So who supports decriminalising cocaine, heroin, LSD, methamphetamine, ecstasy and all dangerous drugs, including marijuana?

No, it’s not your teenage nephew. It’s President Obama’s new acting head of the Justice Department’s Civil Rights Division, Vanita Gupta. In 2012, Gupta wrote that  “states should decriminalise simple possession of all drugs, particularly marijuana, and for small amounts of other drugs.” (Emphasis mine).

Last week, President Obama appointed Vanita Gupta to the position of acting head. According to the Washington Post, the administration plans to nominate her in the next few months to become the permanent assistant attorney general for the Civil Rights Division. Her views on sentencing reform – a bi-partisan effort in recent years – have earned her qualified kudos from some conservatives.

But her radical views on drug policy – including her opinion that states should decriminalise possession of all drugs (cocaine, heroin, LSD, ecstasy, marijuana and so on) should damper that support of those conservatives, and raise serious concerns on Capitol Hill.

As the deputy legal director of the American Civil Liberties Union and the director of its Center for Justice, Gupta’s legal and policy positions are well documented in her long paper trail, which, no doubt, will be closely scrutinised if and when she is nominated and gets a hearing before the Senate Judiciary Committee.

To begin, she believes that the misnamed war on drugs “is an atrocity and that it must be stopped.” She has written that the war on drugs has been a “war on communities of color” and that the “racial disparities are staggering.” As the reliably-liberal Huffington Post proclaimed, she would be one of the most liberal nominees in the Obama administration.

Throughout her career, 39-year old Gupta has focused mainly on two things related to the criminal justice system: first, what she terms Draconian “mass incarceration,” which has resulted in a “bloated” prison population, and second, the war on drugs and what she believes are its perceived failures.

She is particularly open about her support for marijuana legalisation, arguing in a recent CNN.com op-ed that the “solution is clear: …states could follow Colorado and Washington by taxing and regulating marijuana and investing saved enforcement dollars in education, substance abuse treatment, and prevention and other health care.”

Yet just last week the current Democratic Governor of Colorado, John Hickenlooper, said that legalising recreational use of marijuana was a “reckless.” And there is a growing body of evidence to prove his point: (1) pot-positive auto fatalities have gone up 100 percent in 2012, the year the state legalized pot; (2) the majority of DUI drug arrests involve marijuana and 25 to 40 percent were pot alone; (3) from 2011 through 2013 there was a 57 percent increase in marijuana-related emergency room visits – and there are many other indications of failure. New research, from a 20-year study, proves the dangers of marijuana.

But Gupta does not stop with marijuana. In calling for all drugs to be decriminalised – essentially legalising all dangerous drugs – Gupta displays a gross lack of understanding of the intrinsic dangers of these drugs when consumed in any quantity.

Heroin, LSD, ecstasy, and methanqualone are Schedule I drugs, which are defined as “the most dangerous drugs of all the drug schedules with potentially severe psychological or physical dependence.” Cocaine, methamphetamine, Demerol and other drugs are Schedule II drugs, defined as “drugs with a high potential for abuse…with use potentially leading to severe psychological or physical dependence.”

Sound public policy must be based on facts, not radical unsafe, and dangerous theories.

This article is reproduced by the kind permission of The Daily Signal, the multimedia news site created by the Heritage Foundation in Washington DC.

Source: conservativewoman.co.uk 22nd October 2014Bottom of Form 

Neurobiology of Addiction: PET Scans Show Changes in the Brain.

 
The world tends to look at addicts as people who have a character flaw. Are they poor decision makers? Are they narcissists? Are they anti-social? For the most part, we don’t do that with other people and their diseases.

“Oh, you’re diabetic, you must be narcissistic. You have high blood pressure, you’re a poor decision maker. No, we don’t do that. So we’ve got to really come forward with drug addiction as a disease,” said JeanAnne Johnson Talbert, DHA, APRN-BC, FNP, CARN-AP, medical director of Steps Recovery Center, Payson, UT, at the American Psychiatric Nurses Association 28th Annual Conference, held October 22-25, 2014, in Indianapolis, IN.

In the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) that was published last year, addiction is classified as a “substance abuse disorder.” According to Talbert, “the newly revised edition took out the ‘legal ramifications’ criteria and substituted ‘craving.’ And that’s where you’re starting to see some progression with treating this disease.”

What’s the big deal? Nearly 23 million Americans are addicted to alcohol or other drugs. Tobacco, alcohol, and illegal drug addiction costs this country $524 billion a year in direct and indirect costs. The economic burden is twice as much as any other disease affecting the brain.

You may know people who can drink a whole bottle of wine in one evening and then not touch it again for months. And you may know people who can drink socially or on the weekends or holidays. People can also abuse substances, but not all of those people are actually addicted. Then there is full addiction, which involves changes to structures of the brain. “A person can fluctuate in and out of occasional or social abuse, but once you get into the actual addiction, you don’t fluctuate. You’re stuck,” said Talbert.

No one starts out wanting to become an addict, she added. “You may just want to feel good or better, but the younger you are when you start using, the more likely it is that you’ll become addicted,” said Talbert.

Addiction is a chronic and progressive brain disease of the reward, motivation, and memory pathway that moves from an impulse or positive reinforcement to compulsive and negative reinforcement. Brain structure and function change.

Addiction can also affect clinicians. “What really happens in the brain to cause an addicted doctor to lose control and his license to practice medicine? Addiction hijacks your brain and makes you do things that you normally wouldn’t do,”” said Talbert. The thing that’s really important with addiction is this term ‘plasticity,’ which means that the brain actually changes in response to experiences.  This involves both excitatory and inhibitory influences,” she said.

Positron emission tomography (PET) scans and other research over the past 20 years have increased our understanding of the neurologic processes that underlie addiction. Addiction affects the brain circuits involved in reward, motivation, memory, and even inhibitory control.

Talbert said drugs release dopamine‑‑the same chemical you feel after good sex, food, and relationships‑‑in the nucleus accumbens. “You want more. But over time in an addict’s brain, the same drug of choice no longer has that appeal. Then compulsion rears its ugly head and cravings control the addict, sometimes even after years of abstinence,” she said.

Source: http://www.hcplive.com/conferences/apna-2014/Neurobiology-of-Addiction-PET-Scans-Show-Changes-in-the-Brain-#sthash.1OhEsrGb.dpuf

Top 20 Anti-Marijuana Crusaders Fighting Against Pot Legalization

NEW YORK (MainStreet) — Even as a marijuana legalization gains traction around the U.S. and the world, the anti-pot contingent soldiers on to promote its own agenda. These advocates are on a mission to keep marijuana illegal where it is, make it illegal where it is not and to inform the public of the dangers of marijuana legalization as they see it.

So who are these anti-marijuana legalization crusaders?

They come from different backgrounds. Some come from the business world. Two are former White House cabinet members. Another is an academic. Two are former ambassadors. One is the scion of a famous political family. Many are psychiatrists or psychologists. Others are former addicts. Still others are in the field of communications. Oh – one is a Pope.

They have different motivations. Some act because of the people they met who suffered from drug abuse. Others are staunch in their positions for moral reasons and concern for the nation’s future; still others for medical and scientific reasons.

Here is a list of the most significant:

1. Calvina Fay

Drug Free America Foundation, Inc. and Save Our Society From Drugs (SOS). She is also the founder and director of the International Scientific and Medical Forum on Drug Abuse.

She was a drug policy advisor to President George W. Bush and former Tennessee Governor Lamar Alexander. She has been a U.S. delegate and lecturer at international conferences.

President Bush acknowledged her efforts in drug prevention in 2008, and in 2009 she received the President’s Award from the National Narcotics Officers Associations Coalition.

She related during an interview that she became involved in the world of countering drug abuse as a businessperson. She started a company that wrote drug policy for employers, educated employees on the dangers of drugs and trained supervisors on how to recognize drug abuse. It was from this that she became aware of the gravity of the issue.

“People used to come to me to tell me they had a nephew or niece who had a drug problem,” Fay said. “This was when I realized how broad a problem this is. It became personally relevant at one point.”

President Bush acknowledged her efforts in drug prevention in 2008, and in 2009 she received the President’s Award from the National Narcotics Officers Associations Coalition.

I realized how broad a problem this is. It became personally relevant at one point.”

After she sold her company, she was approached by the DEA and the Houston Chamber of Commerce to improve the way substance abuse in the workplace was addressed. After a while she built a coalition of about 3,000 employers.

During this time she kept meeting more and more people who were addicted or had loved ones who were. So it became important to her to be involved in drug abuse prevention and treatment. She then became aware of the movement to legalize drugs.

“I knew that we had to push back against legalization, because if we did not prevention and treatment would not matter,” Fay asserted.

2. Kevin Sabet

Sabet is the director of the Drug Policy Institute at the University of Florida, where he is an assistant professor in the psychiatry department at the College of Medicine.

He is a co-founder of Project SAM (Smart Approaches to Marijuana) and has been called the quarterback of the anti-drug movement.

Sabet served in the Obama Administration as a senior advisor for the White House Office of National Drug Control Policy (ONDCP) from 2009-2011. He previously worked on research, policy and speech writing at ONDCP in 2000 and from 2003-2004 in the Clinton and Bush Administrations, respectively. This gives him the distinction of being the only staff member at ONDCP to hold a political appointment in both the Bush and Obama Administrations.

He was one of three main writers of President Obama’s first National Drug Control Strategy, and his tasks included leading the office’s efforts on marijuana policy, legalization issues, international demand reduction,drugged driving and synthetic drug (e.g. “Spice” and “Bath Salts”) policy. Sabet represented ONDCP in numerous meetings and conferences, and played a key role in the Administration’s international drug legislative and diplomatic efforts at the United Nations.

He is also a policy consultant to numerous domestic and international organizations through his company, the Policy Solutions Lab. His current clients include the United Nations, where he holds a senior advisor position at the Italy-based United Nations Interregional Crime and Justice Research Institute (UNICRI) and other governmental and non-governmental organizations.

Sabet is published widely in peer-reviewed journals and books on the topics of legalization, marijuana decriminalization, medical marijuana, addiction treatment, drug prevention, crime and law enforcement.

He is a Marshall Scholar. He received his Ph.D. and M.S. in Social Policy at Oxford University and a B.A. in Political Science from the University of California, Berkeley.

3. Bill Bennett

Bennett was a former “drug czar” (i.e. director of the Office of National Drug Control Policy) during the administration of President George H.W. Bush. Prior to that he was the Secretary of Education in the Reagan administration. Bennett is a prolific author – including two New York Times Number- One bestsellers; he is the host of the number seven ranked nationally syndicated radio show Morning in America. He studied philosophy at Williams College (B.A.) and the University of Texas (Ph.D.) and earned a law degree from Harvard.

Bennett, along with former prosecutor Robert White, recently penned an op-ed piece for the Wall Street Journal calling marijuana a public health menace. The two are also finishing a book about marijuana legalization which is due out in February 2015.

Bennett frequently features on his radio show guests warning of the dangers of marijuana legalization. He is concerned that while the science shows that legalizing marijuana is not beneficial, public opinion is going in the other direction.

Why is he involved in this? Simply put, he thinks marijuana legalization is bad for America. The author of the acclaimed series of books about American history called America: The Last Best Hope thinks marijuana legalization will have deleterious effect on Americans, especially the youth of America.

“Because as Jim Wilson said, drugs destroy your mind and enslave your soul,” he told MainStreet.

“Medical science now proves it,” he added.

4. Patrick Kennedy

The other co-founder of Project SAM is former Rhode Island Democrat congressman Patrick Kennedy, son of Ted Kennedy. When he started SAM in Denver in 2013, Kennedy, who has admitted past drug use, was quoted as saying, “I believe that drug use, which is to alter the mind, is injurious to the mind … It’s nothing that society should sanction.”

His organization seeks a third way to address the drug problem, one that “neither legalizes or demonizes marijuana.” Kennedy does not think incarceration is the answer. He wants to make small amounts a civil offense. He emphasizes his belief that public health officials need to be heeded on this issue and they are not. He predicts that, if legalized, marijuana will become another tobacco industry.

“The thought that we will have a new legalized drug does not make sense to me,” Kennedy said during a 2013 MSNBC interview.

.

5. Joseph Califano

This former Carter administration U.S. Secretary of Health, Education, and Welfare founded, in 1992, the Center on Addiction and Substance Abuse at Columbia University (since 2013, it has been called CASAColumbia). He is currently the chairman emeritus. The center has been a powerful voice for research, fundraising and outreach on the dangers of addiction. It shines the light, especially on the perils of marijuana for adolescents.

Recently Califano released an updated edition of his book How to Raise a Drug-Free Kid: The Straight Dope for Parents. He believes an update was needed because of the advances in science regarding youth and substance abuse that have occurred during the past five years.

He zeroes in on marijuana in the book, which he says is more potent today than it was 30 or 40 years ago. He points out – during an interview about the book published on the CASAColumbia website – the hazards of “synthetic marijuana” also known as Spice or K2. He says this is available in convenient stores and gas stations but is so lethal it was banned in New Hampshire.

Califano stresses that parents are the bulwark against substance abuse and addiction. He cited data during the interview that “70% of college students say their parents’ concerns or expectations influence whether or how much they drink, smoke or use drugs. Parental disapproval of such conduct is key to kids getting through the college years drug free. This is the time for you to use social media to keep in touch with your kids.”

He makes the analogy that “sending your children to college without coaching them about how to deal with drugs and alcohol is like giving them the keys to the car without teaching them how to drive.”

6. Stuart Gitlow

Gitlow is the President of the American Society of Addiction Medicine (ASAM), a professional organization representing over 3,000 addiction specialist physicians.

In 2005, he also started the Annenberg Physician Training Program in Addictive Disease at the Mount Sinai School of Medicine in New York, NY. He is currently executive director. He is on the faculty of both the University of Florida and Mount Sinai School of Medicine.

About ASAM’s attitudes toward marijuana, he said:

“Our positions and policies with respect to marijuana have been developed over many decades and have been updated based upon the latest scientific evidence. We are firmly opposed to legalization of marijuana and reject the notion that the plant marijuana has any medical application.”

That said, he believes anecdotal evidence supports that more research should be conducted to deduce which parts of the marijuana plan can havemedical value.

Why did he get involved in this?

“I didn’t get involved in this as a “crusader” or because of a specific interest, but rather because I serve as the spokesperson for ASAM,” he told MainStreet.com. “In fact, though, given that there is so much industry-sourced money financing the marijuana proponents, and that the science-based opposition has little funding at all, I recognize the need for the public to actually hear what the facts are, particularly given the media bias and conflict of interest in terms of being motivated by potential ad revenue.”

7. David Murray

A senior fellow at the Hudson Institute, Washington D.C., Murray co-directs the Center for Substance Abuse Policy Research. While serving previous posts as chief scientist and associate deputy director for supply reduction in the federal government’s Office of National Drug Control Policy. Before entering government, Murray, who holds an M.A. and Ph.D. in social anthropology from the University of Chicago, was executive director of the Statistical Assessment Service and held academic appointments at Connecticut College, Brown, Brandeis and Georgetown Universities.

What motivated him to get involved in a campaign to oppose marijuana legalization?

“It results from a steady regress from encountering a host of social pathologies (homelessness, failed school performance, domestic violence, child neglect, poverty, early crime, despair and suicide) and then time and again stumbling over a common denominator that either was a trigger or an accelerator of that pathology – substance abuse,” Murray told MainStreet. “Yet one finds as a dispassionate social analyst that the matter is either discounted, or overlooked, or not given sufficient weight, in the efforts to remediate the other surface manifestation pathologies,” he continued. “Moreover, one keeps encountering a sense that there is a closet with a door that is shut and it holds behind the door a host of explanations or guides to understanding of our woes, yet few are willing to open that door and address what lies behind it.”

He notes that even those who acknowledge the impact of substance abuse across so many maladies seem to not approach the problem with an open and searching mind. He said often one finds a ready-made narrative that serves to explain away the impact. The more that narrative is refuted “with counter argument or robust data indicating otherwise” the more social analysts resist or are in denial about the inadequacy of the standard narrative.

Subsequently, people who do criticize this encounter pressure from peers essentially telling to accept the narrative or shut up.

He mentions a good specific example can be found by encountering the reaction to the “gateway hypothesis” regarding early marijuana exposure. The literature in support of the gateway is quite strong he says.

“Yet everywhere the dominant response is to evade the implications,” he points out. “Our analysts pose alternative and unlikely accountings that seem practically Ptolemaic in their complicated denial of the obviously more simple and more real mechanism: exposure to the drug does, in fact, increase the likelihood of developing dependency on other, ‘harder’ drugs in a measurable way.“

8. John Walters

He was, from December 2001 to January 2009, the director of the White House Office of National Drug Control Policy (ONDCP) and a cabinet member during the Bush Administration. During this time he helped implement policies which decreased teen drug use 25% and increased substance abuse treatment and screening in the healthcare system.

He is a frequent media commentator and has written many articles opposing the legalization of marijuana. He points out many of the fallacies of the pro-legalization movement. His editorials, essays, and media appearances have refuted the claims of the New York Times, pro-legalization libertarians and others.

For example, during a July 2014 appearance on Fox News Walters responded to the editorial boards condoning legalizing pot. Walters said when the science is increasingly revealing the risks of marijuana the “New York Times wants to act like it time to be ruled by Cheech and Chong.”

Walters has taught political science at Michigan State University’s James Madison College and at Boston College. He holds a BA from Michigan State University and an MA from the University of Toronto.

