the authors of the study included Dr. Beth Mueller and Carmen T. Mendoza in Seattle; Dr. Grant Somes in Memphis, Dr Norman B.  Rushforth  in Cleveland, and Dr. Arthur L. Keller. They cautioned that the study ” is limited to homicides and suicides in homes and said that the dynamic of violent deaths outside might be quite different.   They also acknowledged that alcoholism and drug abuse, rather than causing killings and suicides,  “may play a role solely as markers for other risk factors” like anti-social behavior, or a history of mental illness or depression,

Source: New York Times, NATIONAL, August 20, 1997                                        

100 Americans die of drug overdoses each day. How do we stop that? By now, virtually everyone has heard that actor Philip Seymour Hoffman died last Sunday of an apparent heroin overdose. What fewer people know is that, on the same day, roughly 100 other Americans also likely died from drug overdoses — statistically speaking.

The rise of fatal overdoses over the last 15 years is startling. In 2010, according to the Centers for Disease Control and Prevention, there were 38,329 fatal drug overdoses in the United States, more than double the 16,849 fatal overdoses observed in 1999. Overdosing  is now the leading cause of accidental death in the United States, accounting for more deaths than traffic fatalities or gun homicides and suicides. Fatal overdoses from opiate medications such as oxycodone, hydrocodone, and methadone have quadrupled since 1999, accounting for an estimated 16,651 deaths in 2010. Earlier this week, I discussed the overdose issue with my colleague Keith Humphreys. Humphreys is one of the nation’s leading addiction researchers. He teaches psychiatry at Stanford and is a scientist in the VA Palo Alto Health Care System. Below is an edited transcript of our conversation.

Harold Pollack: Let’s start by noting who you are, and why anybody would want to ask your views regarding drug abuse and overdose.

Keith Humphreys: I’m a professor of psychiatry at Stanford University and lead the mental health policy section in my department. I’m also a scientist in the VA Palo Alto Health Care System–though I should make clear that I’m a VA scientist, not a spokesperson for the VA’s official views. I’ve researched drugs and addiction for about 25 years. I’m also a trained clinician, and I’ve treated people for addiction. Last but not least, I work extensively with public policy makers. I was a senior policy adviser at the White House Office of National Control Policy (the “drug czar’s” office) for the first year of the Obama administration. I also served an advisory role within the Bush administration. I work with many states, legislatures, and governors, on how to design policies that reduce the destructive effects of addiction.

HP: Among other things, you are a prolific movie reviewer. Of course, our phone call today is occasioned by Philip Seymour Hoffman’s death. Before we discuss the policy issues, how were you touched by Hoffman’s work as an actor?

KH: He was one of the very best actors this country has produced within the last 20 years. I’m struck by the range of things he could do and by his ability to make audiences care about characters who were difficult, strange or unhappy.

People will always remember him for his Oscar-winning performance in Capote. That’s appropriate because he was brilliant.. But he was also outstanding in some smaller films that not many people saw.  I’ve been encouraging people interested in addiction to seeOwning Mahoney. It’s about a gambling addict, and it’s based on a true story. The film captures how someone who seems to be doing well in many dimensions can still experience an addiction, and experience the emotional emptiness that often goes with that addiction. I don’t know how much of Hoffman’s own life went into that performance, but it’s pitch perfect. It only becomes more powerful when you realize that he himself was suffering from an addiction, albeit of a different sort.

HP: I believe his death is a reminder of two things. First, addiction can exist in people’s lives alongside wonderful connections with other people, wonderful accomplishments, and wonderful abilities. Second, this problem touches so many people in so many different ways. We hold many stereotypes about what opiate addiction is like, what heroin users are like. These stereotypes just don’t match the human experience of many people with opiate use disorders or the experiences of their friends and family members.

KH: That is true; the stereotypes don’t match reality. Most people who have drug problems also have jobs. A huge proportion of people having difficulties with prescription drugs are women; a huge proportion are “nice, middle class people.” While I’m gratified that Hoffman’s death has galvanized discussion, some of this discussion has perpetuated harmful stereotypes. Some are saying: “Philip Seymour Hoffman, that’s the Hollywood lifestyle for you, they’re all into drugs, and all that…” This characterization ignores the fact that, statistically speaking, more than 100 Americans whose names we’ll never know died of drug overdose on the same day that Mr. Hoffman did. Overdose is not a Hollywood story. It’s an American story about an epidemic that’s affecting all layers of American society.

HP: Many people don’t realize that overdose is the leading cause of accidental death in the U.S. I gave a talk about five years ago in Chicago, and I mentioned that we had more overdose deaths than traffic fatalities. My audience literally did not believe me. People were absolutely convinced that I had mis-transcribed the numbers. Every year, America loses a little over 32,000 people in auto crashes, and something like 38,000 from overdose deaths annually.

KH: Yeah, it’s remarkable if you compare overdoses to AIDS, which at its peak was taking about the same number of lives. The difference in reaction is really startling. We appropriately became galvanized about HIV/AIDS, and implemented much better public policy to prevent HIV-related deaths. It’s much harder to get traction on the overdose issue, or even to get people to believe how prevalent the problem actually is.

HP: Why do you think it’s hard to get people galvanized around overdose?

KH: AIDS inspired incredible activism in part because it was localized in particular communities that already had a shared identity. That probably helped groups like Gay Men’s Health Crisis organize politically. People knew each other. They loved the people who were dying. There isn’t a comparable pre-existing  community of people affected by overdose. It’s spread all over. The people who are dying and their loved ones don’t necessarily know each other.. Also, there are also many people — as was true of AIDS — who feel that overdose is just punishment for immoral behavior and therefore isn’t a problem at all.

I should add one other thing which you know well. In drug policy, we have so much culture war screaming that it’s very hard to address issues like overdose that take some planning, thought, and reflective approaches to public policy…. The polarized and uncivil atmosphere in drug policy  generates much heat but very little light regarding what we should do to address this problem. Evidence is often left aside as people start screaming at each other. Overdose is a public health problem and everyone should be working together to save lives.

HP: Within the world of injection drug use, the HIV epidemic sometimes overshadowed the continual reality that overdose was always a prevalent cause of mortality. If you read the classic cohort studies of street injection drug users, you’ll find that there tended to be a one or two percent annual overdose fatality rate in many of those studies. That’s incredibly high in groups of fairly young people who are not dying of other things.

The overdose threat was always there, perhaps in a fashion that led people to think of it as a condition rather than a problem. It became easy to see overdose as just another unavoidable background fact, which we couldn’t really influence. It became easy to see overdose as yet another cost of doing business if you’re engaged in this behavior.

You recently mentioned that most “overdoses” are really not overdoses in the sense that one might think, where people are getting a much  more powerful dose than they were expecting. Can you explain that?

KH: News reports about batches of “killer heroin” are typically overblown. But unusually strong doses of a drug are in fact rarely the cause of overdose. Toxicology results after a fatal overdose usually indicate that the victim has consumed either their normal dosage level or a dose slightly lower than their normal level. It’s too late to fix the language, but “poisoning” might be a better term than overdose.

You might ask: Why would an experienced user die from taking their normal dose? Typically overdose occurs because they’ve had a loss of tolerance. This loss of tolerance often arises because they haven’t used for a while. Maybe they had a voluntary period of abstinence. Maybe they were in jail, and their body can no longer handle the same dose.

The other leading cause of loss of tolerance is consumption of other substances. This is particularly true of alcohol, which seems to lower the body’s ability to tolerate opiates (so do benzodiazepines). Most of what we call “opiate overdoses” are really polydrug overdoses: alcohol and heroin, alcohol and oxycontin, benzodiazepine, alcohol and Vicodin, combinations like that.

