New psychoactive substances (NPS) are synthesized compounds that are not usually covered by European and/or international laws. With a slight alteration in the chemical structure of existing illegal substances registered in the European Union (EU), these NPS circumvent existing controls and are thus referred to as “legal highs”. They are becoming increasingly available and can easily be purchased through both the internet and other means (smart shops). Thus, it is essential that the identification of NPS keeps up with this rapidly evolving market.

In this case study, the Belgian Customs authorities apprehended a parcel, originating from China, containing two samples, declared as being “white pigments”. For routine identification, the Belgian Customs Laboratory first analysed both samples by gas-chromatography mass-spectrometry and Fourier-Transform Infrared spectroscopy. The information obtained by these techniques is essential and can give an indication of the chemical structure of an unknown substance but not the complete identification of its structure. To bridge this gap, scientific and technical support is ensured by the Joint Research Centre (JRC) to the European Commission Directorate General for Taxation and Customs Unions (DG TAXUD) and the Customs Laboratory European Network (CLEN) through an Administrative Arrangement for fast recognition of NPS and identification of unknown chemicals. The samples were sent to the JRC for a complete characterization using advanced techniques and chemoinformatic tools.

The aim of this study was also to encourage the development of a science-based policy driven approach on NPS.

These samples were fully characterized and identified as 5F-AMB and PX-3 using¹H and ¹³C nuclear magnetic resonance (NMR), high-resolution tandem mass-spectrometry (HR-MS/MS) and Raman spectroscopy. A chemo-informatic platform was used to manage, unify analytical data from multiple techniques and instruments, and combine it with chemical and structural information.

Source:    http://www.fsijournal.org/   August 2016   Volume 265, Pages 107–115

DOI: http://dx.doi.org/10.1016/j.forsciint.2016.01.024

Even in a culture that puts safety above all else, pilots aren’t properly educated about the potential dangers of common drugs such as antihistamines and sleeping pills. That’s the conclusion from a new National Transportation Safety Board report on rising drug use among aviators, which largely mirrors trends of greater use of prescription, over-the-counter, and illicit drugs by Americans in general.

About 40 percent of the 6,667 pilots killed in accidents since 1990 had prescription, over-the-counter, or illicit drugs in their bodies, according to a study of nearly 6,600 accidents from 1990 to 2012. Over-the-counter antihistamines such as Benadryl and Claritin were the most common. Antihistamine use rose to almost 10 percent between 2008 and 2012, up from 5.6 percent in the 1990s.

The vast majority of those killed in the period of the study—96 percent—were general aviation pilots typically flying small, one-engine planes; less than 1 percent of incidents involved major airlines. The study focused on evidence of drug use, not on whether the effects of the drug led to impairment while flying. Alcohol was not included in the study because toxicology screenings often detect ethanol the body creates naturally after death.

Use of illicit drugs such as marijuana and cocaine increased to almost 4 percent in the 2008-12 span, up from 2.3 percent in the 1990s. Most of the illicit drugs in the study resulted from greater use of marijuana among the pilots who died, the agency said.

The NTSB, which recommends safety improvements, called on the Federal Aviation Administration to better educate pilots about the potential dangers of some common drugs and develop a policy on marijuana use by pilots. Colorado and Washington have legalized marijuana for adult use, and almost two dozen other states allow marijuana for medical uses. More states are also likely to vote on legalizing recreational and medical marijuana use.

Dr. Mary Pat McKay, the NTSB’s chief medical officer, said more research is needed to determine how drugs can interact with each other and lead to pilot impairment. Sleep aids and pain medications, for example, can hurt pilot performance and yet there aren’t guidelines on how pilots might safely use those drugs.

Source: www.businessweek.com  10^th Sept. 2014

The public is lately inundated with stories about “non-violent” drug offenders who have been sent to prison. One case-in-point is the story of Larry Duke, allegedly a fine upstanding citizen and “non-violent drug offender” who received two life sentences for a 1989 conviction involving 14,000 pounds of marijuana.

Please read the original story at the link below and then read the additional facts not contained in the first article. As you will see, the pro-pot people are happy to lie to the American public to gain sympathy for “non-violent” drug offenders who are anything but.

http://blogs.ajc.com/news-to-me/2013/11/14/non-violent-life-sentences/

Here’s the rest of the story.

Duke originally wanted 18,000 pounds but settled on 16,000 (8 tons) at a wholesale price of over $7 million.

During the undercover operation, Duke was described as the “largest marijuana dealer on the eastern seaboard.” In recorded conversations, Duke admitted that he had marijuana warehouses across the country and boasted that he recently moved 70,000 pounds (35 tons) in four days. Duke stressed that the money and the dope should never be in the same place.

After being convicted at trial, the court determined that Duke was a habitual offender since this was Duke’s third felony drug conviction. One of those convictions involved 18 tons of pot (36,000 pounds) which was smuggled into Canada in 1983.

The bottom line is this:

Multiple tons of pot do not get manufactured, harvested,  imported, transported, packaged and sold unless there are a lot of guns around to protect the dope and the money.

The pro-pot lobbyists lie about the statistics because it furthers their claim that a lot of non-violent drug users are going to prison. Besides being untrue, they couldn’t have picked a worse person to highlight than Mr. Duke.

Source: email to DrugWatch International from  Monte Stiles   2014

Hospital maternity units and new-born care nurseries would have to report the number of infants born addicted to drugs under a bill headed to Ohio’s governor. The state Senate unanimously passed the measure Wednesday, and Gov. John Kasich was expected to sign it.

The measure is one of several aimed at reducing the state’s prescription painkiller addiction epidemic. Supporters say tracking the number of drug-addicted babies will help the state monitor Ohio’s progress in fighting drug addiction.

The facilities would be required to report the information to the state Health Department every three months. Patients would not be identified, and the information could not be used for law enforcement purposes. Should a maternity unit, maternity home or new-born care nursery fail to comply with the requirement, the state could impose a fine or revoke or suspend its license.

Overdose drug deaths have been the leading cause of accidental death in Ohio since 2007, surpassing car crashes. Many of those deaths are from painkillers and heroin.

Opiates and narcotics taken by the mother during pregnancy can pass through the placenta through the baby, causing the infant to be born dependent on harmful drugs. The babies experience neonatal abstinence syndrome and face an array of health complications, said state Sen. Shannon Jones, a Springboro Republican.

“These new-borns are thrown into painful withdrawal symptoms, such as rapid breathing, vomiting and seizures immediately following their birth,” she said.  Jones told her colleagues on the Senate floor that she had witnessed children withdrawing. “It is the most horrifying thing that I have personally experienced,” she said.

Caring for the drug-addicted new-borns and mothers, who are often on Medicaid, can be costly to the system.  Jones said officials hope to use the information to help measure opiate and illegal drug abuse across the state and better target resources to help women and babies struggling from addiction.

Source:    www.sfgate.com Wednesday, April 2, 2014

When The Baltimore Sun ran an editorial about the Maryland mall shooter, who killed two people and then himself, the newspaper said that mental health problems need to be identified sooner. But it failed to breathe a word about killer Darion Aguilar’s admitted marijuana use. Dr. Christine Miller, a semi-retired molecular neuroscientist living in Maryland, was not too surprised by the omission. She says the liberal media tend to ignore the relationship between marijuana and mental illness.

“I know that the editors are aware of the marijuana-psychosis connection because I have corresponded in the past with one of their journalists who was unable to get them interested in a story on the topic,” she told Accuracy in Media. “They did publish one letter I wrote to their local Towson Times affiliate.”

Miller has researched the cause of schizophrenia for many years, and is working to stave off marijuana legalization in Maryland. “Though none of my work involved the study of marijuana use, I became aware of the growing body of literature showing its association with the onset of schizophrenia, and I now regard those numerous reports as the most well-replicated finding in schizophrenia research,” she says.

In a case in Colorado, where marijuana has been legalized, the national news media recently aired a video of a man stealing an SUV with a 4-year-old boy inside, but did not emphasize his history of drug abuse, including marijuana. The Denver Post reported that a pickup truck he had stolen earlier was found with drug paraphernalia, including empty syringes, five pipes containing residues believed to be of methamphetamine and marijuana, as well as 2.1 grams of pot.

In another sensational case, in Tennessee, a woman who said she smoked marijuana all day and all night drove her car into a church and stabbed her husband. Church Hill Police Department Chief Mark Johnson told The Kingsport Times News that the woman stated that God had told her to stab her husband for “worshipping” NASCAR. The woman said, “I smoke a bunch of weed. I love to smoke it. Sometimes when I do, I start seeing things that others don’t. Isn’t God good? He told me that this would happen, and just look, I am okay.”

In the Washington, D.C. area, The Baltimore Sun isn’t the only paper reluctant to examine the marijuana link to mental illnesses, including schizophrenia and psychosis. After Dr. Miller testified to the Maryland House Judiciary Committee about the marijuana-psychosis connection, she was contacted by Frederick Krunkel of The Washington Post, asking for a phone interview. She said, “I replied, along with my phone number and a time to call, but they never called.”

“It turns out that 15 percent of marijuana users experience psychosis, half of whom will go on to become schizophrenic if they don’t stop using,” she told AIM. “Fortunately, many do stop if they aren’t addicted already, because paranoia is no fun.” She says some people are under the misimpression that if someone is psychotic due to marijuana, it comes from what the marijuana is laced with. “In fact,” she says, “the converse is true—a large study out of Finland last year shows that in acute substance-induced psychosis cases, the cannabis users convert to schizophrenia spectrum disorder at the highest rate.”

Incredibly, however, the Maryland House of Delegates passed Del. Cheryl Glenn and Del. Dan Morhaim’s medical marijuana bill in a 127-9 vote. The dope lobby, known as the Marijuana Policy Project, is saying, “Maryland may finally become the 21st state with an effective medical marijuana law!”   In attempting to explain the media’s failure to cover both sides of this debate, Miller said, “I think we are losing our journalistic standards.” She believes that papers like the Post no longer have the “depth of talent” from reporters who understand how to cover scientific evidence in controversies like this.

Another factor, she said, is that there’s a “giddy rush” by the media to jump on the “progressive bandwagon,” which views the marijuana movement as fashionable. In this regard, she singled out CNN’s Dr. Sanjay Gupta, who has been promoting “medical marijuana” without taking into account the serious mental health problems associated with its use. She said liberal reporters are also influenced by the perception that too many members of minority groups are being punished for drug use.

Despite the rush to legalize marijuana for various purposes, Miller said the media will eventually be forced to cover the link between marijuana use and mental illness because of the growing number and severity of violent incidents involving schizophrenic individuals using the drug. Those whose schizophrenia manifests in the context of drug use are much more likely to be violent. She also says that in the wake of its legalization in Colorado, data is coming out of that state about impaired driving associated with the increasing use of marijuana.

Source:   http://www.aim.org/aim-column/media-continue-cover-up-of-marijuana-induced-mental-illness/   27^th March 2014

When an award-winning movie star recently lost his battle with substance abuse and addiction, the headlines and tributes were ubiquitous, and mostly without moral judgment. He was a sick man and his tragedy became our tragedy, because we knew him through his work.

Do we have the same relationship with mostly unknown people throughout our communities, who cannot be free of the scourge of their addiction even during pregnancy? Are we as understanding and supportive of their struggles, of the consequences to the foetuses they carry and the children they bear?

We should be. For their struggles with drugs, and with children born addicted to or affected by the drugs their mothers could not stop taking even during pregnancy, are our struggles, too. If they are to get well and even have a chance at healthy, productive lives, they need medical attention and education and more. They require treatment and other help in a state that continues to be plagued by too many long-term problems and too few long-term solutions.

Courier-Journal Reporter Laura Ungar has visited the life- and resource-shredding issues of substance abuse, addiction and pregnancy several times in recent years. Her latest instalment was a special report in Sunday’s C-J, which outlined the surge of hospitalizations of drug-addicted babies in Kentucky. That surge is attributed in large part to the availability and use of heroin that has filled the vacuum left by the recent crackdown on prescription pain-killers.

Ungar reported that those hospitalizations have increased 30-fold from 2000 to 2012, and that Kentucky is on track for more than 900 for last year — up from 824 in 2012.  Kentucky fares badly in national statistics, with one health official saying that this state has one of the nation’s worst problems with drug-dependent babies.

“The latest national statistics come from a 2012 study in the Journal of the American Medical Association, which said hospitalizations for drug-dependent babies rose 330 percent from 2000 to 2009. Kentucky’s hospitalizations rose more than 1,400 percent during that same time,” Ms. Ungar wrote.

State officials are well aware of the epidemic. The restrictions placed on prescription pain pills were an attempt to curb access to addictive drugs, but heroin has filled the gap left by them. And a recent $32 million settlement the state won with two drug companies has been a windfall for cash- and resource-strapped drug-treatment programs throughout Kentucky, including $1 million dedicated to treatment centres for pregnant addicts.

But $1 million is still not nearly enough — not for the women who struggle with addiction while pregnant, not for the people who try to care for them, not for the drug-dependent babies who are born with a variety of symptoms ranging from low weight, vomiting, inconsolability, hyperactivity, poor feeding and seizures; not for the taxpayers who cover millions in costs associated with the spike in hospitalizations.

Which is why Kentuckians ought to ramp up the same interest in the women and babies struggling with heroin and addiction in our communities as they managed to muster for a tragic movie star whose life ended with a needle hanging from his arm.

That means demanding more up-front education about drugs and their dangers to girls and boys before they start dabbling or using. That means educating their parents, or other caring adults, on the signs and symptoms of drug use in children.  That means demanding more funding for current facilities, and more drug-treatment centers for pregnant women who want help, but often can’t get it; Kentucky’s 55 such centers, most of them outpatient, are not nearly enough, either.

“Ultimately,” Kentucky Attorney General Jack Conway said, “it’s an issue that affects all of society.” So it is. And so it does.

Source: www.harlandaily.com  March 2014

I continue to be puzzled by an attitude that if something is difficult to enforce then we should abandon attempts and just legalize it. That is apparently the attitude of Oregon’s politicians (Republican and Democrat alike) and is reflected in the comments of the official spokesman for the government elites – The Oregonian – in its August 23 edition:

“Oregon has had a wink-wink, nudge-nudge relationship with recreational marijuana use since 1998, when legalization for medical purposes created a wide, open system that distributes pot cards to just about anyone with a vague medical claim and the signature of a compliant physician. We’re not suggesting that marijuana has no palliative value to those with genuine medical problems. But let’s be honest: Recreational marijuana is all but legal in Oregon now and has been for years. Measure 91, which deserves Oregonians’ support, would eliminate the charade and give adults freer access to an intoxicant that should not have been prohibited in the first place.”

There it is. The marijuana advocates foisted a canard on Oregonians by exploiting the plight of those benefiting from the use of medical marijuana. Having convinced Oregonians that those is need should not be denied, they set up a system that guaranteed abuses and then urged others to look the other way when the abuses became obvious and widespread. Wink, wink, nod, nod. There’s a solid foundation for change. (For those of you forced to endure a teachers union led education in Portland public schools, that is what is meant by “sarcasm”.)

And now the second canard is upon us with the assertion that “everyone is already doing it” and that recreational marijuana is not harmful. When the push began, those supporting it chanted “nobody has ever died from marijuana.” And that folks, is just plain bulls—t.

A New York Times article on May 31, 2014, noted:

“Five months after Colorado became the first state to allow recreational marijuana sales, the battle over legalization is still raging.

“Law enforcement officers in Colorado and neighboring states, emergency room doctors and legalization opponents increasingly are highlighting a series of recent problems as cautionary lessons for other states flirting with loosening marijuana laws.

“There is the Denver man who, hours after buying a package of marijuana-infused Karma Kandy from one of Colorado’s new recreational marijuana shops, began raving about the end of the world and then pulled a handgun from the family safe and killed his wife, the authorities say. Some hospital officials say they are treating growing numbers of children and adults sickened by potent doses of edible marijuana. Sheriffs in neighboring states complain about stoned drivers streaming out of Colorado and through their towns.”