9. Robert DuPont

DuPont was the founding director of National Institute on Drug Abuse. He has written more than three hundred professional articles and fifteen books including Getting Tough on Gateway Drugs: A Guide for the Family, A Bridge to Recovery: An Introduction to Twelve-Step Programs and The Selfish Brain: Learning from Addiction. Hazelden, the nation’s leading publisher of books on addiction and recovery, published, in 2005, three books on drug testing by DuPont: Drug Testing in Drug Abuse Treatment, Drug Testing in Schools and Drug Testing in the Criminal Justice System.

DuPont is active in the American Society of Addiction Medicine. He continues to practice psychiatry with an emphasis on addiction and anxiety disorders. He has been Clinical Professor of Psychiatry at the Georgetown University School of Medicine since 1980. He is also the vice president of a consulting firm he co-founded in 1982 with former DEA director Peter Bensinger – Bensinger, DuPont and Associates. DuPont also founded, in 1978, the Institute for Behavior and Health a drug abuse prevention organization.

10. Bertha Madras

A professor of psychobiology for the Department of Psychiatry of Harvard Medical School. She is in a new position at McLean Hospital, a Harvard Medical School hospital affiliate. She was a former deputy director for the White House Office of National Drug Control Policy (ONDCP).

She has done numerous studies about the nature of marijuana. She is the co-editor of The Cell Biology of Addiction, as well as the co-editor of the 2014 books Effects of Drug Abuse in the Human Nervous System andImaging of the Human Brain in Health and Disease.

She rejects the claims of pot proponents. For example, she states that the marijuana chemical content is not known or controlled. She also notes that the “effects of marijuana can vary considerably between plants” and that “no federal agency oversees marijuana, so dose or purity of the plant and the contaminants are not known.”

11. Carla Lowe

A mother of five grown children, grandmother of nine, graduate of UC Berkeley and former high-school teacher, Lowe got started as a volunteer anti-drug activist in 1977 when her PTA Survey to Parents identified “drugs/alcohol” as their priority concern. She organized one of the nation’s first “Parent/Community” groups in her hometown of Sacramento and co-founded Californians for Drug-Free Youth. She also chaired the Nancy Reagan Speakers’ Bureau of the National Federation of Parents for Drug-Free Youth, co-founded Californians for Drug-Free Schools, and in 2010 founded an all-volunteer Political Action Committee, Citizens Against Legalizing Marijuana (CALM)

She has travelled throughout the U.S. and the world speaking to the issue of illicit drug use, primarily marijuana, and its impact on our young people. As a volunteer consultant for the U.S. State Department and Department of Education, she has addressed parents, students, community groups and heads of state in Brazil, Malaysia, Singapore, Thailand, Pakistan, Germany, Italy, Ireland, and Australia.

CALM, is currently working with parents, law enforcement, and local community elected officials to stop the proliferation of marijuana by banning “medical” marijuana dispensaries and defeating the proposed 2016 ballot measure in California that will legalize recreational use of marijuana.

She wants to go national and is part of an effort to start Citizens Against Legalization of Marijuana-U.S.A. that will also function as a Political Action Committee dedicated to defeating legalization efforts throughout the country.

Lowe is a strong proponent of non-punitive random student drug testing. She believes this is the single most effective tool for preventing illicit drug use by our youth, and will result in billions of dollars in savings to our budget and downstream savings from the wreckage to our society in law enforcement, health and welfare, and education.

12. Christian Thurstone

He is one of a few dozen mental health professionals in America who are board certified in general, child and adolescent, and addictions psychiatry. He is the medical director of one of Colorado’s largest youth substance-abuse treatment clinics and an associate professor of psychiatry at the University of Colorado Denver, where he conducts research on youth substance use and addiction.

According to a May 2013 interview posted on the University of Colorado website, Thurstone was named an Advocate for Action by the White House Office of National Drug Control Policy in October 2012 for his “outstanding leadership in promoting an evidence-based approach to youth substance use and addiction.”

Colorado Gov. John Hickenlooper named Thurstone to a state task force convened to make recommendations about how to implement Amendment 64, a constitutional amendment approved by Colorado voters in November 2012 to legalize the personal use and regulation of marijuana for adults 21 and older.

He became involved in the marijuana issue in 2009 “when a whole confluence of events occurred that led to the commercialization of marijuana….What matters is not so much the decriminalization; it’s the commercialization that affects people, especially kids. …95% of the treatment referrals to Denver Health are for marijuana. Nationwide, it’s two-thirds of the treatment referrals according to the Substance Abuse and Mental Health Services Administration (SAMHSA).”

13. Peter Bensinger

Bensinger was a former DEA chief during the Ford, Carter and Reagan administrations. He was in the vanguard opposing medical marijuana in Illinois. He acknowledges medical marijuana as a value but he notes that it is available as a pill or spray, so the idea of legalizing smoked marijuana for medicinal purposes is merely a ploy.

14. David Evans

The executive director of the Drug Free Schools Coalition before becoming a lawyer he was a research scientist, in the Division of Alcoholism and Drug Abuse, New Jersey Department of Health. He was also the manager of the New Jersey intoxicated driving program. He has written numerous articles warning of the dangers of marijuana legalization.

15. Pope Francis

The new pontiff, while being hailed by many as being a liberal influence in the Catholic Church has taken an intransigent line against marijuana legalization. This past June the new international pop culture icon told the 31st International Drug Enforcement Conference in Rome, “No a ogni tipo di droga (No to every type of drug).”

He was an active opponent of marijuana while a bishop in his native Argentina. He says now that attempts to legalize drugs do not produce the desired results.

He deplores the international drug trade as a scourge on humanity. Pope Francis has said it is a fallacy to say that more drug legalization will lead to less drug use.

16. Dennis Prager

A nationally syndicated radio talk show host in Los Angeles, Prager has used his microphone to condemn marijuana legalization. He has asked rhetorically, “Would you rather your pilot smoke cigarettes or pot? and “ How would Britain have fared in World War II if Winston Churchill had smoked pot instead of cigars?

17. Mel and Betty Sembler

The Semblers are longtime soldiers in the war on drugs. They co-founded, in 1976, a nonprofit drug treatment program called Straight, Inc. that successfully treated more than 12,000 young people with drug addiction in eight cities nationally from Dallas to Boston. They also help fund other organizations dedicated to opposing legalizing drugs including marijuana. Betty Sembler is the founder and Board Chair of Save Our Society From Drugs (S.O.S.) and the Drug Free America Foundation, Inc. Both organizations work to educate people about attempts to legalize as “medicine” unsafe, ineffective and unapproved drugs such as marijuana,heroin, PCP and crack as well as to reduce illegal drug use, drug addiction and drug-related illnesses and death.

18. Seth Leibsohn

Leibsohn is a radio host, writer, editor, policy, political and communications expert. He is a former member of the board of directors of the Partnership for a Drug Free America-Arizona Affiliate.

He told MainStreet that he got involved in the campaign against marijuana after seeing the effects of pot smoking on a college friend.

“One thing I noticed and never left my mind was a friend I had in college who so very clearly, freshman year, was one of the most gifted and intelligent thinkers and writers I had ever met,” he said. ” I predicted to myself and others, he’d be the next big American author, published in The New Yorker, books of short stories galore. But then he picked up a really habitual marijuana smoking practice. He smoked, probably, daily. This was the mid to late ’80s. And to this day, I believe he is still a smoker….and he is a waste-case. Lazy, never had a serious job, never published a serious piece of writing, totally ended up opposite what I had predicted. That story never left my mind.”

Leibsohn also noticed this was happening more and more. But the problem really was driven home while he was the producer and co-host for the Bill Bennett radio show, Morning in America.

“We noticed something very interesting: whenever we dealt with the issues of drug abuse, and particularly marijuana, the phone lines lit up like no other issue,” he said. “We had doctors, we had nurses, we had truckers, we had small businessmen, we had housewives, we had moms, we had brothers, we had teachers, we had sisters, we had aunts, we had uncles telling us story after story of the damage marijuana and other drugs had done to their and their loved ones lives. It amazed me how widespread the issue is. I concluded, to myself, this issue of substance abuse may very well be the most important and damaging health issue in America.”

He also noticed that “there just weren’t that many who seemed to give a serious damn about it.” He said Joe Califano and Bill Bennett were about the only ones he knew with a large microphone or following who would address the issue. The silence in other precincts and from others was astounding to him.

“I still am amazed not more people are taking this as seriously as it should be taken,” he said. “But I know, too, that any family that has been through the substance abuse roller coaster, needs to know they are not alone, and they are the real experts–their stories tell the tale I wish more children and pro-legalizers could hear. Today, I still talk, write, and research on the issue and have joined the board of a non-profit dedicated to helping on it as well,” he explained.

19. Alexandra Datig

A political advisor and consultant who has experience of more than 13 years on issues of drug policy she was instrumental in the defeat of California Proposition 19, The Regulate Control & Tax Cannabis Act. Datig serves on the Advisory Board for the Coalition for a Drug Free California, the largest drug prevention coalition in California.

She became involved in the anti-marijuana legalization movement because of her own experiences. She was working in politics at the local and state level for over eight years by 2009, but she also reached ten years in sobriety from a 13-year drug addiction that nearly cost her her life. When California Proposition 19 came along, she decided “to jump in and form my own independent campaign committee “Nip It In The Bud.”

“I began reaching out to several other committees, drug prevention groups and law enforcement and together we built a powerful statewide coalition for which I became one of its leading advisors and strategists,” she told MainStreet

“Today, I consider myself a miracle, because I was able to turn my life around,” she told MainStreet. “This is not something I could have done had I not gotten sober. Having rebuilt my life in recovery, I believed that my experience could convince voters that legalizing a drug like marijuana for recreational use would make our roads more dangerous and, much like cigarettes, was targeted at our youth. That legalization would cause harm to first time users, people who suffer from depression and mental disorders and especially people vulnerable to addiction or relapse.”

20. Monte Stiles

A former state and federal prosecutor, Stiles supervised the Organized Crime/Drug Enforcement Task Force – a group of agents and prosecutors who investigate and prosecute high-level drug trafficking organizations, including Los Angeles street gangs, Mexican cartels and international drug smuggling and money laundering operations.

One of his proudest personal and career achievements was the organization and implementation of the statewide “Enough is Enough” anti-drug campaign which produced community coalitions in every area of Idaho. In addition to the prosecution of drug traffickers, Monte has been a passionate drug educator and motivational speaker for schools, businesses, churches, law enforcement agencies, and other youth and parent organizations. He left government service in April 2011 to devote all of his time to drug education, other motivational speaking and nature photography.

Impact of Methadone on Brain Cell Development

Since 1999, there has been a dramatic increase in opioid overdose deaths and addiction to opioid drugs, including both prescription opioid pain relievers and heroin. Increased rates of addiction have also been seen among pregnant women, which has led to a significant increase in the number of babies born with neonatal abstinence syndrome.  Methadone is a long-acting opioid that is an effective treatment for addiction to opioid drugs and is often used to treat pregnant women. While methadone treatment is safer than non-medical use or abuse of opioids, it is known that methadone can cross the placenta, and little is known about the effects of methadone on an infant’s developing brain. 

During development, some brain cells, including oligodendrocytes, express opioid receptors that bind opioid drugs such as methadone. Oligodendrocytes are involved in multiple complex functions critical to normal brain development, including production of myelin, a substance that enables neurons to send electrical signals and communicate with other cells. In this study, researchers examined the effects of methadone on oligodendrocytes during development in an animal model. Rat pups were exposed to methadone both through the placenta and through maternal milk until postnatal day 14, a period that is equivalent to the third trimester in human pregnancy. The researchers found that therapeutic doses of methadone caused increases in multiple proteins found in myelin and an increase in number of neurons with mature myelin. This accelerated maturation and myelination could potentially disrupt normal connectivity within the developing brain.

These results highlight the importance of understanding how drugs that are used to treat addiction might impact the developing brain of infants prenatally exposed to them. They also raise questions about the impact of methadone on the adolescent brain, which is also still developing.

Source: The Opioid System and Brain Development: Effects of Methadone on the Oligodendrocyte Lineage and the Early Stages of Myelination, Dev Neurosci 2014;36:409–421

http://www.ncbi.nlm.nih.gov/pubmed/25138998

 

The following very pertinent comment re illegal growing of marijuana in California was sent by Monte Stiles of Drugwatch International.

Despite extremely liberal laws and policies in California regarding marijuana, the black market continues to thrive. Those who naively argue that drug dealers will go away when pot is taxed and regulated know little about how the black market operates, and why. 

The underground drug business operates to avoid the law. In the case of legalization, the black market operates to avoid taxes and regulation. The same holds true for other legal commodities such as tobacco and prescription drugs. Does anyone really think that strict regulation has stopped the illegal sale of prescription drugs, or the sale of untaxed cigarettes in New York City?

The bottom line is demand. Until we impact the demand side in a big way, through prevention and eduction, the drug dealers (or the state) will continue to exact payment for their dangerous products. Education works when we do enough of it. Surrender to the drug culture is not a valid option. Monte

RIVERSIDE COUNTY: Authorities battle booming marijuana grows

A boom in illegal backyard marijuana grows – rumoured to be driven by Mexican drug cartels – has sown fear among residents in the unincorporated areas of Riverside County.

In Mead Valley, near Perris, a marijuana garden was growing in plain sight less than 50 yards from a playground. High-powered weapons, such as AK-47s, have been found at some of the grows. And there was a marijuana grow at the scene of a fatal shooting in August.

Sheriff’s officials say they are well aware of the increase in illegal marijuana grows and are aggressively investigating them, but they have disclosed little about their progress or what is driving the trend.

Riverside County Supervisor Kevin Jeffries, who raised the alarm about illegal activity earlier this year after receiving complaints from constituents, said his staff counted more than 300 marijuana gardens in his district alone. “It’s frankly scaring the hell out of the neighbors,” Jeffries said.

Residents have seen armed men around the grows and fear violent crimes in their neighborhoods are linked to them, he said. They have told Jeffries’ staff that people have been approaching property owners offering thousands of dollars to rent their land to grow marijuana and that the grows are affiliated with two particular Mexican drug cartels.

Jeffries has proposed an ordinance to crack down on for-profit marijuana growing, but he has encountered resistance from medical marijuana advocates.

Although Mead Valley and neighboring Good Hope are hot spots for growing, Jeffries said the problem is widespread across the western portion of the county. Among the communities where sheriff’s officials have investigated marijuana grows this year are Norco, Woodcrest, De Luz, Romoland, Nuevo and Anza.

“The Sheriff’s Department is greatly concerned about it,” Chief Deputy Patricia Knudson said of the increase. Though the department has a grant-funded marijuana eradication team that targets illegal marijuana growing, she said, it is dealing with a large number of grows and the investigation process is labor-intensive. Sorting out whether a grow is for-profit or for legitimate medicinal purposes can be particularly time-consuming, she said.

Sheriff’s officials said they received 300 reports of outdoor marijuana grows across the county this year. As of early October, the sheriff’s Special Investigations Bureau, which handles drug cases, had eradicated a total of 63 outdoor marijuana grows – some on public land – and made 66 arrests for illegal marijuana growing, sheriff’s officials said. That figure doesn’t include any grows eradicated by the local sheriff’s stations.

Sheriff’s officials declined to disclose details about their investigations, though they did say investigators have found no direct link to Mexican drug cartels. “We have rumours and innuendo,” Knudson said, adding that if members of the public have information, they should report it.

Source:http://www.pe.com/articles/marijuana-752347-grows-sheriff.html Oct.19^th 2014

One in 10 cancers in men and one in 33 in women are caused by drinking

• The projected number of new cases of alcohol-related cancers in the Republic of Ireland is expected to double by the year 2020 for women and to increase by 81% for men during the same period (Source) 

• Because alcohol consumption is higher among poorer people, their risk for alcohol-related cancers is also higher (Source) 

• The National Cancer Registry has noted the correlation between higher incidence of head and neck cancers and lung cancer among males in the Republic of Ireland living in socio- economically deprived areas and the corresponding higher rates of alcohol consumption and tobacco use in these areas (Source)  

• Alcohol is classified as a group 1 carcinogen and it is one of the most important causes of cancer in Ireland, being a risk factor in seven types of cancer

• Cancers of the mouth, upper throat, larynx, oesophagus, liver, bowel and female breast have a causal relationship to alcohol consumption

• The National Cancer Control Programme (NCCP) conducted research in 2012 to calculate Ireland’s overall cancer incidence and mortality attributable to alcohol consumption and found that approximately 5% of newly diagnosed cancers and cancer deaths are attributable to alcohol – that’s around 900 cases and 500 deaths each year

• There is a risk relationship between the amount a woman drinks, and the likelihood of her developing the most common type of breast cancer. Drinking one standard alcoholic drink a day is associated with a 9% increase in the risk of developing breast cancer, while drinking 3-6 standard drinks a day increases the risk by 41%

• It is estimated that up to 20% of breast cancer cases in the UK can be attributed to alcohol

• Three people in Ireland die from oral and pharyngeal cancer (OPC) every week – which is more than skin melanoma or cervical cancer. Two major risk factors for OPC are tobacco and alcohol consumption

• Ireland has the second highest cancer rate in the world. Regular alcohol consumption is listed by the World Health Organisation (WHO) and World Cancer Research Fund (WCRF) as one of the factors contributing to the high cancer rates

• Alcohol and tobacco together are estimated to account for about three-quarters of oral cancer cases in Europe

• The risk of bowel cancer increases by 8% for every two units of alcohol consumed a day

• Cancer risk due to alcohol are the same, regardless of the type of alcohol consumed and even drinking within the recommended limits carries an increased risk

• A recent study on the burden of alcohol consumption on the incidence of cancer in eight European countries reported that up to 10% of all cancers in men and 3% of women may be attributed to alcohol consumption (Source) 

• While moderate alcohol consumption has been linked to a decrease in risk for cardiovascular disease, the overall net effect of drinking in relation to cancer risk, even of moderate drinking, has been shown to be harmful (Source)

Follow this link for research and reports on alcohol and cancer

Source:http://alcoholireland.ie/facts/alcohol-and cancer/#sthash.JUf1wiYP.dpuf

So who supports decriminalizing cocaine, heroin, LSD, methamphetamine, ecstasy and all dangerous drugs, including marijuana?

