2018 April

Henrietta Szutorisza, Yasmin L. Hurda,

A B S T R A C T

Extensive debates continue regarding marijuana (Cannabis spp), the most commonly used illicit substance in many countries worldwide. There has been an exponential increase of cannabis studies over the past two decades but the drug’s long-term effects still lack in-depth scientific data. The epigenome is a critical molecular machinery with the capacity to maintain persistent alterations of gene expression and behaviors induced by cannabinoids that have been observed across the individual’s lifespan and even into the subsequent generation.

Though mechanistic investigations regarding the consequences of developmental cannabis exposure remain sparse, human and animal studies have begun to reveal specific epigenetic disruptions in the brain and the periphery. In this article, we focus attention on long-term disturbances in epigenetic regulation in relation to prenatal, adolescent and parental germline cannabinoid exposure. Expanding knowledge about the protracted molecular memory could help to identify novel targets to develop preventive strategies and treatments for behaviors relevant to neuropsychiatric risks associated with developmental cannabis exposure.

Source: Neuroscience and Biobehavioral Reviews 85 (2018) 93–101

Filed under: Brain and Behaviour,Cannabis/Marijuana,Drug use-various effects :

The following letter was submitted to the US government Food and Drug Adminstration by Australian Professor Dr. Stuart Reece as evidence against the suggested re-scheduling of cannabinoids in the USA. This item can be found online where a full list of carefully researched references is included. Professor Reece has produced an extraordinary article which should be widely read.

We cannot recommend this article highly enough.

NDPA April 2018

http://GordonDrugAbusePrevention.com

This website has been created as a public service to help address the problem of the use of marijuana and other mood- and mind-altering substances in the United States and around the world. A purpose is help inform the public, the media, and those in positions of public responsibility of the challenges facing the nation as a result of the widespread use of psychoactive and mood-altering substances, particularly marijuana and designer drugs. The harmful effects of these substances have not been well understood. In fact, there is great ignorance of the harmful effects of marijuana and other drugs that are being used for experimental or recreational purposes. The implications that the harmful effects that these drugs have for the health and wellbeing of individuals, families, and society are legion. * * * * * * *

Federal Register Submission
Food and Drug Administration,
10903 New Hampshire Ave.,
Silver Spring,
MD, 20993-0002, USA.

Re: Re-Scheduling of Cannabinoids in USA – Tetrahydrocannabinol and Cannabidiol Related Arteriopathy, Genotoxicity and Teratogenesis

I am very concerned about the potential for increased cannabis availability in USA implied by full drug legalization; however, a comprehensive and authoritative submission of the evidence would take weeks and months to prepare. Knowing what we know now and indeed, what has been available in the scientific literature for a growing number of years concerning a myriad of harmful effects of marijuana, marijuana containing THC should not be reclassified.

These effects that are now well documented in the scientific literature include, alarmingly, harm involving reproductive function and birth anomalies as a result of exposure to or use of marijuana with THC. In addition to all of the usual concerns which you will have heard from many sources including the following I have further particular concerns:

1) Effect on developing brains

2) Effect on driving

3) Effect as a Gateway drug to other drug use including the opioid epidemic

4) Effect on developmental trajectory and failure to attain normal adult goals(stable relationship, work, education)

5) Effect on IQ and IQ regression

6) Effect to increase numerous psychiatric and psychological disorders

7) Effect on respiratory system

8) Effect on reproductive system

9) Effect in relation to immunity and immunosuppression

10) Effect of now very concentrated forms of cannabis, THC and CBD which are widely available

11) Outdated epidemiological studies which apply only to the era before cannabis became so potent and so concentrated

12) Cannabis is now known to have an important arteriopathic effect and cardiovascular toxic effect .

These issues are all well covered by a rich recent literature including reviews from such major international authorities as Dr Nora Volkow Director of NIDA, Professor Wayne Hall and others .

Cannabinoid Therapeutics

In my view the therapeutic effects of cannabinoids have been wildly inflated by the press. Moreover, with over 1,000 studies listed for cannabinoids on clinicaltrials.gov, the chance of a type I experimental error, or studies being falsely reported to be positive when in fact they are not, is at last 25/1,000 at the 0.05 level.

