Governor says other states should learn from Colorado’s example, noting that state initially failed to regulate edibles strongly enough

States preparing to legalize cannabis for recreational use in 2017 have been warned to impose strong regulations on edible products, in order to help prevent children mistaking the drug for candy. John Hickenlooper, governor of Colorado, which pioneered legal cannabis for recreational use in 2014, said other states should learn from his state’s example.

“We didn’t regulate edibles strongly enough at first,” he said this week, at a gathering of the Western Governors’ Association.  Colorado has seen a rise in numbers of children taken to the hospital after eating marijuana products. California, Massachusetts, Nevada and Maine are the latest states to legalize recreational cannabis, after voters passed ballot measures in the November elections.

Recreational use is currently legal in Colorado, Washington, Oregon, Alaska and the District of Columbia. More than half of the 50 states now allow marijuana for medical use.  Los Angeles could become the weed capital of the world, one industry insider has predicted, estimating that the southern California city already generated close to $1bn in annual medical marijuana sales.

The whole of Colorado had just under $1bn in sales in 2015, on which the industry paid $135m in taxes and fees to the state. Revenues are likely to grow to $1.3bn in 2017, according to the state department of revenue. Hickenlooper, who said he had been fielding calls from governors asking for his advice, California’s Jerry Brown among them, opposed legalizing recreational pot. The drug nonetheless became legal for leisure use in Colorado in January 2014. The state has since been forced to toughen regulations, particularly on edible products, because many emerged that looked exactly like non-cannabis-containing products such as gummy bears, lollipops, brownies, cookies and chocolates. Lawmakers in Colorado passed rules requiring manufacturers to improve child-proofing on packaging and use better labelling,  including stamps on food to say it contains pot.  Recent measures will prohibit animal and fruit-shaped edibles. The state also started a public education campaign aimed at teens and children.  Hickenlooper, speaking in California, said that in a few cases children had died. There are, however, no confirmed statistics or details available for the state.

Hickenlooper spokeswoman Holly Shrewsbury told the Guardian there have been no such deaths of under-18s and the governor was including young adults in his reference to children, without citing exact numbers. A study by the University of Colorado published last July reported that in 2015, 16 children under the age of 10 were admitted to the emergency room of the Children’s Hospital of Colorado, in Aurora, with edible-related complaints.

In the same year, state poison control authorities received 47 calls about children falling sick after taking pot. Around half of those incidents involved edibles. In 2009, there were nine such calls to poison control.  It’s more regulated than plutonium at this stage but I’m in favour of common sense rules backed by science, not fear.  Most children affected became drowsy and recovered after a few hours. A small number became seriously ill and ended up in intensive care.

Julie Dooley, who owns Julie’s Natural Edibles, a Denver company that makes cannabis-infused granola, echoed the governor’s advice that states should regulate better from the start of legalization, rather than bring in laws retroactively.

“It’s important to regulate ahead of time,” she said. “We’ve just gone through our fourth round of regulation since legalization and it’s very expensive having to change the labelling and packaging all the time.   “It’s more regulated than plutonium at this stage, but I’m in favour of common sense rules, backed by science, not fear.”

Dooley said it was incumbent on parents to store cannabis and cannabis products safely away from children, but said the state should do “a lot more” to educate the public.  Hickenlooper said that if he could have had a magic wand in 2013, he would have reversed Colorado’s legalization vote.

“Now if I have that magic wand, I probably wouldn’t,” he said. “I would wait and see if we can make a better system.”  He described America’s wider policy of waging a law enforcement “war on drugs” as “a train wreck”.  “It didn’t work, so it remains to be seen whether the new system is actually going to be better,” he said.

Last week, Colorado announced $2.35m in funding for research grants to look into the effects of cannabis on driving ability and cognitive functioning.  Henny Lasley, executive director of Smart Colorado, an advocacy group that campaigns for better protections from cannabis for youth, said: “Cannabis products should not look like candy, or like anything a child would pick up and eat.”

She called for more research and data at the state level and warned about the strength of highly concentrated pot coming on to the market for recreational use.  “I would like states to limit the potency of the products,” she said.

Source:   https://www.theguardian.com/us-news/2016/dec/18/recreational-marijuana-legalization-states-edibles-candy

Regularly smoking cannabis may damage users’ eyesight by triggering an abnormality in the retina, a new study has found.   Researchers in France tested 28 cannabis smokers and 24 people who did not use the drug to see how well their retinal cells responded to electrical signals.

A small but significant delay was found in the time taken for the signals to be processed by the retina of the marijuana users by comparison with the control group.  “This finding provides evidence for a delay of approximately 10 milliseconds in the transmission of action potentials evoked by the retinal ganglion cells,” the researchers wrote in the JAMA Ophthalmology.

“As this signal is transmitted along the visual pathway … to the visual cortex, this anomaly might account for altered vision in regular cannabis users. Our findings may be important from a public health perspective since they could highlight the neurotoxic effects of cannabis use on the central nervous system as a result of how it affects retinal processing.”

A statement issued by the Journal of the American Medical Association described the study as “small” and “preliminary”.  But the researchers, led by Dr Vincent Laprevote, of the Pole Hospitalo-Universitaire de Psychiatrie du Grand Nancy, added: “Independent of debates about its legalisation, it is necessary to gain more knowledge about the different effects of cannabis so that the public can be informed.   “Future studies may shed light on the potential consequences of these retinal dysfunctions for visual cortical processing and whether these dysfunctions are permanent or disappear after cannabis withdrawal.”

In a related article commenting on the research, Dr Christopher Lyons, of the University of British Columbia in Vancouver, and Dr Anthony Robson, of Moorfields Eye Hospital, London, wrote that it dealt with “an important and neglected issue, namely the possible toxic effects of cannabis, with all its implications for the many users of this ubiquitous drug”.

“Addressing this issue through the visual system, as the authors have done, is an elegant concept. Any deleterious effect on the visual system would also have implications for driving, work and other activities and thus warrants further study,” they added.

“Electrophysiology can provide reliable and reproducible measurements of retinal and visual pathway function and is useful in the investigation and localisation of dysfunction, including that caused by toxicity.

“However, the conclusion that cannabis causes retinal ganglion cell dysfunction cannot be made with any degree of certainty based on the evidence provided in the current study.

Source:  http://www.independent.co.uk/news/science/cannabis-eyesight-vision-damage-toxic-effects-study-a7463331.html

Illegal cigarettes and alcohol seized by police have been turned into electricity at a special recycling plant Almost 150,000 cigarettes and tonnes of illegal alcohol seized during raids in Lincolnshire have been turned into electricity.

The substances were taken to a specialist recycling centre where the cigarettes were broken down and the energy fed into the National Grid.

The counterfeit liquid is mixed with foodstuffs and enzymes to create gas. This gas is then burned to produce electricity, which is then also fed into the National Grid

Emma Milligan, principal trading standards officer at Lincolnshire County Council, said: “Tackling the sale of counterfeit and illegal cigarettes and alcohol is a priority. Some cigarettes are not self-extinguishing and therefore extremely dangerous.

“Illegal brands, such as Pect and Jin Lings, don’t comply with the UK safety standard of Reduced Ignition Propensity, meaning they don’t go out when not actively being smoked.”

She explained that many bottles of alcohol were seized for non-payment of duty, while others were seized as they were counterfeit or fake and potentially very dangerous. They can contain industrial alcohol which is unfit for human consumption.

Emma said: “The cigarettes and alcohol being destroyed today have been seized in several operations involving Lincolnshire Trading Standards and Lincolnshire Police. Tobacco detection dogs are often involved, supported by the Smoke Free Alliance.

“With such potential dangers to the public, it’s vital that these products are taken off the streets. I’m glad we can put the cigarettes and alcohol to use in a productive way.

“If you do suspect anyone of selling cheap, illegal cigarettes or alcohol, you can call Crimestoppers anonymously on 0800 555 111 to avoid tragic cases in the future.”

Source: at http://www.grimsbytelegraph.co.uk/illegal-alcohol-and-cigarettes-seized-by-police-turned-into-electricity/story-30016023-detail/story.html#B9POiDF9gKweB85K.99

Randomised controlled trial 

Battistella G, et al. PLoS One. 2013.

Abstract

Marijuana is the most widely used illicit drug, however its effects on cognitive functions underlying safe driving remain mostly unexplored.

Our goal was to evaluate the impact of cannabis on the driving ability of occasional smokers, by investigating changes in the brain network involved in a tracking task. The subject characteristics, the percentage of Δ(9)-Tetrahydrocannabinol in the joint, and the inhaled dose were in accordance with real-life conditions.

Thirty-one male volunteers were enrolled in this study that includes clinical and toxicological aspects together with functional magnetic resonance imaging of the brain and measurements of psychomotor skills. The fMRI paradigm was based on a visuo-motor tracking task, alternating active tracking blocks with passive tracking viewing and rest condition.

We show that cannabis smoking, even at low Δ(9)-Tetrahydrocannabinol blood concentrations, decreases psychomotor skills and alters the activity of the brain networks involved in cognition. The relative decrease of Blood Oxygen Level Dependent response (BOLD) after cannabis smoking in the anterior insula, dorsomedial thalamus, and striatum compared to placebo smoking suggests an alteration of the network involved in saliency detection.

In addition, the decrease of BOLD response in the right superior parietal cortex and in the dorsolateral prefrontal cortex indicates the involvement of the Control Executive network known to operate once the saliencies are identified. Furthermore, cannabis increases activity in the rostral anterior cingulate cortex and ventromedial prefrontal cortices, suggesting an increase in self-oriented mental activity.

Subjects are more attracted by intrapersonal stimuli (“self”) and fail to attend to task performance, leading to an insufficient allocation of task-oriented resources and to sub-optimal performance. These effects correlate with the subjective feeling of confusion rather than with the blood level of Δ(9)-Tetrahydrocannabinol. These findings bolster the zero-tolerance policy adopted in several countries that prohibits the presence of any amount of drugs in blood while driving.

Source:  PLoS One. 2013;8(1):e52545. doi: 10.1371/journal.pone.0052545. Epub 2013 Jan 

THE level of people being hospitalised after taking cannabis and related ‘legal highs’ has reached a 10-year peak, according to official figures from the Scottish Government.  More than 900 acute stays in general hospitals – as opposed to psychiatric admissions – involved the drug last year.

The Scottish Tories said the data showed cannabis was not the benign drug some claimed.

The latest figures show that in 2015-16 there were 7537 hospital stays in Scotland with a diagnosis of drug misuse, involving 5922 people, some admitted more than once.

Of these stays, 913 or 12 per cent, involved “cannabinoids”, which include synthetic highs such as Spice as well as the plant form of cannabis.   This was the highest percentage involving cannabinoids since 13 per cent in 2005-06.

Cannabinoids were the most common cause of drug stays among children – accounting for 45 per cent of cases involving under-15s.

The health boards with the most stays were NHS Greater Glasgow and Clyde (306), NHS Lothian (165) and NHS Lanarkshire (106).  Although still sometimes called a legal high, synthetic cannabis was criminalised last May, with its production and sale made punishable by up to seven years in prison.

Hospital admissions associated with cannabis were almost double those linked to cocaine.

Acute stays involving cocaine were at their highest since 2008-09 last year, but involved 553 admissions, or 7 per cent of all general drug-related cases.

The drugs most associated with hospital admissions were opioids, such as heroin, morphine, oxycodone and fentanyl.

Last year, opioids were behind 4656 stays, or 62 per cent of the drug-related total.  The number and prevalence of opioid admissions has increased hugely in the last 20 years.  In 1996-97, opioids accounted for just 791 stays, then equal to 34 per cent of drug admissions.

Scottish Tory justice spokesman Douglas Ross criticised campaigns to decriminalise cannabis and Police Scotland taking a soft touch approach to its use.  The force said in 2015 it might give people caught with cannabis on-the-spot recorded warnings as an alternative to prosecution.   Mr Ross said: “It’s quite alarming that quite so many people are being hospitalised through using cannabis, a drug many people feel authorities are going soft on.

“Not only is it dangerous in its own right, as these statistics prove, but it’s a gateway drug to even more harmful substances.

“We have a massive fight on our hands in Scotland both with illegal drugs and so-called legal highs.   “Now is not the time to give in and wave the white flag.  “We need to crack down on those circulating drugs of all kinds on our streets, and reinforce the message about just how damaging taking these substances can be.”

Scottish LibDem health spokesman Alex Cole-Hamilton said it was a concern that the figures were rising, but said the Conservatives’ solution was “completely wrong and regressive”.  He said: “If anything these figures show that the LibDems have been right in calling for this dark market to be brought out of the shadows.  “If the Tories had their way then they would drive the market further underground exposing people to more dangerous drugs and endangering more lives leading to more hospitalisations.

“The answer is to educate and regulate not to punish as the Tories want to do.”

Health Secretary Shona Robison said drug use continued to fall in the general population.  She said: “We have greatly reduced drug and alcohol waiting times with 94 per cent of people now being seen within three weeks of being referred.

“We have also invested over £630m to tackle problem alcohol and drug use since 2008 and over £150m over five years to improve mental health services in Scotland.”

Source: http://www.heraldscotland.com/news/15005884.Hospital_stays_linked_to_cannabis_at_10_year_high/   Jan,2017

ABSTRACT

Objective:

To evaluate the association between drug use and parenting styles perceived by Brazilian adolescent children.

Methods:

This cross-sectional study enrolled adolescents aged 14 to 19 years that used the Serviço Nacional de Orientações e Informações sobre a Prevenção do Uso Indevido de Drogas (VIVAVOZ). A total of 232 adolescents participated in the study. Phone interviews were conducted using the Parental Responsiveness and Demandingness Scale, which classifies maternal and paternal styles perceived by adolescent children as authoritative, neglectful, indulgent or authoritarian. Socio demographic variables were collected and an instrument was used to assess monthly drug use and abuse.

Results:

Maternal and paternal parenting styles perceived as neglectful, indulgent or authoritarian (non-authoritative) were significantly associated with drug use (odds ratio [OR] = 2.8; 95% confidence interval [95%CI], 1.3-5.7 for mothers and OR = 2.8; 95%CI, 1.3-6.3 for fathers). Non-authoritative styles also had a significant association with tobacco use in the previous month in the analysis of maternal (OR = 2.7; 95%CI, 1.2-6.5) and paternal (OR = 3.9; 95%CI, 1.4-10.7) styles, and use of cocaine/crack in the previous month (OR = 3.9; 95%CI, 1.1-13.8) and abuse of any drug (OR = 2.2; 95%CI, 1.0-5.1) only for the paternal style. Logistic regression revealed that maternal style (OR = 3.3; 95%CI, 1.1-9.8), adolescent sex (OR = 3.2; 95%CI, 1.5-7.2) and age (OR = 2.8; 95%CI, 1.2-6.2) were associated with drug use.

Conclusions:

Adolescents that perceived their mothers as non-authoritative had greater chances of using drugs. There was a strong association between non-authoritative paternal styles and adolescent drug abuse. PMID:  21556486   DOI:   doi:10.2223/JPED.2089

Source:  J Pediatr (Rio J). 2011 May-Jun 8;87(3):238-44.doi:10.2223/JPED.2089. Epub 2011.

ASK THE DOCTOR  column –  – by Dr. Robert Ashley – Erie Times-News, December 30, 2016

Q:  Marijuana seems to be increasingly accepted in our country.  But I worry about my kids using it.  Is it addictive?

A:  Marijuana has gained greater acceptance in this country, not in small part because its medical use can stimulate appetite, control nausea and control pain.  One potential problem with this degree of acceptance is how adolescents view the drug.

In 2015, 70 percent of high school seniors viewed marijuana as not harmful, according to the National Institute on Drug Abuse’s Monitoring the Future survey;  in 1990, only 20 percent felt this way.

Perhaps the biggest risk with marijuana is how it affects the adolescent brain.  The endocannabinoid system, a vast system of receptors within the brain, spinal cord and smaller nerves, affects multiple brain and body functions.  The system continues to develop in humans until the age of 21 or so.

If used frequently in adolescence, marijuana can rewire many of these nerve pathways.  These changes aren’t seen as much in the adult brain and, if they surface, can be easily reversed by stopping use.  In adolescents, however, this rewiring of the nervous system may create addiction.  According to the NIDA, only 9 percent of people who try marijuana become addicted.  However, this number increases to 16 percent among those who start using marijuana in adolescence.  It increases further if marijuana is used daily in adolescence.

Marijuana not only causes short–term memory loss, it also affects mental abilities for days after its use.  That means a person’s ability to plan, organize, solve problems and make decisions is impaired, which has significant ramifications for adolescents trying to retain information learned in school.

Further, for those predisposed to schizophrenia, marijuana can induce psychosis and, in younger users, can decrease the age of schizophrenia’s onset.  People with a familial predisposition to schizophrenia should certainly avoid use.

Send your questions to askthedoctors@mednet.ucla.edu,, or Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles CA  90095.

Chandigarh: In a first of its kind strike in Punjab, the Narcotics Control Bureau (NCB) on Tuesday raided a wholesaler of ayurvedic drugs in Amritsar and recovered over 1,600 tablets of a drug called ‘Kamini’ containing afeem (laudanum), the purest form of opium. In the run-up to the elections, the Election Commission is keeping a close watch on drug abuse in the state.  Apart from Kamini Vidrawan Ras, which is sold at chemist shops as a herbal formulation, 44 small packs of Barshasha, a Unani preparation that contains pure opium, were also recovered from S A Medicine Center at Galia Road in Amritsar. Though the quantity of the drug recovered is not high, NCB zonal director Kaustubh Sharma confirmed that this was first such bust aimed at curtailing the misuse of ayurvedic drugs in Punjab.