HP: This is an important point easily lost. Many, maybe most people who have a serious drug problem are using more than one substance. Alcohol and other substances are usually in the mix. That poly-substance use complicates efforts to treat people medically. It also complicates the behavioral dimensions of substance use disorders.

KH: That is true, and that is even more true today than it was 20 years ago. If you go back to people who are now in their 60s, there were a lot of people who just were alcoholics. They did not touch other drugs. You see more mixing as you move through the baby boomer generation. And now with adolescents and young adults there’s really a poly-pharmacy of everything: legal pharmaceuticals, illegal street drugs, alcohol. You meet a drug user, and virtually always you’re meeting a poly-drug user.

HP: Philip Seymour Hoffman was a little older, age 46. That’s a pretty typical age for many overdose fatalities. He was having this interrupted period of use in some form. It is ironic that people’s efforts to quit or to reduce their drug use can create such vulnerability for overdose.

KH: That vulnerability helps to explain why it is such a hard decision for people who are on various kind of orally-administered opiate substitute medications, like buprenorphine or methadone, to decide whether they want to stay on them. A former heroin user who is taking these medications is still taking an opiate. You have much lower risk of overdose or HIV infection while you’re on them. At the same time, many people want to be weaned off these medications. Maybe they don’t like the potential health consequences of being on an opiate forever. Maybe they just don’t like the inconvenience or cost. People must decide: “Do I really need this, or can I go without it?”

It’s a really tough decision, because if you are able to successfully transition from them, you may like your life better. On the other hand, your tolerance will decline. So if you do relapse – particularly if you return to injection use — it could be a higher-risk event than it would if you had never gone off the opiates. Many people have strong ideologically tinged feelings about this issue and say it’s always a good idea or always a bad idea to go off of opiate substitution medication. In real life situations with real individuals, it’s a hard decision.

HP: Given these realities, I am very concerned about various detox programs that advertise heavily, but that have uncertain results. If you open some airline flight magazines you’ll sometimes see an ad that says, “Come to the desert for two weeks. You can tell your friends and family that you’re on vacation. We’ll detox you of everything, and you’ll come back a new man.”

KH: What a recipe for overdose!  It’s such a horrible promise to hold out to desperate people and their families. By the way, those programs are usually cash-pay only. They promise to take away your addiction in two weeks but what they really take is your money.

HP: We know that relapse rates for straight detox are almost 100 percent, if detox is not followed up with careful interventions and monitoring. I sometimes wonder whether some very-wealthy people such as Philip Seymour Hoffman are actually getting evidence-based treatment when they seek help.

KH: I don’ think they do. Some are checking into rehabs that don’t seem much different than luxury hotels. I suspect, actually, that you might get better care being a working class veteran, or someone who happens to live near a primary care doctor who has trained him or herself using buprenorphine than you would being a rich and famous person in that luxury tier of care.

The other thing is—and I don’t want single out Hollywood as the only example–there is a lot of enabling of high-status addicts. Rich people, high-status people such as physicians and politicians are sometimes immune from life pressures that provide other people with valuable warning flags. Powerful people can often evade many common legal, financial and social consequences of addiction . They can get into way deeper trouble before someone finally says, “Hey, I think you need to take a look at this problem.”

HP: Michael J. Fox notes an episode in his memoir, when he’s caught driving recklessly and is basically let off the hook by a local police officer. In hindsight Fox realizes how problematic such episodes were for him. Similar challenges arise with college drinking. Students aren’t driving anywhere if they live on campus. They don’t have to wake up early because they don’t have class until eleven o-clock. So they can get blasted and avoid some of the usual social constraints on alcohol consumption they would face in another environment. Most people regulate their own substance use because they start to get negative cues from their life experience. If you attenuate these cues, you may be making someone more vulnerable to longer-term problems.

KH: For related reasons, you can see why substance use disorders might become widespread in a community where there’s very little employment, where people have a huge amount of time with nothing to do, not much fun to do, and not many demands on them…

HP: I want to get back to prescription drug abuse. We’re facing serious problems with medications like Oxycodone. Yet many of the problems that we associate with illegal markets are much less present in the prescription opiate scene. There’s little violence on the supply side of this market. People are buying a medically produced product. They know the potency and the dosage. They’re not getting street drugs that have (say) fentanyl mixed in. One might have thought that this would be a safer environment for people. It doesn’t seem to have turned out that way.

KH: No, it didn’t. Many people were surprised by that, and I’m one of them. I had assumed, as many people did, that heroin overdoses come from the fact that it’s a black market product. This illegality implies that sometimes there’s going to be impurities and the potency is going to dangerously vary from time to time. There’s a very nice paper just out by Professors Shane Darke and Michael Farrell, who are two of the world’s leading experts on the topic. As these authors relate, toxicology studies of overdosed people very rarely find that impurities played an important role. As I said before, victims didn’t particularly receive high doses, either. Such findings surprised me. The fact that we’ve got 16,000 people a year dying from pure or legally-manufactured opiate analgesics shows you that it’s really not about the unpredictability of illegal markets, it’s about the drugs per se.

HP: Just to note the numbers, in 1999 there were about 4,000 prescription opiate overdoses. In 2010, there were about 16,000. By comparison, there are about 10,000 gun homicides in the United States.

KH: It is pretty amazing. Many people are focusing on the return of heroin and saying, “It’s all the fault of criminals.” You’ve got to remember, 4 in 5 of people today who start using heroin began their opioid addiction on  prescription opioids. The responsibility doesn’t start today with the stereotypical criminal street dealer. We basically created this problem with legally manufactured drugs that were legally prescribed. This really flies in the face of the argument that  if we just had a flow of legal drugs, the harms would be minimal.

HP: What did the industry do wrong and what did policymakers do wrong with these prescription opiates. You and I wrote a piece where we noted that a third of the Wounded Warrior group had a substance use disorder. Something is amiss here. What went wrong?

KH: In the late 1990s, many medical societies became appropriately concerned about poor pain management in the United States. Many patients were not receiving needed pain relief, which was and remains a very serious problem. That worthy concern for improved pain management became fused with  the pharmaceutical industry’s profit-seeking goals, which they pursued through aggressively pushing opioids in primary care settings and doing a lot of deceptive marketing. Purdue Pharma was fined $600 million  for deceiving regulators, doctors and patients about the addiction and overdose risks of OxyContin. They told prescribers not to worry, saying that the drug wouldn’t be abused and there was little risk in even very high doses.  These claims turned out to be untrue.

Many good-hearted, well-intended prescribers were so swept up in the need to relieve pain that they were not sufficiently critical of the potential downsides of flooding the country with these medications. Here’s one stunning statistic. The U.S. accounts for  99% of the world’s hydrocodone consumptions is a spectacular level of prescribing.

U.S. prescribers also write more prescriptions for opiate painkillers each year than there are adults in the United States.  When an addictive substance is prescribed on that scale, there will inevitably be substantial leakage out of the medical system. This would be true even if every single doctor proved to be honest and well-trained. And every single doctor isn’t.

