Addiction is treatable. So why aren’t more people receiving quality care?

The crisis is well documented and reported: More people are dying of drug overdose than any other non-natural cause—more than from guns, suicide, and car accidents. Politicians have held press conferences, formed commissions and task forces, and convened town-hall meetings. Vivek Murthy, the Surgeon General under President Obama (fired by Donald Trump), issued an historic report on America’s drug-use and addiction crises. Pharmaceutical companies have been blamed. Drug cartels. Physicians who hand out pain pills like Skittles.

In the meantime, the problem worsens. In 2015, 52,000 people died because of overdose, including 33,000 on OxyContin, heroin, and other opioids. Almost three times that number died of causes related to the most-used mood-altering addictive drug, alcohol. The 2016 and 2017 overdose numbers are predicted to be higher. Currently, fentanyl deaths are skyrocketing. If not politicians, to whom can we turn to address the crisis? Since addiction is a health problem, the logical answer would be the addiction-treatment system, but it’s in disarray.

Currently most people who enter treatment are subjected to archaic care, some of which does more harm than good. Only about 10 percent of people who need treatment for drug-use disorders get any whatsoever. Of those who do, a majority enter programs with practices that would be considered barbaric if they were common in treatment systems for other diseases.

Many programs reject science and employ one-size-fits-all-addicts treatment. Patients are often subjected to a slipshod patchwork of unproven therapies. They pass talking sticks and bat horses with Nerf noodles. In some programs, patients are subjected to confrontational therapies, which may include the badgering of those who resist engaging in 12-Step programs, participation in which is required in almost every program. These support groups help some people, but alienate others. When compulsory, they can be detrimental.

Patients are routinely kicked out of programs for exhibiting symptoms of their disease (relapse or breaking rules), which is unconscionable. They are denied life-saving medications by practitioners who don’t believe in them—as Richard Rawson, PhD, research professor, UVM Center for Behavior and Health, says, “this is tantamount to a doctor not believing in Coumadin to prevent heart attacks or insulin for diabetes.”

Patients are put in programs for arbitrary periods of time. Three or five days of detox isn’t treatment. Many residential programs last for twenty-eight days, but research has shown that a month is rarely long enough to treat this disease. Some of those who enter residential treatment do get sober, but they relapse soon after they’re discharged, with, as addiction researcher Thomas McLellan, PhD, sums, “a hearty handshake and instructions to go off to a church basement someplace.” As he says, “It just won’t work.” Finally, people afflicted with this disease are almost never assessed and treated for co-occurring psychiatric disorders, in spite of the fact they almost always accompany and underlie life-threatening drug use. If both illnesses aren’t addressed, relapse is likely.

The disastrous state of the system suggests that addiction-medicine specialists don’t know how to treat substance-use disorders (or even if they can be treated). It’s not the case. The National Institute on Drug Abuse (NIDA) and organizations of addiction-care professionals like the American Society of Addiction Medicine (ASAM) and American Association of Addiction Psychiatry (AAAP) have identified effective treatments. There’s no easy cure for many complex diseases, including addiction. However, cognitive-behavior therapy, motivational interviewing, and addiction medications, often used in concert with one another and in concert with assessment and treatment dual diagnoses, are among many proven treatments. However, most patients are never offered these treatments because of a fatal chasm between addiction science and practitioners and programs.

Fixing the system requires modeling it on the one in place for other serious illnesses. Most people enter the medical system in their primary-care doctors’ offices, health clinics, or emergency rooms. Currently, most doctors in these settings have had little or no education about addiction. A recent ASAM survey of two thirds of U.S. medical schools found that they require an average of less than an hour of training in addiction treatment.

Doctors must be taught to recognize substance-use disorders and treat them immediately—the archaic “let them hit bottom” paradigm has been discredited. They should offer or refer for brief interventions. A program called SBIRT (Screening, Brief Intervention and Referral to Treatment), which seeks to identify risky substance use and includes as few as three counselling sessions, has proven effective in many cases, and may be implemented in general healthcare settings.

Primary-care doctors should be trained and certified to prescribe buprenorphine, a medication that decreases craving and prevents overdose on opioids. Currently, there are limitations on the number of patients doctors can treat. Still, in Vermont, for example, almost 50 percent of opioid users in treatment receive care in their doctors’ offices- they don’t have to go to addiction specialists or intensive treatment programs to receive care.

When a patient requires a higher level of care, doctors must refer them to addiction specialists, which excludes many current practitioners whose only qualification to treat addiction is their own experience in recovery. Instead, patients must be seen by psychiatrists and psychologists trained to diagnose and treat the wide range of substance use disorders. There’s a shortage of these doctors; there needs to be a concerted effort to fill the void.

According to Larissa Mooney, MD, director of the UCLA Addiction Medicine Clinic, “Individuals entering treatment should be presented with an informed discussion about treatment options that include effective, research-based interventions.  In our current system, treatment recommendations vary widely and may come with bias; medication treatments are either not offered or may be presented as a less desirable option in the path to recovery. Treatment should be individualized, and if the same form of treatment has been repeated over and over with poor results (i.e. relapse), an alternative or more comprehensive approach should be suggested.”

When determining if a patient should be treated in physicians’ offices, intensive-outpatient, or residential setting, doctors should rely on ASAM guidelines, not guesses. The length of treatment must be determined by necessity, not insurance. If a patient relapses, is recalcitrant, or breaks rules, treatment should be re-evaluated. They may need a higher level of care, but sick people should never be put out on the street. In addition, all practitioners must reject the archaic proscriptions against medication-assisted treatment; Rawson says that failing to prescribe addiction medications in the case of opioid addiction “should be considered malpractice.”

Programs must also address the fact that a majority of people with substance-use disorders have interrelated psychiatric illnesses. Patients should undergo clinical evaluation, which may include psychological testing. Those with dual diagnoses must be treated for their co-occurring disorders. Finally, initial treatments must be followed by aftercare that’s monitored by an addiction psychiatrist, psychologist, or physician. In short, the field must adopt gold-standard, research-based best practices.

People blame politicians, drug dealers, and pharmaceutical companies for the overdose crisis. However, that won’t help the millions of addicted Americans who need treatment now. Even the most devoted and skilled addiction professionals must acknowledge that they’re part of a broken system that’s killing people. No one can repair it but them.

Source:https://www.psychologytoday.com/blog/overcoming-addiction/201705/sobering-truth-about-addiction-treatment-in-america  May 2017

O, let me not be mad, not mad, sweet heaven. Keep me in temper and keep the Liberal Democrats away from government. For they would make us all mad.

On Friday, new meaning was given to the Progressive Alliance. Maybe the Lib Dems have taken pity seeing Labour struggling to convince even the BBC that the nationalisation of everything can be paid for just by whacking more taxes on the rich. That was my first thought on reading of their pledge to completely legalise cannabis.

In the spirit of cooperation, I thought they have dreamt up a way to raise a billion quid of Labour’s shortfall. People won’t notice, not when they are stoned anyway.

Yes, the Lib Dems’ great money-raising wheeze depends on getting all us puffing away on the weed, just like we knock back the alcohol or used to grab a fag at the first excuse. Why not? Cigarettes and alcohol have always proved nice little earners, even if smuggling went up with every tax hike.  So why not add dope and kill two birds with one stone (no pun intended) and make yourself popular with all those ageing liberal hippies like Simon Jenkins, Mary Ann Seighart and Camilla Cavendish, former head of David Cameron’s policy unit, who are all forever bellyaching on about accepting drugs as part of the fabric of life and restoring sanity to society.

Hang on a minute – that’s the Lib Dem plan! It’s nothing to do with helping Labour out of a hole. It’s to finance their own mental health programme. Yes, you have read that. Wasn’t it last week that the well-meaning Norman Lamb earmarked, guess what, but a billion quid to fight that historic injustice, he says, is faced by people with mental ill health? An historic injustice that goes back all of 2 years.

‘Under the Conservative Government, services have been stretched to breaking point at a time when the prevalence of mental ill health appears to be rising.’

It is more than bizarre that the Lib Dems fail to join up the dots of mental illness and treatment (on which they have been campaigning vigorously) with increased use of drugs, particularly cannabis (which is what legalisation means).

Have they missed entirely the connection between cannabis use and mental ill health? Are they unaware that cannabis use triples psychosis risk? And from 17 to 38 can lose you 8 IQ points? Perhaps they are suffering that IQ loss already.

In Lib Dem happy land, everything can be squared – even Tiny Tim’s evangelical religious beliefs with gay marriage – and on drugs it is back to the future of hippy protest.

They have all been out straggling the airwaves, forgotten but former Lib Dem MPs – Dr Evan Harris (Dr Death as he was better known) and Dame Molly Meacher’s former sidekick Dr Julian Huppert – emerging into the daylight blinking to press their old cause, along with their Frankenstein master, the suitably named Professor David Nutt, of magic mushroom and alcohol antidote research fame.

One wonders whether the God-fearing Tim knows what he’s conjured up.  As a concerned parent, he should know that if legalisation means anything at all it means drug use going up as the latest stats from Colorado underline. Past-month marijuana use among 12-to-17 year-olds there has increased from 9.82 per cent to 12.56 per cent, according to the most recent year-by-year comparison looking at pre-legalisation data.

Well I for one am looking forward to seeing the contortions he’ll have to go through to join up the dots on his mental health and drugs legalisation policies. I suggest before he finds himself being asked to justify adding to our already overcrowded and underfunded secure psychiatric units – peopled with male psychotics addicted to cannabis – he reads one of the many comprehensive reviews of the link between cannabis and mental illness.

However, I am not holding my breath that Andrew Marr or any other progressive liberal BBC interviewer will press him on it.

Source:  http://www.conservativewoman.co.uk/kathy-gyngell-potty-lib-dems-want-legalise-cannabis-boost-mental-health/   14th May 2017

How do you know when you are being softened up for something? One sure sign is when what you are being asked to give your support to is sold to you as entirely unproblematic or as a panacea to a host of problems. Never believe it.

My antennae began twitching when the latest round in the campaign for legalised ‘medical cannabis’ began back last autumn. The instigator was the All Party Parliamentary Group for Drugs Policy Reform chaired by one Baroness Molly Meacher and its ammunition a misleading and derivative report: Accessing Medicinal Cannabis: Meeting Patients’ Needs.

With a general election under way it seems the good Baroness and her backers have decided to give their ‘medipot’ campaign another crack of the whip, ever hopeful of a change of government heart over legalising so-called medicinal cannabis.

What could be wrong with that, I hear you ask. Well, if I was sceptical about the stated purpose of this report when it was first published, I am even more so this time. Why? First, because the case for medicinal cannabis is based on a false premise, which the recent licensing of cannabidiol demonstrates again. Second, the scientific research on its efficacy doesn’t stack up too well. And third, there no safe way of using the unprocessed plant for recreational let alone medical purposes.

To recap, contrary to received wisdom, no one has stopped or is stopping  the scientific study of the chemicals in cannabis for medicinal purposes. Two approved cannabis-derived medications, Marinol and Sativex, exist already and a third, Epidiolex is undergoing clinical trials at the moment. In addition to this, the non psycho-active CBD or cannabidiol has been approved by Britain’s medicines regulatory authority, the MHRA, and the compound is now to be licensed and regulated as a medicine. Evidence of the efficacy of the derived compounds of cannabis for the wide range of symptoms they have been tested on is at best weak. This is what a dispassionate systematic research review conducted by the American Academy of Neurology and endorsed by the American Autonomic Society, the American Epilepsy Society, the Consortium of Multiple Sclerosis Centers, the International Organization of Multiple Sclerosis Nurses, and the International Rett Syndrome Foundation, shows.

There are indisputable  scientific and safety reasons for why the whole unprocessed cannabis plant is not and will never be approved as a medicine; that’s unless we chose to revert to medieval quackery and throw all scientific and safety advances  out of the window. It is not just that cannabis risks (addiction, psychosis, cancer, impaired cognitive functioning, to name but some) outweigh any possible benefits, but that as a natural ‘herb’ it is untested for pathogens and bacteria. Who is their right mind would chose mould over an approved antibiotic? And where is the luminary who thinks smoking is a sensible medication delivery system? – which how most cannabis users chose to ingest the weed.

But rational science hasn’t stopped the medipot activists in their tracks. Over the last few months they’ve been relentlessly pressing their victimhood status on the media and the inequity they suffer of not having a free and easy access to their preferred untested drug, i.e. dope.  They have really been doing rather well at convincing the media of their non-existent problem. The Daily Mail even fell for it this week, reiterating the campaigners’ victim meme of being sick people unjustly prosecuted by harsh and uncompromising authorities for the crime of tending to their pain when, in fact, it is the regulatory authorities who are protecting people from poisoning themselves. No wonder Baroness Meacher, chair of the aforesaid APPG, sounded so triumphant on the airwaves yesterday as she pushed the case for medipot to an all believing radio host. Even the Mail (all that has stood between us and drugs legalisation, she as much as said) had finally written a balanced article on the topic, she crowed.

She herself certainly was not balanced. I cannot make up my mind, given her ‘economy with truth’ regarding drug statistics on previous occasions that I have taken her up on, here, and here whether the Baroness is just daft and deluded, genuinely ingenuous, or, more worryingly, actively disingenuous. Running true to form, Baroness Meacher failed in her interview (go to circa one hour, 6 minutes into the programme) to either mention the medicines approval system or the recent licensing of cannabidiol as a medicine.  She also misled the public, deliberately it seemed, by giving the impression that the UK government has actively frustrated cannabis-based research when it hasn’t. In fact, the opposite is the case, as drugs policy analyst David Raynes made clear on the same programme.  The UK government broke ground when it licensed research into cannabis in 1998.

In the  absence of research, her spurious argument went, there remains a medical need for public access to the raw cannabis plant and therefore an end to its classification as a harmful recreational drug. There we had it.

The truth is that the APPG on Drugs Policy Reform she chairs is hardly an independent or dispassionate body. It is funded by The Open Society, which is in turn is a George Soros front. According to the Washington Times (Source: www.washingtontimes.com 2nd April 2014) this is the billionaire philanthropist who, with a cadre of like-minded, wealthy donors, has dominated the pro-legalisation side of the marijuana debate in the US by funding grass-roots movements in every state. No wonder so many capitulated.  Through a network of nonprofit groups,  Mr. Soros has spent at least $80 million on these drugs legalisation efforts since 1994. And more in the last three years. I fear the APPG’s effort (ably backed by Nick Clegg who also seems oblivious to the relationship between cannabis and mental illness) is but the latest in a line of such campaigns whose objective is effectively to legalise recreational cannabis. These go back to 1979 when Keith Stroup of NORML, the group “that speaks for pot users’ originally admitted that medipot was  a red herring to get pot a good name.  More recently he revealed that he was not too keen on cannabis compounds being subjected to scientific drug research trials. He said that the “pharmaceuticalisation” of cannabis was a battleground to be fought in order to protect ‘the options of patients’ – to smoke dope as it is.

I wonder if this too is why Meacher is so reluctant to give a full account of cannabis research and medical regulation? It rather pulls her medi-pot carpet from under her feet.

Source:  http://www.conservativewoman.co.uk/kathy-gyngell-the-push-for-medipot-remains-a-push-for-pot/   May 2017

COLUMBUS, Ohio — It’s being called “gray death” — a new and dangerous opioid combo that underscores the ever-changing nature of the U.S. addiction crisis.

Investigators who nicknamed the mixture have detected it or recorded overdoses blamed on it in Alabama, Georgia and Ohio. The drug looks like concrete mix and varies in consistency from a hard, chunky material to a fine powder.

The substance is a combination of several opioids blamed for thousands of fatal overdoses nationally, including heroin, fentanyl, carfentanil – sometimes used to tranquilize large animals like elephants – and a synthetic opioid called U-47700.

“Gray death is one of the scariest combinations that I have ever seen in nearly 20 years of forensic chemistry drug analysis,” Deneen Kilcrease, manager of the chemistry section at the Georgia Bureau of Investigation, said.  Gray death ingredients and their concentrations are unknown to users, making it particularly lethal, Kilcrease said. In addition, because these strong drugs can be absorbed through the skin, simply touching the powder puts users at risk, she said.

Last year, the U.S. Drug Enforcement Administration listed U-47700 in the category of the most dangerous drugs it regulates, saying it was associated with dozens of fatalities, mostly in New York and North Carolina. Some of the pills taken from Prince’s estate after the musician’s overdose death last year contained U-47700.

Gray death has a much higher potency than heroin, according to a bulletin issued by the Gulf Coast High Intensity Drug Trafficking Area. Users inject, swallow, smoke or snort it.

Georgia’s investigation bureau has received 50 overdose cases in the past three months involving gray death, most from the Atlanta area, said spokeswoman Nelly Miles.

In Ohio, the coroner’s office serving the Cincinnati area says a similar compound has been coming in for months. The Ohio attorney general ‘s office has analyzed eight samples matching the gray death mixture from around the state.

The combo is just the latest in the trend of heroin mixed with other opioids, such as fentanyl, that has been around for a few years.  Fentanyl-related deaths spiked so high in Ohio in 2015 that state health officials asked the federal Centers for Disease Control and Prevention to send scientists to help address the problem.

The mixing poses a deadly risk to users and also challenges investigators trying to figure out what they’re dealing with this time around, said Ohio Attorney General Mike DeWine, a Republican.

“Normally, we would be able to walk by one of our scientists, and say ‘What are you testing?’ and they’ll tell you heroin or ‘We’re testing fentanyl,’” DeWine said. “Now, sometimes they’re looking at it, at least initially, and say, ‘Well, we don’t know.’”

Some communities also are seeing fentanyl mixed with non-opioids, such as cocaine. In Rhode Island, the state has recommended that individuals with a history of cocaine use receive supplies of the anti-overdose drug naloxone.

These deadly combinations are becoming a hallmark of the heroin and opioid epidemic, which the government says resulted in 33,000 fatal overdoses nationally in 2015. In Ohio, a record 3,050 people died of drug overdoses last year, most the result of opioid painkillers or their relative, heroin.

Most people with addictions buy heroin in the belief that’s exactly what they’re getting, overdose survivor Richie Webber said.  But that’s often not the case, as he found out in 2014 when he overdosed on fentanyl-laced heroin. It took two doses of naloxone to revive him. He’s now sober and runs a treatment organization, Fight for Recovery, in Clyde, about 45 miles (72 kilometers) southeast of Toledo.

A typical new combination he’s seeing is heroin combined with 3-methylfentanyl, a more powerful version of fentanyl, said Webber, 25. It’s one of the reasons he tells users never to take drugs alone.

“You don’t know what you’re getting with these things,” Webber said. “Every time you shoot up you’re literally playing Russian roulette with your life.”

Source:  https://www.statnews.com/2017/05/04/opioid-gray-death-overdoses/  4th May 2017

The opioid epidemic has led to the deadliest drug crisis in US history – even deadlier than the crack epidemic of the 1980s and 1990s.

Drug overdoses now cause more deaths than gun violence and car crashes. They even caused more deaths in 2015 than HIV/AIDS did at the height of the epidemic in 1995.