“We had written to the ayurvedic department of the state government stating that some chemists were selling these drugs without maintaining proper records. Acting on a specific input we raided the wholesaler and found that he did not even have authorization to stock the medicine,” Sharma said.

Till late evening on Tuesday, officials were checking the records to find out how much drug the wholesaler was selling on a daily basis. An ayurvedic practitioner can prescribe the medicine and the chemist has to get a ‘Form C’ filled before selling the drug and maintain a record of the same. Though, the sale of these medicines is regulated by the ayurveda department of the state government but the chemists have to take authorization from the state drug controller (SDC) office as well.  After TOI reported unmonitored production of opioid-based painkiller tramadol, which is not covered under the NDPS Act, this is second major incident of medicine meant of other purposes being abuse by addicts.

In June 2015, TOI had first reported misuse of these ayurvedic formulations by drug addicts in Punjab, citing a study by PGI, Chandigarh. There had, however, been no major action taken by the authorities since.

Source:  http://timesofindia.indiatimes.com/city/chandigarh/ayurvedic-chemist-selling-afeem-meds-raided-in-pb/articleshow/56331364.cms

Since marijuana is currently illegal in all but physician-approved circumstances, there have been no properly constructed clinical trials of smoking this drug in Canada, writes Lawrie McFarlane of the Victoria Times .

The greatest public-health disaster our species ever brought upon itself began in Europe 400 years ago — the introduction and use of tobacco.

In the 20th century alone, 100 million people died from cigarette smoking worldwide. And while the incidence rate has fallen in western countries, it remains high in Third World nations. Six million tobacco users still die each year. The cause of smoking deaths is not, primarily, the active ingredient in tobacco — nicotine. Rather it is the chemicals that comprise tobacco smoke — among them various tars, ammonia, hydrogen cyanide and formaldehyde.  Collectively, these chemicals cause a host of fatal maladies, including cancer, heart disease and emphysema. In short, a perfect horror show.

Now at this point, you’re probably saying: Tell me something I didn’t know. Well, here it is: Many of those same chemicals form marijuana smoke, and we are about to legalize the consumption of this drug. It’s not clear yet which forms of use might be authorized. If smoking is not among them, we might yet avoid another public-health calamity.

True, there are worrisome effects that come with consuming marijuana by other means, among them elevated pulse rates and memory loss. But these are minor matters, by comparison.

However, if smoking marijuana is blessed for general use, we might have an entirely different situation on our hands. For here is what is currently known with medical certainty about the health impacts of lighting up a joint: Nothing.  Since marijuana is currently illegal in all but physician-approved circumstances, there have been no properly constructed clinical trials of smoking this drug.

For the same reason, there have been no robust after-market research projects, in which users are tracked down years later, and their health status compared with that of non-users. Yet this is an essential process in revealing whether drugs that appear safe at first blush turn out to have serious side-effects downstream.  There have been suggestions that marijuana might act as a gateway drug to such potent narcotics as heroin and fentanyl. But whether these are anecdotal or fact-based, no one really knows.

There is also the matter of what is called the dose effect. Cigarettes have a high dose effect, meaning the risk of illness increases exponentially the more you consume. Hence the toxicology maxim: “The dose is the poison.”  So what is the dose effect of smoking marijuana? Again, we simply do not know and this is no small concern.

Generally speaking, it seems fair to assume that making an addictive substance more readily available will increase consumption rates. So what happens if people begin smoking 20 marijuana joints a day?  What happens if manufacturers find ways to strengthen the active ingredient — THC — while making their product less harsh? That’s what cigarette companies did.

In short, we are on the brink of approving a form of drug use, the medical consequences of which remain uncertain, but which might involve inhaling carcinogens. You would think the history of tobacco might have taught us something about fooling with addictive substances before we know the facts. In particular, you might think we would have learned how difficult, if not impossible, it is to close a Pandora’s box like this after it has been opened.

Once a government-sanctioned infrastructure of production, marketing and distribution is erected around marijuana, and millions of additional users are recruited, there will be no going back, regardless of whatever medical verdict is finally rendered. That’s principally why we continue to license tobacco production, despite its many ills.

I recognize we already turn a blind eye to occasional or “recreational” use of marijuana. But between turning a blind eye and conferring on this drug an official stamp of approval lies a world of unknown harm.

— Lawrie McFarlane is a columnist for the Victoria Times Colonist

Source:   http://theprovince.com/opinion/little-research-on-marijuanas-dangers  2nd Jan 2017

November 28, 2016

This shows a sample case of a visual 3-D rendering of a baseline SPECT scan of a long standing marijuana user compared to a control subject. The marijuana user has multiple perfusion defects with lower perfusion shown as scalloping and gaps …more

As the U.S. races to legalize marijuana for medicinal and recreational use, a new, large scale brain imaging study gives reason for caution. Published in the Journal of Alzheimer’s Disease, researchers using single photon emission computed tomography (SPECT), a sophisticated imaging study that evaluates blood flow and activity patterns, demonstrated abnormally low blood flow in virtually every area of the brain studies in nearly 1,000 marijuana compared to healthy controls, including areas known to be affected by Alzheimer’s pathology such as the hippocampus.

Hippocampus, the brain’s key memory and learning center, has the lowest blood flow in marijuana users suggesting higher vulnerability to Alzheimer’s. As the U.S. races to legalize marijuana for medicinal and recreational use, a new, large scale brain imaging study gives reason for caution. Published in the Journal of Alzheimer’s Disease, researchers using single photon emission computed tomography (SPECT), a sophisticated imaging study that evaluates blood flow and activity patterns, demonstrated abnormally low blood flow in virtually every area of the brain studies in nearly 1,000 marijuana compared to healthy controls, including areas known to be affected by Alzheimer’s pathology such as the hippocampus.

All data were obtained for analysis from a large multisite database, involving 26,268 patients who came for evaluation of complex, treatment resistant issues to one of nine outpatient neuropsychiatric clinics across the United States (Newport Beach, Costa Mesa, Fairfield, and Brisbane, CA, Tacoma and Bellevue, WA, Reston, VA, Atlanta, GA and New York, NY) between 1995-2015. Of these, 982 current or former marijuana users had brain SPECT at rest and during a mental concentration task compared to almost 100 healthy controls. Predictive analytics with discriminant analysis was done to determine if brain SPECT regions can distinguish marijuana user brains from controls brain. Low blood flow in the hippocampus in marijuana users reliably distinguished marijuana users

from controls. The right hippocampus during a concentration task was the single most predictive region in distinguishing marijuana users from their normal counterparts. Marijuana use is thought to interfere with memory formation by inhibiting activity in this part of the brain.

According to one of the co-authors on the study Elisabeth Jorandby, M.D., “As a physician who routinely sees marijuana users, what struck me was not only the global reduction in blood flow in the marijuana users brains , but that the hippocampus was the most affected region due to its role in memory and Alzheimer’s disease. Our research has proven that marijuana users have lower cerebral blood flow than non-users. Second, the most predictive region separating these two groups is low blood flow in the hippocampus on concentration brain SPECT imaging. This work suggests that marijuana use has damaging influences in the brain – particularly regions important in memory and learning and known to be affected by Alzheimer’s.”

Dr. George Perry, editor in chief of the Journal of Alzheimer’s Disease said, “Open use of marijuana, through legalization, will reveal the wide range of marijuana’s benefits and threats to human health. This study indicates troubling effects on the hippocampus that may be the harbingers of brain damage.”

According to Daniel Amen, M.D., Founder of Amen Clinics, “Our research demonstrates that marijuana can have significant negative effects on brain function. The media has given the general impression that marijuana is a safe recreational drug, this research directly challenges that notion. In another new study just released, researchers showed that marijuana use tripled the risk of psychosis. Caution is clearly in order.”

More information: Daniel G. Amen et al. Discriminative Properties of Hippocampal Hypo perfusion in Marijuana Users Compared to Healthy Controls: Implications for Marijuana Administration in Alzheimer’s Dementia, Journal of Alzheimer’s Disease (2016). DOI: 10.3233/JAD-160833

Source:http://medicalxpress.com/news/2016-11-marijuana-users-bloodbrain.html#nRlv

A most detailed and valuable research study printed as a letter in the journal Nature, Vol. 539 – available online.

This study demonstrates that at least one G-protein-coupled receptor present on mitochondrial membranes modulates high brain functions such as memory formation through the modulation of intra-mitochondrial G-protein signalling. Considering that G proteins play a central role in the brain, the present data will probably pave the way for a new field of research that deals with the acute effects of mitochondrial activity on brain functioning.

Cannabinoid drugs have several therapeutic potentials30, unfortunately limited by important side effects, such as impairment of memory5,6. The present data suggest that selective targeting of specific subcellular populations of CB1 receptors in the brain might assist in development of safer therapeutics against several brain disorders.

Source: 2 4 November 2 0 1 6 | VO L 5 3 9 | N AT U RE | 5 5 5

Currently, 29 states and Washington, DC, have passed laws to legalize medical marijuana. Although evidence for the effectiveness of marijuana or its extracts for most medical indications is limited and in many cases completely lacking, there are a handful of exceptions. For example, there is increasing evidence for the efficacy of marijuana in treating some forms of pain and spasticity, and 2 cannabinoid medications (dronabinol and nabilone) are approved by the US Food and Drug Administration for alleviating nausea induced by cancer chemotherapy.

A systematic review and meta-analysis by Whiting et al1 found evidence, although of low quality, for the effectiveness of cannabinoid drugs in the latter indication. The anti -nausea effects of tetrahydrocannabinol (THC), the main psychoactive ingredient in marijuana, are mediated by the interactions of THC with type cannabinoid (CB1) receptors in the dorsal vagal complex. Cannabidiol, another cannabinoid in marijuana, exerts antiemetic properties through other mechanisms. Nausea is a medically approved indication for marijuana in all states where medical use of this drug has been legalized. However, some sources on the internet are touting marijuana as a solution for the nausea that commonly accompanies pregnancy, including the severe condition hyperemesis gravidarum.

Although research on the prevalence of marijuana use by pregnant women is limited, some data suggest that this population is turning to marijuana for its antiemetic properties, particularly during the first trimester of pregnancy, which is the period of greatest risk for the deleterious effects of drug exposure to the foetus. Marijuana is the most widely used illicit drug during pregnancy, and its use is increasing. Using data from the National Survey of Drug Use and Health, Brown et al report in this issue of JAMA that 3.85%of pregnant women between the ages of 18 and 44 years reported past-month marijuana use in 2014, compared with 2.37%in 2002. In addition, an analysis of pregnancy data from Hawaii reported that women with severe nausea during pregnancy, compared with other pregnant women, were significantly more likely to use marijuana (3.7%vs 2.3%, respectively).

Although the evidence for the effects of marijuana on human prenatal development is limited at this point, research does suggest that there is cause for concern. A recent review and a meta-analysis found that infants of women who used marijuana during pregnancy were more likely to be anaemic, have lower birth weight, and require placement in neonatal intensive care than infants of mothers who did not use marijuana. Studies have also shown links between prenatal marijuana exposure and impaired higher-order executive functions such as impulse control, visual memory, and attention during the school years.

The potential for marijuana to interfere with neurodevelopment has substantial theoretical justification. The endocannabinoid system is present from the beginning of central nervous system development, around day 16 of human gestation, and is increasingly thought to play a significant role in the proper formation of neural circuitry early in brain development, including the genesis and migration of neurons, the outgrowth of their axons and dendrites, and axonal pathfinding. Substances that interfere with this system could affect foetal brain growth and structural and functional neurodevelopment.

An ongoing prospective study, for example, found an association between prenatal cannabis exposure and foetal growth restriction during pregnancy and increased frontal cortical thickness among school-aged children. Some synthetic cannabinoids, such as those found in “K2/Spice” products, interact with cannabinoid receptors even more strongly than THC and have been shown to be teratogenic in animals.

A recent study in mice found brain abnormalities, eye deformations, and facial disfigurement (cleft palate) in mouse foetuses exposed at day 8 of gestation to a potent full cannabinoid agonist, CP-55,940. The percentage of mouse foetuses with birth defects increased in a linear fashion with dose. (The eighth day of mouse gestation is roughly equivalent to the third or fourth week of embryonic development in humans, which is before many mothers know they are pregnant.) It is unknown whether these kinds of effects translate to humans; thus far, use of synthetic cannabinoids has not been linked to human birth defects, although use of these substances is still relatively new.

THC is only a partial agonist at the CB1 receptor, but the marijuana being used both medicinally and recreationally today has much higher THC content than in previous generations (12% in 2014 vs 4% in 1995), when many of the existing studies of the teratogenicity of marijuana were performed. Marijuana is also being used in new ways that have the potential to expose the user to much higher THC concentrations—such as the practice of using concentrated extracts (eg, hash oil). More research is needed to clarify the neurodevelopmental effects of prenatal exposure to marijuana, especially high-potency formulations, and synthetic cannabinoids.

One challenge is separating these effects from those of alcohol, tobacco, and other drugs, because many users of marijuana or K2/Spice also use other substances. In women who use drugs during pregnancy, there are often other confounding variables related to nutrition, prenatal care, and failure to disclose substance use because of concerns about adverse legal consequences.    Even with the current level of uncertainty about the influence of marijuana on human neurodevelopment, physicians and other health care providers in a position to recommend medical marijuana must be mindful of the possible risks and err on the side of caution by not recommending this drug for patients who are pregnant. Although no states specifically list pregnancy-related conditions among the allowed recommendations for medical marijuana, neither do any states currently prohibit or include warnings about the possible harms of marijuana to the foetus when the drug is used during pregnancy. (Only 1 state, Connecticut, currently includes an exception to the medical marijuana exemption in cases in which medical marijuana use could harm another individual, although potential harm to a foetus is not specifically listed.)

In 2015, the American College of Obstetricians and Gynecologists issued a committee opinion discouraging physicians from suggesting use of marijuana during preconception, pregnancy, and lactation. Pregnant women and those considering becoming pregnant should be advised to avoid using marijuana or other cannabinoids either recreationally or to treat their nausea.

Source:  http://jamanetwork.com/ on 12/21/2016

Two thirds of drug-misuse patients in the health service in Northern Ireland last year had taken cannabis, new figures show.

From a total of a total of 2,229 people presenting to health services here with problem drug misuse, almost 66% were cannabis users.

The figures are contained in the Department of Health’s Northern Ireland drug misuse database.   Cannabis was by far the most commonly-used substance amongst problem drug-misuse patients here, according to the database.

Benzodiazepines, a class of drug with a host of medical uses that is commonly prescribed to patients suffering from anxiety, was the next most commonly used drug with just over 37% reporting having taken benzodiazepines.

The next on the list is cocaine with more than a third of those in the database (almost 35%) having taken it.  That represents a significant increase in the number of people who said they took cocaine. Last year it was 25%.

The use of ecstasy dropped substantially, from 26% last year to 10% this year, while heroin use has also fallen, from 13% to 10%.

One-in-20 said they had injected themselves with drugs.

The database also shows that most (60%) of those presenting for treatment took more than one drug. A fifth (23%) took two drugs, while another fifth (19%) said they took at least four different drugs.

Almost half (46%) said they took stimulants; this type of drug includes cocaine and amphetamines.  Just over a quarter (26%) said they used at least one opioid analgesic drug – a class of drugs used in medicine to relieve pain, that also includes the illegal drug heroin.  A fifth (20%) of all those who said they used these type of drugs also said it was their “main drug”.   The figures also showed a clear gender divide with males making up 79% of patients.

The Department of Health say they hold “information relating to 2,340 individuals that presented to drug misuse treatment services in 2015/16”.  The figures quoted in this article are based on 2,229 of those individuals who agreed to be included in the database.

Tobacco and alcohol misuse is excluded.

Source:  http://www.newsletter.co.uk/news/crime/two-thirds-of-mental-health-drug-patients-used-cannabis-   23rd December 2016

Fentanyl is a painkiller that is 50 times stronger than heroin. It has already killed thousands, including Prince. Chris McGreal reveals why so many are playing Russian roulette with this lethal drug Natasha Butler had never heard of fentanyl until a doctor told her that a single pill had pushed her eldest son to the brink of death – and he wasn’t coming back. “The doctor said fentanyl is 100 times more potent than morphine and 50 times more potent than heroin. I know morphine is really, really powerful. I’m trying to understand. All that in one pill? How did Jerome get that pill?” she asked, her voice dropping to a whisper as the tears came. “Jerome was on a respirator and he was pretty much unresponsive. The doctor told me all his organs had shut down. His brain was swelling, putting pressure on to the spine. They said if he makes it he’ll be a vegetable.”

Painkiller addiction claims more lives in the US than guns, cutting across class, race and region

The last picture of Jerome shows him propped immobile in a hospital bed, eyes closed, sustained only by a clutch of tubes and wires. Natasha took the near impossible decision to let him die.  “I had to remove him from life support. That’s the hardest thing to ever do. I had him at 15 so we grew together. He was 28 when he died,” she said. “I had to let him die but after that I needed some answers. What is fentanyl and how did he get it?” That was a question asked across Sacramento after Jerome and 52 other people in and around California’s capital overdosed on the extremely powerful synthetic opioid, usually only used by hospitals to treat patients in the later stages of cancer, over a few days in late March and early April 2016. Twelve died.

