Addiction Advocacy Needs A Bill Gates, David Geffen, Warren Buffett, Or Tom Steyer

Addiction doesn’t need someone to put their name on a building, or name a research institute. Addiction desperately needs bold philanthropists who want to leverage the people power of the grassroots. Addiction and drug overdoses claim one life every four minutes in America. In the time it takes to order a latte, someone dies—from an illness that is highly treatable. The addiction crisis is the result of social prejudice; criminal justice policies that incarcerate people with addiction instead of giving them treatment; health care policies that make it difficult or impossible to get medical help for substance use disorders; ignorance; and “abstinence-only” drug policies that are ineffective and backwards.

The fact is, people who struggle with substance use disorder are treated like second-class citizens. Admitting there’s a problem can mean losing your job, home, and custody of your children. That makes addiction a civil rights issue. And, thanks to the work of advocates across the nation, it’s finally being recognized as a moral issue, as well. Thought leaders like Tom Steyer are helping to drive this message home. I first met Tom during the Democratic National Convention. I had just shared my experience with addiction and recovery when Tom approached me. I was taken aback by the story he shared. He, too, lost someone very dear to him due to addiction: his best friend, who struggled with addiction for decades. His friend contracted HIV and Hepatitis C through drug use, and died of medical complications due to his illnesses. A few months later, Tom joined me at the Facing Addiction in America summit in Los Angeles, where we invited him to share his story on stage with the U.S. Surgeon General. As Tom talked, tears filled my eyes. He said, “We must embrace our shared humanity and recognize that addiction is a deadly, chronic illness, not a personal failing.” I’d lost friends, too. I was at risk, too. It was time to bridge the gap between policies and public awareness.

People like Tom Steyer and other pioneering philanthropists, who give tens of millions to progressive causes such as medical research, environmental causes, and water quality, must also step up to end the addiction crisis in America. Our fight is America’s fight. The sooner they do, the quicker we can heal this nation from our generation’s most urgent public health crisis.

Working alongside lobbyists, nonprofit groups, social organizers, and peer recovery groups, they can help fill the gaps left by policies and laws that omit or punish people with substance use disorder. As the current administration takes steps toward a health care bill that will leave people suffering from addiction without medical care, these philanthropic giants are in a unique position to help. Why? Because their involvement would not be tied to political party or personal gain. Rather, they would focus on the solution, plain and simple.

Addiction should be one of the issues on the list of social problems we urgently address, next to finding a cure for cancer and ending childhood hunger. Addiction permeates the social fabric of America. Nobody is exempt. As many people suffer from addiction as diabetes; more people use pain medications than tobacco products. For every person who’s developed full blown substance use disorder, another dozen are on the road to addiction. Substance use disorder affects every corner of society, including our collective health, family unity, the economy, workplace productivity, and our reliance on social programs. It also keeps jails full of people who may struggle to find jobs to support their families once they’re released, and will never be able to vote again.

The recovery advocacy movement has been built slowly, through the efforts of individuals and highly fragmented groups. We have an incredible grassroots movement that addresses an issue that directly impacts one in every three families in America, and indirectly touches all of us. But fundraising for recovery advocacy has been largely through family and friend donations—which, although heartfelt, aren’t sufficient to fund serious research, create desperately needed social infrastructure, or provide education about the true nature of addiction. While organizations dedicated to battling cancer, heart disease, and diabetes raise hundreds of millions of dollars annually, the “addiction field,” such as it is, raises perhaps $25 million from private sources. This is unconscionable.

Gates, Geffen, Buffett, Steyer, and other philanthropic giants have the potential to be visionaries in this space. They could quickly stem the addiction epidemic without waiting for policy makers to hammer out yet another law that places people’s recovery at risk. They could find the solution that keeps families intact. With their help, nobody will lose another friend to this disease or the health problems that come with it. Bob and Suzanne Wright demonstrated the power and possibility of this kind of giving when they funded Autism Speaks. Their philanthropy helped move autism front and center: why not do the same for addiction?

What will our society, our culture, be like when we finally take addiction out of the equation? For many people, and their families, the answer is coming much too slowly.

It’s time to apply our knowledge, build a coalition, and offer the solutions our country so desperately needs. It’s time to change the framework of this crisis and confront our deepest values. Instead of punishment, we need to help the people who are sick—dying from this illness. It’s time to work together and end America’s addiction crisis for good.

What we need now is for America’s philanthropic visionaries to step up to help us dramatically accelerate the pace of progress in this urgent effort. Addiction doesn’t need someone to put their name on a building, or name a research institute. Addiction desperately needs bold philanthropists who want to leverage the people power of the grassroots. Ryan Hampton is an outreach lead and recovery advocate at Facing Addiction, a leading nonprofit dedicated to ending the addiction crisis in the United States.

Source:  http://www.huffingtonpost.com/entry/addiction-advocacy-needs-a-bill-gates-david-geffen_us_592ddfaae4b075342b52c0f5   30th May 20127

As Cpl. Kevin Phillips pulled up to investigate a suspected opioid overdose, paramedics were already at the Maryland home giving a man a life-saving dose of the overdose reversal drug Narcan.

Drugs were easy to find:  a package of heroin on the railing leading to a basement; another batch on a shelf above a nightstand.

The deputy already had put on gloves and grabbed evidence baggies, his usual routine for canvassing a house.  He swept the first package from the railing into a bag and sealed it; then a torn Crayola crayon box went from the nightstand into a bag of its own.  Inside that basement nightstand:  even more bags, but nothing that looked like drugs.

Then—moments after the man being treated by paramedics come to—the overdose hit.

“My face felt like it was burning.  I felt extremely lightheaded.  I felt like I was getting dizzy,” he said.  “I stood there for two seconds and thought, ‘Oh my God, I didn’t just get exposed to something.’ I just kept thinking about the carfentanil.”

Carfentanil came to mind because just hours earlier, Phillips’ boss, Harford County Sheriff Jeffrey Gahler, sent an e-mail to deputies saying the synthetic opioid so powerful that it’s used to tranquilize elephants had, for the first time ever, showed up in a toxicology report from a fatal overdose in the county.  The sheriff had urged everyone to use extra caution when responding to drug scenes.

Carfentanil and fentanyl are driving forces in the most deadly drug epidemic the United States has ever seen.  Because of their potency, it’s not just addicts who are increasingly at risk—it’s those tasked with saving lives and investigating the illegal trade.  Police departments across the U.S. are arming officers with the opioid antidote Narcan.  Now, some first responders have had to use it on colleagues, or themselves.

The paramedic who administered Phillips’ Narcan on May 19 started feeling sick herself soon after;  she didn’t need Narcan but was treated for exposure to the drugs.

Earlier this month, an Ohio officer overdosed in a police station after bushing off with a bare hand a trace of white powder left from a drug scene.  Like Phillips, he was revived after several doses of Narcan.  Last fall, SWAT officers in Hartford, Connecticut, were sickened after a flash-bang grenade sent particles of heroin and fentanyl airborne.

Phillips’ overdose was eye-opening for his department, Gahler said.  Before then, deputies didn’t have a protocol for overdose scenes; many showed up without any protective gear.

Gahler has since spent $5,000 for 100 kits that include a protective suit, booties, gloves, and face masks.  Carfentanil can be absorbed through the skin and easily inhaled. and a single particle is so powerful that simply touching it can cause an overdose, Gahler said.  Additional gear will be distributed to investigators tasked with cataloguing overdose scenes—heavy-duty gloves and more robust suits.

Gahler said 37 people have died so far this year from overdoses in his county, which is between Baltimore and Philadelphia.  The county has received toxicology reports on 19 of those cases, and each showed signs of synthetic opioids.

“This is all a game-changer for us in law enforcement,” Gahler said.  “We are going to have to re-evaluate daily what we’re doing.  We are feeling our way through this every single day . . . we’re dealing with something that’s out of our realm.  I don’t want to lose a deputy ever, but especially not to something the size of a grain of salt.”

Source:  – Erie Times-News, Erie, Pa. – May 28, 2017 – www.goerie.com  The Associated Press

Ohio had the most overdose fatalities in the United States in 2014 and 2015.

A newspaper’s survey of county coroners has painted a grim picture of fatal overdoses in Ohio: more than 4,000 people died from drug overdoses in 2016 in the state badly hit by a heroin and opioid epidemic.

At least 4,149 died from unintentional overdoses last year, a 36 percent climb from the previous year, or a time when Ohio had the most overdose fatalities in the United States so far.

“They died in restaurants, theaters, libraries, convenience stores, parks, cars, on the streets and at home,” wrote The Columbus Dispatch in its report revealing the findings.

Survey Findings

It’s likely getting worse, too, as coroners warned that overdose deaths this year are fast outpacing these figures brought on by overdoses from heroin, synthetic opioids fentanyl and carfentanil, and other drugs.

The Dispatch obtained the number by getting in touch with coroners’ offices in all 88 Ohio counties. Coroners in six smaller counties, according to the paper, did not provide the requested figures.

Leading the counties in rapid drug overdose rises are counties such as Cuyahoga, where there were 666 deaths in 2016, as well as Franklin, Hamilton, Lucas, Montgomery, and Summit.

The devastation, added the survey, did not discriminate against big or small cities and towns, urban or rural areas, and rich and poor enclaves.

“It’s a growing, breathing animal, this epidemic,” said Medina County coroner and ER physician Dr. Lisa Deranek, who has sometimes revived the same overdose patients a few times each week.

Fentanyl Overdoses

Cuyahoga County, which covers Cleveland, had its death toll largely blamed on fentanyl use. Heroin remains a leading killer, but the autopsy reports reflected the major role of fentanyl, a synthetic opiate 50 times stronger than morphine, and animal tranquilizer carfentanil.

“We’ve done so much, but the numbers are going the other way. I don’t see the improvement,” said William Denihan, outgoing CEO of Cuyahoga County Alcohol, Drug Addiction and Mental Health Services Board.

Cuyahoga County had 400 fentanyl-linked deaths from Nov. 21 in 2015 to Dec. 31 last year, more than double related deaths of all previous years in combination. The opioid crisis, too, no longer just affected mostly white drug users, but also minority communities.

Dr. Thomas Gilson, medical examiner of Cuyahoga County, warned that cocaine is now getting mixed into the fentanyl distribution and fentanyl analogs in order to bring the drugs closer to the African-American groups.

Plans And Prospects

The state’s Department of Mental Health and Addiction Services stated that the overdose death toll back in 2015 would have been higher if not for the role of naloxone, an antidote use for opioid overdose cases. It has been administered by family members, other drug users, and friends to revive dying individuals.

State legislature moved to make naloxone accessible in pharmacies without a prescription. Ohio topped the nation’s drug overdose death numbers in 2014 and 2015. In the latter year, it was followed by New York, according to an analysis by the Kaiser Family Foundation using statistics from the U.S. Centers for Disease Control and Prevention.

Experts are pushing for expanding drug prevention as well as education initiatives from schoolkids to young and middle-aged adults, which also make up the bulk of dying people.

And while the state pioneered in crushing “pill mills” that issue prescription painkillers, health officials warned that this sent addicts to heroin and other stronger substances.

Naloxone, too, is merely an overdose treatment and not a cure for the growing addiction. Last May 22 in Pennsylvania, two drug counselors working to help others battle their drug addiction were found dead from opioid overdose at the addiction facility in West Brandywine, Chester County.