A new study suggests that we may be underestimating the death toll of the opioid epidemic and current drug crisis. The study, conducted by researchers at the Centers for Disease Control and Prevention (CDC), looked at 1,676 deaths in Minnesota’s Unexplained Death surveillance system (UNEX) from 2006 – 2015. The system is meant to refer cases with no clear cause of death to further testing and analysis. In total, 59 of the UNEX deaths, or about 3.5 percent, were linked to opioids. But more than half of these opioid-linked deaths didn’t show up in Minnesota’s official total for opioid related deaths.

It is unclear how widespread of a problem this is in other death surveillance systems and other states, but the study’s findings suggest that the numbers we have so far for opioid deaths are at best a minimum. Typically, deaths are marked by local coroners or medical examiners through a system; if the medical examiner marks a death as immediately caused by an opioid overdose, the death is eventually added to the US’s total for opioid overdose deaths. But there is no national standard for what counts as an opioid overdose, so it’s left to local medical officials to decide whether a death was caused by an overdose or not. This can get surprisingly tricky – particularly in cases involving multiple conditions or for cases in which someone’s death seemed to be immediately caused by one condition, but that condition had a separate underlying medical issue behind it.

For example, opioids are believed to increase the risk of pneumonia. But if a medical examiner sees that a person died of pneumonia, they might mark the death as caused by pneumonia, even if the opioids were the underlying cause for the death. “In early spring, the Minnesota Department of Health was notified of an unexplained death: a middle-aged man who died suddenly at home. He was on long-term opioid therapy for some back pain, and his family was a little bit concerned that he was abusing his medication,” said Victoria Hall, one of the study’s authors.

“After the autopsy, the medical examiner was quite concerned about pneumonia in this case, and that’s how the case was referred to the Minnesota Department of Health unexplained deaths program. Further testing diagnosed an influenza pneumonia, but also detected a toxic level of opioids in his system. However, on the death certificate, it only listed the pneumonia and made no mention of opioids.”

Since this is just one study of one surveillance system in one state, it’s unclear just how widespread this kind of underreporting is in the United States. But the data suggests that there is at least some undercounting going on – which is especially worrying, as this is already the deadliest drug overdose crisis in US history. “It does seem like it is almost an iceberg of an epidemic,” said Hall. “We already know that it’s bad. And while my research can’t speak to what percent we’re underestimating, we know we are missing some cases.” In 2015, more Americans died of drug overdoses than any other year on record – more than 52,000 deaths in just one year. That’s higher than the more than

38,000 who died in car crashes, the more than 36,000 who died from gun violence, and the more than 43,000 who died due to HIV/AIDS during that epidemic’s peak in 1995.

See more: • The Changing Face of Heroin Use in the US study • Today’s Heroin Epidemic – CDC

Source:  Prevention Weekly. news@cadca.org  May 2017

Challenges Top Marijuana Lobbyist to Answer Four Questions

[Alexandria, VA, May 2, 2017] – Today, Smart Approaches to Marijuana (SAM), a national organization committed to promoting evidence-based marijuana laws at the Federal, state, and local levels, released the following statement in reaction to the admission by Rob Kampia, the Executive Director of the Marijuana Policy Project, that the special interest group is actively soliciting financial contributions from the tobacco industry in exchange for shaping their marijuana legalization initiatives. MPP is the lead lobbying group responsible for funding and organizing every state-based marijuana commercialization campaign in the U.S.

“Rob Kampia’s shameless solicitation for contributions from the tobacco industry is quid pro quo special interest politics at its worst,” said Dr. Kevin Sabet, President and CEO of SAM. “Marijuana laws in our country should be informed by science and evidence, not the financial interests of the tobacco industry or a growing for-profit marijuana industry.  When the head of the lobbying group responsible for every single marijuana legalization initiative in America asks tobacco companies, ‘what do you want?’ it should send chills down the spine of every public health and safety official in America.

This is an outrage and we challenge the Marijuana Policy Project to immediately disclose any and all ties to the tobacco industry so that communities in Michigan and across the country considering changes to marijuana laws can see through the haze of what’s really driving pro-marijuana legalization campaigns in America.”

Kampia’s admission was published last week in the Marijuana Business Daily in a story entitled, “MPP Chief Ready to Barter For Marijuana Campaign Donations.” According to the Daily:

The executive director of Marijuana Policy Project, Kampia called Marijuana Business Daily on Thursday after reading an MJBizDaily story about negotiations in Michigan over a likely ballot measure to legalize recreational cannabis in the state.

He solicited tobacco business interests in Michigan in search of campaign donations to run what will likely be a multimillion-dollar, 19-month endeavor, but he said he was largely unsuccessful.

“It’s the kind of thing where I actually go out and I try to court well-funded constituencies and philanthropists, and say, ‘What do you want, what do you hate, what’s going to turn you off so I can’t actually ask you for money later,’ and sometimes you get so far as to say … ‘Is there something that we put something in here that would cause you to immediately escalate your commitment?'” Kampia explained…

In response to Kampia’s latest comments, SAM also challenged MPP to answer four questions regarding MPP’s ties to the tobacco industry:

1. How much total money has MPP taken from the tobacco industry since the organization was established in 1995?

2. Which state-based marijuana ballot initiatives led by MPP have been influenced by input from the tobacco industry?

3. What specific changes to marijuana legislation or ballot initiatives has the tobacco industry proposed in exchange for financial contributions to MPP?

4. Has MPP disclosed its ties to the tobacco industry with Members of Congress it is currently lobbying in support of Federal legislation that would incentivize the commercialization of marijuana in the United States?

Evidence demonstrates that marijuana – which has skyrocketed in average potency over the past decades – is addictive and harmful to the human brain, especially when used by adolescents. Moreover, in states that have already legalized the drug, there has been an increase in drugged driving crashes and youth marijuana use. States that have legalized marijuana have also failed to shore up state budget shortfalls with marijuana taxes, continue to see a thriving black market, and are experiencing a continued rise in alcohol sales.

Source:  learnaboutsam.org.  2nd May 2017

Fifty years on, I still wince in recalling those two frightened high school kids I saw hauled into an Oshawa courtroom and handed stiff jail terms, two years less a day, for possessing miniscule amounts of marijuana.

They weren’t dealers. They were just teens dabbling in the latest thing, but they had the misfortune of being the first “drug arrests” in a tough, beer-swilling automotive city that was close to hysteria over the arrival of dirty, long-haired hippies and their damn weed.

Those kids would be senior citizens now, but I still wonder what became of them. Were their lives ruined by that jail time and the criminal records that followed them everywhere? Or did they move on and become brain surgeons and bank presidents?

I get the argument behind decriminalizing marijuana consumption. Nobody should do jail time for simply consuming a product less damaging, at least to the liver, than alcohol. If deterrence was the intent of those harsh marijuana sentences, they utterly failed. By the early 1970s, it was all but impossible to attend a social gathering without being handed a joint and expected to partake, at least a polite puff or two, or be labelled a pariah.

But the pendulum has swung. The anti-weed hysteria of the late ’60s has become raging 21st-century fury that anyone would dare voice concerns about the fallout of Justinian Canada becoming only the second nation to give marijuana its full blessing.

Mayor Drew Dilkens ran afoul of the pot crusaders and their missionary zeal three weeks ago when he described, in this space, how a trip to Denver, Colo., where marijuana was legalized four years ago, left him worried about the possible impact on a border city like Windsor. On the 16th Street pedestrian mall, he had encountered throngs of aggressive “riff-raff and undesirables.” Denver’s mayor has gone even further, decrying the area’s “scourge of hoodlums.”

Enraged readers dumped on Dilkens. They ripped him for being out-of-touch with the times and failing to recognize a potential tourism bonanza for our downtown. They mocked him for being concerned for his safety in Denver and wailed that he was trying to deny them their precious medicinal marijuana.

Never mind that Dilkens never mentioned medical marijuana and didn’t say whether he’s for or against legalization. Facts don’t matter. All that matters is that he wasn’t out front leading the marijuana welcoming parade, pompoms in hand, and that merited condemnation.

The most interesting message Dilkens received after the column appeared came from someone who actually knows what he’s talking about.

“As a Colorado sheriff who’s had to deal with the impacts of commercialized marijuana, I will tell you that your concerns are warranted,” wrote Justin Smith, the outspoken sheriff of Larimer County, population 334,000, an hour’s drive north of Denver.

“Since we approved commercial marijuana production and sales, we’ve been overrun by transients and transient-related crime. In the last three years my jail population has soared by more than 25 per cent. Six years ago, transients accounted for one-in-eight inmates in my jail. Today, they account for one-in-three inmates and many have multiple pending cases. Our county prosecutor predicts a 90 per cent increase in felony crime prosecutions over the last three years.

“Decriminalized marijuana has proven to be anything but safe and well-regulated in my state,” the sheriff warned. “If I could give your country any words of wisdom, they would be, don’t sell the future of your country to the pot industry.”

Too late, sheriff. The industry, now in the clutches of powerful corporations and feverish investors, is slathering over the immense profits to be made now that our flower child PM has given them the all clear.

Late-night host Jimmy Kimmel joked a few nights ago that Canada is becoming “the stoner in America’s attic.”

Funny, yes.   But insightful as well.  Next summer, when the stoners and those who feed off them occupy our downtown, which will be enveloped in the acrid stench of burning weed, we’ll see who’s laughing.

Source:http://www.theprovince.com/opinion/columnists/henderson+laughing+when+recreational+legalized/13316471/story.html

Abstract

Marijuana (Cannabis sativa) is the most commonly used illicit drug by pregnant women, but information is limited about the effects of prenatal cannabis exposure on foetal development. The present study evaluated the influence of early maternal marijuana use on foetal growth.

Women electing voluntary saline-induced abortions were recruited at a mid-gestational stage of pregnancy (weeks 17-22), and detailed drug use and medical histories were obtained. Toxicological assays (maternal urine and foetal meconium) were used in conjunction with the maternal report to assign groups. Subjects with documented cocaine and opiate use were excluded.

Main developmental outcome variables were foetal weight, foot length, body length, and head circumference; ponderal index was also examined. Analyses were adjusted for maternal alcohol and cigarette use. Marijuana (n=44)- and non-marijuana (n=95)-exposed foetuses had similar rates of growth with increased age. However, there was a 0.08-cm (95% CI -0.15 to -0.01) and 14.53-g (95% CI -28.21 to 0.86) significant reduction of foot length and body weight, respectively, for marijuana-exposed foetuses.

Moreover, foetal foot length development was negatively correlated with the amount and frequency of marijuana use reported by the mothers. These findings provide evidence of a negative impact of prenatal marijuana exposure on the mid-gestational foetal growth even when adjusting for maternal use of other substances well known to impair foetal development. PMID: 15734273    DOI: 10.1016/j.ntt.2004.11.002

Source:  https://www.ncbi.nlm.nih.gov/pubmed/15734273

Beery points to 50 deaths in 2016, most linked to drugs

Dr. Jeff Beery doesn’t agree with those who think marijuana is a relatively harmless drug that carries medicinal qualities and should even be winked at for recreational purposes.

But Beery doesn’t just think marijuana is a gateway to more dangerous drugs.

“It’s a gateway to hell,” he says flatly.

Beery’s perspective is based on four years serving as Highland County coroner, with more than a decade before that as a deputy coroner. He provided statistics this week from 2016 on 50 fatalities he investigated last year that he deemed suspicious, or at least unusually odd or interesting.

Beery said there has been a steady increase in deaths related one way or another to drugs, raising fatalities connected to illicit drugs to alarming proportions. He said the word “epidemic” is not sufficient to describe the toll being taken on Highland County.  “It’s a craze, not an epidemic,” he said, adding that “epidemic” implies something beyond people’s control.

The 50 cases provided by Beery from 2016 range from deaths by car crashes, burns, gun shots, heart attacks, hyperthermia and suicides to asphyxia and embolisms. But most of them have a common denominator, he said – the presence of drug use, or a history of drug use.

At least eight cases out of the 50 cited by Beery include marijuana as a factor contributing to the fatalities, in his opinion. Six fatalities were connected to heroin, three to cocaine, eight to amphetamines, including methamphetamine, and several to drugs like Xanax, Valium, Clonazepam and, especially, Fentanyl, which has been increasingly found mixed with heroin.

Beery blames a lax attitude by society and particularly by elected officials, including at the state and federal level, for contributing to the rise in drug-related deaths. He said former U.S. Attorney General Eric Holder’s decision not to pursue marijuana charges at the federal level “opened the door to the wild progression of illicit drugs.”

Holder consistently expressed views on marijuana that were opposed to treating the drug as seriously as other narcotics. In a 2016 PBS interview, after he was no longer attorney general, Holder said, “It’s hard for me to imagine ever decriminalizing crack cocaine, drugs like that. But the whole question of should marijuana be decriminalized, I mean, that’s a conversation I think that we should engage in.”

Beery is aware of the fierce pushback among many people and organizations to his stand on marijuana. Groups like the National Organization for the Reform of Marijuana Laws (NORML) – whose mission is “to move public opinion sufficiently to legalize the responsible use of marijuana by adults, and to serve as an advocate for consumers to assure they have access to high quality marijuana that is safe, convenient and affordable,” according to its website – have won referendums and convinced legislatures to at least legalize marijuana for medicinal purposes.

Many patients suffering from certain serious illnesses or chronic pain insist that marijuana is the only effective relief they have found. Beery disagrees, saying marijuana has no medicinal qualities. He blames Ohio’s Republican-led “so-called conservative” legislature for caving in on the medical marijuana issue, even though the consequences of marijuana use and cultivation are obvious, especially in southern Ohio, he said.

“Just look at Pike County,” said Beery, referring to the murders last year of the Rhoden family, where a large marijuana growing operation worth hundreds of thousands of dollars on the street was found.  Beery said a lax attitude about border security and drugs also contributes to the problem.

Beery said that while investigating deaths in recent years, “I would see other things,” ranging from marijuana to heroin to cocaine that, to him, were obvious contributors not just to overdoses but to car wrecks, gun shots, homicides, burns and suicides.

Source: http://timesgazette.com/news/13879/highland-county-coroner-marijuana-is-gateway-to-hell

March 2017

A new study released today by JAMA Psychiatry found that rates of marijuana use and marijuana addiction increased significantly more in states that passed medical marijuana laws as compared to states that have not. Examining data from 1992 to 2013, researchers concluded that medical marijuana laws likely contributed to an increased prevalence of marijuana and marijuana-addicted users.

“Politicians and pro-pot special interests are quick to tout the benefits of medical marijuana legalization, but it’s time to see through the haze —     medical marijuana has gone completely unregulated,” said SAM President Kevin Sabet. “More people in these states are suffering from an addiction to marijuana that harms their lives and relationships, while simultaneously more have begun using marijuana. No one wants to see patients denied something that might help them, but this study underscores the fact that “medical” and “recreational” legalization are blurred lines. Smoked marijuana is not medicine, and has not been proven safe and effective as other FDA-approved medications have.”

The study’s researchers wrote that increases in marijuana use in states with medical marijuana laws “may have resulted from increasing availability, potency, perceived safety, [or] generally permissive attitudes.” They conclude that “changing state laws (medical or recreational) may also have adverse public health consequences.”  Evidence demonstrates that marijuana —     which has skyrocketed in average potency over the past decades —     is addictive and harmful to the human brain, especially when used by adolescents. Moreover, in states that have already legalized the drug, there has been an increase in drugged driving crashes and youth marijuana use. States that have legalized marijuana have also failed to shore up state budget shortfalls with marijuana taxes, continue to see a thriving black market, and are experiencing a continued rise in alcohol sales.

Source:  http://www.learnaboutsam.org.  Alexandria, VA, April 26, 2017

About SAM

Smart Approaches to Marijuana (SAM) is a nonpartisan, non-profit alliance of physicians, policy makers, prevention workers, treatment and recovery professionals,  scientists, and other concerned citizens opposed to marijuana legalization who want health and scientific evidence to guide marijuana policies. SAM has affiliates in more than 30 states. For more information about marijuana use and its effects, visit http://www.learnaboutsam.org.

Alzheimer’s and Marijuana ?

An estimated 200,000 people in the United States under age 65 are living with younger-onset Alzheimer’s disease. And hundreds of thousands more are coping with mild cognitive impairment, a precursor to Alzheimer’s and other dementias.

“It’s beyond epidemic proportions. There truly is a tidal wave of Alzheimer’s disease,” said Dr. Vincent Fortanasce, a clinical professor of neurology in Southern California who is also a renowned Catholic bioethicist, author and radio host.

Fortanasce, a member of Legatus’ San Juan Capistrano Chapter, for several years has studied Alzheimer’s disease, its underlying causes and treatments. Through his research, he believes there may be a link between chronic use of marijuana — especially when started at a young age — and Alzheimer’s.

Finding the link

Fortanasce notes that medical research shows chronic users of marijuana, in particular the kind with high quantities of THC, have reduced volume in the hippocampus, the region of the brain responsible for memory and learning. In Alzheimer’s disease, Fortanasce said, medical researchers have also noticed reduced hippocampus volume with increased B-amyloid plaques and neurofibrillary tangles.

Taking into account other factors, such as skyrocketing obesity rates and lack of exercise, Fortanasce argues that chronically smoking marijuana and consuming products laced with cannabis are harming the long-term mental health of millions of young Americans. He is trying to convince the American Academy of Neurology to conduct a major survey to see if people diagnosed with dementia have also smoked marijuana.

Source: :  http://legatus.org/kicking-pot-curb/  April 9th 2017

Misleadingly marketed as a legal and safe alternative to marijuana, synthetic cannabinoids have a variety of adverse health effects. A new review summarizes the clinical cases that have so far been linked to the use of the synthetic substances.

A new review warns that so-called synthetic marijuana is actually very different from cannabis and is potentially unsafe. Synthetic cannabinoids (SCBs) are a type of psychotropic chemical increasingly marketed as a safe and legal alternative to marijuana.

They are either sprayed onto dried plants so that they can be smoked, or they are sold as vaporizable and inhalable liquids.

A new review from the University of Arkansas for Medical Sciences (UAMS) warns against the dangerous side effects of the compounds popularly (and misleadingly) referred to as “synthetic marijuana.”

Referring to the SCBs currently sold as “K2” and “Spice,” Paul L. Prather, a cellular and molecular pharmacologist at UAMS and corresponding author of the review, explains the motivation behind it:

“In the United States, in 2007 or so, we started seeing all kinds of people coming into emergency rooms saying they smoked marijuana, but they had these really bizarre symptoms that did not correspond with the effects you see with marijuana.”

The report, therefore, set out to give an overview of the existing literature on SCBs, and to show that not only are they different from marijuana, but also that they do not constitute an appropriate substitute for cannabis. On the contrary, SCBs are drugs in their own right, with many toxic – and sometimes even fatal – effects. The review has been published in the journal Trends in Pharmacological Sciences.

SCBs are different from marijuana

SBCs are known to create psychotropic effects in much the same way as marijuana – by activating the CB1 cannabinoid receptor, which is found primarily in the brain and the central nervous system. Additionally, in the case of marijuana, its main active ingredient is tetrahydrocannabinol (THC), which also activates the CB2 receptor (found mainly in the immune system).