No, it’s not your teenage nephew. It’s President Obama’s new acting head of the Justice Department’s Civil Rights Division, Vanita Gupta. In 2012, Gupta wrote that “states should decriminalize simple possession of all drugs, particularly marijuana, and for small amounts of other drugs.” (Emphasis mine).

Last week, President Obama appointed Vanita Gupta to the position of acting head. According to the Washington Post, the administration plans to nominate her in the next few months to become the permanent assistant attorney general for the Civil Rights Division. Her views on sentencing reform–a bi-partisan effort in recent years–have earned her qualified kudos from some conservatives.

But her radical views on drug policy–including her opinion that states should decriminalize possession of all drugs (cocaine, heroin, LSD, ecstasy, marijuana etc.) should damper that support of those conservatives, and raise serious concerns on Capitol Hill.

As the deputy legal director of the American Civil Liberties Union and the director of its Center for Justice, Gupta’s legal and policy positions are well documented in her long paper trail, which, no doubt, will be closely scrutinized if and when she is nominated and gets a hearing before the Senate Judiciary Committee.

To begin, she believes that the misnamed war on drugs “is an atrocity and that it must be stopped.” She has written that the war on drugs has been a “war on communities of color” and that the “racial disparities are staggering.” As the reliably-liberal Huffington Post proclaimed, she would be one of the most liberal nominees in the Obama administration.

Throughout her career, 39-year old Gupta has focused mainly on two things related to the criminal justice system: first, what she terms draconian “mass incarceration,” which has resulted in a “bloated prison population, and second, the war on drugs and what she believes are its perceived failures.

She is particularly open about her support for marijuana legalization, arguing in a recent CNN.com op-ed that the “solution is clear: …states could follow Colorado and Washington by taxing and regulating marijuana and investing saved enforcement dollars in education, substance abuse treatment, and prevention and other health care.”

Yet just last week the current Democratic Governor of Colorado, John Hickenlooper, said that legalizing recreational use of marijuana was a “reckless.” And there is a growing body of evidence to prove his point: (1) pot-positive auto fatalities have gone up 100 percent in 2012, the year the state legalized pot; (2) the majority of DUI drug arrests involve marijuana and 25 to 40 percent were pot alone; (3) from 2011 through 2013 there was a 57 percent increase in marijuana-related emergency room visits–and there are many other indications of failure. New research, from a 20-year study, proves the dangers of marijuana.

But Gupta does not stop with marijuana. In calling for all drugs to be decriminalized–essentially legalizing all dangerous drugs–Gupta displays a gross lack of understanding of the intrinsic dangers of these drugs when consumed in any quantity.

Heroin, LSD, ecstasy, and methanqualone are Schedule I drugs, which are defined as “the most dangerous drugs of all the drug schedules with potentially severe psychological or physical dependence.” Cocaine, methamphetamine, Demerol and other drugs are Schedule II drugs, defined as “drugs with a high potential for abuse…with use potentially leading to severe psychological or physical dependence.”

Sound public policy must be based on facts, not radical unsafe, and dangerous theories.

Cully Stimson@cullystimson

Charles “Cully” D. Stimson is a leading expert in criminal law, military law, military commissions and detention policy at The Heritage Foundation’s Center for Legal and Judicial Studies. Read his research.

Source: www.dailysignal.com

Pro-legalisers often quote the so-called models of Portugal and the Netherlands – but more people in these countries want cannabis to be illegal.

In 2011, 52% of portuguese aged 15-24 years old argued that cannabis should remain illegal – that figure is now 66%. In the Netherlands the figures also rose by 14%. The direction is contrary to european countries whose policies have not experimented with it, where 53% of young europeans want to keep cannabis illegal, a fall of 6% from 2011.

Original story by Leonor Paiva Watson, with Anthony Soares in Jornal de Noticias 26 August 2014

Translation below.

The Portuguese trend “is surprising,” said Manuel Cardoso, deputy director general of the Department of Intervention in Sicad (Intervention on Addictive Behaviours and Dependencies).  “But his reflects the work done to sensitise for youth risk behaviours.”

He recalls that SICAD recently undertook a study addressing on new psychoactive substances, verifying also that “most young people, even those that drank, did not agree with its legalisation… Consumption (in small quantities) is not a crime, but marketing is prohibited. People know that can hurt.”

Alongside Portugal are countries like the Netherlands (14% more than 2011), Belgium (plus 13%), Latvia (8%) and France (6% more than in 2011).

Elsewhere in Europe, even in countries where the overwhelming majority do not want legalisation, the tendency is for fewer young people to think so. In Cyprus, for example, 72% of young people do not want the legalisation of cannabis, but that is 10% less than 2011. In Italy, for example, the figures are down 22%, Germany 14-17%, Austria and Slovenia least 13%. In the Netherlands (53%), Austria (53%), Slovakia (54%), Poland (55%), Ireland (57%), Italy (60%), Slovenia (64%) and Republic Czech (73%), most people want legalisation. It is noteworthy is that, although the Netherlands generally is perceived as wanting legalisation of cannabis, there is a 14% increase in those who defend the substance remaining illegal.

Source: dbrecoveryresources.com   27th August 2014

Abstract

To review and summarise the literature reporting on cannabis use within western communities with specific reference to patterns of use, the pharmacology of its major psychoactive compounds, including placental and fetal transfer, and the impact of maternal cannabis use on pregnancy, the newborn infant and the developing child. Review of published articles, governmental guidelines and data and book chapters. Although cannabis is one of the most widely used illegal drugs, there is limited data about the prevalence of cannabis use in pregnant women, and it is likely that reported rates of exposure are significantly underestimated. With much of the available literature focusing on the impact of other illicit drugs such as opioids and stimulants, the effects of cannabis use in pregnancy on the developing fetus remain uncertain. Current evidence indicates that cannabis use both during pregnancy and lactation, may adversely affect neurodevelopment, especially during periods of critical brain growth both in the developing fetal brain and during adolescent maturation, with impacts on neuropsychiatric, behavioural and executive functioning. These reported effects may influence future adult productivity and lifetime outcomes. Despite the widespread use of cannabis by young women, there is limited information available about the impact perinatal cannabis use on the developing fetus and child, particularly the effects of cannabis use while breast feeding. Women who are using cannabis while pregnant and breast feeding should be advised of what is known about the potential adverse effects on fetal growth and development and encouraged to either stop using or decrease their use. Long-term follow-up of exposed children is crucial as neurocognitive and behavioural problems may benefit from early intervention aimed to reduce future problems such as delinquency, depression and substance use.

Introduction

About 3.9% (or 180.6 million) of the world’s population between 15 and 64 years of age use cannabis, making it one of the most widely used illegal psychoactive drugs in the world.[1] In some countries, cannabis has been used by up to 40% of adults at some point during their lives.[2] Cannabis is accepted as a relatively harmless recreational agent in many parts of the world[3] despite gathering evidence of its detrimental impact on both the adult[4] and the developing[5] central nervous system. Severe cannabis use, for example, decreases the metabolism of the prefrontal and temporal cortex,[63] and chronic exposure doubles the risk of psychosis and memory and cognitive dysfunction, most likely from neurotransmitter dysregulation.[7] This risk of neurological impairment is especially pronounced if cannabis is consumed during periods of critical brain development, such as adolescence.[8]

Cannabis, however, is one of the most commonly used illicit drugs in pregnancy and lactation.[1,2] Approximately 2.5% of women admit to continued cannabis use even during pregnancy.[9] This is of great concern because its lipophilic nature[10]allows it to readily cross many types of cell barriers, including the blood/brain and transplacental membranes. Cannabis metabolites are consequently easily detectable in many types of human tissues,[11] including the placenta, amniotic fluid and the fetus.[12] The effects of cannabis on the developing fetus may, however, be subtle and not be detectable for many months to years after birth, as the aetiology of some of the ‘softer’ neurological signs such as aggressive behaviours[5] or other neuropsychological problems[13] are difficult to be attributed unequivocally to cannabis exposure due to frequently concurrent negative environmental influences such as parental drug use, poverty[14] and psychiatric co-morbidity.[15]

Evidence regarding the effects of perinatal cannabis exposure, that is, during pregnancy and lactation, is plentiful but, unfortunately, ambiguous. In this review, we offer an overview of this problem, including discussion about the potential effects of this practice on the unborn, newborn and older child and adolescent. We also discuss some of the pertinent issues associated with perinatal management, including the utility of drug screening and the practical aspects of breast-feeding in the known cannabis user. Our overall aim is to provide the health practitioner with some guidance for advising women who use cannabis in pregnancy, including best available information on the potential effects of cannabis use on their unborn baby and future childhood development.

What Is Cannabis?

Cannabis is a genus of flowering plant with three main varieties: sativa, indica and ruderalis. It has been used for thousands of years for its fibre (hemp) and for its medicinal and psychoactive effects that are mediated through a unique family of at least 85 different compounds called cannabinoids, the most abundant of which are cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC). THC is the only cannabinoid with psychoactive properties, and plants are categorised according to the amount of THC or ratio of THC/CBD they contain. Hemp-producing cannabis strains are specifically bred, as per the United Nations Convention, to produce low THC levels.[16]

Cannabinoids are most abundant in the floral calyxes of the plant. The forms and strengths of THC obtained are dependent on the part of the plant that is used as well as the process used to extract and manufacture the plant product. Hash oil is the strongest, followed by hashish (resin) and marijuana (dried leaves/flowers). Cannabis may be inhaled by smoking with tobacco or through a water pipe or ingested in foods and drinks.[17] Most countries in the world have criminalised the growing and recreational use of cannabis, but controlled programmes in some countries such as the United States, Holland and Canada allow regulated use of medicinal cannabis, including the synthetic compounds dronabinol and nabiolone, for the management of conditions, such as cancer-related nausea[18] and neuropathic pain.[19]

Pharmacodynamics of Cannabis

Endocannabinoids are naturally occurring arachidonic acid metabolites[20] that are essential for the regulation of movement, memory, appetite, regulation of body temperature, pain and immunity.[21] Endogenous endocannabinoids and plant-derived phytocannabinoids exert their effects by activating the cannabinoid receptors of the endocannabinoid system. To date, five cannabinoid receptors have been identified, including the cloned CB1 and CB2 receptors.[22] The CB1 receptor is predominantly located in the central nervous system while the CB2 receptor is largely confined to immune cells and the retina.[23,24]

Psychoactive drugs, such as cannabis, are generally lipophilic and of small molecular size, enabling them to readily cross the blood–brain or other cellular (for example, placental) barriers. In animal studies, fetal blood and tissue THC concentrations are around 10% lower than maternal blood levels,[25] but in the rat model repeated dosing of the dam, particularly at higher doses, resulted in significantly higher plasma concentrations in the fetus as compared with single acute dosing. This suggests that heavy and chronic cannabis use may result in concentration of active cannabinoids in the developing fetus.[26] No similar human studies exist, but when plasma concentrations were measured in human cord blood samples, THC levels were found to be 3 to 6 times lower than in simultaneously collected maternal blood, with a similar concentration gradient being noted for the metabolite 9-carboxy-THC.[27]

Endogenous cannabinoids and cannabinoid receptors are expressed early in the developing fetal brain. CB1 receptors are identifiable in white matter and cell proliferative regions and are involved in critical neurodevelopmental events, such as neuronal proliferation, migration and synaptogenesis. Endocannabinoids are also pivotal in regulating neural progenitor cell commitment and survival.[28] Cannabis exposure during pregnancy therefore has the potential to induce supra-physiological stimulation of the endogenous cannabinoid system, which may then disrupt the ontogeny of endogenous endocannabinoid signalling and interfere with synaptogenesis and the development of neuronal interconnections. In addition to the possible effects of cannabis use on endocannabinoid-mediated neuronal maturation, it appears that cannabis exposure in pregnancy may also disrupt developing neurotransmitter systems. Dopaminergic neurones are expressed very early in the developing brain and exert trophic effects on neuronal cells.[29] Cannabis exposure during pregnancy disrupts tyrosine hydroxylase activity, the rate-limiting enzyme in dopamine synthesis, which has the potential to impact on the maturation of dopaminergic target cells.[28] Disturbances in dopamine function have consequently been associated with an increased risk of neuropsychiatric disorders, such as drug addiction,[30] schizophrenia[31] and depression.[32] Prenatal THC has also been noted to alter endogenous enkephalin precursor and the expression of opioid and serotonin receptors in animal models.[28]Whether these changes are implicated in the future risk of addictive behaviours and depression in the human is as yet uncertain.

Is There a Genetic Susceptibility to the Effects of Cannabis?

The effect of phytocannabinoids on mature neuronal cells is complex. Both neurotoxic and neuroprotective effects have been described depending on the cannabinoid, the cell type and the stage of cell differentiation.[22] There is evidence that individual susceptibility to cannabis, at least in the adolescent onset user, may be substantially influenced by heredity. Adolescent catechol-O-methyltransferase (COMT) knock-out mice, as compared with wild type, are more vulnerable to cannabinoid-induced modification of expression of schizophrenia-related behaviours.[33] In humans, neuroimaging studies demonstrate that chronic consumption of cannabis beginning before the age of 16 years is associated with alterations in the volume of the caudate nucleus and amygdala in users with specific COMT gene polymorphisms that produce increased copies of the val allele.[34] The presence of the COMT gene polymorphism val158met and the SLC6A4 gene 5-HTTLPR polymorphism in young adult cannabis users, on the other hand, has a moderating effect of decreased performance on executive functioning.[35]Whether genetic susceptibility influences the long-term neuropsychiatric and cognitive outcomes of gestational cannabis-exposed children has not been explored but could lead to individual direction of early intervention and supportive services to ameliorate possible undesirable outcomes.

The Prevalence of Cannabis Use in Pregnant Women

Cannabis is the most frequently used substance in any drug-taking population. In the gravid population, it accounts for >75%,[35] and generally self-reporting from developed Western countries such as Australia[36] and the United Kingdom[37] place the prevalence of cannabis use at up to 5% of all pregnant women. However, the certainty of these estimates is limited due to the variability of self-reporting rates.[37] Although many illicit drug users stop or decrease drug use during pregnancy, cannabis users often continue to use throughout pregnancy and while breast feeding.[38] Persisting cannabis use throughout pregnancy may, in part, be due to widespread societal acceptance of cannabis as a relatively harmless recreational agent compared with other ‘hard’ drugs of dependency such as heroin,[3, 36] and certainly more study into why this occurs is warranted. It must be noted that cannabis use in pregnancy is frequently accompanied by other forms of drug use or abuse. Many women continue to smoke tobacco and/or consume alcohol. Using record linkage data collected over a 5-year period, Burns et al. [39]demonstrated that 12% of cannabis users were concurrently identified as using opioids, 10% as using stimulants and 4% were identified as having an alcohol-related diagnosis during pregnancy. Almost 50% reported that they smoked >10 cigarettes per day. Identifying cannabis use in a pregnant woman therefore should prompt investigation into exposure to other substances.

Detecting Cannabis Use in Pregnancy

Optimal identification of drug exposure has a crucial impact on pregnancy and long-term health outcomes for both the mother and her child.[40] Early detection of drug use allows for timely implementation of harm-reduction strategies designed to moderate drug use as well as to minimise the impact of drug-using lifestyles (for example, unstable home situations, poor nutrition, poverty) on the family. Supportive care may favour changes that alter drug-using behaviours,[41] although it must also be acknowledged that complete cessation or abstinence of drug use is not possible for many women. Nevertheless, early detection facilitates ongoing support and may produce potentially valuable lifestyle changes that go beyond the perinatal period.

Other health issues may be addressed with timely detection of drug use. Ongoing drug use and abuse is frequently associated with psychiatric co-morbidities, and the impact of this on the mother and her family can be further complicated by socioeconomic problems, such as domestic violence and ongoing drug use by co-addicted partners.[42] Reducing drug use may also not be possible without appropriate identification and management of underlying psychiatric co-morbidities, such as anxiety disorders or depression. Evidence suggests that these psychiatric co-morbidities themselves may be a significant trigger for drug use[33] and that the co-existence of mental health problems may independently impact on pregnancy outcomes. Maternal depressive illness, for example, is strongly correlated with an increased risk of preterm delivery,[43–46]and of course, the earlier in pregnancy drug-dependent women have access to psychosocial supports, the higher the likelihood is of them to establish appropriate living conditions for their family and of addressing financial and any associated legal problems.