Source:  http://www.techtimes.com/articles/208540/20170529/ohio-leads-in-nations-fatal-drug-overdoses-with-4-000-dead-in-2016-survey.htm  29.05.17

“I wish that all families would at least consider investigating medication-assisted treatment and reading about what’s out there,” says Alicia Murray, DO, Board Certified Addiction Psychiatrist. “I think, unfortunately, there is still stigma about medications. But what we want people to see is that we’re actually changing the functioning of the patient.” Essentially, medication-assisted treatment (MAT) can help get a patient back on track to meeting the demands of life – getting into a healthy routine, showing up for work and being the sibling, spouse or parent that they once were. “If we can change that with medication-assisted treatment and with counselling,” says Murray, “that’s so valuable.” The opioid epidemic is terrifying, especially so for a parent of someone already struggling with prescription pills or heroin use. It’s so important to consider any and all options for helping your child recover from their opioid dependence.

Part of the reason it’s so hard to overcome an opioid addiction is because it rewires your brain to focus almost exclusively on the drug over anything else, and produces extreme cravings and withdrawal symptoms as a result. By helping to reduce those feelings of cravings and withdrawal, medication-assisted treatment can help your son or daughter’s brain stop thinking constantly about the drug and focus on returning to a healthier life.

Medication-assisted treatment is often misunderstood. Many traditional treatment programs and step-based supports may tell you that MAT is simply substituting one addictive drug for another. However, taking medication for opioid addiction is like taking medication for any other chronic disease, such as diabetes or asthma. When it is used according to the doctor’s instructions and in conjunction with therapy, the medication will not create a new addiction, and can help.

As a parent, you want to explore all opportunities to get your child help for his or her opioid addiction, and get them closer and closer to functioning as a healthy adult – holding down a job, keeping a regular schedule and tapering, and eventually, stopping their misuse of opioids. Medication-assisted treatment helps them do that.

“MAT medications are most effective when they are used in conjunction with therapy and recovery work. We would never recommend medication over other forms of treatment. We would recommend it in addition to it.”

The three most-common medications used to treat opioid addiction are:

· Naltrexone (Vivitrol)

· Buprenorphine (Suboxone)

· Methadone

NALTREXONE

Naltrexone, known by its brand-name Vivitrol, is administered by a doctor monthly through an injection. Naltrexone is an opioid antagonist. Antagonists attach themselves to opioid receptors in the brain and prevent other opioids such as heroin or painkillers from exerting the effects of the drug. It has no abuse potential.

BUPRENORPHINE

Buprenorphine, known by its brand-name Suboxone, is an oral tablet or film dissolved under the tongue or in the mouth prescribed by a doctor in an office-based setting. It is taken daily and can be dispensed at a physician’s office or taken at home. Buprenorphine is a partial agonist. Partial agonists attach to the opioid receptors in the brain and activate them, but not to the full degree as agonists. If used against the doctor’s instructions, it has the potential to be abused.

METHADONE

Methadone is dispensed through a certified opioid treatment program (OTP). It’s a liquid and taken orally and usually witnessed at an OTP clinic until the patient receives take-home doses. Methadone is an opioid agonist. Agonists are drugs that activate opioid receptors in the brain, producing an effect. If used against the doctor’s instructions, it has the potential to be abused. There is no “one size fits all” approach to medication-assisted treatment, or even recovery. Recovery is individual.

The most important thing to do is to consider all of your options, and speak to a medical professional to determine the best course of action for your family. The best path is the path that helps and works for your child.

Source:  http://drugfree.org/parent-blog/medication-assisted-treatment/  19th May 2017

During the 2015 election, the Liberals campaigned on a plan to greenlight marijuana for recreational use to keep it out of the hands of children and the profits out of the hands of criminals.

The party’s election platform said Canada’s current approach — criminalizing people for possession and use — traps too many Canadians in the justice system for minor offences.

Last month, the government spelled out its plans in legislation, setting sweeping policy changes in motion.  The new law proposes setting the national minimum age to legally buy cannabis at 18 years old. It will be up to the provinces should they want to restrict it further.

Is it true, as Wilson-Raybould and the Liberals suggest, that legalization will in fact keep cannabis out of the hands of kids?

Spoiler alert: The Canadian Press Baloney Meter is a dispassionate examination of political statements culminating in a ranking of accuracy on a scale of “no baloney” to “full of baloney” (complete methodology below)

This one earns a lot of baloney — the statement is mostly inaccurate but contains elements of truth. Here’s why:

THE FACTS

There is no doubt cannabis is in the hands of young people today.

In fact, Canada has one of the highest rates of teenage and early-age adulthood use of marijuana, says Dr. Mark Ware, the vice-chair of the federally-appointed task force on cannabis and a medicinal marijuana researcher at McGill University.

“We don’t anticipate that this is going to eliminate it; but the public health approach is to make it less easy for young adolescents, young kids, to access cannabis than it is at the moment,” he said.

Bonnie Leadbeater, a psychology professor at the University of Victoria who specializes in adolescent behaviour, said as many as 60 per cent of 18-year-olds have used marijuana at some point in their lives.

The aim of a regulated, controlled system of legalized cannabis is to make it more difficult for kids to access pot, Ware said, noting the principle goal is to delay the onset of use.

So will a recreational market for adults coupled with a regulatory regime really keep pot out of the hands of kids?

THE EXPERTS

Public health experts — including proponents of legalization — say that probably won’t happen.

“I don’t exactly know what they are planning to do to keep it out of the hands of young people and I think some elaboration of that might be helpful,” Leadbeater said. “It is unlikely that it will change … it has been very, very accessible to young people.”

Benedikt Fischer, a University of Toronto psychiatry professor and senior scientist with the Centre for Addiction and Mental Health, agrees the expectation that legalization will suddenly reduce or eliminate use among young people is counter-intuitive and unrealistic to a large extent.

“The only thing we could hope for is that maybe because it is legal, all of a sudden it is so much more boring for young people that they’re not interested in it anymore,” he said.

Increasing penalties for people who facilitate access to kids will help discourage law-abiding Canadians from doing so, says Steven Hoffman, director of a global strategy lab at the University of Ottawa Centre for health law, policy and ethics.

“That being said, when there’s a drug, there’s no foolproof way of keeping it out of the hands of all children,” Hoffman said. “For sure, there will still be children who are still consuming cannabis.”

Cannabis will not be legal for people of all ages under the legislation, he added, noting this means there may still be a market for criminal activity for cannabis in the form of selling it to children.

In Colorado, officials thought there would be an increase in use as a result of legalization, according to Dr. Larry Wolk, chief medical officer at the Department of Public Health and Environment, but he said there’s been no increase among either youth or adults.    Nor has there been a noticeable decrease.

“What it looks like is folks who may have been using illicitly before are using legally now and teens or youth that were using illicitly before, it’s still the same rate of illicit use,” he said.

THE VERDICT

Donald MacPherson, executive director of the Canadian Drug Policy Coalition, said the Liberal government could provide a more nuanced, realistic message about its plans to legalize marijuana.

“To suddenly go over to the rhetoric … that strict regulation is going to keep it out of the hands of young people doesn’t work,” he said.

“There’s a better chance of reducing the harm to young people through a … public health, regulatory approach. That’s ideally what they should be saying.”

Careful messaging around legalized marijuana — like the approach taken by the Netherlands — could make cannabis less of a tempting forbidden fruit for young people, said Mark Haden, an adjunct professor at the University of British Columbia.

“What we know is that prohibition maximizes the engagement of youth, so if we did it well and skillfully and ended prohibition with a wise approach and made cannabis boring, it would keep it out of the hands of kids,” he said.

“It isn’t completely baloney, it just hasn’t gone far enough in terms of a rich, real discussion. It is just political soundbites.”

For this reason, Wilson-Raybould’s statement contains “a lot of baloney.”

METHODOLOGY

The Baloney Meter is a project of The Canadian Press that examines the level of accuracy in statements made by politicians. Each claim is researched and assigned a rating based on the following scale:

· No baloney – the statement is completely accurate

· A little baloney – the statement is mostly accurate but more information is required

· Some baloney – the statement is partly accurate but important details are missing

· A lot of baloney – the statement is mostly inaccurate but contains elements of truth

· Full of baloney – the statement is completely inaccurate

Source:   http://www.ctvnews.ca/politics/fact-check-will-legalizing-pot-keep-it-out-of-the-hands-of-kids-1.3397542   4th May 2017

The first to die was the family’s pet duck, killed in an attempt to rid the house of evil.

By then, Raina Thaiday had already been on a cleaning frenzy for a week, scrubbing the ceilings of her Cairns home and tossing possessions out into the yard in a bid to “cleanse” the house.  But it was when she heard a dove’s call, which she interpreted as a sign from God, that she decided she must “kill her children in order to save them”.

The Mental Health Court of Queensland last month ruled, in a decision not made public until Thursday, that Raina Mersane Ina Thaiday was of unsound mind when she stabbed to death seven of her children and a niece in her home on December 19, 2014.

In 2009, Raina Thaiday was interviewed thanking paramedics for safely delivering her child in the back of an ambulance. Photo: Nine News

“To her way of thinking at the time, what she was doing was the best thing she could do for her children. She was trying to save them,” Justice Jean Dalton said, exempting the mother from trial and confining her to mental health treatment.

Along the way the court heard details of the 40-year-old’s descent into “schizophrenia at its very depths”, likely exacerbated by years of heavy cannabis use, and culminating in her being in a psychotic state when she killed eight children under the age of 15.

A week before the killing, her then-20-year-old son, Lewis Warria found Mrs Thaiday stressed and serious, spending large amounts of time lecturing him about God, the court heard.  She went on a mission to “cleanse” her house, which Justice Dalton noted went far beyond a “normal spring clean”.

“All the furniture from the house was taken outside and put in the yard,” she said.”Inside the house was cleaned, in a most unusual way, including scrubbing the ceilings and the walls and a lot of Mrs Thaiday’s possessions were thrown away.  “And a lot of them were quite valuable.”

Things deteriorated still further the night of December 18. Her eldest daughter, niece and godchild had gone out shopping and did not return at 10pm as she had requested. Mrs Thaiday walked up and down the street, “preaching” to neighbours about their use of drugs and alcohol.  Agitated, she slept outside on a mattress dragged out in the cleaning.

Justice Dalton said with the benefit of hindsight, the things neighbours heard as Mrs Thaiday walked up and down the street, talking to herself or on the phone, were “clearly psychotic”.  “She was saying things like ‘I am the chosen one’,” the judge said.

“‘I have the power to kill people and to curse people. You hurt my kids, I hurt them first. You stab my kids, I stab them first. If you kill them, I’ll kill them’.”

At 11.40am on December 19, Mr Warria arrived home to find his mother slumped on the front verandah, covered in approximately 35 self-inflicted stab wounds that included a punctured lung. His siblings and cousin were dead inside.

Nearly two-and-a-half years later Mr Warria was in the courtroom inside Brisbane’s Queen Elizabeth II Courts of Law as a judge heard the opinions of six psychiatrists who had painstakingly analysed his mother’s mental state.

The court heard when police and paramedics arrived Mrs Thaiday immediately admitted she had killed the children inside. “Papa God” had been speaking to her, she told

psychiatrists, describing herself as the “anointed one” at risk from demons, who had to rid her Cairns home of an evil presence.

Psychiatrist Dr Angela Voita treated Mrs Thaiday from the day she came into The Park, one of Australia’s largest mental health facilities, on Christmas Eve 2014, five days after the mass killing.  She assessed her more than 50 times and, along with three other psychiatrists who gave evidence to the hearing, unanimously agreed she was mentally ill at the time of the offences.

After examining reams of evidence and interviews, Dr Voita said her patient was not capable of telling right from wrong or being able to control her actions at the time of the killings.  Assisting psychiatrist Dr Frank Varghese described the “unique” crime as “a horrendous case, the likes of which I have never seen before, and hopefully will never see (again).”   This is not ordinary schizophrenia,” he advised the judge.

“This is schizophrenia at its very depths and at its worst in terms of the terror for the patient as well as for the consequences for the individuals killed as a result of psychotic delusions.”