On May 24, 2014, Newsweek reported:

“Wednesday’s move in Colorado to tighten rules on edible goods made with pot comes after two adult deaths possibly linked to such products. Meanwhile, a Colorado children’s hospital said it has seen an uptick in the number of admissions of children who ingested marijuana-laced foods since the start of the year.

“’Since the … legalization of recreational marijuana sales, Children’s Colorado has treated nine children, six of whom became critically ill from edible marijuana,’ the statement from Colorado Children’s Hospital said.”

And The Raw Story reported on April 2, 2014:

“A Wyoming college student visiting Colorado on spring break is the first reported death related to the legal sale of recreational marijuana.

“Levy Thamba, a student at Northwest College, fell to his death last month from the balcony of a Holiday Inn in Denver.

“Autopsy results released Monday showed the 19-year-old Thamba, who was also known as Levi Thamba Pongi, died from multiple injuries caused by the fall. But the coroner also listed ‘marijuana intoxication’ from a pot-infused cookie as a significant contributor to the student’s death.”

And finally, CBS reported from Seattle on February 4, 2014:

“According to a recent study, fatal car crashes involving pot use have tripled in the U.S.

‘Currently, one of nine drivers involved in fatal crashes would test positive for marijuana,’ Dr. Guohua Li, director of the Center for Injury Epidemiology and Prevention at Columbia, and co-author of the study told HealthDay News.”

But the Oregonian is undeterred by the mounting evidence of harm:

“Opponents of the measure are right about a couple of things. Allowing retail sales of recreational marijuana inevitably will make it easier for kids to get their hands on the stuff, as will Measure 91′s provision allowing Oregonians to grow their own. It’s also true that outright legalization will increase the number of people driving under the influence, which is particularly problematic given the absence of a simple and reliable test for intoxication. There is no bong Breathalyzer.

“As real as these consequences are, Oregonians should support outright legalization. . .”

We have imposed safety requirements on a whole host of things including guns, automobiles, golf carts, children’s toys and food products that have a lower incident rate of death and injury than is being currently compiled by the unrestricted use of marijuana. Oregon is now tying itself in knots trying to eliminate the use of genetically modified organisms (GMO) with no scientific evidence of harm and only a speculation as to what might become. But there is no apparent concern about the modification of marijuana to increase its potency which has resulted in numerous adverse health issues with children and adults alike.

And while the Oregonian acknowledges that there is no “simple and reliable test for marijuana intoxication” it fails to note that there is similarly no simple and reliable test for testing potency. There are no labeling requirements and no guidelines as to the limits of consumption and impairment. Contrast that with the liquor industry that has defined limits and labeling on the alcohol content of various beers, wine and liquors. There are exacting studies that demonstrate the effects of alcohol on a person given weight variations.

And yet the Oregonian ignores that in favor of addressing it sometime in the future – maybe.

And Oregon’s politicians are even less helpful because they are fixated on tax revenue opportunities from the unrestricted use of marijuana. Little thought is

being given to the problems that will be caused. Their sole focus is upon using regression analysis to determine how high the tax can be without seriously reducing the volume of consumption – it is the same myopic view used when determining the tax on tobacco. That amount of tax will increase over time as the use becomes more widespread and the dependency becomes more pronounced and as state government becomes more dependent on the revenue generated, the ability to correct the abuses of marijuana will be marginalized – just like tobacco.

In the end, this is all about the “me generation” and that pervasive attitude that “if it feels good, do it.” It furthers the myth of life without consequences. The only upside is for those who eschew getting high in favor of getting hired – your prospects for getting a good job and routine promotion are greatly enhanced.

Source: www.oregoncatalyst.com 27th August 2014

If medical marijuana is a step toward legalization, just make it legal — or at least decriminalize it — and don’t dump it all on doctors. Making physicians the gatekeepers of legal marijuana is not fair to doctors and is not conducive to public health.

The problem is that marijuana has been prescribed by the courts, not by health-care professionals.

“Dried marijuana is not an approved drug or medicine in Canada,” says the Health Canada website. “The Government of Canada does not endorse the use of marijuana, but the courts have required reasonable access to a legal source of marijuana when authorized by a physician.” Many physicians are reluctant to take on that responsibility.

“We have Health Canada telling us that marijuana is not a medicine, we have our malpractice insurance company telling us to be very cautious because nobody is taking responsibility for the safety of it,” says Dr. Chris Simpson, a Queen’s University cardiologist and incoming president of the Canadian Medical Association.

Simpson doesn’t dismiss marijuana — he says “many compelling anecdotes” indicate that marijuana can help patients with HIV, hard-to-treat seizures and other conditions. But, he adds, “we have people out there saying marijuana can cure cancer, which seems quite improbable.”

“Somewhere in between those two extremes is the truth, and I think we need to find the truth, and the way to do that is with the appropriate research.” Testifying before a parliamentary health committee in May, Dr. Meldon Kahan, medical director of the substance-use service at Women’s College Hospital in Toronto, detailed a long list of harmful effects from cannabis use. They included impairments in attention, increased anxieties, psychosis and cancer.

“Widespread cannabis prescribing by physicians will increase the social and psychiatric harms of cannabis,” Kahan said, calling for the development of evidence-based guidelines for prescribing smoked marijuana.

“Guidelines will give physicians solid grounds on which to make prescribing decisions. Physicians are facing a deluge of requests to prescribe cannabis, and guidelines will give them the support they need to refuse to prescribe cannabis when medically unnecessary or unsafe.”

Because Health Canada allows marijuana to be prescribed by physicians, that enhances the public perception that marijuana is not only harmless, but therapeutic.

“The evidence suggests otherwise,” Kahan said. “Smoked cannabis has negligible therapeutic benefits.” Would marijuana pass the scrutiny of the University of B.C.’s Therapeutics Initiative, established to examine the effectiveness of prescription drugs? It uses solid evidence and rigorous scientific research, and it has saved lives. Marijuana should undergo the same scrutiny as to its potential benefits and harms.

But medical marijuana is not treated the same as other drugs. Science has little to do with it.

“The current means of ‘prescribing’ violates all of the usual practices of medicine,” wrote Maryland psychiatrists Dinah Miller and Anette Hanson in a 2012 Baltimore Sun commentary. “What other medication do we authorize for a year, with no stipulation as to frequency, dose or certainty that there has been a positive response without side effects?”

If marijuana can relieve the agony of someone with severe chronic pain or terminal cancer, who would withhold it? But let’s face it, the biggest demand for pot is as a recreational drug, like alcohol and tobacco. It should be handled the same, with regulations as to its production and distribution. We should not clog our courts and jails with pot-smokers.

By all means, investigate its potential for good, but let’s not pretend it does no harm.

Source: http://www.timescolonist.com/opinion/editorials/editorial-don-t-pretend-pot-is-harmless-1.1304417#sthash.8ubjqn0w.dpuf 9th August 2014

Many of the Op-Eds on the subject of the legalisation or otherwise of cannabis are written by journalists or protagonists of one or other point of view. The following links give scientific evidence from scientist and medics in the USA, and do not support the use of cannabis.

News coverage about marijuana legalization is fairly predictable. If there’s even a toehold to support driving this addictive substance into the country, count on splashy headlines. Today’s breathless summaries of President Barack Obama’s remarks on the subject to The New Yorker were no exception.

The chief narrative spinning out at this hour boils down to this one quote from the President: “I don’t think it (marijuana) is more dangerous than alcohol.”

Cue the sampling of headlines appearing this evening on a Google search:

Fox News: “Marijuana no more dangerous than alcohol”
USA Today: “Obama: Pot no more dangerous than alcohol”
CNN: Obama says marijuana ‘no more dangerous than alcohol’
Huffington Post: “Obama: Marijuana no more dangerous than alcohol’
Time’s Swampland: “Obama says marijuana can be less dangerous than alcohol”
The (U.K.) Telegraph: “Barack Obama says smoking marijuana less dangerous than alcohol”
NPR: Marijuana is ‘not more dangerous than alcohol’

(Check out how this article conveniently lops off the President’s most critical remarks about marijuana — and asks readers to click over to The New Yorker to see those.)

Then there’s this from Time: “Obama on Marijuana Legalization: ‘It’s important for it to go forward.’”

Now, take a look at the full passage to which these news organizations — and many others — were reacting. It appears at the bottom of this post. The President expresses a fair amount of skepticism about marijuana legalization — but you wouldn’t know that if you’re just skimming the headlines and stories rocketing around the world at this hour.

Why no headlines screaming that the President called the case for marijuana legalization “overstated?” Why aren’t news organizations trumpeting that he called marijuana use a “bad idea, a waste of time, not very healthy.” Where are the headlines about the President’s acknowledgement that marijuana legalization could lead to a slippery slope of negotiated doses of cocaine and finely calibrated doses of meth?

After all, the President has to know the nation’s largest marijuana-advocacy groups already are laying the groundwork for full-scale recreational drug legalization that includes psychedelics, meth and cocaine. This is no secret. They’ve been at it for decades. Just a few months ago, Ethan Nadelmann, executive director of the Drug Policy Alliance, led what amounted to a pep rally for recreational drug lovers. Among his rah rah sis boom bah:

“What is it we’re fighting for? Is it simply to legalize it all … some of us, yes, some of us, yes. Some of us believe deeply in our hearts that the best way to treat every drug is the way we treat alcohol and cigarettes today. And we may in fact be right. But what I also know is that to make that argument to the broader public, the public who has engaged and accepted that marijuana should be legally regulated, that we need to hold their hands and engage them into a different basis.”

Nadelmann followed up with this: “We’re not just a movement or people who like marijuana and relish our psychedelics … all the other drugs we enjoy, and we do so responsibly.”

Let’s ask President Obama what he thinks about all of that — and let’s demand the clear and straight answers we’re not getting from him.

While reporters eager to make the case that using weed is much like having a glass of wine or craft beer with a meal spin like tops, far more astute observers see very clearly what’s going on here: the President is playing both sides of a fence. Even some staunch legalization advocates bemoaned his waffling remarks, calling his position on marijuana “incoherent.” Again, judging from today’s giddy and incredibly myopic news coverage, you’d think he was crystalline.

Similarly, smart and responsible journalists will stop the cheerleading for weed — and the stenography — and doggedly question the President’s easy-breezy comparisons of marijuana and alcohol. He’s got opinions, but does current, reputable science support them? Not really, especially if we’re talking child health. Today’s marijuana is at least 10 times more potent than the strains the President recalls using when he was a teenager and young adult. The President — and everyone else basing their opinions on their experiences in the 1960s, ’70s, ’80s and ’90s — must also stop to consider highly concentrated and increasingly popular forms of marijuana called “hash oil.” Doses of that oil often exceed 80 percent THC. That’s a far cry from the weed of Woodstock, which contained 1-3 percent THC, and the marijuana of around 8 percent THC the President used in the 1980s. This is obvious, and it’s worth mentioning.

Also worth mentioning? Kids take their cues from adults — especially adults they admire, like President Obama. So, when he says he doesn’t think marijuana is more dangerous than alcohol, is he stopping to consider what our nation’s health — specifically our nation’s child health — would look like if adolescent marijuana use rates caught up with youths’ use rates of alcohol? The rest of us should certainly stop to think about that — and let’s not wait for news organizations to get around to the reporting. Review the University of Michigan’s Monitoring the Future study for yourself. In 2013, 22.7 percent of high school seniors reported past-month use of marijuana compared to 39.2 percent of seniors who said they used alcohol in the previous 30 days.

Another elephant in this room? The President’s senior drug policy advisors at the White House Office of National Drug Control Policy and the National Institute on Drug Abuse are not on board with marijuana legalization — and it sure would be interesting to know what they make of the President’s comparison of marijuana and alcohol. Similarly, it would be great to know what they think of the President’s remark that it’s “important” for efforts to legalize recreational marijuana in Colorado and Washington — which he also said would be “a challenge” — to move forward. When is it also going to be just as important for these states to pull the plugs on their grand experiments? How much death and destruction must be recorded to make those determinations? Whatever those limits are, it’s probably safe to say the President will be out of office when our country faces them.

At least President Obama makes clear he wants to reform laws that perpetuate racial and ethnic disparities and punish addiction more than treat it. That, too, is a case wildly overstated by marijuana supporters — and the President, having very easy access to public records and advisors who routinely present this information to communities across the country, probably knows this, too. But good for him. Many drug-prevention groups — such as Smart Approaches to Marijuana, or Project SAM — stand with him there. I strongly suspect the President knows marijuana legalization is not at all necessary to make those reforms — so it’s worth asking him what he’s waiting for. Why not champion reform now? We can certainly make changes without compromising the interests of public health and safety.

On the issue of marijuana legalization, President Obama needs to get serious because, whether he likes it or not, pot — especially as the drug harms American youth in greater numbers — is fast becoming a very big part of his legacy and grossly undermining his stated goals for reforming healthcare and education. He needs to lead — and that guidance for our nation must be rooted in much, much more than his opinions and personal experience.

Christine Tatum is a former staff writer for The Denver Post, Chicago Tribune, (Arlington Heights, Ill.) Daily Herald and (Greensboro, N.C.) News & Record. She was elected to serve as 2006-07 national president of the Society of Professional Journalists.

Global reaction:

The United States has staggering problems with alcohol and is failing to control its use and harm — which is all the more reason marijuana legalization is a bad idea for the U.S. and the world, writes Sven-Olov Carlsson, intentional president of IOGT International, in this open letter to President Obama. The IOGT is the world’s largest body of drug-prevention-and-policy advocates.

The President’s remarks on marijuana legalization as reported by The New Yorker:

“When I asked Obama about another area of shifting public opinion—the legalization of marijuana—he seemed even less eager to evolve with any dispatch and get in front of the issue. “As has been well documented, I smoked pot as a kid, and I view it as a bad habit and a vice, not very different from the cigarettes that I smoked as a young person up through a big chunk of my adult life. I don’t think it is more dangerous than alcohol.”

“Is it less dangerous? I asked.

“Obama leaned back and let a moment go by. That’s one of his moves. When he is interviewed, particularly for print, he has the habit of slowing himself down, and the result is a spool of cautious lucidity. He speaks in paragraphs and with moments of revision. Sometimes he will stop in the middle of a sentence and say, ‘Scratch that,’ or, ‘I think the grammar was all screwed up in that sentence, so let me start again.’

“Less dangerous, he said, ‘in terms of its impact on the individual consumer. It’s not something I encourage, and I’ve told my daughters I think it’s a bad idea, a waste of time, not very healthy.’ What clearly does trouble him is the radically disproportionate arrests and incarcerations for marijuana among minorities. ‘Middle-class kids don’t get locked up for smoking pot, and poor kids do,’ he said. ‘And African-American kids and Latino kids are more likely to be poor and less likely to have the resources and the support to avoid unduly harsh penalties.’ But, he said, ‘we should not be locking up kids or individual users for long stretches of jail time when some of the folks who are writing those laws have probably done the same thing.’ Accordingly, he said of the legalization of marijuana in Colorado and Washington that ‘it’s important for it to go forward because it’s important for society not to have a situation in which a large portion of people have at one time or another broken the law and only a select few get punished.’

“As is his habit, he nimbly argued the other side. ‘Having said all that, those who argue that legalizing marijuana is a panacea and it solves all these social problems I think are probably overstating the case. There is a lot of hair on that policy. And the experiment that’s going to be taking place in Colorado and Washington is going to be, I think, a challenge.’ He noted the slippery-slope arguments that might arise. ‘I also think that, when it comes to harder drugs, the harm done to the user is profound and the social costs are profound. And you do start getting into some difficult line-drawing issues. If marijuana is fully legalized and at some point folks say, Well, we can come up with a negotiated dose of cocaine that we can show is not any more harmful than vodka, are we open to that? If somebody says, We’ve got a finely calibrated dose of meth, it isn’t going to kill you or rot your teeth, are we O.K. with that?’”

Source: Dr.Thurstone.com Jan.19^th 2014

Powdered alcohol was approved by a government agency on Tuesday, The Washington Post reports. The product, called “Palcohol,” could arrive in stores this summer. Last year the Alcohol and Tobacco Tax and Trade Bureau (TTB) approved labels for powdered alcohol. It then said the approval had been a mistake.