However, as the authors warn, SCBs activate the CB1 receptor to a much higher intensity than THC does.

William E. Fantegrossi, a behavioral pharmacologist at UAMS and co-author of the review, notes that SCBs “are highly efficacious drugs; they tend to activate the CB1 receptor to a greater degree than we can ever get to with THC from marijuana.”

Additionally, the authors caution that because SCBs are chemically different from THC, they may activate other receptors aside from CB1. These cellular receptors, so far unknown, may be causing the negative health effects noticed in SCB users.

SCBs linked to serious adverse health effects and even death

As reported in the review, some of these effects suggest that SCBs cause much more toxicity than marijuana. Toxicity has been reported across a wide range of systems, including the gastrointestinal, neurological, cardiovascular, and renal systems.

The clinical cases documented in the review include acute and long-term symptoms, such as:

•  Seizures
•  Convulsions
•  Catatonia
• Kidney injury § Hypertension
•  Chest pain
•  Myocardial toxicity
•  Ischemic stroke

Common adverse effects include prolonged and severe vomiting, anxiety, panic attacks, and irritability. Additionally, SCBs reportedly caused extreme psychosis in susceptible individuals, whereas marijuana only causes mild psychosis in those predisposed.

Furthermore, 20 deaths have been linked to SCBs between 2011 and 2014, whereas no deaths were reported among marijuana users during that time.

Finally, SCBs are likely to result in tolerance, dependence, and withdrawal.

SCBs are not safe, authors warn

Because SCBs cannot be detected by standard drug screening, they are particularly popular among users who want to avoid detection, such as teenagers and army personnel. These users often purchase the drugs online, but as Prather and colleagues warn, customers often do not know what they are purchasing because they get something different each time.

“Not only does the amount of the active pharmacological agent change with different batches of drugs, made by different labs, but the active compound itself can change,” says Fantegrossi. Prather adds that “there are usually a minimum of three, if not five, different synthetic cannabinoids in a single product.”

However, the potential therapeutic benefits of cannabinoids should not be dismissed entirely, write the authors. As with opioids in general, misuse or abuse can have severely adverse or even fatal consequences, but proper use may offer significant benefits.

Overall, though, SCBs should be viewed with suspicion and treated with caution.

“The public sees anything with the marijuana label as potentially safe, but these synthetic compounds are not marijuana […] You never know what they are, and they are not safe.”

Source:  http://www.medicalnewstoday.com/articles/315634.php?mc_cid=4a0d722034&mc_eid=46cee4286 0  Feb 2017

In 2014, recreational cannabis use was legalized in Colorado, and seven other states have since followed suit. With an ever-expanding part of the population using marijuana to cure a number of ailments, researchers at Colorado State University have investigated its effects on mood. The researchers – led by Lucy Troup, assistant professor in the university’s Department of Psychology – publish their findings in the journal PeerJ.

They note that the “relationship between cannabis use and symptomatology of mood and anxiety disorders is complex,” adding that although “a great deal of research exists and continues to grow, the evidence remains contradictory.” Troup and colleagues point to a large international survey published in 2013, in which 5.2 percent of respondents reported that they used cannabis to alleviate depressive symptoms. Meanwhile, a survey of medical marijuana users in California revealed that 26.1 percent of participants reported therapeutic benefits for depression, and 37.8 percent reported benefits for anxiety.

“This trend of self-medication for conditions other than the one prescribed is too large to ignore when investigating the associations between cannabis use and mood disorders,” write the Colorado State University researchers.

They add that this increases “the need to include recreational users for research, especially when the casual user group are most likely recreational users and seem to sustain the greatest deficits in mood.”

Is cannabis used correctly for self-medication? For their study, Troup and colleagues wanted to focus on Colorado, which was the first state to legalize recreational marijuana.

As such, they conducted an in-depth, questionnaire-based study of 178 legal cannabis users who were aged 18-22.

They divided their participants into three groups based on self-reported use: a control group who never used cannabis, a casual user group, and a group of chronic users.

Interestingly, the participants who were categorized with subclinical depression, and who also used cannabis to treat their depressive symptoms, scored lower on anxiety symptoms than on their depressive symptoms. In short, they were more depressed than anxious.

The researchers also say that the self-reported anxiety sufferers were found to be more anxious than depressed.

Study co-author Jacob Braunwalder, a researcher in Troup’s laboratory, says that “if they were using cannabis for self-medication, it wasn’t doing what they thought it was doing.”

The questionnaire used in the study was developed by co-author Jeremy Andrzejewski. Called the Recreational Cannabis Use Evaluation, the questionnaire delved into users’ habits, including whether they smoked cannabis or used stronger products such as hash oils or edibles.

The researchers say that inconsistencies in previous studies are better understood when considering how cannabis use is reported. “Phytocannabinoid type and strength is not consistent between studies,” they say, “and there have been significant changes in the strength of these products post-legalization.”

‘Infrequent users have stronger relationship with negative mood’

Troup and colleagues say that it is important to point out that they looked at the residual effects of cannabis use, not administration of specific doses.

However, they do note that their results “suggested that cannabis use had an effect on measurements of mood disorder symptomatology. In particular, those who used cannabis less frequently, the casual user group, had the strongest correlations with overall score and negative effect on the CES-D [Center for Epidemiological Studies depression scale].”

Interestingly, the researchers did not observe a relationship with pre-anxiety symptoms in the cannabis user groups, compared with controls.

The researchers emphasize that their study does not conclude that cannabis causes depression or anxiety. It also does not show that cannabis cures these conditions. However, they add that their analysis displays a need for further study regarding how cannabis affects the brain.

Andrzejewski adds that “there is a common perception that cannabis relieves anxiety,” but this has not been fully backed by research.

“It is important not to demonize cannabis, but also not to glorify it,” adds Troup. “What we want to do is study it, and understand what it does. That’s what drives us.”

Concluding their study, the researchers write:

“Our data indicate that infrequent users have a stronger relationship with negative mood. Our data suggested that those that use cannabis casually scored higher on the CES-D scale for depression, and consequently could be at greater risk for developing pre-depression symptomology compared to both chronic users and controls.”

It is important to note that the study has limitations, including:

•  Sample size
•  Control for phytocannabinoids in terms of strength and type
•  Confounding variables such as multiple drug use and alcohol consumption
•  The self-report design
• A limited interpretation of depression due to lack of clinical evaluation.

Still, the researchers say that their study “provides a starting point from which to design controlled experiments to further investigate the relationship between mood and cannabis use in a unique population.”

Source:  http://www.medicalnewstoday.com/articles/314823.php   Dec. 2014

A disturbing majority of businesses in the U.S. are being negatively impacted by prescription painkiller abuse and addiction among employees.

A survey recently released by the National Safety Council reveals more than 70 percent of workplaces are feeling the negative effects of opioid abuse. Nearly 40 percent of employers said employees are missing work do to painkiller abuse, with roughly the same percent reporting employees abusing the drugs on the job. Despite the prevalence of addiction in offices across the country, employers are doing little to mitigate risk. Record pill abuse in workplaces is coming at a time when Americans are taking more opioids than ever before, reports The Washington Post.

A recent survey from Truven Health Analytics and NPR reveals more than half of the U.S. population reports receiving a prescription for opioids at least once from their doctor, a 7 percent increase since 2011. Data released by the Centers for Disease Control and Prevention (CDC) Friday reveals that almost half of non-cancer patients prescribed opioids for a month or more are still dependent on the pills a year later.

Experts say that current opioid and heroin abuse is driven in large part by the over-prescribing of pain pills from doctors. Despite the problems opioid abuse is causing in the workplace, many employee drug tests do not look for the substance. Fifty-seven percent of businesses test for drugs, but 41 percent of those businesses do not test for opioids.

“Employers must understand that the most dangerously misused drug today may be sitting in employees’ medicine cabinets,” Deborah Hersman, president and CEO of the National Safety Council, said in a statement. “Even when they are taken as prescribed, prescription drugs and opioids can impair workers and create hazards on the job.”

Among people not currently taking opioids, nearly half view addiction as the biggest threat from using painkillers. Among current patients on opioids, fears over unwanted side effects still dwarf fears about long-term dependence and addiction. Medical professionals say doctors need to start by prescribing the least potent and least addictive pain treatment option, and then cautiously go from there.

Experts also say the patient must take greater responsibility when they visit their doctor and always ask “why” before accepting a prescription.

Addicts may begin with a dependence on opioid pills before transitioning to heroin after building up a tolerance that makes pills too expensive. States hit particularly hard by heroin abuse are beginning to crackdown on doctors liberally doling out painkillers.

“When four out of five new heroin users are getting their start by abusing prescription drugs, you have to attack the problem at ground zero – in irresponsibly run doctors’ offices,” New Jersey Attorney General Porrino said in a statement March 1. “Physicians who grant easy access to the drugs that are turning New Jersey residents into addicts can be every bit as dangerous as street-corner dealers. Purging the medical community of over-prescribers is as important to our cause as busting heroin rings and locking up drug kingpins.”

A record 33,000 Americans died from opioid related overdoses in 2015, according to the CDC. Opioid deaths contributed to the first drop in U.S. life expectancy since 1993 and eclipsed deaths from motor vehicle accidents in 2015. Combined, heroin, fentanyl and other opiate-based painkillers account for roughly 63 percent of drug fatalities, which claimed 52,404 lives in the U.S. in 2015.

Source:  http://dailycaller.com/2017/03/19/opioid-addiction-is-infiltrating-a-majority-of-us-workplaces/

“We should all be dead,” said Jonathan Goyer one bright morning in January as he looked across a room filled with dozens of his co-workers and clients. The Anchor Recovery Community Center, which Goyer helps run, occupies the shell of an office building in Pawtucket, Rhode Island. Founded seven years ago, Anchor specializes in “peer-to-peer” counselling for drug addicts. With state help and private grants, Anchor throws everything but the kitchen sink at addiction. It hosts Narcotics Anonymous meetings, cognitive behavioral therapy sessions, art workshops, and personal counselling. It runs a telephone hotline and a hospital outreach program. It has an employment center for connecting newly drug-free people to sympathetic hirers, and banks of computers for those who lack them. And all the people who work here have been in the very pit of addiction—shoplifting to pay for a morning dose, selling their bodies, or dragging out their adult lives in prison. Some have been taken to emergency rooms and “hit” with powerful anti-overdose drugs to bring them back from respiratory failure.

That is how it was with Goyer. His father died of an overdose at forty-one, in 2004. His twenty-nine-year-old brother OD’d and died in 2009. When he was shooting heroin he slept on the floor of a public garage. He would pick up used hypodermic needles if they were new enough that the volume gauges inked on the outside hadn’t been rubbed off with use. He OD’d several times before getting clean in 2013. Now he visits people after overdoses and tells them, “I was right where you’re at.”

There have always been drug addicts in need of help, but the scale of the present wave of heroin and opioid abuse is unprecedented. Fifty-two thousand Americans died of overdoses in 2015—about four times as many as died from gun homicides and half again as many as died in car accidents. Pawtucket is a small place, and yet 5,400 addicts are members at Anchor. Six hundred visit every day. Rhode Island is a small place, too. It has just over a million people. One Brown University epidemiologist estimates that 20,000 of them are opioid addicts—2 percent of the population.

Salisbury, Massachusetts (pop. 8,000), was founded in 1638, and the opium crisis is the worst thing that has ever happened to it. The town lost one young person in the decade-long Vietnam War. It has lost fifteen to heroin in the last two years. Last summer, Huntington, West Virginia (pop. 49,000), saw twenty-eight overdoses in four hours. Episodes like these played a role in the decline in U.S. life expectancy in 2015. The death toll far eclipses those of all previous drug crises.

And yet, after five decades of alarm over threats that were small by comparison, politicians and the media have offered only a muted response. A willingness at least to talk about opioid deaths (among other taboo subjects) surely helped Donald Trump win last November’s election. In his inaugural address, President Trump referred to the drug epidemic (among other problems) as “carnage.” Those who call the word an irresponsible exaggeration are wrong.

Jazz musicians knew what heroin was in the 1950s. Other Americans needed to have it explained to them. Even in the 1960s and 1970s, with bourgeois norms and drug enforcement weakening, heroin lost none of its terrifying underworld associations. People weren’t shooting it at Woodstock. Today, with much of the discourse on drug addiction controlled by medical bureaucrats, it is common to speak of addiction as an “equal-opportunity disease” that can “strike anyone.” While this may be true on the pharmacological level, it was until quite recently a sociological falsehood. In fact, most of the country had powerful moral, social, cultural, and legal immunities against heroin

and opiate addiction. For 99 percent of the population, it was an adventure that had to be sought out. That has now changed.

America had built up these immunities through hard experience. At the turn of the nineteenth century, scientists isolated morphine, the active ingredient in opium, and in the 1850s the hypodermic needle was invented. They seemed a godsend in Civil War field hospitals, but many soldiers came home addicted. Zealous doctors prescribed opiates to upper-middle-class women for everything from menstrual cramps to “hysteria.” The “acetylization” of morphine led to the development of heroin. Bayer began marketing it as a cough suppressant in 1898, which made matters worse. The tally of wrecked middle-class families and lives was already high by the time Congress passed the Harrison Narcotics Tax Act in 1914, threatening jail for doctors who prescribed opiates to addicts. Americans had had it with heroin. It took almost a century before drug companies could talk them back into using drugs like it.

If you take too much heroin, your breathing slows until you die. Unfortunately, the drug sets an addictive trap that is sinister and subtle. It provides a euphoria—a feeling of contentment, simplification, and release—which users swear has no equal. Users quickly develop a tolerance, requiring higher and higher amounts to get the same effect. The dosage required to attain the feeling the user originally experienced rises until it is higher than the dosage that will kill him. An addict can get more or less “straight,” but approaching the euphoria he longs for requires walking up to the gates of death. If a heroin addict sees on the news that a user or two has died from an overly strong batch of heroin in some housing project somewhere, his first thought is, “Where is that? That’s the stuff I want.”

Tolerance ebbs as fast as it rises. The most dangerous day for a junkie is not the day he gets arrested, although the withdrawal symptoms—should he not receive medical treatment—are painful and embarrassing, and no picnic for his cellmate, either. But withdrawals are not generally life-threatening, as they are for a hardened alcoholic. The dangerous day comes when the addict is released, for the dosage he had taken comfortably until his arrest two weeks ago may now be enough to kill him.

The best way for a society to avoid the dangers of addictive and dangerous drugs is to severely restrict access to them. That is why, in the twentieth century, powerful opiates and opioids (an opioid is a synthetic drug that mimics opium) were largely taboo—confined to patients with serious cancers, and often to end-of-life care. But two decades ago, a combination of libertarian attitudes about drugs and a massive corporate marketing effort combined to instruct millions of vulnerable people about the blessed relief opioids could bring, if only mulish oldsters in the medical profession could get over their hang-ups and be convinced to prescribe them. One of the rhetorical tactics is now familiar from debates about Islam and terrorism: Industry advocates accused doctors reluctant to prescribe addictive medicines of suffering from “opiophobia.”

In 1996, Purdue Pharmaceuticals brought to market OxyContin, an “extended release” version of the opioid oxycodone. (The “-contin” suffix comes from “continuous.”) The time-release formula meant companies could pack lots of oxycodone into one pill, with less risk of abuse, or so scientists claimed. Purdue did not reckon with the ingenuity of addicts, who by smashing or chewing or dissolving the pills could release the whole narcotic load at once. That is the charitable account of what happened. In 2007, three of Purdue’s executives pled guilty to felony misbranding at the time of the release of OxyContin, and the company paid $600 million in fines. In 2010, Purdue brought out a reformulated OxyContin that was harder to tamper with. Most of Purdue’s revenues still come from OxyContin. In 2015, the Sackler family, the company’s sole owners,

suddenly appeared at number sixteen on Forbes magazine’s list of America’s richest families.

Today’s opioid epidemic is, in part, an unintended consequence of the Reagan era. America in the 1980s and 1990s was guided by a coalition of profit-seeking corporations and concerned traditional communities, both of which had felt oppressed by a high-handed government. But whereas Reaganism gave real power to corporations, it gave only rhetorical power to communities. Eventually, when the interests of corporations and communities clashed, the former were in a position to wipe the latter out. The politics of the 1980s wound up enlisting the American middle class in the project of its own dispossession.

OxyContin was only the most commercially successful of many new opioids. At the time, the whole pharmaceutical industry was engaged in a lobbying and public relations effort to restore opioids to the average middle-class family’s pharmacopeia, where they had not been found since before World War I. The American Pain Foundation, which presented itself as an advocate for patients suffering chronic conditions, was revealed by the Washington Post in 2011 to have received 90 percent of its funding from medical companies.

“Pain centers” were endowed. “Chronic pain” became a condition, not just a symptom. The American Pain Society led an advertising campaign calling pain the “fifth vital sign” (after pulse, respiration, blood pressure, and temperature). Certain doctors, notoriously the anaesthesiologist Russell Portenoy of the Beth Israel Medical Center, called for more aggressive pain treatment. “We had to destigmatize these drugs,” he later told the Wall Street Journal. A whole generation of doctors was schooled in the new understanding of pain. Patients threatened malpractice suits against doctors who did not prescribe pain medications liberally, and gave them bad marks on the “patient satisfaction” surveys that, in some insurance programs, determine doctor compensation. Today, more than a third of Americans are prescribed painkillers every year.

Very few of them go on to a full-blown addiction. The calamity of the 1990s opioid revolution is not so much that it turned real pain patients into junkies—although that did happen. The calamity is that a broad regulatory and cultural shift released a massive quantity of addictive drugs into the public at large. Once widely available, the supply “found” people susceptible to addiction. A suburban teenager with a lot of curiosity might discover that Grandpa, who just had his knee replaced, kept a bottle of hydrocodone on the bedside table. A construction boss might hand out Vicodin at the beginning of the workday, whether as a remedy for back pain or a perquisite of the job. Pills are doseable—and they don’t require you to use needles and run the risk of getting AIDS. So a person who would never have become a heroin addict in the old days of the opioid taboo could now become the equivalent of one, in a more antiseptic way.

But a shocking number of people wound up with a classic heroin problem anyway. Relaxed taboos and ready supply created a much wider appetite for opioids. Once that happened, heroin turned out to be very competitively priced. Not only that, it is harder to crack down on heavily armed drug gangs that sell it than on the unscrupulous doctors who turned their practices into “pill mills.” Addicts in Maine complain about the rising price of black-market pharmaceutical pills: They have risen far above the dollar-a-milligram that used to constitute a kind of “par” in the drug market. An Oxy 30 will now run you forty-five bucks. But you can shoot heroin when the pills run out, and it will save you money. A lot of money. Heroin started pouring into the eastern United States a decade ago, even before the price of pills began to climb. Since then, its price

has fallen further, its purity has risen—and, lately, the number of heroin deaths is rising sharply everywhere. That is because, when we say heroin, we increasingly mean fentanyl.