A small number of criminal doctors realized that this was a cash cow and started setting up pain pill mills in places like Florida that had weak regulations.  The clinics advertised nakedly with promises such as, “No pill, no pain. Cash only, no I.D. required,” and thereby fueled an opioid epidemic all across the Southeastern states. At one point, 49 of the top 50 prescribers of opiates in the United States were located in Broward County, Florida. That small group of doctors who were intentionally criminal were part of the problem. The rest of it was the far larger number of doctors who were well intended but just didn’t know any better. I was on a public radio call-in program yesterday and heard multiple stories  of people with mild pain being written refillable prescriptions for large numbers of opioid painkillers.. There’s a lot of that andit’s irresponsible and dangerous. What happens is either the person takes all the medicine, which they shouldn’t, and maybe they start then developing a problem. Alternatively, they take two pills and then there’s a bunch of Vicodin or OxyContin sitting in the medicine cabinet for someone else to find: a local teenager, a friend of a friend, a guest at a party. Overprescribing and then loose storage fueled the epidemic. It’s still true today. When you ask people who abuse prescription opioids, “Where do you get them?” Their usual source is friends and family, not street purchases. It’s frightening, we’ve flooded the whole country with these things and they’re everywhere.

HP: It shows harm reduction is a difficult challenge, because this market doesn’t have many of the harms that we usually think of when we talk about harm reduction, and yet it produces a lot of fatalities.

KH: Right, as you know there’s different types of harm. There’s market harms and then there’s harms down at the end of a user. For sure, there is some violence around the black market in hydrocodone and oxycodone, but since these drugs are mostly coming from people who wear stethoscopes and white coats, that’s not clearly not a primary locus of violence.

The more than 16,000 overdose deaths from prescription opioids each year disproves the idea that it’s easy to regulate addictive drugs if they are produced and provided legally. We can reduce the violence in markets, but we’ve paid a real cost in public health harms and in safety failures from reckless corporate behavior.

HP: Can I ask you an embarrassingly basic question? If someone like Philip Seymour Hoffman presumably had access to all sorts of prescription opioids, why does he end up injecting heroin?

KH: That’s actually a good question. Cost drives many people to heroin. It’s more expensive to buy oxycodone than it is to buy heroin. Presumably that was a less pressing concern for Mr. Hoffman. Perhaps the intensity of the rush of injected heroin was more reinforcing to him than opioid medications were. The prescription medications have a longer, slower cycle of action in the body. His heroin use could also be the result of habit. He had experienced a heroin problem before, many years ago. It could be that that was the drug that he knew best or was available in the networks of dealers he used. I’m speculating about somebody I don’t know, but those are some possible reasons.

For most people it’s cost. Add one other thing; when people lose their health insurance, they may need the opioids to manage their pain. People sometimes end up buying street drugs including heroin to manage their pain because they have lost the insurance that used to cover their pain medication.

HP: The first heroin user that I knowingly had ever met had actually hurt his back at work. He had been on pain medication. And that basically led him down the road to his use of injected heroin. Many people suffer some sort of muscular skeletal injury. Powerful prescription pain medications can set in motion a cycle which can lead to addiction or that can reinforce someone’s disabilities.

KH: This happens all the time.

HP: Downstream, there will be more people having overdoses. What can we do as a public health policy to be more effective to prevent people from dying?

KH: One thing is to equip more people with Naloxone. Naloxone is an opiate antagonist that rapidly knocks opioids out of the brain receptor to which they bind. For someone who has stopped breathing due to heroin, for example, or oxycodone, it immediately starts them breathing again. It wakes them up, and creates an opportunity for more extensive medical care. It doesn’t remove the addiction, but in an overdose emergency it gives another 30-90 minutes to get someone to the hospital.

Some cities have distributed Naloxone (also known as Narcan) to police and firefighters. There are also programs that train family members. Let’s say you’re a mom or a dad and your teenager is addicted to heroin and might overdose at some point, you can learn how to administer Naloxone, and how to do CPR and put somebody in a rescue position.

That requires new laws, typically. If you’re not a licensed medical professional  you can’t legally administer prescribed medication to someone whom you find overdosed.  So when cities or states start expanding access to naloxone  they typically create regulations exempting people from that medical requirement and also from any liability, if, in good faith, they used Naloxone to try to save somebody’s life.

There is also an important role here for what are called Good Samaritan laws. Suppose a group of teenagers are at a party. They’re drinking and maybe popping some Vicodin or the like and then somebody falls to the floor and stops breathing. You don’t want everyone to be afraid to call 911 out of worry that they’ll get arrested. A Good Samaritan law would say that there would be a different kind of legal arrangement for people who overdosed or who are contacting authorities to say somebody had overdosed, so that the fear of punishment doesn’t prevent the saving of a life.

HP: Would you give Naloxone to street users so that they could help each other in situations where they are the people present?

KH: That is certainly being done. If you had an infinite budget, maybe everybody should carry Naloxone, every single person. If you think about it from the point of view that we only have so much money, which is always the case, ninety percent of what is distributed directly to users is ultimately not accounted for, it’s not used or it’s lost. Whereas if you distribute to police, firefighters, ambulance, and other first responders, virtually none of it goes to waste. All of it gets used to save people. From that point of view, my policy preference is the one with the first responders because I know funds are always limited, and I think you’re going to save more lives that way than by distributing it among users.

HP: Well the first responders should obviously have it. You could waste 90 percent of this stuff, and you still wouldn’t need to save very many lives to justify the return on investment for a small Naloxone kit. I guess the training would be expensive.

KH: If budget were no concern, you’d want to have everybody in the country to carry it.  But if you’re a city and you’ve got a $50,000 grant to do a Naloxone access expansion program, and your police and firefighters don’t have it, that’s where you will probably save the most lives.

HP: So there’s Naloxone and Good Samaritan Laws, what else should we be thinking about in policy?

KH: Expanding access to a range of addiction treatments. Such treatments could include psychotherapies, 12-step based treatment, and medications like buprenorphine, methadone and naltrexone. Residential options, such as Oxford House, are also important. Treatments that engage addicted people for long periods are especially valuable. As we discussed, short-term detoxes may be actually worse than nothing.  There’s been more beneficial movement in this regard in the last couple years than there has in the last 50. As you know, the Affordable Care Act specifies that substance use disorder treatment must be covered as a mandatory healthcare benefit. Every single plan on the health exchanges now covers drug and alcohol treatments at the same level as other disorders.

The new expanded Medicaid provided under ACA also covers addiction treatment.  Concurrent with that, the Obama Administration has just released the regulations implementing the 2008 Mental Health Parity and Addiction Equity Act which affects employer-provided insurance.. For the more than 100 million people who receive insurance through large employers, any benefits offered for addiction treatment have to be comparable to those for other medical conditions. Because of these two laws as well some recent improvements in what Medicare covers, more people have good insurance in the public and private sector to cover addiction treatments than in any time in U.S. That’s an extraordinary change in the public policy environment. It will take some time for the capacity of the health care system to catch up to it, but the coverage is now there in a way it never has been before.

HP: How about the striking number of overdose deaths among people released from correctional settings.

KH: We don’t want to incarcerate anybody that we don’t have to. But many people with opiate problems are in the criminal justice system. A huge proportion of property crime is driven by people with problems with opiates. Similar statistics exist for petty theft and muggings. The challenge is to find alternatives to incarceration that manages people in the community while addressing their drug use and protecting public safety. These alternatives could be drug courts, or it could also be things like Hope Probation where people are regularly tested for drug use, and if they use they endure swift, certain but not severe consequences..

For example, maybe they have to spend just one night in jail if they go back to use, and then they’re out the next day. Those kinds of programs should be used much more instead of putting drug-addicted criminal offenders in prison. If someone does endure a prison sentence of any length, then it’s really critical to do the transition planning, because the death rate of people just leaving prison who are addicted to opioids is appalling. In Scotland, 1 in 200 male heroin addicts dies within 14 days of prison release.