Less than a month later, this mysterious drug – largely unheard of by most Americans – killed the musician Prince and burst on to the national consciousness. Fentanyl, it turned out, was the latest and most disturbing twist in the epidemic of opioid addiction that has crept across the United States over the past two decades, claiming close to 200,000 lives. But Prince, like almost all fentanyl’s victims, probably never even knew he was taking the drug.

“The number of people overdosing is staggering,” said Lieutenant Tracy Morris, commander of special investigations who manages the narcotics task force in Orange County, which has seen a flood of the drug across the Mexican border. “It is truly scary. They don’t even know what they’re taking.” The epidemic of addiction to prescription opioid painkillers, a largely American crisis, sprung from the power of big pharmaceutical companies to influence medical policy. Two decades ago, a small family-owned drug manufacturer, Purdue Pharma, unleashed the most powerful prescription painkiller yet sold over the pharmacist’s counter. Even though it was several times stronger than anything else on the market, and bore a close relation to heroin, Purdue claimed that OxyContin was not addictive and was safe to treat even relatively minor pain. That turned out not to be true.

It spawned an epidemic that in the US claims more lives than guns, cutting across class, race and geographic lines as it ravages communities from white rural Appalachia and Mormon Utah to black and Latino neighbourhoods of southern California. The prescription of OxyContin and other painkillers with the same active drug, oxycodone, became so widespread that entire families were hooked. Labourers who wrenched a back at work, teenagers with a sports injury, just about anyone who said they were in pain

was put on oxycodone. The famous names who ended up as addicts show how indiscriminate the drug’s reach was; everyone from politician John McCain’s wife Cindy to Eminem became addicted.

Clinics staffed by unscrupulous doctors, known as “pill mills”, sprung up churning out prescriptions for cash payments. They made millions of dollars a year. By the time the epidemic finally started to get public and political attention, more than two million Americans were addicted to opioid painkillers. Those who finally managed to shake off the drug often did so only at the cost of jobs, relationships and homes.

After the government finally began to curb painkiller prescriptions, making it more difficult for addicts to find the pills and forcing up black market prices, Mexican drug cartels stepped in to flood the US with the real thing – heroin – in quantities not seen since the 1970s. But, as profitable as the resurgence of heroin is to the cartels, it is labour intensive and time-consuming to grow and harvest poppies. Then there are the risks of smuggling bulky quantities of the drug into the US.

The ingredients for fentanyl, on the other hand, are openly available in China and easily imported ready for manufacture. The drug was originally concocted in Belgium in 1960, developed as an anaesthetic. It is so much more powerful than heroin that only small quantities are needed to reach the same high. That has meant easy profits for the cartels. The Drug Enforcement Administration (DEA) has said that 1kg of heroin earns a return of around $50,000. A kilo of fentanyl brings in $1m.

At first the cartels laced the fentanyl into heroin to increase the potency of low-quality supplies. But prescription opioid painkillers command a premium because they are trusted and have become increasingly difficult to find on the black market. So cartels moved into pressing counterfeit tablets.  But making pills with a drug like fentanyl is a fairly exact science. A few grammes too much can kill. “It’s very lethal in very small doses,” said Morris. “Even as little as 0.25mg can be fatal. One of our labs had a dime next to 0.25mg and you could barely see it. It’s about the size of the head of a pin. Potentially that could kill you.”

The authorities liken buying black market pills to playing Russian roulette. “These pills sold on the street, nobody knows what’s in them and nobody knows how strong they are,” said Barbara Carreno of the DEA.

After Prince died, investigators found pills labelled as prescription hydrocodone, but made of fentanyl, in his home, suggesting he bought them on the black market. The police concluded he died from a fatal mix of the opioid and benzodiazepine pills, a particularly dangerous combination. It is likely Prince did not even know he was taking fentanyl.  Others knowingly take the risk. In his long battle with addiction, Michael Jackson, used a prescription patch releasing fentanyl into his skin among the arsenal of drugs he was fed by compliant doctors. Although it was two non-opioids that killed him, adding fentanyl into the mix was hazardous.

Jerome Butler, a former driver for Budweiser beer who was training to be a security guard, thought he was taking a prescription pill called Norco. His mother’s voice breaks as she recounts what she knows of her son’s last hours. Natasha said she was aware he used cannabis, but had no idea he was hooked on opioid painkillers. She said her son at one time had a legitimate prescription and may have become addicted that way. She has since discovered he was paying a doctor, well known for freely prescribing opioids, to provide pills.  “I didn’t even know,” she said. “You find stuff out after. It’s killing me because they’re saying, ‘Well, yeah, Jerome was taking them pills all the time.’ And I’m like, ‘He was doing what?’”

Jerome may have had a prescription, but like many addicts he will have needed more and more. The pill that killed him was stamped M367, a marking used on Norco pills made of an opioid, hydrocodone. It was a fake with a high dosage of fentanyl.   This is fentanyl. The first time you take it you’re not coming back. You’re gone

“If Jerome had known it was fentanyl he would never have took that,” said Natasha. “This ain’t like crack or a recreational drug that people been doing for so many years and survived it but at 60 or 70 die from a drug overdose because their heart can’t take it no more. This is fentanyl. The first time you take it you’re not coming back. You’re gone.”

That wasn’t strictly true of the batch that hit Sacramento. It claimed 11 other lives. The youngest victim was 18-year-old George Berry from El Dorado Hills, a mostly white upscale neighbourhood. The eldest was 59. But others survived. Some were saved by quick reactions; doctors were able to hit them with an antidote before lasting damage was done. Others swallowed only enough fentanyl to leave them seriously ill but short of death.

It was a matter of luck. When investigators sent counterfeit pills seized after the Sacramento poisonings for testing at the University of California, they found a wide disparity in the amount of fentanyl each contained. Some pills had as little as 0.6mg. Others were stuffed with 6.9mg of the drug, which would almost certainly be fatal. The DEA thinks the difference was probably the result of failing to mix the ingredients properly with other powders, which resulted in the fentanyl being distributed unevenly within a single batch of counterfeit pills.

That probably explains the unpredictable mass overdosing popping up in cities across the US. In August, 174 people overdosed on heroin in six days in Cincinnati, which has one of the fastest-growing economies in the Midwest. Investigators suspect fentanyl because the victims needed several doses of an antidote, Naloxone, where one or two will usually suffice with heroin. The same month, 26 people overdosed on fentanyl-laced heroin in a four-hour period in Huntington, a mostly white city in one of the poorest areas of West Virginia. In September seven people died from fentanyl or heroin overdoses in a single day in Cuyahoga County, Ohio.

The US authorities don’t know for sure how many people fentanyl kills because of the frequency with which it is mixed with heroin, which is then registered as the cause of death. The DEA reported 700 fatalities from fentanyl in 2014 but said it is an underestimate, and rising. In 2012, the agency’s laboratory carried out 644 tests confirming the presence of fentanyl in drug seizures. By 2015, the number of positive tests escalated to 13,002.

The police did not have to look far for the source of the drug that killed Jerome. He and his girlfriend were staying at the house of her aunt, Mildred Dossman, while they waited for their own place to live. Jerome was smoking cannabis and drinking beer with Dossman’s son, William. Shortly before 1am, William went to his mother’s bedroom and came back with the fake Norco pill. Jerome took it and said he was going to bed.  Jerome’s girlfriend was in jail after being arrested for an unpaid traffic fine and so he was alone with their 18 month-old daughter, Success, lying next to him.

“The doctors explained to me that within a matter of minutes he went into cardiac arrest,” said his mother. “Then as he lay there that’s when time progressed for the organs to be poisoned by fentanyl. He was dying with his daughter next to him.” Natasha said other people in the house heard her son in distress, complaining his heart was hurting. But they did nothing because they were afraid that calling an ambulance would also bring the police.

It was not until 10 hours later that the Dossmans finally sought help from a neighbour who knew Jerome. He tried CPR and then called the medics. The police came, too, and in time Mildred Dossman, 50, was charged with distributing fentanyl and black market opioid painkillers. She was the local dealer.

The DEA is tightlipped about the investigation into the Sacramento deaths as its agents work on persuading Dossman to lead them to her suppliers. But it is likely she was getting the pills from Mexican cartels using ingredients from labs in China where production of fentanyl’s ingredients is legal.  Carreno said some Mexican cartels have long relationships with legitimate Chinese firms which for years supplied precursor chemicals to make meth amphetamine.

Packages of fentanyl are often moved between multiple freight handlers so their origins are hard to trace. Larger shipments are smuggled in shipping containers. Last year, six Chinese customs officials fell ill, one of them into a coma, after seizing 72kg of various types of fentanyl from a container destined for Mexico. American police officers have faced similar dangers. In June, the DEA put out a video warning law enforcement officers across the US that fentanyl was different to anything they have previously encountered and they should refrain from carting seizures back to the office.   “A very small amount ingested, or absorbed through the skin, can kill you,” it said.   A New Jersey detective appears in the video after accidentally inhaling “just a little bit of fentanyl puffed into the air” during an arrest: “It felt like my body was shutting down… I thought that was it. I thought I was dying.”

Along with the Mexican connection, a home-grown manufacturing industry has sprung up in the US. Weeks after Jerome died, agents arrested a married couple pressing fentanyl tablets in their San Francisco flat.

Candelaria Vazquez and Kia Zolfaghari made the drug to look like oxycodone pills. They sold them across the country via the darknet using Bitcoin for payment – on one occasion Zolfaghari cashed in $230,000. The couple shipped the drugs through the local post office. Customers traced by the DEA thought they were buying real painkiller pills. The couple ran the pill press in their kitchen. According to a DEA warrant, a dealer said Zolfaghari made large numbers of tablets: “He could press 100 out fast as fuck.”

The pair made so much money that agents searching their flat found luxury watches worth $70,000, more than $44,000 in cash and hundreds of “customer order slips” which included names, amounts and tracking numbers. The flat was stuffed with designer goods. The seizure warrant described Vazquez’s shoe collection as “stacked virtually from floor to ceiling”. Some still had the $1,000 price tags on them. Zolfaghari was arrested carrying a 9mm semi-automatic gun and about 500 pills he was preparing to post. The dealers made so much money that their flat was stuffed with luxury goods and cash.

Even as Americans are getting their heads around fentanyl, it is being eclipsed. In September, the DEA issued a warning about the rise of a fentanyl variant that is 100 times more powerful – carfentanil, a drug used to tranquilise elephants.

“Carfentanil is surfacing in more and more communities,” said the DEA’s acting administrator, Chuck Rosenberg. “We see it on the streets, often disguised as heroin. It is crazy dangerous.”

The drug has already been linked to 19 deaths in Michigan. Investigators say that with its use spreading, it is almost certainly claiming other lives. Dealers are also getting it from China, where carfentanil is not a controlled drug and can be sold to anyone.

Natasha Butler is still trying to understand the drug that killed her son. She wants to know why it is that it took Jerome’s death for her to even hear of it. She accuses the authorities of failing to warn people of the danger, and politicians of shirking their responsibilities.   A bill working its way through California’s legislature stiffening sentences for fentanyl dealing died in the face of opposition from the state’s governor, Jerry Brown, because it would put pressure on the already badly crowded prisons.

“I’m so dumbfounded. How does that happen?” says Natasha. Her tears come frequently as she sits at a tiny black table barely big enough to seat three people. She talks about Jerome and the tragedy for his three children, including Success, who she is now raising.

But some of the tears are to mourn the devastating impact on her own life. “Look where I’m at. I was in Louisiana. I had a house. I had a job. I had a car. I had a life. I worked every day. I was a manager for a major company. I came here, I became homeless. I had to move into this apartment to help out my granddaughter,” she said. “You see me. This is what my kitchen table is. My son is dead. He had three kids and those two mothers of those kids are depending on me to be strong. I want answers and help. I say, you got the little fish. Where did they get it from? How did they get it here? You are my government. You are supposed to protect us.”

Source:  https://www.theguardian.com/global/2016/dec/11/pills-that-kill-why-are-thousands-dying-from-fentanyl-abuse–

States with Lax Marijuana Laws Also Show Higher Marijuana “Edible” Use than Other States

[WASHINGTON, DC] – The nation’s annual school survey of drug use, Monitoring the Future (MTF), shows marijuana use among adolescents, including heavy marijuana use, remaining stubbornly high and higher than ten years ago — despite reductions across the board among other drugs. Past year and past month marijuana use among high school seniors is up versus last year, and marijuana use among almost all categories is higher than ten years ago. And students in states with lax marijuana laws are much more likely to use marijuana in candy or edible form than students in other states.

“Why would marijuana use not be falling like the use of other substances? The answer is likely marijuana commercialization and industrialization, spurred by legalization initiatives,” said Dr. Kevin A. Sabet, a former White House drug policy advisor and President of Smart Approaches to Marijuana (SAM). “It also might explain why six percent of high school seniors use marijuana daily. Moreover, this study does not include kids who have dropped out of school — and are thus more likely to be using drugs than the study’s sample.”

Additionally, the MTF showed differences between students in states with loose marijuana laws and students in other states. Students in lax policy states were much more likely to use marijuana, and also more likely to use edibles. Among 12th graders reporting marijuana use in the past year, 40.2 percent consumed marijuana in food in states with medical marijuana laws compared to 28.1 percent in states without such laws.

“While drug, cigarette, and alcohol use are falling almost across the board, due to decades of work and millions of taxpayer dollars, kids are turning more and more to marijuana,” said Jeffrey Zinsmeister, SAM’s Executive Vice President. “It’s unsurprising now that the marijuana industry — following in the footsteps of the tobacco industry — is pouring millions into marketing kid-friendly edible products like pot candy to maximize their profits.”

According to statements from the American Medical Association, American Academy of Child and Adolescent Psychiatry, American Society of Addiction Medicine, and the American Psychiatric Association, marijuana use, especially among youth, should be avoided, and legalization efforts opposed.

“Medical research is very clear that marijuana is both addictive and harmful,” noted Dr. Stu Gitlow, immediate past president of the American Society of Addiction Medicine. “One in six adolescents that use marijuana develop an addiction, and use is associated with lower IQ, lower grades, and higher dropout rates in that same population. It is therefore of significant concern that this year’s study may actually underreport marijuana use and downplay its impact.”

Meanwhile, the toll of legalized marijuana continues to climb in Colorado and Washington. For example, the AAA Foundation reported earlier this year that the percentage of fatal crashes in the state of Washington linked to drivers who had recently used marijuana more than doubled the year marijuana retail sales were authorized. Similarly, cases of marijuana poisonings are up 108% in Colorado after legalization, and up 206% among children ages 0 to 8 years old. (More data on these trends is available in SAM’s recent report on legalization in both states.)

Source:  jeff@learnaboutsam.org  Dec. 2016  For more information about marijuana use and its effects, see http://www.learnaboutsam.org.

Cannabinoid AMB-FUBINACA in New York

ABSTRACT

BACKGROUND

New psychoactive substances constitute a growing and dynamic class of abused drugs in the United States. On July 12, 2016, a synthetic cannabinoid caused mass intoxication of 33 persons in one New York City neighborhood, in an event described in the popular press as a “zombie” outbreak because of the appearance of the intoxicated persons.

METHODS

We obtained and tested serum, whole blood, and urine samples from 8 patients among the 18 who were transported to local hospitals; we also tested a sample of the herbal “incense” product “AK-47 24 Karat Gold,” which was implicated in the outbreak. Samples were analyzed by means of liquid chromatography–quadrupole time-of-flight mass spectrometry.

RESULTS

The synthetic cannabinoid methyl 2-(1-(4-fluorobenzyl)-1H-indazole-3-carboxamido)-3-methylbutanoate (AMB-FUBINACA, also known as MMB-FUBINACA or FUB-AMB) was identified in AK-47 24 Karat Gold at a mean (±SD) concentration of 16.0±3.9 mg per gram. The de-esterified acid metabolite was found in the serum or whole blood of all eight patients, with concentrations ranging from 77 to 636 ng per milliliter.

CONCLUSIONS

The potency of the synthetic cannabinoid identified in these analyses is consistent with strong depressant effects that account for the “zombielike” behavior reported in this mass intoxication. AMB-FUBINACA is an example of the emerging class of “ultrapotent” synthetic cannabinoids and poses a public health concern. Collaboration among clinical laboratory staff, health professionals, and law enforcement agencies facilitated the timely identification of the compound and allowed health authorities to take appropriate action.

Source: New England Journal of Medicine;  10.1056/NEJMoa1610300

Examining the data closely and correctly.

By:  By DAVID W. MURRAY, BRIAN BLAKE, JOHN P. WALTERS

The closing reports on the Obama administration’s drug policy were delivered this week. Drug-induced deaths for the year 2015 were reported by the Centers for Disease Control (CDC) on December 8, and the youth school survey of drug use for 2016, Monitoring the Future (MTF), was just released by the National Institutes on Drug Abuse (NIDA). The findings document Obama’s eight years of unbroken failure.

Simply put, it appears inescapable that the two sets of findings are related, in that the flood of commercial, high-potency marijuana unleashed by legalization in the states has served as a “gateway” to the opioid problem, both by priming greater drug use by those who initiate with heavy, developmentally early marijuana use, and further by empowering the illicit drug market controlled by criminal cartels.