Fentanyl is an opioid invented in 1959. Its primary use is in transdermal patches given to people for end-of-life care. If you steal a bunch of these, you can make good money with them on the street. Addicts like to suck on them—an extremely dangerous way to get a high. Fentanyl in its usual form is about fifty times as strong as street heroin. But there are many different kinds of fentanyl, so the wallop it packs is not just strong but unpredictable. There is butyrfentanyl, which is about a quarter the strength of ordinary fentanyl. There is acetylfentanyl, which is also somewhat weaker. There is carfentanil, which is 10,000 times as strong as morphine. It is usually used as an animal tranquilizer, although Russian soldiers used an aerosol version to knock out Chechen hostage-takers before their raid on a Moscow theater in 2002. A Chinese laboratory makes its own fentanyl-based animal tranquilizer, W-18, which finds its way into Maine through Canada.

China manufactures a good deal of the fentanyl that comes to the U.S., one of those unanticipated consequences of globalization. The dealers responsible for cutting it by a factor of fifty are unlikely to be trained pharmacists. The cutting lab may consist of one teenager flown up from the Dominican Republic alone in a room with a Cuisinart and a box of starch or paracetamol. It takes considerable skill to distribute the chemicals evenly throughout a package of drugs. Since a shot of heroin involves only the tiniest little pinch of the substance, you might tap into a part of the baggie that is all cutting agent, no drug—in which case you won’t get high. On the other hand, you could get a fentanyl-intensive pinch—in which case you will be found dead soon thereafter with the needle still sticking out of your arm. This is why fentanyl-linked deaths are, in some states, multiplying year on year. The federal CDC has lagged in reporting in recent years, but we can get a hint of the nationwide toll by looking at fentanyl deaths state by state. In Maryland, the first six months of 2015 saw 121 fentanyl deaths. In the first six months of 2016, the figure rose to 446.

Sometimes arrested or hospitalized users are surprised to find that what they thought was heroin was actually fentanyl. But there are addicts who swear they can tell what’s in the barrel of their needles. One in Rhode Island, whom we’ll call Gilberto, says heroin has a pleasant caramel brown tint, like the last sip of Coca-Cola in a glass. Fentanyl is clear. And many addicts claim they can recognize the high. “Fentanyl just hits you. Hard,” Gilberto says. “But it’s got no legs on it. It lasts about two hours. Heroin will hold you.” This makes fentanyl a distinctly inconvenient drug, but many addicts prefer it. All dealers, at least around Rhode Island, describe their heroin as “the fire,” in the same way all chefs describe their ribs as so tender they just fall off the bone.

“I knew we were screwed, as a state and as a country,” Jonathan Goyer says, “when I had a conversation with a kid who was going through withdrawals.” Although he had enough money to get safer drugs, the kid was going to wait through the sweats and the diarrhea and the nausea until his dealer came in at 5 p.m. That would allow him to risk his life on fentanyl.

Those in heroin’s grip often say: “There are only two kinds of people—the ones I get money from and the ones I give money to.” A man who is dead to his wife and his children may be desperate to make a connection with his dealer. They don’t buy much besides heroin—perhaps a plastic cup of someone else’s drug-free urine on a day when they need to take a drug test for a hospital or employer. This will set them back twenty or thirty dollars. In addiction, as in more mainstream endeavors, the lords of hedonism

are the slaves of money. Gilberto in Rhode Island claims to have put a million dollars into each of his needle-pocked arms, at the rate of three fifty-bag “bricks” of heroin a day.

Dealers are businessmen and behave like businessmen, albeit heavily armed ones. They may “throw something” to a particularly reliable customer—that is, give him enough heroin from time to time to allow him to deal a bit on his own account and stay solvent. An addict who discovers that the 10mg pills he is paying $18 each for in Maine are available for $10 in Boston, a three-hour drive away, may be tempted to sell them to support his own habit. The line between users and pushers blurs, rendering impractical the policy that most people prefer—be merciful to drug users, but come down hard on dealers.

Addicts wake up “sick,” which is the word they use for the tremulous, damp, and terrifying experience of withdrawal. They need to “make money,” which is their expression for doing something illegal. Some neighborhood bodegas—the addicts know which ones—will pay 50 cents on the dollar for anything stolen from CVS. That is why razor blades, printer cartridges, and other expensive portable items are now kept under lock and key where you shop. Addicts shoplift from Home Depot and drag things from the loading docks. They pull off scams. They will scavenge for thrown-out receipts in trash cans outside an appliance store, enter the store, find the receipted item, and try to return it for cash. On the edge of the White Mountains in Maine, word spread that the policy at Hannaford, the dominant supermarket chain, was not to dispute returns of under $25. For a while, there was a run on the big cans of extra virgin olive oil that sold for $24.99, which were brought to the cash registers every day by a succession of men and women who did not, at first sight, look like connoisseurs of Mediterranean cuisine. Women prostitute themselves on Internet sites. Others go into hospital emergency rooms, claiming a desperately painful toothache that can be fixed only with some opioid. (Because if pain is a “fifth vital sign,” it is the only one that requires a patient’s own testimony to measure.) This is generally repeated until the pain-sufferer grows familiar enough to the triage nurses to get “red-flagged.”

The population of addicts is like the population of deer. It is highest in rustic places with access to urban supplies. Missouri’s heroin problem is worst in the rural counties near St. Louis. New Hampshire’s is worst in the small cities and towns an hour or so away from the drug markets of Massachusetts: Lawrence, Lowell, and Boston. But the opioid epidemic of the past decade is unusually diverse. Anchor’s emergency room clients are 82 percent white, 9 percent Hispanic, and 6 percent black. The state of Rhode Island is 85 percent white, 9 percent Hispanic, and 5 percent black. “I try to target outreach,” Goyer says, “but the demographics are too random for that.”

Drug addiction used to be a ghetto thing. Now Oxycodone has joined shuttered factories and Donald Trump as a symbol of white working-class desperation and fecklessness. The reaction has been unsympathetic. Writes Nadja Popovich in The Guardian: “Some point to this change in racial and economic demographics as one reason many politicians have re-evaluated the tough ‘war on drugs’ rhetoric of the past 30 years.”

The implicit accusation is that only now that whites are involved have racist authorities been roused to act. This is false in two ways. First, authorities have not been roused to act. Second, when they do, they will have epidemiological, and not just tribal, grounds for doing so. A plague afflicting an entire country, across ethnic groups, is by definition more devastating than a plague afflicting only part of it. A heroin scourge in America’s housing projects coincided with a wave of heroin-addicted soldiers brought back from Vietnam, with a cost peaking between 1973 and 1975 at 1.5 overdose deaths per 100,000. The Nixon White House panicked. Curtis Mayfield wrote his soul ballad

“Freddie’s Dead.” The crack epidemic of the mid- to late 1980s was worse, with a death rate reaching almost two per 100,000. George H. W. Bush declared war on drugs. The present opioid epidemic is killing 10.3 people per 100,000, and that is without the fentanyl-impacted statistics from 2016. In some states it is far worse: over thirty per 100,000 in New Hampshire and over forty in West Virginia.

In 2015, the Princeton economists Angus Deaton and Anne Case released a paper showing that the life expectancy of middle-aged white people was falling. Prominent among the causes cited were “the increased availability of opioid prescriptions for pain” and the falling price and rising potency of heroin. Census figures show that Case and Deaton had put the case mildly: Life expectancy was falling for all whites. Although they are the only racial group to have experienced a decline in longevity—other races enjoyed steep increases—there are still enough whites in the United States that this meant longevity fell for the country as a whole.

Bill Clinton alluded to the Case-Deaton study often during his wife’s presidential campaign. He would say that poor white people are “dying of a broken heart.” Heroin has become a symbol of both working-class depravity and ruling-class neglect—an explosive combination in today’s political climate.

Maine’s politicians have taken the opioid epidemic as seriously as any in the country. Various new laws have capped the maximum daily strength of prescribed opioids and limited prescriptions to seven days. The levels are so low that they have led some doctors to warn that patients will go onto the street to get their dosages topped off. “We were sad,” State Representative Phyllis Ginzler said in January, “to have to come between doctor and patient.” She felt the deadly stakes of Maine’s problem gave her little alternative.

Paul LePage, the state’s garrulous governor, has been even more direct. Speaking of drug dealers at a town hall in rural Bridgton in early 2016, he said: “These are guys with the name D-Money, Smoothie, Shifty, these types of guys. They come from Connecticut and New York, they come up here, they sell their heroin, they go back home. Incidentally, half the time they impregnate a young white girl before they leave.” This is what the politics of heroin threatens to become nationwide: To break the bureaucratic inertia, one side will go to any rhetorical length, even invoking race. To protect governing norms, the other side will invoke decency, even as the damage mounts. It is what the politics of everything is becoming nationwide. From town to town across the country, the correlation of drug overdoses and the Trump vote is high.

The drug problem is already political. It is being reframed by establishment voices as a problem of minority rights and stigmatization. A documentary called The Anonymous People casts the country’s 20 million addicts as a subculture or “community” who have been denied resources and self-respect. In it, Patrick Kennedy, who was Rhode Island’s congressman until 2011 and who was treated for OxyContin addiction in 2006, says: “If we can ever tap those 20 million people in long-term recovery, you’ve changed this overnight.” What’s needed is empowerment. Another interviewee says, “I refuse to be ashamed of what I am.”

This marks a big change in attitudes. Difficult though recovery from addiction has always been, it has always had this on its side: It is a rigorously truth-focused and euphemism-free endeavor, something increasingly rare in our era of weasel words. The face of addiction a generation ago was that of the working-class or upper-middle-class man, probably long and intimately known to his neighbors, who stood up at an AA meeting in a church basement and bluntly said, “Hi, I’m X, and I’m an alcoholic.”

The culture of addiction treatment that prevails today is losing touch with such candour. It is marked by an extraordinary level of political correctness. Several of the addiction professionals interviewed for this article sent lists of the proper terminology to use when writing about opioid addiction, and instructions on how to write about it in a caring way. These people are mostly generous, hard-working, and devoted. But their codes are neither scientific nor explanatory; they are political.

The director of a Midwestern state’s mental health programs emailed a chart called “‘Watch What You Call Me’: The Changing Language of Addiction and Mental Illness,” compiled by the Boston University doctor Richard Saltz. It is a document so Orwellian that one’s first reaction is to suspect it is a parody, or some kind of “fake news” dreamed up on a cynical website. We are not supposed to say “drug abuse”; use “substance use disorder” instead. To say that an addict’s urine sample is “clean” is to use “words that wound”; better to say he had a “negative drug test.” “Binge drinking” is out—“heavy alcohol use” is what you should say. Bizarrely, “attempted suicide” is deemed unacceptable; we need to call it an “unsuccessful suicide.” These terms are periphrastic and antiscientific. Imprecision is their goal. Some of them (like the concept of a “successful suicide”) are downright insane. This habit of euphemism and propaganda is not merely widespread. It is official. In January 2017, less than two weeks before the end of the last presidential administration, drug office head Michael Botticelli issued a memo called “Changing the Language of Addiction,” a similarly fussy list of officially approved euphemisms.

Residents of the upper-middle-class town of Marblehead, Massachusetts, were shocked in January when a beautiful twenty-four-year-old woman who had excelled at the local high school gave an interview to the New York Times in which she described her heroin addiction. They were perhaps more shocked by her description of the things she had done to get drugs. A week later, the police chief announced that the town had had twenty-six overdoses and four deaths in the past year. One of these, the son of a fireman, died over Labor Day. At the burial, a friend of the dead man overdosed and was rushed to the hospital. One fireman there said to a mourner that this was not uncommon: Sometimes, at the scene of an overdose, they will find a healthy- and alert-looking companion and bring him along to the hospital too, assuming he might be standing up only because the drug hasn’t hit him yet. In communities like this, concerns about “hurtful” words and stigma can seem beside the point.

Former Bush administration drug czar John Walters and two other scholars wrote last fall, “There is another type of ‘stigma’ afflicting drug users—that their crisis is somehow undeserving of the full resources necessary for their rescue.” Walters is talking largely about law enforcement. As he said more recently: “If someone were getting food poisoning from cans of tuna, the whole way we’re doing this would be more aggressive.”

Which is not the direction we’re going. In state after state, voters have chosen to liberalize drug laws regarding marijuana. If you want an example of mass media–induced groupthink, Google the phrase “We cannot arrest our way out of the drug problem” and count the number of politicians who parrot it. It is true that we cannot arrest our way out of a drug problem. But we cannot medicate and counsel our way out of it, either, and that is what we have been trying to do for almost a decade.

Calling addiction a disease usefully describes certain measurable aspects of the problem—particularly tolerance and withdrawal. It fails to capture what is special and dangerous about the way drugs bind with people’s minds. Almost every known disease is something people wish to be rid of. Addiction is different. Addicts resist known cures—even to the point of death. If you do not reckon with why addicts go to such

lengths to continue suffering, you are unlikely to figure out how to treat them. This turns out to be an intensely personal matter.

Medical treatment plays an obvious role in addressing the heroin epidemic, especially in the efforts to save those who have overdosed or helping addicts manage their addictions. But as an overall approach, it partakes of some of the same fallacies as its supposed opposite, “heartless” incarceration. Both leave out the addict and his drama. Medicalizing the heroin crisis may not stigmatize him, but it belittles him. Moral condemnation is an incomplete response to the addict. But it has its place, because it does the addict the compliment of assuming he has a conscience, a set of thought processes. Those thought processes are what led him into his artificial hell. They are his best shot at finding a way out.

In 1993, Francis F. Seeburger, a professor of philosophy at the University of Denver, wrote a profound book on the thought processes of addicts called Addiction and Responsibility. We tend to focus on the damage addiction does. A cliché among empathetic therapists, eager to describe addiction as a standard-issue disease, is that “no one ever decides to become an addict.” But that is not exactly true, Seeburger shows. “Something like an addiction to addiction plays a role in all addiction,” he writes. “Addiction itself . . . is tempting; it has many attractive features.” In an empty world, people have a need to need. Addiction supplies it. “Addiction involves the addict. It does not present itself as some externally imposed condition. Instead, it comes toward the addict as the addict’s very self.” Addiction plays on our strengths, not just our failings. It simplifies things. It relieves us of certain responsibilities. It gives life a meaning. It is a “perversely clever copy of that transcendent peace of God.”

The founders of Alcoholics Anonymous thought there was something satanic about addiction. The mightiest sentence in the book of Alcoholics Anonymous is this: “Remember that we deal with alcohol—cunning, baffling, powerful!” The addict is, in his own, life-damaged way, rational. He’s too rational. He is a dedicated person—an oblate of sorts, as Seeburger puts it. He has commitments in another, nether world.

That makes addiction a special problem. The addict is unlikely ever to take seriously the counsel of someone who has not heard the call of that netherworld. Why should he? The counsel of such a person will be, measured against what the addict knows about pleasure and pain, uninformed. That is why Twelve Step programs and peer-to-peer counselling, of the sort offered by Goyer and his colleagues, have been an indispensable element in dragging people out of addiction. They have authority. They are, to use the street expression, legit.

The deeper problem, however, is at once metaphysical and practical, and we’re going to have a very hard time confronting it. We in the sober world have, for about half a century, been renouncing our allegiance to anything that forbids or commands. Perhaps this is why, as this drug epidemic has spread, our efforts have been so unavailing and we have struggled even to describe it. Addicts, in their own short-circuited, reductive, and destructive way, are armed with a sense of purpose. We aren’t. It is not a coincidence that the claims of political correctness have found their way into the culture of addiction treatment just now. This sometimes appears to be the only grounds for compulsion that the non-addicted part of our culture has left.

Christopher Caldwell is a senior editor at the Weekly Standard.

Source:  https://www.firstthings.com/article/2017/04/american-carnage

ABSTRACT

Background

It has long been established that smoking tobacco during pregnancy causes increased risk of miscarriage, increased placental problems, reduction of birth weight, and a variety of birth defects [1].

In light of the recent legalization of marijuana in Colorado, Washington, Alaska and Washington, D.C., we felt it important to establish and publicize the causative relationship between cannabis usage and embryological outcomes. The main psychoactive cannabinoid in marijuana is delta-9-tetrahydrocannabinol (THC), which has a half-life of approximately 8 days in fat deposits and can be detected in blood for up to 30 days before becoming entirely eliminated from the blood [2]. These characteristics act as a direct risk factor to the developing embryo, as the maternal tissues act as reservoirs for THC and other cannabinoids.

Certain drugs cross the placenta to reach the embryo in the same manner as oxygen and other nutrients [3]. Drugs consumed during pregnancy can act directly on the embryo, or they can alter placental function, which is critical for normal growth and development.

Ingestion of drugs can interfere with these functions, resulting in compromised fetal development and growth [3]. THC readily crosses the placenta, which, in conjunction with slow fetal clearance, results in prolonged fetal exposure to THC, even after consumption is discontinued [2].

The use of marijuana in early pregnancy is associated with many of the same risks as tobacco, including miscarriage, congenital malformations, and learning disabilities [4]. Adverse effects of marijuana use during pregnancy have been exacerbated over the years, as THC levels in marijuana have increased nearly 25-fold since 1970 [5]. This paper looks to examine recent studies on cannabinoids and embryonic development in order to establish the mechanisms through which these cannabinoids act.

Source:  Friedrich, Joseph et al. “The Grass Isn’t Always Greener: The Effects of Cannabis on Embryological Development.” BMC Pharmacology & Toxicology 17 (2016): 45. PMC. Web. 21 Apr. 2017.

Substance use disorders affect businesses in surprising ways. Although there are obvious signs that an employee is struggling with a substance use disorder, there are other factors affecting their workplace performance that may be less obvious. Unfortunately, a survey from the National Safety Council found that employers underestimate how prescription drug abuse affects their businesses. Employers may not realize some of the facts illuminated in the study, such as:

• Employees with substance use disorders miss nearly 50 percent more days than their peers and up to six weeks of work annually.

• Healthcare costs for employees who misuse or abuse prescription drugs are three times the costs for an average employee.

• Getting an employee into treatment can save an employer up to $2,607 per worker annually.

The survey serves as a reminder that although some employees need support, they may not ask for it. “Businesses that do not address the prescription drug crisis are like ostriches sticking their head in the sand,” said Deborah A.P. Hersman, president and CEO of the National Safety Council. “The problem exists and doing nothing will harm your employees and your business.”

The National Safety Council alongside NORC at the University of Chicago and Shatterproof created a tool to show how the substance use disorder crisis can affect your workplace.

The Substance Use Cost Calculator is a quick and easy way to track the potential cost of substance use disorders. Employers input basic statistics about their workforce, such as industry, location, and number of employees. The tool then calculates the estimated prevalence of substance use disorders among employees and dependents. Once you have all that information on hand, you can figure out a way to prioritize helping those who are struggling with a substance use disorder. If you are worried about addressing such a difficult problem, remember that leaders ask how they can help others and utilize subject-matter resources.