Scotland has a worse heroin problem than we do. Nonetheless, the basic principle would apply here. The stereotype is it’s easy to get drugs in prison. But it’s actually much, much harder  than it is on the street. Most people who go into prison dependent on opioids are not able to get a regular supply of opioids in prison. So they’re tolerance drops dramatically. They go out of prison, maybe they’re celebrating their release, they have a few drinks, they take their normal dose of opioids, and they die because they don’t have the tolerance anymore to be able to have that dose in their body without shutting off their breathing.

HP: Two challenges make this issue especially difficult. One is that the systems that we have are pretty passive. When you leave jail or prison you really have to present for intervention. Of course it’s just not going to happen until somebody has a crisis. We could also do a better job of preparing people for predictable risks and specifically warning them about this. Because we don’t want to talk to drug users about some realities of relapse, we may not be giving them sufficient resources to protect them against overdose. KH: There’s a closely watched clinical trial under way in England, run by my friend John Strang. Heroin-addicted people leaving prison are going to be given training in overdose reversal, and a supply of Naloxone. That will be very interesting to see whether that works. I suspect that it will be helpful even if no Naloxone is ever used because it will reorient prison staff as to what their responsibilities are when somebody leaves prison. It’s more than just shoving them out the door and saying, “Good luck to you….”

HP: I like that there is an actual field trial. So we have an opportunity for evidence-based policy. If you take an issue like Naloxone distribution, most people have very strong policy preferences. If you talk to people about these issues, you can go an awfully long way before anyone gets to any sentence that is in any way influenced by data. It would be nice to see what we can accomplish. I suspect the impact will be more modest than what many of the supporters are hoping, but it will be real. Most substance abuse policies are helpful but not decisive when they’re effective.

KH: It’s hard to change human behavior. That’s not just true in addiction. It’s also true of weight loss programs, getting people to use seat belts, and more. Fortunately, even if you can change half the behavior of half of the people, you can produce absolutely massive benefits in the public health and public safety sphere.

HP: Weight loss is a great example because we know randomized trials of diets show real benefits for some of them, but very small effects. There is also almost universal non-adherence to the strictures of any of the diets. In a way, needle exchange makes us ripe for disappointment, because it requires such minor behavior change and because people generally like new, sharp needles. If you look at almost anything else, for example trying to get people to use condoms for HIV prevention, it’s a much tougher behavioral challenge.

KH: That’s right. That’s been the challenge for the oral version of the medication naltrexone. If you are addicted to opioids and you get buprenorphine or methadone, it’s still reinforcing. You’re activating opiate receptors, and that feels good. Naltrexone blocks the effect of opiates, and it’s been very hard to get drug users to take that up.  It’s kind of like walking into a bar and saying, “Hey, everybody, I have a pill that would make the alcohol you’re now consuming not feel very good. Line up everybody, no crowding please.” Nobody would give you the time of day. That medication has had a hard time getting traction just because it doesn’t sound very appealing to the average opiate addict.

HP: It’s very appealing if you have many other cues in your life that are raising your urgency, if you’re already very highly motivated. Some of these methods are especially effective for doctors are trying to get off of opiates because they have many powerful external motivations that are further reinforcing their efforts to address the behavior.

KH: We’ve learned a lot from the way doctors are managed when they have an addiction. They face regular testing with swift and certain responses. A lot of people say, “Well, that’s doctors, but they are different from most addicts.” But it turns out that those same principles of regular testing with consequences has worked really well in tougher populations. That’s the findings of Hope Probation, and for Alcohol 24/7 Sobriety too.

Diffusing those principles would be really productive, because most of these people wind up in the criminal justice system. They engage in other crimes, and the criminal justice system normally does nothing, nothing, nothing, and then suddenly brings down the hammer. We have to do a better job of responding mildly but consistently and swiftly to the drug use of people who are on probation and parole. It’s a much better way to change people’s behavior.

HP: Let’s talk a little bit about some upstream issues. Given that these opiate medications are out there and they’re being widely misused, how can we change the way we do business so that there are fewer people emerging with these addiction disorders on these medications?

KH: We need to have way-better prescribing practice. Most of that involves provider education for well-intended medical professionals. A small amount involves criminal justice actions against few really bad people who run pill mills that should be shut down. A model of what is needed most is what happened in the Puget Sound Health System. They internally decided among their own staff to take a look at how they were prescribing opioids. They met in groups, they developed consensus procedures, they took a look at providers who were prescribing at high levels, patients who were being prescribed high levels. They learned about alternative methods of pain management.  It’s a great example of responsible group practice medicine, and they were able to keep the people they were taking care of healthy while prescribing a lot less opioids. We need more examples of that around the country so that people don’t think pain management always means more opioids.

We also need better ways for the public to dispose of excess of opioids. Many people don’t realize that you can’t legally just walk back to your doctor or your pharmacist and say, “I didn’t take these 15 fentanyl tablets, can you take them?” They’re not allowed to accept them. There’s been some movement on fixing that in Washington, but far too slow. The DEA runs “take back prescription” days. That’s fantastic, but that’s one or two days a year. Disposal needs to become normative, so that when you went into Wal-Mart, for example, there would be a bin where you could just toss your extra prescriptions in, the things you didn’t use.

It’s kind of like where we are now is like the beginning of recycling. Recycling glass and plastic was once this weird practice that a few people did. Then maybe there were special events and special centers that did recycling. Now millions of people do it without thinking,it’s automatic. We need to make it simple so that it just becomes automatic. You’d never leave leftover medication in your cabinet. You bring it back to the pharmacist on your regular trip to the grocery store.

We could also implement better procedures around surgeries. We have 40 million surgeries a year. Something like 5 to 10 percent of those result in persistent pain, persistent opioid use, or both. That means we are potentially generating a large number of people at risk for  prescription opioid dependence.  And some of those people may end up ultimately  going to the street heroin market, as did  the person you knew with the back injury.

There’s some exciting work underway that could teach us how to reduce this risk of iatrogenic addiction after surgery. The amount of pain and fear patients have right at the time of operation predicts how much pain and opiate use they’ll have later.  Relaxation exercises or anti-anxiety medications administered moments before surgery could therefore produce long term benefits in terms of reduced pain and opiod use down the road.   My colleague Dr. Ian Carroll is leading a clinical trial on this question now, and along with some related studies being done around the country it could teach surgical teams  how to reduce post-operative pain and the risk of opioid addiction at the same time.   That would be a huge benefit to public health.

Source:  www.WashingtonPost.com 7th Feb 2014

A group that opposes marijuana legalization has placed billboards around the New York-New Jersey area in advance of Sunday’s Super Bowl, the Seattle Post Intelligencer reports. Earlier this week, a group advocating for legalization placed billboards on the highway leading to MetLife Stadium, where the game will be played.

The new anti-legalization billboards were placed by Project SAM (Smart Approaches to Marijuana). The chairman of the group, former Congressman Patrick J. Kennedy, said in a news release, “Marijuana use saps motivation, perseverance, and determination – the opposite of what it takes to win the Super Bowl. It is not a safe drug, especially for kids, and we need to reiterate the message to coaches, parents, players, and teens alike that it has no place in football.”

Earlier this week, five billboards with pro-marijuana messages appeared along New Jersey highways leading to MetLife Stadium. One of the billboards reads: “MARIJUANA: Safer than alcohol…and football.” Another says nearly as many people were arrested for marijuana in 2012 (749,824) as have attended the past 10 Super Bowls combined (751,203).

The signs were purchased by the Marijuana Policy Project. The group’s spokesman, Morgan Fox, said the billboards highlight what the group feels is the National Football League’s hypocrisy with its beer sponsors. “The same organization has no problem actively advertising a much more dangerous substance, particularly in a relatively family environment,” Fox said.