Both data releases were somewhat muddled in the offering, neither of them being presented with public briefings at venues such as the National Press Club, as was common in the past.

Instead, the MTF data were only presented in a teleconference for reporters, while the CDC at the last minute determined that the official data for drug overdoses would not be ready until next year, instead directing researchers and the press to their online data system, WONDER, where searchers could uncover them for themselves.

These data releases are bookends—the youth survey showing us the likely future patterns of drug misuse as the high-school-aged cohort ages through adulthood, while the CDC overdose death data are retrospective, revealing where the worst drug epidemic in American experience was more than a year ago.

Data on deaths for 2016, which by all indications from states and municipalities are accelerating upward even more sharply, have not even been analyzed yet (their release is scheduled for December 2017), and will no doubt surface as a further shock in a succeeding administration.

Because there has yet to be a formal report of 2015 final numbers, the precise CDC figures for overdoses by drug remain troublingly vague. That said, the increases are shocking. There were 52,404 overall drug-induced deaths for 2015. That figure has climbed from about 38,000 (and stable) as recently as 2008. For 2015, fully 33,091 deaths were attributable to the opioids, alone (up from 28,647 in 2014, the toll rising most steeply dating from 2010).

Regarding the recent increase, the head of death statistics at the CDC stated; “I don’t think we’ve ever seen anything like this. Certainly not in modern times.”

For the MTF survey, marijuana use rose between 2015 and 2016. High school seniors saw their past month (or current) use rise to a rate of 23 percent, (up from 21 percent in 2015), while past year use rose to 36 percent (up from 35 percent). For the past year category, the rise since 2007 exceeds a 12 percent increase, but most of that rise took place earlier in the Obama years, peaking in 2011-2012 and then stabilizing at the higher level.

Somewhat surprisingly, given the anticipated impact of commercial legalization of marijuana in some states in 2014, with yet other states being added in this last election cycle, the overall impact on youth marijuana use appears modest, especially when compared to the wider data showing steep increases in young adults and those 26 and older, from other national surveys.

There are two immediate cautions in reading these data, however. The first is that many teens are now consuming marijuana in forms other than smoking; that is, as edibles and drinks, which this survey has difficulty detecting. In other words, there may be a hidden dimension of use of what is now a drug of unprecedented potency and availability. The second caveat is the known impact of marijuana use on high-school drop-out rates, pushing them higher. The effect is that the very students most at risk of heavy use are no longer captured in this school-based survey, which might be systematically understating actual prevalence increases because we have lost our ability to capture them.

The real drug use stunner lies elsewhere, largely in the CDC overdose data. The United States is in the grip of a wide and deepening drug use crisis, the most visible alarm being the opioid overdose contribution to the overall drug-induced death data, which by 2015 were sufficient to show up in general health data as driving a decrease in American life-expectancy tables.

Moreover, it is clear that the situation will worsen quickly, for both opioids and for newly resurgent cocaine use, which also registered as an increase in drug overdose deaths, and in recent measures of college-age youth, where use of cocaine, after steep declines, suddenly shot up 63 percent in a single year, 2013-2014, and remained high.

Coupled with the nationwide spread of adult commercial marijuana use and the still surging methamphetamine crisis, the situation is dire across all the major illicit drugs.

The opioid crisis has two dimensions, only one of which has received administration attention. The epidemic has been driven by misuse of prescription opioids, which climbed steadily for several years, and by the emergence of surging illicit drugs, both heroin and new synthetics like fentanyl and its analogs, from illicit rogue labs and smuggled into the United States.

Curiously, even though production increases of heroin and of cocaine have shot up in source countries such as Mexico and Colombia, and as synthetic opioid seizures have rocketed up in border seizures, the administration and the press seem seized by the prescription overdose dimension, which has begun to slow and even abate.

For instance, outlets such as the Washington Post continue to misstate the actual data. In a recent editorial, they insist that “the prescription opioid category accounted for the largest share of deaths, at 17,536.” Accordingly, they urge further policy attention to doctor prescribing practices.

But the latest data show otherwise. According to the CDC WONDER database, there were 19,885 deaths from illicit opioid production, heroin/illicit fentanyl and analogs. And that latter category is the one surging, rising 23 percent for heroin and a stunning 73 percent for synthetics from 2014 to 2015, while strictly prescription deaths rose only 4 percent.

Apparently, the blind spot for the administration (and the press) is that to address the real engine of overdose deaths, they must confront international and cross-border production and smuggling, an understanding of the problem that the Obama administration has abjured, since it requires the forces of law enforcement, national security, and reductions in illicit drug supply.

Two final notes on the 2015 opioid data, which are but harbingers for the hurricane of use and deaths already being seen in the states for 2016.

First, the steep line of ascent for overdose deaths can be closely paralleled by the administration’s mainstay, the insistent distribution and use of naloxone, the opioid overdose antidote medication. Without that reversal drug being deployed, the true death toll would be much worse. But it also means that simply giving out more and more naloxone cannot be a solution to the crisis, as deaths have accelerated away in spite of a reliance on such measures, which prove ineffectual in the long run and faced with new potencies.

The second sobering realization can be found in an analysis we published on the crisis in November, where we noted that for 2014, heroin overdose deaths were now comparable to those from gun homicides nationwide, both standing at 10,500 per year. The point may have been an inspiration for the Washington Post article on CDC WONDER data for 2015, proclaiming that heroin overdoses now exceeded gun homicide deaths (12,989 to 12,979, respectively).

The fact is true, but what is remarkable is the deep parallel in the rise of the respective figures in a single year, both keeping pace by climbing at a nearly identical rate.

It’s almost as if the trafficking in heroin driving the overdoses is itself tied to the emergent gun homicide crisis surging in our major cities. Those who lived through the violent 1980s and early 1990s will remember the connection well.

The Obama drug policy began with unilateral executive action opening the floodgates to marijuana commercial legalization and it is closing with never-before-seen death rates from drug use. The Trump administration faces a drug death epidemic worse than the crisis the Reagan administration inherited from President Jimmy Carter—and that contributed to even greater levels of violence and addiction before the Carter legacy was reversed.

David W. Murray and Brian Blake are senior fellows at Hudson Institute’s Center for Substance Abuse Policy Research; both served in the Office of National Drug Control Policy during the George W. Bush administration. John P. Walters is Hudson’s chief operating officer and former director of drug control policy for President George W. Bush.

Source:  WEEKLY STANDARD  DEC 15, 2016

National statistics show 2,367 users aged 18 to 24 sought treatment in 2015-16 as drug becomes increasingly unfashionable.   A total of 149,807 opiate addicts came for treatment in England during 2015-16, down 12% on a peak of 170,032 in 2009-10.

The number of 18 to 24-year-olds in England entering treatment for addiction to heroin has plummeted 79% in 10 years, as the stigma surrounding the drug and changing tastes in intoxication have made it increasingly unfashionable.

In the year to March, 2,367 people from that age group presented with heroin and opiate addiction at the approximately 900 drug treatment services in England, compared with 11,351 10 years earlier, according to statistics from the National Drug Treatment Monitoring System (NDTMS).

They constituted a tiny fraction of the 149,807 opiate addicts who came for help to kick their habit throughout the year, a number that is itself 12% down on a peak of 170,032 who came for treatment in 2009-10. The median age of those users was 39, the statistics showed.  Michael Linnell, the coordinator of UK DrugWatch, a network of drug treatment professionals, said many of the heroin users currently accessing treatment would have become addicted during a boom in the drug’s popularity in the late 1980s. Young addicts were “as rare as hen’s teeth”, he said.

Our neglect of ageing heroin users has fuelled the rise of drug-related deaths

“For the Thatcher generation who didn’t see a future and there were no jobs or employment and the rest of it, it was an alternative lifestyle in that you were really, really busy being a heroin user: getting up, scoring, nicking stuff to get the money to score and the rest of it,” Linnell said.

“There was a whole series of factors until you got to that point where people from those communities – the poorest communities – where you were likely to get heroin users, could see the visible stigma of the scarecrow effect, as some people called it.

“They didn’t want to aspire to be a heroin user because a heroin user just had negative connotations, rather than someone who was rebelling against something.”

Overall, 288,843 adults aged 18 to 99 came into contact with structured treatment for drug addiction during 2015-16, 52% of whom were addicted to heroin or some other opiate. Among opiate addicts, 41% were also addicted to crack cocaine, with the next highest adjunctive drugs being alcohol (21%) and cannabis (19%).

About half of those presenting to treatment – 144,908 – had problems with alcohol, a fall of 4% compared with the previous year. Among those, 85,035 were treated for alcohol treatment only and 59,873 for alcohol problems alongside other substances.

The most problematic drug among the 13,231 under-25s who came into contact with drug treatment services in the past year was cannabis, which was cited as a problem by 54%, followed by alcohol (44%) and cocaine (24%).

The numbers from this age group accessing treatment had fallen 37% in 10 years, which the Public Health England report accompanying the statistics said reflected shifts in the patterns of drinking and drug use over that time, with far fewer young people experimenting with drugs than in the past.  Karen Tyrell, the spokeswoman for the drug treatment charity Addaction, said the decline in problem drug use among young people reflected what drugs workers see on a daily basis, and credited evidence-based education, prevention and early intervention programmes for the change.

The shift, though, was precarious, Tyrell said, warning that yearly spending cuts to treatment services risked reversing the gains.

She added: “Of course, what this also means is that we have an ageing population of heroin users, many of whom have been using since the 80s or 90s, and who are now dealing with poor physical health and increasing vulnerability. In an environment of ever rising drug-related deaths, it’s imperative we don’t lose sight of their needs.”

Source:  https://www.theguardian.com/society/2016/nov/03/

NIH Monitoring the Future survey shows use of most illicit substances down, but past year marijuana use relatively stable

December 13, 2016

The 2016 Monitoring the Future (MTF) annual survey results released today from the National Institutes of Health (NIH) reflect changing teen behaviors and choices in a social media-infused world. The results show a continued long-term decline in the use of many illicit substances, including marijuana, as well as alcohol, tobacco, and misuse of some prescription medications, among the nation’s teens. The MTF survey measures drug use and attitudes among eighth, 10th, and 12th graders, and is funded by the National Institute on Drug Abuse (NIDA), part of the NIH.

Findings from the survey indicate that past year use of any illicit drug was the lowest in the survey’s history for eighth graders, while past year use of illicit drugs other than marijuana is down from recent peaks in all three grades.

Marijuana use in the past month among eighth graders dropped significantly in 2016 to 5.4 percent, from 6.5 percent in 2015. Daily use among eighth graders dropped in 2016 to 0.7 percent from 1.1 percent in 2015. However, among high school seniors, 22.5 percent report past month marijuana use and 6 percent report daily use; both measures remained relatively stable from last year. Similarly, rates of marijuana use in the past year among 10th graders also remained stable compared to 2015, but are at their lowest levels in over two decades.

The survey also shows that there continues to be a higher rate of marijuana use among 12th graders in states with medical marijuana laws, compared to states without them. For example, in 2016, 38.3 percent of high school seniors in states with medical marijuana laws reported past year marijuana use, compared to 33.3 percent in non-medical marijuana states, reflecting previous research that has suggested that these differences precede enactment of medical marijuana laws.

Further, some 40.2 percent of seniors in so-called medical marijuana (MMJ) states are using edibles—foods infused with marijuana concentrates—compared to 28.1 percent of seniors in states that have not medicalized pot. High school seniors are in the healthiest part of the life span. One wonders why so many young people need so much “medicine.”

The survey indicates that marijuana and e-cigarettes are more popular than regular tobacco cigarettes. The past month rates among 12th graders are 12.4 percent for e-cigarettes and 10.5 percent for cigarettes. A large drop in the use of tobacco cigarettes was seen in all three grades, with a long-term decline from their peak use more than two decades ago. For example, in 1991, when MTF first measured cigarette smoking, 10.7 percent of high school seniors smoked a half pack or more a day. Twenty-five years later, that rate has dropped to only 1.8 percent, reflecting the success of widespread public health anti-smoking campaigns and policy changes.

There has been a similar decline in the use of alcohol, with the rate of teens reporting they have “been drunk” in the past year at the survey’s lowest rates ever. For example, 37.3 percent of 12th graders reported they have been drunk at least once, down from a peak of 53.2 percent in 2001.

Although non-medical use of prescription opioids remains a serious issue in the adult population, teen use of prescription opioid pain relievers is trending downwards among 12th graders with a 45 percent drop in past year use compared to five years ago. For example, only 2.9 percent of high school seniors reported past year misuse of the pain reliever Vicodin in 2016, compared to nearly 10 percent a decade ago.

“Clearly our public health prevention efforts, as well as policy changes to reduce availability, are working to reduce teen drug use, especially among eighth graders,” said Nora D. Volkow, M.D., director of NIDA. “However, when 6 percent of high school seniors are using marijuana daily, and new synthetics are continually flooding the illegal marketplace, we cannot be complacent. We also need to learn more about how teens interact with each other in this social media era, and how those behaviors affect substance use rates.”

“It is encouraging to see more young people making healthy choices not to use illicit substances,” said National Drug Control Policy Director Michael Botticelli. “We must continue to do all we can to support young people through evidence-based prevention efforts as well as treatment for those who may develop substance use disorders. And now that Congress has acted on the President’s request to provide $1 billion in new funding for prevention and treatment, we will have significant new resources to do this.”

The MTF survey, the only large-scale federal youth survey on substance use that releases findings the same year the data is collected, has been conducted by researchers at the University of Michigan at Ann Arbor since 1975.

Other highlights from the 2016 survey:

Illegal and Illicit Drugs

* Illicit Drugs other than Marijuana: Past year rates are the lowest in the history of the survey in all three grades. For example, 14.3 percent of 12th graders say they used an illicit drug (other than marijuana) compared to its recent peak of 17.8 percent in 2013.

* Marijuana-Past year use: Past year marijuana use among eighth graders dropped significantly to 9.4 percent in 2016, from 11.8 percent last year. Past year rates were somewhat stable for sophomores at 23.9 percent, and for seniors at 35.6 percent when compared to last year. However, past year marijuana use has dropped in the last five years among eighth and 10th graders.

* Marijuana-Daily use: Daily rates among 10th and 12th graders remained relatively stable at 2.5 percent and 6 percent for the past few years.

* Marijuana Edibles: Teens who live in states where medical marijuana is legal report a higher use of marijuana edibles. For example, among 12th graders reporting marijuana use in the past year, 40.2 percent consumed marijuana in food in states with medical marijuana laws compared to 28.1 percent in states without such laws.

* Synthetic Cannabinoids: Past year “synthetic marijuana” (K2/Spice) use among 10th and 12th graders dropped significantly from last year. For example, the rate for seniors fell to 3.5 percent compared to 5.2 percent in 2015, with a dramatic drop from its peak of 11.4 percent the first year it was measured in 2011.

* Cocaine: Past year cocaine use was down among 10th graders to 1.3 percent from 1.8 percent last year. Cocaine use hit its peak in this measure at 4.9 percent in 1999.

* Inhalants: Inhalant use, usually the only category of drugs used more by younger teens than their older counterparts, was down significantly among eighth graders compared to last year, with past year use at 3.8 percent, compared to 4.6 percent in 2015. Past year inhalant use peaked among eighth graders in 1995 at 12.8 percent.

* MDMA (Ecstasy or “Molly”): Past year use is down among eighth graders to 1 percent, from last year’s 1.4 percent. MDMA use is at its lowest point for all three grades in the history of the MTF survey.

* Heroin: Heroin rates remain low with teens still in school. High school seniors report past year use of heroin (with a needle) at 0.3 percent, which remains unchanged from last year. In the history of the survey, heroin (with a needle) rates have never been higher than 0.7 percent among 12th graders, as seen in 2010.

* Cold and Cough Medicine: Eighth graders alone reported an increase in misuse of over-the-counter cough medicine at 2.6 percent, up from 1.6 percent in 2015, but still lower than the peak of 4.2 percent when first measured in 2006.

* Attitudes and Availability: Attitudes towards marijuana use have softened, but perception of harm is not necessarily linked to rates of use. For example, 44 percent of 10th graders perceive regular marijuana smoking as harmful (“great risk”), but only 2.5 percent of them used marijuana daily in 2016. This compares to a decade ago (2006) when 64.9 percent of 10th graders perceived marijuana as harmful and 2.8 percent of them used it daily. The number of eighth graders who say marijuana is easy to get is at its lowest in the history of the survey, at 34.6 percent.

Prescription Drugs

* Opioid Pain relievers (described as “Narcotics other than Heroin” in the survey):  The  past year rate for non-medical use of all opioid pain relievers among 12th graders is at 4.8 percent, down significantly from its peak of 9.5 percent in 2004.

* Vicodin/OxyContin: The past year non-medical use of Vicodin among high school seniors is now lower than misuse of OxyContin (2.9 percent compared to 3.4 percent). The past year data for 12th graders 10 years ago was 9.7 percent for Vicodin and 4.3 percent for OxyContin.

* ADHD Medicines: Past year non-medical use of Adderall is relatively stable at 6.2 percent for 12th graders; however, non-medical use of Ritalin dropped to 1.2 percent, compared to 2 percent last year, and a peak of 5.1 percent in 2004.

* Tranquilizers: Non-medical use of this drug category, which includes benzodiazepines, has seen a general decline. For example, among 12th graders the 2016 past year rate is 4.9 percent, compared to its peak in 2002 at 7.7 percent.