THC as dronabinol is actually a failed drug from USA which has such a high incidence of side effects that it was rarely used as superior agents are readily available for virtually all of its touted and alleged therapeutic applications. My American liaisons advise that dronabinol sales have climbed in recent times as patients use it as a ruse to avoid detection of cannabinoid use at work in states where it is not yet legal. So when I call it a failed therapeutic I mean in a traditional sense, not in the novel way it is now applied for flagrantly flouting the law.

In considering the alleged benefits of cannabis one has to be particularly mindful of cannabis addiction in which cannabinoids will alleviate the effect of drug withdrawal as they do in any other addiction. Moreover, the fact that cannabis itself is known to cause both pain and nausea, greatly complicates the interpretation of many studies.

I also have the following concerns which relate in sum to the arteriopathy and vasculopathy and the genotoxicity of cannabis, tetrahydrocannabinol and likely including cannabidiol and various other cannabinoids:

Cannabinoid Arteriopathy

Particularly noteworthy amongst these various reports are two reports by Dr Nora Volkow in 2014, the Director of the National Institute of Drug Abuse at NIH to the New England Journal of Medicine which together document the adverse cardiovascular and cerebrovascular effects of cannabis at the epidemiological level ; a report from our own increase cardiovascular aging to BMJ Open ; a series of reports showing a fivefold

increase in the rate of heart attack within one hour after cannabis smoking ; several reports of cannabis related arteritis ; other reports of the cerebrovascular actions of cannabis ; documentation that cannabis exposure increases arterial stiffness and cardiovascular and organismal aging ; and a recent report showing that human endothelial vascular function – vasodilation – is substantially inhibited within just one minute of cannabis exposure .

It is also relevant that a synthetic cannabinoid was recently shown to directly induce both thromboxane synthase and lipoxygenase, and so be directly vasoconstrictive, prothrombotic and proinflammatory .

Vascular aging, including both macrovascular and microvascular aging is a major pathological feature not only because most adults in western nations die from myocardial infarction or cerebrovascular accidents, but also because local blood flow and microvascular function is a key determinant of stem cell niche activity in many stem cell beds. This has given rise to the vascular theory of aging which has been produced by some of the leading researchers at the National Health Lung and Blood Institute at NIH, amongst many others .

It can thus be said not only that “You are as old as your (macrovascular) arteries”, but also that “you are as old as your (microvascular) stem cells.” Hence the now compelling evidence for the little known arteriopathic complications of cannabis and cannabinoids, carry very far reaching implications indeed. This was confirmed directly in the clinical study of arterial stiffness from my clinic mentioned above .

Whilst aging, myocardial infarction and cerebrovascular accidents are all highly significant outcomes and major public health endpoints, these effects assume added significance in the context of congenital anomalies. Some congenital defects, such as gastroschisis, are thought to be due to a failure of vascular supply of part of the anterior abdominal wall . Hence in one recent study the unadjusted odds ratio of having a gastroschisis pregnancy amongst cannabis users (O.R.=8.03, 95%C.I. 5.63-11.46) was almost as high as that for heroin, cocaine and amphetamine users (O.R.= 9.35, 95%C.I.
6.64-13.15), and the adjusted odds ratio for any illicit drug use (of which was 84% cannabis) was O.R.=3.54 (95%C.I. 2.22-5.63) and for cannabis alone was said by these Canadian authors to be O.R.=3.0. Hence cannabis related vasculopathy – arteriopathy beyond its very serious implications in adults also carries implications for paediatric and congenital disorders and may also constitute a major teratogenic mechanism.

Cannabinoid Genotoxicity and Teratogenesis

Cannabis is associated with 11 cancers (lung, throat, bladder, airways, testes, prostate,

cervix, larynx) including;

Four congenital and thus inherited cancers (rhabdomyosarcoma, neuroblastoma,ALL,

AML and AMML);

Sativex product insert in many nations carries standard warning against its use by

males or females who might be having a baby.

Cannabis – and likely also CBD – is known to be associated with epigenetic changes

some of which are believed to be inheritable for at least four generations.

Cannabis is known to interfere with tubulin synthesis and binding and it also

acts via Stathmin so that microtubule function is impeded . This leads directly to

micronucleus formation. Cannabis has been known to test positive in the

micronucleus assay for over fifty years. This is a major and standard test for

genotoxicity. Micronucleus formation is known to lead directly to major chromosomal toxicity including chromosomal shattering – so-called chromothripsis –and is known to be associated with cell death, cancerogenesis and major foetal abnormalities.