Mrs Thaiday had no psychiatric history or previous contact with mental health services outside of counselling at a local indigenous health service.  Independent psychiatrist Dr Pamela van de Hoef said there was some evidence that in 2007 she was also very disturbed.

“She had cut all her own hair off and threatened to kill one of the children with an axe.”

In 2011, she had ideas to drown herself and similar thoughts two weeks out from the 2014 killing, the psychiatrist said. The court heard cannabis was commonly linked to the onset of schizophrenia in those already vulnerable to the illness.

Ms Thaiday kicked a 10-20 cone a day habit in the months before the slaughter, leading psychiatrists to question whether her “psychosis” was a form of withdrawal, before mostly rejecting the notion.

Instead, Dr Jane Phillips and Dr Donald Grant agreed it was more likely the illness began to affect her while she was still using cannabis, causing to her to develop “religious delusions” that “forced her to live a clean life”.

“Altogether it amounts to a very convincing body of evidence that Mrs Thaiday was psychotic at the time of the killing,” Justice Dalton said.

She ruled Mrs Thaiday had the defence of unsoundness of mind available to her and issued a forensic order for ongoing mental health treatment.

Source: http://www.brisbanetimes.com.au/queensland/schizophrenia-at-its-very-depths-drove-mother-to-kill-eight-children-20170503-gvyf42.html   4th May 2017

SAN FRANCISCO – Visits by teens to a Colorado children’s hospital emergency department and its satellite urgent care centers increased rapidly after legalization of marijuana for commercialized medical and recreational use, according to new research being presented at the 2017 Paediatric Academic Societies Meeting in San Francisco.

The study abstract, “Impact of Marijuana Legalization in Colorado on Adolescent Emergency Visits” on Monday, May 8 at the Moscone West Convention Center in San Francisco.

Colorado legalized the commercialization of medical marijuana in 2010 and recreational marijuana use in 2014. For the study, researchers reviewed the hospital system’s emergency department and urgent care records for 13- to 21-year-olds seen between January 2005 and June 2015.

They found that the annual number of visits with a cannabis related diagnostic code or positive for marijuana from a urine drug screen more than quadrupled during the decade, from 146 in 2005 to 639 in 2014.

Adolescents with symptoms of mental illness accounted for a large proportion (66%) of the 3,443 marijuana-related visits during the study period, said lead author George Sam Wang, M.D., FAAP, with psychiatry consultations increasing from 65 to 442. More than half also had positive urine drug screen tests for other drugs. Ethanol, amphetamines, benzodiazepines, opiates and cocaine were the most commonly detected.

Dr. Wang, an assistant professor of paediatrics at the University of Colorado Anschutz Medical Campus, said national data on teen marijuana use suggest rates remained roughly the same (about 7%) in 2015 as they’d been for a decade prior, with many concluding no significant impact from legalization. Based on the findings of his study, however, he said he suspects these national surveys do not entirely reflect the effect legalization may be having on teen usage.

“The state-level effect of marijuana legalization on adolescent use has only begun to be evaluated,” he said. “As our results suggest, targeted marijuana education and prevention strategies are necessary to reduce the significant public health impact of the drug can have on adolescent populations, particularly on mental health.”

Dr. Wang will present the abstract, “Impact of Marijuana Legalization in Colorado on Adolescent Emergency Department (ED) Visits,” from 8 a.m. to 10 a.m. Numbers in this news release reflect updated information provided by the researchers. The abstract is available at https://registration.pas-meeting.org/2017/reports/rptPAS17_abstract.asp?abstract_final_id=3160.11.

The Paediatric Academic Societies (PAS) Meeting brings together thousands of individuals united by a common mission: to improve child health and well-being worldwide. This international gathering includes paediatric researchers, leaders in academic paediatrics, experts in child health, and practitioners. The PAS Meeting is produced through a partnership of four organizations leading the advancement of paediatric research and child advocacy: Academic Paediatric Association, American Academy of Paediatrics, American Paediatric Society, and Society for Paediatric Research. For more information, visit the PAS Meeting online at www.pas-meeting.org, follow us on Twitter @PASMeeting and #pasm17, or like us on Facebook. For additional AAP News coverage, visit http://www.aappublications.org/collection/pas-meeting-updates.

Source:   http://www.aappublications.org/news/2017/05/04/PASMarijuana050417

 A New Agenda to  Turn Back the Drug Epidemic

Robert L. DuPont, MD, President , Institute for Behavior and Health, Inc.

A. Thomas McLellan, PhD, Senior Strategy Advisor , Institute for Behavior and Health, Inc.  May 2017

Institute for Behavior and Health, Inc. , 6191 Executive Blvd , Rockville, MD 20852 , www.IBHinc.org 1

Background 

The Institute for Behavior and Health, Inc. (IBH) is a 501(c)3 non-profit substance use policy and research organization that was founded in 1978. Non-partisan and non-political, IBH develops new ideas and serves as a force for change.

Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs and Health was published in November 2016. Four months later, in March 2017, IBH held a meeting of 25 leaders in addiction treatment, health care, insurance, government and research to discuss the scope and implications of this historic document. The US Surgeon General, VADM Vivek H. Murthy, MD, was an active participant in the meeting. The significance of this new Surgeon General’s Report is analogous to the historic 1964 Surgeon General’s report, Smoking and Health, a document that inspired an extraordinarily successful public health response in the United States that has reduced the rates of cigarette smoking by over 64% and continues its impact even today, more than 50 years following its release.

The following is a summary of the discussion at the March 2017 meeting and the conclusions and recommendations that were developed.

Introduction: The 2016 Surgeon General’s Report 

The two primary objectives of the US Surgeon General’s Report of 2016 are first to provide scientific evidence that shows that in addition to nicotine, other substance misuse and addiction issues (e.g., alcohol, opioids, marijuana, etc.) also are best understood and addressed as public health problems; and second to encourage the inclusion of addiction – its prevention, early recognition and intervention, treatment and active long-term recovery management – into the mainstream of American health care. At present these elements are not integrated either as a stand-alone continuum or within the general medical system. As is true for other widespread illnesses, addiction to nicotine, alcohol, marijuana, opioids, cocaine and other substances is a serious chronic illness. This perspective is contrary to the common perception that addiction reflects a moral failing, a personal weakness or poor parenting. Such opinions have stigmatized individuals who are suffering from these often deadly substance use disorders and have led to expensive and ineffective public policies that segregate prevention and treatment outside of mainstream medical care. A better public health approach encourages afflicted individuals and their family members to seek and receive help within the current health care system for these serious health problems.

An informed public health approach to reducing the prevalence and the harms associated with substance use disorders requires more than the brief treatment of serious cases. Particularly important are substance use prevention programs in schools, healthcare and in all other parts of the community to protect adolescents (ages 12 – 21), the group most at risk for the initiation of substance-related harms and substance use disorders.  Importantly, abundant tragic experience and accumulating science show that substance use disorders are not effectively treated with only short-term care. Because substance use disorders produce 2 significant long-lasting changes in the brain circuits responsible for memory, motivation, inhibition, reward sensitivity and stress tolerance, addicted individuals remain vulnerable to relapse years following specialized treatment.1, 2, 3 Thus, as is true for all other chronic illnesses, long periods of personalized treatment and monitoring are necessary to assure compliance with care, continued sobriety, and improved health and social function. In combination, science-based prevention, early intervention, continuing care and monitoring comprise a modern continuum of public health care. The overall goals of this continuum comport well with those of other chronic illnesses:

1 US Department of Health and Human Services (HHS), Office of the Surgeon General. (2016). Chapter 2. The Neurobiology of Substance Use, Misuse, and Addiction. In: Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS. Available: https://addiction.surgeongeneral.gov/

2 US Department of Health and Human Services (HHS), Office of the Surgeon General. (2016). Chapter 5. Recovery: The Many Paths to Wellness. In: Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS. Available: https://addiction.surgeongeneral.gov/

3 Betty Ford Institute Consensus Panel. (2007). What is recovery? A working definition from the Betty Ford Institute. Journal of Substance Abuse Treatment, 33(3), 221-228.

4 White, W. L. (2012). Recovery/remission from substance use disorders: An analysis of reported outcomes in 415 scientific reports, 1868-2011. Philadelphia, PA: Philadelphia Department of Behavioral Health and Intellectual Disability Services.

· sustained reduction of the cardinal symptom of the illness, i.e., substance use;

· improved general health and function; and,

· education and training of the patient and the family to self-manage the illness and avoid relapses.

In the addiction field achieving these goals is called “recovery.” This word is used to describe abstention from the use of alcohol, marijuana and other non-prescribed drugs as well as improved personal health and social responsibility.3,4 Over 25 million formerly addicted Americans are in stable, long-term recovery of a year or longer.4 Understanding how to consistently accomplish the life-saving goal of recovery must inform health care decisions.

The 2016 Surgeon General’s Report offers a science-informed vision and path to recovery in response to the nation’s serious addiction problem, including specifically the opioid overdose epidemic. Research shows that it is possible to prevent or delay most cases of substance misuse; and to effectively treat even the most serious substance use disorders with recovery as an expectable result of comprehensive, continuous care and sustained monitoring. To do this, substance use disorders must be recognized as serious, chronic health conditions that are both preventable and treatable. The nation must integrate the short-term siloed episodes of specialty treatment that now are isolated from mainstream healthcare into a fully integrated continuum of care comparable to that currently available to those with other chronic illnesses such as diabetes, hypertension, asthma and chronic pain.

Meeting Discussion and Conclusions 

The Surgeon General’s Report and the meeting convened by the Institute for Behavior and Health, Inc. (IBH) to promote its recommendations are significant responses to the expanding epidemic of opioid 3 and other substance use disorders, an epidemic that struck nearly 21 million Americans aged 12 and older in 2015 alone.5 That year saw more than 52,000 overdose deaths.6 This drug epidemic has devastated countless families and communities throughout the US. Unlike earlier and smaller drug epidemics, the current opioid epidemic is not limited to a few regions or communities or a narrow range of ethnicities or incomes in the United States. Instead it afflicts all communities and all socioeconomic groups; its impacts include smaller communities and rural areas as well as suburban areas and inner cities. Fuelled by the suffering of countless grieving families, the nation is in the early stages of confronting the new epidemic. A growing national determination to turn back this deadly epidemic has opened the door to innovation that is sustained by strong bipartisan political support for new and improved efforts in both prevention and treatment of substance use disorders.