Source:  https://images.magnetmail.net/images/clients/CADCA/attach/SubstanceUseCosts.pdf April 2017

Meet Ryan Hampton, 36, recovery advocate, political activist and recovering heroin addict igniting America’s social media feeds with stories of hope, recovery and activism. From his advocacy that led Sephora to take their eyeshadow branded “druggie” off the shelves to the activism that urged an Arizona politician to apologize for a statement stigmatizing addiction, he’s certainly become a social media powerhouse for all things addiction, recovery and policy. And with an estimated 7 out of 10 people on social media platforms, it’s no coincidence he’s found success taking the addiction advocacy fight digital.

Today, more than 22 million people are struggling with addiction, and it’s estimated that as a result, more than 45 million people are affected. But what many people don’t realize is that there are more than 23 million people living in active, long-term recovery today. Yet, because of shame and stigma, many stay silent. To fight this often-lethal silence, Hampton has urged the public to speak up and share personal stories of recovery through his recently launched Voices Project. The project, a collaborative effort to encourage people across the nation to share their story, exists to put real faces and names behind the addiction epidemic.

A Personal Struggle

Before becoming a national recovery advocate and social media powerhouse, Hampton himself faced a personal struggle with addiction. A former staffer in the Clinton White House, Hampton did not appear to be a likely candidate for heroin addiction, or so stigma would say. But after an injury and subsequent prescription for pain medication, Hampton found himself addicted to opiates, eventually leading to a heroin addiction that would span more than a decade.  After a long struggle, Hampton decided to get help.

It was the phone call that started his recovery journey that changed everything – his life and his view on the power of his phone. After getting sober, he began connecting with others in recovery, amazed at the magnitude of the digital community. But still, while uncovering these online stories of recovery, Hampton lost four friends to opioid addiction.

It was a breaking point for Hampton – one that led to the beginning of a movement that would someday reach and impact millions.

A Notable Partner

Hampton began reaching out to others in recovery and started realizing the power of digital tools to connect and build an online recovery community. And as he was slowly networking and meeting others in recovery, on October 4, 2015, Hampton’s advocacy met its catalyst: Facing Addiction.   The non-profit organization hosted a concert at the National Mall in Washington, D.C., an event that drew thousands to the capitol with celebrities, musicians and other well-known names willing to publicly celebrate the reality of recovery and call for reform in the addiction industry. Hampton, a Los Angeles resident, tuned into the event from across the country through Facebook Live and was again inspired by the content delivered through his mobile phone.

After meeting co-founders of Facing Addiction, Jim Hood and Greg Williams, Hampton plugged in, partnered and even joined the Facing Addiction team as a recovery advocate.

The importance of online advocacy aligns with Facing Addictions’ national priorities, shares CEO Jim Hood, “When enough people tell enough stories and the people who are impacted by addiction look like all of us and our kids and neighbors and relatives, the stigma has to start going away. And then we can get to work.”

After partnering with Facing Addiction, Hampton understood the priorities, the strategy and the mechanism. Said by Hampton, “I stand on the shoulders of giants”.

Leveraging the power of the algorithms at his fingertips every day, Hampton has grown his online presence to be one of the most influential in the recovery movement. Digital communication helped him get to treatment, connected him with Facing Addiction, and now is the platform in which he is sharing recovery stories from across the nation.

In just one week, more than 200 stories were submitted to the Voices Project and over 500 people sent in personal messages to express their support. Among those speaking up are notable voices such as pro skateboarder and former Jackass member Brandon Novak;   Grammy Award-winning musician Sirah;  rapper Royce da 5’9’’;   American politician and mental health advocate Patrick Kennedy;  former child actress and now-addiction counselor Mackenzie Phillips, and more.

According to Royce da 5’9’’, “Addiction is a problem that we all have to deal with. It affects us all in one way or another, and having someone giving it a voice, a name and a face not only helps get rid of the stigma regarding addiction, but he’s [Ryan] on the forefront letting people know there are solutions out there and recovery is real.”

Patrick Kennedy shares the importance of building a digital recovery movement to influence and support political reform in the addiction recovery space. “With the push of a button we’ll be able to have others show up to support communities across the nation,” says Kennedy, “because their fight is our fight.”

“The face of addiction is everyone,” Sirah shares. “The Voices Project gives people a voice and a connection to hope.”

The hope offered through open dialogue about addiction and recovery has now grown into a digital movement.

The pages that Hampton started with $20 and an old computer have gained more than 200,000 followers across platforms, reaching nearly 1 million people each week. “We’re the fastest-growing social movement in history – and the funny thing is, we’re a community that nobody ever wanted to be a part of,” Novak says.

“This is the one space where we cannot be ignored. The time has come for us to speak out, and we’re a community that speaks loudly. With addiction, we’re dealing with imminent death every day,” Hampton says. “Through social media, we’ve found an innovative way to communicate with each other and connect with people we haven’t met, and now, we’re having this conversation with the rest of the world.”

Perhaps the most intriguing impact of Hampton’s work is the paradoxical ability to bring the work of addiction recovery advocacy online – only to take it back offline through real-world change in communities across the country. According to Hampton, the work he’s doing shouldn’t stay digital – it should impact community laws, help new non-profits emerge and influence real people to seek treatment and find it.

“No matter if you have social media or not – your way of doing this is talking about addiction at the dinner table, to a parent or a friend or an employer. You should not be afraid to tell your story of recovery or loss and, most importantly, your story of struggle and how you need help. It may not just change your life, it may change someone else’s life,” Hampton says.

At the crux of digital advocacy in the addiction recovery realm are real lives being saved – people finding treatment, families finding hope and those in recovery being freed of stigma that can keep them in shame and silence.  This is the mission that has fuelled Hampton’s work since the beginning. And Hampton’s reason is hard to refute: “My story is powerful, but our stories are powerful beyond measure.”

Source: https://www.forbes.com/sites/toriutley/2017/04/18/the-recovering-heroin-addict-shaking-social-media/2/#273606f0689c

[Alexandria, VA, April 20, 2017]

Today, a group of national drug policy leaders, elected officials, and public health experts convened in Atlanta to coordinate the opposition to marijuana legalization in the U.S. and advance evidence-based marijuana laws. Held in conjunction with the National Rx Drug Abuse & Heroin Summit, the 4th Annual Smart Approaches to Marijuana (SAM) Summit featured keynote speakers including Former Clinton Drug Czar Barry McCaffrey and Arizona Governor Doug Ducey. The day-long program highlighted concerns about the special interest marijuana lobby and empowered concerned citizens with grassroots advocacy strategies to protect public health and safety in their local communities.

“So far, 2017 has been a bad year for the pro-marijuana special interests looking to profit off the next big addictive industry,” said SAM President and CEO Kevin A. Sabet. “More states are realizing that marijuana legalization produces more costs than benefits, so this momentum gives our summit new significance as we look to energize our base and move the needle toward evidence-based marijuana policy that puts people over profit.”

“Smart drug policy starts with science and research, not ideology or profit,” said SAM Honorary Advisor and Former Drug Czar General Barry McCaffrey. “SAM embodies this belief by advocating for common-sense laws that protect American families and communities from the social and health consequences of marijuana legalization. I continue to be concerned about the serious problems around drug abuse and its effects on our country, so I’m proud to stand up for SAM’s health first agenda today.”

“Last year, Arizonans went to the ballot and soundly rejected the misguided and harmful proposal to legalize marijuana,” said Arizona Governor Doug Ducey. “This vote shows that Arizonans don’t want the harmful consequences of legalizing this drug that have been seen in other states, like drugged driving incidents and more kids using marijuana. I am honored to stand with SAM today in support of the message that the health and safety of our communities must come first.”

Evidence shows that marijuana – which has skyrocketed in average potency over the past decades – is addictive and harmful to the human brain, especially when used by adolescents. Moreover, in states that have already legalized the drug, there has been an increase in drugged driving crashes and youth marijuana use. States that have legalized marijuana have also failed to shore up state budget shortfalls with marijuana taxes, continue to see a thriving black market, and are experiencing a continued rise in alcohol sales.

Source:  anisha@learnaboutsam.org   20th April 2017 About SAM Smart Approaches to Marijuana (SAM) is a nonpartisan, non-profit alliance of physicians, policy makers, prevention workers, treatment and recovery professionals, scientists, and other concerned citizens opposed to marijuana legalization who want health and scientific evidence to guide marijuana policies. SAM has affiliates in more than 30 states. For more information about marijuana use and its effects, visit http://www.learnaboutsam.org.

Business Insider published a harrowing account of the expansion of illegal marijuana grows on public lands in California and the ways these grows are damaging the environment. “The lethal poisons these growers use to protect their crops and campsites from pests are annihilating wildlife, polluting pristine public lands, and maybe even turning up in your next bong hit,” writes Julian Smith, the report’s author. He follows agents from several federal and state agencies assigned to eliminate illegal grows and clean up the areas they have damaged. The agents’ lives are endangered not only from armed growers who may be present at the sites but from pesticides and rodenticides that are so toxic they are banned in the US, Canada, and the EU. Containers of a neurotoxic insecticide called carbofuran, for example, are often strewn around such sites. It can cause such symptoms as nausea, blurred vision, convulsions, and death. Small animals who eat the poison can pass it on to larger animals. One study of barred owls in the Pacific Northwest found 80 percent tested positive for such pesticides. Agents are concerned that the poisons used in grow sites could contaminate the water supply of cities and towns downstream. The author says  nationwide  legalization  would bring an end to illegal grows.  However, states that have legalized find illegal grows increase so growers can undercut the cost of commercial marijuana.

Source:    We recommend you read full story at:  http://finance.yahoo.com/news/cartels-growing-marijuana-illegally-california-194700553.html   8th April 2017  

Kuei Y. Tseng was awarded $1.95 million by NIH for a five-year study of “Adolescent Maturation of the Prefrontal Cortex: Modulation by Cannabinoids.” Regular marijuana use by teens can stop the brain from maturing, according to a new study by scientists at Rosalind Franklin University of Medicine and Science, North Chicago, IL. Published March 4 in the journal Molecular Psychiatry, the study is the first to establish a causal link between repeated cannabinoid exposure during adolescence and an interruption of the normal maturation processes in the prefrontal cortex, a region in the brain’s frontal lobe, which regulates decision making and working memory and undergoes critical development during adolescence.

The findings apply to natural cannabinoids, including those in marijuana, and a new generation of more potent, synthetic cannabinoid products. THC, the compound in marijuana that produces feelings of euphoria, is of particular concern. The chemical can be manipulated, resulting in varying concentrations between marijuana strains – from 2 to 28 percent. A higher concentration of THC and increasing use by younger teens poses a greater risk for long term negative effects, the study finds. Kuei Y. Tseng, MD, PhD, associate professor of cellular and molecular pharmacology at the Chicago Medical School at RFUMS and principal investigator of the study, blames the CB1 cannabinoid receptor, which governs neuronal communication, for the drug’s long -lasting effect.

Tseng and his team of researchers used rat models in testing the effect of cannabinoid exposure during narrow age windows and analyzed the way information is later processed by the adult prefrontal cortex. They discovered that when CB1 receptors are repeatedly activated by cannabinoids during early adolescence, development of the prefrontal cortex stalls in that phase. The window of vulnerability represents two thirds of the span of adolescence. Test animals showed no such effect when exposure occurred in late adolescence or adulthood.

“We have conclusively demonstrated that an over activation of the CB1 receptor during the window equivalent to age 11 to 17 in humans, when the prefrontal cortex is still developing, will inhibit its maturation and have a long lasting effect on its functions,” Tseng said.

The study shows how chronic cannabis use by teens can cause persistent behavioral deficits in adulthood, including problems with attention span and impulse control. The findings also add to prior research that draws a correlation between adolescent marijuana abuse and the development of schizophrenia.

The discovery, which comes as a growing number of states are considering legalization of marijuana for both medicinal and recreational use, calls for the attention of physicians who prescribe medical marijuana and policy makers who, according to Tseng, “will have to establish regulations to take advantage of the beneficial effects of marijuana while minimizing its detrimental potential.”

Researchers are focusing on developing outcome measures to reveal the degree of frontal lobe maturation and history of drug exposure. The challenge now, Tseng said, is to find ways to return the frontal lobe back to a normal state either through pharmacological or cognitive interventions.

“Future research will tell us what other mechanisms can be triggered to avoid this type of impairment of the frontal lobe,” Tseng said. “Ultimately, we want to restore the prefrontal cortex.”

Supported by RFUMS, the research was funded primarily through NIH Grant R01-MH086507 to Tseng and also by a 2012 seed grant from the Brain Research Foundation.

Source:  https://www.rosalindfranklin.edu/news/profiles/study-shows-marijuana-use-interrupts-adolescent-brain-development/   4th March 2017

As Manchester police report a spike in spice related incidents, homeless people say the highly addictive drug is causing deaths.

When Alex first tried spice in 2014, he thought it was cannabis. The 23-year-old had been sleeping on the streets in Manchester after his mum had lost her council house. He was just looking to take his mind off his problems, but at lightning speed he became addicted, buying increasing quantities of the drug to feed his habit.

“I was waking up, buying it, smoking it, going to sleep, waking up, buying it, smoking it, going to sleep again,” he says.

Alex spent about a year addicted to spice, while he was living in tents in the city centre, before kicking the habit near the start of 2016. At the peak of his addiction, he was spending around £200 a week on the drug. “It was horrible,” he says. “Every morning I was waking up being physically sick. I was worn out and tired. I couldn’t eat. I couldn’t drink. My bones kept on aching.”

Spice, one of the names used for a group of substances known as synthetic cannabinoids, has been in the UK for more than a decade and was initially marketed as having effects similar to those of cannabis. The highly addictive psychoactive substance, an illegal class B drug since December, induces an inactive state and in recent years has become commonly used among the UK’s homeless population.

Although charities in other big UK cities report spice addiction as an issue among their homeless communities, Manchester’s problem is particularly visible. Between the city’s main train station and Piccadilly Gardens, a transport and shopping hub, it is common to see figures slumped in doorways apparently passed out after smoking the drug.

Earlier this week, Greater Manchester police released figures showing the burden the drug has placed on the city’s emergency services. The force attended 58 spice-related incidents in the city centre on Friday, Saturday and Sunday last week. There were also 23 incidents to which an ambulance was called, and 18 dispersal orders or directions to leave were issued.

Researchers estimate that 90-95% of homeless people in Manchester smoke the drug. And while there is very little research into the effects of spice on the body, there are scores of reports of people dying after smoking it. “We try and keep our outreach teams away from Piccadilly Gardens,” says Yvonne Hope, operations and resources director at the Manchester-based homelessness charity Barnabus. “It’s so unsafe there now.”

The release of police figures prompted a flurry of media interest in the problem. A series of photographs of homeless spice users in Manchester city centre, some covered in vomit and being helped by emergency services, were published by local and national newspapers. Local charities were critical of the coverage, describing it as dehumanising and sensationalist.

Spice’s main attractions are that it is cheap and strong. It is thought to be imported from China in liquid form, then sprayed on an inert plant such as marshmallow before being sold to be smoked. Only the tiniest amount of the chemical is needed to have an effect.

Alex, who has been helped into supported accommodation by the homelessness charity Depaul UK, is due to start a new job next month. He realised he needed to kick the habit when his former partner refused him access to his daughter. “I went cold turkey,” he says. “I got my cousin to lock me in the back of a van and just leave me there to sweat it out.” The withdrawal symptoms include sweating, vomiting, stomach cramps and headaches, he says.

Standing outside Barnabus’s Beacon drop-in centre – which provides showers, cooked breakfasts and cups of tea to Manchester’s rough sleepers – John and Steve, 52 and 35, agree spice has largely replaced heroin, crack and even alcohol as the drug of choice.

“You can go get a fiver, buy half a gram and it’ll knock you out for a few hours,” says John, who has been homeless since 2014. “It’s better than buying a bottle of White Ace [cider].”

“I have tried heroin and it’s worse than that,” says Steve, adding that friends of his have died after taking spice. The last time he smoked a joint of spice he woke up in a hospital bed, he says. “I don’t touch the stuff any more, it doesn’t agree with me.”

Hope says there has been a rise in crime associated with the drug since it was banned in May last year, with fights breaking out among people who visit the drop-in centre. “Up until about 2015, we had people who were mostly a community and people who respected each other, and spice just seems to have killed that,” she says. The use of spice has also reached crisis point in Britain’s prisons, helped by the fact that it does not show up in routine drugs tests. Dr Robert Ralphs, a senior lecturer in criminology at Manchester Metropolitan University, who has conducted research into the use of spice in the city, says the drug is used partly because of its ability to make hours pass in what feels like a few minutes. “People have told me they’ve used [spice] for the last two or three years, but that it seems like a couple of months,” he says.

Dr Oliver Sutcliffe, a senior lecturer in psychopharmaceutical chemistry at Manchester Metropolitan University, says the strength of the drug can vary wildly, which poses serious health risks. Tests on samples of the drug provided by police show the most recent batch to hit the streets in Manchester was 10 times stronger than is usual.

Sutcliffe says that although the packets look the same, they can contain a range of different cannabinoids at varying strengths. “You’re playing Russian roulette,” he adds. The chemicals found in spice in Manchester have been linked to 10 deaths in Japan.

Peter Morgan, a support worker with Depaul UK who is helping Alex in his transition back to work, says there is a need for rehabilitation programmes like those provided for heroin addicts. “Spice is clearly the strongest drug in the country right now,” he says.

Alex agrees with Morgan and swears he will not touch the drug again. He wants to rebuild his life with his girlfriend and hold down his new job. He says he has seen homeless friends in tears because they want to stop using spice. “But they can’t,” he continues. “Because no one’s going to help them do it.”

Some names in this article have been changed.

What is spice?

Spice, or synthetic cannabis, is not a single drug, but a range of laboratory-made chemicals designed to mimic the effects of the main psychoactive compound in cannabis, tetrahydrocannabinol (THC).

The active substance in spice is mass-produced in underground labs, often in China, and sent to Europe in powder form where suppliers typically spray the chemical on to mixes of herbal leaves that are then sold on. The precise chemical formulation of the drug is constantly shifting, meaning there are potentially hundreds or even thousands of variations available.

The THC in natural cannabis works by travelling through the blood to the brain, where it binds to cannabinoid receptors. The synthetic version does the same thing, but can be 100 times more potent, binding to the receptors more efficiently and in some cases for far longer. This has led to anecdotal reports of people remaining under the “high” of the drug for more than a day.

The precise effects are likely to depend on the chemical formula and, probably more importantly, on the concentration of the substance in the product. Since the drug is sprayed on, even within a single bag of the product there can be highly concentrated “hot spots”. This has made it difficult for scientists to come up with a typical profile of the effects of the drug and associated risks.

The positive short-term effects of spice appear to be approximately similar to that of herbal cannabis: users report feeling warm, happy and relaxed, and sometimes report confusion, paranoia and anxiety. But the adverse effects appear to be more severe and wide-ranging. A characteristic side-effect of smoking cannabis is an increased heart rate and there is some evidence that the cardiovascular effects of synthetic cannabis can be more extreme, with case reports of people having heart attacks and strokes after taking the drug. Cases have also been reported of kidney and liver damage and psychosis.