Cannabis has also been linked definitively with congenital heart disease is a statement

by the American Heart Association and the American Academy of Pediatrics in 2007, on the basis of just three epidemiological studies, all done in the days before cannabis became so concentrated. Congenital heart defects have also been linked with

the father’s cannabis use . Indeed, one study showed that paternal cannabis use was

the strongest risk factor of all for preventable congenital cardiac defects.

Cannabis has also been linked with gastroschisis in at least seven cohort and case

control studies some of which are summarized in a Canadian Government

Report 200. In that report the geographic incidence of most major congenital anomalies

closely paralleled the use of cannabis as described in other major Canadian reports.

The overall adjusted odds ratio for cannabis induction of gastroschisis was

quoted by these authors as 3.0. Moreover, outbreaks of both congenital heart disease and gastroschisis in North Carolina also paralleled the local use of cannabis in that state as described by Department of Justice Reports . The incidence of gastroschisis was noted to double in North Carolina 1999-2001 in the same period the cannabis trade there was rising.

Figures of cannabis use in pregnant women in California by age were also

recently reported to JAMA 229, age group trend lines by age group which closely

approximate those reported by CDC for the age incidence of gastroschisis in the USA

Importantly much of the cannabis coming into both North Carolina and Florida is said to originate in Mexico. An eight-fold rise in the rate of gastroschisis has been reported from Mexico . Gastroschisis has also risen in Washington state. Cannabis has also been associated with 17 other major congenital defects by major Hawaiian epidemiological study reported by Forrester in 2007 when it was used alone

When considered in association with other drug use – which in many cases cannabis leads to – cannabis use was associated with a further 19 major congenital defects. In addition to the effect of cannabinoids on the epigenome and microtubules, cannabinoids have been firmly linked to a reduction of the ability of the cell to produce energy from their mitochondria. An extensive and robust evidence base now links cellular energy generation to the maintenance and care of cellular DNA .

Moreover, as the cellular energy charge falls so too DNA maintenance collapses, and indeed, the cell can spiral where its remaining energy resources, particularly as NAD+, are routed into failing and futile DNA repair, the cell slips into pseudohypoxic metabolism like the Warburg effect well known in cancerogenesis , NAD+ falls below the level required for further energy generation and cellular metabolism collapses. Hence this well-established collapse of the mitochondrial energy charge and transmembrane potential forms a potent engine of continuing and accelerating genotoxicity .

Moreover, the well documented decline in mitochondrial respiration induced by cannabinoids, including tetrahydrocannabinol, cannabidiol and anandamide achieves particular significance in the light of the robustly documented decline in cellular energetics including NAD+ which not only occurs with age but indeed, has now been shown to be one of the primary drivers of cellular and whole organismal aging. It follows therefore that cannabinoid administration (including THC andCBD) necessarily phenocopies cellular aging. This implies of course that cannabinoid dependent patients are old at the cellular level. Indeed, normal human aging is phenocopied in the clinical syndrome of cannabinoid dependence which includes:

1) Neurological deficits in:

i) attention,

ii) learning and

iii) memory;

iv) social withdrawal and disengagement and

v) academic and

vi) occupational underachievement

2) Psychiatric disorders including

i) Anxiety,

ii) Depression,

iii) Mixed Psychosis

iv) Bipolar Affective disorder and

v) Schizophrenia,

3) Respiratory disorders including:

i) Asthma

ii) Chronic Bronchitis (increased sputum production)

iii) Emphysema (Increased residual volume)

iv) Probably increased carcinomas of the aerodigestive tract

4) Immune suppression which generally implies

i) segmental immunostimulation in some parts of the immune system since the innate and adaptive immune systems exert profound homeostatic mechanisms in response to suppression of one of its parts. A Substantial literature on immunostimulation

5) Reproductive effects generally characterized by reduced

i) Male and

ii) Female fertility

6) Cardiovascular toxicity with elevated rates of

i) Myocardial infarction

ii) Cerebrovascular accident

iii) Arteritis

iv) Vascular age – vascular stiffness

7) Genotoxicity in

i) Respiratory epithelium and

ii) Gonadal tissues.

8) Osteoporosis

9) Cancers of the

i) Head and neck

ii) Larynx

iii) Lung

iv) Leukaemia

v) Prostate

vi) Cervix

vii) Testes

viii) Bladder

ix) Childhood neuroblastoma

x) Childhood acute lymphoblastic leukaemia

xi) Childhood Acuter Myeloid and myelomonocytic leukaemia

xii) Childhood rhabdomyosarcoma 201,202.