In addition to specific supports targeting drug use, detection of drug use in pregnancy also permits implementation of strategies that provide drug-using mothers with specific mothercraft and intensive postnatal support, such as intensive home-visiting programmes. Such programmes have been demonstrated to decrease the risk of childhood morbidity and mortality in high-risk disadvantaged adolescent parents.[47] Similarly, targeted education in other aspects of routine parenting, such as safe sleeping practices, may be beneficial as the incidence of night-time Sudden Infant Death Syndrome is significantly higher (for as yet uncertain reasons), in cannabis-exposed infants.[48]

Screening for drug and alcohol use should be considered a normal part of the standard antenatal interview process. Screening tools used in this setting are generally questionnaires that are designed to be administered face-to-face by the provider to the patient. They are not intended to specifically diagnose a substance abuse problem but rather to determine if a patient may be at risk for alcohol or drug problems and would therefore benefit from a more comprehensive evaluation. Ideally, a screening tool should be administered multiple times during each pregnancy, because patients may be more willing to disclose substance abuse problems once they develop rapport with a provider. Screening tests can also provide an opportunity to educate the patient about alcohol and drug abuse and the benefits of addressing these problems while pregnant. Asking every patient relevant but sensitive questions in a health context lessens the stigma associated with the topic. However, administering these screens in the antenatal period can be problematic. Seib et al. [49] demonstrated that while only 15% of the patients being screened were uncomfortable with the process, staff compliance was an issue, with 25% of women not being screened adequately or not being screened at all. All maternity hospitals should therefore encourage staff training to ensure that health providers are comfortable and familiar with screening processes used for their particular local area.

In contrast to the proven effectiveness of specific screening tests for identifying alcohol consumption in pregnancy,[50] the evidence for the efficacy of formal screening tests for drug use in the antenatal period is not as clear. Few screening tools have been directly evaluated for their efficacy in detecting drug, or more specifically cannabis, use in pregnancy. Phillips et al. [102]found that direct questioning by midwives using a structured screening tool facilitated drug use disclosure during early antenatal consults but that the use of some forms of questionnaires, for example, the Drug Abuse Screening Test (DAST-10), had only a sensitivity of 0.47 when self-reporting was validated against positive toxicology screens.[51] Again, we suggest that all staff involved in maternity care be trained to administer (and act on) drug screening tools confidently and without prejudice.

Toxicology screening for drug metabolites is generally carried out with the expectation of increasing the likelihood of detecting undisclosed drug use in pregnancy. Either maternal urine and hair samples or newborn urine, hair and meconium samples can be collected and analysed for the presence of drug metabolites, but only maternal toxicology screening has any value if the intention is to implement harm-minimisation strategies early in pregnancy. Newborn toxicology screening primarily focuses on identifying families at risk of ongoing drug use, to address child protection concerns that may be associated with parental drug use and to provide appropriate treatment for suspected cases of withdrawal or intoxication.[41]

Depending on the locale, toxicology screens may increase the chance of drug detection by up to fivefold,[52] but the general applicability of such screening programmes has often been limited by their selective application to perceived high-risk groups, such as infants of certain racial groups.[51,53] The value of screening maternal urine for drug metabolites is limited by the narrow time frame in which many drugs are excreted after use. Drug testing for cannabis is particularly problematic as there is generally a wide variability in individual excretion profiles.[53] Cannabis metabolites may also be undetectable in the naive user after 48 h. However, they can be potentially detectable in the urine for several weeks in chronic users, making it difficult to determine whether or not a positive urine sample represents past or recent ongoing use.

Maternal hair samples can also be used to detect substance use in pregnancy. However, hair toxicology has not been proven to be of great value in the detection of undisclosed cannabis use in pregnancy. Ostrea et al. [54] compared the sensitivity and specificity of maternal interview, maternal hair analysis and newborn meconium analysis in detecting perinatal exposure to opioids, cocaine and cannabis. Although hair and meconium analysis showed a high sensitivity in detecting opioid and cocaine exposure as compared with interview, hair and meconium analysis demonstrated a sensitivity of only 21% and 23%, respectively, as compared with a sensitivity of 58% for detection by maternal interview. The use of maternal hair samples is further complicated, because results may be affected by passive exposure to environmental cannabis smoke.[55] It is possible to distinguish between environmental contamination and true exposure by assaying for the derivative, Δ9-tetrahydrocannabinolic acid-A (THCA-A), as low concentrations of THCA-A compared with other metabolites suggests environmental contamination,[56] but this increases the complexity and expense of maternal hair analysis and will therefore not be considered suitable in most facilities for routine screening purposes.

Neonatal urine testing by immunoassay provides rapid results but is limited by the short time frame in which an infant will excrete recently used drug metabolites post delivery, resulting in a high rate of false negatives. In contrast, meconium that is collected within the first 2 days of life can be used to detect maternal cannabis use from the second trimester onwards. Neonatal hair samples can also be examined for evidence of exposure during the last trimester of pregnancy, as this is when fetal hair grows. Both meconium and neonatal hair sampling have been shown to be helpful in confirming suspicion of maternal cannabis use, at least in the second and third trimesters of pregnancy. A direct comparison between sensitivity of meconium and neonatal hair testing has found meconium to be more sensitive but is limited by the need to collect a sample within a few days of birth. Hair samples may be useful in confirming prenatal exposure to cannabis for up to 3 months after delivery but facilities for hair analysis remain limited for many care practitioners.

Although both maternal and newborn toxicology screening can increase the likelihood of detecting drug use in pregnancy, most authors do not recommend their routine use because of the expense and the burden on laboratory time constraints. Rather, they suggest toxicology testing be selectively used where there is a suspicion of maternal drug use that can not be confirmed by maternal interview.[41,57]

The Impact on the Fetus and Newborn Infant

It is difficult to determine the direct effects of maternal cannabis use on the developing fetus because of the often high prevalence of other concurrent drug use, including tobacco,[48, 58] and other adverse parenting and lifestyle issues, including poor nutrition, poverty and stress. The endogenous cannabinoid system has a crucial role in maintaining and regulating early pregnancy. Human placental studies have determined that the CB1 receptor is present in all the placental membrane layers[59] and that stimulation of these receptors will impair fetal growth by inhibiting cytotrophoblastic proliferation.[60] In a large population-based prospective cohort study, maternal cannabis use during pregnancy was found to be associated with growth restriction in mid-pregnancy and late pregnancy, with effects on low birth weight being most pronounced if maternal cannabis use continued throughout pregnancy.[61] These growth effects remained significant even after adjustment for potential confounding variables, such as exposure to tobacco and self-reporting of cannabis use (raising the possibility of selection bias). To date, there is no known association between cannabis exposure and spontaneous abortions of either chromosomally normal or abnormal fetuses,[62] and any such links are probably more likely to be related to concomitant stressful life events than to cannabis use per se.[63]

Although some animal studies indicate that cannabis may be teratogenic in very high doses, there is no firm link between gestational cannabis use and congenital malformations in humans.[64] Reports of associations between cannabis use in pregnancy and gastroschisis remain unsubstantiated.[65] A study of almost 420 000 Australian live births over a 5-year period by Burns et al. [39] found that in utero cannabis exposure increased the risk of neonatal intensive care unit admissions, predominantly for prematurity, but there was no relation to any increased risks of perinatal death.

Significant newborn withdrawal or intoxication syndromes requiring pharmacological treatment have not been described with exclusive gestational cannabis exposure, but subtle neurobehavioural disturbances such as exaggerated and prolonged startle reflexes and increased hand–mouth behaviour have been described.[66] High-pitched cries[67] and sleep cycle disturbances with EEG (electroencephalography) changes have been noted,[68] suggesting that prenatal cannabis affects newborn neurophysiological function. Pharmacological treatment for neonatal cannabis withdrawal has not been described, although this may be secondary to a lack of definitive evaluation techniques. Indeed, cannabis withdrawal has been described as a’mild narcotic withdrawal’,[69] and further study into additional treatments, evaluation and long-term outcomes is required.

Long-term Growth and Neurodevelopment

Of greater concern, however, is the increasing evidence that in utero cannabis exposure may impair long-term growth and neurodevelopment, particularly in terms of cognition and behaviour. Evidence from population-based human studies and in vitroanimal data indicates that interference with the endocannabinoid system disrupts normal neurobiological development,[70]particularly of neurotransmitter maturation[5] and neuronal survival.[22]

A longitudinal cohort study of growth parameters in children exposed to cannabis and cigarettes during pregnancy found that cannabis-exposed children have smaller head circumferences at birth, which increase in disparity in adolescence.[71] It must be noted that head growth, especially during the first month of life, is significantly associated with future intelligence quotient.[72]

Most studies, nevertheless, do not support measureable differences in neurodevelopmental outcomes in infants aged <2 years after cannabis exposure, but by early childhood and school age, cannabis-exposed children acquire visual–perceptual tasks and language skills more slowly and show increased levels of aggression and poor attention skills, particularly in girls.[73] The levels of cognitive and intellectual deficits are also related to the timing and degree of in utero exposure. Heavy use (defined as >1 joint per day) during the first trimester was associated with lower verbal reasoning scores in 648 children at 6 years of age when compared with their non-exposed peers, while second trimester use was associated with deficits of composite, short-term memory and quantitative scores.[74]

Problems with tasks requiring visual memory, analysis and integration appear to persist beyond late childhood[75] into adolescence.[76] The long-term effects of in utero cannabis exposure on visuospatial working memory were explored by Smithet al. [78] using functional magnetic resonance imaging. They demonstrated that in 19 to 21-year olds, high levels of maternal prenatal cannabis use was associated with significantly more neural activity in the left inferior and middle frontal gyri, parahippocampal gyrus, middle occipital gyrus and cerebellum and right inferior and middle frontal gyri.[77] The specific learning problems identified in these children appear to significantly interfere with school achievement scores[78] from as early as 6 years of age.

The aetiology of these problems is uncertain. In utero cannabis exposure alters neurotransmitter homeostasis, including ventral striatal dopamine D2 gene regulation[79] and expression,[80] and these changes have been linked to a risk of future neuropsychiatric problems, including disorders of impulse control associated with addiction behaviours.[79] Further, a significantly increased risk of childhood depressive symptoms and attention problems was identified at age 10 years in a large prospective cohort study documenting the use of cannabis in low-income pregnant women.[81] The same group of investigators also demonstrated that the risk of delinquency at 14 years was significantly increased in a prospective longitudinal study of cannabis-exposed children.[82] Other factors, however, are undeniably important in the expression of adverse behaviours during the teenage years. For example, the risk of adverse behaviours, including early initiation of drug abuse, is more likely in an intrauterine drug-exposed child if they are male or simultaneously exposed to other problems such as violence.[83] There is no firm association with prenatal cannabis and future psychiatric problems such as psychosis,[84] but depressive symptoms are increased.[82] Assisting the family unit with moderating adverse environmental influences from as early as possible after birth may have the potential to decrease future problems in young people affected by prenatal cannabis exposure.

The effects of cannabis on future physical growth are still to be determined. CB1 receptors mediate energy incorporation into adipose tissue and reduce energy expenditure. The Ponderal Indices of adolescents exposed to prenatal cannabis are higher than non-exposed children,[85] but further work needs to be done to determine their risk of developing clinically important sequelae such as appetite problems, dyslipidemia and diabetes, which are all common manifestations in chronic adult cannabis users.[86]

Medical Cannabis

In recent years, there has been a re-emergence in the use of medicinal cannabis to treat a variety of conditions, including amelioration of neurogenic pain and management of chemotherapy- and pregnancy-associated hyperemesis.[87] Increasing numbers of states in the United States, for example, have legalised medical marijuana for certain specific indications.[88]However, it is not known whether the long-term effects of prenatal exposure to medicinal cannabis used in a controlled manner differ from the effects of cannabis used as a recreational drug during pregnancy, and urgent study is required. At this point in time, any advice about medicinal cannabis use during pregnancy must take into consideration both the potential benefits of the substance with regards to maternal well being and potential impact of this type of cannabis exposure on the developing fetus.

Lactation

Cannabis and its metabolites readily pass in to breast milk in variable concentrations that depend considerably on the amount of drug ingested by the mother. When cannabis is regularly consumed by breast-feeding mothers, human milk THC concentrations may be up to eightfold higher than simultaneously measured maternal plasma concentrations.[89] Certainly, even bovine consumption of cannabis results in detectable metabolites in at least 30% of children even up to the age of 3 years.[90] There are substantial concerns that continued maternal cannabis use during the first month of life may impede neurodevelopment at 1 year of age,[91] but the effects of postnatal exposure is difficult to delineate from prenatal use as most mothers will not begin using cannabis as a de novo habit after birth.

Delta 9-THC inhibits gonadotropin, prolactin, growth hormone and thyroid-stimulating hormone release and stimulates the release of corticotropin, thereby inhibiting the quantity and reducing the quality of breast milk.[92] The Academy of Breastfeeding Medicine, in line with most professional bodies, recommends against breastfeeding whenever illicit drug use has occurred in the 30-day period before birth. This is especially pertinent if substance abuse is ongoing post delivery or if the mother is not engaged in substance abuse treatment programmes.[93–95] Unfortunately, specific recommendations with respect to breast feeding while using cannabis are hampered by the lack of substantial and definitive studies. In particular, occasional users should be counselled on a case-by-case basis and made aware of the risks of maternal intoxication while caring for an infant and the potential neurodevelopmental sequelae on their child, should cannabis usage become a regular activity.

Recommendations for the Management of Women Using Cannabis in Pregnancy

There are no known ‘safe’ threshold limits for cannabis use in pregnancy, and currently, there are also no specific pharmacological treatments for cannabis dependency. Evidence overwhelmingly indicates that cannabis use during pregnancy and possibly in the postnatal period remains a significantly under-recognised problem that has the potential to cause long-term harm. However, there are a variety of approaches that can facilitate identification of cannabis use in women presenting for pregnancy care that may allow implementation of harm-minimisation procedures to reduce long-term risks for both the mother and her child.

Carefully directed and sensitive histories should be routinely taken to elucidate cannabis and other substance use in pregnancy. In some high-risk cases, toxicological screening may be appropriate where heightened suspicions are not in keeping with maternal history offered. Due to increasing concerns about long-term neurodevelopmental, behavioural and possibly even metabolic consequences of perinatal cannabis exposure, women should be objectively informed of the possible impact of cannabis use during pregnancy and lactation and be strongly advised to stop using cannabis wherever possible. If complete abstinence is not possible, women should be advised to reduce regular cannabis use during pregnancy, as current evidence indicates that daily use of cannabis is most strongly associated with future adverse neurobehavioural outcomes. A harm-reduction approach focusing on minimising risks to the woman and her baby rather than complete cessation may be most effective in this scenario. Engaging women into an antenatal service that provides drug relapse prevention support or referring women to drug and alcohol services should be considered, particularly where an antenatal service cannot offer specific drug and alcohol counselling services itself. Cognitive behavioural therapy centred around drug relapse and prevention support and tobacco cessation education is recommended. Midwives and doctors should ask women about their level of cannabis use and their willingness to change their drug-use behaviours at each antenatal contact. General health education, including the adverse effects from continued cannabis and tobacco exposure and safe sleeping guidelines should be reinforced. Depending on family circumstances, the benefits of breast feeding, even with continued cannabis use, may outweigh the negative side-effects, especially in infrequent cannabis users. Each institution should work towards a policy of ensuring best practices for their particular population of cannabis users.

During the postnatal period, mothers should be advised not to smoke either tobacco or cannabis around their infants and children. They should be educated about the risks of passive smoke exposure as well as the potential effect of cannabis use on a mother’s decision-making ability. Mother-crafting support may be required to ensure best infant care, including safe sleeping practices. Of particular note, counselling cannabis-using fathers is also crucial as continued paternal cannabis triples the risk of Sudden Infant Death Syndrome[96] ( ).

Summary of recommendations

Issue

Detection of maternal use

Recommendations                         

Antenatal drug and alcohol questions best to screen large populations

Maternal and infant toxicology most likely unhelpful unless maternal history is ambiguous56

Early detection may help implement harm-minimisation strategies

Issue

Fetal effects

Recommendations

No definitive link to increased spontaneous abortions97 or congenital abnormalities64, 65  Intrauterine growth restriction, including head size of fetus, common61

Issue

Neonatal effects

Recommendations

Severe withdrawal uncommon but mild symptoms similar to an opioid-type withdrawal is recognised69

Need for pharmacological treatment from cannabis only exposure uncommon

Transient high pitched cry67 and sleep disturbances68 noted

Increased risk of sudden infant death syndrome96

Issue

Effects on childhood and later life

Recommendations

Small head circumference may persist into teenage life

Risk of long-term problems correlated with severity of prenatal exposure,74 particularly on visual memory and executive function74, 75 that may persist to late childhood75 and adolescence76

Aggression and attention problems noted in toddlers (especially girls)73

Issue

Lactation

Recommendations

Cannabis and metabolites cross the milk barrier, and levels in milk may be higher than maternal plasma89

Effects of continued use during lactation may impair early (<1 year) neurodevelopment90

Issue

General

Recommendations

Screen all pregnant women for drug use with a well-validated questionnaire

Cease or decrease use as early as possible—chronic/heavy use (>1 joint per day) increases risk of long-term adverse outcomes for the child

Lactation recommendations must be taken on a case by case basis. Mother must be aware of dangers of breast feeding while intoxicated, of passage of cannabis and metabolites into milk and of possible adverse influence of continued cannabis exposure via breast milk on childhood neurodevelopmental outcomes There is insufficient current evidence to provide definitive recommendations for the use of medicinal cannabis

Conclusion

It is not uncommon for the health-care professional caring for pregnant women to encounter the problem of maternal cannabis use during the antenatal period. Although cannabis is viewed by many as a harmless recreational drug when compared with other illicit drugs, there is mounting evidence to suggest that prenatal cannabis exposure can have a negative effect on fetal growth and that exposure to cannabis during periods of critical brain development, particularly during the fetal and adolescent periods, has the propensity to significantly adversely impact on neurodevelopmental and behavioural outcomes. Ultimately, long-term changes in neurobehaviour, particularly those involving executive functioning, may adversely affect adult educational and vocational outcomes. As health-care professionals, we have a responsibility to seek to actively identify women who use cannabis in the antenatal period and inform them of the possible risks of their cannabis use in a non-threatening and non-judgmental manner. Currently, pregnant and breast-feeding cannabis users should be advised to cease use where possible or substantially decrease their drug use. At this point in time, there remains ongoing uncertainty about both short- and long-term implications of cannabis use during pregnancy and lactation, especially if use is intermittent. Further adequately powered studies are required to resolve this pressing dilemma.