Source:  Partnership@drugfree.org   30th January   2014

Devout Christian mother-of-three, 31, becomes first woman in Britain to DIE from cannabis poisoning after smoking a joint in bed

Gemma Moss, a 31-year-old churchgoer, of Boscombe, in Bournemouth, Dorset, collapsed in bed after smoking a cannabis cigarette that led her to have moderate to high levels of the class B drug in her system. Tests of her vital organs found nothing wrong with them although it was suggested she might have suffered a cardiac arrest triggered by cannabis toxicity.

Miss Moss’ death was registered as cannabis toxicity and a coroner has recorded a verdict of death by cannabis abuse.  Deaths directly from cannabis are highly unusual. In 2004 a 36-year-old man from Pembrokeshire became the first person in the UK to died from cannabis toxicity.

David Raynes, of the National Drug Prevention Alliance, said: ‘It is extremely rare and unusual for a coroner to rule death from cannabis abuse.  ‘In 40 years I have never come across deaths from cannabis alone. There have been cases where it has been combined with other drugs or alcohol.  ‘It has often been said that cannabis doesn’t cause death. Users usually pass out before they can take enough cannabis to kill them.  ‘This case serves as a warning that cannabis can cause immense harm.   ‘Cannabis is known to increase heart rate and blood pressure. Cannabis these days is designed to be much stronger than cannabis used in the sixties to meet demand of users who want a stronger hit.’

Miss Moss, a devout Christian, had frequently used cannabis during her adult life but had stopped for two years before her death last October. She started using it again to help her sleep after becoming depressed and anxious due to breaking up with her boyfriend.

An inquest heard Miss Moss smoked half a joint a night to help get her to sleep. Her friend, Zara Hill, said she and Miss Moss smoked cannabis worth about £20 together in the week before her death. Miss Hill told police that Miss Moss smoked as much as £60 of the drug a week, although this was disputed by her family. On the night of October 28 last year, Miss Moss, who had two sons, Tyler, 15, and Tessiah, eight, and a daughter, went to bed after rolling a joint. She was found unresponsive in bed the following morning by Chloe Wilkinson, the girlfriend of Miss Moss’ teenage son. She summoned an ambulance to the flat in Boscombe but Miss Moss was pronounced dead at the scene.

Her friend said she and Miss Moss smoked cannabis worth about £20 together in the week before her death.  Half of a joint was found underneath her body and a wrapper containing brown and green leaves of the class B drug was discovered in her handbag. A post-mortem examination revealed that there were no obvious signs of abnormality in Miss Moss’ body.

But Dr Kudair Hussein, a pathologist, told the inquest in Bournemouth, that there were moderate to heavy levels of canabinoids in her blood. He said: ‘The physical examination and the examination of various organs including the heart and the liver showed no abnormality that could account for her death. ‘The level of canabinoids in the blood were 0.1 to 0.15 miligrams per litre, this is considered as moderate to heavy cannabis use. ‘I looked through literature and it’s well known that cannabis is of very low toxicity. ‘But there are reports which say cannabis can be considered as a cause of death because it can induce a cardiac arrest.’

Tests of her vital organs found nothing wrong with them although it was suggested she might have suffered a cardiac arrest triggered by cannabis toxicity

Mr Sheriff Payne, the Bournemouth coroner, asked Dr Hussein: ‘You are satisfied it was the affects of cannabis that caused her death.’  Dr Hussain replied: ‘Yes sir.’

The inquest heard Miss Moss grew up in London but moved to Bournemouth about five years ago. She was said to have changed her lifestyle and found faith since relocating to the south coast. She regularly attended the evangelical Citygate Church in Bournemouth and was baptised there last year. Her mother, Kim Furness, told the inquest her daughter struggled to sleep and had admitted that she had started smoking a ‘small amount’ of cannabis at night. Miss Furness said: ‘For years she smoked it (cannabis) every day. ‘When she moved to Bournemouth she stopped for two years and then had a break up with her relationship and started again+6

‘It was one half of a joint to get to sleep. She never smoked in the day. She was really honest about cannabis because from where we come from its normal to smoke cannabis. ‘She was trying to stop again. She rang me and said “mum, I have just started again, I will stop but I needed half to get to sleep”.’ ‘She said she would go to the doctors to get something to help her sleep to stop her doing it. She wasn’t excessively smoking.’

Detective Inspector Peter Little read a statement from Miss Hill.

She also Miss Moss was stressed about her benefit money being stopped and because her son had been excluded from school. In recording a verdict that Miss Moss died from drug abuse, Mr Payne said: ‘Gemma had been a long term user of cannabis. ‘She suffered from depression and was on prescription drugs to try and deal with that although it would not appear she was taking them at the time of her death. ‘She usually used it (cannabis) in the evenings to try and help her to get to sleep and did not use it in the day time. The post mortem could find no natural cause for her death.

‘With the balance of probability that it is more likely than not that she died from the effects of cannabis.’ Carolyn Stuart, a coroner’s officer, said: ‘It is very rare to have cannabis toxicity as a cause of death. She was a healthy 31-year-old woman who had nothing wrong with her.’ Russell White, a leader at the Citygate Church, said: ‘Gemma was a good mother and brought up her children mainly on her own. ‘She was full of fun and loved life and loved coming to church. She was a committed member of the church and brought her children along.  ‘I think she came from a difficult background but she I think she was clean to a large degree in terms of drugs. ‘She is very much missed and her death was a real shock to us.’

Miss Moss lived with her two sons but it believed her daughter lived with her father in Jamaica. Last October Miss Moss posted on her Facebook page about how excited she was about travelling to the Caribbean to visit her daughter over Christmas. Lucy Dawe, from the anti-cannabis group Cannabis Skunk Sense, said: ‘People who are pro-cannabis will say it won’t kill anybody but unfortunately it does. It is very upsetting because we now have three young people with no mother and the mother probably thought she was doing something perfectly safe.

‘Along with death, cannabis can also cause a lot of other problems like psychosis, chronic depression, strokes, and anxiety.

‘These effects need to be something that are generally well-known. People think because cannabis is a plant it won’t be dangerous but it leads people to a false sense of security.’ But Peter Reynolds, president of CLEAR Cannabis Law Reform, a group that campaigns legalising the class B drug, said he doesn’t believe anyone can die from taking it. He said: ‘It is popularly believed that there has never been a death because of a toxic effect of cannabis on the body. ‘Clearly, it is possible that somebody may have had an accident while intoxicated through cannabis use but that would be an indirect cause. ‘Unlike opiates, alcohol or other drugs, cannabis cannot depress basic life functions to the point of death. ‘Cannabis is probably the least toxic therapeutically active substance known to man. ‘In conclusion, I would say that it is pretty much unbelievable that anyone’s death could be directly attributable to cannabis.’

Source:  MailOnline  30th January 2014

 

NDPA comment:

Despite increasing evidence of the harmfulness of cannabis, and the Coroner and Pathologist agreeing that Gemma Moss died from cannabis toxicity, Peter Reynolds, of the Cannabis Law Reform group,  unsurprisingly, believes he knows better.  Whenever any article is published from reputable sources – often scientists or doctors – about health risks from the use of cannabis there will inevitably follow hundreds of comments from users of the drug denying the scientific findings.

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

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

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

The study took place in Germany and involved a random sample of 1,923 adolescents and young adults aged 14 to 24 years.

The researchers excluded anyone who reported cannabis use or pre-existing psychotic symptoms at the start of the study so that they could examine the relation between new (incident) cannabis use and psychotic symptoms.