The issue here of course is that cannabinoid dependence therefore copies without exception all of the major disorders of old age, each of which is also faithfully phenocopied by cannabis dependence.

The most prominent disorders of older age include:

1) Alzheimer’s disease

2) Cardiovascular and cerebrovascular disease

3) Osteoporosis

4) Systemic inflammatory syndrome

5) Changes in lung volume and the mechanics of breathing

6) Cancers

Hence this provides one powerful pathway by which cannabinoid exposure can replicate and phenocopy the disorders of old age. This is not of course to suggest that this is the only such pathway. Obviously changes of the general level of immune activity, or alterations of the level of DNA repair occurring directly or indirectly associated with cannabis use can form similar such pathways: both are well documented in cannabis use and also in the aging literature as major pathways implicated in systemic aging.

Nevertheless, the decline in mitochondrial energetics together with its inherent genotoxic implications does seem to be a particularly well substantiated and robustly demonstrated pathway which must give serious pause to cannabinoid advocates if the sustainability of the health and welfare systems is to be factored in together with any consideration of individual patient, advocate and industrial-complex rights.

The genotoxicity of THC, CBD and CBN has been noted against sperm since at least 1999 (Zimmerman and Zimmerman in Nahas “Marijuana and Medicine” 1999, Springer). This is clearly highly significant as sperm go directly into the formation of the zygote and the new human individual. CB1R receptors are known to exist intracellularly on both the membranes of endoplasmic reticulum and mitochondria. In both locations they can induce organellar stress and major cell toxicity including disruption of DNA maintenance. Interestingly mitochondrial outer membrane CB1R’s signal via a complex signalling chain involving the G-protein transduction machinery, protein kinase A and cyclic-AMP across the intermembrane space to the inner membrane and cristae, in a fashion replicating much of the G-protein signalling occurring at the cell membrane. This machinery is also implicated in mitonuclear signalling, and the mitonuclear DNA balance between mitochondrial DNA and nuclear DNA transcriptional control, which has long been implicated in inducing the mitochondrial unfolded protein cellular stress response cell aging, stem cell behaviour and DNA genotoxic mechanisms.

You are no doubt aware that human sperm are structured like express outboard motors behind DNA packets with layers of mitochondria densely coiled around the rotating flagellum which powers their progress in the female reproductive tract. These mitochondria also carry CB1R’s and are significantly inhibited even at 100 nanomolar THC. The acrosome reaction is also inhibited .

Cannabidiol is known to act via the PPARγ system 101,302-308. PPARγ is known to have a major effect on gene expression, reproductive and embryonic and zygote function during development 309-332 so that significant genotoxic and / or teratogenic effects seem inevitable via this route. Drugs which act in this class, known as the thiazolidinediones, are classed as category B3 in pregnancy and caution is indicated in their use in pregnancy and lactation.

The Report of the Reproductive and Cancer Hazard Assessment Branch of the Office of Environmental Health Hazard Assessment of the Health Department of California was mentioned above in connection with the carcinogenicity of marijuana smoke . Since virtually all mutagens are also teratogens it follows therefore from the basic tenets of mutagenesis that if cannabis is unsafe as a known carcinogen it must also be at the very least a putative teratogen.

CBD has also been noted to be a genotoxic in other studies . All of which points to major teratogenic activity for both THC and CBD. Some of the quotations from Professor James Graham’s classical book on the effects of THC in hamsters and white rabbits, the best animal models for human genotoxicity, bear repeating:

a) “The concentration of THC was relatively low and the malignancy severe.”

b) “40-100μg resin/ml there occurred marked inhibition of cell division.

c) “large total dose, Hamsters, 25-300mg/kg …“oedema,phocomelia,omphalocoele, spina bifida, exencephaly, multiple malformations and myelocoele. This is a formidable list.”

d) “It is to this anti-mitotic action that the authors attribute the embryotoxic action of cannabis.”

e) “By such criteria resin or extract of cannabis would be forbidden to women

during the first three months of pregnancy.”