Lipsmark, the company that makes Palcohol, plans to sell four powdered products: cosmopolitan, margarita, a vodka and a rum, the article notes. The product will be sold in foil pouches that can be used as a glass. A person pours in five ounces of water, zips up the bag and shakes it until the powder dissolves.

Several states, including Louisiana, South Carolina and Vermont, have banned the use/sale of powdered alcohol, and a number of other states are considering similar legislation.

U.S. Senator Charles Schumer of New York introduced a bill last year to ban powdered alcohol. Last May Schumer urged the Food and Drug Administration (FDA) to prevent federal approval of powdered alcohol. He said it could become “the Kool-Aid of teen binge drinking.” Schumer noted the product can be mixed with water, sprinkled on food or snorted. He asked the FDA to investigate the potential harmful effects of the product.

In a statement released last May, Mothers Against Drunk Driving (MADD) said it agreed with Schumer. “This product is the latest in a long list of specialty alcohol fads,” MADD said. “As with anything ‘new,’ this product may be attractive to youth. … In the case of Palcohol, we share Senator Schumer’s view that the U.S. Food and Drug Administration should carefully review this product as it would seem to have the potential to increase underage drinking.” The FDA approved powdered alcohol last summer, the article notes.

Source: www.drugfree.org 12^th March 2015

For decades, the Netherlands has been known for its tolerant cannabis laws – the poster nation for pro-pot advocates. Cannabis users from across the world have flocked to Amsterdam to patronize its many cannabis-selling “coffee shops.” Throughout this time cannabis has remained illegal in the Netherlands; although, the Dutch have not prosecuted anyone in possession of less than five grams of cannabis for personal use. This distinctive drug policy of tolerance toward cannabis is called gedoogbeleid, and known as the “Dutch model.”

Now, the U.S. now is the first, and so far the only, nation in the world to have fully legal production, sale, promotion, and use of cannabis for people 21 an older. In stark contrast, the Dutch are moving in the opposite direction, limiting the growth, distribution, and use of cannabis and showing no interest in “medical marijuana.” Cannabis with a THC level of more than 15 percent is now under consideration to be reclassified as a “hard drug.” In the Netherlands, that designation comes with stiff criminal penalties. Furthermore, the nation once had more than 1,000 coffee shops, 300 in Amsterdam alone. Now, there are fewer than 200 in the city and 617 nationwide. This is the result of the government’s actions to force coffee shops to choose either to sell alcohol or marijuana. Notably, many are choosing to sell alcohol.

While it has always been illegal to grow cannabis in the Netherlands, for years police acted as if they didn’t know where the shops were getting the drug. This is no longer the case. Now, new laws target even the smallest cannabis growers. In the past, anyone could grow up to five plants without fear of penalty. In 2011, the government issued new police guidelines declaring that anyone who grew cannabis with electric lights, prepared soil, “selected” seeds or ventilation would be considered a “professional” grower. This is a significant change because professional growers risk major criminal penalties, including eviction and blacklisting from the government-provided housing in which more than half of the country’s citizens reside.

What made the Netherlands make such a strong shift in its cannabis policy? The overall drug policy of the Netherlands – not just for cannabis but including cannabis – has four major objectives:

1. To prevent recreational drug use and to treat and rehabilitate recreational drug users.

2. To reduce harm to users.

3. To diminish public nuisance by drug users (the disturbance of public order and safety in the neighborhoods).

4. To combat the production and trafficking of recreational drugs.

The Netherlands has determined that its relaxed cannabis laws were a threat to these expressed public health objectives. The nation’s new, more restrictive laws on cannabis, including the banning of cannabis with THC levels of 15 percent or more, demonstrate that the government wants to reduce cannabis sale and use for reasons of public health.

As the legalization of medical and recreational marijuana spreads to more states in the U.S., we need to look anew to the Netherlands. The U.S. can benefit from what the lessons the Netherlands has learned about cannabis over the past four decades. How surprising is it that the American media frequently praised the Dutch cannabis policy when it seemed permissive but now that Dutch have become more restrictive their new cannabis policy is ignored?

Robert L. DuPont, M.D.

President, Institute for Behavior and Health, Inc.

Former Director, National Institute on Drug Abuse (1973-1978) Former White House Drug Chief (1973-1977)

Source: www.ibhinc.org 15^th March 2015

However the following information shows this substance is far from harmless and more and more users are seeking treatment to help them give up.     NDPA  March  2015

The emerging cannabis treatment population:

http://www.emeraldinsight.com/doi/abs/10.1108/DAT-01-2014-0005?journalCode=dat 

Shootings in New York City have gone up nearly 20 percent in the past year, NYPD Commissioner Bill Bratton announced on March 3, saying that marijuana legalization and the loosening of restrictions across the United States are partly to blame.

Bratton referred to marijuana as “the seemingly innocent drug that’s been legalized around the country,” and says that yes, it’s connected to a rise in shootings. He’s not off the mark. In Colorado, Pueblo County Sheriff Kirk Taylor in Colorado noticed an uptick in crimes, and he’s now tracking the link between crimes and marijuana.

In New York City, marijuana is not legalized, but it has been decriminalized to some degree and the NYPD has stopped arresting people with small amounts of marijuana on their person.

“It is ironic that in a city which is a transfer point for huge amounts of drugs . . . heroin, cocaine, hallucinogens, that one drug [that] is actually the causal factor in so much of our shootings and murder is marijuana,” Bratton said. “We just see marijuana everywhere when we make these arrests, and get the guns off the street.”

Watch WABC’s report, along with Bratton’s remarks, in the video.

Murders revolving around marijuana occur in Washington and Colorado. A week ago in Steamboat Springs, a man with an indoor marijuana grow was robbed and murdered. Two have been charged. The black markets are also alive and well in both Washington and Colorado, as a New York Times article explains.

Please share this post with every concerned parent you know! Spread the Word about Pop Pot! Parents Opposed to Pot is a non-partisan grassroots campaign started by parents concerned about the commercial pot industry and its devastating impact on youth and communities. We write anonymously to explore these important issues and protect the privacy of our bloggers. We are totally funded by private donations, rather than industry or government. If you have an article to submit, or want to support us, please go to Contact or Donate page

Source: http://www.poppot.org/2015/03/09 9th March 2015

From:

Advisory Council on the Misuse of Drugs

First published: 27 November 2014

Last updated: 25 March 2015 , see all updates

Part of: Drug misuse and dependency

Report presented to the crime prevention minister recommends a revised generic description, designed to control a broad-range of ‘third generation’ synthetic cannabinoids.

Documents

‘Third generation’ synthetic cannabinoids    –  PDF, 611KB, 29 pages

Addendum to report on ‘third generation’ synthetic cannabinoids   –  PDF, 21.1KB, 2 pages

Among the 137 people who completed the study, the number of seizures fell by an average of 54 percent, according to a team led by Dr. Orrin Devinsky, of New York University Langone Comprehensive Epilepsy Center in New York City.

Keep in mind that Epidiolex is VERY different than the so-called low THC strains of marijuana (also known as Charlotte’s Web) that are being grown and sold in several states. Unlike Epidiolex, the strains of marijuana are not cloned and the end products vary widely. Most importantly, these strains contain varying levels of THC whereas Epidiolex is virtually pure CBD.

Liquid Medical Marijuana Shows Promise for Epilepsy

A liquid form of medical marijuana may help people with severe epilepsy that does not respond to other treatments, according to a new report.

The study included 213 child and adult patients with 12 different types of severe epilepsy. Some of them had Dravet syndrome and Lennox-Gastaut syndrome, which are types of epilepsy that can cause intellectual disability and lifelong seizures.

The patients took a liquid form of medical marijuana, called cannabidiol, daily for 12 weeks.

Among the 137 people who completed the study, the number of seizures fell by an average of 54 percent, according to a team led by Dr. Orrin Devinsky, of New York University Langone Comprehensive Epilepsy Center in New York City.

Among the 23 patients with Dravet syndrome who completed the study, the number of convulsive seizures fell by 53 percent, the investigators found. The 11 patients with Lennox-Gastaut syndrome who finished the study also had a 55 percent decline in the number of attacks called “atonic” seizures, which cause a sudden loss of muscle tone.

The drug wasn’t always easy to take, however, and 12 patients stopped taking it due to side effects, the researchers said. The types of side effects seen in more than 10 percent of the patients included drowsiness (21 percent), diarrhea (17 percent), tiredness (17 percent) and decreased appetite (16 percent).

The study was supported by drug maker GW Pharmaceuticals. The findings are scheduled to be presented next week at the annual meeting of the American Academy of Neurology (AAN) in Washington, D.C. Experts note that findings presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal

Devinsky agreed that larger, placebo-controlled studies are needed to assess the effectiveness of the drug.

“So far there have been few formal studies on this marijuana extract,” he said in an AAN news release. “These results are of great interest, especially for the children and their parents who have been searching for an answer for these debilitating seizures.”

One expert unconnected to the study called the findings “very exciting.”

“Prior to this study, there were mainly anecdotal reports and very few formal studies evaluating cannabidiol, a component of cannabis, in treating seizures,” explained Dr. Scott Stevens, director of Advanced Clinical Experience in Neurology at North-Shore-LIJ Health System in Manhasset, N.Y.

Stevens believes that “these results stand as a stepping stone toward further studies evaluating the use of marijuana in the treatment of epilepsy.”

Source:http://www.webmd.com/epilepsy/news 13/04/2015 (HealthDay News

Funded by a five-year, $7 million federal grant, the University of Illinois at Chicago College of Medicine will create a new center, the first of its kind, to study the effect of long-term alcohol exposure on genes.

The National Institute on Alcohol Abuse and Alcoholism, one of the National Institutes of Health, awarded the funding to establish a Center for Alcohol Research in Epigenetics (CARE). Subhash Pandey, UIC professor of psychiatry, will direct the center.

“Epigenetics” refers to chemical changes to DNA, RNA, or specific proteins, that change the activity of genes without changing the genes themselves. Epigenetic changes can occur in response to environmental or even social factors, such as alcohol and stress — and these changes have been linked to changes in behavior and disease.  Epigenetics plays a role in the development and persistence of neurological changes associated with alcoholism, says Pandey, who is director of neuroscience alcoholism research at UIC and research career scientist at the Jesse Brown VA Medical Center.

The CARE researchers will investigate how alcohol-related epigenetic changes influence gene expression and “synaptic remodelling” — the networking of nerve cells to each other. They will also look closely at how these changes correlate with behavior, such as anxiety and depression, and whether epigenetics may play a role in the withdrawal symptoms that make abstinence difficult.

“This award will allow the College of Medicine to build on Professor Pandey’s exemplary research on chronic alcohol use and alcoholism in addition to bolstering our leadership in understanding the causes of alcoholism as well as finding new ways to treat this devastating disease,” said Dr. Dimitri Azar, dean of the University of Illinois College of Medicine.

In a recent study using an animal model, Pandey and colleagues at UIC found that epigenetic changes resulting from exposure to alcohol during adolescence were associated with abnormal brain development and anxiety and alcohol preference in adulthood. In earlier work, the researchers were able to show that reshaping of the DNA scaffolding that supports and controls the expression of genes in the brain may play a major role in alcohol withdrawal symptoms, particularly anxiety.

Several brain regions play a crucial role in regulating both the positive and negative emotional states associated with alcohol addiction. Pandey said the center will look at the circuitry involved in reward and pleasure, depression, cognition, and anxiety.  CARE researchers will study disease using preclinical animal models and post-mortem examination of human brain. Investigators will also do neuroimaging of patients diagnosed with alcohol abuse and dependence and search for “biomarkers” of alcoholism — measurable indicators in blood that correlate with alcohol addiction.

There are two causes of dependence on alcohol, said Pandey — people may drink to get pleasure, or to self-medicate to relieve depression or anxiety. But alcohol addiction may itself cause depression and anxiety, feeding into a cycle.

“Ultimately, we hope these studies may lead to the identification of molecular cellular targets and gene networks which can be used to develop new pharmacotherapies to treat or prevent alcoholism,” Pandey said.

UIC’s CARE is the only NIH-funded alcohol research center in Illinois, said Dr. Anand Kumar, Lizzie Gilman Professor and head of psychiatry, and is “well positioned to perform state-of-the-art basic translational and clinical research in alcoholism.”

In addition to its research projects, CARE will provide resources for training and community outreach. Based in the UIC psychiatry department, it includes collaborators from biophysics and physiology, anaesthesiology, the Jesse Brown VA Medical Center, and the University of Illinois Urbana-Champaign campus.

Source: http://www.newswise.com/articles/view/632573/?sc=dwtn   13th April 2015

Those using strong strains of illegal drugs such as cannabis skunk, or the illegal use of prescription drugs are risking their mental health and the lives of others. Suicidal thoughts are not unknown and this letter from a doctor discusses the problems of confidentiality versus life saving – of the patient or others.

To the Clinicians of the Co-Pilot of Germanwings Flight 9525

Dear German Medical Colleagues,

Please bear with me through this rather long letter. There is so much that I have been wondering and worrying about—including you.

I may never know who you are, but if you provided medical or psychiatric care for Andreas Lubitz, co-pilot of Germanwings Flight 9525, we are colleagues. Whether you saw Mr Lubitz years ago or more recently, or whether you saw him privately or as an airline-appointed medical examiner, you had some responsibility for his care.

And you too are his victims, of sorts. I hope your reputation does not suffer unduly. I hope PTSD does not develop as a result of his apparent suicide. If you provided ethical care (ie, competent care), I hope you are not scapegoated. “Monday morning quarterbacking”—an American football saying about reviewing a game the day after it is played—is always so much easier than preventing problems in real time.

After all, if reports of Mr Lubitz taking an injectable antipsychotic during training in 2009 are true, that doesn’t for sure mean that he had an ongoing or intermittent psychosis. Maybe, just maybe, it could have been a short-acting injection for acute agitation due to extreme stress and/or drug abuse. Similarly, treatment back then for an “episode” of “severe” depression could have seemed to be a one-time episode.

On the other hand, there are reports that Lubitz saw psychotherapists “over a long period of time.” Those psychotherapists probably knew the patient best, especially if he had a particular personality disorder or significant traits of concern (eg, undue narcissism, paranoia).

We have not yet heard anything about whether Lubitz had PTSD, but people with this disorder can appear normal. Perhaps the co-pilot dissociated as he crashed the airplane, which would have allowed him to ignore for minutes the passengers’ screams and the banging on the door of the cockpit. That could account for the fact that voice recording picked up no triumphal shouts, only his steady breathing.

This analysis is all speculation, of course. Maybe it’s the kind of “wild analysis” that Freud so deplored.

I do not know how prominent so-called “anti-psychiatrists” are in Germany, but if they are anything like they are here in the US, they are likely to blame psychiatric medication for the co-pilot’s bizarre and tragic behavior. Of course, they could well have a point. Some antidepressants, which can cause visual side effects, were prescribed for Mr Lubitz, agents perhaps, that we don’t in the US.

We know he was concerned about his vision, but speculation so far is that this complaint was psychosomatic. In addition, sudden withdrawal from some antidepressants can lead to increased agitation. Moreover, antidepressants can trigger a (hypo)manic episode, although of course a manic episode can occur that leads to grandiosity and agitation. On the other hand, no one seems to have described such changes in Mr Lubitz before the crash.

Therefore, I hope your medical documentation was good—better than mine usually was. I hope you documented your risk assessment adequately. If you were unsure of what to do, I hope you obtained consultation and/or supervision. If you worked in a system of care, I hope they adequately monitored the quality of care you provided.

I understand that your medical privacy laws are much more stringent than our patchwork of state and national privacy laws are here in the US, both in life and in death. I heard that you can be imprisoned for up to 5 years for not following strict standards of patient confidentiality. Perhaps that prevented you from contacting Lufthansa instead of just giving the patient an unfit-for-work note, which he subsequently tore up. That, and other reasons, may be causing you to bite your tongue to offer further explanation.

I wonder if your stringent privacy laws are a reaction to the breaches of physicians when the Nazis ruled, as well as the subsequent invasion of privacy in East Germany. Are they an overreaction that needs some degree of correction? After all, airline safety is good, and this may have been a perfect confluence of various factors. Further, to exacerbate our existential anxiety, we have the unexplained disappearance of the Malaysian airliner from just about 2 years ago. Was there a copycat aspect to the Germanwings crash?