The remaining participants were then assessed for cannabis use and psychotic symptoms at three time points over the study period (on average four years apart).

Incident cannabis use almost doubled the risk of later incident psychotic symptoms, even after accounting for factors such as age, sex, socioeconomic status, use of other drugs, and other psychiatric diagnoses. Furthermore, in those with cannabis use at the start of the study, continued use of cannabis over the study period increased the risk of persistent psychotic symptoms

There was no evidence for self medication effects as psychotic symptoms did not predict later cannabis use. These results “help to clarify the temporal association between cannabis use and psychotic experiences,” say the authors. “In addition, cannabis use was confirmed as an environmental risk factor impacting on the risk of persistence of psychotic experiences.”

The major challenge is to deter enough young people from using cannabis so that the prevalence of psychosis is reduced, say experts from Australia in an accompanying editorial.  Professor Wayne Hall from the University of Queensland and Professor Louisa Degenhardt from the Burnet Institute in Melbourne, question the UK’s decision to retain criminal penalties for cannabis use, despite evidence that removing such penalties has little or no detectable effect on rates of use. They believe that an informed cannabis policy “should be based not only on the harms caused by cannabis use, but also on the harms caused by social policies that attempt to discourage its use, such as criminal penalties for possession and use.”

Source:    ScienceDaily. ScienceDaily, 3 March 2011. <www.sciencedaily.com/releases/2011/03/110301184056.htm>

Daily consumption of cannabis in teens can cause depression and anxiety, and have an irreversible long-term effect on the brain.

Canadian teenagers are among the largest consumers of cannabis worldwide. The damaging effects of this illicit drug on young brains are worse than originally thought, according to new research by Dr. Gabriella Gobbi, a psychiatric researcher from the Research Institute of the McGill University Health Centre. The new study, published in Neurobiology of Disease, suggests that daily consumption of cannabis in teens can cause depression and anxiety, and have an irreversible long-term effect on the brain.

“We wanted to know what happens in the brains of teenagers when they use cannabis and whether they are more susceptible to its neurological effects than adults,” explained Dr. Gobbi, who is also a professor at McGill University. Her study points to an apparent action of cannabis on two important compounds in the brain — serotonin and norepinephrine — which are involved in the regulation of neurological functions such as mood control and anxiety.

“Teenagers who are exposed to cannabis have decreased serotonin transmission, which leads to mood disorders, as well as increased norepinephrine transmission, which leads to greater long-term susceptibility to stress,” Dr. Gobbi stated.

Previous epidemiological studies have shown how cannabis consumption can affect behaviour in some teenagers. “Our study is one of the first to focus on the neurobiological mechanisms at the root of this influence of cannabis on depression and anxiety in adolescents,” confirmed Dr. Gobbi. It is also the first study to demonstrate that cannabis consumption causes more serious damage during adolescence than adulthood.

Dr. Gabriella Gobbi is a researcher at the neuroscience axis of the Research Institute of the McGill University Health Centre and also a psychiatrist and associate professor at the Department of Psychiatry, McGill University.

Source: ScienceDaily. ScienceDaily, 20 December 2009. <www.sciencedaily.com/releases/2009/12/091217115834.htm:

A current study by an international consortium of researchers shows that the consumption of Cannabis during pregnancy can impair the development of the fetus’ brain with long-lasting effects after birth. Cannabis is particularly powerful to derail how nerve cells form connections, potentially limiting the amount of information the affected brain can process.

An increasing number of children suffer from the consequences of maternal drug exposure during pregnancy, and Cannabis is one of the most frequently used substances. This motivated the study, published in the EMBO Journal, conducted in mice and human brain tissue, to decipher the molecular basis of how the major psychoactive component fromCannabis called delta-9-tetrahydrocannabinol or THC affects brain development of the unborn foetus.

The study highlights that consuming Cannabis during pregnancy clearly results in defective development of nerve cells of the cerebral cortex, the part of the brain that orchestrates higher cognitive functions and drives memory formation. In particular, THC negatively impacts if and how the structural platform and conduit for communication between nerve cells, the synapses and axons, will develop and function. Researchers also identified Stathmin-2 as a key protein target for THC action, and its loss is characterized as a reason for erroneous nerve growth. It is stressed that Cannabis exposure in experimental models precisely coincided with the fetal period when nerve cells form connections amongst each other.According to study leader Professor Tibor Harkany, who shares his time between Karolinska Institutet and the Medical University Vienna in Austria, these developmental deficits may evoke life-long modifications to the brain function of those affected. Even though not all children who have been exposed to Cannabis will suffer immediate and obvious deficits, Professor Harkany warns that relatively subtle damage can significantly increase the risk of delayed neuropsychiatric diseases.

“Even if THC only would cause small changes its effect may well be sufficient to sensitize the brain to later stressors or diseases to provoke neuropsychiatric illnesses in those affected in the future,” says Professor Harkany. “This concerns also the medical use of Cannabis, which should be avoided during pregnancy.”

Source: EMBO Journal, January 2014

As the Florida Legislature and citizens debate the issues of medical marijuana, our hearts are with the families struggling to find answers for their children who live with severe forms of epilepsy like Dravet Syndrome.

Yet, as physicians and researchers specializing in the treatment of this challenging spectrum of disorders we must ensure that our professional and lay community does not make treatment decisions that are not based in sound research and science.

While there are a number of anecdotal reports of positive outcomes from a particular strain of marijuana used for treating patients with epilepsy, robust scientific evidence for the use of marijuana for treatment of epilepsy is lacking. The lack of information does not mean that marijuana is ineffective for epilepsy. It merely means that we do not know if marijuana is a safe and efficacious treatment for epilepsy.

In addition, little is known about the long term effects of using marijuana in infants and children on memory, learning and behavior. This is of particular concern because of both clinical data in adolescents and adults and laboratory data in animals demonstrating potential negative effects of marijuana and its derivatives on their critical neurological functions.

Such safety concerns coupled with a lack of evidence of efficacy in controlled studies result in a risk/benefit ratio that does not yet support use of marijuana for treatment of seizures.

The form of marijuana in the spotlight is known as Charlotte’s Web from a plant that is thought to contain relatively little tetrahydrocannabinol, or THC, the primary component that produces a high. Instead, the strain has high amounts of another compound — cannabidiol, or CBD. This is not smoked but used in an oil form.

Several members of the American Epilepsy Society are now conducting clinical trials of CBD including one developed by a British drug company. There are several steps in a clinical trial and we need to wait to draw conclusions until there has been a trial with a control group or a placebo-controlled trial.

The preliminary steps underway now will not have a placebo group and will be used for dose finding, tolerability and to establish an understanding of how human bodies absorb and process the drug. If these initial safety studies are encouraging then further controlled studies will be needed to determine if CBD is effective in the treatment of seizures and in which patient populations (ie., what ages and types of epilepsy). These studies are critical, as the pathway to finding new drugs and treatments is full of treatments once thought to be the “miracle cure” that were rejected after the rigors of a clinical trial.

These studies are especially important in a condition like epilepsy that has a very variable course, and sometimes significant improvement can actually be a result of unpredictable ebb and flow of the disease.

Treatments cannot advance without clinical trials. Clinical trials are necessary to test the safety and effectiveness of new therapies and to develop better ways of using known treatments. The American Epilepsy Society is supportive of well-designed clinical research to determine the safety and efficacy of marijuana in the treatment of epilepsy. We urge the entire community of

medical professionals, patients, families and regulators to focus their efforts on getting accurate information and allowing proper research to be done.