* Attitudes and Availability: The majority of teens continue to say they get most of their opioid pain relievers (for non-medical use) from friends or relatives,

either taken, bought or given. The only prescription drugs seen as easier to get in 2016 than last year are tranquilizers, with 11.4 percent of eighth graders reporting they would be “fairly easy” or “very easy” to get, up from 9.8 percent in 2015. Also, when eighth graders were asked if occasional non-medical use of Adderall is harmful (“great risk”), 35.8 percent said yes, compared to 32 percent last year.

Tobacco

* Daily Smoking: The 2016 daily smoking rates for high school seniors was 4.8 percent compared to 22.2 percent two decades ago (1996). For 10th graders, the 2016 daily smoking rate is 1.9 percent, compared to 18.3 percent in 1996.

* Hookah Use: For past year tobacco use with a hookah, the 2016 rate dropped to 13 percent among high school seniors, from 22.9 percent two years ago, its peak year since the survey began measuring hookah use in 2010.

* E-Cigarettes (Vaporizers): The rate for e-cigarettes among high school seniors dropped to 12.4 percent from last year’s 16.2 percent. Of note: only 24.9 percent of 12th graders report that their e-cigarettes contained nicotine (the addictive ingredient in tobacco) the last time they used, with 62.8 percent claiming they contain “just flavoring.”

* Little Cigars: The 2016 past year rate dropped to 15.6 percent among 12th graders, from a peak of 23.1 percent in 2010, when first included in the survey.

* Attitudes and Availability: This year, more 10th graders disapprove of regular use of e-cigarettes than last year. For example, 65 percent of 10th graders say they disapprove, up from last year’s 59.9 percent. In addition, more 10th graders think it is harder to get regular cigarettes than last year; 62.9 percent said they are easy to get, compared to 66.6 percent last year. This represents a dramatic shift from survey findings two decades ago, when 91.3 percent of 10th graders thought it was easy to get cigarettes.

Alcohol

* Past year use: More than half (55.6 percent) of 12th graders report having used alcohol in the past year, compared to the peak rate of about 75 percent in 1997. Thirty-eight percent of 10th graders and 17.6 percent of eighth graders report past year use, compared to the peaks of 65.3 percent in 2000 among 10th graders and 46.8 percent in 1994 among eighth graders.

* Binge drinking: Among eighth graders, binge drinking (described as five or more drinks in a row in the last two weeks) continues to significantly decline, now

at only 3.4 percent, the lowest rate since the survey began asking about it in 1991, down from a peak of 13.3 percent in 1996. Binge drinking among high school seniors is down to 15.5 percent, half its peak of 31.5 percent in 1998.

* Been drunk: Representing a long-term downward trend, 37.3 percent of 12th graders say they have been drunk in the past year; 20.5 percent of 10th graders say they have been drunk, down from a peak of 41.6 percent in 2000. Eighth graders reported a rate of 5.7 percent, down from a peak of 19.8 percent in 1996.

* Attitudes: Just over 71 percent of 10th graders think it is easy to get alcohol, compared to last year’s rate of 74.9 percent, and down from 90.4 percent two decades ago.

Overall, 45,473 students from 372 public and private schools participated in this year’s MTF survey. Since 1975, the survey has measured drug, alcohol, and cigarette use and related attitudes in 12th graders nationwide. Eighth and 10th graders were added to the survey in 1991. Lloyd D. Johnston, Ph.D., who has been the principal investigator at the University of Michigan’s Institute for Social Research for all 42 years, is retiring from that position this year, but the survey of teens will continue under the leadership of Richard A. Miech, Ph.D., who is currently a member of the MTF scientific team.

“The declining use of many drugs by youth is certainly encouraging and important,” said Dr. Johnston. “But we need to remember that future cohorts of young people entering adolescence also will need to know why using drugs is not a smart choice. Otherwise we risk having another resurgence of use as was seen in the 90s.”

“We want to thank Dr. Johnston for his lifetime of work building this survey into the important public health tool it is today,” added Dr. Volkow.

Source:  National Families in Action’s The Marijuana Report srusche=nationalfamilies.org@mail230.atl101.mcdlv.net  12th Dec.2016

Robert J. Tait, et al

Abstract

Context: Synthetic cannabinoids (SCs) such as “Spice”, “K2”, etc. are widely available via the internet despite increasing legal restrictions. Currently, the prevalence of use is typically low in the general community (<1%) although it is higher among students and some niche groups subject to drug testing. Early evidence suggests that adverse outcomes associated with the use of SCs may be more prevalent and severe than those arising from cannabis consumption.

Objectives: To identify systematically the scientific reports of adverse events associated with the consumption of SCs in the medical literature and poison centre data.

Method: We searched online databases  and manually searched reference lists up to December 2014. To be eligible for inclusion, data had to be from hospital, emergency department, drug rehabilitation services or poison centre records of adverse events involving SCs and included both self-reported and/or analytically confirmed consumption.

Results: From 256 reports, we identified 106 eligible studies including 37 conference abstracts on about 4000 cases involving at least 26 deaths. Major complications include cardiovascular events (myocardial infarction, ischemic stroke and emboli), acute kidney injury (AKI), generalized tonic-clonic seizures, psychiatric presentations (including first episode psychosis, paranoia, self-harm/suicide ideation) and hyperemesis. However, most presentations were not serious, typically involved young males with tachycardia (≈37–77%), agitation (≈16–41%) and nausea (≈13–94%) requiring only symptomatic care with a length of stay of less than 8 hours.

Conclusions: SCs most frequently result in tachycardia, agitation and nausea. These symptoms typically resolve with symptomatic care, including intravenous fluids, benzodiazepines and anti-emetics, and may not require inpatient care. Severe adverse events (stroke, seizure, myocardial infarction, rhabdomyolysis, AKI, psychosis and hyperemesis) and associated deaths manifest less commonly. Precise estimates of their

incidence are difficult to calculate due to the lack of widely available, rapid laboratory confirmation, the variety of SC compounds and the unknown number of exposed individuals. Long-term consequences of SCs use are currently unknown. Keywords: Emergency medical services, street drugs, drug overdose, mental disorders, drug-related side effects and adverse reactions

Discussion

The prevalence of SC consumption is low in the general population.   However, the risk of requiring medical attention following use of SC seems to be greater than that for cannabis consumption.  Our systematic review of adverse events found that typically events were not severe, only required symptomatic or supportive care and were of short duration.

Nevertheless, a number of deaths have been attributed either directly or indirectly to SC consumption, together with other major adverse sequelae, including a significant number with persistent effects including new on-set psychosis with no family history of psychosis

We did not include popular media reports or the grey literature in the search, which would probably reveal further cases but would be less likely to contain reliable medical information. We were unable to determine the exact number of cases in the scientific literature due to the potential overlap between poison centre data and hospital reports. We could not even definitively establish the number of deaths attributed to SC consumption. Of the 28 531 ED visits in 2011 recorded in the DAWN database, 119 (0.4%) led to death potentially related to SC use

Our review of published cases identified only 22 fatal cases in the USA through to the end of 2014. As not all presentations especially for psychiatric problems or palpitations will include assessment of SC use, SC presentations may currently be seriously underreported. This suggests that the magnitude of the health burden due to SC use is considerably greater than that currently documented. Most of the data were based on self-reported consumption of SC, with no simple screening test available yet for clinicians.

Some of the information on adverse effects of SCs arises from poison centre data. Wood et al. outlined the strengths and weakness of poison centre data for novel psychoactive substances.  In brief, poison centres may detect new and unfamiliar exposures, but the rates of detection may decline with familiarity with the substances involved. In addition, the data depend upon voluntary reporting, often lack analytical confirmation, and may not discern which symptoms to attribute to a given substance, in cases of poly-drug exposure. Similarly, novel adverse events and events involving new SCs are more likely to be reported or published in the medical literature.

The consumption of cannabis affects the cardiovascular system and increases the risk of myocardial infarction.  Similarly, cannabis has been implicated in ischemic stroke, especially multifocal intracranial stenosis among young adults.   Cannabis use, ischemic stroke, and multifocal intracranial vasoconstriction, a prospective study in 48 consecutive young patients. The potential mechanisms include cardiac ischemia due to increased heart rate, postural hypotension, impaired oxygen supply arising from raised carboxyhemoglobin levels, especially in conjunction with tobacco smoking, and catecholamine-mediated pro-arrhythmic effects.  Marijuana as a trigger of cardiovascular events: speculation or scientific certainty? It is thus perhaps unsurprising that similar adverse outcomes have occurred following the use of SCs given their increased potency at CB1 receptors. Whether these compounds have significant direct effects on other receptors is still unknown.

The comparatively short period for which SC have been available and used in the general community means that long-term outcomes are currently unknown. However, the occurrence of AKI has implications for future health with a meta-analysis estimating a nearly nine-fold increase in the risk of developing chronic kidney disease, and a three-fold increase in the risk of end stage renal disease, compared to those who have not had AKI.   Thus, even low prevalence events with apparently limited duration, like AKI, have the potential to result in significant health costs following the resolution of acute symptoms. The other effects with long-term potential health consequences are initiation or exacerbation of psychiatric disorders, particularly psychosis. These are extremely debilitating and disabling conditions with large societal and health impacts for patients, families and the health system.

Clinical implications

SC intoxication appears to be a distinct and novel clinical entity. Use of SCs can cause more significant clinical effects than marijuana. There also appear to be qualitative differences in the nature of the symptoms with which patients present. The sheer number of SCs available and the rate at which they continue to change confound examinations of the scale and extent of the problem.   More recent formulations (in the UK termed “Third Generation”) are typically more potent that earlier SCs and seem to be associated with greater harms.  Trecki and colleagues report that the incidence of clusters and severity of adverse events involving SCs appears to be increasing.   This increase could be due to greater familiarity with presentations, better coordination between public health authorities and laboratories or the characteristics of newer SCs.   The overall effects of SC can resemble those of cannabis, but other than anxiety and paranoia these are not usually the symptoms associated with acute hospital presentation. Instead, patients seem to present in EDs because of behavioural abnormalities (agitated behaviour, psychosis, anxiety) or symptoms associated with acute critical illness. The latter includes seizures (which if prolonged can lead to rhabdomyolysis and hyperthermia), AKI, myocardial ischaemia and infarction in demographic groups where this would be most unusual. The majority of mild intoxications only require symptomatic treatment and generally do not require hospital admission. Severe intoxications, involving seizures, severe agitation or mental health disturbances, arrhythmias and significant chest pain, should be admitted to hospital for further investigation.

The lack of an antidote to SCs, analogous to that for opioid overdose, complicates management, as does the unpredictable effects and lack of a clear toxidrome to distinguish SCs from other recreational drugs.   The differential diagnosis requires the elimination of diverse conditions including hypoglycaemia, CNS infection, thyroid hyperactivity, head trauma and mental illness.  Benzodiazepines are usually sufficient to control agitation: while the use of haloperidol has also been described.  Caution is advised in undifferentiated agitation. Benzodiazepine failure should prompt consideration of definitive airway control. In addition to intravenous fluids for dehydration, the primary goals are protecting the airway, preventing rhabdomyolysis and to monitor for either cardiac or cerebral ischemia.

Traditionally, most recreational drug overdoses have been easily explicable based on clinical presentation alone. From an epidemiological perspective, this position should be revisited. Both the Welsh Emerging Drugs and Identification of Novel Substances (WEDINOS) and the Australian Capital Territory Novel Substances (ACTINOS) projects, routinely analyse raw product samples in the possession of patients, associated with severe or unusual presentations. This protocol has been able to characterize novel products well before their identification by law enforcement, arguably generating important information, not just for the patient concerned but also for population health services.

Conclusions

Data from poison centres and drug monitoring systems in Europe, the UK, the USA, and Australia illustrate trends of increased use of SCs. The number of unique SCs appears to continue growing, but the SCs seem to share common characteristics within the class. The most common effects include tachycardia, agitation and nausea; these generally respond to supportive care. However, physicians should be aware of the severe cardiovascular, cerebrovascular, neurological, psychiatric and renal effects, which occur in a minority of cases.

Differences among compounds in the class are difficult to assess. Methods to detect, identify and confirm new SCs lag behind the appearance of these drugs. Further, many of the cases depend upon self-report of the patients, whose information may be unreliable or inaccurate. Improving the availability of advanced laboratory resources will improve our ability to recognize SCs with higher risk of severe toxicity.

Source:  Extracts from Clinical Toxicology  Volume 54, 2016 – Issue 1  Nov.2015

By Robert Charles

The Christmas carol is poignant – reminder of Christmas, and beyond.  “What child is this, who, laid to rest …” the carol begins.  “Whom angels greet with anthems sweet, while shepherds watch are keeping?” it continues.  The stanza ends, “Haste, haste ….”  Lovely, lilting, full of promise – like the birth of a child.  Here, a special child – but also every child.

In a season of joy, it is a message of joy.  But the mind wanders, to our mortal world.  New numbers on drug addiction and drugged driving death, so many lost souls – mitigate the joy.   They caught me off guard this week. My brother, a high school teacher, shared with me the loss of another student, another fatal crash, as drugged driving numbers rise.  What is the season for heartbroken parents – but a season of loss?  Each year, upwards of 100,000 parents lose a child to drug abuse.

What child is this?  It is America’s child, and America’s childhood.  How is it that we have, collectively, forgotten to keep watch over those entrusted to our watch – especially from high office?  Last year, 47,055 Americans, most of them young, were lost to drug abuse – just statistics now.  Why?

In part, because so many Americans have heard a mixed message from their leaders – with devastating effects. Led to believe drugs are “recreation,” something not different from beer or wine, kids try and die.  Synthetic opioids, heroin, cocaine, high potency marijuana – then to ER, or not even, and mortuary. Numbers do not lie.

Drugged driving is now another epidemic.  Drivers and helpless passengers are all at risk, along with everyone on the road.  Near home, not long ago, several kids died in a terrible car crash.  They missed a bend and hit a tree.  The sister of a child known to my son was almost in that car – but courageously declined the ride.  She knew the driver was compromised.  That decision saved her life.  Unfortunately, the searing truth caught others off guard.  Drugged driving is death on wheels, period.  Drug legalization is the unabashed promoter of that death.  So, where are the shepherds?  Where are the outspoken leaders, why silent?

What child is this, who starts with marijuana, soon is addicted, ends overdosing on opiates or as a roadside cross?  What child is this, who needed knowledge from someone they trusted – but got misinformation?  What child is this, who is force-fed popular lies, that drug abuse is “recreation?”

And what child is this, “greeted by angels,” who was forsaken here – by leaders for political advantage?  “Laid to rest” by parents’ inconsolable hands?  Where were those leaders, a thoughtful president, governor, congressman, legislator, mayor?  How could we, in a blink, give up 50,000 souls – this year, again?  Silence is not just holy – it can also be complicit.  Permitting legal expansion of drug abuse, legalized money laundering, an insidious tax grab, or turning a Federal blind eye – comes at the expense of young lives.  That is the truth.

Needed in this season of change are new national and community leaders, who are unafraid to say:   Do not compromise your future.  Do not risk everything for nothing.  Do not break faith with yourself, or those who are counting on you.   The mind wanders … from a Christmas carol to those not here to celebrate.  To parents, siblings, friends and teachers sadly asking “what if…”  And bigger questions:  What if the legalization pabulum and knowing disinformation were stopped?  What if drugs sure to addict and kill were less available?  What if policy indifference turned to saving young lives, not putting them at risk?

Said Henry David Thoreau, every child is an “empire.”  But today, these empires are falling fast.  Risk is inherent in our indifference, disinformation, disregard for truth, and treating death as recreation.  Addiction’s darkness comes on so fast, too.  A life soon narrows, ambitions die, dependence rises, users feel boxed in, relationships and functions are degraded, nightmares start, and then an awful and big question – who cares?

These days, few seem to – not this President, Congress, many of our State “leaders.”  They just go along.  Meantime, more families are drained and left alone – victims of accelerating drug abuse, drugged driving, drug-related crime, and life-changing addiction.  The Trump team has a chance:  To say enough, this experiment is over.  That would help American families stop grieving, save kids from this unparalleled dance with false information and societal indifference.  That would be real leadership – and long overdue.  So, pull the Drug Czar back up to Cabinet rank, put Federal resources and smart people into enforcing the law, and re-educate the country.

“What child is this?”  It is America’s child.  With new hope and real leadership, may we have no more compromises with evil.  Instead, truth spoken to power, power asserted by well-informed people.  Let us stand watch, shepherds for young America.  “Haste, haste …” in this, and in all seasons.  Here may be a resolution for the new year.

Robert Charles is a former Assistant Secretary of State for International Narcotics and Law Enforcement under George W. Bush, former Naval Intelligence Officer and litigator, who served in the Reagan and Bush 41 White Houses.  He wrote the book “Narcotics and Terrorism,” and writes widely on national security and law.

Source: townhall.com/columnists 10th December 2016

After three tours in Iraq and Afghanistan, C. J. Hardin wound up hiding from the world in a backwoods cabin in North Carolina. Divorced, alcoholic and at times suicidal, he had tried almost all the accepted treatments for post-traumatic stress disorder: psychotherapy, group therapy and nearly a dozen different medications. “Nothing worked for me, so I put aside the idea that I could get better,” said Mr. Hardin, 37. “I just pretty much became a hermit in my cabin and never went out.”