All medical colleagues must weigh risk to others against the need for patient confidentiality. This can include whether to divulge patient information such as highly contagious diseases like AIDS or Ebola; abuse of a minor or domestic violence; driving while impaired; carrying a gun; running a nuclear power plant; and being responsible for all kinds of public transportation and safety.

Maybe you wish you could talk and give condolences to those who lost family and friends on the doomed airliner. That would be the human thing to do, but perhaps you can’t?

As psychiatrists, suicide and homicide are essentially our only life and death challenges. So when a patient commits suicide and kills 149 others at the same time, what could feel professionally worse?

Yet we all know that we are not particularly successful at predicting actual suicide or homicide. Complicating that, someone troubled who decides that his or her solution is suicide and/or homicide often seems surprisingly well right before the act. He or she is relieved, having decided on the solution to his problems. We must appreciate our limitations.

Everyone wants to know the co-pilot’s motivation. So do I. But nothing is convincing yet about why he would make sure to kill everyone on board. Way back when, I was taught that in general, suicide was motivated by a desire to die, to kill, and/or be killed. This is a rare example of all—a triple play.

We may need system and cultural changes to how we approach some aspects of mental illness, such as the Air Force Suicide Prevention Program in the US. This program has significantly reduced suicide attempts as well as violence to others.

We and our psychiatric patients are stigmatized in many countries. If such stigma can cause inadequate attention to mental health in routine annual check-ups, no wonder mental health examinations are inadequate for airline pilots.

Complicating our work is the denial, lack of insight, and/or loss of memory among some of our patients. The people that we (clinicians and the public) need to fear most (ie, sociopaths) can be the best at hiding the risk they pose. Periodic research about faking psychiatric symptoms in the emergency department indicates how easily we, in our quest to be helpful, can be fooled. We don’t have corroborating lab tests to fall back on, unlike in other areas of medicine.

During my career, I evaluated and treated a fair number of pilots. Almost always, we grappled with the implications of getting treatment and taking medication. What might help their mental problems might, at the same time, cost them their job, and thereby worsen their mental health. No wonder so many pilots hide psychiatric treatment from their employers.

Who knows? Maybe some of you who treated him didn’t even know that Andreas Lubitz was a pilot. We often know little about the real day to day lives of our patients. Maybe we need to know more.

About a century ago, Freud concluded that his was “an impossible profession.” This may well still be so. The burnout rate of physicians and psychiatrists in the US is over 50%. Know that.

I appreciate why we may never hear your side of the story. That may be a shame, for you probably have much to teach us and can transform some of our fantasies into reality.

In terms of our ethical responsibilities to each other, we are indeed our brothers’—and sisters’—keepers. In that regard, let me know if there is anything more I should know or do.

Your colleague,
H. Steven Moffic, MD (Steve)

Source: Psychiatric Times psychiatrictimes@email.cmpmedica-usa.com 16^th April 2015

Should heavy drinking in pregnancy be a crime? A recent test case in the UK was thrown out, but in the US hundreds of women have been imprisoned. We meet women and children affected by foetal alcohol syndrome

I’d had problems all my life and I didn’t know why,’ says Stella, who found out at 19 that she has foetal alcohol syndrome.

Stella was 19 when she discovered she has foetal alcohol syndrome. “I found out in a horrible way, to be honest,” she says. She had taken her boyfriend to meet her father for the first time. Stella and her father had only limited contact, but her boyfriend hoped that he might help to explain some of Stella’s erratic, unreliable behaviour, and asked him upfront, “What’s wrong with your daughter? Why is she the way she is?”

“That’s when he paused, and he breathed, and he said it,” Stella says, still distressed at the memory of the conversation. “I was shocked. I asked, ‘Why wasn’t I told about it?’ He said he didn’t want me to dwell on something like that.

“My heart felt like it was jumping out of my mouth,” the 25-year-old remembers. “It killed me inside. Why have I lived all my life without knowing about it? It was a really bad time.”

Stella and I arrange to meet at her friend’s flat, and she arrives two hours late, hugely apologetic that she forgot all about it. She tells me she has struggled with timekeeping all her life. Articulate and thoughtful, she gives no real indication of having the disorder, aside from occasionally trailing off and losing her train of thought, asking, “What was I just saying there?” But she describes how catastrophically her life has been affected by the legacy of her mother’s drinking.

Foetal alcohol spectrum disorder (FASD) is the umbrella term for a range of birth defects associated with drinking in pregnancy. At the extreme end of the spectrum is foetal alcohol syndrome (FAS), a very rare condition caused by heavy or frequent alcohol consumption during pregnancy. FAS can cause a range of physical and cognitive problems. Some babies are born with facial abnormalities – thin upper lips, a flatter area between the lip and the nose, smaller eyes. Babies with both FAS and FASD are often smaller than other babies, and typically remain small throughout their lives. Some children may have no physical signs of the condition, but a range of developmental disorders – attention deficit, hyperactivity, poor coordination, language problems and learning disabilities. There is no reliable research on how common it is in the UK; some doctors believe FAS may affect one child in 1,000, and FASD between three and four times more. Adolescents and adults with FASD are overrepresented in the criminal justice system.

Stella spent much of her childhood in care, until she was 11, when her aunt took her in. Her mother died before her father broke the news, so she was never able to ask her about the past. Instead, she went to her GP, who looked at her files. “She said, ‘Yes, you do have this. Your mum was a heavy alcoholic.’” The GP printed out a document that said Stella had been diagnosed in 1993, aged three.

She took to researching the condition online. “It described things that made sense,” Stella says. “All my life, things had been happening to me, and it was suddenly explained. I’m not good with organisation, bills, day-to-day things. I can’t read and write. I’m not good at maths. I’d had these problems and I didn’t know why.” She has never had a job and wonders if she would manage. “I want everything to be simple. If it isn’t, my head feels scattered. I can’t focus. I can’t concentrate.”

Women shouldn’t be prosecuted – they should be given alcohol rehabilitation

At the end of last year, a controversial British court case hinged on whether a woman should be considered to be committing a crime if she drinks heavily during pregnancy. The case looked at whether the council caring for a seven-year-old girl with FAS was entitled to extract compensation from the Criminal Injuries Compensation Authority on her behalf. Lawyers examined the legal rights of an unborn child and asked whether alcohol consumption by the mother constituted the crime of poisoning.

The court of appeal ruled in December that the mother, who inflicted lifelong damage on her child by consuming large quantities of alcohol while pregnant, had not committed a criminal offence, and that her daughter was not, therefore, entitled to compensation. To date, no woman has been prosecuted under English law for harm she caused to her child in utero, but hundreds of women in the US have been imprisoned for drinking or taking drugs during pregnancy. And the legal battle here is far from over; lawyers representing the seven-year-old (who remains anonymous), and around 80 other children affected by FASD, are considering whether to pursue the case in the supreme court.

We’re not talking here about the effects of drinking a couple of glasses of wine at a friend’s wedding. The test case involved a woman who drank, by her own account, half a bottle of vodka and several cans of strong lager daily. But there is a growing sense among politicians and doctors that drinking during pregnancy is an issue that is not taken seriously enough. In Westminster, politicians have been debating whether official guidance over drinking in pregnancy is sufficiently clear. The Royal College of Obstetricians & Gynaecologists recently hardened its advice, saying women should avoid alcohol altogether in the first three months of pregnancy. NHS Choices, the government’s health advisory website, states that the UK chief medical officers’ advice is that abstinence is best, but adds, “If they do choose to drink, to minimise the risk to the baby, we recommend they should not drink more than one or two units once or twice a week and should not get drunk.” The chief medical officer for England is currently reviewing these guidelines.

Lost in all these discussions, however, have been the voices of adults affected by the condition, and those of mothers who have given birth to, and brought up, children with FAS. Among them, there is little appetite for further stigmatising of mothers. But there is agreement that pregnant women need clearer guidance and help, and that affected children need much more support.

Stella thinks she can identify in herself the facial characteristics that sometimes go with the condition (although they are not discernible to others, or me; she looks lovely). But, she says, “It is more mental. I am not capable of doing things. I was hyperactive when I was young. I never listened. I got picked on a lot at primary school; there was a lot of spiteful behaviour. I went to a special needs secondary school – that was better – but I should have had more support as a teenager.”

Although she finds it painful to talk about her childhood, Stella is determined to raise awareness of the syndrome. Recently, she has spoken at conferences arranged by support group the National Organisation for Foetal Alcohol Syndrome (Nofas), which has helped find a charity that provides regular support sessions, allowing her to live independently: “They help with finances and forms, things I am not capable of doing.”

Stella feels ambivalent towards her mother. “I feel some sort of hate and some sort of love,” she says. “I want to be able to go back and ask her questions – questions that will never be answered, because she is dead.” She wishes she had known earlier what the cause of her difficulties was, but she is clear that moving towards prosecuting women is not the right answer. “What difference will it make? She hasn’t committed a crime – she has an issue with alcohol.”

No woman I have met ever wants to harm her baby. This is an illness, not a choice

 Laura has two sons with FASD: ‘I need to make sure this doesn’t happen to other people.’ Photograph: Sophia Spring for the Guardian

Laura has two teenage sons who were diagnosed with FASD a few years ago. She was pregnant with them in the 1990s, when – as she remembers it – there was real ambiguity about the levels of safe alcohol consumption for pregnant women, and she doesn’t remember being confronted by her midwives. Her partner was violent, she was beaten during the first pregnancy, and had panic attacks. “I was a social drinker, but increasingly I was using alcohol to cope. I went to all my appointments, they were aware that I drank – I was drinking beer, mainly, Holsten Pils. The midwife knew I was a four-times-a-week drinker.”

Laura’s first pregnancy progressed without any problems, and she “gave birth to a beautiful child”. Over the next few years, her relationship with the child’s father deteriorated, she lost her job and her home, and began to drink more and more. By the time she was pregnant with her second son, she was an alcoholic. “I had to go into hospital early, and by that time I was drinking 24/7 – mainly beer, a few cans a day, not massive binges. But nobody mentioned the drink: not the doctors, not the midwives. They didn’t advise about the risk of FAS. I had no suspicion that my child could be affected.”

Her second son was born a few weeks prematurely. Neither child had any of the physical features of FAS, and both went to mainstream schools, but their behaviour was very challenging. Gradually, as her life became more stable and she stopped drinking, Laura began to be aware that both her sons had serious issues.

Her younger son had learning difficulties and was diagnosed with ADHD. She had taken him to a hospital appointment and was carrying his notes from one doctor to another, when she spotted a note on his file that said: “Possible FAS.”

“I was devastated,” Laura says. “I knew in my gut that’s what it was.” Both children were later given a formal diagnosis at Great Ormond Street hospital.

Laura is dynamic and energetic; she has a good job now, as she did when she was first pregnant. We meet in a cafe near Hampstead Heath in London, at teatime, and it soon becomes obvious from the discreet twitching of other customers’ heads that her calm, powerful account of this rarely discussed subject has them all engrossed.

She knows people will blame her for her actions, and is very conscious of her own responsibility for her sons’ difficulties, but she is adamant that mothers need support, not criminalisation. “There is sometimes a witch-hunt to go after the mothers, but I am living with my guilt every day. That’s a real life sentence.” She has coped by devoting herself to making sure her sons get all the support they need, and by volunteering to help other mothers who also drank during pregnancy, through the European Birth Mother Network.

“I need to make sure this doesn’t happen to other people,” Laura says. “Women shouldn’t be prosecuted – they should be given alcohol-rehabilitation services. No woman I have ever met ever wants to harm her baby. This is an illness, not a choice. But people need to be told if they do drink, what will happen. There aren’t enough clear guidelines. I think midwives are scared sometimes to confront women.”

Although Laura drank more during her second pregnancy, she thinks her older child has struggled more with the consequences of his condition. “My younger son got support earlier. For the older one, it was harder – we didn’t understand, so he was always being told, ‘You are awful – why do you behave like that?’ He had an organic brain injury; he couldn’t read people’s facial expressions, he had problems with social skills, he was overwhelmed by noise. We didn’t understand that.”

“There is a witch-hunt to go after the mothers, but I am living with my guilt every day. That’s a real life sentence”

Twenty years on from Laura’s pregnancy, the medical guidance is still confusing and contradictory. There are those, such as paediatrician and former children’s commissioner Sir Al Aynsley-Green, who argue for total abstinence. “Exposure to alcohol before birth is the most important preventable cause of brain damage in children, that could affect up to one in every 100 babies in England,” he says. “Its effects range from devastating physical and learning disabilities to subtle damage causing bad behaviour, violence and criminality.”

At the other end of the spectrum are groups such as the British Pregnancy Advisory Service, who point out that most women are already very sensible and warn against demonising their behaviour. According to BPAS, the main consequence of publishing excessively frightening advice is that women come to its clinics unnecessarily considering abortions, concerned about damage they might have inflicted on their foetus before they knew they were pregnant.

In the submission made by BPAS to the court case last year, it was pointed out that there are a wide variety of substances that may cause damage to an unborn baby, from food to plastics and household products. Lawyers in the case questioned whether demanding criminal injuries compensation for alcohol poisoning could mean by extension that “a pregnant mother who eats unpasteurised cheese or a soft-boiled egg, knowing that there is a risk of harm to the foetus might also find herself accused of a crime”.

At the frontline, Jo Austin, a midwife who works with vulnerable mothers in London, says it’s easier to get women to talk about heroin or crack addiction than it is to get them to confront their drinking during pregnancy. “We have lots of leaflets for women who take heroin and crack, who are quite a small minority of the women we see. But alcohol is more socially acceptable and it is legal. A large proportion of society drinks, at least socially. Our feeling is that it is a problem that women don’t admit to, perhaps because of stigma, guilt or fear of social services involvement.”

Austin says most of the pregnant women she sees are better informed about the risks of smoking during pregnancy. “There has been so much health promotion done on smoking, but the effects of alcohol are potentially much worse.”

Gail Priddey, CEO of Haringey Advisory Group on Alcohol, which supports families affected by alcohol, says she is currently writing an advice leaflet for midwives that attempts to navigate a line between being straightforward with the facts without “scaring pregnant women witless”. “It is such an emotive and difficult subject,” Priddey says. “You say, ‘Best not to drink when you’re pregnant,’ then someone says, ‘Well, actually, I’ve been drinking heavily. I didn’t realise.’ Where do you go from there? Do you say, ‘You may have done some damage’? It’s an area professionals don’t want to touch.”

The flipside of this is that children with FAS and FASD are not diagnosed early enough, and often do not receive the help they need. Raja Mukherjee, a neurodevelopmental psychiatrist and lead clinician at the national FASD clinic, says awareness of the condition has risen dramatically in the 12 years he has worked in the area, but diagnosis remains complicated. He believes doctors are often unwilling to label a child as suffering from FASD because it is “too stigmatising”. “It is easier to say, ‘You have ADHD,’” he says.

Yet Mukherjee is uncomfortable about the fight for criminal injuries compensation for children, because “criminalisation just pushes it underground. We struggle already with people who tell us, ‘I didn’t drink at all in pregnancy’ – yet they were an alcoholic before and an alcoholic afterwards.”

Neil Sugarman, the lawyer for the unidentified local authority in the north-west that took the legal action, said they were motivated by a quest to get adequate funding for the girl’s care. “This wasn’t about trying to get women prosecuted,” he says. “My job as a lawyer is to look at the interests of terribly badly impaired children. We have a state scheme that if you can show you are a victim of a crime, you are entitled to compensation.

“The Criminal Injuries Compensation Scheme has never required someone to be prosecuted – no one needs to be taken to court, charged, sentenced or convicted. All it requires is that a judge has to be satisfied that what happened can be recognised as a crime. It is very difficult for young people to get access to their therapeutic needs on the NHS – the occupational therapy and speech therapy they need is not always readily available. The true benefit of compensation would be to open up access to private treatment for these children and enhance their lives.”