Healthcare professionals, patients, and caregivers are reminded that use of marijuana for epilepsy may not be advisable due to lack of information on safety and efficacy, and that despite 20 states legalizing the use of medical marijuana, it has not been reviewed and approved by the Food and Drug Administration for use in the treatment of any form of seizures or epilepsy.

Under federal law, every new therapy and device must go through carefully monitored studies in human volunteers before it can be marketed for regular use in patients. The studies with CBD and many other clinical studies need people with epilepsy to volunteer. To this end, those with epilepsy are in a special position to help themselves and others through participation in medical research that can lead to effective treatments.

The recent discussions surrounding medical marijuana highlight the fact that the epilepsy community desperately needs new therapies and approaches for patients with resistant or refractory seizures. We need to know more about the basic mechanisms and causes of epilepsy so that we can better match therapies to patients, and someday soon find targets for cures.

But none of these giant steps forward will be possible without robust, careful research that safeguards the health of study participants while uncovering important new findings

The actions of the people of Florida will be watched closely by the entire nation. We hope the needs of people living with epilepsy and their families will be a strong voice in this debate. However we also urge that the eagerness to find treatments will not overshadow the need to conduct rigorous research and testing. Together as an epilepsy community we must take this step to find the answers for people living with these severe forms of epilepsy.

Dr. Elson So,  president of the American Epilepsy Society.

Source: http://www.miamiherald.com/2014/01/22/3886526/  22.01.14

The National Institute on Drug Abuse (NIDA) is releasing new resources to help parents, health care providers and substance abuse treatment specialists treat teens who are struggling with drug abuse. The resources also provide advice on identifying and interacting with teens who may be at risk.

The resources are being released in advance of National Drug Facts Week, January 27 to February 2, when communities and schools around the country will host events to allow teens to learn how drugs affect the brain, body and behavior.

One of the new resources is an online publication, Principles of Adolescent Substance Use Disorder Treatment: A Research Based Guide. The guide includes principles to consider in treating adolescent substance use disorders; frequently asked questions about adolescent drug use; evidence-based approaches to treating adolescent substance use disorders; and the role of family and medical professionals in identifying teen substance use and supporting treatment and recovery.

NIDA notes that teen drug use and treatment needs differ from those of adults. Teens are less likely to seek treatment on their own, because they may not want or think they need help. Only 10 percent of 12- to 17-year-olds needing substance abuse treatment receive any services, according to the 2012 National Survey on Drug Use and Health.

“Because critical brain circuits are still developing during the teen years, this age group is particularly susceptible to drug abuse and addiction,” NIDA Director Dr. Nora D. Volkow said in a news release. “These new resources are based on recent research that has greatly advanced our understanding of the unique treatment needs of the adolescent.”

Source:  www.jointogether.org    23.01.2014

Emergency rooms in Denver, Colorado reported a surge in visits related to synthetic marijuana in the late summer and early fall, according to the Los Angeles Times. Experts say similar patterns may emerge in other parts of the country.

Between August 24 and September 19, area emergency rooms saw 263 patients, mostly young men, with symptoms related to synthetic marijuana. Most patients were treated in the emergency room, but seven were admitted to intensive care units. In a letter in this week’s New England Journal of Medicine, Dr. Andrew A. Monte of the University of Colorado School of Medicine writes synthetic marijuana appears to be growing more potent. “Although the effects of exposures to first-generation synthetic cannabinoids are largely benign, newer products have been associated with seizures, ischemic stroke and cardiac toxicity, possibly due to potency,” he wrote.

Synthetic marijuana is sold under names including K2, Spice and Black Mamba. It is made with dried herbs and spices that are sprayed with chemicals that induce a marijuana-type high when smoked, the article notes. The products are widely available, despite laws prohibiting them.

“These substances are not benign,” Monte said. “You can buy designer drugs of abuse at convenience stores and on the Internet. People may not realize how dangerous these drugs can be — up to 1,000 times stronger binding to cannabis receptors when compared to traditional marijuana.”

In September, the Colorado Department of Public Health and the Centers for Disease Control and Prevention announced they were investigating whether three deaths and 75 hospitalizations were caused by synthetic marijuana.

Short-term effects of using synthetic marijuana include loss of control, lack of pain response, increased agitation, pale skin, seizures, vomiting, profuse sweating, uncontrolled/spastic body movements, elevated blood pressure, heart rate and palpitations.

Source: www.drugfree.org            Jan 23rd 3014

He ought to change federal drug law rather than refuse to enforce it.

To the delight of dorm rooms everywhere, President Obama has all but endorsed marijuana legalization. “We should not be locking up kids or individual users for long stretches of jail time when some of the folks who are writing those laws have probably done the same thing,” he told the New Yorker magazine. Let’s try to see through this political haze.

Mr. Obama also muses to an admiring David Remnick that while pot is “a bad habit and a vice” and not something he would encourage his daughters to try, “I don’t think it is more dangerous than alcohol.” He called the Colorado and Washington legalization experiments “important for society,” while offering no comment on the federal Controlled Substances Act that he has an obligation to enforce equally across the country.

Marijuana remains a Schedule I substance under that 1970 law, meaning that it has a high risk of abuse. “No more dangerous than alcohol” is still dangerous, given the destructiveness of alcohol-related disease and social ills like drunk driving. There’s an industry related to mitigating alcohol problems, after all.

We tolerate drinking because most adults use alcohol responsibly, and by all means let’s have a debate about cannabis given how much of the country has already legalized it under the false flag of “medical” marijuana. But an honest debate would not whitewash pot’s risks.

A growing body of medical research shows that the psychoactive substance in marijuana may cause permanent cognitive damage when used by adolescents, such as impaired memory and learning. The drug can trigger psychotic episodes, especially among vulnerable late adolescents, and the price decreases and social normalization of recreational use will increase the number of underage potheads.

“Middle-class kids don’t get locked up for smoking pot, and poor kids do,” Mr. Obama added. Actually, almost nobody gets locked up for pot. Americans collectively smoke for three billion days a year and use has increased 38% since 2007, according to a Rand Corp. analysis of federal health survey data, yet there were merely about 750,000 marijuana-related “arrests” in the U.S. in 2012. In the official FBI statistics that can mean anything from a ticket or summons to a full booking.

Very few people are incarcerated for simple possession, which makes up about 88% of arrests. There are currently about 40,000 state and federal prisoners serving time for marijuana-related convictions, and most have violent criminal histories. Most judges

must be persuaded that someone is a true danger to society to sentence prison for mere drug use.

Mr. Obama is also kidding himself if he thinks drug legalization will be a boon to the poor. His own history of drug use is well known, but most users aren’t the privileged students of the Punahou School. Like all human vices, the misery of addiction is always worse for those who lack the resources and family support of the affluent.

Mr. Obama is now the President, not a stoned teenager riffing with his Choom Gang, and he might have set a better example. Parents trying to teach their kids to make better choices than getting high are at a disadvantage when the person in charge of upholding the law says breaking the law is no big deal.

If the President believes that marijuana prohibition is an injustice, he has an obligation to propose his own legislative reforms, instead of unilaterally suspending the enforcement of federal drug laws that don’t fit his political agenda. Why not start with the State of the Union address? Whatever Mr. Obama’s personal views on marijuana, his picking and choosing from the U.S. code is far more corrosive to the rule of law and trust in government.

Source: 21.01.2014 http://online.wsj.com/news/articles/SB10001424052702303802904579334710499090836?mod=WSJ_Opinion_LEADTop

When President Obama says he thinks marijuana is less dangerous than alcohol in terms of its impact on the individual consumer , I think he’s profoundly wrong. When he says smoking pot is no more dangerous than smoking cigarettes, I think he’s wrong about that too. When I see evidence of what seems to be a global trend in favour of decriminalising or legalising cannabis, I think that’s wrong too.