Indeed, even from the other side of the world I have heard many exceedingly adverse reports from US states in which cannabis has been legalized including Colorado, Washington, Oregon, Florida and California. Taken together the above evidence suggests that these negative reports stem directly from the now known actions of cannabis and cannabinoids, and are by no means incidental epiphenomena somehow related to social constructs surrounding cannabis use or the product forms, dosages, or routes of administration involved.

Cannabis that contains increasingly high levels of THC is now widely available, particularly in the jurisdictions where the use of cannabis has been legalized. This means that another major genotoxin, akin to Thalidomide, is being unleashed on the USA and the world. This is clearly a very grave, and. indeed, an entirely preventable occurrence.

Dr Frances Kelsey of FDA is said to have the public servant based at FDA who saved American from the thalidomide scandal which devastated so many other English-speaking nations including my own . This occurred because the genotoxicity section of the file application with FDA was blank. It was blank because thalidomide tested positive in various white rabbit and guinea pig assays. It is these same tests which cannabis is known to have failed. Dr Kelsey’s photograph has been published in the medical press with President Kennedy for her service to the nation. The challenge to FDA at this time seems whether Science can triumph over agenda driven populism, its primary vehicle, the mass media, and its primary proximate driver the burgeoning cannabis industry. Since FDA is the Federal agency par excellence where Health Science is weighed, commissioned and thoughtfully considered the challenge in our time would appear to be no less.

Evidence to date does not suggest that major congenital malformations are as common after prenatal cannabis exposure as they are after prenatal thalidomide exposure. Nevertheless the qualitative similarities remain and indeed are prominent. It is yet to be seen whether the rate of congenital anomalies after cannabis are quantitatively as common: epidemiological studies in a high potency era have not been undertaken; and even the birth defects rates from most birth defects registers in western nations including that held by CDC, Atlanta appear to be seriously out of date at the time of writing. Moreover the non-linear dose response curve in many cannabis genotoxicity studies which includes a sharp knee bend upwards beyond a certain threshold level which suggests that we could well be in for a very unpleasant quantitative surprise. At the time of writing this remains to be formally determined.

Dr Bertha Madras, Professor of Addiction Psychiatry at Harvard Medical School has recently argued against re-scheduling of cannabis. Her comments include the following:

“Why do nations schedule drugs? …… Nations schedule psychoactive drugs because we revere this three-pound organ (of our brain) differently than any other part of our body. It is the repository of our humanity. It is the place that enables us to write poetry and to do theater, to conjure up calculus and send rockets to Pluto three billion miles away, and to create I Phones and 3 D computer printing. And that is the magnificence of the human brain. Drugs can influence (the brain) adversely. So, this is not a war on drugs. This is a defense of our brains, the ultimate source of our humanity” .

I look forward to seeing the comments that you post concerning the reasons why the classification for marijuana should not be changed and that, indeed, the public should be alerted to the very harmful effects of marijuana with THC, especially in light of the wide range of marijuana’s harmful effects and the high potency of THC in today’s marijuana and in light of the idiosyncratic effects of marijuana of even low doses of THC and owing to the certain risk of harm to progeny and babies born to users of marijuana.

Please feel free to call on me if you would like further information concerning the research to which I have referred herein.

Yours sincerely,

Professor Dr. Stuart Reece, MBBS (Hons.), FRCS(Ed.), FRCS(Glas.), FRACGP, MD(UNSW). School of Psychiatry and Clinical Neurosciences Edith Cowan University and University of Western Australia, Perth, WA stuart.reece@uwa.edu.au

Source: http://GordonDrugAbusePrevention.com.

Filed under: Australia,Effects of Drugs (Papers),Political Sector,Social Affairs (Papers),USA :

A small but vocal contingent of drug policy interpreters is attempting again to further the fallacious meme that ‘prohibition’ and ‘supply reduction’ are driving drug deaths in Australia, not poor policy interpretation and use which foster a permission model for the vulnerable and pop-culture informed community – particularly the young, Dalgarno Institute writes.