I didn’t know the kids’ mother was an alcoholic. She loved them, but couldn’t cope. It didn’t put me off adopting them

 Kay Collins adopted three children, two of whom have foetal alcohol spectrum disorder. Photograph: Sophia Spring for the Guardian

Kay Collins, 61, would also like to see more funding for children with FASD, but not if it means prosecuting their mothers. Ten years ago, she adopted three children, two of whom have the condition. She knew them before she adopted them, because they lived in a flat upstairs in the west London mansion block where they still live.

“We’d meet on the stairs and say hello, and I got to know them – they were lovely kids. I didn’t know their mother was an alcoholic. It was only as time went on, I realised. She was somebody who needed help, not someone to abuse or to judge.

“You saw that she loved the kids, but she couldn’t manage. She was in her 20s, the children’s father was there on and off. She never harmed the kids in any way. She loved them – she just didn’t know how to care for them.”

Eventually, the children were taken into care. Collins, who was working as a teaching assistant and had four, much older children of her own, decided to adopt them – a girl of 17 months and boys of four and five. She knew nothing about FASD until she was called by a paediatrician who was helping to prepare the adoption papers. She was told the two younger children might have learning disabilities and was asked how she would cope. “I said, ‘If I knew that now, I would be a genius. I can only know when I am dealing with it.’ It didn’t put me off. I knew that the children just needed a lot of love and attention.”

Now that she knows more about the condition, she can see some of the facial characteristics of FASD in pictures of the youngest as a baby. These have become less noticeable as she has grown up, but her cognitive problems have become more evident over time. “When they were about seven, it was clear things were not happening as with normal children. They both didn’t speak very well for a long time, they didn’t understand a lot of things. The younger one still doesn’t. Her brother understands better, but his behaviour is worse. If you try to correct him, he gets very angry.”

Collins is fighting for the youngest, now 12, to be given a place in a special needs school. “She has language difficulties. If things are not explained to her at a slower pace, she is not going to understand them. At the moment, I’m at loggerheads with the local authority and in a tribunal because they don’t think that’s necessary. They don’t want to pay for it. It’s down to cost.”

Collins thinks her 12-year-old daughter won’t take GCSEs and knows that, long-term, life will be complicated for her. “She will live independently, but she will need a lot of support – she is quite vulnerable because she thinks everyone is her friend.” But she doesn’t like the idea of fighting for compensation through the Criminal Injuries Compensation Scheme. “It would be nice to have the money; we could use it to get them educated in the right environment,” she says, but she is uncomfortable with the idea that this might be a step in the direction of criminalising troubled women. “Mothers who drink when pregnant need more support and understanding. No one sits down and just starts drinking. There has to be something that triggered it.”

Meanwhile, she just tries to help her children understand. “My daughter keeps asking, ‘Is there something wrong with me?’ I say, ‘Yes, you have foetal alcohol spectrum disorder.’” The middle child is angry about his mother’s role in his condition. “He says, ‘I hate my mum’, but I try to explain: ‘She couldn’t look after you. It doesn’t mean she didn’t love you. She was never a bad mum.’”

• Some names have been changed. To contact Nofas UK, call 020-8458 5951 or go to nofas-uk.org.

Source: http://gu.com/p/475mq April 2015 http://www.theguardian.com/society/2015/apr/04

Underage youth who cite alcohol marketing and the influence of adults, movies or other media as the main reasons for choosing to consume a specific brand of alcohol are more likely to drink more and report adverse consequences from their drinking than youth who report other reasons for selecting a specific brand, new research suggests.

The findings, published in the May issue of the Journal of Adolescent Health, add to a growing body of research suggesting youth exposure to alcohol marketing affects their drinking behavior. The study was conducted by researchers from the Johns Hopkins Bloomberg School of Public Health’s Center on Alcohol Marketing and Youth and the Boston University School of Public Health.

The researchers conducted an Internet survey in 2012 of 1,031 people between the ages of 13 and 20 who reported having consumed alcohol in the previous 30 days. Of those, 541 reported having a choice of multiple alcohol brands the last time they drank and researchers wanted to know why they chose the brand they did. They classified the underage drinkers into five groups:

· Brand Ambassadors, who selected a brand because they identified with its marketed image (32.5 percent of respondents)
· Tasters, who selected a brand because they expected it to taste good (27.2 percent of respondents)
· Bargain Hunters, who selected a brand because it was inexpensive (18.5 percent of respondents)
· Copycats, who selected a brand because they’d seen adults drinking it, or seen it consumed in movies or other media (10.4 percent of respondents)
· Others (11.5 percent of respondents)

“Almost one in three underage drinkers reports choosing a brand of alcohol to drink based on branding and marketing,” says lead study author Craig Ross, PhD, president of Fiorente Media, Inc. and a consultant to the Johns Hopkins Bloomberg School of Public Health’s Center on Alcohol Marketing and Youth. “These findings suggest that alcohol advertisements, media portrayals of alcohol use, and celebrity endorsements play a significant role in alcohol brand selection among young people.”

Alcohol is the most commonly used drug among youth in the United States and is responsible on average for the deaths of 4,300 underage persons each year, researchers say. Approximately 33 percent of eighth graders and 70 percent of twelfth graders have consumed alcohol, and 13 percent of eighth graders and 40 percent of twelfth graders drank during the past month.

The researchers also examined whether different reasons for selecting a brand of alcohol were associated with riskier drinking behaviors. Brand Ambassadors and Copycats reported consuming the largest amount of alcohol and were most likely to report both heavy episodic drinking and negative alcohol-related health consequences, such as being injured while drinking or suffering an injury serious enough to require medical attention.

“The prevalence of heavy drinking among these two groups and the high rates of negative health consequences they report are of particular concern,” says study author David Jernigan, PhD, director of the Center on Alcohol Marketing and Youth at the Johns Hopkins Bloomberg School of Public Health. “Further research to explore methods of offsetting negative influences of alcohol marketing and promotion on our children’s health is sorely needed, as are more effective restrictions on advertising placement to reduce youth exposure to alcohol marketing and promotion.”

Alcohol advertising in the U.S. is primarily regulated by the industry itself. Several leading public health groups and officials, including the National Research Council, the Institute of Medicine and 24 state and territorial attorneys general, have called upon the alcohol industry to strengthen its standards to reduce youth exposure to alcohol advertising and marketing.

“Selection of Branded Alcohol Beverages by Underage Drinkers” was written by Craig S. Ross, PhD, MBA; Josh Ostroff; Timothy Naimi, MD, MPH; William DeJong, PhD; Michael Siegel, MD, MPH; and David H. Jernigan, PhD. This research was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (R01AA020309-01).

Source: www.newswise.com 20^th April 2015 Journal of Adolescent Health, May 2015

If you had to guess which country had the most marijuana users, which would it be? It’s not the Netherlands—they’re not even in the top five. This map, courtesy of Conrad Hackett and UNODC, shows where marijuana use is most widespread.

Per capita, Iceland leads the pack:

1. Iceland

2. United States

3. New Zealand

4. Nigeria

5. Canada

You can read the UN’s full report on cannabis here (PDF).

Source: UNODC April 2015 http://www.unodc.org/

Hendriks V., van der Schee E., Blanken P.
Drug and Alcohol Dependence: 2011, 119, p. 64–71.

US research led by the programme’s developers has found that a family therapy which intervenes across a child’s social environment is more effective than alternatives for problem substance using teenagers, but this independent European study found individually-focused cognitive-behavioural therapy overall just as effective.

SUMMARY Cognitive-behavioural therapy is a mainstay of addiction treatment, but young problem substance users might benefit more from approaches which intervene with their families and wider environments. The featured study tested this proposition among cannabis users in The Netherlands, pitting multidimensional family therapy against a more conventional, individually-focused cognitive-behavioural therapy.

Key points

• Multidimensional family therapy is one of a family of approaches which intervene not just with the individual young problem substance user but with their family and other important influences in their lives.

• US research led by the programme’s developers has found this approach more effective than alternatives or usual treatment or criminal justice procedures.

• The featured study offers a test of the approach on a non-US caseload and in a study by independent researchers not involved in the programme’s development.

• As with another independent study, the approach was not found preferable overall to a well-structured alternative, but – again as in other studies – it might have been more effective with the more multiply and severely problematic youngsters.

• Extra cost and the relative scarcity of qualified practitioners are an obstacle to implementation.

Multidimensional family therapy addresses problem drug use and related problems among adolescents not through a set regimen, but by applying principles and a therapeutic framework to the individual seen as situated within a particular set of environmental influences and constraints. What distinguishes it from some other family therapies is that therapists see substance use as potentially a problem in its own right, and that the intervention extends beyond the child and family to all the social systems (school, juvenile justice, etc) in which the child may be involved.

US studies involving young cannabis users have shown promising results, but almost all these were obtained by one research group. Independent replication studies are needed, and it is unclear whether the impacts of multidimensional family therapy observed in the United States can be generalised to a country such as The Netherlands, where attitudes to cannabis use are more permissive.

To answer these questions the featured study compared the effectiveness of multidimensional family therapy and cognitive-behavioural therapy among adolescent cannabis users in The Netherlands. Between 2006 and 2009 it recruited 109 children aged from 13 to 18 diagnosed as experiencing cannabis abuse or dependence within the past year. They were among the intake at two treatment centres for adolescents in The Hague, one specialising in substance use problems, the other in mental and behavioural health. Patients in the study had to have regularly used cannabis in the past three months and have at least one parent figure who agreed to participate in treatment and in study assessments.

Participants averaged just under 17 years of age and 80% were male. According to their own accounts, they had on average been using cannabis for two years and at study entry had averaged 162 ‘joints’ in the past 90 days – equivalent to nearly two a day. Other substances were used relatively little. They reported an average of about six violent or property crimes in the past three months and a substantial minority were diagnosed with a conduct disorder or oppositional defiant disorder. Four in 10 lived in single-parent households and the same proportion had been imprisoned.

They were allocated at random to multidimensional family therapy or cognitive-behavioural therapy, each planned to last five to six months and delivered on an outpatient basis. In weekly one-hour sessions, the cognitive-behavioural option focused on enhancing patients’ motivation to change their addictive behaviour, and then on changing problem behaviours by means of training in self-control, social and coping skills, and relapse prevention. Monthly sessions were also scheduled for the parents to provide information and support, but not to intervene in family dynamics or parenting.

Multidimensional family therapy was more intensive, scheduled to occupy two one-hour sessions a week with the adolescent, parent(s) and/or family, plus contacts with schools and court staff and other people. It was delivered by trained and supervised therapists who followed a manual by the approach’s developers and were trained by the developers, whose unit in the USA was contacted monthly for feedback and consultation.

An attempt was made to reassess patients to track their progress, the final assessment being 12 months after the baseline assessment conducted just before patients were allocated to the treatments. At the final follow-up, just over 94% of patients were reassessed.

Main findings

Though continued cannabis use was the norm, the general picture was of improvements between the 90 days before starting treatment and the 90 days before the final 12-month assessment. However, these improvements were not significantly greater depending on the treatment to which patients had been allocated. This was the case despite multidimensional family therapy being far better attended; 8 in 10 children completed this treatment compared under 3 in 10 allocated to the cognitive-behavioural option, and they attended sessions totalling 35 hours compared to 10. Significant others in the child’s life also spent much more time engaged in the multidimensional than in the cognitive-behavioural programme.

The number of days in which the children had used cannabis fell from 62–63 days out of 90 to 43 with multidimensional family therapy and 47 with cognitive-behavioural therapy, and the number of joints smoked fell respectively by 38% and 46%. In both options a good treatment response – at least 30% fewer cannabis-using days without substantial increases in use of other substances – was recorded by 42–44% of patients. In both options the number of crimes the children said they had committed fell by over a third.

Despite overall near equivalence, there were indications that children with the severest problems reduced their cannabis use more when allocated to multidimensional family therapy. This was the case whether severity was assessed in terms of intensity of cannabis use or substance use in general, criminality, presence of conduct and/or oppositional defiant disorders (among whom the extra reduction in days of cannabis use peaked at 42 days), and whether the child’s family was assessed as dysfunctional. Differential impacts among children with severe substance use or exhibiting conduct and/or oppositional defiant disorders reached statistical significance.

The authors’ conclusions

The study indicates that multidimensional family therapy and cognitive-behavioural therapy are equally effective in reducing cannabis use and delinquency among adolescents with a cannabis use disorder in The Netherlands, though neither was sufficient to eliminate problem substance use altogether among most of the children. Despite some limitations, the results are robust and applicable to most treatment-seeking adolescents with problem cannabis use in The Netherlands. The results are notable given the much higher treatment ‘dose’ – and consequently, higher costs – of multidimensional family therapy. As others have done, the study also found indications that multidimensional family therapy is differentially effective with adolescents and families with more severe problems.

It should be acknowledged that without a no-treatment control group, it cannot be said for certain that the treatments caused the observed improvements. Also the results derived from youngsters who frequently used cannabis, but not other substances, and who often had a history of delinquency and psychiatric treatment, and from a country with a relatively permissive attitude to cannabis.

COMMENTARY This well designed study has considerable clinical relevance since participants were seeking treatment in the normal way and were clearly using cannabis excessively as well as having other serious problems in their lives – the kind of caseload one would expect at substance use and mental health treatment services for young people, and the kind seen in the UK, where among under-18s cannabis is now by far the most common primary drug in relation to which treatment is provided. Numbers in England in 2013/14 continued to increase to a record 13,659, 71% of all young patients in specialist treatment. Forms of cognitive-behavioural therapy are a common component of treatment in Britain, but family-based therapeutic work is surprisingly rare, given that for example in England, over 80% of young patients were living with their families. Based on the evidence, British practice standardsfrom the Royal College of Psychiatrists on the care of young people with substance misuse problems commend family work, but say it is not standard in British services.

The featured study offers some guidance on whether for young, frequent cannabis users, UK services would do better to replace cognitive-behavioural therapies with family work in the form of multidimensional family therapy. Overall the answer is no; this would cost more without substantially improving outcomes. The finding is particularly important since it derives from a rare test conducted with a European caseload and by a research team independent of the developers of the programme. Independence is important because in several social research areas (1 2 3), programme developers and other researchers with an interest in the programme’s success have been found to record more positive findings than fully independent researchers.

Promising as US studies led by the developers of the programme have been (for example, 1 2), an independent US study found multidimensional family therapy slightly (but not significantly) less effective at promoting recovery from substance use problems than two other therapies, and substantially less cost-effective. Like the featured study, the focus was on young problem cannabis users, and cognitive-behavioural therapy featured among the alternatives.

Multidimensional family therapy is one of a similar set of programmes which integrate intervention in to several domains of a child’s life. Such approaches can improve on typically less well organised and less extensive usual practices (1 2), but this is not always the case, and performance against stronger alternative approaches focused on the individual young cannabis user has been equivalent. Evaluations conducted independently of programme developers have usually been unconvincing, and results overall have not been as impressive as investment in these programmes might be seen to require, especially if they supplement rather than replace legally or socially required procedures. A major obstacle to their use is the expensive training and supervision and considerable skills required to implement them in ways which have been associated with good outcomes.

Best for the hardest cases?

Britain’s National Institute for Health and Clinical Excellence (NICE) has recommended the types of programmes exemplified by multidimensional family therapy for problem-drinking children who also have other major problems and/or limited social support, signalling their particular suitability for the most severely affected and multiply problematic youngsters. In line with this recommendation, the featured study and others suggest that investment in multidimensional family therapy might be warranted for more problematic youngsters – particularly in the featured study, those so at odds with families and society that they can be diagnosed as exhibiting these traits to a pathological degree. That suggestion is tentative, however, primarily because these analyses were not planned in advance so may have capitalised on chance variations in outcomes.

The same limitation applies to the US trials which found multidimensional family therapy particularly suitable for high-severity youngsters. Other limitations too make the US findings an unreliable guide to whether multidimensional family therapy really is best for the most severely affected youngsters (details below), though the plausibility of the findings and the similar findings in The Netherlands mean this contention cannot be dismissed.