5 Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series H-50). Available: http://www.samhsa.gov/data/

6 Rudd, R. A., Seth, P., David, F., & Scholl, L. (2016, December 30). Increases in drug and opioid-involved overdose deaths – United States. Morbidity and Mortality Weekly Report, 65(50-51), 1445-1452. Available: https://www.cdc.gov/mmwr/volumes/65/wr/mm655051e1.htm

7 Levy, S. J., Williams, J. F., & AAP Committee on Substance Use and Prevention. (2016). Substance use screening, brief intervention, and referral to treatment. Pediatrics, 138(1), e20161211. Available: http://pediatrics.aappublications.org/content/138/1/e20161211

8 US Department of Health and Human Services (HHS), Office of the Surgeon General. (2016). Chapter 3. Prevention Programs and Policies. In: Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS. Available: https://addiction.surgeongeneral.gov/

Abstinence is an Achievable Goal, both for Prevention and for Treatment 

Embracing and synthesizing the 30 years of science supporting the findings of the 2016 Surgeon General’s Report, the group discussed a single goal for the prevention of addiction: no use of alcohol, nicotine, marijuana or other non-prescribed drugs by youth for reasons of health. This goal should be the core prevention message to all children from a very young age. Health care professionals, educators and parents should understand the importance of this simple, clear health message. They should continue to reinforce this message of no-use for health as children grow to adulthood. Even when prevention fails, it is possible for parents, other family members, friends, primary care clinicians, educators and others to identify and to intervene quickly to stop youth substance use from becoming addiction.7

The science behind this ambitious but attainable prevention goal is clear. Alcohol, nicotine products, marijuana and other non-prescribed drug use is uniquely harmful to the still-developing brains of adolescents. Thus any substance “use” among youth must be considered “misuse” – use that may harm self or others. The goal of no substance use is not just for the purpose of preventing addiction, though that is one clear and important by product of successful prevention. Addiction is a biological process that can take years to develop. In contrast, even a single episode of high-dose use of alcohol or other substance could immediately produce an injury, accident or even death. While it is true that most episodes of substance misuse among adults do not produce serious problems, it is also true that substance misuse is associated with 70% or more of the injuries, disabilities and deaths of young people.8 These figures are even higher for minority youth. Many adolescent deaths are preventable 4 because most are related to substance use – including substance-related motor vehicle crashes and overdose.9

9 Subramaniam, G. A., & Volkow, N. D. (2014). Substance misuse among adolescents. To screen or not to screen? JAMA Pediatrics, 168(9), 798-799. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4827336/

10 Data analyzed by the Center for Behavioral Health Statistics and Quality. CBHS. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15- 4927, NSDUH Series H-50).

11 2014 data obtained by IBH from the Monitoring the Future study. For discussion of data through 2013 see DuPont, R. L. (2015, July 1). It’s time to re-think prevention; increasing percentages of adolescents understand they should not use any addicting substances. Rockville, MD: Institute for Behavior and Health, Inc. Available: https://www.ibhinc.org/s/IBH_Commentary_Adolescents_No_Use_of_Substances_7-1-15.pdf

Youth who use any one of the three most common “gateway” substances, i.e., alcohol, nicotine and marijuana, are many times more likely than those who do not use that single drug to use the other two substances as well as other illegal drugs.10 The use of any drug opens the door to an endless series of highly risky decisions about which drugs to use, how much to use, and when to use them. This perspective validates the public health goal for youth of no use of any drug.

Complete abstinence from the use of alcohol or any other drug among adolescents is not simply an idealistic goal – it is a goal that can be achieved. Data were presented at the meeting from the nationally representative Monitoring the Future study showing that 26% of American high school seniors in 2014 reported no use of alcohol, cigarettes, marijuana or other non-prescribed drugs in their lifetimes. 11 This is a remarkable increase from only 3% reported by American high school seniors in 1983. Moreover, in the same survey, 50% of high school seniors had not used any alcohol, cigarettes, marijuana or other non-prescribed substance in the past 30 days, up from 16% in 1982. These largely overlooked and important findings show that youth abstinence from any substance use is already widespread and steadily increasing.

In parallel with the goal of abstinence for prevention, the recommended goal for the treatment of those who are addicted is sustained abstinence from the use of alcohol and other drugs, with the caveat, explicitly acknowledged by the group, that individuals who are taking medications as-prescribed in the treatment of substance use disorders (e.g., buprenorphine, methadone and naltrexone) and who do not use alcohol or other non-prescribed addictive substances – are considered to be abstinent and ”in recovery.” Abstinence from all non-prescribed substance use is the scientifically-informed goal for individuals in addiction treatment. This treatment goal is widely accepted in the large national recovery community. The long-lasting effects of addiction to drugs are easily seen among cigarette smokers: smoking only a single cigarette is a serious threat to the former smoker, even decades after smoking the last cigarette. There is incontrovertible evidence from brain and genetic research showing the long-term effects of substance misuse on critical brain regions.2 It is unknown when or if these brain changes will return to being entirely normal following cessation of substance use; however, it is known that the recovering brain is particularly vulnerable to the effects of return to any substance use, often leading to overdose or rapid re-addiction. 5

Participants in the IBH meeting supported the idea that abstinence is the high-value outcome in addiction treatment; and that while any duration of abstinence is valuable, longer-term, stable abstinence of 5 years is analogous to the widely-used standard in cancer treatment of 5-year survival. The scientific basis for the value of sustained recovery is validated by the experience of the estimated 25 million Americans now in recovery. This increasingly visible recovery community is a remarkable and very positive new force in the country.

Measuring and Attaining these Goals 

The mantra from the IBH meeting was, if you don’t measure it, it won’t happen. The group of leaders recognized the paucity of current models for systematic integration of addiction treatment and general healthcare. The group encouraged the identification of promising models and the promotion of innovation to achieve the goal of sustained recovery. Even programs that include fully integrated care of other diseases, managed care and other comprehensive health programs do not reliably achieve the goal of sustained or even temporary recovery for substance use disorders. The meeting participants noted the absence of long-term outcome studies of the treatment of substance use disorders and encouraged all treatment programs not only to extend the care of discharged patients but also to systematically study the trajectories of discharged patients to improve their long-term treatment outcomes. The increasing range of recovery support services after treatment is an important and promising new trend that is now actively promoting sustained recovery.

Meeting participants noted one particularly promising model of public health goal measurement and attainment – the 90-90-90 goals for the treatment of HIV/AIDS: 90% of people with HIV will be screened to know their infection status; 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy; and 90% of all patients receiving antiretroviral therapy will have viral suppression (i.e., zero viral load).12 These measurable goals provide an operational definition of public health success for the country, states and individual healthcare organizations.

12 UNAIDS. (2014). 90-90-90: An Ambitious Treatment Target to Help End the AIDS epidemic. Geneva, Switzerland: Joint United Nations Programme on HIV/AIDS. Available: http://www.unaids.org/sites/default/files/media_asset/90-90-90_en_0.pdf

With this model as background, the IBH group concluded that a similar public health approach and similarly specific numeric goals should be established for preventing and treating substance use disorders. Examples of parallel national prevention goals could include 90% rates of screening for substance misuse among adolescents; 90% provision of interventions and follow-up for those screening positive; and 90% total abstinence rates among youth aged 12-21. While these are admittedly ambitious prevention goals, adoption of them could incentivize families, schools and communities to increase the percentage of youth who do not use any alcohol, nicotine, marijuana or other drugs every year.

A similar approach was adopted by the IBH group to improve the impact of addiction treatment. Again, there would be significant public health value if the US adopted the following goals: 90% of individuals aged 12 or older receive annual screening for substance misuse and substance use disorders; 90% of those who receive a diagnosis of a substance use disorder are referred and meaningfully engaged (at 6 least three sessions) in some form of addiction treatment; and 90% of those engaged in treatment achieve sustained abstinence as measured by drug testing, during and for six months following treatment.

Source:  IBH-Report-A-New-Agenda-to-Turn-Back-the-Drug-Epidemic  May 2017

In Southern Ohio, the number of drug-exposed babies in child protection custody has jumped over 200%.  The problem is so dire that workers agreed to break protocol to invite a reporter to hear their stories.  Foster care placements are at record levels, and the number of drug-exposed newborns in their custody has jumped over 200% in the past decade

Inside the Clinton County child protection office, the week has been tougher than most.

Caseworkers in this thinly populated region of southern Ohio, east of Cincinnati, have grown battle-weary from an opioid epidemic that’s leaving behind a generation of traumatized children. Drugs now account for nearly 80% of their cases. Foster-care placements are at record levels, and the number of drug-exposed newborns in their custody has jumped over 200% in the past decade. Funding, meanwhile, hasn’t budged in years.

“Many of our children have experienced such high levels of trauma that they can’t go into traditional foster homes,” said Kathi Spirk, director of Clinton County job and family services. “They need more specialized care, which is very expensive.”

The problem is so dire that workers agreed to break protocol and invite a reporter to camp out in a conference room and hear their stories. For three days, they relived their worst cases and unloaded their frustrations, in scenes that played out like marathon group therapy, for which they have no time. Many agreed that talking about it only made them feel worse, yet still they continued, one after another.

Hence the bad week.

Given the small size of their community, they asked that their names be changed out of concern for their own safety and the privacy of the children.

The caseworkers, like most, are seasoned in despair. Many worked in the 1990s when crack cocaine first arrived, followed by crystal meth in the early 2000s. In 2008, after the shipping giant DHL shuttered its domestic hub here in Wilmington and shed more than 7,000 jobs, prescription pill mills flourished while the economy staggered. Back then, a typical month saw 30 open cases, only a few of them drug-related. But the flood of cheap heroin and fentanyl, now at its highest point yet, has changed everything. A typical month now brings four times as many cases, while institutional knowledge has been flipped on its head.

“At least with meth and cocaine, there was a fight,” said Laura, a supervisor with over 20 years of experience. “Parents used to challenge you to not take their kids. And now you have them say: ‘Here’s their stuff. Here’s their formula and clothes.’ They’re just done. They’re not going to fight you any more.”

Heroin has changed how they approach every step of their jobs, they said, from the first intake calls to that painstaking decision to place a child into temporary foster care or permanent custody. Intake workers now fear what used to be routine.

“Occasionally, we’d get thrown a dirty house, something easy to close and with little trauma to the child,” said Leslie, another worker. “We’re not getting those any more.

Now they’re all serious, and most of them have a drug component. So you may get a dirty house, but it’s never just a dirty house.”

‘I had a four-year old whose mom had died in front of her and she described it like it was nothing’ Children come into the system in two ways. The first is through a court order after caseworkers deem their environment unsafe, and if no friends or family can be found.

Because of the added trauma, removing a child is always the last option, caseworkers said. But in a county with only 42,000 people spread out over 400 square miles, the magnitude of the epidemic has compromised an already delicate safety net. Relatives are overwhelmed financially. Multiple generations are now addicted, along with cousins, uncles, and neighbors. In many cases, a safe house with a grandparent or other relative will eventually attract drug activity.

Law enforcement will also bring children in, usually after parents overdose. These cases often reveal the most horrendous neglect: a three-year old who needed every tooth pulled because he’d never been made to brush them, or kids found sleeping on bug-infested mattresses, going to the toilet in buckets because the water had been shut off. Children are coming in more hardened, they said, older than their years.

“I had a four-year-old whose mom had died in front of her and she described it like it was nothing,” said Bridgette, another caseworker. “She knew how to roll up a dollar bill and snort white powder off the counter. That’s what she thought dollar bills were for.” She added that many of the children could detail how to cook heroin. One foster family had a five-year-old boy who put his medicine dropper in his shoe. “Because that’s where daddy hid his needles,” she said.

“The kids are used to surviving in that mess,” added Carole, another veteran. “Now all the sudden the system is going in and saying it’s not safe. All their survival instincts are taken away and they go ballistic. They don’t know what to do.”

During the first weeks of foster care, meltdowns, tantrums, and violence are common as children navigate new landscapes and begin to process what they’ve experienced.

One afternoon, the caseworkers brought in a foster couple who’d taken in two sisters, an infant born drug-exposed, and her four-year old sister. The baby had to be weaned off opioids and now suffered chronic respiratory problems. Part of her withdrawal had included non-stop hiccups. The older girl had lived with her parents in a drug house and displayed clear signs of post-traumatic stress. Once, a family friend sitting next to her in a car had overdosed and turned purple. She’d witnessed domestic abuse, and one day a neighbor shot and killed her dog while she watched (she’d let the dog out). After a meltdown at a classmate’s pool party, over a year after entering foster care, she revealed having seen a toddler drown in a pond while adults got high. Through therapy, she’d also revealed sexual assault. The foster mother described how the girl suffered flashbacks, triggered by stress and certain anniversaries, like the day of her removal, and other seemingly random events. When this happened, she slipped into catatonic seizures.

“Her eyes are closed and you can’t wake her,” she said. “It’s like narcolepsy, a deep, unconscious sleep. We later discovered it was a coping mechanism she’d developed in order to survive.”