Little is known about the long-term effects of synthetic cannabis, since these products have only been in widespread recreational use since around 2008.

Source:  https://www.theguardian.com/society/2017/apr/15/its-worse-than-heroin-how-spice-is-ravaging-homeless-communities

I am not a long-time user.  I used casually for about six months, but then suddenly had a terrible experience with marijuana-induced psychosis.   I had moved from a state where is was illegal, to Washington.  A dispensary sold me something incredibly strong just recently, in March.   It was a joint mixed with a marijuana wax- I didn’t even know what that was.  I was SO naive, but there is literally NOTHING out there that lets consumers know that ANYthing even remotely bad can happen.

As long as I didn’t drive under the influence, what could go wrong?   I thought all pot was “safe.”    The irony is that I am nearly 40, a stay-at-home mom with honor roll kids, no history, ZERO history with drug usage, or ANY depression, mental illness etc etc.. NONE.  I never used marijuana before I moved to Washington. I literally just set out to listen to music and unwind while I got the house clean….awaiting the arrival of my husband who was gone on a business trip.   My kids were on Spring break, at a friend’s house.

About halfway through I felt very dizzy and unbalanced… So I thought I just needed to sit down, or maybe eat.. I looked at the glass of wine I had poured… and dumped it in the drain…. Then I had a sudden disturbing image of myself biting THROUGH the wine glass… It came over and over.  Bite the glass….. the words wouldn’t leave my head…. I’m biting glass.  My heart began to race, my hands began to shake. I felt freezing cold, yet was sweating. Then I was feeling a sudden surge of Adrenalin and was panic stricken.  I began having suicidal ideations, in MINUTES…

Shooting Myself and Biting Glass

Over and over and over… shoot yourself… bite through the glass… shoot yourself…and much worse.. it was as if a tape of my worst nightmares were playing over and over and over again in my head…and it was just as physical as it was psychological….. With absolute sincerity, I tell you that I barely made it through that night alive, and even the subsequent days and weeks… I still suffered terrible suicidal ideation……….

NEVER, ever did I have suicidal thoughts or feelings in my life. I am happy, well-adjusted, and a warm, outgoing person with lots of friends and a solid marriage.

Within days I began researching, because I KNEW what I had experienced was from smoking…again, I reiterate, I had nothing else in my system or history to indicate otherwise….and there it was.. All the research indicating that it WAS the pot.. Marijuana-induced psychosis is a proven thing and all too common. There is ZERO safety put in place in these recreational pot stores.  They don’t warn a consumer about strength, concentration or side effects.  It as if you are buying a glass of milk to them!! I later found out that marijuana wax is known as a “dab” and I am still unsure of what they really are…

No Warnings Against Psychosis! The ER in Olympia Washington sees on average TWO cases of marijuana-induced psychosis a DAY!! Yet we don’t hear of this!? Why not? I would have NEVER tried any medicine or drink that could even remotely do this to me, but thought I was using something as harmless as a glass of wine because they say it is.   I can’t even fully describe the horror of that night as it’s very, very hard to revisit. Thank you for warning people.  I am glad I was able to use some of the resources and information you have shared to help recover…….People need to know.  Marijuana can be deadly.   I almost lost everything to very casual use.

I am lucky to have health insurance and lucky that my husband could be with me.  My husband had to take an entire week off to stay home with me! Again how fortunate I am and I’m in the position to have someone that could do that.

I am lucky in that I am NOT an addict or addicted to it. So not using isn’t an issue….. I would never smoke pot again, but the suicidal ideation was so intense and such a terrible and traumatic experience…. It is hard to describe how horrific it is was and I’d rather be tortured than ever experience that again…. I just never thought that was even possible….    From BK, Washington

Source:  http://www.poppot.org/2017/04/14/biting-glass-biting-my-way-delirium/

Please share this post with every concerned parent you know! The Parents Against Pot website has many very useful and interesting articles and testimonies and we would thoroughly recommend anyone interested in the arguments for and against the use of marijuana (pot) to log on to: http://www.poppot.org

Formerly inconceivable ideas—like providing drug users a safe place to inject—are gaining traction.

America’s opioid problem has turned into a full-blown emergency now that illicit fentanyl and related synthetic drugs are turning up regularly on our streets. This fentanyl, made in China and trafficked through Mexico, is 25 to 50 times as potent as heroin. One derivation, Carfentanil, is a tranquilizer for large animals that’s a staggering 1,000 to 5,000 times as powerful.

Adding synthetic opioids to heroin is a cheap way to make it stronger—and more deadly. A user can die with the needle still in his arm, the syringe partly full. Traffickers also press these drugs into pills that they sell as OxyContin and Xanax. Most victims of synthetic opioids don’t even realize what they are taking. But they are driving the soaring rate of overdose—a total of 33,091 deaths in 2015, according to the Centers for Disease Control and Prevention.

Hence the ascendance of a philosophy known as “harm reduction,” which puts first the goal of reducing opioid-related death and disease. Cutting drug use can come second, but only if the user desires it. As an addiction psychiatrist, I believe that harm reduction and outreach to addicts have a necessary place in addressing the opioid crisis. But as such policies proliferate—including some that used to be inconceivable, such as providing facilities where drug users can safely inject—Americans shouldn’t lose sight of the virtues of coerced treatment and accountability.

What does harm reduction look like? One example is Maryland’s Overdose Survivor Outreach Program. After an overdose survivor arrives in the emergency room, he is paired with a “recovery coach,” a specially trained former addict. Coaches try to link patients to treatment centers. Generally this means counseling along with one of three options: methadone; another opioid replacement called buprenorphine, which is less dangerous if taken in excess; or an opioid blocker called naltrexone. Overdose survivors who don’t want treatment are given naloxone, a fast-acting opioid antidote. Coaches also stay in touch after patients leave the ER, helping with court obligations and social services.

Similar programs operate across the country. In Chillicothe, Ohio, police try to connect addicts to treatment by visiting the home of each person in the county who overdoses. In Gloucester, Mass., heroin users can walk into the police station, hand over their drugs, and walk into treatment within hours, without arrest or charges. It’s called the Angel Program. Macomb County, Mich., has something similar called Hope Not Handcuffs.

Another idea gaining traction is to provide “safe consumption sites,” hygienic booths where people can inject their own drugs in the presence of nurses who can administer oxygen and naloxone if needed. No one who goes to a safe consumption site is forced into treatment to quit using, since the priority is reducing risk.

In Canada, staffers at Vancouver’s consumption site urge patrons to go into treatment, but they also distribute clean needles to reduce the spread of viruses such as HIV and hepatitis C. Naloxone kits are on hand in case of overdose. One study found that opening the site has reduced overdose deaths in the area, and more than one analysis showed reduced injection in places like public bathrooms, where someone can overdose undiscovered and die.

There are no consumption sites in the U.S., but in January the board of health in King County, Wash., endorsed the creation of two in the Seattle area. A bill in the California

Assembly would allow cities to establish safe consumption sites. Politicians, physicians and public-health officials have called for them in Baltimore; Boston; Burlington, Vt.; Ithaca, N.Y.; New York City; Philadelphia and San Francisco. Drug-war-weary police officers and harm reductionists would rather see addicts opt for treatment and lasting recovery, but they’ll settle for fewer deaths.

When all else fails, handcuffs can help, too. A problem with treatment is that addicts often stay with the program only for brief periods. Dropout rates within 24 weeks of admission can run above 50%, according to the National Institute on Drug Abuse. Courts can provide unique leverage. Many drug users are involved in addiction-related crime such as shoplifting, prescription forgery and burglary. Shielding them from the criminal-justice system often is not in society’s best interests—or theirs.

Drug courts, for example, keep offender-patients in treatment through immediately delivered sanctions (e.g., a night in jail) and incentives (e.g., looser supervision). Upon successful completion of a 12- to 18-month program, many courts erase the criminal record. This seems to work. The National Association of Drug Court Professionals reports that 75% of drug court graduates nationwide “remain arrest-free at least two years after leaving the program.”

What’s more, if the carrot-and-stick method used by drug courts is scrupulously applied, treatment may not always be necessary. This approach, called “swift, certain and fair,” has been successful with methamphetamine addicts in Hawaii and alcoholics in South Dakota. Some courts in Massachusetts and New Hampshire have now adopted it with opioid addicts. I predict that the combination of anti-addiction medication plus “swift, certain, and fair” will be especially effective.

With synthetic drugs similar to fentanyl turbocharging the opioid problem, the immediate focus should be on keeping people safe and alive. But for those revived by antidotes and still in a spiral of self-destruction, the criminal-justice system may be the ultimate therapeutic safety net.

Source:  https://www.wsj.com/articles/saving-lives-is-the-first-imperative-in-the-opioid-epidemic-1491768767  April 9, 2017

Marijuana Legalization Proposals Die in Committee

[Alexandria, VA, April 12, 2017] –  Yesterday, an alliance of concerned citizens, public health experts, and safety officials soundly defeated two marijuana legalization bills in Maryland. The bills, which would have permitted commercial pot shops in communities throughout the state, died without a vote in the Maryland Senate last night. SAM Executive Vice President Jeff Zinsmeister and Maryland-based neuroscientist and SAM Science Advisor Dr.Christine Miller testified in Annapolis last month, urging the legislature to reject marijuana legalization and commercialization. AAA Mid-Atlantic also testified against the bills, citing traffic safety concerns due to drugged driving increases in states that have legalized marijuana.

“This is a major victory in the effort to put public health and common sense before special interests,” said SAM Executive Vice President Jeff Zinsmeister. “The costs of legalization, including more stoned drivers on the roads causing fatalities, more people being driven into treatment for addiction, and higher regulatory costs far outweighed any benefit Maryland would see. The Big Marijuana lobbyists came into Maryland touting the notion that marijuana legalization would fix our criminal justice system and rake in millions – but Maryland smartly concluded that legalization actually exacerbates these issues. All they had to do was look to Colorado, where more minority youth are being arrested for marijuana and the state deficit is growing.”

“We believe that science and research, not profit, should drive what marijuana laws look like in our state,” said Dr. Christine Miller, a Maryland neuroscientist and member of SAM’s Science Advisory Board.  “The pro-marijuana lobby was looking to profit by selling a harmful, addictive substance that would harm our communities and endanger public safety. I’m proud that evidence-based policy putting health first prevailed in Maryland yesterday.”

Evidence demonstrates that marijuana – which has skyrocketed in average potency over the past decades – is addictive and harmful to the human brain, especially when used by adolescents. Moreover, in states that have already legalized the drug, there has been an increase in drugged driving crashes and youth marijuana use. States that have legalized marijuana have also failed to shore up state budget shortfalls with marijuana taxes, continue to see a thriving black market, and are experiencing a continued rise in alcohol sales.

Source: info@learnaboutsam.org  April 2017

Chairman Murphy, Ranking Member DeGette, and Members of the Committee: thank you for inviting the National Institute on Drug Abuse (NIDA), a component of the National Institutes of Health (NIH), to participate in this important hearing to provide an overview of what we know about the role of fentanyl in the ongoing opioid overdose epidemic and how scientific research can help us address this crisis.

The misuse of and addiction to opioids – including prescription pain medicines, heroin, and synthetic opioids such as fentanyl – is a serious national problem that affects public health as well as social and economic welfare.  The Centers for Disease Control and Prevention (CDC) recently estimated that the total “economic burden” of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of health care, lost productivity, addiction treatment, and criminal justice involvement.1  In 2015, over 33,000 Americans died as a result of an opioid overdose.2  That year, an estimated 2 million people in the United States suffered from substance use disorders related to prescription opioid pain medicines (including fentanyl), and 591,000 suffered from a heroin use disorder (not mutually exclusive).3

This issue has become a public health epidemic with devastating consequences including not just increases in opioid abuse and related fatalities from overdoses, but also the rising incidence of neonatal abstinence syndrome due to opioid use during pregnancy, and the increased spread of infectious diseases, including HIV and hepatitis C.4-6  Recent research has also found a significant increase in mid-life mortality in the United States particularly among white Americans with less education.  Increasing death rates from drug and alcohol poisonings are believed to have played a significant role in this change.7

The Pharmacology of Fentanyl and Other Synthetic Opioids

Prescription opioids, heroin, and synthetic opioid drugs all work through the same mechanism of action.  Opioids reduce the perception of pain by binding to opioid receptors, which are found on cells in the brain and in other organs in the body.  The binding of these drugs to opioid receptors in reward regions in the brain produces a sense of well-being, while stimulation of opioid receptors in deeper brain regions results in drowsiness and respiratory depression, which can lead to overdose deaths.  The presence of opioid receptors in other tissues can lead to side effects such as constipation and cardiac arrhythmias through the same mechanisms that support the use of opioid medications to treat diarrhea and to reduce blood pressure after a heart attack.  The effects of opioids typically are mediated by specific subtypes of opioid receptors (mu, delta, and kappa) that are activated by the body’s own (endogenous) opioid chemicals (endorphins, enkephalins).  With repeated administration of opioid drugs (prescription or illicit), the production of endogenous opioids decreases, which accounts in part for the discomfort that ensues when the drugs are discontinued (i.e., withdrawal).8

The rewarding effects of opioids – whether they are medications, heroin, or illicitly produced synthetic opioids – are increased when they are delivered rapidly into the brain, which is why non-medical users often inject them directly into the bloodstream.9 Fentanyl, in particular, is highly fat-soluble, which allows it to rapidly enter the brain, leading to a fast onset of effects. This high potency and rapid onset are likely to increase the risk for both addiction and overdose, as well as withdrawal symptoms.10  In addition, injection use increases the risk for infections and infectious diseases.  Another important property of opioid drugs is their tendency, when used repeatedly over time, to induce tolerance.  Tolerance occurs when the person no longer responds to the drug as strongly as he or she initially did, thus necessitating a higher dose to achieve the same effect.  The establishment of tolerance results from the desensitization of the brain’s natural opioid system, making it less responsive over time.11  Furthermore, the lack of sufficient tolerance contributes to the high risk of overdose during a relapse to opioid use after a period of abstinence whether it is intentional – for example, when a person tries to quit using – or situational – for example, if a person cannot obtain opioid drugs while incarcerated or hospitalized.  Users no longer know what dose of the drug they can safely tolerate, resulting in overdoses.

While all of these opioids belong to a single class of drugs, each is associated with distinct risks. The risk of overdose and negative consequences is generally greater with illicit opioids due to the lack of control over the purity of the drug and its potential adulteration with other drugs.  All of these factors increase the risk for overdose, since users have no way of assessing the potency of the drug before taking it.  In the case of adulteration with highly potent opioids such as fentanyl or carfentanil, this can be particularly deadly.12-14  Another contributing factor to the risk of opioid-related mortality is the combined use with benzodiazepines or other respiratory depressants, like some sleeping pills or alcohol.15

The Role of Fentanyl in the Opioid Crisis

The emergence of illicitly manufactured synthetic opioids including fentanyl, carfentanil, and their analogues represents an escalation of the ongoing opioid overdose epidemic.  Fentanyl is a µ-opioid receptor agonist that is 80 times more potent than morphine in vivo. While fentanyl is available as a prescription – primarily used for anesthesia, treating post-surgical pain, and for the management of pain in opioid-tolerant patients – it is the illicitly manufactured versions that have been largely responsible for the tripling of overdose deaths related to synthetic opioids in just two years – from 3,105 in 2013 to 9,580 in 2015.2  A variety of fentanyl analogues and synthetic opioids are also included in these numbers, such as carfentanil (approximately 10,000 times more potent than morphine), acetyl-fentanyl (about 15 times more potent than morphine), butyrfentanyl (more than 30 times more potent than morphine), U-47700 (about 12 times more potent than morphine), and MT-45 (roughly equivalent potency to morphine), among others.17

The opioid crisis began in the mid-to late 1990’s, following a confluence of events that led to a dramatic increase in opioid prescribing, including: a regulatory, policy and practice focus on opioid medications as the primary treatment for all types of pain;18 an unfounded concept that opioids prescribed for pain would not lead to addiction;19 the release of guidelines from the American Pain Society in 1996 encouraging providers to assess pain as “the 5th vital sign” at each clinical encounter; and the initiation of aggressive marketing campaigns by pharmaceutical companies promoting the notion that opioids do not pose significant risk for misuse or addiction and promoting their use as “first-line” treatments for chronic pain.19-21

The sale of prescription opioids more than tripled between 1999 and 2011, and this was paralleled by a more than four-fold increase in treatment admissions for opioid abuse and a nearly four-fold increase in overdose deaths related to prescription opioids.22  Federal and state efforts to curb opioid prescribing resulted in a leveling off of prescriptions starting in 2012;23 however, heroin-related overdose deaths had already begun to rise in 2007 and sharply increased from just over 3,000 in 2010 to nearly 13,000 in 2015.2  We now know prescription opioid misuse is a significant risk factor for heroin use; 80 percent of heroin users first misuse prescription opioids.24  While only about four percent of people who misuse prescription opioids initiate heroin use within 5 years,24,25 for this subset of people the use of the cheaper, often easier to obtain street opioid is part of the progression of an opioid addiction.26

The opioid overdose epidemic has now further escalated, with the rise in deaths related to illicitly manufactured synthetic opioids.  Often, the population of people using and overdosing on fentanyl looks very similar to the population using heroin. However, the drivers of fentanyl use can be complicated as the drug is often sold in counterfeit pills – designed to look like common prescription opioids or benzodiazepines (e.g. Xanax) – or is added as an adulterant to heroin or other drugs, unbeknownst to the user.14  And there are also market forces supporting the proliferation of higher-potency opioids, as people with opioid addictions develop increasing tolerance to these drugs.27

History of Fentanyl Misuse

The first fentanyl formulation (Sublimaze) received approval by the Food and Drug Administration (FDA) as an intravenous anesthetic in the 1960s.  Other formulations, including a transdermal patch, a quick acting lozenge or “lollipop” for breakthrough pain, and dissolving tablet and film, have since received FDA approval.28  Misuse of prescription fentanyl was first described in the mid-1970s among clinicians,29 and continues to be reported among the people misusing prescription opioids.3  More recently, between April 2005 and March 2007 there was an uptick in deaths related to illicitly manufactured fentanyl that was traced to a single laboratory in Mexico. Once the laboratory shut down the rate of overdose declined.30  However, over the last few years there has been a growing production of illicitly manufactured fentanyl, much of which is imported from China, Mexico, and Canada.14  The increase in illicitly manufactured fentanyl availability in the U.S. is reflected by the substantial increase in seizures of fentanyl by law enforcement which jumped from under 1,000 seizures in 2013 to over 13,000 in 2015.31 Research shows that the increasing availability of illicitly manufactured fentanyl closely parallels the increase in synthetic opioid overdose deaths in the U.S.32

HHS Response and NIDA-Supported Research Related to Fentanyl

Within HHS, the Office of the Assistant Secretary for Planning and Evaluation (ASPE) has been leading a targeted and coordinated policy and programmatic effort to reduce opioid abuse and overdose, including fentanyl use and overdose. The effort focuses on strengthening surveillance, improving opioid prescribing practices and the treatment of pain, increasing access to treatment for opioid addiction, expanding use of naloxone to reverse opioid overdose, and funding and conducting research to better understand the epidemic and identify effective interventions. Under this effort, NIDA is engaged in number critical activities.