One of the US studies compared multidimensional family therapy with cognitive-behavioural therapy. In this study the researchers identified a set of youngsters (about 4 in 10 of the sample) initially more strongly engaged with and affected by substance use, and among whom this engagement weakened less over the course of treatment and a 12-month post-treatment follow-up. They also had more psychological problems. Among this sub-sample, engagement with substance use weakened significantly more when they had been allocated to multidimensional family therapy. Less engaged youngsters were affected about equally by both treatments. But these results were extracted only by a complex analysis which divided the sample up based not just on initial severity, but on their progress in and after treatment. The formation of these categories itself partly depended on the effects of the treatments, then the analysis tested whether the treatments affected each class differently – a circularity which complicates assessment of just what the results mean in practice. This analysis also had to contend with the fact that at each follow-up around 40% or more of the sample could not be reassessed, presumably meaning it had to estimate how they would have scored based on the available data. Such estimates can only be relied on if the data is randomly missing – in this case, if the reasons why a young person did not attend for reassessment had nothing to do with the factors which affected their response to treatment, an unlikely assumption.

Less affected by these complications, a simpler analysis of whether youngsters who started treatment with a deeper engagement with substance use became more disengaged when allocated to multidimensional family therapy was negative, as was one which tested initial psychological problems as a predictor of differential response to treatment. Nor were any relationships found between frequency of substance use and differentially benefiting from multidimensional family therapy. In a similar analysis of a second study comparing multidimensional family therapy to usual criminal justice procedures, the reverse was the case; here it was not the more deeply engaged youngsters who benefited more from multidimensional family therapy, but those who used substances most often. Such inconsistency heightens concerns over cherry-picking of results to demonstrate that multidimensional family therapy is best for most severely affected youngsters.

Last First uploaded 18 April 2015

Source:http://findings.org.uk/PHP/dl.php?file=Hendriks_V_2.tx

Revised 27th April 2015

Those who despise Big Tobacco’s notorious electioneering ain’t seen nothing yet. Big Tobacco 2.0, aka Big Marijuana, can negate Colorado’s grassroots petition process — which helped establish the industry.

When Colorado voters legalized marijuana, they meant well. They wanted a safe trade, regulated like alcohol.

They ended up with a system of, by and for Big Marijuana. It is a racket in which the will of voters gets quashed before votes are cast.

Any doubt about Big Marijuana’s disregard for Colorado’s desire for good regulation will disappear with a new revelation: the industry bought away the public’s chance to vote.

That’s right. Big Marijuana bought away a proposed vote on regulations in Colorado, where we vote on fixing potholes.

At issue is proposed ballot initiative 139, written to give voters a few reasonable options to improve regulation of recreational pot sales. The measure proposed no changes for medical marijuana. On recreational sales, it would have:

* Required child-resistant packaging, as we have for aspirin and ibuprofen.

* Put health warnings on marijuana labels.

* Restricted product THC potency to 16 percent, even though THC occurs naturally at only .2 to .5 percent in cannabis.

Initiative 139 was so reasonable, so in line with the intentions of voters who legalized pot, recent polling showed 80 percent support among registered voters.

Big Marijuana opposes 139 because the industry wants to do as it pleases. It views potency restrictions, which would keep Colorado’s pot products among the more potent in the world, as a sales barrier. Big Marijuana doesn’t want the nuisance of labelling requirements and child-resistant packaging.

Knowing 139 was likely to pass, Big Marijuana sued to keep it off the ballot. The suit stalled efforts to raise money and recruit voluntary signature gatherers. When the Colorado Supreme Court ruled in defense of letting voters decide, Big Marijuana’s anti-139 campaign paid Colorado’s major signature firms to avoid gathering signatures for the pro-139 campaign.

“They were offering $75,000 to $200,0000, depending on size of each company, to get contracts that say they will not gather signatures for this ballot measure,” said attorney and former Colorado House Speaker Frank McNulty, passing along information an anti-139 consultant shared with him.

As Big Marijuana paid for anti-petition contracts, the price of collecting signatures rose. Advocates of 139 responded by raising more money. Former lawmaker Patrick Kennedy, son of former Sen. Ted Kennedy, swooped in to help with a last-ditch fundraising effort this week that boosted the 139 war chest to nearly $800,000.

Just when the campaign planned to hire an Arizona-based firm to gather signatures, Big Marijuana paid the company off.

“The narrative of the marijuana industry has been ‘don’t meddle with our business, because the voters have spoken and the will of the voters is sacred. This is a democracy.’ Then we have a genuine democratic effort to improve recreational marijuana regulation, and the industry shuts down democracy with big money and a bag of dirty tricks,” said Ben Cort, a member of the board of directors of Smart Approaches to Marijuana. “It became clear. No matter how much money we raised, and who we tried to hire, they were going to prevent voters from having any say.”

It is a sad day when an industry’s lawyers can buy away the people’s opportunity to petition for a vote, even after the state’s highest court defended the process. Big Marijuana stopped 139 by stomping on Colorado voters — the people who legalized their industry — as if their will should no longer count. Big Marijuana is officially corrupt.

Source: www.gazette.com  Editorial.  8th July 2016

The seizure of a massive cartel marijuana operation in the mountains of Oregon this week reveals the absurdity of one of the primary arguments used to dupe the general public and politicians. Consider the following:

The pro-pot crowd claims that legalization will eliminate the black market. This is a lie.

The legalization of marijuana allows the pot industry to aggressively advertise and market a crude street drug and 100s of additional products containing extremely high levels of THC. The marketing of these products, and easy access to unlimited supplies, expands the customer base for marijuana and normalizes its use. As a result, the pot industry is free to openly advertise, manufacture, process, transport, and distribute massive quantities of drugs. This gives other “unlicensed” drug dealers the ability to blend in – to literally “hide in plain sight.”

Because the black market exists to avoid taxes, regulations, and make money, cartels can easily undercut the price of “legal” sources and provide a “best price guarantee.”

The demand for high-grade pot from Colorado, California, Washington, Oregon and other legalized states means that massive quantities are exported to every other state in the country. None of this happens legally.

Because of massive fraud and abuse, California has effectively been a recreational use state since 1996, and yet their hills and mountains are full of cartel grows. Despite all of their claims of regulation and enforcement, Colorado has become a source nation for the rest of the country. And in Oregon, where over $9 million in pro-pot spending caused the people of Oregon to legalize “personal use” possession of one half pound quantities of pot, the black market continues to thrive.

Just like the other big pro-pot lie, that regulation keeps marijuana out of the hands of children, we have never had better evidence to reveal the absurd and fraudulent nature of their half-baked claims.

As a federal drug prosecutor who has interviewed 1000s of drug traffickers for over two decades, I can say the following with absolute certainty:

Drug cartels and other criminal drug trafficking organizations are not intimidated by legalization, they are emboldened by it.

www.statesmanjournal.com/

Here is the latest evidence of that. A  massive marijuana grow connected to a Mexican drug trafficking organization was raided early Tuesday morning, resulting in one arrest and the seizure of more than 6,500 plants.

A two-month long investigation in rural Dayton led the Yamhill County Interagency Narcotics Team to the illegal marijuana grow in the wetlands near the Willamette River, according to the Yamhill County Sheriff’s Office.

In the early morning darkness, the team, with tactical help from the Oregon State Police SWAT, raided the production site. They discovered thousands of plants valued at more than $9 million.

Officials found an elaborate living area and kitchen hidden underneath a tarp within the marijuana gardens. They discovered 42-year-old Manuel Madrigal hiding in the secret living area. Deputies detained Madrigal, a resident of San Antonio, Texas, who had previous drug arrests.

Madrigal was arrested on federal charges of drug trafficking and transferred into U.S. Marshal custody in Portland.

Yamhill County Sheriff Tim Svenson said the raid was a good example of the dangers Oregon faces from marijuana, even though it is now legal in certain quantities.

“There is still a profit to be made in marijuana by these illegal organizations,” Svenson said. “As long as this continues, we will need to remain diligent in our investigations to keep this money from being routed to other areas of criminal activity.”

The grow was the first-large scale drug trafficking organization operation Yamhill County has seen in several years.

“Historically, these grows have been located on public lands in the mountains of western Yamhill County, and were difficult to access due to steep, dangerous terrain,” a sheriff’s official said in a statement. “This shows a shift in tactics by the drug trafficking organizations.”

The sheriff’s office said the investigation remained ongoing and encouraged anyone with information about the operation to contact the narcotics team at 503-472-6565.

Source:  monte@montestiles.com    July  2016

A broad coalition of organizations working to prevent and treat substance abuse sent a letter today to the Democratic National Committee (DNC) ahead of their decision on their party platform, including marijuana policy.

These groups, which include Faces and Voices of Recovery (FAVOR), the National Alliance of Alcohol and Drug Counselors (NAADAC), Treatment Alternatives for Safer Communities (TASC) , and Smart Approaches to Marijuana (SAM) specifically urge the DNC “not to view legalization and commercialization of marijuana as a solution” to any current issues related to marijuana policy.

The letter was also signed by Patrick Kennedy, Honorary Chair of SAM, who once chaired the Democratic Congressional Campaign Committee.  “The DNC should resist any calls to legalize drugs,” said Kevin Sabet, a former advisor to the Obama Administration and current President of SAM, a bipartisan organization dedicated to implementing science-based marijuana-policies. “The legalization of marijuana is about one thing: the creation of the next Big Tobacco. Marketers cleverly package pot candies to make them attractive to kids, and pot shops do nothing to improve neighborhoods and communities. Moreover, there are other, more effective ways to address questions of racial justice and incarceration.

So does the DNC want to be known for fostering the next tobacco industry, or will it stand with the scientific community, parents, and public health?” Indeed, the letter also details how legalization has resulted in huge spikes in arrests of Colorado youth from communities of color-up 29 percent among Hispanics from 2012 (pre-legalization) to 2014 (post-legalization), and up 58 percent among Black youth in the same timeframe-while arrests of White children fell. Additionally, there has been a doubling of the percentage of marijuana-related traffic fatalities in Washington in just one year after legalization (2013 to 2014).

Emergency poison control calls related to marijuana from 2013 to 2014 in both Colorado and Washington rose, by 72 percent and 56 percent, respectively, and there has been a 15 percent average annual increase in drug and narcotics crime in Denver since 2014, when retail sales of marijuana began. “The pot lobby has successfully fought off Colorado’s attempts to regulate advertising targeting children, rules restricting the use of pesticides, and rules to limit marijuana potency. This same lobby is now exporting these tactics to other states in November,” said Jeffrey Zinsmeister, Executive Vice President of SAM. “This assault on health and safety regulations is no less than a repeat of Big Tobacco’s tactics from the 1960s and 1970s. Our broad coalition urges the DNC to resist these calls.”

Source:   jeff@learnaboutsam.org   6th July 2016

For more information about marijuana policy, please visit http://www.learnaboutsam.org. ### About SAM Smart Approaches to Marijuana (SAM) is a nonpartisan, non-profit alliance of physicians, policy makers, prevention workers, treatment and recovery professionals, scientists, and other concerned citizens who oppose marijuana legalization and want health and scientific evidence to guide marijuana policies. Learn more at www.learnaboutsam.org.

Almost one in 500 babies in hospitals in England is born dependent on substances their mother took while pregnant, a BBC investigation has found.

Of 72 NHS hospital trusts who responded to a Freedom of Information request, the average rate for babies born with neonatal abstinence syndrome was 0.2%.

It is caused by women taking legal and illegal drugs while pregnant.  Health experts say it is a declining trend.

BBC’s Look North and the English regions data unit asked NHS hospital trusts to provide details about the number of babies born who were addicted to drugs between 2011 and 2015.  The figures show a wide geographical variation in the number of newborns who were dependent on harmful substances.

One in 100 babies born at Bedford Hospital in 2015 displayed signs of neonatal abstinence syndrome. In contrast, Leicester General had one of the lowest rates with one in every 5,000 babies born addicted to a harmful substance.  In Leeds, around one in 250 babies was born with the condition.

Lisa Batty, 37, from Bradford, gave birth to four children who were addicted to heroin.

“I didn’t care that my kids were addicted to drugs, I was more concerned about where I was getting my next fix from. I know it’s selfish but that’s how it felt at the time,” she said.

“I remember visiting my children in hospital as they suffered withdrawal symptoms from the methadone they were being given as part of their treatment. I remember seeing them trembling and shaking in their cots. I admit I was a bad mum but I’ve turned my life around now”.

Lisa has now recovered from drug addiction and has become involved with the charity Narcotics Anonymous to help others.

The data for England also shows that over the past four years there has been general decline in the number of babies being diagnosed with neonatal abstinence syndrome.   Those working to treat mothers and babies with a drug addiction say the majority of parents they deal with come from a disadvantaged socio-economic background, with most cases involving an abuse of drugs like heroin, cocaine or alcohol.

Susan Flynn is a specialist midwife in Leeds who helps treat mothers who have a drug addiction.   “I have seen the numbers begin to fall slightly in the past three years,” she said. “I don’t think we can say there is one single reason for the decline but maybe the message is getting out there that it’s not right to take drugs or alcohol whilst you’re pregnant.

“There are of course people who say that women who take drugs whilst they’re pregnant should have their children removed from them, but for me I believe everyone should have the chance to turn their life around.”

Liz Butcher, from Public Health England in Yorkshire and the Humber, said: ‘It is particularly important pregnant women who use drugs get supportive, collaborative care

to reduce the risks to the health of their babies.      Many places in the region have specialist staff and well-established training to make sure that happens.”

 Source:  http://www.bbc.co.uk/news/uk-england-36703939    5th July 2016

Tamara D. Warner, PhD1, Dikea Roussos-Ross, MD2, and Marylou Behnke, MD1

Tamara D. Warner: warnertd@peds.ufl.edu; Dikea Roussos-Ross: kroussos@ufl.edu; Marylou Behnke: behnkem@peds.ufl.edu

1University of Florida, Department of Pediatrics, P.O. Box 100296, Gainesville, FL 32610-0296, (352) 273-8985

2University of Florida, Department of Obstetrics and Gynecology, P.O. Box 100294, Gainesville, FL 32610-0294, (352) 273-7660

SYNOPSIS

Pro-marijuana advocacy efforts exemplified by the “medical” marijuana movement, coupled with the absence of conspicuous public health messages about the potential dangers of marijuana use during pregnancy, could lead to greater use of today’s more potent marijuana, which could have significant short- and long-term consequences. This article will review the current literature regarding the effects of prenatal marijuana use on the pregnant woman and her offspring.

INTRODUCTION

Societal attitudes towards marijuana use in the United States are undergoing an historical shift. In the 1960s, a generation of young people embraced marijuana for personal recreational use. Today, “medical” marijuana (cannabis sativa) has been approved for use in 22 states and the District of Columbia either by legislation or by popular vote in statewide referenda or ballot initiatives; 15 of the 22 legal actions were passed in the last decade (since 2004).1 As of May, 2014, another seven states have pending legislation or ballot measures to legalize medical marijuana.2 In addition, two states, Colorado and Washington state, have legalized marijuana for recreational use. The attitudinal shift is apparent not just among adults but among teens as well. The most recent annual survey of adolescent drug use indicates that the annual prevalence of marijuana use has been trending upward since 2008 for 8th, 10th, and 12th graders; perhaps more importantly, the perceived risk of regular marijuana use has declined sharply in recent years, a trend that started in 2005.3

Source:  Clin Perinatal 2014 December 41(4):  877-894  doi 10.1016/j.clp  2014.0.009

PSA Warning Issued in 2005 was Ignored

Eleven years ago the ONDCP and SAMHSA held a press conference to inform of research that confirms what many families already knew–that marijuana use was a trigger for psychosis and mental illness.

The ONDCP is the White House Office of National Drug Control Policy; SAMHSA is the Substance Abuse and Mental Health Services Administration.  Each agency has a crucial role in trying to ascertain usage and reduce demand for drugs. Specifically, Dr. Neil McKehaney from the University of Glasgow came to the US and spoke at the national Press Club on May 5, 2005. The agencies went to great effort to share important information.  A video was recently found online.

Cover up of the Marijuana – Mental Illness  Risk

At this same Press Conference, a couple who had lost their 15-year-old son to suicide due to the mental health problems arising from marijuana use, spoke.  The Press covered the story, but did not use their considerable investigative skills to probe into what those parents and Dr. McKenagey were describing.  It is true that about one quarter of American high school students are depressed, which points to multiple problems of American culture, not just drugs. However, knowing how vulnerable teens are, and then not exposing the factors that could make their outcomes worse, is lamentable.