Despite what they’ve endured, most children wish desperately to return to their parents. Many come to see themselves as their parents’ caretakers and feel guilty for being taken away, especially if they were the ones to report an overdose, as in the case of a four-year-old girl who climbed out of a window to alert a neighbor. “She asked me: if I took her away, who was going to take care of mommy?” Bridgette remembered.

For caseworkers, reunification is the endgame. After children enter temporary foster care, the agency spends up to two years working closely with the family while the parents try to stay sober. The only contact with their children comes in the form of twice-weekly visits held in designated rooms here at the office. Each contains a tattered sofa and some second-hand toys. Currently, the agency runs about 200 visits each week. The encounters are monitored through closed-circuit cameras. For everyone involved, it can be the most trying period.

Many parents use the time to build trust and re-establish bonds. “During those first four years, a child gets such good stuff from their parents,” said Sherry, the caseworker who monitors the visits. “The kids are just trying to get that back.” Some parents bring doughnuts and pictures, while others need more guidance. Caseworkers hold parenting classes. Some moms lost newborns at the hospital after they tested positive for drugs; workers teach them how to feed and hold the child, and encourage them to bring outfits to dress their babies.

For other children, the visits trigger a storm of emotion that churns up the trauma of removal. “We had one girl who’d scream and wail at the end of every visit,” Laura, the supervisor, remembered. “Each time she thought she’d never see her mother again. We’d have to pry her out of mom’s arms and carry her down the hallway.”

“We’d sit in our offices and just sob,” added another worker. “But that girl’s cries weren’t enough to keep Mom off heroin.”

The number of available foster families is dwindling, while the cost of supporting them has never been higher

Perhaps the greatest difference with heroin and opioids, caseworkers said, is their iron grasp. Staying sober is a herculean task, especially in this rural community short on resources, where the nearest treatment facilities are over 30 miles away in Dayton, Cincinnati, or Columbus. At some point, nearly every parent falls off the wagon. They disappear and miss visits, leaving children to wait. One of the hardest parts of the job is telling a child that mom or dad isn’t coming, or that they can’t even be found.

“You see the hurt in their eyes,” Sherry said. “It’s a look of defeat, and it just breaks your heart.” She remembered a mother who’d failed to show up for months, then made it for her twin boys’ birthday. “The next day she overdosed and died.”

A tally sheet is used to track how many times prospective clients waiting to enter the program call a detox center, in Huntington, West Virginia. Photograph: Brendan Smialowski/AFP/Getty Images

When parents fail drug screenings during the 18-month period, caseworkers use discretion. Parents might be doing better in other areas like landing a job, or finding secure housing, so workers help them to get back on the wagon. “It’s all about showing progress,” Laura said. Some parents make it 16, 17 months sober and fully engaged. “And they’re the toughest cases, because we’ve been rooting for them this whole time and helping them. We’re giving kids pep talks, saying: ‘Mom’s doing great, she’s getting it together!’ They’re so happy to be going home. And then it all falls apart.”

With heroin, defeat is something the workers have learned to reckon with. Lately they’ve started snapping photos of parents and children during their first visit together, getting medical histories and other vital information – something they used to do much later. “Because we know the parents probably aren’t going to make it,” Laura admitted. “And if we never see them again, this is the info we need.” When asked how many opioid cases had ended in reunification, only two workers raised their hands.

The repeated disappointments come as resources and morale have reached their tipping point. The number of available foster families is dwindling, they said, while the cost of supporting them – over $1.5m a year – has never been higher.

Spirk, the agency’s director, said that all the agency’s budget was paid for with federal dollars and a county tax levy, although they’ve been flat-funded for nearly 10 years. The state contributes just 10%. When it comes to investing in child protection, Ohio ranks last in the country – despite having spent nearly $1bn fighting its opioid problem in 2016 alone.

The Ohio house of representatives recently passed a new state budget with an additional $15m for child protective services, but the state senate has yet to pass its own version. The only bit of hope came in March, when the Ohio attorney general’s office announced a pilot program that will give Clinton County, along with others, additional resources to help treat children for trauma, and to assist with drug treatment. It starts in October.

The epidemic’s unrelenting barrage has also taken a toll on mental health. “Our caseworkers are experiencing secondary trauma and frustration at not being able to reunify children with their parents because of relapses,” Spirk said.

Almost every caseworker said they had experienced depression or some form of PTSD, although no one had sought professional help. The privacy of their cases also means that few can speak openly with friends or family members. Some chose to drink, while others leaned on their faiths. But most said coping mechanisms they once relied on had failed.

“I used to have a routine on my drive home,” Laura said. “I’d stop in front of a church, roll down my window, and throw out all the day’s problems. The next morning I’d pick them back up. These days, I can’t do that anymore.”

“There’s no more outlet,” added Shelly, another supervisor. “You think you’re able to separate but you can’t let it go anymore. You try to eat healthy, do yoga, whatever they tell you to do. But it’s just so horrific now, and it keeps getting worse.”

At some point, the inevitable happens. When a parent can’t stay sober, or stops showing progress, the decision is made to place the child into permanent custody and put them up for adoption. For everyone, including caseworkers, it’s the most wrenching day.

The final act of every case is the “goodbye visit”, held in one of the nicer conference rooms. It’s a chance for parents to let their children know they love them and will miss them, and that it’s time to move on. Adoptive parents can choose to stay in contact, but it isn’t mandatory.

To make the time less stressful, Sherry, the worker who monitors the visits, has them draw pictures together, which she scans and gives to them as mementoes. She also tapes the meetings for them to keep. Watching from her tiny room full of TV screens, she can’t help but cry. “What people don’t realize is that when a baby comes into our custody, they’re still in a carrier seat. By the time the case is over, we’ve helped to potty train them. Two years is a very long time with a child. So in a way, it’s like my goodbye visit, too.”

Caseworkers have started making “life books” for kids once they come into the system. It’s where they put the photos they’ve taken, plus any pictures of birth parents or relatives they can find, report cards, ribbons and medals – the souvenirs of any childhood.  “It’s their history,” Sherry said, “so that one day they can make sense of their lives.”   She noted that one kid, after turning 18, tore his to pieces, taking with him only the good memories.

Source:  https://www.theguardian.com/us-news/2017/may/17/ohio-drugs-child-protection-workers

Carfentanil. If there was ever a drug designed to wreak havoc – this is it!

5 milligrams (about 1/16th the size of a baby aspirin) is strong enough to take down a one-ton Buffalo, actually make that 7 one-ton Buffalos, and it’s readily available through illicit sales on street corners throughout the US. It is also now one of the leading causes of opioid related death, which claimed over 33,000 lives (out of 52,000+ drug related overdose deaths) in 2015, the most recent year for which statistics are available.  Carfentanil first showed up in the Ohio area in mid-2016 and has been advancing it’s destructive power across the nation with a vengeance. If it came in a bottle, it would need to have a warning label that is longer than the Great Wall of China, stating something to the effect of “If you take this drug, you are committing suicide. Avoid it at all costs.” In fact, its only legal use is for the sedation of large animals, like “elephants”. Addicts generally work their way up to Carfentanil. The typical gateway is by medical prescription for something like Oxycontin, with the user then graduating to cheaper heroin once the prescriptions run out. In fact, the majority of heroin users admit they started with prescription opioids. They beckon you like the sirens from Greek mythology, tempting you past your breaking point. It eventually gets to a level that heroin is no longer nearly enough, so you start taking fentanyl, many multiple times stronger than morphine which sucked so many war veterans into addiction during the Vietnam era. Your tolerance builds as your habit expands from a few days a week to every day.  Eventually fentanyl too is not enough. What else is there? Carfentanil. ‘Do I risk it?’ is what an addict should now ask himself, but they rarely listen to their voice of reason. They jump ‘all in’ without any thought or concern of consequences, they just want to get high. Then again, oftentimes they don’t even get to make that choice, it’s made for them. Carfentanil is so cheap that it’s used as an additive on the street.

I read an article the other day where someone bought street Xanax. It was laced with Carfentanil; he was dead within minutes. This same scenario has repeated itself throughout the country, as drug dealers seek to convert a small amount of Carfentanil, into a large amount of sale-able product, mixing it with ‘whatever is available’, solely to line their pockets with addicts’ money. Carfentanil is also a concern for first responders. It is odorless, colorless and can be absorbed via skin contact, inhalation, oral exposure or ingestion. EMS crews typically wear protective gloves and masks because a dose as small as a grain of salt could kill a person even if just absorbed through the skin, much like Anthrax. The increases in opioid-related emergencies are overwhelming the country on a state-by-state and city-by-city basis. Incidents are up 13.3 percent in Minnesota, over 20 percent throughout Ohio and the numbers are even worse in Kentucky, New Hampshire, New Mexico and West Virginia. The growth in Native American communities is by far the worst at 32.7 percent. 50 people recently overdosed in one day alone in Philadelphia, which experienced 35 overdose related deaths over five days. Cincinnati had 174 overdoses in six days, Cleveland 46 in one day and tiny Akron 236 over 20 consecutive days. In Maryland, Gov. Larry Hogan declared a state of emergency after opioids killed nearly 1,500 residents in the first nine months of 2016. The US represents just 4.6 percent of the world’s population, yet we consume 80 percent of its opioids. So, where’s all this Carfentanil coming from?  The usual suspects. China and India were the largest suppliers for the illegal online pharmacies during the early 2000s.

Distributors located in the Caribbean and Central American countries, typically run by American ex-pats, bought knock-offs of everything from Viagra to Xanax to Oxycontin for pennies a pill, sending shipments ‘directly to your door’ without the need of a pesky prescription. Those same large suppliers simply shifted to the next hot product and now sell to Mexican cartels distributing it street-by-street. After recent pressure from the US Drug Enforcement Agency (DEA), China clamped down on bootleg opioid operations to curb the flow of illicit drugs into the US. Yet, the Mexican drug-lords are resourceful. I fear it won’t take too much time for them to find other suppliers to fill the gap. There’s already evidence of them trying to produce substantial quantities on their own, to eliminate the need for an outside source. According to the DEA, 144 people now die each day from a drug overdose. As recently as 10 years ago, gun related deaths outnumbered drug overdose deaths by a factor of 5-to-1. Today more people die from opioids than guns and traffic accidents combined. It is estimated that 600 people try heroin for the first time each and every day. The issue is now mission critical. President Trump has appointed a SWAT Team of business executives to tackle the opioid crisis, led by his son-in-law Jared Kushner, a leading businessman and near billionaire in his own right. They are already working with a ‘Who’s Who’ of Fortune 500 Company leaders including such luminaries as Apple’s Tim Cook and Microsoft’s Bill Gates, just to name a few. Kipu and our sister company, InRecovery Magazine, have reached out to this Team to offer our unique experience, knowledge, perspective and support. We are hopeful that this is a key step toward helping to start to turn the tide in this life-or-death struggle against addiction.

Source: http://campaign.r20.constantcontact.com/render?m=1125801102133&ca=c086bc62-9760-47b5-8dad-385b0609ab8d   May 2017

Background:

Cannabis use (CU) has recently been legalized in several states for medicinal purposes and remains the most commonly used illicit drug. Cardiovascular effects of CU are not well established as studies thus far have been limited by size. We therefore utilized a large national database to examine the incidence of cardiovascular risk factors and events amongst patients with CU.

Methods:

Patients aged 18-55 years with CU were identified in the Nationwide Inpatient Sample 2009-2010 database using the Ninth Revision of International Classification of Disease (ICD) code 304.3. Demographics, risk factors, and cardiovascular event rates were collected on these patients and compared to general population data.