And I’m otherwise pretty liberal about banned drugs. Most problems associated with banned drugs, it seems to me, stem from the fact of their being illegal rather from the fact of their being taken.  To place the supply of selected drugs in the hands of violent criminals seems to me a very bad idea. Yet I feel differently about cannabis. I think governments should be making it harder to acquire, not easier.

Barack Obama and the many other now middle-aged politicians who smoked a bit of dope in their youth and can’t quite see the harm in it,  need to understand the drug has fundamentally changed since they enjoyed their last toke. Genetically re-engineered, cannabis is now a very different product to the one puffed at parties in the Seventies. The days of a mild innocent high are gone – the prospect of grave mental instability has arrived.

A year ago, in order to write a feature for The Times Magazine, I spent three days at a rehab clinic in the Zurich suburb of Küsnacht. The Küsnacht Practice is reportedly, at close on £7,000 a day, the most expensive such clinic in the world. Patients have included Russian oligarchs, Saudi sheikhs, English aristocrats, German bankers and American film stars. Addictions range from alcohol to cocaine to morphine to food to sex, or various combinations of the above. Patients are quartered in luxury flats and must undertake to stay a minimum of four weeks.

Unsurprisingly, given the amount of care and attention 50 grand a week can buy, the success rates at Küsnacht are very high. High yet not, however, total. His most signal failure, Lowell Monkhouse, the practice’s founder told me, was a young man in his twenties now confined to a secure psychiatric hospital, where he will probably have to remain for the rest of his life. He had cannabis psychosis,  Monkhouse said sadly. “We couldn’t help him.”

Cannabis addiction, Monkhouse explained, is the hardest one to break – harder than heroin, harder than booze, harder than a compulsion to order up a couple of hookers and a big bag of coke. He added that cannabis (certain strains of it at least) was also the drug most capable of causing the most profound and least reversible neurological damage. And cannabis could inflict such damage quickly, in the brains of young and otherwise healthy people.

I’d never much liked cannabis, even before I heard what Monkhouse had to say. I’d dabbled in it perhaps a dozen times in my twenties and thirties, each experience less enjoyable than the last. Under its influence, I became, at best silly and sleepy, at worst paranoid, unstable, offensive. Cannabis seemed to me to be far more powerfully mood-altering than the received wisdom claimed. People I knew who smoked a lot of it were not just boring and a bit dozy, many seemed to be seriously mentally impaired. I haven’t touched the stuff for years. Good decision, one later confirmed during my trip to Zurich.

A big mistake is being made. The illegal drug regarded as the least harmful is the one most likely to send people round the bend.

Source: http://www.thetimes.co.uk/tto/life/article3980960.ece  21.01.14

By William J. Bennett

Editor’s note: William J. Bennett is the author of “The Book of Man: Readings on the Path to Manhood.” He was U.S. secretary of education from 1985 to 1988 and director of the Office of National Drug Control Policy under President George H.W. Bush.

(CNN) — President George H.W. Bush appointed me as the nation’s first director of national drug control policy — or “drug czar” — in 1989. We took on many big fights, the largest of which was the cocaine epidemic spreading from the jungles of Colombia to the streets of the United States. We conducted an all-out assault on drugs through tough enforcement measures and public education. Contrary to “war on drugs” critics, drug use and addiction dropped across the country.

The issue of marijuana legalization was far less prominent than it is today, although even then, some argued that we should experiment with legalization. I told them not on my watch; the cost to society would be too great.

If you don’t want to take my word that it can be harmful, perhaps you’ll take Lady Gaga’s. In a recent interview, the world-famous pop star admitted she was heavily addicted to marijuana. “I have been addicted to it and it’s ultimately related to anxiety coping and it’s a form of self-medication and I was smoking up to 15 or 20 marijuana cigarettes a day with no tobacco,” she said. “I was living on a totally other psychedelic plane, numbing myself completely.”

Lady Gaga said she was speaking out to bust the myth that marijuana is just a harmless plant. “I just want young kids to know that you actually can become addicted to it, and there’s this sentiment that you can’t and that’s actually not true.”

Today a fully functioning experiment in legal marijuana for adults is going on in Colorado and another one is set to begin later this year in Washington. Supreme Court Justice Louis Brandeis once remarked that in our democratic Republic, the states are the laboratories of democracy. We are running a few labs now and shall see what happens.

But, as with any public debate, we need to hear all sides. So far, the advocates of marijuana legalization have dominated the public arena. It’s certainly had an effect. According to a new CNN poll, a majority of Americans support legalizing marijuana. But where are the voices of the wounded? Where is the outrage from the families who have been hurt? We know they are out there. More Americans are admitted to treatment facilities for marijuana use than any other illegal drug.

I’ve talked to parents all over the country who lost children to drug abuse — not to marijuana alone; though in many cases it was a gateway drug or part of their deadly

drug concoction. People have been deeply hurt by drug related accidents or spent thousands of dollars on drug rehabilitation. We need to hear their voices.

During my tenure as drug czar, I traveled to more than 120 communities to see firsthand the impact of illegal drugs. Among those visits was a trip to Boston to take part in drug busts in some of the city’s most broken and dangerous neighborhoods. Not once during that visit did a parent or community leader advocate for legalization or loosening drug restrictions. Rather, they wanted the drugs confiscated and drug dealers locked up. They knew the damage drugs had inflicted on their children and communities.

That same evening Harvard University held a discussion on drugs and law enforcement. There I listened to scores of academics argue for legalizing or decriminalizing drugs.

It’s hardly an exercise in intellectual rigor for those in the middle- and upper-class who live in areas with little crime and violence to be willing to experiment with drug legalization. They live far removed from the realities of the drug trade.

But travel to its core, to the slums and projects run by ruthless drug dealers, and these intellectuals may rethink their position.

It’s a myth that marijuana, because it is not as harmful as cocaine, heroin or some other illegal hard drugs, is safe or safe enough to warrant legalization.Opponents contest that marijuana hasn’t ravaged communities or that the drug itself isn’t to blame.

But that’s not true. It’s ravaged the community of the young.

Marijuana is the most widely used drug in the country, especially among young people. According to the 2012 National Survey on Drug Use and Health, “of the 7.3 million persons aged 12 or older classified with illicit drug dependence or abuse in 2012, 4.3 million persons had marijuana dependence or abuse,” making marijuana the drug with the largest number of people with dependence or abuse.

The medical community has warned about the danger. A recent Northwestern University study found that marijuana users have abnormal brain structure and poor memory and that chronic marijuana abuse may lead to brain changes resembling schizophrenia. The study also reported that the younger the person starts using marijuana, the worse the effects become.

In its own report arguing against marijuana legalization, the American Medical Association said: “Heavy cannabis use in adolescence causes persistent impairments in neurocognitive performance and IQ, and use is associated with increased rates of anxiety, mood and psychotic thought disorders.”

The country can ill-afford a costly experiment with drugs. While we are undergoing a national debate over improving health care costs and education performance, legalizing marijuana will undercut those vital missions.

We will wait and see what Colorado’s and Washington’s experiments hold, but I expect that after several years, we will see marijuana use rise dramatically, even among adolescents. The states will come to regret their decisions.

As the late, great political scientist James Q. Wilson remarked, “The central problem with legalizing drugs is that it will increase drug consumption” — and all its inherent harm.

Source: http://www.cnn.com/2014/01/16/opinion/bennett-keep-pot-illegal/index.html?iid=article_sidebar     January  2014