In addition to depression, anxiety and suicide, there are the risks of psychosis, bipolar disorder and schizophrenia that arise from marijuana use.  Pot proponents love to state that anyone who has a psychotic reaction to pot already had the problem before they used it.  They tend to blame family members for not  wanting to admit  mental health problems, and argue that pot is used as a scapegoat.

Several studies have shown a link between marijuana and schizophrenia.  Explains pharmacologist Christine Miller, Ph.D:  “No one is destined to develop schizophrenia. With identical twins, one can develop the disease and the other one will do so only 50% of the time, illustrating the importance of environmental factors in the expression of the disease.  Marijuana is one of those environmental factors and it is one we can do something about.”

A Missed Opportunity

One person who worked in the office of ONDCP Director John Walters told Parents Opposed to Pot, “They accused us of being pot-crazy during a time when there was a methamphetamine crisis going on.  Marijuana is almost always the first drug introduced to young people and the evidence for the mental health risks were very strong by 2005.  Although pot was getting stronger as it is today, the warning was falling on deaf ears.  Members of Congress wanted us to focus on the meth crisis, but marijuana was a growing issue and we had a myriad of issues.”

This Public Service Announcement reached audiences in the Press, and some newspapers and magazines reported about it.  Since the Internet and search engines were not as they are  today,  few parents, children,  schools and mental health professionals took notice.   (Did the marijuana lobbying groups bully and try squelch the information?)

Lori Robinson, whose son suffered the mental health consequences of marijuana said:  “I will always deeply regret Shane not hearing this PSA .  Shane was a smart, gregarious and fun-loving young man who naively began using pot never knowing he was playing Russian roulette with his brain in ’05-’06 at the age of 19.   Dr McKeganey so clearly stated that the public views marijuana as harmless, not realizing the potency of THC was rising while the “antipsychotic” property of CBD was being bred out.  Sadly, despite both parents never used an illegal drug in our lives, our son assumed that since a few of his friend had smoked in high school, it was just a “harmless herb.”   Shane’s story is on the Moms Strong website.

Robinson added, “This video is absolutely current TODAY.  Let’s keep this video circulating & it WILL save young brains & families the destruction that lies ahead when marijuana hijacks your kid’s brain.

The research has expanded since that time and scientific evidence on each of the following outcomes from marijuana use is voluminous: marijuana & psychosis, marijuana & violence and marijuana & psychiatric disorders.

Lessons to be Learned

Lives could have been saved, and so many cases of depression, psychotic breakdowns and crimes could have been prevented – if the public had become more aware back in 2005.   Congress, the Press and most of all, the American psychiatric community was wrong to ignore the warnings that were issued with this PSA. Let’s not continue to ignore  the evidence. Today in the US, mental health is worse than it’s ever been, and the promotion of drug usage may be a huge factor in this problem.  Harm reduction in preference to primary prevention strategies is practiced in many jurisdictions.  Drug overdose deaths have overtaken gun violence deaths and traffic fatalities in the USA — by far — under this strategy. Today Dr. McKeganey is the Director of the Center for Substance Use Research in Glasgow.

Parents Opposed to Pot is totally funded by private donations, rather than industry or government. If you have an article to submit, or want to support us, please go to Contact or Donate page.

Source:  http://www.poppot.org/2016/07/06/warning-pot-causes-mental-illness

For most people, the idea of winning some money will ignite a rush of emotions – joy, anticipation, excitement.

If you were to scan their brains at that very moment, you would see a surge of activity in the part of the brain that responds to rewards.

But, for people who’ve been smoking cannabis, that rush is not as big – and gets smaller and smaller over time, new research suggests.

And that dampened, blunted response may actually increase the risk that marijuana users are more likely to become addicted to pot and other drugs.

Dr Mary Heitzeg, senior author of the new study, a neuroscientist from the University of Michigan Medical School, said: ‘What we saw was that over time, marijuana use was associated with a lower response to a monetary reward.

‘This means that something that would be rewarding to most people was no longer rewarding to them, suggesting but not proving that their reward system has been “hijacked” by the drug, and that they need the drug to feel reward – or that their emotional response has been dampened.’

The findings come from the first long-term study of young marijuana users, that tracked brain responses to rewards over time, and is published in the JAMA Psychiatry.

They reveal measurable changes in the brain’s reward system with cannabis use – even when other factors like alcohol use and cigarette smoking were taken into account.

The study involved 108 people in their early 20s – the prime age for cannabis use.

All were taking part in a larger study of substance abuse, and all had brain scans at three points over a four-year period.

Three-quarters were men, and nearly all were white.

While MRI scans were performed, participants were invited to play a game.

People who smoke cannabis regularly show less activity in the area of the brain that releases the ‘pleasure’ hormone, dopamine

They were required to click a button when they saw a target on a screen in front of them.

Before each round, they were told they could win 20 cents, or $5 – or that they might lose that amount, have no reward or loss.

The researchers were most interested in assessing what happened to the volunteers’ brains – specifically activity in the reward center – the area called the nucleus accumbens.

And the moment that was deemed most important, was the moment of anticipation – when the volunteers knew they might win some money, and were anticipating what it would take to win the simple task.

In that moment of anticipating reward, that area of the brain should spark into action, pumping out the ‘pleasure’ hormone, dopamine.

The greater a person’s response, the more pleasure or thrill a person feels – and the more likely they will be to repeat the behavior later.

The researchers found that the more marijuana use a volunteer reported, the smaller the response in this part of the brain over time.

Past research has shown the brains of people who use a high-inducing drug repeatedly respond more prominently when they are shown cues related to that drug.

That increased response means the drug has been associated in their brains with positive, rewarding feelings.

And, that can make it harder for users to stop seeking out the drug and using it.

First author, Meghan Martz, doctoral student in developmental psychology, said: ‘It may be that the brain can drive marijuana use, and that the use of marijuana can also affect the brain.

‘We’re still unable to disentangle the cause and effect in the brain’s reward system, but studies like this can help that understanding.’

Regardless of that fact, the new findings show there is a change in the reward system over time, when a person regularly uses cannabis, the researchers noted.

Dr Heitzeg and her colleagues also showed recently in a paper in Developmental Cognitive Neuroscience that marijuana use impacts emotional functioning.

The new data on response to potentially winning money may also be further evidence that long-term marijuana use dampens a person’s emotional response – something scientists call anhedonia.

‘We are all born with an innate drive to engage in behaviors that feel rewarding and give us pleasure,’ said co-author Dr Elisa Trucco, a psychologist at the Center for Children and Families at Florida International University.

‘We now have convincing evidence that regular marijuana use impacts the brain’s natural response to these rewards.

‘In the long run, this is likely to put these individuals at risk for addiction.’

Marijuana’s reputation as a ‘safe’ drug, and one that an increasing number of states are legalizing for small-scale recreational use, means that many young people are trying it – as many as a third of college-age people report using it in the past year.

But Dr Heitzeg said that her team’s findings, and work by other addiction researchers, has shown that it can cause effects including problems with emotional functioning, academic problems, and even structural brain changes.

And, the earlier in life someone tries marijuana, the faster their transition to becoming dependent on the drug, or other substances.

‘Some people may believe that marijuana is not addictive or that it’s ‘better’ than other drugs that can cause dependence,’ said Dr Heitzeg.

‘But this study provides evidence that it’s affecting the brain in a way that may make it more difficult to stop using it.

‘It changes your brain in a way that may change your behavior, and where you get your sense of reward from.’

Source: http://www.dailymail.co.uk/health/article    6th July  2016

A new coalition funded by the cannabis industry has formed in Colorado to fight a ballot measure that some say would crush the state’s billion-dollar marijuana industry.

The Colorado Health Research Council (CHRC) announced its formation Thursday to oppose Amendment 139, a constitutional amendment that would limit the THC-potency of marijuana and pot products at 16 percent. The average potency of Colorado pot products is already higher — 17.1 percent for cannabis flower and 62.1 percent for marijuana extracts, according to a state study.

The amendment also would mandate warnings printed on pot packaging that say marijuana’s health risks include “permanent loss of brain abilities” and “birth defects and reduced brain development.”

If passed by voters, the amendment “would have devastating unintended consequences to the citizens and economy of Colorado,” according to CHRC media materials, which add that 80 percent of the pot products on shelves now would be considered illegal under the measure.

Source:  http://www.denverpost.com/2016/06/30/pot-potency-campaign

An analysis has found moderate-quality evidence supporting the use of cannabinoids for certain types of pain, but not for other conditions such as nausea and sleep disorders. This review of nearly 80 randomized controlled trials has been published in JAMA.

Penny F. Whiting, PhD, of the University of Bristol, Bristol, United Kingdom, and colleagues collected data from 79 randomized controlled clinical trials with 6,462 patients on the use of cannabinoids for nausea and vomiting due to chemotherapy, appetite stimulation in HIV/AIDS, chronic pain, spasticity due to multiple sclerosis or paraplegia, depression, anxiety disorder,sleep disorder, psychosis, glaucoma, or Tourette syndrome. Study quality was determined using the Cochrane risk of bias tool.

Improvements in symptoms with use of cannabinoids were not statistically significant in most studies. Only two trials evaluated cannabis and there was no evidence of differential effects between cannabis and other cannabinoids. There was moderate-quality evidence suggesting that cannabinoids could be beneficial for the treatment of chronic neuropathic or cancer pain, along with spasticity due to multiple sclerosis but low-quality evidence for nausea and vomiting due to chemotherapy, weight gain in HIV, sleep disorders, and Tourette’s syndrome. For cannabinoids in the treatment of anxiety, there was very low-quality evidence; in addition, there was low-quality evidence for no effect on psychosis and very low-level evidence for no effect on depression. No clear evidence for benefits or risks with specific types of cannabinoids or modes of administration was noted. An increased risk of short-term adverse events including dizziness, dry mouth, nausea, fatigue, somnolence, euphoria, vomiting, disorientation, drowsiness, confusion, loss of balance, and hallucination was also found.

In an accompanying editorial, Deepak Cyril D’Souza, MBBS, MD, and Mohini Ranganathan, MD, of the Yale University School of Medicine noted that large double-blind randomized clinical trials are needed to test the short- and long-term safety and efficacy of medical marijuana for various medical conditions. They also added that “since medical marijuana is not a life-saving intervention, it may be prudent to wait before widely adopting its use until high-quality evidence is available to guide the development of a rational approval process.” Currently 23 states and the District of Columbia have introduced laws permitting the use of medical marijuana. For more information visit JAMANetwork.c

Source:  http://www.empr.com/   3rd June 2016

Between January 1, 2015 and April 22, 2015, the American Association of Poison Control Centers reported getting 1900 calls related to synthetic cannabinoid exposure, proving that the popularity of this alternative to natural marijuana has been steadily increasing. Synthetic cannabinoids, when smoked or ingested, act on the endocannabinoid receptors, similar to delta-9 tetrahydrocannabinol, the primary psychoactive ingredient in marijuana.  While dyspnea related to synthetic cannabinoid use is common, other pulmonary adverse effects have rarely been reported, specifically inhalation fever which is discussed in a recent case published in the American Journal of Case Reports.

The patient, a 29-year-old male, presented to the emergency department with severe agitation after smoking the synthetic cannabinoid K2. Medical history included a diagnosis of schizoaffective disorder for which he was not receiving treatment. To sedate him, multiple doses of lorazepam and haloperidol were used. Physical examination of the patient showed the following:

* Temperature: 100.2º F

* Blood pressure: 110/50 mmHg

* Heart rate: 109/min

* Respiratory rate: 18/min

* Oxygen saturation: 95%

* Chest exam: No crackles, wheeze, rhonchi on auscultation; chest radiograph: diffuse reticular-nodular and interstitial infiltrates

* Cardiovascular exam: JVP not elevated, S1 and S2 heard, no additional heart sounds, murmurs, rubs; rate/rhythm regular

* Lab tests: Leukocytosis with predominant neutrophilia (83.4%); blood culture samples showed no growth after 5 days

* Urine toxicology: Negative for cannabinoids, benzodiazepine, phenycyclidine, opiates, cocaine, barbiturates

The patient was given ceftriaxone 1g IV, azithromycin 500mg IV, magnesium sulfate 2g IV (for hypomagnesemia), potassium phosphate 22mEq IV (for hypophosphatemia), famotidine 40mg daily for GI prophylaxis and heparin 500 Units SC twice daily for prophylaxis of venous thromboembolism. His mental status improved and his fever dissipated 24 hours after admission; repeat chest radiograph showed resolution of the pulmonary infiltrates. Clinicians were unable to re-evaluate his blood levels, as the patient refused repeat blood draws.

Once in stable condition, he was discharged with a diagnosis of inhalation fever due to synthetic cannabinoid and was told to abstain from use of this substance. For empirical treatment of pneumonia, he was given levofloxacin 750mg daily for seven days; he was also given a prescription for risperidone 1mg twice daily for two weeks for his schizoaffective disorder. Though an outpatient appointment was scheduled, the patient did not follow-up and so his long-term outcome is uncertain.

In the United States, there are over 50 types of synthetic cannabinoids; the substances are typically available in herbal blends, potpourri, and incense.  In this patient, given the fever and transient pulmonary infiltrates, inhalation fever is believed to have developed as a consequence to K2 inhalation. Symptoms associated with inhalation fever may include cough, dyspnea, headache, malaise, myalgia and nausea, however, this patient did not experience any of these, apart from leukocytosis which is a feature of this condition.

Treatment generally includes supportive care and avoidance of the causative agent. Other diagnoses considered for this patient included acute hypersensitivity pneumonitis (which may present in a similar manner), chemical pneumonitis (an inflammatory reaction to a particulate), or bacterial pneumonia (given the fever, tachycardia, leukocytosis, and pulmonary infiltrates). Infection, however, was not considered likely given a repeat chest radiograph 24 hours later showed resolution of the pulmonary infiltrates and blood culture was negative.

Given this is the first case to report on inhalation fever as a side effect of synthetic cannabinoid inhalation, further research is needed to understand the mechanism by which this reaction occurred. In the meantime, the authors warn that “as the Emergency Department visits by synthetic cannabinoid abusers are increasing, the importance of physicians being aware of these adverse effects cannot be overstated.”

Source:   Thiru Chinnadurai, Srijan Shrestha, Raji Ayinla. A Curious Case of Inhalation Fever Caused by Synthetic Cannabinoid. American Journal of Case Reports. 2016, doi: 10.12659   6th July 2016    http://www.empr.com/

* There is no Colorado “survey;” and no capacity to “represent” Colorado youth.

* The sample represents no more than the kids who participated.

* Media reported youth use “flat,” but steep increases were nonetheless widespread.

* Colorado youth marijuana use cannot be “below the national average.” They have the highest rate of marijuana use in the nation.

* The survey response rate, only 46 percent, was inadequate; crucially, below the threshold set by the Centers for Disease Control.

* The only “lesson” about legalization is a warning sign.

What is wrong with the marijuana legalization debate, and who is responsible for its sorry state? No better example of misdirection can be offered than the results of a recent Colorado poll. Because of the public health stakes for the nation’s youth, getting this right is essential. The 2015 version of the Healthy Kids Colorado (HKCS) school survey, which polled both middle school and high school students, garnered a tremendous amount of news. Since it is the first state level estimate to be taken after marijuana legalization (accelerated with retail sales in January 2014), there was reporting concerning possible impact, compared to the previous HKCS taken in 2013.

While not without flaws, the study is an interesting snap-shot of youth health concerns, and legitimately alerts us to some genuine problem areas for marijuana use. But the media reporting was appalling, and theHKCS did little to prevent misunderstanding.

Media Advocacy

Uniformly, media described good news for marijuana legalization advocates. Most coverage (in the Washington Post, Denver Post, Fox News) reported that, compared to two years prior, marijuana use was “flat,” because not “statistically significant.”

Yet even a flat outcome is surprising, not least because other national surveys in Colorado have disclosed alarming increases in use for adults and young adults, rates rising in ten years some 99 percent (7.5 percent to 14.93 percent).