Then, in 2013, he joined a small drug trial testing whether PTSD could be treated with MDMA, the illegal party drug better known as Ecstasy.  “It changed my life,” he said in a recent interview in the bright, airy living room of the suburban ranch house here, where he now lives while going to college and working as an airplane mechanic. “It allowed me to see my trauma without fear or hesitation and finally process things and move forward.”

Based on promising results like Mr. Hardin’s, the Food and Drug Administration gave permission Tuesday for large-scale, Phase 3 clinical trials of the drug — a final step before the possible approval of Ecstasy as a prescription drug.   If successful, the trials could turn an illicit street substance into a potent treatment for PTSD.   Through a spokeswoman, the F.D.A. declined to comment, citing regulations that prohibit disclosing information about drugs that are being developed.

“I’m cautious but hopeful,” said Dr. Charles R. Marmar, the head of psychiatry at New York University’s Langone School of Medicine, a leading PTSD researcher who was not involved in the study. “If they can keep getting good results, it will be of great use. PTSD can be very hard to treat. Our best therapies right now don’t help 30 to 40 percent of people. So we need more options.”  But he expressed concern about the potential for abuse. “It’s a feel-good drug, and we know people are prone to abuse it,” he said. “Prolonged use can lead to serious damage to the brain.”

The Multidisciplinary Association for Psychedelic Studies, a small non-profit created in 1985 to advocate the legal medical use of MDMA, LSD, marijuana and other banned drugs, sponsored six Phase 2 studies treating a total of 130 PTSD patients with the stimulant. It will also fund the Phase 3 research, which will include at least 230 patients.

Two trials here in Charleston focused on treating combat veterans, sexual assault victims, and police and firefighters with PTSD who had not responded to traditional prescription drugs or psychotherapy. Patients had, on average, struggled with symptoms for 17 years.

After three doses of MDMA administered under a psychiatrist’s guidance, the patients reported a 56 percent decrease of severity of symptoms on average, one study found. By the end of the study, two-thirds no longer met the criteria for having PTSD. Follow-up examinations found that improvements lasted more than a year after therapy.

“We can sometimes see this kind of remarkable improvement in traditional psychotherapy, but it can take years, if it happens at all,” said Dr. Michael C. Mithoefer, the psychiatrist who conducted the trials here.   “We think it works as a catalyst that speeds the natural healing process.”  The researchers are so optimistic that they have applied for so-called breakthrough therapy status with the Food and Drug Administration, which would speed the approval process. If approved, the drug could be available by 2021.

Under the researchers’ proposal for approval, the drug would be used a limited number of times in the presence of trained psychotherapists as part of a broader course of therapy. But even in those controlled circumstances, some scientists worry that approval as a therapy could encourage more illegal recreational use.

“It sends the message that this drug will help you solve your problems, when often it just creates problems,” said Andrew Parrott, a psychologist at Swansea University in Wales who has studied the brains of chronic Ecstasy users. “This is a messy drug we know can do damage.”

Allowing doctors to administer the drug to treat a disorder, he warned, could inadvertently lead to a wave of abuse similar to the current opioid crisis.  During initial studies, patients went through 12 weeks of psychotherapy, including three eight-hour sessions in which they took MDMA. During the sessions, they lay on a futon amid candles and fresh flowers, listening to soothing music.

Dr. Mithoefer and his wife, Ann Mithoefer, and often their portly terrier mix, Flynn, sat with each patient, guiding them through traumatic memories.  “The medicine allows them to look at things from a different place and reclassify them,” said Ms. Mithoefer, a psychiatric nurse. “Honestly, we don’t have to do much. Each person has an innate ability to heal. We just create the right conditions.”

Research has shown that the drug causes the brain to release a flood of hormones and neurotransmitters that evoke feelings of trust, love and well-being, while also muting fear and negative emotional memories that can be overpowering in patients with post-traumatic stress disorder. Patients say the drug gave them heightened clarity and ability to address their problems.

For years after his combat deployments, Mr. Hardin said he was sleepless and on edge. His dreams were marked with explosions and death. The Army gave him sleeping pills and antidepressants. When they didn’t work, he turned to alcohol and began withdrawing from the world.

Ed Thompson, a former firefighter, took part in a study of Ecstasy as a treatment for PTSD. Without the drug, “he’d be dead,” his wife said.  “I just felt hopeless and in the dark,” he said. “But the MDMA sessions showed me a light I could move toward. Now I’m out of the darkness and the world is all around me.”  Since the trial, he has gone back to school and remarried.

The chemist Alexander Shulgin first realized the euphoria-inducing traits of MDMA in the 1970s, and introduced it to psychologists he knew. Under the nickname Adam, thousands of psychologists began to use it as an aid for therapy sessions. Some researchers at the time thought the drug could be helpful for anxiety disorders, including PTSD, but before formal clinical trails could start, Adam spread to dance clubs and college campuses under the name Ecstasy, and in 1985, the Drug Enforcement Administration made it a Schedule 1 drug, barring all legal use.

Since then, the number of people seeking treatment for PTSD has exploded and psychiatry has struggled to keep pace. Two drugs approved for treating the disorder worked only mildly better than placebos in trials. Current psychotherapy approaches are often slow and many patients drop out when they don’t see results. Studies have shown combat veterans are particularly hard to treat.

In interviews, study participants said MDMA therapy had not only helped them with painful memories, but also had helped them stop abusing alcohol and other drugs and put their lives back together.

On a recent evening, Edward Thompson, a former firefighter, tucked his twin 4-year-old girls into bed, turned on their night light, then joined his wife at a backyard fire. “If it weren’t for MDMA …” he said   “He’d be dead,” his wife, Laura, finished.   They both nodded.

Years of responding to gory accidents left Mr. Thompson, 30, in a near constant state of panic that he had tried to numb with alcohol and prescription opiates and benzodiazepines.  By 2015, efforts at therapy had failed, and so had several family interventions. His wife had left with their children, and he was considering jumping in front of a bus.

A member of a conservative Anglican church, Mr. Thompson had never used illegal drugs. But he was struggling with addiction from his prescription drugs, so he at first rejected a suggestion by his therapist that he enter the study. “In the end, I was out of choices,” he said.

Three sessions with the drug gave him the clarity, he said, to identify his problems and begin to work through them. He does not wish to take the drug again.  “It gave me my life back, but it wasn’t a party drug,” he said. “It was a lot of work.”

Correction: November 29, 2016

An earlier version of this article misstated the year that the Multidisciplinary Association for Psychedelic Studies was founded. It was 1985, not 1986. A picture caption misspelled the surname of a psychiatrist and his wife, a psychiatric nurse, who studied the use of Ecstasy. They are Dr. Michael C. Mithoefer and Ann Mithoefer, not Mitheofer.

Source:  http://www.nytimes.com/2016/11/29/us/ptsd-mdma-ecstasy.html

Hippocampus, the brain’s key memory and learning center, has the lowest blood flow in marijuana users suggesting higher vulnerability to Alzheimer’s. As the U.S. races to legalize marijuana for medicinal and recreational use, a new, large scale brain imaging study gives reason for caution. Published in the Journal of Alzheimer’s Disease, researchers using single photon emission computed tomography (SPECT), a sophisticated imaging study that evaluates blood flow and activity patterns, demonstrated abnormally low blood flow in virtually every area of the brain studies in nearly 1,000 marijuana compared to healthy controls, including areas known to be affected by Alzheimer’s pathology such as the hippocampus.

All data were obtained for analysis from a large multisite database, involving 26,268 patients who came for evaluation of complex, treatment resistant issues to one of nine outpatient neuropsychiatric clinics across the United States (Newport Beach, Costa Mesa, Fairfield, and Brisbane, CA, Tacoma and Bellevue, WA, Reston, VA, Atlanta, GA and New York, NY) between 1995-2015. Of these, 982 current or former marijuana users had brain SPECT at rest and during a mental concentration task compared to almost 100 healthy controls.

Predictive analytics with discriminant analysis was done to determine if brain SPECT regions can distinguish marijuana user brains from controls brain. Low blood flow in the hippocampus in marijuana users reliably distinguished marijuana users from controls.

The right hippocampus during a concentration task was the single most predictive region in distinguishing marijuana users from their normal counterparts. Marijuana use is thought to interfere with memory formation by inhibiting activity in this part of the brain.

According to one of the co-authors on the study Elisabeth Jorandby, M.D., “As a physician who routinely sees marijuana users,  what struck me was not only the global reduction in blood flow in the marijuana users brains, but that the hippocampus was the most affected region due to its role in memory and Alzheimer’s disease.

Our research has proven that marijuana users have lower cerebral blood flow than non-users. Second, the most predictive region separating these two groups is low blood flow in the hippocampus on concentration brain SPECT imaging.

This work suggests that marijuana use has damaging influences in the brain – particularly regions important in memory and learning and known to be affected by Alzheimer’s.”

Dr. George Perry, Editor in Chief of the Journal of Alzheimer’s Disease said, “Open use of marijuana, through legalization, will reveal the wide range of marijuana’s benefits and threats to human health.  This study indicates troubling effects on the hippocampus that may be the harbingers of brain damage.”

According to Daniel Amen, M.D., Founder of Amen Clinics, “Our research demonstrates that marijuana can have significant negative effects on brain function. The media has given the general impression that marijuana is a safe recreational drug, this research directly challenges that notion.  In another new study just released, researchers showed that marijuana use tripled the risk of psychosis. Caution is clearly in order.”

Source: Press http://content.iospress.com/articles/journal-of-alzheimers-disease/jad160833 – DOI: 10.3233/JAD-160833

Abstract

INTRODUCTION:

The social developmental processes by which child maltreatment increases risk for marijuana use are understudied. This study examined hypothesized parent and peer pathways linking preschool abuse and sexual abuse with adolescent and adult marijuana use.

METHODS:

Analyses used data from the Lehigh Longitudinal Study. Measures included child abuse (physical abuse, emotional abuse, domestic violence, and neglect) in preschool, sexual abuse up to age 18, adolescent (average age=18years) parental attachment and peer marijuana approval/use, as well as adolescent and adult (average age=36years) marijuana use.

RESULTS:

Confirming elevated risk due to child maltreatment, path analysis showed that sexual abuse was positively related to adolescent marijuana use, whereas preschool abuse was positively related to adult marijuana use. In support of mediation, it was found that both forms of maltreatment were negatively related to parental attachment, which was negatively related, in turn, to having peers who use and approve of marijuana use. Peer marijuana approval/use was a strong positive predictor of adolescent marijuana use, which was a strong positive predictor, in turn, of adult marijuana use.

CONCLUSIONS:

Results support social developmental theories that hypothesize a sequence of events leading from child maltreatment experiences to lower levels of parental attachment and, in turn, higher levels of involvement with pro-marijuana peers and, ultimately, to both adolescent and adult marijuana use. This sequence of events suggests developmentally-timed intervention activities designed to prevent maltreatment as well as the initiation and progression of marijuana use among vulnerable individuals.

Source:  Addict Behav. 2016 Nov 17;66:70-75. doi: 10.1016/j.addbeh.2016.11.013. 

 

A man holds a sheet of THC concentrate known as “shatter,” in Denver, Colorado. (Brennan Linsley/Associated Press)

An emergency psychiatrist in Victoria warns that a dramatic increase in severe mental illness cases may be connected to use of a powerful, relatively new drug called “shatter.” Dr, Kiri Simms told On the Island host Gregor Craigie she treated 10 patients needing hospitalization in the past year after using shatter or other highly concentrated marijuana-based products made from butane hash oil.

“They’re coming in with symptoms of depression, anxiety and sometimes psychosis, which for a psychiatrist means a break from reality, hallucinations, delusions,” Simms said.

Marijuana psychosis previously rare

In the past, when most marijuana use involved smoking dried leaves and buds, she said the infrequent cases of marijuana-related psychosis usually were patients with a family history of schizophrenia.  “Most people did not become psychotic from marijuana alone.” Simms said.

Several medical marijuana stores in Victoria openly advertise shatter and related marijuana products which an emergency psychologist links to an increasing number of cases of severe psychosis. (CBC)

That has changed. Now, most of the patients she currently sees are regular users of different marijuana products, often what she calls butane hash oil products. Those include shatter, wax and a gooey substance called honey or butter or oil, she said.

Simms said she has personally seen 10 people in the past year, “very, very ill and with the kind of psychotic experience that requires a stay in our psychiatric intensive care or on one of our in-patient wards.”    She said it’s not like the ‘old days’ when symptoms of psychosis would pass in a few hours or days.  “Now, sometimes it’s taking weeks before there is a clearing and occasionally it’s taking months and the patients are not cleared yet,” Simms said.   “Almost all of our patients, even our young patients tell us they can easily obtain these products in the local dispensaries.”

Shatter is openly advertised online by a number of medical marijuana storefront businesses in Victoria.Dana Larsen, the director of the Vancouver Dispensary Society, acknowledged that products such as shatter are too strong for inexperienced users but he does not support new rules or regulations for selling it.

“I think perhaps there should be better labelling and warnings on how to use cannabis products,” Larsen said. “I don’t think this is inherently more dangerous than other cannabis products.”

Source:  http://www.cbc.ca/news/canada/british-columbia/illicit-drugs-shatter-victoria-mental-illness-1.3862535    22nd  Nov. 2016

A recognized deficiency: Inadequate protective protocols

An evaluation of risk applied to marijuana products for medical purposes concludes that advanced mitigation strategies and new protective delivery protocols are necessary to adequately protect the public from harm. The Risk Evaluation and Mitigation Strategies (REMS) program is already an approved protocol in the United States (US) by the US Food and Drug Administration and in Canada a similar controlled distribution program is in place including RevAid®.1,2    These programs are intended to assure patients are monitored to prevent or minimize major side effects and or reactions.   There are a number of medications that fall into existing REMS restrictions include thalidomide, clozapine, isotretinoin, and lenilidomide.  In both of these programs only prescribers and pharmacists who are registered or patients who are enrolled and who have agreed to meet all the conditions of the program are given access to these drugs.1,2

Current Government-approved Cannabinoid Products

Dronabinol (Marinol®, generic), nabilone (Cesamet®, generic) are synthetic cannabinoids to mimic delta-9-THC and nabiximols (Sativex®) is a combination of delta-9-THC and cannabidiol. They all lack the pesticides, herbicides and fungicides placed on marijuana plants during growth.

The longest approved agents, dronabinol and nabilone are indicated for short term use in nausea and vomiting due to chemotherapy and appetite stimulation.3,4  Nabiximols is used as a buccal spray for multiple sclerosis and as an adjunct for cancer pain.5  The maximum delta-9-THC strengths available are 10 mg for dronabinol and 2.7 mg/spray of nabiximols.3,5  Cannabidiol (CBD), a non-psychoactive compound, is one of many cannabinoids found in marijuana.   CBD is currently available for free from the U.S. National Institute of Health in government-sponsored clinical trials as potential treatment of resistant seizures (Dravet’s Syndrome and Lennox-Gastaut Syndrome).6

‘Medical’ Marijuana products

All marijuana products, including marijuana for medical purposes, fit the prerequisites for a REMS program. The average potency of marijuana more than doubled between 1998 and 2009.7 In 2015 common leaf marijuana averaged 17.1% THC in Colorado.8  Examples of oral marijuana products contain 80 mg of THC in chocolates, cookies and drinks and even 420 mg of THC in a “Dank Grasshopper” bar.9  Butane hash oil (BHO) is a concentrated THC product used in water bongs and/or e- cigarettes and contains upwards of 50 – 90% THC with a Colorado average of 71.7 % THC.8   One “dab” (280 mg) of 62.1% BHO is equal to 1 gram of 17% THC in marijuana leaf form.8  These extremely elevated levels of THC make true scientific research with these products incapable of passing Patient Safety Committee standards.10

The Thalidomide Parallel

The risks are so severe for thalidomide, in terms of use in pregnancy that a special protocol that educates, evaluates, mitigates and monitors has been made obligatory.11

Thalidomide (Contergan®) was developed by a German company, Chemie Gruenenthal, in 1954 and approved for the consumer market in 1957.12 It was available as an over-the-counter drug for the relief of “anxiety, insomnia, gastritis, and tension” and later it was used to alleviate nausea and to help with morning sickness by pregnant women. Thalidomide was present in at least 46 countries under a variety of brand names and was available in “sample tablet form” in Canada by 1959 and licensed for prescription on December 2, 1961. Although thalidomide was withdrawn from the market in West Germany and the UK by December 2, 1961, it remained legally available in Canada until March of 1962. It was still available in some Canadian pharmacies until mid-May of 1962.12

Canada had permitted the drug onto the Canadian market when many warnings were already available

An association was being made in 1958 of phocomelia (limb malformation) in babies of mother’s using thalidomide.  A trial conducted in Germany against Gruenenthal, for causing intentional and negligent bodily injury and death, began in 1968 ending in 1970 with a claim of insufficient evidence.  Later, the victims and Gruenenthal settled the case for 100 million dollars.11

In 1962 the American pharmaceutical laws were increased by the Kefauver-Harris Drug Amendment of 1962 and proof for the therapeutic efficiency through suitable and controlled studies would be required for any government approved medication.13 According to paragraph 25 of the Contergan foundation law, every 2 years a new report is required to determine if further development of these regulations are necessary.13

In 1987 the War Amputations of Canada established The Thalidomide Task Force, to seek compensation for Canadian-born thalidomide victims from the government of Canada.12

In 1991, the Ministry of National Health and Welfare (the current Health Canada) awarded Canadian-born thalidomide survivors a small lump-sum payment.12

In 2015 the Canadian government agreed on a settlement of $180 million dollars to 100 survivors of thalidomide drug exposure and damage.14 Through Rona Ambrose, in her capacity as the Health Minister for the government of Canada at the time of the negotiations, an attempt was made to involve the drug companies related to the thalidomide issue in the survivor’s settlement agreement. Negotiations with the drug companies failed.  The Canadian taxpayer alone paid to amend the survivors by way of monetary award.