Results:

Incidence of heart failure (HF), cerebrovascular accident (CVA), coronary artery disease (CAD), sudden cardiac death, and hypertension (HTN) were significantly higher in patients with CU. After multivariate regression adjusting for age, gender, diabetes mellitus, HTN, CAD, tobacco use, and alcohol use, CU remained an independent predictor of both HF (OR=1.1 [1.03-1.18], p<0.01) and CVA (OR=1.24 [1.14-1.34], p<0.001).

Conclusions:

CU independently predicted the risks of HF and CVA in individuals 18-55 years old. With continued legalization of cannabis, potential cardiovascular effects and their underlying mechanisms need to be further investigated.

1187-055 – Cannabis Use Predicts Risks of Heart Failure and Cerebrovascular Accidents: Results from the National Inpatient Sample

Background: Cannabis use (CU) has recently been legalized in several states for medicinal purposes and remains the most commonly used illicit drug. Cardiovascular effects of CU are not well established as studies thus far have been limited by size. We therefore utilized a large national database to examine the incidence of cardiovascular risk factors and events amongst patients with CU.

Methods: Patients aged 18-55 years with CU were identified in the Nationwide Inpatient Sample 2009-2010 database using the Ninth Revision of International Classification of Disease (ICD) code 304.3. Demographics, risk factors, and cardiovascular event rates were collected on these patients and compared to general population data.

Results: Incidence of heart failure (HF), cerebrovascular accident (CVA), coronary artery disease (CAD), sudden cardiac death, and hypertension (HTN) were significantly higher in patients with CU. After multivariate regression adjusting for age, gender, diabetes mellitus, HTN, CAD, tobacco use, and alcohol use, CU remained an independent predictor of both HF (OR=1.1 [1.03-1.18], p<0.01) and CVA (OR=1.24 [1.14-1.34], p<0.001).

Conclusions: CU independently predicted the risks of HF and CVA in individuals 18-55 years old. With continued legalization of cannabis, potential cardiovascular effects and their underlying mechanisms need to be further investigated.

Source: http://ativsoftware.com/appinfo.php?page=Inthtml&project=ACC17&server=ep70.eventpilot.us&id=2545   March 2017

by David Sergeant  of The Bow Group

The Bow Group is a leading conservative think tank based in London. Founded in 1951, the Bow Group is the oldest conservative think tank in the UK and exists to publish the research of its members, stimulate policy debate through an events programme and to provide an intellectual home to conservatives. Although firmly housed in the conservative family, the Bow Group does not take a corporate view and represents all strands of conservative opinion. The Group’s Patrons are The Rt Hon. The Lord Lamont of Lerwick, The Rt Hon. The Lord Tebbit of Chingford CH, Dr David Starkey CBE & Professor Sir Roger Scruton.  The Group’s Parliamentary Board consists of The Rt Hon. The Lord Tebbit of Chingford CH, The Rt Hon. David Davis MP, Sir Gerald Howarth MP, Geoffrey Clifton-Brown MP FRICS, Daniel Hannan MEP, The Rt Hon. Dominic Grieve QC MP, David Rutley MP, The Rt Hon. John Redwood MP, Dr. Phillip Lee MP and Adam Afriyie MP.

 INTRODUCTION

The evidence couldn’t be clearer. Cannabis is a hugely damaging drug that causes misery, particularly for our poorest citizens. Our aim should be its eradication and that can never be achieved through legalised capitulation. According to a report published last November by the Adam Smith Institute, our drug policy is: ‘An embarrassment.’ (Laven-Morris, 2016, para. 1) Commenting on the report, Steve Moore, Director of ‘Volteface’ concurred, insisting that: ‘The global movement towards legalisation, regulation and taxation of cannabis is now inexorable.’ (Laven-Morris, 2016, para. 16)

While this supposed ‘inexorability’ may have political and social elites jumping for joy, it’s yet another step toward greater suffering for those vulnerable individuals at risk of damage from the mind-altering drug, as well as for families and communities who are, and will increasingly, be forced to pick up the pieces. Within this paper, I will seek to address some of the primary points of contention and concern surrounding cannabis and counter the myths and assertions propounded by ideologues, corporate lobbyists, and the liberal media, each dogmatic in their pursuit of recreational cannabis legalisation. I will conclude that the consistent application of the meaningful criminal penalties already legislatively available, aggressive and rigorous policing across the socio-economic spectrum, the use of evidence based education, conferring the real health-risks of the drug and well-funded, compassionate, abstinence-based treatment for those who have become dependent on cannabis can, deliver its eradication.

 1) HARM 

Forgive my scepticism, but when that all-knowing beacon of progress and morality, billionaire Richard Branson insisted that, ‘most of us’ could smoke skunk without it doing us ‘any harm,’ I was not immediately convinced. (Holehouse, 2015, para. 2) The problem is that most of the people that Mr Branson has ever met are wealthy, expensively educated elites, who likely have access to the private health insurance he’s so keen for ‘Virgin Healthcare’ to bestow on the rest of us. Even if Mr Branson was right and cannabis, for most, presented no tangible health risks, this would still not be sufficient moral rationale for its legalisation. If we care about all our fellow citizens we cannot sacrifice the mental health of some for the recreational pleasure of ‘most.’

Correspondingly, also in support of legalisation is Amanda Fielding, Countess of Wemyss and March and founder of the pro-drug Beckley Foundation – located at Fielding’s Oxfordshire Tudor estate. The foundation boldly assert in their book: ‘Cannabis Policy: Moving beyond Stalemate,’ that with regards to cannabis: ‘Those harms at the population level are modest in comparison with alcohol or cocaine.’ (Beckley Foundation, 2009, para. 2) While there is no doubt that both alcohol and cocaine can create as much if not more misery than cannabis, its possible nature as a ‘slightly lesser’ evil is no cause for its celebration. Long gone are the 3 days in which advocates could claim that the effects of cannabis were ‘modest.’ This well perpetuated myth of ‘harmlessness’ has now been comprehensively medically discredited.

There is an increasingly diverse research consensus that cannabis use is directly connected to serious mental health issues. Timms and Atakin (2014) revealed that Adolescents who use cannabis daily are ‘five times more likely to develop depression and anxiety later in life,’ (para. 36) while Hall & Degenhardt’s (2011) strong body of evidence indicates that: ‘cannabis precipitates schizophrenia in vulnerable people.’ (p. 511) Further, Hall & Degenhardt discovered that, for those with a family history of psychosis, regular cannabis use doubles the likelihood of development from one in ten, to one in five. (2011, p. 512)

When we look at expectant mothers who smoke cannabis we see a direct correlation. The more they smoke, the greater the likelihood that their children will report feelings of depression and anxiety at the age of ten. (Goldschmidta, Richardson, Cornelius & Dayb, 2004, p. 526) Moreover, a huge American study, utilising the latest technology in brain-scanning equipment discovered that cannabis users had: ‘abnormally low blood flow in virtually every area of the brain.’ This means that users are at considerably higher risk of developing diseases such as Alzheimer’s. (Tatera, 2016, para. 1)   Even Professor Nutt, a well-known proponent of legalisation, concedes that cannabis smokers are ‘2.6 times more likely to have a psychotic-like experience than non-smokers.’ (Nutt, 2009, para. 7).

In addition to the real danger cannabis poses to mental health, research suggests that the use of cannabis doubles the risk of infertility in men under the age of 30. (Connor, 2014, para. 1) The mind is complicated beyond the possibility of human comprehension. A cautious and respectful approach to its potential damage is surely wise, as once it is lost it must be an exceedingly difficult thing to get back. There are few more disturbing things than seeing a friend or relative struggle with mental health issues – a daily battle not with the world but with themselves. Indeed, youngsters who use cannabis daily are seven times more likely to commit suicide. (Laccino, 2014, para. 1) So, while Mr Branson might encourage you to smoke cannabis with your children, (Janssen, 2016, para 4) the evidence would suggest that doing so could be very damaging indeed.

 2) USAGE RATES AND CANNABIS AS A GATEWAY DRUG 

Those who back legalisation might argue that it is they who truly care about cannabis users and they who truly want to reduce the drug’s harmful impacts. This, they insist, will be made possible by the reduction in usage rates that a legalised market will deliver. Indeed, the entire foundation of the argument for legalisation rests on its ability to decrease the numbers of people using cannabis. The facts and evidence stand comprehensibly against this assertion. Every single location in which there has been meaningful analysis of usage rates before and after legalisation or decriminalisation, including Portugal, Colorado, Southern Australia and Amsterdam, show an upsurge in the number of people using the drug. (Hughes and Steven, 2010, p. 1005), (Korf, 2002 pp. 854-856), (Single, Christie & Ali para. 25), (Keyes, 2015) Even within individual nations, the difference between usage rates in jurisdictions with varying legislative approaches is stark. 15.6% of citizens in the Netherlands have used cannabis compared to 36.7% of residents in Amsterdam. (Korf, 2002, p. 854-856) In fact, following the mainstream promotion of coffee-shops in Amsterdam, the rate of regular cannabis use among 18-to-20-year-olds more than doubled. (MacCoun and Reuter, 2010 as cited in Mineta, n.d para. 8) Furthermore, legal cannabis would mean cheaper cannabis. Prohibition drives up the price of the drug by ‘at least’ 400%. (Mineta, n.d, para. 7) Studies have shown that when cigarettes are reduced in price by 10% their consumption shoots up by 7-8%.(Mineta, n.d, para. 7)

While its proponents might have you believe ‘everyone’s getting high nowadays,’ it’s worth remembering that only 5% of our population regularly smoke cannabis. (Dunt 2013 para. 1) This compared to 19% who smoke tobacco (Ash, 2016, para. 1) and 58% of adults who regularly drink alcohol. (Drinkaware, n.d, para. 10) For some advocates of legalisation who, either genuinely believe or pretend to believe that legalisation will lead usage rates to decline, this evidence will, of course, be somewhat inconvenient.

For others, it brings only adulation. In the US state of Colorado, the CEO of the Harvest Company dispensary, rejoiced that: ‘People who would never have considered pot before are now popping their heads in.’ (Keyes, 2015, para. 7) Likewise, when asked why he believed cannabis use had increased in the state since its legalisation, Henson, President of the Colorado Cannabis Chamber of Commerce, argued that more people felt at ease with the drug: ‘They don’t see it as something that’s bad for them.’ (Keyes, 2015, para. 6) What’s more, with regards to the gateway theory, the evidence is clear. Cannabis is a gateway drug. A 25-year longitude study revealed that in 86% of cases of those who had taken two or more illegal drugs, cannabis had been the substance they had used first. (Fergusson. D, Boden. J & Horwood. J 2011, p. 556)

Moreover, those who used cannabis weekly were a staggering 59 times more likely to use other illegal drugs than those who did not use cannabis at all. (Fergusson, D. & Horwood J. 2000, pp. 505–520) In the United States, research revealed that only 7% of young people who had never used cannabis had indulged in other illegal drug use, compare this to 33% of the young people who reported using cannabis regularly and 84% of those who used it daily. (Kandel, 1984, pp. 200 – 209)

Advocates of legalisation, while often conceding the gateway theory, insist that this can easily be countered through legalisation that would disentangle legal cannabis from the illegal ‘hard drug’ black market. However, cannabis users are not using other drugs because their dealers are forcing them down their throats or up their noses. Rather: ‘the biochemical changes induced by marijuana in the brain result in a drug-seeking, drug-taking behaviour, which in many instances will lead the user to experiment with other pleasurable substances.’ (Nahas, 1990, p. 52) Thus, cannabis users will likely seek to experiment with other illegal drugs regardless of the legal status of cannabis. Legalisation would result only in more cannabis users and thus a higher secondary demand for and entanglement within the remaining illegal drug market.

 3) MONEY: A PRICE WORTH PAYING?