Key Notes

1. Regular cannabis use in pregnancy is a widespread but an under-recognised problem.

2. Fetal growth is possibly affected by gestational cannabis exposure, but the dose-response relationship has not been well defined.

3. There is evidence that regular cannabis use in pregnancy significantly increases the risk of future neurodevelopmental and behavioural problems, with particular effect on executive functioning.

4. Pregnant and breast feeding cannabis users should be identified early and advised to either decrease or where possible cease cannabis use entirely.

Source:  J Perinatol. 2014;34(6):417-424. 

“The toxic properties of chemical molecules and their cellular damage are not matters of opinion or debate.

They are not determined by adolescent servicemen, or by scientifically uneducated lawyers, legislators, judges, or ‘doctors’ without the facts. Certainly they are not determined  by Ted Koppel, Abbie Hoffman, Benjamin Spock, William Buckley, Geraldo Rivera, Oprah Winfrey, Dan Rather, or the mayors of our beleaguered cities.

We cannot vote for or against the ‘toxicity’ of a drug. How much a drug impairs cell structure or chemical function is neither subject to nor governed by congressional committee, public referendum, or the federal constitution.

We cannot govern the electromagnetic behavior of chemical molecules by popular vote, judicial proclamation, personal opinion or individual desire.

Everyone is entitled to his own ‘opinion.’ He is not entitled to his own ‘facts.’

Chemically, marijuana is far more dangerous drug than most scientifically ignorant media and American consumers have been duped into believing.”

Robert C. Gilkeson, M.D.,

Child and Adolescent Neuro-psychiatrist

 

A long-term study of Swedish men finds that those who smoked marijuana at age 18, especially the heaviest users, were more likely to end up on the nation’s disability rolls by age 59.

It’s unclear whether the pot use in adolescence may have led to more severe substance abuse or was an early sign of psychiatric or social factors that contributed to later disability, the researchers caution.

“There is reason to believe that the associations found in our study develop over a long period of time and are intertwined with problems in the labor market, in the social security system, and with the individual,” said study leader Anna Karin Danielsson of the Karolinska Institute in Stockholm.

Marijuana is one of the most commonly used illicit drugs in the world, with 77 million Europeans reporting having tried it in a recent study.

Pot use in the U.S. has been on the rise since 2007, possibly due in part to a perception of diminishing risks. Colorado and Washington became the first states to legalize the possession and use of recreational marijuana by adults in 2012.

Nonetheless, studies continue to link cannabis with a variety of psychiatric and health problems as well as adverse social consequences, Danielsson said. The research is limited, though, by short follow-up times and small study samples, she told Reuters Health in an email.

“With our unique Swedish cohort of men comprising 98 percent of the male population at baseline and a 39-year long follow-up time, we had the opportunity to expand on existing knowledge,” Danielsson said.

She and her colleagues analyzed data from a large study that included almost 50,000 men born between 1949 and 1951 and conscripted into compulsory military service in 1969 and 1970.

When the men entered the military, they were asked about their drug, tobacco and alcohol use, as well as questions about their family and social backgrounds, school performance, behavior, psychological issues and general health.

Danielsson’s team was specifically interested in the frequency of marijuana use at age 18, when the men were conscripted. The young men were grouped according to how often they had ever used pot at that point: never, 1?10 times, 11?50 times or more than 50 times.

Next, the study team looked at data from the Swedish national social insurance agency, the education registry and labor market statistics to see how many were granted disability pensions through 2008.

About 9 percent of the teens reported having used marijuana when they entered the military, and 1.5 percent said they had used it more than 50 times.

The researchers found that men who used marijuana more than 50 times before the age of 18 were 30 percent more likely to go on disability sometime between the ages of 40 and 59.

A similar pattern was seen for young men who used pot less frequently, with the chance of being on disability in middle age rising with increasing pot use at age 18.

However, when the study team adjusted for other factors, including socioeconomic background, other substance use by age 18, psychiatric diagnoses and other health problems, the link remained statistically significant – meaning it could not have been due to chance – only for the heaviest users who had smoked pot more than 50 times as young men.

That group already had a number of problems in their teens, the researchers note in the journal Drug and Alcohol Dependence. Of the 654 heaviest pot users at age 18, 80 percent also reported using other drugs, 47 percent reported risky alcohol use and 55 percent had a psychiatric diagnosis.

Danielsson said that smoking marijuana at a young age may increase the risk of negative social consequences later on in life, and that prior studies have shown frequent marijuana use increases the risk of using other illicit drugs.

“It may be the case that adolescent cannabis use may lead to a series of negative life events such as, for example, subsequent illicit drug use, illness (e.g., dependence) and associated disability pensions,” she said.

The study cannot prove that pot use in the teen years caused the men to end up on disability later in life, the researchers acknowledge. They don’t know how much marijuana the men used after they entered the military or many other details of their lives after age 18.

Despite the study’s limitations, the findings highlight the need for further studies on marijuana and other illicit drug use in relation to possible health and social consequences, the study authors conclude.

Source:   Reuters  Aug.21st 2014  http://www.gmanetwork.com/news/story/375774/lifestyle/healthandwellness/heavy-pot-use-in-teen-years-may-predict-later-life-disability

According to the 2012 National Survey on Drug Use and Health, about 16 million people have used ecstasy at some point in their life, and during the 2012 year, 869,000 people used ecstasy for the first time, far higher than the number of new LSD and PCP users combined. The number of new ecstasy users is also greater than the number of new users of cocaine, stimulants, and inhalants. The percentage of people who will use ecstasy sometime in their life is between 2 percent and 3.5 percent. The average age for first-time users was 20.3 years old, smack dab in the middle of the college years.

Ecstasy has been and remains primarily a college drug. Not only is it a college drug, it’s a college party drug. It is a hallucinogen, and users report increased energy and feelings of connectedness to others. An article in the Suffolk Journal quotes a student, Steve, saying, “It’s everything. In your head, you’re happy with the position you’re in. Physically, things around you feel good, familiar. You feel what it is and enjoy it.”

Perfect for a party, right? According to a fact sheet from The Higher Education Center for Alcohol and Other Drug Abuse and Violence Prevention, ecstasy also creates short term effects including severe anxiety, paranoia, teeth clenching, and sweating. Longer term effects include impulsivity and damage to areas of the brain involved in thinking and memory. Additional dangers include the frequent combination of ecstasy with other drugs including heroin and methamphetamines, which can cause physical harm to long-term overall health.

In 2001, there were 76 deaths attributed to ecstasy use, most due to heatstroke associated with dancing to the point of dehydration and exhaustion. Additional deaths are attributed to hyponatremia—drinking too much water without accompanying salts, due to the fear of heatstroke while taking ecstasy.

The risks of the drug extend far past use of the drug itself. Ecstasy is commonly known as the “love drug” and consequences of this love drug include everything you might expect when young people have sex without the use of their best judgment, from unplanned pregnancies to the spread of sexually transmitted diseases to legal problems due to unclear consent. College-aged ecstasy users are more likely to have unprotected sex. This population also has a higher rate of sexually transmitted diseases including HIV/AIDS and herpes. Finally, ecstasy use leads to a higher rate of unwanted sex, especially in young women who take the drug. Additionally, the use of ecstasy increases suicide risk. Also quoted in the Suffolk Journal article, a student named Ryan says, “It gives you a feeling of euphoria for four or five hours, but then you feel like shit when it’s over. You feel depressed. You shouldn’t take it if you’re already depressed. You’ll just feel worse.” A study from the National Institutes of Health confirms this observation, finding almost double the risk for suicide in young adults that had used the drug in the past year and writing that, “Adolescent ecstasy users may require enhanced suicide prevention and intervention efforts.”

No matter its name—ecstasy, X, E, molly, or others like love drug, dancing shoes, skittles, or beans—the fact of the drug is that it is an unpredictable mix of lab chemicals produced in uncontrolled labs around the world, likely designed for stimulation and hallucination. With ecstasy, you simply don’t know what you’re getting and so you can’t predict its effect. Every time you take ecstasy is a roll of the dice. Is it really worth it?

Source: http://blogs.psychcentral.com/science-addiction/  August 2014

For at least my first decade as Chief Executive of the Addiction Recovery Foundation, campaigning for recovery treatment for addicts and alcoholics, the evidence I presented to government ministers, their ‘health’ expert advisers and even large ‘treatment’ chains as to what worked was met with accusations. I was being “ideological” and representing a “different philosophy” – and worse.

My perceived defect was that I advocated abstinence-based treatment, based not just on my own and countless millions of others’ experience, but also on world-class empirical research published in 1996 with Project Match (an 8-year, multi site, $27-million investigation that studied which types of alcoholics respond best to which forms of treatment).

In my second decade of campaigning for best-practice treatment for recovery from addiction, rigorous research confirmed and consolidated proof for the effectiveness and efficacy of abstinence-based therapy linked to and/or based on the 12-step programme that I and others had advocated. But all efforts to communicate this evidence to the Department of Health’s National Treatment Agency fell on stony ground.

It is true, with the advent of the Conservative-led Coalition Government, the efficacy of abstinence-based rehabilitation was finally acknowledged in the Government’s new drugs strategy.

Well nominally this was the case. But the old approach – the default medical management of ‘clients’ with substitute opiate prescription – was written in too. In the small print. For as has become disappointingly clear over the last four years, while politicians now pay lip-service to rehabilitation, the funding and practice of treatment has not changed.

Rather than investing in the abstinence-based residential rehabs that result in 60 per cent of their clients achieving sobriety and the chance of a new life, funding has continued to pour into the services and providers developed under the Labour government, whose skill, if it can be called that, is to ‘manage’ rather than transform addicts’ lives.

As a result, at least 18 more rehabs have closed under the current Government, on top of the 24 rehabs that gave up the ghost in face of inadequate government-financed referrals in the 24 months up to the last general election. Yet Iain Duncan Smith had promised in the lead-up to the election that rehab capacity would increase tenfold. Instead it has halved. Why is this?

Answer: it is not about best clinical practice but about money, numbers, proxy targets and endless performance management.

Earmarked government expenditure for addressing drug problems has been running at over £1 billion a year for several years. Yet only about £20-30 million of this huge budget is spent funding addicts to recover at the rehabs that have managed through their own enterprise to survive closure. Even so this allocation is not evenly spread but according to how treatment providers work the system. Those businesses and charities who know how to operate in the public sector secure more funding, regardless of the quality of their provision.

Unsurprisingly, given the Department of Health’s historic antipathy to abstinence and its stubborn adherence to counter-productive ‘methadone’ treatment, some treatment providers who stand to gain financially are working with civil servants to redefine rehabs as not necessarily being abstinent!

The Department of Health’s default is still substitution treatment – swapping an illicit drug for a state-provided drug: for example, prescribing methadone for heroin addicts, then prescribing heroin in the very expensive diamorphine form if the methadone does not work. Government ministers who acknowledge that this approach has proved an expensive failure – in welfare terms too – seem to be powerless over these civil servants and their network of advisers. Top civil servants, for their part, have told me that ministers were not specific in their directives, something sadly borne out when I discussed fine-tuning the wording of government guidance with them.

Big Pharma and those others who profit from government largesse always seem to win: witness the unnecessary spending of £1 billion from the public purse on unused flu jabs a few winters ago.

Now we read of the Prime Minister’s public support for pharma “investment” and employment. It might seem promising that the Government now includes alcohol as well as other drugs when it discusses treatment – but is it a fluke that the timing coincides with the launch by pharmaceutical companies of new drugs which are, basically, equivalent to methadone for alcoholics?

The general public might be forgiven for thinking that the strength ranking of research on how to treat addiction indicates strength of accuracy and efficacy. But ranking may simply reflect the number of research trials, which of course multinational ‘pharmas’ have endless resources to fund. The small rehab or intervention therapists can never hope to compete and can only offer the evidence of their experience. The Government is on record as saying this does not count – despite testimony after testimony of successful rehabilitation.

Although there is discussion of this changing, little has happened. Trials with negative results still need not be publicised; only the three best trial results are usually enough to secure official UK or US medical approval. Impartiality and transparency – and users of these products – are sacrificed for commercial gain.

Now we see Big Tobacco and Big Pharma turning to marijuana products. What a gift of a marketing tool that so many pro-legalisers pave the way for them. There will be a high cost to pay. For, financially and personally, it will borne by a society that is still denied the most cost-effective and clinically-effective solutions to the addiction it will drive.

Worse we have a Minister for Drugs in Norman Baker who is seriously considering making cannabis available for pain relief, despite no scientific evidence for it and negligible evidence even for the licensed medicine Sativex. Science, not ideology, should guide his responsibility to the public he is supposed to serve.

His stance belies the fact that legalising drugs demonstrably increases demand and harms – as evidenced by alcohol, tobacco and emerging research on benzodiazepines and prescribed drugs as well as by so called medical marijuana in the United States.

This is a far cry from the hopes we had when the Coalition took power. There is little to choose between its lip-service and Labour’s original policy, something the Centre for Social Justice’s latest report reminds us of.

Source: www.conservativewoman.co.uk   22nd August 2014

North Korea is likely to be a major target in China’s new war on drugs.

As The Diplomat has been following closely, China recently launched a crackdown on illegal narcotics in the country. So far, public reports have indicated that the main targets in this stepped up war on drugs are high-profile celebrities and foreigners from Western nations and Asian countries like South Korea and Japan.

However, the biggest loser in China’s new war on drugs is likely to be North Korea. It has long been documented that large amounts of North Korean-produced narcotics are smuggled across the border into China either for sale there or for shipment elsewhere. This used to largely consist of opium and heroin but in the last decade or so those drugs have seemingly been surpassed in volume by insanely pure methamphetamine (along with other synthetic drugs like MDMA, the main ingredient in ecstasy and molly).

This is particularly troubling from North Korea’s perspective, as Chinese authorities have repeatedly singled out synthetic drugs as one of their main targets in the new war on drugs. This focus derives from the fact that synthetic drug use has spiked in China in recent years, even as use of more traditional drugs has fallen. According to official Chinese statistics, synthetic drug users accounted for 72.6 percent of the total registered drug users in 2012, up from 55.6 percent in 2010. By contrast, Chinese state media reported that “the percentage of drug users addicted to opioids fell from 70.5 percent in 2010 to 60.6 percent in 2012.”

North Korea is believed to be a major source of synthetic drugs in China, such as crystal meth (often called “ice” in both countries). A 2010 Brookings Institution report on North Korean drug smuggling noted: “Across China, more than 70 percent of drug addicts abuse heroin, but in Jilin Province [on the North Korean border] more than 90 percent of addicts abuse new synthetic drugs and ice in particular.” While there are a lot of synthetic drug users in Yunnan Province, which borders Southeast Asia’s notorious Golden Triangle, this appears to be because the province is used as a hub to smuggle synthetic drugs out of China into Southeast Asia. A recent in-depth Chinese state media report on China and Vietnam’s joint anti-narcotics efforts cited numerous cases of heroin being smuggled from Southeast Asia into China. However, on synthetic drugs the story was reversed: “While China has placed huge resources toward stemming the flow of drugs, new synthetic drugs from China are finding their way into to Southeast Asian countries like Vietnam, complicating anti-drug trafficking work.” All of this suggests that North Korea may be a huge target in China’s war on drugs.

While ice appears to predominate North Korea’s drug smuggling these days, it is certainly not the only drug. It has long been speculated that the rise of ice in North Korea was fueled in part by poppy plants being destroyed by the heavy rains that swept through northern North Korea during the middle of the 1990s, which contributed to the country’s famine. However, recently opium has seemingly been making something of a comeback. Two of the South Koreans recently executed by China for drug smuggling were arrested for trying to smuggle opium into China from North Korea. Similarly, the Chosun Ilbo, a South Korean daily, reported just last week that North Korean-grown opium is once again “flooding the Northeast Chinese market.” The same report also said that Chinese security forces had begun setting up barbed wired fences along the border near North Korean towns known for their drug production in an effort to stem the flow of drugs into China. The timing of this and other reports is interesting.

It’s impossible to know for sure just how much of these drugs are smuggled into China from North Korea, and it’s quite likely that the Golden Triangle countries still account for a plurality of drugs smuggled into China. Still, the amounts coming from North Korea are large. According to South Korean officials, Chinese authorities seized $60 million of North Korean drugs in 2010, and Seoul officials said that this was only a “fraction” of what is actually smuggled.

It’s also impossible to know the degree to which the North Korean government is directly involved in peddling the drugs. In the past, the North Korean government has more or less been directly linked to the trafficking of opium and heroin. However, the U.S. State Department has said in recent years that available evidence suggests that the North Korean government has scaled back its involvement in the drug smuggling industry. Its 2013 International Narcotics Control Strategy Report, for instance, stated, “There have been no confirmed reports of large-scale drug trafficking involving DPRK state entities since 2004.”