Moreover, in the regional breakdown there were major increases since 2013 in past month use for some students who were juniors and seniors, the increase in some regional breakdowns rising between 50 and 90 percent.

But the survey combined those results with younger grades to produce an overall mean (an ill-advised methodology without weightings), so officials were reported to declare no statistically significant change in marijuana prevalence.

Predictably, the results were treated as a report card on legalization, and media seized on the purported lesson — no rising rates, hence, no worries. There was even more confusion (or worse) by some media. Both Timemagazine and the Scientific American ran articles claiming that the survey had indeed found change, after all. But remarkably, they reported that the new results showed marijuana use had “dipped” from 2013. Of course, in the absence of significance, this claim would be simply wrong. If the non-significant outcome cannot be up, it certainly cannot be down.

There is worse in store. Media thought that calling the changes “not significant” meant that changes were not sufficiently large. But as we shall see, what happened is that the survey did not, methodologically, produce an outcome capable of being statistically significant, as a true weighted probability survey would be. That is a very different matter.

What they seem to have produced is a (partial) census of students, for whom marijuana is variously steeply up or on occasion down, depending on grade and geography. But this survey does not fulfill the necessary criteria for a probability sample.

What National Average?

A further question is, to what are the results being compared? Both theHKCS report itself, and the media, compared the outcome of HKCS 2015 not only to HKCS 2013, but to what they termed the “national average” of youth marijuana use.

According to the reports, 21.2% of Colorado teens were past month marijuana users in 2015. The “national rate” of pot use by youth was reported as higher, at 21.7%.

What is the possible source for deriving that “national average”? There is one genuinely national sample of youth drug use, that from the National Survey on Drug Use and Health (NSDUH) that covers all states. But this cannot be the basis for the claim. In their latest 2014 estimates, NSDUHreported that 7.2 percent of adolescents aged 12 to 17 across the nation used marijuana in the past month – that figure, not 21.7 percent, would be the youth “national average.”

Moreover, the NSDUH specifically declared that Colorado had the nation’s highest rates. Adolescent marijuana use ranged from 4.98 percent in Alabama to 12.56 percent in Colorado. Worse, the NSDUH showed for youth that from 2009, when medical marijuana took off in Colorado, there has been a stunning rise of 27 percent through 2014 (from 9.91 percent to 12.56 percent). So Colorado youth use rates in the NSDUH are not only higher than the national average, but, after freer access to marijuana, have been steeply climbing.

There is also Monitoring the Future (MTF), a school survey (8th, 10th, an 12th grades) produced by the National Institute on Drug Abuse. In 2014 MTF showed 21.2 percent of students reporting past month marijuana use. But that rate applied only to seniors in their survey, while the HKCS results were supposed to represent all grades. (Rates for 8th graders in the MTF stood at only 6.5 percent.)

Apparently worried about such data contradictions, the Washington Postsought to mitigate concern by pointing out that the HKCS had a very large in-state sample, of 17,000 kids. Says the Post, “That much larger sample could produce a more accurate estimate than the smaller numbers in the federal drug survey.”

But the Post‘s maneuver only magnifies the problems. HKCS is modeled on the Youth Risk Behavioral Survey (YRBS) conducted every two years by the Centers for Disease Control, and the YRBS (which covers most but not every state), also has a sample that estimates a national average.

Critically, however, the YRBS has nowhere near 17,000 youth in each state as their national sample. Their national estimate is based on a total 13,600 responses, for the entire nation; that would average just a few hundred kids per state if evenly distributed. Moreover, the YRBSsurveys youth in 9th through 12th grade. Hence, the YRBS is not really comparable to what happened in Colorado.

Likely Missed Most At-Risk Youth

The fact that HKCS and YRBS are both school-based surveys (that is, not taken in households, as is the NSDUH) may account for some of the difference in their respective magnitudes – school surveys produce traditionally higher figures. But this fact raises questions about the validity of any school-based survey.

School-base surveys cannot capture youth not in schools. Given that marijuana use itself is strongly associated with school drop-out rates (as well as high rates of absenteeism), the population of interest may not have been included in a representative fashion. Further, the rising number of young homeless marijuana users flooding into Colorado shows another side of the problem; they are not captured in the school surveys.

That is, the HKCS survey might have systematically missed exactly the kids most at-risk of using marijuana. Of course, if true, the same impact might have affected the HKCS 2013 results that formed the contrast. However, if marijuana use had

increased substantially since legalization, there could be a differential impact on student attrition by 2015, as the situation worsened.

Response Rates Undermined Validity

The 2013 survey reported in their “demographics” breakdown that the earlier iteration had an even larger sample than the 2015 run. The 2013sample was 40,000 youth, who answered with a response rate of 58 percent. But the 2015 sample, the 17,000, registered a truly dismal 46 percent response rate. This is a real problem.

First, when fewer than half of the sample responds, there is a risk that those who did answer are not representative of the actual youth total. Second, that drop in response could signal that there were more youth at risk in the 2015 sample, and hence, not present in the classroom during the second round.

Third, however, these data also show the non-comparability of the surveys. The 58 percent response in the 2013 survey, with a much larger sample, stands in genuine contrast with the lower 46 percent response rate and smaller initial sample for 2015. By way of contrast, the CDCYRBS has an 88 percent student response rate, while the NSDUH stands at 71.2 percent.

Here the point made by the Post about larger samples can be turned back on them; surely the smaller 2015 HKCS would be less accurate than the previous iteration, by the Post‘s own logic. Moreover, the surveys are non-comparable not only because of sample size and response rates, but further because a different set of schools was included in the 2015 iteration, not reporting, for instance, some large school districts near urban areas, where rates of use are often higher.

Given such differences, the two different sets of results cannot meaningfully be put side-by-side. And as we have seen, because theHKCS study was unique to Colorado, there is no methodologically comparable “national average” to which comparisons could be made. Hence, there is no lesson to be derived regarding the impact of legalization; certainly not one sufficiently robust to counter the worrisome NSDUH data to the contrary.

But here’s the most devastating problem of all. The official YRBS, run every two years, requires a 60 percent “participation” rate in order to generate valid weightings for the results. If they are unable to weight a state survey (such as HKCS), they cannot provide an estimate that is representative of the state population. As the CDC participation map shows, Colorado did not receive a proper weighted sample.

This means that the HKCS, according to the criteria offered by the CDC, cannot be used to represent all students in Colorado – there can be no extrapolation of the findings beyond the survey respondents. According to the CDC criteria, these results cannot be extrapolated beyond the participants themselves, and therefore “stands for” no one but the kids who participated. As such, there can be no statistically significant comparisons between these results and previous years, nor with what was termed a “national sample.”

Correction Needed

And yet the media were allowed (where they were not encouraged) to run the “top line” results as though they stood for Colorado youth. And to declare the results “better” following legalization. And to declare use in Colorado post-legalization to be below the national average. As we have seen, none of these statements is warranted. In fact, we now learn about other states that did not participate in the latest 2015 YRBS round. They include Minnesota, but more importantly, both Oregon and Washington, states that have recently legalized marijuana – that is, states that could have provided a report-card on legalization, but about which we will learn even less than we learned about Colorado. (The next NSDUH state-level estimate won’t come until 2017, post-election.)

This apparent coincidence does little to allay concerns that we are witnessing the effects of a pro-marijuana agenda, perhaps forwarded by well-meaning state boosters and,

more surely, by their enablers in the media. Given that other states are looking to Colorado to comprehend their own legalization risks, it is important that the record be corrected.

Children born to mothers who use cannabis during pregnancy are more likely to have an abnormal brain structure, which may have long-term consequences for mental health.  This is the conclusion of a new study published in the journal Biological Psychiatry,led by Dr. Hanan El Marroun, of Erasmus University Medical Center in the Netherlands.

According to the researchers, around 2-13 percent of women worldwide use cannabis during pregnancy.  Previous research has suggested that expectant mothers who use the drug are more likely to have children with behavioral and mental health problems.

Exactly how cannabis use affects the brain structure of offspring, however, has been unclear, and this is what Dr. El Marroun and colleagues set out to investigate.

“This study is important because cannabis use during pregnancy is relatively common and we know very little about the potential consequences of cannabis exposure during pregnancy and brain development later in life,” says Dr. El Marroun.  “Understanding what happens in the brain may give us insights in how children develop after being exposed to cannabis.”

Thicker prefrontal cortex for children prenatally exposed to cannabis

The team analyzed the data of 263 children aged 6-8 years who were part of the Generation R Study – a population-based study in the Netherlands, in which they were followed from birth.

Of these children, 96 were born to mothers who used cannabis during pregnancy, and most of these mothers were also smokers. A total of 54 children were prenatally exposed to tobacco only, while 113 were not prenatally exposed to either substance. All of the children underwent magnetic resonance imaging (MRI) scans, which allowed the researchers to assess their brain volume and cortical thickness.

Overall, the researchers found no difference in total brain volume, gray matter volume, or white matter volume between the three groups.

However, compared with children who were prenatally exposed to tobacco only, the researchers found those who were prenatally exposed to both cannabis and tobacco had a thicker prefrontal cortex.

The prefrontal cortex is a brain region that plays a role in complex cognitive behavior, planning, decision-making, working memory, and social behavior.

Given the increase in legalization of cannabis across the United States, Dr. John Krystal, editor of Biological Psychiatry, believes expectant mothers should take note of these findings. “The growing legalization, decriminalization, and medical prescription of cannabis increases the potential risk of prenatal exposure. This important study suggests that prenatal exposure to cannabis could have important effects on brain development.” Dr. John Krystal

Additionally, the researchers found that children who were prenatally exposed to tobacco only had a thinner prefrontal cortex than those who were not prenatally exposed to tobacco or cannabis.

Dr. El Marroun says the study results should be interpreted with caution, noting that further studies are needed to determine the underlying mechanisms that link prenatal cannabis exposure to changes in brain structure.

“Nevertheless,” she adds, “the current study combined with existing literature does support the importance of preventing smoking cannabis and cigarettes during pregnancy.”

Source:   www.medicalnewstoday.com   21st  June 2016

Marijuana remains the most commonly used illicit drug in the United States, and its use is particularly widespread among adolescents. Now, a new study has identified the ages at which adolescents are most likely to try the drug, which may have implications for current marijuana intervention programs.

According to the National Institute on Drug Abuse (NIDA), last year, around 6.5 percent of eighth-grade students, 14.8 percent of 10th-graders, and 21.3 percent of 12th-graders reported current marijuana use. Among 12th-graders, 6 percent reported using the drug daily. Marijuana use can pose a number of risks to physical and mental health, including mood changes, altered senses, impaired movement and breathing problems.

Additionally, use of the drug in adolescence may raise the risk of long-term problems, such as poor cognitive functioning; studies have shown that teenagers who use marijuana have a lower IQ and poorer academic outcomes.

Previous research has also indicated that teenagers who use marijuana are more likely to engage in the use of other illicit drugs.  However, NIDA report that adolescent awareness of these risks is gradually decreasing, likely due to increased legalization of marijuana for medical or recreational use across the U.S.

For this latest study, published in the American Journal of Drug and Alcohol Abuse, researchers from the University of Florida (UF) set out to determine the ages at which adolescents are most likely to try marijuana – information that they say could help guide drug prevention programs.

‘Drug education needs to start earlier’

Lead author Dr. Xinguang Chen, a professor in the Department of Epidemiology at UF, and colleagues analyzed data from the 2013 National Survey on Drug Use and Health, which included 26,659 participants aged 12-21 years.

The researchers used the data to estimate the risk of marijuana use initiation among the participants from birth.   Overall, the team found that 54 percent of adolescents had started using marijuana by the age of 21. They found that adolescents are at risk of trying marijuana from the age of 11. This risk steadily increases until the age of 16, at which point it hits a peak, the researchers report.

The authors note that current marijuana intervention programs focus on adolescents aged 15 and older. Based on their results, the authors suggest such programs should be initiated earlier. “Our findings demonstrate the need to start drug education much earlier, in the fourth or fifth grade. This gives us an opportunity to make a preemptive strike before they actually start using marijuana.”

Dr. Xinguang Chen

Marijuana use risk drop at age 17

At the age of 17, the team found that the risk of first-time marijuana use drops. The authors say this could be because teenagers are more focused on their studies and college entrance exams at this age, rather than drug use.

At the age of 18, however, the researchers found the risk of marijuana use initiation hits another peak – a finding they say might be explained by the life changes that occur at this age.  “At 18, many adolescents leave their parents’ homes to start college or enter the workforce,” says study co-author Dr. Bin Yu, also of UF’s Department of Epidemiology. “They may be more susceptible to influence from peers and they have less monitoring by their parents and the community.”

On analyzing the risk of marijuana use by race/ethnicity, the researchers were surprised to find it varied; adolescents from a multiracial background were significantly more likely to use the drug than those from other backgrounds.

The authors say future research should investigate why people from multicultural backgrounds may be at greater risk for marijuana use, as well as why certain age groups are at heightened risk.

They believe such information could aid the development of more targeted marijuana prevention programs.  “This study finding supports the idea of precision intervention. Intervention programs should be developed for both parents and adolescents, and delivered to the right target population at the right time for the best prevention effect.”    Dr. Xinguang Chen

Source:  http://www.medicalnewstoday.com/articles/311391.php  3rd July 2016  Alcohol / Addiction / Illegal Drugs Pediatrics / Children’s HealthNeurology / NeurosciencePublic Health

Summary

This annual statistical report presents information on drug misuse among both adults and children. The topics covered include:

• Prevalence of drug misuse, including the types of drugs used;
• Trends in drug misuse over recent years;
• Patterns of drug misuse among different groups of the population;
• Health outcomes related to drug misuse including hospital admissions, drug treatment and number of deaths.

The report also summarises Government plans and targets in this area, as well as providing sources of further information and links to relevant documents.

The report draws together data from a variety of different sources and presents it in a user-friendly format. Most of the data contained in the bulletin have been published previously by the Health and Social Care Information Centre, the Home Office, the Office for National Statistics or the National Treatment Agency for Substance Misuse. Previously unpublished figures on drug-related admissions to hospital are presented using data from the Health and Social Care Information Centre’s Hospital Episode Statistics (HES).

Key facts

Drug misuse related hospital admissions (England)

• In 2014/15, there were 8,149 hospital admissions with a primary diagnosis of drug-related mental health and behavioural disorders. This is 14 per cent more than 2013/14 but only 4 per cent higher than 2004/05.
• There were 14,279 hospital admissions with a primary diagnosis of poisoning by illicit drugs. This is 2 per cent more than 2013/14 and 57 per cent more than 2004/05.

Deaths related to drug misuse (England and Wales)

• In 2014 there were 2,248 deaths which were related to drug misuse. This is an increase of 15 per cent on 2013 and 44 per cent higher than 2004.
• Deaths related to drug misuse are at their highest level since comparable records began in 1993.

Drug use among adults (England and Wales)

• In 2015/16, around 1 in 12 (8.4 per cent) adults aged 16 to 59 had taken an illicit drug in the last year. This equates to around 2.7 million people.
• This level of drug use was similar to the 2014/15 survey (8.6 per cent), but is significantly lower than a decade ago (10.5 per cent in the 2005/06 survey).

Drug use among children (England)

• In 2014, 15 per cent of pupils had ever taken drugs, 10 per cent had taken drugs in the last year and 6 per cent had taken drugs in the last month.
• The prevalence of drug use increased with age. For example, 6 per cent of 11 year olds said they had tried drugs at least once, compared with 24 per cent of 15 year olds.

Resources

Statistics on Drug Misuse: England, 2016 – Report [.pdf](Opens in a new window)

Statistics on Drug Misuse: England, 2016 – Appendices [.pdf](Opens in a new window)

Statistics on Drug Misuse: England, 2016 – Data Quality Statement [.pdf](Opens in a new window)

Statistics on Drug Misuse: England, 2016 – Tables [.xlsx](Opens in a new window)

Statistics on Drug Misuse: England, 2016 – CSV data pack [.zip](Opens in a new window)

Statistics on Drugs Misuse: England, 2016: Pre-release access list [.pdf]

Source:  http://digital.nhs.uk/catalogue/PUB21159    28^th July 2016