Thalidomide continues to be sold under the brand name of Immunoprin®, among others in a REMS program. It is an immunomodulatory drug and today, it is used mainly as a treatment of certain cancers (multiple myeloma) and leprosy.11

Question: If the drug thalidomide included psychotropic properties and offered the “high” of marijuana would it be prudent or responsible to allow it to be legally sold and marketed for non-medical purposes – acknowledging thalidomide’s record for toxicity in pregnancy?

Marijuana Risk Assessment and Government Acknowledgement

Risks demonstrated in the scientific literature include genetic and chromosomal damage.15, 16

When exposure occurs in utero, there is an association with many congenital abnormalities including cardiac septal defects, anotia, anophthalmos, and gastroschisis. Marijuana use can disrupt foetal growth and the development of organs and limbs and may result in mutagenic alterations in DNA. Cannabis has also been associated with foetal abnormalities in many studies including low birth weight, foetal growth restriction, preterm birth spontaneous miscarriage, spina bifida and others.15

Phocomelia has been shown in testing in a similar preclinical model (hamster) to that which revealed the teratogenicity of thalidomide.15

THC has the ability to interfere with the first stages in the formation of the brain of the fetus; this event occurs two weeks after conception.  Exposure to today’s high potency marijuana in early pregnancy is associated with anencephaly, a devastating birth defect in which infants are born with large parts of the brain or skull missing.15

The existence of specific health risks associated with marijuana products are acknowledged by national and various local governments and a plethora of elected officials in both Canada and the United States.16, 17, 18

Warnings and the contraindications for use by specific populations and in association with identified conditions, have been publicized by the Federal Government of Canada and the Federal Government of the United States of America through their respective health agencies.16, 17, 18

A government of Canada leaflet produced by Health Canada and updated in December 2015: Consumer Information – Cannabis (Marihuana, marijuana) reads19:

“The use of this product involves risks to health, some of which may not be known or fully understood. Studies supporting the safety and efficacy of cannabis for therapeutic purposes are limited and do not meet the standard required by the Food and Drug Regulations for marketed drugs in Canada.”19

“Using cannabis or any cannabis product can impair your concentration, your ability to think and make decisions, and your reaction time and coordination. This can affect your motor skills, including your ability to drive. It can also increase anxiety and cause panic attacks, and in some cases cause paranoia and hallucinations.”19

“When the product should not be used: under the age of 25, are allergic to any cannabinoid or to smoke, have serious liver, kidney, heart or lung disease, have a personal or family history of serious mental disorders such as schizophrenia, psychosis, depression, or bipolar disorder, are pregnant, are planning to get pregnant, or are breast-feeding, are a man who wishes to start a family, have a history of alcohol or drug abuse or substance dependence.”19

“A list of health outcomes related to long term use includes the following:

Increased risk of triggering or aggravating psychiatric and/or mood disorders (schizophrenia, psychosis, anxiety, depression, bipolar disorder), decrease sperm count, concentration and motility, and increase abnormal sperm morphology. Negatively impact the behavioural and cognitive development of children born to mothers who used cannabis during pregnancy.”19

In Canada, the College of Family Physicians has issued guidelines for issuing marijuana prescriptions.20

“Dried cannabis is not appropriate for patients who: a) Are under the age of 25 (Level II) b) Have a personal history or strong family history of psychosis (Level II) c) Have a current or past cannabis use disorder (Level III) d) Have an active substance use disorder (Level III) e) Have cardiovascular disease (angina, peripheral vascular disease, cerebrovascular disease, arrhythmias) (Level III) f) Have respiratory disease (Level III) or g) Are pregnant, planning to become pregnant, or breastfeeding (Level II)”20

“Dried cannabis should be authorized with caution in those patients who: a) Have a concurrent active mood or anxiety disorder (Level II) b) Smoke tobacco (Level II) c) Have risk factors for cardiovascular disease (Level III) or d) Are heavy users of alcohol or taking high doses of opioids or benzodiazepines or other sedating medications prescribed or available over the counter (Level III)”20

In February 2013 The College of Family Physicians of Canada issued a statement advancing the position that physicians should sign a declaration rather than write a prescription as the potential liability, as well as the ethical obligations, for health professionals prescribing marijuana for medical purposes appears not to have been adequately addressed by Health Canada. 21

“In our view, Health Canada places physicians in an unfair, untenable and to a certain extent unethical position by requiring them to prescribe cannabis in order for patients to obtain it legally. If the patient suffers a cannabis-related harm, physicians can be held liable, just as they are with other prescribed medications. Physicians cannot be expected to prescribe a drug without the safeguards in place as for other medications – solid evidence supporting the effectiveness and safety of the medication, and a clear set of indications, dosing guidelines and precautions.”21

Representatives of the government of the United States held a press conference at the Office of National Drug Policy (ONDCP) in 2005. Mental health experts and scientists joined high-ranking government officials to discuss an emerging body of research that identified clear links between marijuana use and mental health disorders, including depression, suicidal thoughts and schizophrenia.22

The US Substance Abuse and Mental Health Service Administration (SAMHSA) report about the correlation between age of first marijuana use and serious mental illness; and an open letter to parents on “Marijuana and Your Teen’s Mental Health,” signed by twelve of the Nation’s leading mental health organizations, ran in major newspapers and newsweeklies across the country.23

Included were the following announcements:

“Regular use of the drug has appeared to double the risk of developing a psychotic episode or long-term schizophrenia.”23

“Research has strongly suggested that there is a clear link between early cannabis use and later mental health problems in those with a genetic vulnerability – and that there is a particular issue with the use of cannabis by adolescents.” 23

“Adolescents who used cannabis daily were five times more likely to develop depression and anxiety in later life.” 23

In 2016 the Obama Administration steadfastly opposes legalization of marijuana and other drugs because legalization would increase the availability and use of illicit drugs, and pose significant health and safety risks to all Americans, particularly young people.24 The US government still maintains marijuana is classified as a Schedule I drug, meaning it has a high potential for abuse and no currently accepted medical use in treatment in the United States.17, 18

Risk Evaluation and Mitigation Strategy for Marijuana Products

The dispensing of marijuana for medical purposes must follow a strict dispensing and monitoring protocol; no less arduous than that used for the delivery of drugs such as thalidomide.

Recommendation – The implementation of a REMS for marijuana products (REMSMP).

1. The first order for a government is to protect the public. As such, it befits a government approving marijuana for medical purposes to implement a REMS program.

2. Medical cannabis/marijuana dispensaries/stores/delivery systems will be       required to comply with all necessary components of a rigorous REMS program prior to selling and dispensing marijuana products.

3. Governmental regulatory organizations must be responsible for the cannabis/marijuana for medical purposes programs and obtain the required evaluations [(i.e. laboratory tests (pregnancy, HCG, etc.), physical and mental health examination documentation], signed patient consent, provider contract and education forms – performed in the required time frames both before initiation, during and after continued usage of marijuana products for medical purposes.

4. Quarterly audits will be performed, by the government regulatory organization, on each medical marijuana/cannabis dispensary for compliance.  Failure to comply with the REMSMP program will result in fines and other appropriate penalties to the marijuana dispensaries.

A REMS for Marijuana Product Potential Framework:

EMBRYO-FETAL TOXICITY & BREASTFEEDING

* Marijuana causes DNA damage in male and female patients.15  If marijuana is used during conception or during pregnancy, it may cause birth defects, cancer formation in the offspring, Downs Syndrome or embryo-fetal death.15, 16, 18

* Pregnancy must be ruled out before the start of marijuana treatment.  Pregnancy must be prevented by both the male and female patients during marijuana treatment by the use of two reliable methods of contraception.

* When there is no satisfactory alternative treatment, females of reproductive potential may be treated with marijuana provided adequate precautions are taken to avoid pregnancy.

* Females of Reproductive Potential: Must avoid pregnancy for at least 4 weeks before beginning marijuana therapy, during therapy, during dose interruptions and for at least 4 weeks after completing therapy.  Females must commit to either abstain continuously from heterosexual intercourse or use two methods or reliable birth control as mentioned.  They must have two negative pregnancy tests prior to initiating marijuana therapy and monthly pregnancy test with normal menses or two months with abnormal menses and for at least 1 month after stopping marijuana therapy.

* Males (all ages): DNA damage from marijuana is present in the semen of patients receiving marijuana.15 Therefore, males must always use a latex or synthetic condom during any sexual contacts with females of reproductive potential while using marijuana and for up to at least 28 days after discontinuing marijuana therapy, even if they have undergone a successful vasectomy.  Male patients using marijuana may not donate sperm.

* Blood Donation: Patients must not donate blood during treatment with marijuana and for at least 1 month following discontinuation of marijuana because the blood might be given to a pregnant female patient whose fetus should not be exposed to marijuana.

* Marijuana taken by any route of administration may result in drug-associated DNA damage resulting in embryo-fetal toxicity. Females of reproductive potential should avoid contact with marijuana through cutaneous absorption, smoke inhalation or orally.

* If there is contact with marijuana products topically, the exposed area should be washed with soap and water.

* If healthcare providers or other care givers are exposed to body fluids of a person on marijuana, the exposed area should be washed with soap and water.  Appropriate universal precautions should be utilized, such as wearing gloves to prevent the potential cutaneous exposure to marijuana.

* Several psychoactive cannabinoids in marijuana are fat soluble and are found to concentrate in breast milk.  Nursing mothers must not be receiving marijuana.16 Consult the primary care provider about how long to be off of marijuana before considering breast feeding.

NON-SEMINOMA TESTICULAR GERM CELL CARCINOMA

* Marijuana use is a known risk factor in the development of non-seminoma testicular germ cell carcinoma in males.25 – 28

* The presence of non-seminoma testicular germ cell carcinoma must be excluded before the start of marijuana treatment.  The patient’s primary care provider must perform a testicular examination and review the patient’s human chorionic gonadotropin (HCG) blood test before starting marijuana.  Male patients must perform weekly testicular self-evaluations while receiving marijuana.  They are also required to have their primary care provider perform a testicular evaluation and a HCG blood test performed every 4 months while receiving marijuana.29, 30

MENTAL HEALTH:

* Short term high dose and chronic marijuana usage is a known risk factor for the development of multiple mental health disorders.16, 18, 20, 31 – 34  Depression, paranoia, mental confusion, anxiety, addiction and suicide potential are all associated with acute and chronic exposure to marijuana.16, 18   Decline in intelligence is a potential risk of adolescent-onset marijuana exposure. 16, 18, 35

The presence of these mental health disorders must be evaluated by a licensed psychiatrist or psychologist by use of the Mini International Neuropsychiatric Interview or equivalent validated diagnostic instrument before marijuana is started.  The diagnostic mental health evaluation tool will be completed every 1month by an independent licensed psychiatrist or psychologist for a minimum of 6 months until unchanging and then every 4 months thereafter while receiving marijuana ending 4 months after the last exposure to marijuana.36

PSYCHIATRIC EVALUATIONS:

History of Substance Abuse Disorder: As the prevalence of substance use disorders amongst those patients requesting medical authorization of marijuana products is known to be extremely high the patient population must be screened prior to dispensing marijuana products for risk of a substance use disorder.  Substance use must be monitored prior to onset of marijuana with the World Health Organization, Smoking and Substance Involvement Screening Test (WHO-ASSIST, V3.0), and repeated at monthly intervals until unchanging and every 3 months thereafter while receiving marijuana, ending 6 months after the last exposure to marijuana.37

Conclusion

The evidence that thalidomide and tobacco products were harmful was known to the manufacturers/distributors before government and the populous acknowledged these dangers.

To date, there continue to be legal repercussions to said manufacturers/distributors/government for knowingly placing the public at risk.  We believe that the same will happen for marijuana products and that it is our responsibility to assist the Canadian government to protect the public from a similar outcome.

Since the government is fully aware of the marijuana harms, the  government must not be complicit in risking Canadian health/lives, but rather must mitigate any and all such risk to current and future generations.38, 39

The REMSMP program described assists in providing patient education, provider education and required patient monitoring before any marijuana products are allowed to be dispensed.  The program also requires on-going data collection and analysis, to determine the actual hazards from marijuana use and whether the program should even continue.  As the stewards of the country’s human and financial resources, it is critical that government protect the public from potential irreversible harm and itself from litigation risk by harmed individuals knowing that, in the context of marijuana use, harm is not only possible but probable.

Source:  Pamela McColl,  National Director,  Smart Approaches to Marijuana Canada and The Marijuana Victims’ Association,    Vancouver BC Canada    August  2016

Endorsements

Philip Seeman, M.D. Ph.D., O.C. Departments of Pharmacology and Psychiatry University of Toronto,   Nobel Prize nominee (Science)

Elizabeth Osuch, M.D. Associate Professor Rea Chair of Affective Disorders, University of Western Ontario Schulich School of Medicine and Denistry,  London, Ontario

Ray Baker, M.D., FCFP, FASAM, Associate Clinical Professor, University of British Columbia Faculty of Medicine,  Vancouver, British Columbia

Pamela McColl, Smart Approaches to Marijuana – Canada.  Board Member Campaign for Justice Against Tobacco Fraud

Robert L. DuPont, MD,  President, Institute for Behavior and Health, Inc. Clinical Professor of Psychiatry, Georgetown University School of Medicine,  First Director, National Institute on Drug Abuse,  Second US White House Drug Chief

Bertha K Madras, PhD Professor of Psychobiology, Department of Psychiatry,Harvard Medical School

Phillip A. Drum Pharm. D., FCSHP.    Smart Approaches to Marijuana – USA

Professor Gary Hulse, School of Psychiatry and Clinical Neurosciences, University of Western Australia, Crawley, Australia

Grainne Kenny, Dublin, Ireland Co-founder and Hon. President of EURAD ,Brussels, Belgium

Peter Stoker Director, National Drug Prevention Alliance, United Kingdom

Mary Brett, BSc (Hons), Chair of Charity Cannabis Skunk Sense (CanSS) www.cannabisskunksense.co.uk ,United Kingdom

Deidre Boyd, CEO: DB Recovery Resources, Editor: Recovery Plus UK

References  1. Accessed on 7/28/16:http://www.fda.gov/Drugs/DrugSafety/Postmarket DrugSafetyInformationforPatients andProviders/ucm2008016.htm#rems  2. Accessed on 7/28/16: https://www.revaid.ca  3. Accessed on 7/31/16: http://www.fda.gov/ohrms/dockets/dockets/05n0479/05N-0479-emc0004-04.pdf

4. Accessed on 7/31/16: https://www.cesamet.com/pdf/Cesamet_PI_50_count.pdf

5. Accessed on 7/31/16: http://www.ukcia.org/research/SativexMonograph.pdf

6. Accessed on 7/28/16:https://clinicaltrials.gov/ct2/results?term=CBD+and+ epilepsy&Search=Search

7. National Center for Natural Products Research (NCNPR), Research Institute of Pharmaceutical Sciences. Quarterly Report, Potency Monitoring Project, Report 107, September 16, 2009 thru December 15, 2009. University, MS: NCNPR, Research Institute of Pharmaceutical Sciences, School of Pharmacy, University of Mississippi (January 12, 2010).

8. Orens A, et al. Marijuana Equivalency in Portion and Dosage. An assessment of physical and pharmacokinetic relationships in marijuana production and consumption in Colorado. Prepared for the Colorado Department of Revenue. August 10, 2015.

9. Accessed on7/30/16: https://weedmaps.com/dispensaries/tree-house-collective-dispensary-san-marcos

10.  Personal conversation with Marilyn Huestis, NIH researcher, June 2015.

11. Accessed on 8/4/16:http://www.contergan.grunenthal.info/grt-ctg/GRT-CTG/Die_Fakten/Chronologie/152700079.jsp

12. Accessed on 7/28/16: http://www.thalidomide.ca/the-canadian-tragedy/ 13. Accessed on 7/28/16:  http://www.fda.gov/Drugs/NewsEvents/ucm320924.htm 14. Accessed on 7/29/16: http://news.gc.ca/web/article-en.do?nid=945369&tp=1

15. Reece AS, Hulse GK. Chromothripsis and epigenomics complete causality criteria for cannabis- and addiction-connected carcinogenicity, congenital toxicity and heritable genotoxicity. Mutat Res. 2016;789:15-25. 16. Accessed on 7/28/16: http://www.hc-sc.gc.ca/dhp-mps/marihuana/med/ infoprof-eng.php 17. Accessed on 1/8/16:  https://www.whitehouse.gov/ondcp/frequently-asked-questions-and-facts-about-marijuana#harmless 18. Accessed on 1/8/16:  https://www.whitehouse.gov/ondcp/marijuana  19. Accessed on 7/20/16: http://www.hc-sc.gc.ca/dhp-mps/marihuana/info/cons-eng.php

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Homeless people in the streets are a staple of the landscape in downtown areas of Colorado Springs, Denver and most other Colorado communities. Visitors from other states are struck by the dilemma, even when visiting from large cities on the coasts. Experts on homelessness point to marijuana.