It’s possible that the North Korean regime has scaled back its involvement with drug trafficking in response to Chinese pressure, or because drug addiction is believed to be rapidly rising within the DPRK itself. At the same time, the fact that state entities themselves are not being used to traffic narcotics does not mean that senior members of the regime are not directly involved in the trade. North Korea’s informal “princelings” group, called the Ponghwajo — which current regime leader Kim Jong-un is believed to be a huge part of — has long been tiedto drug trafficking. Furthermore, the volume and purity of the meth being smuggled out of North Korea suggests some state-level support, many experts say. Still, there’s little doubt that private drug traffickers do exist in North Korea’s border regions. In any case, the steadily deterioration of Sino-North Korean relations in recent months gives Chinese authorities less incentive to use restraint in trying to root out the drug pipeline along its border with North Korea. Even if Chinese state media reports don’t directly implicate North Korea, Pyongyang is almost certainly a major target of China’s new war on drugs.

Source: www.thediplomat.com   21st August 2014

HOSPITALS across Bristol are under pressure from hundreds of admissions as a result of alcohol-poisoning – including more than 60 cases involving children.

The Department of Health figures released in the House of Commons show that there were 1,510 admissions in 2012-13 where alcohol poisoning was identified as the primary or secondary diagnosis.

While most cases involved adults, 62 admissions involved youngsters under the age of 18. Of those, 18 were aged between 11 and 16.

University Hospitals Bristol NHS Foundation Trust, which runs the city centre hospitals, had 970 people admitted with alcohol-poisoning, including 40 minors. North Bristol NHS Trust, in charge of Southmead and Frenchay during the time covered by the statistics, recorded 540 comparable admissions, of which 22 were children.

Figures for the same year showed there were 3,748 alcohol abuse-related admissions among children younger than 18 years old in England, of which 52 were under 11.

Labour MP Kerry McCarthy said it was regrettable that the Government scrapped plans to introduce a minimum pricing on alcohol.

The Bristol East MP said: “It’s worrying to see the number of people being admitted to hospital in Bristol due to alcohol poisoning, particularly young people under the age of 18 and even 16.”

Ms McCarthy said more needed to be done to educate young people about the dangers of drinking too much, as well as greater support for local services, which can help problem drinkers overcome their addiction.

A commitment to introduce a 45p minimum unit price for alcohol to deter youngsters and other drinkers from buying cheap alcohol was axed by the coalition in July last year, following lobbying by the drinks industry.

Earlier this year, the Government adopted a new approach, introducing a ban on the sale of alcohol below cost price (defined as the level of alcohol duty plus VAT), meaning that a can of average strength lager can now not be sold for less than 40p, while a standard bottle of vodka cannot be sold for less than £8.89.

The figures, which came in answer to a parliamentary question, show that there were also 21,401 admissions in 2012-13, where substance abuse was identified as the primary or secondary diagnosis, including 426 cases involving under-18s.

Maggie Telfer, chief executive of the Bristol Drugs Project, said the figures indicated that Bristol appeared to have a similar number of hospital admissions to other cities of a similar size.

Source: http://www.bristolpost.co.uk/Young-Bristol-drinkers-admitted-hospital-alcohol/story-22786043-detail/story.html#ixzz3B1QYWsC6    August 20, 2014

The Centre for Social Justice has just produced a report “Ambitious for Recovery” on how well the UK is doing in tackling its drugs problem. An assessment coming from what is widely seen as a Conservative leaning think-tank might be expected to be favourably inclined towards the government- if that was the government’s own view they’ll be revising it now. This is a report that identifies failure at every turn.

When the Conservative Party won the election there was an expectation that the world of drug treatment would undergo massive change, ushering in a focus on recovery and abstinence-oriented treatment, rather than presiding over a national methadone programme that saw tens of thousands of heroin addicts left long-term on their substitute medication.

Things are not as bad now as they were, with pockets of excellence in recovery-oriented care and treatment, but they are not as good as it should be.  We know from research that those addicts who are lucky enough (and they are shockingly few in number) to get a place in an abstinence-focused residential rehabilitation programme stand the greatest chance of overcoming their addiction. Sadly, the demise of the residential rehab sector that Labour presided over has continued under the  Coalition Government. If Nick Clegg wants to get in a lather about drug issues, then why does he not take up the fact that we don’t have single residential rehabilitation centre for adolescents with drugs problems?

This report from the CSJ is welcome and courageous in taking the Government to task. It boldly calls for more use of drug courts, for scrapping the awful FRANK programme, for taxing alcohol and using the money to pay for residential drug treatment programmes, for improving prison-based treatment and for tackling the problem of new psychoactive drugs.

Over the last few years, we have seen an alarming increase in the number of deaths associated with these drugs – in Scotland there has been a 1000 per cent increase in novel psychoactive substance linked deaths in four years. However, alongside all the handwringing and the exhortation to “do something” we still have these drugs being openly sold on the high streets across the UK.

New Zealand tried to license their sale in a move that was prematurely championed by the drugs legalisers only to find that the drugs they were licensing were so harmful they needed to institute an immediate outright ban. In England, we have a Lib Dem Home Office Minister who seems more interested in punting liberal ideas on drugs than tackling a problem that is being compounded by his own Government’s failure to act.

Source:  www.conservativewoman.co.uk    18th August 2014

Australians have become accustomed to labels on cigarettes warning about the risk of smoking causing cancer and other diseases. And our research, published in the latest edition of BMC Public Health, shows similar labels could help consumers better understand the harms of drinking alcohol. Alcohol is estimated to cost the Australian economy A$36 billion a year in preventable death, illness, injury, and hospitalisation. There is growing evidence that alcohol increases the risk of certain types of cancer, diabetes and heart disease. The national alcohol guidelines recommend Australians limit their alcohol consumption to no more than two standard alcoholic drinks per day or drink no more than four drinks in a single sitting to reduce the risk of alcohol-related disease and injury.

But despite the risks, no warnings are given when alcohol is advertised, other than to suggest responsible drinking, often tacked on at the end of the ad.

Even worse, ads sponsored by Australia’s alcohol industry, such as DrinkWise’s ad showing young people how to drink “properly”, do little to inform. They serve only as a token demonstration of balancing the A$125 million-plus a year spent on indirect and direct advertising of alcohol.

There are few opportunities for the public to be made aware of the health risks of alcohol. Around 90% of men and 81% of women believe that they can drink alcohol every day without affecting their health.

Labelling cans and bottles with health warnings is one way of raising awareness of the risks of alcohol, and has been adopted in a range of countries including France and the United States.

The problem with these messages is that they tend to focus on the risks of drinking when pregnant and the dangers of drink driving. Even in these countries, few people would necessarily associate alcohol with an increased risk of a range of cancers, including breast cancer.

Unsurprisingly, little research has been done into the effectiveness of labelling of alcohol with cancer warnings. This is what motivated a team of researchers from Curtin, the University of Western Australia and the Cancer Council WA to investigate how the public would respond to cancer warnings and which messages would be the most effective in getting salient information across.

The online survey tracked the responses of 2,168 drinkers to 12 different health messages: 11 about cancer and a general health warning. The messages had been generated out of a previous round of focus sessions with a group of 48 drinkers.

The results showed that overall, responses to cancer statements were neutral or favourable. Younger, female and more educated participants were more likely to find the messages believable, convincing and personally relevant.

Heavy drinkers – defined as those who drink more than two drinks a day and more than four drinks in a single sitting – were also more likely to consider the messages personally relevant than those who drank less. This is particularly encouraging because this group is most at short-term and long-term risk from the harmful effects of alcohol.

People tended to believe messages about specific cancers and those that said alcohol can “increase the risk of cancer” more than general messages about cancer. A message such as “Alcohol increases your risk of bowel cancer” was more effective than the message “Alcohol causes one in 20 cancer deaths”.

The results of the survey showed there would not be a significant amount of negative reaction to the labelling of alcohol among the general public. This is important because legislation will be easier to pass if it’s unlikely to cause a public backlash.

The other important finding was that the messages about the risk of alcohol and cancer were believable, convincing and personally relevant. This suggests they could help inform consumers about the true risks involved in drinking, especially large amounts regularly.

It’s important for consumers to make informed decisions about whether and how much alcohol to drink. It’s time for Australia to join the growing list of nations mandating alcohol labelling. But we should do so with more targeted and relevant health warnings.

Source:   uwa.edu.au  18th August 2014

A new study found that campaigns to prevent prescription drugs misuse can be more effective by focusing on peers and not peer pressure.

The study was conducted by researchers from Purdue University. The researchers evaluated survey interviews with 404 adults ages 18 to 29 who misused prescription drugs in the past 90 days. This included 214 in-person interviews. These individuals were recruited from popular nightlife locations such as bars, clubs, and lounges in New York City. Average misuse of prescription drugs, such as painkillers, sedatives and stimulants, was 38 times in the past 90 days.

“With the 18-29 age group we may be spending unnecessary effort working a peer pressure angle in prevention and intervention efforts. That does not appear to be an issue for this age group,” said study co-author Brian Kelly, a professor of sociology and anthropology who studies drug use and youth cultures, in a press statement. “Rather, we found more subtle components of the peer context as influential. These include peer drug associations, peers as points of drug access, and the motivation to misuse prescription drugs to have pleasant times with friends.”

“People normally think about peer pressure in that peers directly and actively pressure an individual to do what they are doing,” said Kelly, who also is director of Purdue’s Center for Research on Young People’s Health. “This study looks at that form of direct social pressure as well as more indirect forms of social pressure. We find that friends are not actively pressuring them, but it’s a desire to have a good time alongside friends that matters.”

For the study, researchers evaluated the role of peer factors on three prescription drug misuse outcomes: the frequency of misuse; administering drugs in ways other than swallowing, such as sniffing, smoking, and injecting the drugs; and symptoms of dependency on prescription drugs.

“We found that peer drug associations are positively associated with all three outcomes,” Kelly said. “If there are high perceived social benefits or low perceived social consequences within the peer network, they are more likely to lead to a greater frequency of misuse, as well as a greater use of non-oral methods of administration and a greater likelihood of displaying symptoms of dependence. The motivation to misuse prescription drugs to have a good time with friends is also associated with all three outcomes. The number of sources of drugs in their peer group also matters, which is notable since sharing prescription drugs is common among these young adults.”

The Centers for Disease Control and Prevention (CDC) has officially declared that prescription drug abuse  in the United States is an epidemic.

As of 2012, overdose deaths involving prescription opioid analgesics, which are medications used to treat pain, have increased to almost 17,000 deaths a year in the United States. In 2013, only 16 percent of Americans believed that the United States is making progress in its efforts to reduce prescription drug abuse. Significantly more Americans, 37 percent, say the country is losing ground on the problem of prescription drug abuse. That figure is among the most pessimistic measures for any of the seven public health issues included in the survey.

The study was funded by the National Institute on Drug Abuse (NIDA). Findings will be presented at the 109th Annual Meeting of the American Sociological Association by study co-author Alexandra Marin, a Purdue sociology doctoral student.

Source:  www.hngn.com   16th August 

Bertha K. Madras1

Division on Alcohol and Drug Abuse, Harvard University Medical School, McLean Hospital,

Belmont, MA 02478

The current watershed in legal status and rising use of marijuana can be traced to a Cal-ifornia ballot initiative (Prop. 215, its legal successor SB420), that enabled widespread access to smokeable or edible forms of marijuana for self-reported medical conditions. Circumventing the Food and Drug Adminis-tration (FDA) drug approval process, the movement in California was replicated by ballot or legislative initiatives in 23 states and the District of Columbia, and culminated in the legalization of marijuana in 2012 by Washington state and Colorado. The shifting status of marijuana reflects a change in public perception and belief that marijuana is harm-less. Marijuana use in the population over age 12 is escalating; 60% of 12th graders do not perceive marijuana as harmful, and daily or nearly daily use has risen dramatically in this cohort (1, 2). Paradoxically, public perception of marijuana as a safe drug is rising simulta-neously with accumulating evidence that frequent marijuana use is associated with adverse consequences, especially among youth (3). In PNAS, Volkow et al. register compelling new observations that marijuana abusers manifest adaptive behavioral, physiological, and biological responses, which conceivably contribute to marijuana addiction and com-promised function (4). In response to a dopamine challenge (methylphenidate) and compared with non-using controls, marijuana abusers self-reported blunted reward (less “high”) and heightened negative responses (anxiety and restlessness), which were associated with attenuated dopamine responses in brain and cardiovascular responses.

Dopamine, Reward, the Adapted Brain

The role of the neurotransmitter dopamine in drug reward and addiction is the key to understanding the rationale for interrogating dopamine function in long-term marijuana abusers.Thedopaminehypothesisofaddiction was formulated by preclinical observations showing that opiates, cocaine, amphetamine, nicotine, alcohol, and (delta-9)-tetrahydro-cannabinol(THC,thepsychoactiveconstituent of marijuana), raise extracellular dopamine levels in the dopamine-rich nucleus accum-bens, a brain region associated with reward (5, 6). Repeated drug-induced dopamine surges were subsequently shown to engender neuroadaptive changes in brain regions implicated in drug salience, drug reward, motivation, memory, and executive function (7–9). In humans dependent on alcohol, cocaine,  methamphetamine, nicotine, or heroin, adaptation of dopamine signalling is manifest by reduced D2 dopamine receptor availability and blunted dopamine release in cocaine, heroin, and alcohol abusers challenged with a psychostimulant (10–14). In-terrogation of whether marijuana abusers manifest parallel adaptive changes in dopamine signaling has yielded inconsistent results (15).

By integrating behavioral and brain-imaging measures following a dopamine challenge (methylphenidate) in marijuana abusers, Volkow et al. (4) add a new di-mension to clarifying the impact of long-term marijuana use on brain dopamine response. Methylphenidate, a surrogate for dopamine, elevates extracellular levels of dopamine (and norepinephrine) by blocking the dopamine transporter (DAT) in dopa-mine-expressing neurons. As the DAT sequesters dopamine in dopamine-releasing neurons, the blockade raises extracellular dopamine levels in dopamine-rich brain regions. The rapid rise in dopamine triggers self-reports of a “high.” Marijuana abusers self-reported blunted measures of “high,” drug effects, increased anxiety, and rest-lessness. The magnitude and peak behavioral effects of methylphenidate were more robust in controls than marijuana abusers. Cardiovascular responses (diastolic blood pressure, pulse rate) were also attenuated in the abusers. Significantly, the younger marijuana use was initiated, the higher the scores for negative emotionality. These findings reinforce the accumulating evidence that earlier age of initiation of mar-ijuana abuse is associated with worse out-comes (3, 16). Collectively this phase of the study suggests that brain dopaminergic, pos-sibly noradrenergic systems, are significan-tly modified in long-term, heavy marijuana abusers. These changes conceivably contribute to reduced rewarding effects, emotion-ality and motivation, increased propensity for addiction, with early initiators being more vulnerable.

D2/D3 dopamine receptors are critical mediators of the initial responses to drugs of abuse. PET imaging of brain revealed a more complex pattern of change in dopamine signaling than previously reported for other specific drugs of abuse. D2/D3 dopamine receptor availability, measured with the D2/D3 receptor antagonist [11C]raclopride, was not reduced in marijuana abusers, in contrast to reduced dopamine receptor availability observed in subjects with other specific substance use disorders (11–14).

This conclusion remains tentative, as the age of the marijuana-abusing cohort was considerably younger than drug-abusing subjects previously interrogated for D2 dopamine receptor availability.

[11C]Raclopride can also serve as an in-direct measure of dopamine production, release, and extracellular levels (17). Reduced [11C]raclopride binding-site availability is detectable following administration of a psy-chostimulant (e.g., methylphenidate or amphetamine), which elevates the extracellular dopamine by blocking transport or promoting its release from neurons. The dopamine surge competes with [11C]raclopride for binding to the D2/D3 receptor, with [11C]raclopride displacement proportional to extracellular dopamine. In marijuana abusers, diminished dopamine responses were observed in the ventral striatum compared with controls, and were inversely correlated with addiction severity and craving. The attenuated responses to methylphe-nidate are consistent with decreased brain reactivity to dopamine stimulation in marijuana abusers, which conceivably contributes to the increase in stress responses, irritability, and addictive behaviors. Thus, marijuana joins the roster of other abusable drugs in promoting blunted dopaminergic responses in a brain region implicated in drug reward, but deviates from other drugs in that it apparently does not promote a decline in D2/D3 receptor availability.

The study yielded several unanticipated discoveries. Marijuana abusers displayed enhanced dopamine release in the substantia nigra/subthalamic nucleus, which correlated with marijuana and tobacco craving, as well as addiction severity. Because this brain re-gion has relatively high densities of the D3 receptor, this preliminary finding reinforces the need to expand PET imaging to multiple, discrete brain regions, with higher-resolution cameras, and to enlist other probes capable of selective monitoring of each of five dopamine receptor subtypes. Another surprising obser-vationwasthedecreaseindistributionvolume in the cerebellum by methylphenidate in con-trols, but not in marijuana abusers, another manifestationofabluntedresponse.Thisbrain region characteristically is used as a reference region to normalize for nonspecific binding (“baseline”) of PET imaging probes if comparing group differences, possibly resulting in overestimates of the methylphenidate re-sponse in other brain regions of marijuana abusers. This finding, which may reflect vas-cular changes engendered by marijuana, highlights the necessity of heightened scrutiny ofthe cerebellum asa“neutral”baseline region for dopamine receptor monitoring in group comparisons.