NIDA supports the National Drug Early Warning System (NDEWS), which monitors emerging drug use trends to enable health experts, researchers and others to respond quickly to potential outbreaks of illicit drugs.  In partnership with the NDEWS, the Northeast Node of the NIDA’s Clinical Trials Network (CTN) has been funded to complete a Fentanyl Hot Spot Study in New Hampshire.  In 2015, New Hampshire had the highest rate of fentanyl-related deaths in the country and this study is investigating the causes of increased fentanyl use and related deaths in this region.

In the first phase of the study, multiple stakeholders throughout the state, including treatment providers, medical responders, law enforcement, state authorities and policymakers were interviewed about their perspectives on the fentanyl crisis.33  Many expressed that better user-level data was imperative to answer pointed questions to more accurately inform policy, such as the trajectory of fentanyl use, supply chain, fentanyl-seeking behavior versus accidental ingestion, value of testing kits, treatment preferences, etc. The researchers reported that, “Some may seek out a certain dealer or product when they hear about overdoses because they think that it must be good stuff.”  According to the group leader, only approximately a third of users knowingly use fentanyl, but the number of users is slowly increasing.

The second phase of the study is conducting a rapid epidemiological investigation of fentanyl users’ and first responders’ perspectives, so that real-time data can inform policy in tackling the fentanyl overdose crisis.

Another ongoing NIDA funded study is characterizing the fentanyl crisis in Montgomery County, Ohio – an area experiencing one of the largest surges of illicitly manufactured fentanyl in the country. This study will explore the scope of the fentanyl crisis in this area, collecting data from postmortem toxicology and crime laboratories, and will explore active user knowledge and experiences with fentanyl.  Other NIDA funded research is working to develop faster methods for screening for fentanyl and other synthetic opioids to track overdoses through emergency department screening and improve surveillance of the fentanyl threat across the country.

NIDA-supported research is also working to develop new treatments for opioid addiction, including treatments targeting fentanyl specifically. One ongoing NIDA-funded study is in the early stages of developing a vaccine for fentanyl that could prevent this drug from reaching the brain.34

Evidence-Based Approaches

With the emergence of very high potency opioids addressing supply becomes increasingly difficult because the quantities transported may be much lower.  Thus, it is critical to address demand reduction through the deployment of evidence-based prevention and treatment strategies to reduce the number of people developing an opioid addiction and treating the population of Americans who already suffer from this addiction.

Evidence-Based Treatments for Opioid Addiction

Three classes of medications have been approved for the treatment of opioid addiction : (1) agonists, e.g. methadone , which activate opioid receptors; (2) partial agonists, e.g. buprenorphine, which also activate opioid receptors but produce a diminished response; and (3) antagonists, e.g. naltrexone, which block the opioid receptor and interfere with the rewarding effects of opioids.35  These medications represent the first-line treatments for opioid addiction.

The evidence strongly demonstrates that methadone, buprenorphine, and injectable naltrexone (e.g., Vivitrol) all effectively help maintain abstinence from other opioids and reduce opioid abuse-related symptoms.  These medications have also been shown to reduce injection drug use and HIV transmission and to be protective against overdose.36-40  These medications should be administered in the context of behavioral counseling and psychosocial supports to improve outcomes and reduce relapse.  Two comprehensive Cochrane reviews, one analyzing data from 11 randomized clinical trials that compared the effectiveness of methadone to placebo, and another analyzing data from 31 trials comparing buprenorphine or methadone treatment to placebo, found that38,39:

* Patients on methadone were over four times more likely to stay in treatment and had 33 percent fewer opioid-positive drug tests compared to patients treated with placebo;

* Methadone treatment significantly improves treatment outcomes alone and when added to counseling; long-term (beyond six months) outcomes are better for patients receiving methadone, regardless of counseling received;

* Buprenorphine treatment significantly decreased the number of opioid-positive drug tests; multiple studies found a 75-80 percent reduction in the number of patients testing positive for opioid use;

* Methadone and buprenorphine are equally effective at reducing symptoms of opioid addiction; no differences were found in opioid-positive drug tests or self-reported heroin use when treating with these medications.

To be clear, the evidence supports long-term maintenance with these medicines in the context of behavioral treatment and recovery support, not short-term detoxification programs aimed at abstinence.41  Abstinence from all medicines may be a particular patient’s goal, and that goal should be discussed between patients and providers.  However, the scientific evidence suggests the relapse rates are extremely high when tapering off of these medications, and treatment programs with an abstinence focus generally do not facilitate patients’ long-term, stable recovery.42,43

Treatment Challenges

Unfortunately, medications approved for the treatment of opioid abuse are underutilized and often not delivered in an evidence based manner.44,45  Fewer than half of private-sector treatment programs offer these medications; and of patients in those programs who might benefit, only a third actually receive it.45  Further, many people suffering with opioid addiction do not seek treatment. Identifying the need for and engaging them in treatment is an essential element of addressing the opioid crisis. For example, recent research suggests that initiating patients on buprenorphine following an opioid overdose can increase treatment retention and improve outcomes.46  Overcoming the misunderstandings and other barriers that prevent wider adoption of these treatments is crucial for tackling the opioid crisis.

In addition, to achieve positive outcomes, treatments must be delivered with fidelity. To be effective, methadone and buprenorphine must be given at a sufficiently high dose.38,39  Some treatment providers wary of using methadone or buprenorphine have prescribed lower doses for short treatment durations, leading to treatment failure and the mistaken conclusion that the medication is ineffective.38,47

As of 2011, more than 22 percent of patients in a methadone treatment programs were receiving less than the minimum recommended dose of methadone.48  Interestingly, a recent study identified a genetic variant near the mu opioid receptor gene associated with a higher required dose of methadone (corresponding to a need for about an additional 20 mg per day) in African American patients but not European Americans with this gene variant.49  This highlights the need for dosing flexibility to achieve the effective dose for an individual patient.  The NIH Precision Medicine Initiative and other ongoing research projects are working to define the genetic, biological, and clinical factors that influence the efficacy of treatment to help clinicians deliver care precisely tailored for a specific patient to improve outcomes.

Research has also shown that tapering off of buprenorphine can present significant risks for relapse.43,50  A recent analysis of five studies that examined outcomes following buprenorphine taper found that on average only 18 percent (a range of 10 to 50 percent) of patients remained abstinent one to two months after tapering off of buprenorphine.50  In addition, some state programs and insurance providers limit the duration of treatment a patient may receive.  There is no evidence base to support this practice, and the available evidence suggests that it poses a significant risk for patient relapse.  This is also an important consideration in the context of the two years of funding for the opioid crisis authorized through the 21st Century Cures Act. This funding will be critical for helping states address the ongoing opioid epidemic, however, opioid addiction is a chronic condition and many patients will need ongoing treatment for many years.  It will be important to develop sustainability strategies to ensure that patients do not lose access to these life-saving medications when a particular funding program is discontinued.

While users seeking treatment are on a wait list they generally continue to engage in opioid use and this may contribute to failure to enter treatment when a slot becomes available.  Research has shown that providing interim treatment with medications while patients are awaiting admission to a treatment program increases the likelihood that they will engage in treatment.  In one study, over 64 percent of study participants receiving interim methadone entered comprehensive care within six months, compared with only 27 percent in the control group, and the group receiving methadone had lower rates of heroin use and criminal behavior.51 One model for interim treatment with buprenorphine would use urine testing call backs and a special medicine dispensing device to prevent diversion.52  Implementation would require a regulatory change because take home buprenorphine is not allowed under interim regulations currently. When this model was tested, patients showed strong adherence to the interim treatment plan and reported strong satisfaction with the treatment. State regulations and payment system issues (bundled payment that does not accommodate billing for interim treatment) are often barriers to this type of program and they are not frequently used.

Fentanyl specific challenges

While specific data on treatment outcomes for patients addicted to fentanyl or other high potency synthetic opioids are not available, the same principles of treatment still apply.  In addition, patients regularly using these substances and surviving would be expected to have a strong opioid dependency. At this time we are not sure how many people fit this clinical picture. In this scenario the withdrawal symptoms are likely to be severe, and could lead to life threatening cardiac arrhythmias and seizures if untreated or if extreme opioid withdrawal is potentiated during overdose reversal.53 There is an urgent need for more research to determine if people using fentanyl or other high potency opioids respond differently to medications for overdose reversal as well as treatment and to determine the most effective approaches for utilizing medications and psychosocial supports in this population.

In general outcomes are better predicted by the strength of the psychosocial supports around patients to support their recovery – educational or job opportunities, supportive friends and family, stable housing, access to child care – than the severity of their addiction.  Providing behavioral counseling and wrap around services to address these needs is important for achieving the best outcomes.

Prevention of Opioid Misuse and Addiction

Since the majority of people who develop an opioid addiction begin by misusing prescription opioids, the Department of Health and Human Services (HHS) continues to focus efforts on improving opioid prescribing and preventing the misuse of prescription drugs as the long-run strategy to stop the opioid epidemic.  NIDA supports research to understand the impact of federal and state policy changes on rates of opioid abuse and related public health outcomes.  This and other federally supported research has demonstrated the efficacy of multiple types of interventions, including:

* Educational initiatives delivered in school and community settings (primary prevention)54

* Supporting consistent use of prescription drug monitoring programs (PDMPs)

* Aggressive law enforcement efforts to address doctor shopping and pill mills56,57

* Providing healthcare practitioners with tools for managing pain, including prescribing guidelines and enhanced warnings on drug labels with expanded information for prescribers58-61

In states with the most comprehensive initiatives to reduce opioid overprescribing, the results have been encouraging.  Washington State’s implementation of evidence-based dosing and best-practice guidelines, as well as enhanced funding for the state’s PDMP, helped reduce opioid deaths by 27 percent between 2008 and 2012.58  In Florida, new restrictions were imposed on pain clinics, new policies were implemented requiring more consistent use of the state PDMP, and the Drug Enforcement Administration (DEA) worked with state law enforcement to conduct widespread raids on pill mills, which resulted in a dramatic decrease in overdose deaths between 2010 and 2012.62  These examples show that state and Federal policies can reduce the availability of prescription opioids and related overdose deaths.  However, the increasing supply of heroin and illicit fentanyl in the United States is undermining the effects of these improvements. While we have seen a leveling off of overdose deaths related to commonly prescribed opioids over the last few years, overdose deaths related to illicit opioids have risen dramatically during this time.

In early 2016 CDC released guidelines for prescribing opioids for chronic pain.60  We believe they represent an important step for improving prescriber education and pain prescribing practices in our nation.  NIDA is advancing addiction awareness, prevention, and treatment in primary care practices through seven Centers of Excellence for Pain Education.63  Intended to serve as national models, these centers target physicians-in-training, including medical students and resident physicians in primary care specialties (e.g. internal medicine, family practice, and pediatrics).

Addressing the Public Health Consequences of Opioid Misuse

Other evidence-based strategies can be used to reduce the health harms associated with opioid use, including increasing access to the opioid-overdose-reversal drug naloxone.

Preventing Overdoses with Naloxone

The opioid overdose-reversal drug naloxone can rapidly restore normal respiration to a person who has stopped breathing as a result of an overdose from heroin or prescription opioids.  Naloxone is widely used by emergency medical personnel and some other first responders.  Beyond first responders, a growing number of communities have established overdose education and naloxone distribution programs that make naloxone more accessible to opioid users and their friends or loved ones, or other potential bystanders, along with brief training in how to use these emergency kits.  Such programs have been shown to be effective, as well as cost-effective, ways of saving lives.64,65  CDC reported that, as of 2014, more than 152,000 naloxone kits had been distributed to laypersons and more than 26,000 overdoses had been reversed since 1996.66  In addition, the majority of states now allow individuals to obtain naloxone from retail pharmacies without a patient-specific prescription.67

Two naloxone formulations specifically designed to be administered by family members or caregivers have recently been developed.  In 2014 the FDA approved a handheld auto-injector of naloxone, and in late 2015 the FDA approved a user-friendly intranasal formulation that was developed through a NIDA partnership with Lightlake Therapeutics, Inc. (a partner of Adapt Pharma Limited).68

The availability of naloxone is critical to reduce opioid-related fatalities.69  However, research examining past fentanyl outbreaks shows that higher than typical naloxone doses were required to reverse fentanyl overdose.70  As the use of fentanyl and other highly potent opioids is increasing, it would be prudent to promote the use of naloxone while recognizing that multiple doses may be needed to revive someone experiencing a fentanyl overdose.71  It is also important for first responders to know that, while fentanyl has a short duration of action (30-90 minutes), it can stay in fat deposits for hours, and patients should be monitored for up to 12 hours after resuscitation.72  More research may be needed to develop new naloxone formulations tailored to higher-potency opioids.

Ongoing Opioid-Related Research: Implementation Science

Despite the availability of evidence based treatments for opioid abuse, we have a significant and ongoing treatment gap in our Nation.  Among those who need treatment for an addiction, few receive it.  In 2014, less than 12 percent of the 21.5 million Americans suffering with addiction received specialty treatment.3   Further, many specialty treatment programs do not provide current evidence based treatments – fewer than half provide access to MAT for opioid use disorders.45  In addition, it is clear that preventing drug use before it begins—particularly among young people—is the most cost-effective way to reduce drug use and its consequences.73  Evidence based prevention interventions also remain highly underutilized.

Ongoing NIDA research is working to better understand the barriers to successful and sustainable implementation of evidence based practices and to develop implementation strategies that effectively overcome these barriers.  This work also seeks to understand the role environment—be it social, familial, structural, or geographic—plays in preventing opioid use and in the success of prevention and treatment interventions, as well as how to tailor prevention and treatment interventions to individuals with unique needs, including those in the criminal justice system or with HIV.

Other NIDA supported research is looking at how to improve access to treatment among other high risk populations.  For example, patients with opioid addiction are at increased risk of adverse health consequences and often seek medical care in emergency departments (EDs). NIDA is also collaborating with the Baltimore County Health Department on a pilot study to explore the possibility of providing methadone through pharmacies to increase access to treatment in underserved parts of the city. In the pilot, pharmacies would be considered satellite locations of licensed methadone treatment facilities; this model has been used in Pennsylvania and New York. Discussions are underway to explore whether regulatory exceptions can be granted to make this possible. Similarly, ongoing research is examining on the impact of providing opioid addiction treatment within infectious disease clinics.  This type of research is essential for translating evidence based strategies into real-world interventions that will reach the greatest number of people and get the most out of limited prevention and treatment resources.

Implementation Research to Address the Opioid Crisis in Rural Communities

Our efforts are also focused on addressing the opioid crisis in the epicenter of the epidemic – Appalachia.  NIDA is partnering with the Appalachian Regional Commission (ARC) to fund one-year services planning and needs assessment research grants to provide the foundation for future intervention programs and larger scale research efforts to test interventions to address opioid misuse in rural Appalachia.  Four grants were awarded in FY 2016 that will address issues related to injection drug use and associated transmission of infectious disease as well as the coordination of care for prisoners with opioid addiction as they re-enter the community.

A second funding opportunity announcement in partnership with the Substance Abuse and Mental Health Services Administration (SAMHSA), CDC, and ARC was released in October 2016 to support comprehensive, integrated approaches to prevent opioid injection and its consequences, including addiction, overdose, HIV and hepatitis C, as well as sexually transmitted diseases.  High rates of injection drug use in Appalachia has led to a rapid increase in the transmission of hepatitis C, raising concern about an outbreak of HIV.6 These projects will work with state and local communities to develop best practices that can be implemented by public health systems in the Nation’s rural communities including opioid abuse treatment  and other strategies to increase the testing and treatment for HIV.

HIV Testing and Treatment

NIDA supported research has helped to develop the seek, test, treat, and retain model of care (STTR) that involves reaching out to high-risk, hard-to-reach drug users who have not been recently tested for HIV; engaging them in HIV testing; engaging those testing positive in antiretroviral therapy; and retaining patients in care. Research has shown that implementation of STTR has the potential to decrease the rate of HIV transmission by half.75

Ongoing Opioid-Related Research: Development of Pain Treatments with Reduced Potential for Misuse

NIDA is one of multiple institutes of the NIH supporting research into novel pain treatments with reduced potential for misuse and diversion, including abuse resistant opioid analgesics, non-opioid medication targets, and non-pharmacological treatments. Some of the most promising potential therapies include:

* Abuse Resistant Opioid Analgesics: Efforts are underway to identify new opioid pain medicines with reduced misuse, tolerance, and dependence risk, as well as alternative delivery systems and formulations for existing drugs that minimize diversion and misuse (e.g., by preventing tampering) and reduce the risk of overdose deaths.  Multiple recent NIH-funded studies have reported progress in the discovery of opioid compounds with selective analgesic effects with reduced respiratory depressive effects and reduced abuse liability.76-78

* Non-Opioid Medications: Some non-opioid targets with promising preliminary data include fatty acid binding proteins, the G-protein receptor 55, cannabinoids, and transient receptor potential cation channel A1.

* Nervous Stimulation Therapies: Several non-invasive nervous stimulation therapies – including transcranial magnetic stimulation and transcranial direct current stimulation, as well as electrical deep brain stimulation, spinal cord stimulation, and peripheral nerves/tissues stimulation – have shown promise for the treatment of intractable chronic pain.  These devises have been approved by the FDA for treatment of other conditions but more research is needed on their effectiveness for pain.

* Neurofeedback: Neurofeedback is a novel treatment modality in which patients learn to regulate the activity of specific brain regions by getting feedback from real-time brain imaging.  This technique shows promise for altering the perception of pain in healthy adults and chronic pain patients and may also be effective for the treatment of addiction.

*

Ongoing Opioid-Related Research: Accelerating Development of New Treatments for Addiction

While the three available medications have represented significant advances in the ability to treat opioid use disorders the efficacy of these medications is far from ideal.  NIDA is funding research to accelerate development of new treatments.  This includes development of non-pharmacological interventions including biologics – such as vaccines, monoclonal antibodies, and bioengineered enzymes designed to prevent a drug from entering the brain – and novel brain stimulation techniques – such as TMS and transcranial direct current stimulation (tDCS), that target brain circuits impaired in addiction with improved specificity and temporal and spatial resolutions, and thus, with less adverse effects.  One ongoing NIDA-funded study is in the early stages of developing a vaccine for fentanyl that could prevent this drug from reaching the brain.34

Since the pharmaceutical industry has traditionally made limited investment in the development of medications to treat SUDs, NIDA has focused on forming alliances between strategic partners (pharmaceutical and biotechnology companies as well as academic institutions) with the common goal of advancing medications through the

development pipeline toward FDA approval.  NIDA conducts research to decrease the risks associated with medications development to make it more appealing for pharmaceutical companies to complete costly phase IIb and III clinical studies.  An example of such a project is a partnership with US World Meds, is in late stage development of lofexidine, a medication for the treatment of opioid withdrawal symptoms that might also hold promise for the treatment of other addictions.