The Adam Smith Institute have promised the UK one billion pounds in additional annual tax revenue. All we must do is legalise the drug. However, we can see by examining the cost of alcohol

abuse that any additional tax revenue would be dwarfed by the hugely increased medical and social costs brought about by increased usage. The taxes raised from alcohol cover only a tiny percentage of the societal cost brought about by alcohol misuse. Indeed, while there are no similar statistics available in the UK, a 2002 analysis of alcohol-related costs in America was estimated to be 184 billion dollars annually. (Mineta, n.d. para 10) But surely the billions of dollars raised in taxes more than covered it? Not quite! Taxes on alcohol raised only 8.3 billon dollars in the same timeframe, just 4.5% of costs. (Mineta, n.d. para 10)

In addition, we can be sure that where there is profit to be made, there will be also be predatory capitalism. The aggressive commercialisation of cannabis has already begun, with ‘big tobacco’ companies investing considerable funding in their next project for the betterment of humanity. Similarly, Microsoft have unashamedly announced their partnership with ‘Kind financial,’ a business that ‘logistically supports’ cannabis growers. (Becker, 2016, para. 1) By definition, the purpose of dope companies within legal markets is to sell as much cannabis to as many people as possible and crucial to this pursuit is persuading new users to try their product. In the US there is growing concern these companies have already begun to target a young, impressionable audience with their advertisement.

Likewise, disingenuous associations between cannabis and wellness and barefaced lies regarding the non-existent curative potential of the drug are becoming common-place. According to Vara, the aim is simple. Make as much money as possible by making: ‘Pot seem as all American as an ice-cold beer.’ (Vara, 2016, para. 1)

4) SOCIAL MOBILITY and PUBLIC OPINION 

Inevitably, it is working class young people who are least able to afford the damage that cannabis wreaks on their focus, self-belief and motivation, as well as on their education and career opportunities. It’s well known that cannabis users have lower levels of dopamine in the striatum part of their brains, meaning lower levels of motivation and aspiration. (Bergland, 2013, para. 1) Even after a wide ranging and comprehensive allowance for confounding factors, a Christchurch study observing 1265 children found a strong link between educational underachievement and the use of cannabis. (Fergusson, Horwood & Beautrais, 2003, p. 1682) Those who had used the drug one hundred times or more before the age of sixteen were three times more likely than those who had never used cannabis to leave education without any qualifications. (Fergusson, Horwood & Beautrais, 2003, p. 1690)

In addition, the numbing effect the drug has on the brain of a user and its ability to concentrate and remember things can continue for days after usage. This means that, for regular users, they may never be able to operate at the best of their ability and fulfil their potential. (National Institute on Drug Abuse, 2016, p. 1) Overall then, after adjustment for confounding factors, Fergusson & Boden conclude that cannabis usage between the ages of 14 and 18 was ‘Associated significantly’ with ‘lower levels of life and relationship satisfaction, lower income and higher levels of unemployment and welfare dependency.’ (2011, p. 974)

Nevertheless, unlike many prominent proponents of legalisation, I’m a true believer in democracy. If working-class communities genuinely believe that the best way to combat cannabis is through legalisation, then who am I to argue. The reality is quite the contrary. While many, like Lib Dem

Norman Lamb falsely claim that Brits want cannabis to be legalised. (Doward, 2016, para. 1) A comprehensive poll showed that the British public oppose cannabis legalisation by forty-nine to thirty-two percent. (Jordan, 2015, para. 7) Moreover, various surveys show that those groups who are amongst the hardest hit by cannabis, namely the poor and ethnic 6 minorities, often hold the toughest legal views. In 2010 30% of intermediate non-manual workers had used cannabis compared to 10% of unskilled manual workers. (Park, Curtice & Thompson, 2007, p. 127) Likewise, ‘restrictive views’ on cannabis were higher among those with lower educational attainment. In 2001, just 25% of those with a degree held ‘restrictive’ views compared to 40% of those with A levels as highest qualification and 61% with no qualifications. (Park, Curtice &Thompson, 2007, p. 126)

Even an Ipsos Mori poll which found a slight majority of the overall public in favour of decriminalisation, found that this was supported by only 25% of Asians and 41% of blacks, compared to 55% of whites. (Ames & Worsley, 2013, p. 17) Is this really surprising? After all, the dark world of drug-related crime, violence and addiction hit harder in the streets of Hull than they do in Hampstead. If we as a society, truly care about those who suffer the most at the hands of cannabis, maybe we should take the revolutionary approach of listening to what they think we should do about it.

 5) SOLUTIONS AND PROPOSALS

Having demonstrated the toxic and damaging effects of cannabis on our society we must consider how we can best eradicate it. In 1999, The Runciman report was published, calling for the decriminalisation of cannabis and concluding that … ‘The present law on cannabis produces more harm than it prevents.’ (Runciman Report, 1999). This paper fully agrees that the present laws produce more harm than they prevent. However, this is not due to our nation’s refusal to give in to the drug completely, but because we refuse to properly confront it. Law enforcement Insisting the only way to tackle drug criminality in working class communities is to capitulate to those terrorising them by legalising their product is defeatist madness. The legislative framework and established penalties for the possession of cannabis are, in theory, suitable and rigorous. The maximum sentence for cannabis possession stands at five years’ imprisonment. It is not therefore the theoretical legislative provision that is at fault, we require no new dramatic laws or hard-line legislation. To eradicate cannabis, we require only the practical application of existing legal provision by responsible judges and a police service, uniformly educated in and committed to this endeavour.

The Runciman report itself acknowledged that: ‘almost no one is given an immediate custodial sentence solely for possession of cannabis.’ (Runciman Report, 1999, p. 105) Real deterrence in the form of strict criminal penalties must be consistently enforced to stem the demand side of the trade. Police forces in the United Kingdom should operate a zero-tolerance approach to cannabis possession, with every case leading to arrest and a formal criminal record. In addition, the criminal justice system ought to implement a ‘two strikes’ policy. Upon a second arrest for cannabis possession the individual must always be given a prison sentence of meaningful length. This can be enforced in several ways. Rigorous, visible and aggressive policing can drive up the price of cannabis while mitigating the drug’s negative secondary societal consequences. Community policing must, once again, be the focus of our law enforcement.

Areas synonymous with youth cannabis usage must be visibly policed  and dimly lit, urban, cannabis ‘trouble spots’ should be provided, where possible, with better lighting provision and mainstream

public access. The two-tier, confused policing of cannabis must also be immediately halted, while drug-snobbery and police profiling stamped out. Why are extensive bag searches and sniffer dogs common place at music festivals whose attendees are predominantly working class, such as Creamfields, while glittercovered Home County revellers at Glastonbury can visibly consume drugs without consequence?

The message that drugs are ok so long as secondary behaviour does not cause a nuisance must end – replaced by the message that taking drugs is wrong full-stop. Similarly, distinctions between supposed ‘hard’ and ‘soft’ drugs are largely unhelpful. The consumption of any illegal drug is morally wrong and so the use of all drugs must be discouraged with equal vigour. Equally as important is the insistence that our police force consistently and fairly enforce the law and that certain, politically motivated members of the police hierarchy, who have sought to enact a backdoor decriminalisation process, stop.

In a 2013 study, 103 officers out of 150 interviewed admitted they did not always arrest for cannabis possession. (Warburton May & Hough, 2005, p. 118) One officer stated: ‘I never nick anyone for cannabis, and never will, unless it’s a van load.’ (Warburton May & Hough, 2005, p. 119) Nowhere is this problem better illustrated as in County Durham, who’s Police Chief Constable, Mick Barton, has taken it upon himself to give criminals in the county permission to grow skunk for their own consumption. (Evans, 2015, para. 1)

Sweden provides a useful case study into the potential effectiveness of this approach. Largely considered to have the toughest cannabis laws in Europe, few consider the drug ‘soft.’ Police have pursued a zero-tolerance approach with the vast majority of instances of possession leading to prosecution. This, coupled with the visible and proactive ‘disturb and annoy’ tactics of the national police force (Mapes, 2016, p. 1) have delivered a cannabis usage rate of just 3%. Lower than any other nation in Northern, Western or Southern Europe, with the exception of Lithuania, on 2%. (European monitoring centre for drugs and drug addiction, 2016)

Treatment and education

Further, we must counter the false claim that only legalisation can allow for effective and compassionate treatment for those who have become mentally dependent. Judgement-free, abstinence based assistance for those struggling, but willing to cease their habitual high should be well funded and available. This should be coupled with early intervention for those who have developed mental health problems. Likewise, we cannot be seen to be shying away from the debate on drugs, why would we? The facts and the evidence regarding the harmfulness of cannabis stand in our support. Education, countering fanciful claims that cannabis is ‘twenty-two thousand’ times less dangerous than alcohol ,should be comprehensive. Of course, there could indeed be occasional situations in which cannabis might be a small force for good. Whilst it possesses no curative potential, it is reasonable to conduct a serious and evidence based debate on the merits of tightly-regulated, prescriptive cannabinoids medication for the relief of specific symptoms in exceptional circumstances. In certain situations, morphine is of invaluable  medical assistance. Using heroin recreationally is of great societal and personal damage. Nonetheless, this tiny element of cannabis usage has long been hijacked by those dogmatic in their pursuit of legalised recreational usage and until this ends, progress will be difficult.

Similarly, this paper is not an attack on the middle class in general, or even all those members of the middle class who smoke the drug. While sensible support networks and access to early intervention may help many navigate the pitfalls of cannabis, schizophrenia and depression respect not income nor family stability. It’s our societal responsibility to safeguard all our people from a drug that may not, but may well, ruin their life.

 CONCLUSION 

However, most of those pushing for cannabis legalisation aren’t doing so because they truly believe it is in the best interests of anyone’s health or even finances. They’re doing so because a world that gets high, is a world that appeals to them. If cannabis was legalised it would be a monumental mistake impossible to reverse. We owe it to everyone to resist, with all our might, the ‘inevitable’ social normalisation and legislative legalisation of cannabis.

ABOUT THE AUTHOR David Sergeant read Politics at Durham University and is an Intern and Research Contributor at the Bow Group. He Co-Chaired the High Peak Constituency ‘Vote Leave’ group, sits on the Australian Monarchist League’s New South Wales Committee and is Treasurer of Conservatives Abroad – Sydney.

Source:  https://www.bowgroup.org/sites/bowgroup.uat.pleasetest.co.uk/files/David%20Sergeant%20-%20Cannabis%20paper%20evidence_0.pdf

Abstract

Childhood maltreatment increases the risk of subsequent depression, anxiety and alcohol abuse, but the rate of resilient victims is unknown. Here, we investigated the rate of victims that do not suffer from clinical levels of these problems after severe maltreatment in a population-based sample of 10980 adult participants.

Compared to men, women reported more severe emotional and sexual abuse, as well as more severe emotional neglect. For both genders, severe emotional abuse (OR = 3.80 [2.22, 6.52]); severe physical abuse (OR = 3.97 [1.72, 9.16]); severe emotional neglect (OR = 3.36 [1.73, 6.54]); and severe physical neglect (OR = 11.90 [2.66, 53.22]) were associated with depression and anxiety while only severe physical abuse (OR = 3.40 [1.28, 9.03]) was associated with alcohol abuse.

Looking at men and women separately, severe emotional abuse (OR = 6.05 [1.62, 22.60] in men; OR = 3.74 [2.06, 6.81] in women) and severe physical abuse (OR = 6.05 [1.62, 22.60] in men; OR = 3.03 [0.99, 9.33] in women) were associated with clinical levels of depression and anxiety. In addition, in women, severe sexual abuse (OR = 2.40 [1.10, 5.21]), emotional neglect (OR = 4.78 [2.40, 9.56]), and severe physical neglect (OR = 9.86 [1.99, 48.93]) were associated with clinical levels of depression and anxiety.