Collectively, abnormal behavioral responses to a methylphenidate challenge implicate dopamine signaling adaptation in mari-juana abusers. Even though a decrease in striatal D2 receptor density does not ac-count for the responses, other components of the synapse (e.g., DAT, dopamine syn-thetic capacity, the dopamine signaling cascade, events downstream of dopamine receptors) conceivably contribute to mani-festations of blunted subjective responses.

Future Multidisciplinary Research

The current research (4), providing strong evidence that marijuana abuse is associated with blunted dopamine responses and re-ward, is a major contribution to a growing body of evidence that heavy marijuana use is associated with brain changes that could be detrimental to normal brain function. Numerous other brain-imaging studies have been conducted in heavy adult marijuana users (e.g., ref. 18), with reported changes in brain morphology and density, defor-mation of specific structures, altered con-nectome (e.g., hippocampus), and function.

The current research, which integrates be-havioral and physiological changes within the context of a specific neurochemical substrate, dopamine, provides important leads for in-tegrating with other changes gleaned from MRI technologies. Intriguingly, evidence that dopamine receptor signaling can affect ex-pression of genes encoding axonal guidance molecules that are critical for brain devel-opment and neuroadaptation (19) may pro-vide a link between drug-induced receptor activity and gross and discrete altered mor-phology and circuitry characteristic of the drug-adapted brain.

There remains a compelling need for prospective, integrated longitudinal research in this field, especially in adolescent mari-juana users, as the impact of marijuana on the developing brain is more robust with early age of initiation (3, 16). Imaging studies are predominantly snapshots in time, relying on self-reports of marijuana use, dose, and frequency, with subjects of varying ages, group sizes, differing imaging tech-niques, and other variables that confound meta-analyses or integration of data from different sites to expand study power. A critical longitudinal study showing a signifi-cant IQ decline in early marijuana users is a prime example of the direction in which the field should be going, but with co-ordinated brain-imaging approaches (20).

Preclinical studies can circumvent the limitations of some clinical metrics, and es-tablish causality for specific changes that are not feasible to measure in humans. Yet the divergence of the human brain anatomically and functionally limits unfettered extrapola-tion from animals to humans. Large-scale, multicenter prospective longitudinal human research starting before initiation of drug use and extending for three decades of life is needed to further pursue causal relation-ships of marijuana and adverse consequences reported in numerous shorter-term studies. Research design could include: (i) brain im-aging to document occurrence of, resolution, or persistence of structural, circuitry, vascu-lar, and associated and neuropsychological decrements; (ii) neurocognitive function; (iii) behavioral, emotional assessment; (iv) neural, cognitive, epigenetic, proteomic, and affec-tive markers; and (v) preclinical, relevant parallel studies.

In view of the growing public health con-cerns of escalating high-dose, high-frequency marijuana use, early age of initiation and daily use, high prevalence of marijuana addiction, rising treatment needs, the void of effective treatment, high rates of relapse, association with psychosis and IQ reduc-tion, a rising tide of emergency room epi-sodes, and vehicular deaths, constitute compelling reasons to expand marijuana research and to clarify its underlying biology and treatment targets/strategies. Longitudinal studies that begin before initiation of use, and that integrate brain imaging with behavioral, cognitive, and other parameters, will facilitate shaping of public perception and public policy with more informed scientific evidence.

1 Center for Behavioral Health Statistics and Quality (2013) National

Survey on Drug Use and Health (Substance Abuse & Mental Health Services Administration, Rockville, MD).

2 Johnston LD, et al. (2013) Monitoring the Future: National Survey Results on Drug Use, 1975–2013 — Overview, Key Findings on Adolescent Drug Use. (Institute for Social Research, University of Michigan, Ann Arbor) Avaliable at http://monitoringthefuture.org// pubs/monographs/mtf-vol1_2013.pdf. Accessed July 13, 2014.

3 Volkow ND, Baler RD, Compton WM, Weiss SR (2014) Adverse health effects of marijuana use. N Engl J Med 370(23):2219–2227.

4 Volkow ND, et al. (2014) Decreased dopamine brain reactivity in marijuana abusers is associated with negative emotionality and addiction severity. Proc Natl Acad Sci USA, 10.1073/ pnas.1411228111.

5 Di Chiara G, Imperato A (1988) Drugs abused by humans preferentially increase synaptic dopamine concentrations in the mesolimbic system of freely moving rats. Proc Natl Acad Sci USA 85(14):5274–5278.

6 Chen JP, et al. (1990) Delta 9-tetrahydrocannabinol produces naloxone-blockable enhancement of presynaptic basal dopamine efflux in nucleus accumbens of conscious, freely-moving rats as measured by intracerebral microdialysis. Psychopharmacology (Berl) 102(2):156–162. 7 Hyman SE, Malenka RC, Nestler E (2006) Neural mechanisms of addiction: The role of reward-related learning and memory. Annu Rev Neurosci 29:565–598.

8 Koob GF, Volkow ND (2010) Neurocircuitry of addiction. Neuro-psychopharmacology 35(1):217–238.

9 Volkow ND, Wang GJ, Fowler JS, Tomasi D (2012) Addiction circuitry in the human brain. Annu Rev Pharmacol Toxicol 52:321–336. 10 Volkow ND, et al. (1997) Decreased striatal dopaminergic responsiveness in detoxified cocaine-dependent subjects. Nature 386(6627):830–833.

11 Martinez D, et al. (2005) Alcohol dependence is associated with blunted dopamine transmission in the ventral striatum. Biol Psychiatry 58(10):779–786.

12 Martinez D, et al. (2012) Deficits in dopamine D(2) receptors and presynaptic dopamine in heroin dependence: Commonalities and differences with other types of addiction. Biol Psychiatry 71(3): 192–198.

13 Wang GJ, et al. (2012) Decreased dopamine activity predicts relapse in methamphetamine abusers. Mol Psychiatry 17(9):918–925.

14 Fehr C, et al. (2008) Association of low striatal dopamine d2 receptor availability with nicotine dependence similar to that seen with other drugs of abuse. Am J Psychiatry 165(4):507–514.

15 Ghazzaoui R, Abi-Dargham A (2014) Imaging dopamine transmission parameters in cannabis dependence. Prog Neuropsychopharmacol Biol Psychiatry 52:28–32. 16 Lynskey MT, et al. (2003) Escalation of drug use in early-onset cannabis users vs co-twin controls. JAMA 289(4): 427–433.

17 Seeman P, Guan HC, Niznik HB (1989) Endogenous dopamine lowers the dopamine D2 receptor density as measured by [3H]raclopride: Implications for positron emission tomography of the human brain. Synapse 3(1):96–97.

18 Batalla A, et al. (2013) Structural and functional imaging studies in chronic cannabis users: A systematic review of adolescent and adult findings. PLoS ONE 8(2):e55821.

19 Jassen AK, Yang H, Miller GM, Calder E, Madras BK (2006) Receptor regulation of gene expression of axon guidance molecules: Implications for adaptation. Mol Pharmacol 70(1):71–77.

20 Meier MH, et al. (2012) Persistent cannabis users show neuropsychological decline from childhood to midlife. Proc Natl Acad Sci USA 109(40):E2657–E2664.

Source: www.pnas.org/cgi/doi/10.1073/pnas.1412314111 PNAS Early Edition

 ALASKA Association of Chiefs of Police, Inc.

1.     Legalization will place a significant financial burden on local law enforcement agencies due to the need for special training that will be necessary to identify marijuana users who are driving impaired and to create or enhance youth education programs.

•  It is estimated that Alaskan police departments will have combined costs of nearly $6,000,000 to respond to immediate needs which will arise from legalization of marijuana. These costs include necessary training of police officers to establish drug impairment based on symptomology because there are no roadside tools like breathalyzers for testing marijuana usage, and for increasing the number of School Resource Officers (SROs) in communities to educate teens about the dangers of drug use. These are expenditures that have been tallied by mostly municipal police departments, therefore the bulk of these costs will likely need to be borne by taxpayers in the impacted communities. Additional costs may exist for the Department of Public Safety.

• After medicinal marijuana became easy to get in Colorado, seizures of smuggled marijuana quadrupled in roughly 4 years as “legal” marijuana was diverted to other markets . No comparable studies have been found addressing this problem in Alaska, but if legalization in this state results in a similar increase in diversion trafficking, more than 75% of Alaskan police feel they will not have sufficient local resources to combat the potential impact in their community.

• In 2011, the national average for youth aged 12 to 17 years old and considered “current” marijuana users was 7.64 percent which was the highest average since 1981. The most recent figures found for Alaska teens dates from 2009 and puts the number of students claiming to have used marijuana within the last 30 days at 22.7% and the number who have used the drug  during their lifetime at 44.5% . Only 16 Alaskan chiefs report currently having SROs in their communities. If legalization occurs in Alaska, 64% of police chiefs felt it would be necessary to increase the number of school resource and DARE officers doing youth outreach in their communities to protect against an increase in local teen drug usage.

•  In 2006, Colorado drivers testing positive for marijuana were involved in 28 percent of fatal vehicle crashes involving drugs. By 2011 that number had increased to 56 percent. These statistics clearly indicate the importance of traffic enforcement, but identification of impairment due to marijuana requires special skills. No figures seem to exist which can illuminate the degree of the problem in Alaska  but the consistency of data from other states would support the assumption that the Alaskan experience would be comparable. Ninety seven percent of Alaskan chiefs responding to the AACOP survey felt their officers needed additional Advanced Roadside Impaired Driving Enforcement (ARIDE) or Drug Recognition Expert (DRE) training to help them properly identify drivers impaired by marijuana. Of more than 950 police officers in the state, less than 100 are estimated to have ARIDE training, and less than 20 now have DRE training.

• Less than 6% of the AACOP survey respondents felt their local taxpayers would support a sufficient increase in their police budget to meet the anticipated financial implications of marijuana legalization.

• Seventy five percent of respondents felt their agency would require financial assistance to meet training needs that will be created by legalization. Providing this training for all police officers will not only be costly to local taxpayers and also logistically difficult.

• ·Unlike alcohol, for which impairment can be reasonably measured using a breathalyzer (and confirmed with a blood alcohol content measurement), valid detection for cannabis is time-consuming, and blood tests cannot definitively determine an approximate degree of impairment. The lack of suitable roadside tests and agreed-upon intoxication levels will make enforcement of impaired driving more difficult.       

• The necessity of drawing blood for toxicology testing creates another potential problem for police as it will necessitate training officers as phlebotomists, contracting with an independent phlebotomist to be on call, or taking all drivers suspected of impaired driving due to drugs (DUID) to the nearest hospital or clinic to have blood drawn.. In this “post-CSI” era, juries are likely to expect effective prosecution of drug impairment will require a toxicology evaluation combined with the testimony of a trained Drug Recognition Expert.

 

2.     Stoned driving and other dangers would be increased, while the difficulty of proving impairment from marijuana may impact prosecutions, and could make civil settlements more difficult in the case of personal injury lawsuits.

• Drugged driving impairs one’s motor skills, reaction time, and judgment and  is a public health concern because it puts not only the driver at risk, but also passengers and others who share the road.

• In other states where there has been an enormous increase in “medical” marijuana cardholders, DUI arrests involving marijuana have skyrocketed, as have traffic fatalities where marijuana was found in the system of one of the drivers. Because toxicology results are not universally reported for Alaskan crashes no definitive data exists which would demonstrate a different result here.

• In 2011 there were 9.4 million persons aged 12 and older who reported driving under the influence of illicit drugs during the past year. The rate was highest among young adults aged 18 to 25.

• Drugs that may affect driving were detected in one of every seven weekend night time drivers in California during the summer of 2012. In the first California state wide roadside survey of alcohol and drug use by drivers, 14 percent of drivers tested positive for drugs, 7.4 percent of drivers tested positive for alcohol, and just as many as tested positive for marijuana as alcohol.

• In a study of seriously injured drivers admitted to a Maryland Level-1 shock-trauma center, 65.7 percent were found to have positive toxicology results for alcohol and/or drugs. Almost 51 percent of the total tested positive for illegal drugs. A total of 26.9 percent of the drivers tested positive for marijuana.

• The National Organization for the Reform of Marijuana Laws (NORML) has called for a science-based educational campaign targeting drugged driving behavior. In a January 2008 report titled, Cannabis and Driving, it is noted that motorists should be discouraged from driving if they have recently smoked cannabis and should never operate a motor vehicle after having consumed both marijuana and alcohol. The report also calls for the development of roadside, cannabis-sensitive technology to better assist law enforcement in identifying drivers who may be under the influence of pot.

• In a 2007 National Roadside Survey of alcohol and drug use by drivers, a random sample of weekend nighttime drivers across the United States found that 16.3 percent of the drivers tested positive for drugs, compared to 2.2 percent of drivers with blood alcohol concentrations at or above the legal limit. Drugs were present more than 7 times as frequently as alcohol.

• Low doses of THC moderately impairs cognitive and psychomotor tasks associated with driving, while severe driving impairment is observed with high doses, chronic use and in combination with low doses of alcohol. The more difficult and unpredictable the task, the more likely marijuana will impair performance.

 

3.     Persons under the influence of marijuana will present a risk on job-sites. If marijuana is legalized, aggressive drug screening and periodic testing of medical personnel, industrial workers, transportation workers. and others will be necessary to insure safety of the public and other workers. 

• According to the American Council for Drug Education in New York, employees who abuse drugs are 10 times more likely to miss work, 3.6 times more likely to be involved in on-the-job incidents (and 5 times more likely to injure themselves or another worker in the process) and 5 times more likely to file a workers’ compensation claim. They also are said to be 33 percent less productive and responsible for potentially tripling health care costs.

• The risk that your surgeon, pilot, bus driver, or coworker has used marijuana will increase if the drug is decriminalized.

• A Rand study suggests drug use leads to about a 25-percent increase in men’s risk of having a workplace injury.

•  In addition to the acute effects of alcohol and other drug use on judgment and psychomotor skills, substance use that occurs hours before a worker begins his or her shift can cause spillover effects, such as fatigue and hangovers, that may independently increase injury risk. Studies have shown that hangovers affect cognitive skills, including tasks related to driving or piloting aircraft, which may therefore influence the risk of injury in a manner similar to the influences of acute alcohol intoxication.

• Persons more likely to misuse alcohol and other substances may be more likely to be engaged in other behaviors that increase the risk of injury, a concept termed deviance proneness

 

4.     Marijuana legalization will usher in Drug Commercialization increasing the chances of the drug falling into the hands of kids.

• Already, private holding groups and financiers have raised millions of start-up dollars to promote businesses that will sell marijuana and marijuana-related merchandise.

• Cannabis food and candy is being marketed to children and are already responsible for a growing number of marijuana-related ER visits.  Edibles with names such as “Ring Pots” and “Pot Tarts” are inspired by common children’s candy and dessert products such as “Ring Pops” and “Pop Tarts.”

• Several, profitable vending machines containing products such as marijuana brownies are emerging throughout the country.

• The former head of Strategy for Microsoft has said that he wants to “mint more millionaires than Microsoft” with marijuana and that he wants to create the “Starbucks of marijuana.”

 

5.     Marijuana use will increase under legalization

• Because they are accessible and available, our legal drugs are used far more than our illegal ones. According to recent surveys, alcohol is used by 52% of Americans and tobacco is used by 27% of Americans. Marijuana is used by 8% of Americans.

• When RAND researchers analyzed California’s 2010 effort to legalize marijuana, they concluded that the price of the drug could plummet and therefore marijuana consumption could increase.

•  The 2011 Monitoring the Future Survey noted that daily or near daily marijuana use, defined as use on 20 or more occasions in the past 30 days rose significantly in the 8th, 10th and 12^th grades in 2010 and rose slightly higher again in 2011. This translates to one in every 15 high school seniors smoking pot on a daily or near daily basis, the highest rates that has been seen in thirty years – since 1981.

 

6.     Marijuana is especially harmful to kids and adolescents.

• Marijuana use that begins in adolescence increases the risk they will become addicted to the drug. The risk of addiction goes from about 1 in 11 overall to 1 in 6 for those who start using in their teens, and even higher among daily smokers.

• Marijuana contributes to psychosis and schizophrenia , addiction for 1 in 6 kids who ever use it once , and it reduces IQ among those who started smoking before age 18.

• Regular or daily use of marijuana may be robbing many young people of their potential to achieve and excel. THC, a key ingredient in marijuana, alters the ability of the brain’s hippocampus to communicate effectively with other brain regions. In addition, recent research has shown that marijuana use that begins during adolescence can lower IQ and impair other measures of mental function in adulthood.

 

7.     Today’s marijuana is NOT your Woodstock weed.

•  In the 1960s and ‘70s, THC levels of the marijuana smoked by baby boomers averaged around 1%, increasing to just under 4% in 1983, and almost tripling in the subsequent 30 years to around 11% in 2011.

 

8.     Marijuana legalization will increase public costs.

• For every $1 in alcohol and tobacco tax revenues, society loses $10 in social costs, from accidents to health damage .

• In addition to the costs to law enforcement for training and prevention, the anticipated increase in impaired driving arrests would result in additional court costs including prosecution and public defenders. Even in places where these costs are not borne directly by taxpayers, they will divert funds which might otherwise be used to support other civic needs.

 

9.     People are not in prison for small time marijuana use.

• Few people are currently in prison for marijuana possession (in fact, only 0.1% of prisoners with no prior offenses ) and current alcohol arrest rates are over three times higher than marijuana arrest rates.

• Statistics on state-level prisoners around the United States reveal that just 0.3% of all state inmates were behind bars for marijuana possession only (with many of those pleading down from more serious crimes).

• 99.8% of federal prisoners sentenced for drug offenses were incarcerated for drug trafficking.