Conclusion

NIDA will continue to closely collaborate with other federal agencies and community partners with a strong interest in preserving public health to address the interrelated challenges posed by misuse of prescription opioids, heroin, and synthetic opioids such as fentanyl.  We commend the committee for recognizing the serious and growing challenge associated with this exceedingly complex issue.  Under the leadership of the Department of Health and Human Services and the Office of National Drug Control Policy, NIDA will continue to support the implementation of the multi-pronged, evidence-based strategies to improve opioid prescribing and pain management, reduce overdose deaths, and increase access to high quality opioid abuse treatment.

Source:https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2016/americas-addiction-to-opioids-heroin-prescription-drug-abuse 

March 2017

Highlights

* Cannabis collisions resulted in 75 deaths and 4407 injuries in 2012.

* There were up to 24,879 victims of property damage only cannabis collisions in 2012.

* Cannabis collisions costs ranged from $1.09 to $1.28 billion CAD in 2012.

* Cannabis collision harms were particularly high amongst those ages 16–34 years old.

Abstract

Introduction

In 2012, 10% of Canadians used cannabis and just under half of those who use cannabis were estimated to have driven under the influence of cannabis. Substantial evidence has accumulated to indicate that driving after cannabis use increases collision risk significantly; however, little is known about the extent and costs associated with cannabis-related traffic collisions. This study quantifies the costs of cannabis-related traffic collisions in the Canadian provinces.

Methods

Province and age specific cannabis-attributable fractions (CAFs) were calculated for traffic collisions of varying severity. The CAFs were applied to traffic collision data in order to estimate the total number of persons involved in cannabis-attributable fatal, injury and property damage only collisions. Social cost values, based on willingness-to-pay and direct costs, were applied to estimate the costs associated with cannabis-related traffic collisions. The 95% confidence intervals were calculated using Monte Carlo methodology.

Results

Cannabis-attributable traffic collisions were estimated to have caused 75 deaths (95% CI: 0–213), 4407 injuries (95% CI: 20–11,549) and 7794 people (95% CI: 3107–13,086) were involved in property damage only collisions in Canada in 2012, totalling $1,094,972,062 (95% CI: 37,069,392–2,934,108,175) with costs being highest among younger people.

Discussion

The cannabis-attributable driving harms and costs are substantial. The harm and cost of cannabis-related collisions is an important factor to consider as Canada looks to legalize and regulate the sale of cannabis. This analysis provides evidence to help inform Canadian policy to reduce the human and economic costs of drug-impaired driving.

Source:  Estimating the harms and costs of cannabis-attributable collisions in the Canadian provinces     Drug & Alcohol Dependence , Volume 173 , 185 – 190

Abstract

Cannabis use remains a critical issue in the United States.  In 2014, an estimated 22 million US residents used cannabis,1 double the number from 10 years age.

As of December 2016, 28 states and the District of Columbia have implemented or have voted to authorize medical cannabis programs, and 8 states and the District of Columbia have legalized recreational cannabis.

Health care professionals often are concerned about whether cannabis use will lead to psychiatric illnesses such as substance use disorders, anxiety disorders, or mood disorders among their patients. Many stakeholders are concerned that an association between cannabis use and psychiatric illnesses will lead to a steady increase in these illnesses as more states implement medical or recreational cannabis legalization policies. Given these trends and concerns, it has become increasingly important to obtain longitudinal data to clarify the relationship between cannabis use and subsequent psychiatric disorders.

Source:  JAMA. 2017;317(10):1070-1071. doi:10.1001/jama.2016.19706

Both experience and research has proven that drug addiction and other drug-related problems are both preventable and treatable. Prevention is effective, humane, cost-effective, and empowering. Prevention solves problems before they ever occur. And prevention reduces other social problems and should therefore be integrated into general health and development strategies based on the United Nations’ Sustainable Development Goals. Indeed, the introductory paragraphs of the UNGASS Outcome Document highlight prevention as an important part of a drug strategy that is integrated, multidisciplinary, mutually reinforcing, balanced, evidence-based, and comprehensive.

Chapter 1 of that same document details the many aspects of prevention, demand reduction, and early intervention. Of course, no “silver bullets” to drug-related problems exist. Rather, the causes of drug use, the consequences of such use, and the interventions needed to reduce drug-related harm are all multi-dimensional, as the UNGASS Outcome Document stresses.

Member States should use the UNODC International Standards on Drug Use Prevention for guidance on prevention programs. These Standards offer a wide range of evidence-based primary prevention interventions that governments and civil society can easily implement. There is no reason to wait for more theoretical discussion in this area. Effective prevention efforts as listed in the UNODC Standards are even more effective when they are combined and implemented across a broad cross-section of a community.

Accordingly, local coalitions should involve a wide range of local authorities and public services, such as schools, police, parents groups, and community-based organisations. Several countries have developed this type of community actions through coalitions of committed people, and we advise Members States to build on these examples and experiences.

· Define the overarching goal of their drug policies as reduction in drug use prevalence, or maintaining low levels of drug use.

· Monitor drug use prevalence on a regular basis, both on national and local level, and to use results to adjust policies and develop even more efficient prevention programmes.

· Develop and implement a culturally-sensitive model for “community-based multicomponent actions” where communities are mobilized as part of a national programme of prevention. Drug Policy Futures is a global platform for a new drug policy debate based on health www.drugpolicyfutures.org

· Involve young children and youth in prevention, instead of exclusively engaging adolescents as a target audience for such programmes.

· Establish a national clearinghouse that can connect the many local prevention coalitions, provide them with training and documentation, and elevate prevention initiatives on the national political agenda.

· Introduce training and support programmes for local prevention workers and volunteers.

· Mobilize human resources and funds to secure that schools and local communities have proper systems for identification of and assistance to vulnerable groups, for young children and adolescents in particular.

· Establish national “better parenting” programmes that can be used by local communities and schools.

Given the existing heavy burden on public health systems in many developing societies, prevention may be the only viable option for many Member States. Public health infrastructure in many of these states is often weak or already overburdened, further increasing the need for successful prevention programmes, before drug-related problems develop.

Similarly, drug prevention programmes must aim to reduce drug use prevalence, as it is a good proxy for the level of drug-related harm in a society. This means that prevention programmes must address both the availability of drugs and the social acceptability of drug use. Reduced numbers of regular drug users will lead to lower rates of problematic drug users, as well as a reduction in numbers of adolescents who are exposed to drug use in their circle of friends.

Effective prevention programmes result in more than just reduction in drug-related harm. They also contribute to the prevention of other social problems, empower individuals and communities, mobilize of human resources, promote good governance, rebuild the social fabric, and strengthen civil society. This is particularly true when prevention programs begin early, such as with early detection of adolescents who struggle with childhood traumas, family problems, abuse, school attendance, and other problematic issues. At such an early stage, basic support and interventions by teachers, health personnel or social workers, and even by family and neighbours can make a great difference for the rest of a child’s life.

This statement is supported by an alliance of networks covering more than 300 NGOs from all over the world: Drug Policy Futures European Cities Against Drugs IOGT International Smart Approaches to Marijuana World Federation Against Drugs Active – Sobriety, Friendship and Peace Recovered Users Network EURAD – A network for prevention, treatment and recovery Actis – Norwegian Policy Network on Alcohol and Drugs FORUT – Campaign for Development and Solidarity

Source:  http://drugpolicyfutures.org/  2017

‘What can we do?’ This was the question that dominated the weekend’s news and current affairs in the aftermath of the Westminster ‘terror’ attack. We still do not know if it was organised by so-called Islamic State or, as seems increasingly likely, was the savage work of a ‘lone wolf’.

The discussion I heard on Any Questions centred on rooting out radicalisation, smartening up security, or accepting ‘the new normal’ that the likes of Sadiq Khan and Dominic Grieve (the security services have done well and something was bound to happen at some point) seem resigned to – a world where increasingly frequent human sacrifices are subliminally accepted as a price worth paying to protect our democracy and ‘our way of life’.

Two factors were not considered. One, the role of family dysfunction and two, the role of drugs, in catalysing the sort of violence perpetrated in Westminster last Wednesday.

From the moment he was born to a 17-year-old lone mother, Adrian Ajao was statistically at risk. Newspapers referred to his ‘well to do’ Home Counties upbringing but of far more significance for this baby’s future life path was a birth certificate that listed only his mother. I am not asking you to weep but to accept, statistically, that Adrian didn’t get off to a very good start. The hard statistical fact is that children who live continuously with lone mothers have poorer cognitive and socio-emotional outcomes compared to children who have biological fathers as a stable part of the household and family life.

Any idea that the presence of a stepfather helps can be forgotten. It doesn’t stack up statistically either – children are no less at risk of poor outcomes in step households. Adrian adopted his stepfather’s name only symbolically to abandon it later.

While some children in Africa are named after the unfortunate circumstances they are born to, in the modern West the unfortunate circumstance is not to have a biological father to name you.

Here is where the trajectory from pain to violence begins. As the young Adrian hit his late teens, his chances of his hitting drugs too were high. From the graphic descriptions volunteered by former friends it was to prove disastrous. Cannabis, it seems likely, triggered the psychosis that was a key factor in his increasingly psychotic and violent behaviour.

Before his final horrific killing spree in Westminster last week, Khalid Masood (as he became) had gone from troubled teen to terror of his neighbourhood; once he tried to run a neighbour down and the wife he married in 2004 fled for her life. He would be jailed twice for slashing people with knives.

For anyone in a culture of denial about cannabis, schizophrenia and violence let me refer them to the epidemiological evidence in the public domain. It not only identifies cannabis use as a risk factor for schizophrenia, but in individuals with a predisposition for schizophrenia, it results in an exacerbation of symptoms and worsening of the schizophrenic prognosis (Simona A. Stilo,MD; Robin M. Murray RM. Translational Research 2010: The epidemiology of schizophrenia: replacing dogma with knowledge. Dialogues Clin Neurosci. 2010 Sep;12(3):305–315). A recently published Cambridge Study in Delinquent Development – a 50-year cohort study – has categorically found that cannabis caused a seven-fold increase in a violent behaviour and that continued use of cannabis over the lifetime of the study was strongest predictor of violent convictions, even when all other factors that contributed to violent behaviour were accounted for. A study of Norwegian youths similarly found an association between cannabis use and violence and that frequency of cannabis use relates to frequency of incidents of violent behaviour. The preliminary findings of another study have found the changes in brain function that suggest the mechanism for cannabis-induced violence.

Ajao is not the only young British drug user to become prone to sudden bursts of violence, to dream about killing someone or to harbour a blood lust. Our NHS psychiatric wards are full of them on anti-psychotic medication to stop them hearing voices while they yet still abuse cannabis.

An analysis of hospital episode statistics I investigated a few years ago revealed the extent of the cannabis mental health crisis in the UK, despite an overall fall in use. Between 1998 and 2011, mental and behavioural disorders due to cannabis use increased overall by 54 per cent. This included an 108 per cent increase in harmful use episodes, a 51 per cent increase in dependence, a 61.8 per cent increase in psychotic disorders, and a 450 per cent increase in ‘other mental and behavioural disorders. Drug-related hospital admissions have reached record highs too in recent years. Most, 70 per cent are men and most of these are young men. The science is there for the behavioural unit in the Home Office to investigate, as Amber Rudd promised would be the case last year when she was asked.

Since Wednesday police have been searching for explanations for Khalid Masood’s violence. They are checking all possible contacts with ISIL cells and the influence of Islamist radicals, quite rightly. Masood, I have no doubt, was ripe for radicalisation in his own unhappy quest for personal ‘justice’.

Like Lee Rigby’s killers before him, I suspect the drugs came first and the conversion followed, giving a purpose to the violent impulses lurking within. Newspaper columnist Peter Hitchens has been right to ask what violent killers have in common and to ask whether it is dope that may be the real mind-blowing terror threat in our midst and where dysfunctional families abound. For the fact is that mental illness, triggered by cannabis, increases the risk of aggressive behaviour, crime and violence.

British longitudinal data on cannabis use and schizophrenia shows that the incidence of schizophrenia in South London doubled between 1965 and 1999. The study uniquely allowed for the examination of trends in cannabis use prior to first presentation with schizophrenia. The greatest increase was found in people under 35. Its author Professor Sir Robin Murray has suggested that up to 20 per cent of schizophrenia cases could be cannabis attributable.

Despite all this, the Government in the UK has kept its head in the sand over this public health and safety time bomb. It has never fulfilled its pledge to run a major public health education campaign.

The evidence should tell Amber Rudd’s Home Office ‘behaviour unit’ that it is overdue, as is committed policing to protect young men at risk.  This has to be part of any prevention strategy in response to the carnage in Westminster last week. The link between cannabis and violence, as I argued before, can no longer be ignored.

Source:  http://www.conservativewoman.co.uk/kathy-gyngell-did-cannabis-trigger-westminster-killers-madness/   28th March 2017 

The Director of the NDPA, Peter Stoker, visited Vancouver East Side in 1999.  It was tragic to see drug dependent men and women living rough on the streets – in the alleys behind the main road – injecting in public.  A team of police officers called The Odd Squad worked the area and did everything they could to help these people – producing a great video called ‘Through the Blue Lens’ – we took this video into schools and it was the most powerful drug prevention message we had ever used.  We would urgently ask you to see this video on You Tube – https://www.youtube.com/watch?v=gwFRsfATaag

The article below is covering the same story – 19 years later.  Isn’t it about time that Canada began to promote good drug prevention instead of relaxing their drug laws? 

As overdose deaths spike, provincial health officials say more overdose prevention sites will soon open across the province.

The number of overdose deaths related to illicit drugs in British Columbia leapt to 755 by the end of November, a more than 70-per-cent jump over the number of fatalities recorded during the same time period last year.

In August, 50 people died of drug overdoses in British Columbia.  In September, 57 died. In October, the number jumped to 67 — an increase that worried health officials, who had thought that increasing the supply and training for administering the overdose reversal drug naloxone was making a difference.

In November, drug overdoses caused 128 deaths — 61 more than the previous month, and nearly double the October total. That spike has brought the total number of deaths between January and November to 755, the highest number ever recorded by the BC Coroner and a 70 per cent increase over this time last year

“We’re quite fearful that the drug supply is increasingly toxic, it’s increasingly unpredictable, and it’s very, very difficult to manage,” said Lisa Lapointe, B.C.’s chief coroner, referring to the increasing prevalence of the synthetic opioid fentanyl being added to many illicit drugs.  “Those who…attempt to use drugs safely, it’s almost impossible.”

With advance notice from the coroner that November numbers would be much higher, provincial health officials announced three weeks ago that several overdose prevention sites would open in Vancouver, Surrey and Victoria. People can go inside the sites to inject drugs, and are given first aid if they overdose.

An unofficial safe consumption site located in the alley behind the Downtown Eastside Market off East Hastings Street.

Health officials have insisted the sites are temporary and are not supervised injection sites, which are currently difficult to open because of a strict Conservative-era law that current federal health minister Jane Philpott has promised to change.

If there is any good news to be found within the grim statistics, it is that no deaths have occurred at any of those overdose prevention sites. And no one has died at a volunteer-run tent that has been operating since September, without official permission or government funding, out of an alley in the heart of the Downtown Eastside. People can smoke or snort drugs at that site, not just inject.

“We’re pretty steady, we get about 100 people a day,” said Sarah Blyth, the Downtown Eastside market coordinator and one of the organizers of the tent. “We’re coming up to welfare (day)…it’s happening this Wednesday, so I imagine up until Christmas it’s going to be pretty busy.”

A sign on the front door of VANDU’s storefront at 380 E. Hastings advertises that the location is an overdose prevention site, with volunteers trained in first aid

“A lot of people use during Christmas,” Blyth added. “Not everybody’s Christmas is as happy as others.”  At the Vancouver Area Network of Drug Users storefront further down East Hastings Street, Linda Bird confirmed the overdose prevention site located there has been busy, with around 60 people a day passing through. Volunteers, who are paid a small stipend by Vancouver Coastal Health, work two to four hour shifts. Overdoses are common, small stipend by Vancouver Coastal Health, work two to four hour shifts. Overdoses are a small stipend by Vancouver Coastal Health, work two to four hour shifts. Overdoses are common, Bird said.

“A lot of them are taking this very, very seriously,” Bird said of the volunteers. “It’s a crisis and a lot of them have seen their friends dropping.”

Vancouver Coastal Health has announced a fourth overdose prevention site in Vancouver, while Fraser Health has added more sites in Langley, Abbotsford and Maple Ridge.

Overdose deaths in November were nearly double the number seen in October

Health authorities in the Interior, Vancouver Island and the north are also planning to open sites in the future, said Perry Kendall, B.C.’s health officer.  “We’re still struggling in many communities with the idea of having these (overdose prevention) sites open,” Kendall said. “That doesn’t help.”

He urged the federal government to introduce the new legislation as soon as possible.

“You must use (drugs) in the presence of somebody who can help you,” Lapointe emphasized. “We are seeing people die with a naloxone kit open beside them, but they haven’t even had time to use it. We are seeing people die with a needle in their arm or a tablet nearby…You must go somewhere where someone is able to give you immediate medical assistance.”

Source:  http://www.metronews.ca/news/vancouver/2016/12/19/bc-drug-deaths

The country with the biggest weed habit?    That might surprise you

Though cannabis is not actually legal in the Netherlands, it can be widely consumed in the country’s infamous coffee shops.

However, despite the ubiquity of the drug, Dutch citizens are not the world’s biggest tokers: according to the United Nations Office on Drugs and Crime (UNODC), that dubious distinction goes to Iceland.

Top 30 cannabis consuming countries

1. Iceland – 18.3% (prevalence of use as percentage of population)

2. US – 16.2%

3. Nigeria – 14.3%

4. Canada – 12.7%

5. Chile – 11.83%

6. France – 11.1%

7. New Zealand – 11%

8. Bermuda – 10.9%

9. Australia – 10.2%

10. Zambia – 9.5%

11. Uruguay – 9.3%

12. Spain – 9.2%

13. Italy – 9.2%

14. Madagascar – 9.1%

15. Czech Republic – 8.9%

16. Israel – 8.88%

17. St Lucia – 8.87%

18. Belize – 8.45%

19. Barbados – 8.3%

20. Netherlands – 8%

21. Greenland – 7.6%

22. Jamaica – 7.21%

23. Denmark – 6.9%

24. Switzerland – 6.7%

25. Egypt – 6.24%

26.UK – 6.2%

27. Ireland – 6%

28. Estonia – 6%

29. Bahamas – 5.54%

30. Sierra Leone – 5.42%

The UNODC’s data suggests that cannabis is used by 18.3 per cent of Iceland’s population (aged 15-64). The US (16.2 per cent) and Nigeria (14.3 per cent) had the second and third highest rates of consumption; the UK came 26th on the list, followed by Ireland. And the Netherlands? It came 20th.

Data is not available for all of the world’s countries – and some figures have been updated more recently than others – meaning caution should be exercised when drawing comparisons.

Source:  http://www.telegraph.co.uk/travel/maps-and-graphics/mapped-the-countries-that-smoke-the-most-cannabis/    1st Dec. 2016