Severe emotional abuse in men (OR = 3.86 [0.96, 15.48]) and severe physical abuse in women (OR = 5.18 [1.48, 18.12]) were associated with alcohol abuse. Concerning resilience, the majority of severely maltreated participants did not report clinically significant levels of depression or anxiety (72%), or alcohol abuse (93%) in adulthood. Although the majority of severely abused or neglected individuals did not show clinical levels of depression, anxiety or alcohol use, severe childhood maltreatment increased the risk for showing clinical levels of psychopathology in adulthood.

Introduction

Severe child maltreatment is conventionally defined within child protection practice as severe physical, emotional, sexual abuse and/or severe physical and emotional neglect by adults [1]. Severity can be defined on the basis of the type of maltreatment, its frequency, if the child was subjected to multiple forms of maltreatment, if a weapon had been used, if the maltreatment resulted in an injury, and if the abuse was considered severe by the victim. For sexual abuse, even a single experience is often considered to be severe [1].

Childhood maltreatment and its psychosocial consequences

There are annually over one million victims of childhood maltreatment in the USA alone and childhood maltreatment has a large public health impact [2]. Several studies show that childhood physical, emotional, and sexual abuse are all related to an increased risk of depression and anxiety disorders in adulthood [3–9]. Other studies have found that the severity of abuse and neglect is associated with increased depression and anxiety symptoms in adulthood [10–12]. This means that as a general rule, the more severe the abuse and neglect, the more likely the abused individuals are to show symptoms of depression and anxiety.

There is also a robust relationship between childhood maltreatment and later alcohol abuse [13–16]. For example, Young-Wolff et al. [17] found that men who had experienced childhood maltreatment were 1.7 times more likely to suffer from alcohol abuse in adulthood than men who did not report experiences of childhood maltreatment. Similar findings have been made when investigating the consequences of abuse and neglect in women (e.g., [18]). Findings from a study by Schwandt et al. [19] suggested that the severity of emotional and physical abuse plays a prominent role in the development of alcohol abuse. In line with these results suggesting a role of the severity of childhood abuse on later substance misuse, Hyman et al. [20] found that the severity of abuse was predictive of cocaine use after having been discharged from an inpatient treatment for cocaine addiction.  This was true for women but not for men. Kendler et al. [21] showed that women who had experienced child sexual abuse reported higher incidences of alcohol abuse. Twin studies have also shown that childhood sexual abuse increases the risk of alcohol abuse and addiction later in life [21–24]. To summarize, there is a strong, robust relationship between childhood maltreatment and mental disorders in adulthood. These associations include associations between childhood experiences of physical abuse, emotional abuse, and neglect, respectively, and mental disorders such as depression and anxiety disorders, and alcohol abuse [25–26]. Moreover, multi-type maltreatment in childhood is associated with greater impairment in adulthood, and this association also includes a range of psychological and behavioral problems, such as depression, anxiety, and alcohol abuse [27].

However, not all victims of childhood maltreatment develop symptoms of substance abuse or psychopathology in adulthood. Meta-analyses suggest that many (but not all) children who have experienced abuse succeed in overcoming some of the possible negative outcomes [28]. For example, Klika and Herrenkohl [28] found that some individuals who have experiences of abuse in childhood do not suffer long-term negative sequelae. Collishaw et al. [29] reported that despite serious experiences of childhood sexual or physical abuse, some individuals did not develop psychiatric problems during adulthood. Moreover, Hamilton et al. [30] reported that emotional neglect did not significantly predict increases in depressive or anxiety symptoms later in life. It has been estimated that 12–22% of maltreated individuals are functioning well despite experiencing childhood maltreatment [31].

The current study

Several studies have focused on only experiencing one type of maltreatment (e.g., sexual abuse) or one type of outcome (e.g., depression). Moreover, most previous studies have relied on either convenience samples or samples from health care services, and especially samples of the latter kind might bias the results and show less resilience than is actually the case.

In the present study, we used a large, population-based sample of Finnish men and women. The types of maltreatment included emotional, physical, and sexual abuse as well as emotional and physical neglect.   Thus, the aims of the present study were to:

1. Investigate gender differences in severe experiences of different types of childhood abuse;

2. Compare if and how individuals reporting severe experiences of different types of childhood abuse differ from individuals who did not report experiencing childhood abuse, in terms of presence of clinically significant symptoms of depression and anxiety in adulthood; and

3. Compare if and how individuals reporting severe experiences of different types of childhood abuse differ from individuals who did not report experiencing childhood abuse in terms of presence of alcohol abuse symptoms in adulthood.

Results

Descriptive results

The proportion of participants with severe experiences of emotional abuse was 0.6% (n = 64). The corresponding proportion for severe experiences of physical abuse was 0.2% (n = 26) while the proportions for severe experiences of sexual abuse was 0.4% (n = 43). For severe experiences of emotional neglect, the proportion was 0.4% (n = 44) and for severe experiences of physical neglect 0.1% (n = 7).  With regard to gender differences in the different types of severe experiences of abuse, Table 2 shows that there were statistically significant differences between men and women in the proportion of individuals with severe experiences of emotional abuse, sexual abuse and emotional neglect. All of these were more prevalent in women. There were no statistical differences between men and women in terms of having severe experiences of physical abuse and physical neglect.

We then investigated whether the proportion of individuals having clinical levels of depression and anxiety was higher in individuals with severe experiences of abuse and neglect compared to individuals with less severe (or no) experiences of abuse and neglect. Table 3 shows that, for both genders, severe experiences of emotional and physical abuse and emotional and physical neglect increased the likelihood of suffering from clinical depression or anxiety compared to less severe experiences of the said forms of childhood maltreatment.

In men, severe abuse experiences were significantly associated with increases in the prevalence of clinical depression or anxiety when it came to experiences of severe emotional and physical abuse and physical neglect. No association was observed for severe sexual abuse and severe emotional neglect. For women, severe experiences of all childhood maltreatment types increased the likelihood of suffering from clinical depression or anxiety compared to other lower experiences of maltreatment.

Next, we explored the proportions of both men and women who were resilient to severe experiences of childhood maltreatment with regards to not suffering from clinical levels of depression or anxiety in adulthood. Depending on the abuse type, 55.6% to 100% of men with experiences of severe abuse did not show clinically significant levels of depression or anxiety. For women, 50% to 80.5% did not show clinically significant levels of depression or anxiety.

Discussion

The present study investigated five types of maltreatment: emotional, physical and sexual abuse, and physical and emotional neglect; and their relationships to depression, anxiety and alcohol abuse. The study used a population-based sample of 10980 participants and used validated measures of experiences of childhood maltreatment, current depression and anxiety, and current alcohol abuse.

More particularly, our aim was to investigate gender differences in victims of severe childhood maltreatment, as well as to compare if and how individuals reporting severe experiences of different types of childhood abuse differ from individuals without such severe experiences in terms of presence of clinically significant symptoms of depression, anxiety and alcohol abuse in adulthood.

The present study found that women reported more childhood experiences of severe emotional, sexual abuse and emotional neglect than men. Our findings are inconsistent with the results of those of previous studies indicating that men reported more childhood experiences of abuse than women [3, 38]. However, our results are consistent with findings suggesting that women are more sensitive than men to the effects of experiences abuse in childhood [29].

Compared to another Finnish population based sample, the frequencies of severe abuse were relatively low in our sample. This could be due to samples being obtained at different times, as abuse in Finland has been decreasing [39], or that in the present study the complete CTQ was used: in the study by Albrecht’s et al. [33], only one item per factor was used. The decrease in measurement reliability that follows from removing 80% of the original items might have inflated the estimates in Albrecht’s study [33].

More specifically, our results revealed that, in men, severe experiences of emotional and physical abuse as well as physical neglect were significantly associated with increases in the prevalence of depression and anxiety symptoms. For women, there was an association between all types of severe childhood maltreatment (emotional, physical and sexual abuse, and physical and emotional neglect) with depression and anxiety symptoms in adulthood.

These results were consistent with previous literature indicating that physical abuse and/or emotional abuse are related to depression and anxiety disorders [4–5, 40–41]. These findings also corroborate findings from meta-analyses and extend previous reports of severe experiences of abuse or neglect being associated with greater risk of developing depressive and anxiety disorders in adulthood [26].

When we examined each type of maltreatment for associations with alcohol abuse, the results showed that severe emotional abuse was associated with alcohol abuse in men. For women, severe physical abuse emerged as a predictor for problematic alcohol use. This is consistent with research suggesting that childhood experiences of emotional and physical abuse were found to be the primary predictor of alcohol abuse [19, 42].

It is intriguing, however, that there appears to be a gender difference in response to abuse type, with men having a considerably more severe response to emotional abuse in terms of propensity to develop alcoholism later in life. For example, an explanation for why women appear to suffer greater consequences in terms of abusing alcohol later in life could be that boys are more likely to engage in rough-and-tumble play and play fights [43], and are thus desensitized to physical abuse to a higher extent than women. It is also, however, possible that measurement invariance could explain the perceived gender differences.

Our current findings suggest that, fortunately, more than half of the participants who have severe experiences of abuse and neglect in childhood seem to succeed in overcoming some of the possible consequences with regards to depression and anxiety symptoms and alcohol abuse in adulthood. While the present study did not investigate mediators of resilience, many studies have considered successful psychosocial adjustment as a mediator of psychological resilience following adverse events [44–45]. It should also be mentioned that some individuals likely have heritable factors that have been shown to protect against adverse effects of maltreatment, by means of gene–environment interaction (i.e., the concept that individuals respond differently to environmental stressors depending on their genotype) [46].

Limitations of the research

Despite the strengths of the present study, it is also characterized by some limitations worth mentioning. First, memories are usually influenced by later experiences, and since the questionnaire was about events that happened during childhood, the obtained information might be somewhat biased. Second, we did not consider the possible overlap between experiences of maltreatment types. Because experiencing one type of abuse or form of neglect is associated with experiencing also another type of abuse or form of neglect [10, 47], it is possible that also severe forms of abuse and neglect are correlated across types or maltreatment. This could, for example, mean that several of the individuals with clinical cases of depression and anxiety or alcohol abuse, not only had experienced one form of severe abuse, but several. Should this be the case, the additive effect of multiple types of abuse could influence the results.

In the present study, it is possible that the true prevalence of anxiety, depressive symptoms or alcohol abuse has been underestimated, as we have only one cross-sectional assessment of the above mentioned indicators (i.e., some individuals may have experienced clinically significant symptoms before study participation, or may experience symptoms in the future, but did not do so at the time of assessment). A longitudinal assessment of adulthood symptoms would thus arguable have been more appropriate than a single, cross-sectional measure.

Also, some of our results and group comparisons were based on very few individuals. This might both influence the estimated prevalence of depression and anxiety or problematic alcohol use and undermines the statistical power to detect differences. Finally, we only included three known consequences of experiencing childhood maltreatment: Depression and anxiety and problematic alcohol use. It is possible that individuals showing resilience on these possible consequences of maltreatment are not resilient with respect to other negative outcomes, such as social functioning or health-risk behavior.

Conclusions  

To our knowledge, this is the first study that has looked at the effects of severe experiences of abuse in childhood on depression and anxiety symptoms and alcohol abuse in adulthood in a relatively large sample.

We found that a majority of individuals with severe experiences of childhood maltreatment did not meet the criteria for clinical of levels depression and anxiety or clinical significant levels of alcohol abuse. Although this is a positive message, it is important to remember that experiences of child maltreatment increase the risk of psychosocial problems in adulthood and several of the victims of severe maltreatment included in our study may have had increased, but non-clinical significant levels of depression, anxiety, and alcohol abuse.

Source: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0177252