• The risk of arrest for each joint smoked is estimated at 1 in 12,000. 

• On the most recent prison census date only 4 people were incarcerated in Alaska prisons due to conviction on 6^th degree Misconduct Involving Controlled Substance (MICS) which would include possession of less than 1 oz. of marijuana (the amount legalized by the proposed legislation). It is undetermined if these MICS-6 offenders had concurrent convictions for other offenses as well, but it is possible that at least some do.

 

10.  Drug cartels and the black market will continue to function under legalization.

• A recent RAND report showed that Mexican drug trafficking groups only received a minority of their revenue (15-25%) from marijuana. For them, the big money is found in illegal trade such as human trafficking, kidnapping, extortion, piracy, and other illicit drugs.

• We know from past experience with other businesses that illegal actors have a lot to do with so called legal industries. These cartels will only be helped with legalization and more addiction, not hurt.

• Dealers aren’t likely to give up their lucrative income. Legalization of marijuana will lead entrepreneur dealers and cartels to focus their energies on selling harder drugs.

 

11.  The foreign experience is not promising. Neither Portugal nor Holland provides any successful example of legalization.

• Offenses related to drug use or possession for use continued to comprise the majority of drug law offenses in 2010; between 2005 and 2010, there was an estimated 19 percent increase in the number of offenses related to drug use in Europe.

• Independent research reveals that in the Netherlands, where marijuana was commercialized and sold openly at “coffee shops,” marijuana use among young adults increased almost 300%. Now, the Dutch are retreated from their loose policies. About 70 percent of Dutch towns have a zero-tolerance policy toward cannabis cafes.

• There are signs that tolerance for marijuana in the Netherlands is receding. They have recently closed hundreds of coffee shops, and today Dutch citizens have a higher likelihood of being admitted to treatment than nearly all other countries in Europe.

• In Portugal, use levels are mixed, and despite reports to the contrary, they have notlegalized drugs. In 2001, Portugal started to refer drug users to three person “panels of social workers” that recommend treatment or another course of action. As the European Monitoring Center’s findings concluded: “the country does not show specific developments in its drug situation that would clearly distinguish it from other European countries that have a different policy.”

 

12.   Marijuana is believed by some to have medicinal properties, but we shouldn’t smoke the plant in order to derive those benefits, just like we do not smoke opium to get the benefits of morphine. More widespread use would increase the dangers of secondhand smoke damage to nonsmokers  and children in the homes of users.

• A 1999 The Institute of Medicine (IOM) study explained that “smoked marijuana . . . is a crude THC delivery system that also delivers harmful substances.” In addition, “plants contain a variable mixture of biologically active compounds and cannot be expected to provide a precisely defined drug effect.” Therefore, the study concluded that “there is little future in smoked marijuana as a medically approved medication.”

• The principal IOM investigators explicitly stated that using smoked marijuana in clinical trials “should not be designed to develop it as a licensed drug, but should be a stepping stone to the development of new, safe delivery systems of cannabinoids.”

• In states with medical marijuana laws, the average user is a male in his 30s with no terminal illness and a history of drug abuse. 

• Less than 2% of users have cancer or AIDS.

• Residents of states with medical marijuana laws generally have abuse and dependence rates almost twice as high as states with no such laws.

• ·Research should be conducted to produce pharmacy-attainable, non-smoked medications based on marijuana.

 

13.   The Alaska Initiative is premature. The experience of Colorado and Washington is not promising. It is better to wait to see if predictions of both sides are borne out by hard data rather than rely on speculation and the promise that benefit will outweigh harm.

• Two independent reports released in August 2013 document how Colorado’s supposedly regulated system is not well regulated at all.

• Teen use has increased in the past five years. Currently, the marijuana use rate among Colorado teens is 50% above the national average.

• Drug-related referrals for high school students testing positive for marijuana has increased.

• Medical marijuana is easily diverted to youth.

• While the total number of car crashes in Colorado declined from 2007 to 2011, the number of fatal car crashes with drivers testing positive for marijuana rose sharply.

 

14.   Marijuana is often used as a stepping-stone drug, leading to heroin, cocaine, or other harder drugs.

• Teens who experiment with marijuana may be making themselves more vulnerable to heroin addiction later in life, if the findings from experiments with rats are any indication. Cannabis has very long-term, enduring effects on the brain..

• Marijuana is a frequent precursor to the use of more dangerous drugs and signals a significantly enhanced likelihood of drug problems in adult life. The Journal of the American Medical Association reported, based on a study of 300 sets of twins, “that marijuana-using twins were four times more likely than their siblings to use cocaine and crack cocaine, and five times more likely to use hallucinogens such as LSD.”

• Long-term studies on patterns of drug usage among young people show that very few of them use other drugs without first starting with marijuana. For example, one study found that among adults (age 26 and older) who had used cocaine, 62 percent had initiated marijuana use before age 15. By contrast, less than one percent of adults who never tried marijuana went on to use cocaine. 

• Columbia University’s National Center on Addiction and Substance Abuse (CASA) reports that teens who used marijuana at least once in the last month are 13 times likelier than other teens to use another drug like cocaine, heroin, or methamphetamine and almost 26 times likelier than those teens who have never used marijuana to use  another drug.

• An estimated 3.1 million persons aged 12 or older – an average of approximately 8,400 per day – used a drug other than alcohol for the first time in the past year according to the 2011 National Survey on Drug Use and Health. More than two-thirds (68 percent) of these new users reported that marijuana was the first drug they tried. 

• Nearly one in ten high school students (9 percent) report using marijuana 20 times or more in the past month according to the findings of the 2011 Partnership Attitude Tracking Survey.

• Teens past month heavy marijuana users are significantly more likely than teens that have not used marijuana in the past to: use cocaine/crack (30 times more likely); use Ecstasy (20 times more likely); abuse prescription pain relievers (15 times more likely): and abuse over the counter medications (14 times more likely). This clearly denotes that teens that use marijuana regularly are using other substances at a much higher rate than teens who do not smoke marijuana, or smoke less often.

 

ENDNOTES

AACOP survey of  Alaskan police chiefs conducted April 28-May 5, 2014

The Legalization of Marijuana in Colorado: The Impact Vol. 1/August 2013

AACOP survey of  Alaskan police chiefs conducted April 28-May 5, 2014

MARIJUANA USE BY YOUNG PEOPLE: The Impact of State Medical Marijuana Laws By Karen O’Keefe, Esq, .Director of State Policies, Marijuana Policy Project and Mitch Earleywine, Ph.D., Professor of Psychology University at Albany, State University of New York, Updated: June 2011

AACOP survey of  Alaskan police chiefs conducted April 28-May 5, 2014

The Legalization of Marijuana in Colorado: The Impact Vol. 1/August 2013

AACOP survey of  Alaskan police chiefs conducted April 28-May 5, 2014

AACOP survey of  Alaskan police chiefs conducted April 28-May 5, 2014

AACOP survey of  Alaskan police chiefs conducted April 28-May 5, 2014

http://en.wikipedia.org/wiki/Cannabis_drug_testing

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Volz, Matt. “Drug overdose: Medical marijuana facing a backlash.” http://www.msnbc.msn.com/id/37282436

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DuPont, Robert. “National Survey Confirms that Drugged Driving is Significantly More Widespread than Drunk

Driving.” Commentary, Institute for Behavior and Health, July 17, 2009. page 1. http://www..ibhinc.org.

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DuPont, Robert. “National Survey Confirms that Drugged Driving is Significantly More Widespread than Drunk

Driving.” Commentary, Institute for Behavior and Health, July 17, 2009. page 1. http://www.ibhinc.org

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increase in kids’ accidental poisonings CBS News. Retrieved from http://www.cbsnews.com/8301-204_162-

57586408/laxer-marijuana-laws-linked-to-increase-in-kids-accidental-poisonings    

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Kilmer, B., et al. “Altered State? Assessing How Marijuana Legalization in California Could Influence Marijuana Consumption and Public Budgets”. Santa Monica, CA: RAND Corporation, 2010.http://www.rand.org/pubs/occasional_papers/OP315

Alaska Department of Corrections prison population census data 2013

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http://www.rand.org/pubs/occasional_papers/OP325  ___“Annual Report 2012: The State of the Drugs Problem in Europe.” European Monitoring Centre for Drugs and Drug Addiction. Lisbon. November 2012. P. 35.

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MacCoun, R. & Reuter, P. (2001). Evaluating Alternate Cannabis Regimes. The British Journal of Psychiatry, 178.

INTRAVAL Bureau for Research & Consultancy. “Coffeeshops in the Netherlands 2004.” Dutch Ministry of Justice. June 2005.http://www.intraval.nl/en/b/b45.html.

MacCoun, R. (2010). What can we learn from the Dutch Cannabis Coffeeshop experience? RAND Drug Policy Research Center.Retrieved from http://www.rand.org/content/dam/rand/pubs/working_papers/2010/RAND_WR768.pdf

European Monitoring Center for Drugs and Drug and Addiction. (2011). Drug Policy Profiles-Portugal. Retrieved fromhttp://www.emcdda.europa.eu/publications/drug––policyprofiles/portugal

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O’Connell, T.J. & Bou-Matar, C.B. (2007). Long term marijuana users seeking medical cannabis in California

(2001–2007): demographics, social characteristics, patterns of cannabis and other drug use of 4117 applicants. Harm

Reduction Journal, 4(16)

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Cerda, M., et al. (2012). Medical marijuana laws in 50 states: Investigating the relationship between state legalization of medical marijuana and marijuana use, abuse and dependence. Drug & Alcohol Dependence, 120(1-3).

Colorado Office of the State Auditor. (2013). & City of Denver Office of the Auditor. (2013).

 NSDUH, Summary of National Findings, 2012. Retrieved from

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Rocky Mountain HIDTA. (2013). Legalization of Marijuana in Colorado: The Impact. Retrieved from

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http://www.rmhidta.org/html/FINAL%20Legalization%20of%20MJ%20in%20Colorado%20The%20Impact.pdf

Harding, Anne. “Pot May Indeed Lead to Heroin Use, Rat Study Shows” Reuters. July 12, 2006. See also: “Why Teenagers Should Steer Clear of Cannabis” Vine, Gaia. www.NewScientist.com

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“Nearly One in Ten U.S High School Students Report Heavy Marijuana Use in the Past Month: One Third or More of  Heavy Users Also Used Cocaine, Ecstasy, or Other Drugs.” CESARFAX, Vol 21. Issue 21. May 29, 2012

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Source:

Alaska Association of Chiefs of Police, Inc. – 14 Reasons Against Marijuana Legalization Sept.2014

 

A poll reported in the Washington Post on September 23 offers positive news for those troubled by the movement to legalize marijuana. It also does not auger well for those pushing more states to follow Colorado and Washington, where legalization is already underway.

In a national poll, support for legal marijuana fell seven percentage points in a single year, from 51 percent in 2013 to 44 percent in 2014. The results are well outside the poll’s margin of sampling error, and though only a single result, represent the first sign that the public may be reconsidering what had been climbing enthusiasm.

Of course, public support for issues in the abstract (such as nationalized health care, or ending involvement in Middle Eastern wars) can change when actual events begin to shape perceptions. It is possible that deteriorating public health and public safety conditions in places like Colorado are giving pause.

The public has to be made aware of the actual damage, however, which is no easy task given the widespread presence of media bias on behalf of legal marijuana, both explicitly (the New York Times’s editorial support for legalization) or more implicitly through a steadfast neglect of bad news in reportage (the Washington Post on any given day).   Yet word has gotten out, and credit is due the various groups and individuals (educators, physicians, and family advocates, as well as a small core of policy analysts) who have created a growing source of data and genuine analysis.

But the uphill struggle is not over. For instance, though the Post did cover the poll results, their story contained this striking effort at spin: the results “could mean that Americans generally don’t like the news coming out of Colorado and Washington—even if that news has been largely positive.”

Really? The referenced “news”—a Brookings study, the headline of which is, “Colorado’s Rollout of Legal Marijuana is Succeeding”—can only be regarded, charitably, as a weak reed. Sure enough, media coverage followed suit (“Colorado Legalization is Working, says Brookings Institute,” San Francisco Gate, July 31, 2014). Does that mean things are going fine?

Not exactly. What the Brookings report actually argues is that the state has met “the most basic standard of success” because it has “created regulatory and administrative apparatuses that facilitate the legal retail marijuana market.” Is the mere fact that Colorado now has businesses selling marijuana a serious standard of success?

It is revealing that in order to reference the positive Brookings report, the Post had to climb over a mound of data about the actual impact on the ground in Colorado. A High Intensity Drug Trafficking Area (HIDTA) report in August detailed a parade of damage across the spectrum. And last week’s Quest Workplace Drug Testing national results showed for the first time in a decade an increase in marijuana positives nationally—5 percent overall in a single year—compared with Colorado’s 20 percent increase over that same period. That can’t be a success for businesses, can it?

Showing even more evasion, the Post did decide to report on the impact of legalized marijuana—in Alaska, based on a ruling from 39 years ago—“Alaska Legalized Weed 39 Years Ago. Wait, What?” (September 25, 2014).

The piece attempts to draw implications for the current Colorado “experiment.” In Alaska, we are told, the lesson is, “the sky hasn’t fallen.” Never mind the striking differences between the two states. Alaska “legalized” marijuana in 1975, but not through a voter referendum. Rather, a court ruling held that a provision of the state’s constitution concerning privacy extended to personal possession of marijuana. Voters explicitly overturned this result in 1991, but a successful ACLU suit kept the judges’ ruling largely intact, though a legalization measure on the ballet in 2000 was beaten by 60 percent of the vote.

In reality, not only is the judge’s ruling against federal Controlled Substance law, it is also a continued violation of state law (a felony punishable by up to 5 years in prison and a fine of $50,000) to have more than 25 marijuana plants or more than 4 ounces of pot. And in Alaska it has never been permissible to have commercial growing, sales, or even a commercial building providing pot; homegrown personal amounts only.

To argue that the Alaska scheme is remotely similar to Colorado’s commercial run-away—and that we should evaluate Alaska’s drug use rates or social conditions as though they contained a lesson for Colorado—is to mislead. Colorado is awash in for-profit enterprises enlisting advertising gurus and marketing their products to youth and adults alike. Alaska, thankfully, did not and does not face these conditions—though we are told at the piece’s conclusion that Alaskans “use marijuana twice as much as Americans elsewhere.”

Nonetheless, the Post’s takeaway is that there is clearly no truth to the view that “the slightest departure from full prohibition would inevitably lead to a stoner dystopia, with a nation of drug-addled high school dropouts.”

To make this non-serious point, it is worth noting that the Post also had to “forget” the report in the British journal Lancet (September 9, 2014), showing that youth who were daily smokers of marijuana had a 60 percent greater likelihood of dropping out of high school. Just as they neglected to even mention the results of the 2013 National Household Survey on Drug Use and Health (September 2014) showing that rates of near-daily use of marijuana have risen some 80 percent since 2007.

Lastly, one more point about Alaska. The total state population (700,000) is roughly a fifth of the Denver metropolitan area (3.3 million). This fact makes national household surveys of drug use in that state less than reliable. In fact, for the use of some drugs, such as methamphetamine and heroin, the numbers are so small in Alaska that extrapolating to the wider population is precarious, and in some cases, difficult to disaggregate from the larger sample of marijuana users.

The Post sees in this data gap an opportunity to speculate. Perhaps, we are told, “Alaskans are substituting marijuana for more habit-forming drugs, such as heroin or methamphetamine.” Well, yes, perhaps; maybe in Alaska marijuana serves as a kind of “reverse gateway,” helping people stay away from the use of other drugs. There are not sufficient data to contradict this conjecture, so why not float it?

Except, the same Lancet study (“Young Adult Sequelae of Adolescent Cannabis Use: An Integrative Analysis”) also provided strong support for the actual “gateway” hypothesis. The study’s authors found that youth who were daily users of marijuana also had an 8 times greater risk to use other drugs, such as heroin and methamphetamine, than youth who did not use. There is further the important 2012 finding in the Proceedings of the National Academy of Sciences that heavy marijuana users in youth lost, over time, fully eight IQ points, enough to diminish many aspirations.

It is impossible to miss the fact that those trying to educate the public about the dangers of the course we are on must overcome a tendentious, even agenda-driven, media “narrative” in support of greater drug access.

The positive news is that the resistance may have begun to check the momentum of the marijuana movement for the 2014 and 2016 electoral cycles, when legalization advocates are planning their big breakout. That there has been some headway in public opinion is no small feat.   There is now an unexpected opportunity to change direction and avert the problems that have been of our own making—or at least the making of the Department of Justice which, following the policy of the then Attorney General, transformed the fundamental guardian against an American drug debacle into a facilitator of legalization nationwide.

It was the explicit guidance of AG Eric Holder that not only would the DOJ decline to defend its Constitutional authority, upheld by the Supreme Court, establishing the pre-eminence of federal law concerning drugs, he further opened the door to Colorado and Washington state by declining to prosecute clear violations of federal law. His departure presents an opening for a return to lawfulness—and protecting many, many young lives now at risk.

Drug policy should at a minimum be a hard question posed for the next AG nominee, appearing before the Senate. And we should hope the reporters covering these confirmation hearings are not blinded by their preference for legal dope. Their readers, it would appear, are rethinking that choice.

John P. Walters and David W. Murray, of Hudson Institute, direct its Center for Substance Abuse Policy Research. They both served in the Office of National Drug Control Policy.

Source: http://www.weeklystandard.com/blogs/does-eric-holder-s-successor-face-momentum-shift-dope_808439.html       1st October 2014