The Department of Housing and Urban Development on Thursday confirmed a homeless phenomenon anyone can see.

HUD ranks Colorado fourth behind California, Washington and the District of Columbia for its absolute increase in the homeless population this year. All four jurisdictions have legalized recreational pot.

Colorado’s growth in homeless veterans leads the nation, at 24 percent. Other states averaged a decrease of 17 percent in veteran homeless populations. They are leaving other states and moving to Colorado.

To put this in perspective, compare Colorado and New York. Colorado has a general population of 5.4 million. New York has general population of 20 million. The number of homeless veterans is nearly identical in the two states.

“While most states saw their homeless veteran populations drop an average of 17 percent in the past year to a total of 39,471, Colorado was one of only eight states going in the opposite direction with increasing numbers,” explained The Denver Post.

Daniel Warvi, spokesman for the Department of Veterans Affairs, told the Post how veterans come to Colorado hoping to work in the marijuana industry. Few come here knowing they must prove a year of residence before the law allows them to work in marijuana-related jobs.

“They don’t have a plan B,” Warvi told the Post. Those who find employment typically cannot afford the state’s soaring housing costs.

Larry Smith, executive director of Catholic Charities of Denver, said his staff sees “a direct correlation” between marijuana migration and increasing homelessness. Smith oversees the 380-bed Samaritan House homeless shelter, three other major homeless shelters in northern Colorado, single-family shelters and multiple food pantries and soup kitchens.

“It’s epidemic,” Smith told The Gazette. “We’ve never seen the kind of street living, and camping, that we’re seeing. It is exploding this year, and it is a different type of homeless population. They won’t come in. They won’t take a bed and a shelter, and there are beds available. It’s a different behavior and mentality. They are more aggressive, much more agitated. A large part of that is due to marijuana. This is insanity.”

Even impassioned advocates of legalization should be concerned when professionals link marijuana to increasing homelessness. If the connection is proved, the marijuana industry should take responsibility for some of the social costs.

When states determined the tobacco industry strained Medicaid resources, Big Tobacco agreed to mitigate burdens associated with its trade. In a settlement, states won a minimum $206 billion settlement and concessions that curtail the industry’s marketing practices.

Colorado has long attracted the homeless, for reasons it attracts other demographics. It would be a stretch to blame all new homelessness on legal marijuana. It is reasonable to heed the increasingly impassioned warnings of social workers who say marijuana plays a big role in the recent surge.

When the General Assembly convenes in January, legislators should cooperate to commission a nonpartisan study that assesses the suspected link between marijuana and homelessness. From there, non-profits, politicians and businesses can determine the scope of a constructive and compassionate response.

The Gazette editorial board

Source:  http://gazette.com/editorial-experts-link-homeless-surge-to-pot/article/1590734 Nov. 22nd  2016

Current brain science is suggesting strong plausibility that the opiate and heroin epidemic will continue to worsen with commercializing and industrializing production and sales of marijuana at levels the likes of tobacco, alcohol and prescription drugs. With more 21st century marijuana in our communities, opiate and heroin use rises. The brain science is beginning to explain why this is. We are, with marijuana research, where we were in the 1920s and 30s with tobacco research linking smoking to cancer.

Studies are revealing that the cannabinoid-opioid systems of the brain are intimately connected.

In the areas of the brain where cannabinoids bind, opioids bind as well, and if you modify one system, you automatically change the other. Specifically, there is a functional interaction between the mu and Cb1 receptors of the brain; these receptors commonly exist together on brain cells. The mechanism is not yet well understood; more research is needed. But ultimately cannabinoids and opioids are known to strictly interact in many physiological and pathological functions, including addiction. Overall, evidence confirms a neurobiological convergence of the cannabinoid and opioid systems that is manifest at both receptor and behavioral levels.

What does this mean? We are learning that brain cross-talk between the endocannabinoid and endogenous opioid systems may cause, if there has been early brain exposure to marijuana, changes in the sensitivity to other drugs of abuse such as heroin.

Specifically, the sensitivity may be blunted, which would cause a greater risk for abuse and addiction. This new science supports the plausibility that a person who uses marijuana as a teenager may be increasing his/her risk of opiate addiction later in life. For example, a 20 year old who takes an opiate pain killer for a skiing injury or wisdom tooth removal may become much more at risk of becoming addicted to that pain killer as a result of his or her earlier marijuana use – no matter how insignificant that earlier use may seem. To be clear, this does not mean every teen marijuana user will be challenged with opioid addiction when they take an opiate-based pain killer later in life, as certainly, not every cigarette smoker ends up with lung cancer. Nor does this remove the enormous accountability opioid medications have in the current opiate crisis. It does put some teeth behind that old-school term “gateway drug” as now there is clear scientific evidence of a neuropathway link between opioids and cannabinoids in the brain. Perhaps “pathway drug” is a more accurate term.

The opioid-marijuana brain cross talk is very real and the newest research shows very important experimental evidence on “epigenetics.” A study in rodents showed that somehow, sperm or ova evade genetic cleansing during reproduction and epigenetic modifications triggered by THC are carried forward to the next generation. These changes were produced by THC exposure during adolescence, and yet persisted during reproduction in adulthood long AFTER exposure ended. The research needs to be reproduced in humans but there are others studies on trans-generational effects of other drugs in humans that appear to be consistent with discoveries in rodents.

This research is indicating that with more 21st century marijuana use, we are not only exposing more people to a serious decline in cognitive & mental-health functioning, but we conceivably are also priming populations for more opiate addiction and brain changes. And alarmingly, this priming can take place in utero, even if marijuana use ceases prior to childbearing years.

So frankly, it may not be a coincidence that the states with highest rates of youth marijuana use are also experiencing a soaring heroin epidemic – a trend we are seeing rise across the United States.

This science-based possibility that marijuana exposures in the brain are a foundational feature of the opiate addiction crisis deserves to be weighed heavily in the current decision-making process in how best to change marijuana law – especially given our nation’s tobacco history and tobacco’s impact on health and healthcare costs.  We will learn more about all of this opioid-cannabinoid brain connection, and very soon. with what this science is revealing, if it takes 50 years like it did with tobacco to confirm smoking cigarettes causes lung cancer, our species may be facing a profound and permanent decline in cognitive functioning.

Those in the field of substance abuse and drug use prevention are grateful to our esteemed researchers in Massachusetts and throughout our nation working diligently every day to not only figure out this opioid-cannabinoid neuropathway link, but to explain it to the rest of us so we begin to truly understand what is at stake as the marijuana lobby pushes for full government protection to engineer, produce, market and sell marijuana products in every community for recreational use, like tobacco.

Source:   http://marijuana-policy.org/marijuana-and-opiateheroin-epidemic-brain-science-explains-a-connection/ Feb.2016     By Heidi Heilman, Founder and CEO Massachusetts Prevention Alliance (MAPA); Founder and CEO, Edventi  

The Marijuana Policy Initiative

Don’t Legalize. We Change Minds About Marijuana Legalization/Commercialization

A volunteer non-partisan coalition of people from across the US and Canada who have come to understand the negative local-to-global public health and safety implications of an organized, legal, freely-traded, commercialized and industrialized marijuana market.

With special thanks to Dr. Bertha Madras, Dr. Sion Harris, and Dr. Sharon Levy for their work in translating the complexities of the latest brain science. ___

References (partial list of a lengthy list)

1. Ellgren M, Spano SM, Hurd YL. Adolescent cannabis exposure alters opiate intake and opioid limbic neuronal populations in adult rats. Neuropsychopharmacology. 2007 Mar;32(3):607-15

2. Spano MS, Ellgren M, Wang X, Hurd YL. Prenatal cannabis exposure increases heroin seeking with allostatic changes in limbic enkephalin systems in adulthood. Biol Psychiatry. 2007 Feb 15;61(4):554-63.

3. Ellgren M, Artmann A, Tkalych O, Gupta A, Hansen HS, Hansen SH, Devi LA, Hurd YL. Dynamic changes of the endogenous cannabinoid and opioid mesocorticolimbic systems during adolescence: THC effects. Eur Neuropsychopharmacol. 2008 Nov;18(11):826-34.

4. DiNieri JA, Wang X, Szutorisz H, Spano SM, Kaur J, Casaccia P, Dow-Edwards D, Hurd YL. Maternal cannabis use alters ventral striatal dopamine D2 gene regulation in the offspring. Biol Psychiatry. 2011 Oct 15;70(8):763-9.

5. Spano MS, Ellgren M, Wang X, Hurd YL. Prenatal cannabis exposure increases heroin seeking with allostatic changes in limbic enkephalin systems in adulthood. Biol Psychiatry. 2007 Feb 15;61(4):554-63.

A new study by researchers at the University of Rochester sheds light on how parents and caregivers of children with foetal alcohol spectrum disorders (FASD) can best help their kids achieve to the best of their abilities, and at the same time, maintain peace at home and at school.

Children with FASD often have problems with executive functioning, including deficiencies in impulse control and task planning, information processing, emotion regulation, and social and adaptive skills. Young people with FASD are at high risk for school disruptions and getting into trouble with the law.

The study involved 31 parents and caregivers of children with FASD ages four through eight. The research team looked at data taken from standardized questionnaires and qualitative interviews that focused on parenting practices.

The findings reveal that parents of children with FASD who attribute their child’s misbehavior to their underlying disabilities — rather than to wilful disobedience — are more likely to use pre-emptive strategies designed to help prevent undesirable behaviors.

Given the brain damage associated with FASD, pre-emptive strategies are typically more effective than incentive-based strategies, such as the use of consequences or punishment for misbehavior.   The study shows that educating families and caregivers about the disorder is critical.

“Children with FASD often have significant behavior problems due to neurological damage,” said Dr. Christie Petrenko, a research psychologist at the University’s Mt. Hope Family Center.   She adds that parents who use pre-emptive strategies “change the environment in a way that fits their child’s needs better. They give one-step instructions rather than three-steps because their child has working memory issues.”

“They may buy clothes with soft seams if their child has sensory issues, or post stop signs to cue the child to not open the door. All of these preventive strategies help reduce the demands of the environment on the child,” said Petrenko.

The findings also reveal that parenting practices correlate with levels of caregiver confidence and frustration.   Families of children with FASD are frequently judged and blamed for their children’s misbehavior. However, parents who are successful in preventing unwanted behaviors have greater confidence in their parenting skills and lower levels of frustration with their children than parents who respond to unwanted behaviors with consequences after the fact.

Petrenko and her team at Mt. Hope Family Center are continuing to test new parenting strategies and interventions in order to identify which practices are most effective.

Source:  http://psychcentral.com/news/2016/11/20/best-parenting-strategies-for-kids-with-fetal-alcohol-syndrome/112788.html

Getting behind the wheel while high or mashed off your face is obviously a terrible idea.

But even though new laws were introduced last year to clamp down on drug driving, tonnes of people still take the risk.

Illegal or medical drugs contributed to 62 fatal road crashes last year and another 259 causing serious injury. On top of that some 8,000 people were arrested for drug driving between March 2015 and April this year.

This is despite how badly having drugs in your system impairs your driving.  All of the most commonly used illegal drugs will make you a terrible driver. Just take a look at Brake’s summary below:

Drug driving

More than 8,000 people were arrested for drug driving in the first year of the new law .

Cannabis (2µg/L): Slows reactions; affects concentration; often gives a sedative-like effect, resulting in fatigue; affects co-ordination. Research using driver simulators has found cannabis makes drivers less able to steer accurately and slower to react to another vehicle pulling out

Cocaine (10µg/L) : Causes over-confidence; can cause erratic behaviour. After a night out using cocaine, people may feel like they have flu, feel sleepy and lack concentration

Ecstasy (10µg/L) : Makes the heart beat faster, which can cause a surge of adrenaline and result in a driver feeling over-confident and taking risks

Ketamine (20µg/L): Can cause muscle paralysis; hallucinations; confusion, agitation, panic attacks; and memory impairment

LSD: Can speed up or slow down time and movement, making the speed of other vehicles difficult to judge; can distort colour, sound and objects; may cause people to see objects which aren’t there; makes people feel panicky and confused

Speed: Makes people feel wide awake and excited, causing erratic behaviour and risk-taking; and can make people panicky. Users have difficulty sleeping, so will be unsafe to drive due to tiredness, sometimes for several days

But it’s not just illegal drugs that will impair your ability to drive, many prescription drugs will do to.  A UK study in 2000 found 5% of drivers and 4% of motorcyclists who died in road crashes had taken medicines that could have affected their driving.  Aside from the dangers you pose to other drivers by getting behind the wheel with drugs on your system, the legal ramifications are bad too.

Drivers convicted of drug driving receive::

* A minimum 12-month driving ban

* A criminal record; and

* A fine of up to £5,000, or up to 6 months in prison, or both Greg Marah, a spokesperson for Brake, told metro.co.uk that It is estimated that 200 deaths a year in the UK may result from drug driving.

He added: ‘Drink-driving is rightly seen as socially unacceptable, yet the dangers of driving under the influence of drugs are not as well-known and the drivers who choose to drug drive need to know that it’s illegal and potentially lethal.

‘With Police now having the power to test for drugs at the roadside, there is no hiding place for those who engage in this behaviour and endanger lives on our roads.  ‘However, with traffic policing being hit hard by budget cuts and resources stretched, more drivers may still be escaping prosecution despite these advances in testing for drug driving.

‘Every day we see the devastating consequences of crashes caused by drug drivers and people need to understand that these substances will seriously affect their ability to drive safely.’

Source:  http://metro.co.uk/2016/11/22/how-taking-drugs-before-you-get-behind-the-wheel-will-make-you-a-terrible-driver-6276207/

(Medical Xpress)—An international team of researchers has found what they believe is the source of memory loss in people who smoke marijuana—disruption to mitochondria. In their paper published in the journal Nature, the group describes their study of receptor activation due to exposure to active ingredients in cannabis and its impact on mitochondria.

A mitochondrion is an organelle located inside of most cells—it is commonly referred to as the part of the cell responsible for energy regulation. In this new effort, the researchers looked into the impact of cannabis on mitochondria in brain cells to find out if it may play a role in immobility, catalepsy (onset of seizures or a trance-like state) or memory loss due to use of the controversial drug.

Prior research has shown that CB1 receptors are located in the plasma membrane that surrounds typical brain cells. Other research has also shown that chronic use of cannabis can cause memory loss and other problems and that substances in it bind to CB1 receptors on nerve terminals, which, in turn, can cause a disruption in the transmissions of messages between cells. The net result is memory loss, catatonic states or blackouts. In this new effort, the researchers found that chemicals in cannabis also caused activation of CB1 receptors in mitochondria in brain cells located in the hippocampus, which is where most memory processing occurs. This, they claim, suggests memory loss due to use of cannabis can be sourced to the impact it has on the organelles.

The team came to this conclusion by removing the CB1 receptors in mitochondria in mice brain cells and testing the mice to see if they continued to experience memory loss due to the introduction of the cannabis chemicals. The team reports they did not, which suggests that interactions between cannabis chemicals and mitochondria plays a major role in memory loss and likely other negative health effects associated with chronic use of marijuana. They suggest their findings indicate that chronic use of the drug could cause permanent damage to mitochondria, leading to long-term or permanent memory loss and other health problems.

The researchers also suggest their findings indicate that there may be a way to modify medical cannabis used to treat diseases such as glaucoma so that it does not cause memory loss or other associated health problems, by removing its impact on mitochondria.

Source:http://medicalxpress.com/news/2016-11-memory-loss-due-cannabis-mitochondria.html

More information: Etienne Hebert-Chatelain et al. A cannabinoid link between mitochondria and memory, Nature (2016). DOI: 10.1038/nature20127

Abstract  Cellular activity in the brain depends on the high energetic support provided by mitochondria, the cell organelles which use energy sources to generate ATP.

Acute cannabinoid intoxication induces amnesia in humans and animals, and the activation of type-1 cannabinoid receptors present at brain mitochondria membranes (mtCB1) can directly alter mitochondrial energetic activity. Although the pathological impact of chronic mitochondrial dysfunctions in the brain is well established, the involvement of acute modulation of mitochondrial activity in high brain functions, including learning and memory, is unknown.

Here, we show that acute cannabinoid-induced memory impairment in mice requires activation of hippocampal mtCB1 receptors. Genetic exclusion of CB1 receptors from hippocampal mitochondria prevents cannabinoid-induced reduction of mitochondrial mobility, synaptic transmission and memory formation. mtCB1 receptors signal through intra-mitochondrial Gαi protein activation and consequent inhibition of soluble-adenylyl cyclase (sAC).

The resulting inhibition of protein kinase A (PKA)-dependent phosphorylation of specific subunits of the mitochondrial electron transport system eventually leads to decreased cellular respiration. Hippocampal inhibition of sAC activity or manipulation of intra-mitochondrial PKA signalling or phosphorylation of the Complex I subunit NDUFS2 inhibit bioenergetic and amnesic effects of cannabinoids. Thus, the G protein-coupled mtCB1 receptors regulate memory processes via modulation of mitochondrial energy metabolism. By directly linking mitochondrial activity to memory formation, these data reveal that bioenergetic processes are primary acute regulators of cognitive functions.