PRESS RELEASE FROM THE DALGARNO INSTITUTE…

The National Drug Strategy

The latest National Drug Strategy 2017-26, now puts Demand Reduction as the priority! The strategy states that “Harm Minimisation includes a range of approaches to help prevent and reduce drug related problems…including a focus on abstinence-oriented strategies… [Harm minimisation] policy approach does not condone drug use.” (page 6)“Prevention of uptake reduces personal, family and community harms, allow better use of health and law enforcement resources, generates substantial social and economic benefits and produces a healthier workforce. Demand Reduction strategies that prevent drug use are more cost effective than treating established drug-related problems…Strategies that delay the onset of use prevent longer term harms and costs to the community.” (page 8)

The National Drug Strategy segments the drug issue into three main categories:

Tobacco – Alcohol – Illicit drugs

A quick summary of the policy focus/emphasis on each drug can be encapsulated as follows:

Tobacco

QUIT! Cessation, and exit from tobacco use is the ONLY goal for this drug. There is no illusion about the journey to that destination being difficult, and the reality of failure clear, but the goal posts don’t move QUIT is the ONE message ONE focus and ONE voice in all sectors of the media, community, education and legislation arenas. (Remember this is a legal drug, and until about 20 years ago, utterly socially acceptable) We have reduced smoking rates of 75% of Australian Males (not including females) after World War II down to around 14% of total population. According to health data, approximately 100,000 people give up tobacco each year, but about the same take it up. No prizes for guessing that cohort make up? The 16-24-year-old demographic usually engage (research shows us) in tobacco use mostly when drinking alcohol. Of course, learning ‘smoking’ as a delivery mechanism also equips the tobacco user for ‘smoking’ of other drugs.

Alcohol

‘Moderate! Drink Responsibility!’ However, a growing educative and legislative push (due to the rising costs of alcohol harms to community) is seeing attitudes change, with now approx. 21 per cent of Australians of drinking age now abstinent! (Remember this is a legal and completely socially acceptable drug.)

Illicit drugs

The mantra? ‘Use is likely, so use carefully and don’t die!’ And we are perpetually informed by certain vested interests that for the 3.5 – 4% of illicit drug users in this country (Cannabis use excised from stats here) that cessation of, or exiting from, drug use is virtually impossible – well so the mantra educates, and that ‘learned behaviour’ of powerlessness and choice stripped victimhood is now parroted as reason enough to ‘validate’ the notion of intractability.

So, then it is touted, the only answer for this demographic is either legalisation or a suite of policies or policy interpretations that enables, empowers, endorses or equips on going drug use, because, it is believed any ‘prohibition’ messaging will not only fail, but be counterproductive. But apparently NOT so with Tobacco, where such prohibition messaging has worked brilliantly!!The cognitive dissonance in this space continues to be breathtaking!

So, what of Harm Reduction ONLY policy implementation of our three pillar National Drug Strategy?

Harm Reduction.

Let’s be clear – what we have now in Australia’s drug taking public psyche (learned/taught behaviour), is well educated and fully self-aware, (and product aware) young adults determining that any drug use risk is manageable. Why? These purported intelligent, sophisticated ‘buzz’ seeking and cashed up adult party goers, willingly and deliberately seek out illicit drugs, purchase them with disposable income, not because of the tyranny of addiction, but to ‘enhance the party experience’. They then take these substances to public events and consume these psychotropic toxins.

Of course, they are fully aware of the mantra they have been taught, as early as secondary school, that if something happens all you should do is call the ambulance. Not only will these remarkable and brave tax-payer funded public servants attend to your self-inflicted illegally induced harm, but will ferry you, at cost to the public purse, to an already overcrowded and strained public health facility. There they will be treated by caring professionals, who have more regard for their well-being than the hapless drug user does. Once they are discharged from the hospital, there (for the most part) is no cost to them, and complete impunity from the law. Little, if no legal action or facilitated diversion is taken and the illicit drug user goes on their way until next drug taking episode.

Whilst no one wants to see injury, let alone death from these reckless behaviours, the mechanisms to ‘save lives’ are already well in play and consequently risk/responsibility factors are disregarded. What must not happen, but clearly is happening, is this utter carelessness for wellbeing of self and others cannot, must not be endorsed or worse, enabled/empowered by poor policy or policy interpretation/use.

There is little or absolutely no accountability for this costly, dangerous, self-indulgent and illegal behaviour. And the cry from the pro-drug lobby is not to call for best practice demand reduction, prevention and/or recovery/exit from this activity/behaviour – No, it’s to declare ‘inevitability’ of behaviour and then, the careless equipping, enabling or empowering of mechanisms to assist the educated self-harmer to continue to use!

Again, it is this permission, NOT prohibition that is continuing to put young lives (and more of them) at risk. The no-longer tacit, but now abundantly clear message in the cultural market place, is that ‘you can take drugs anytime and anywhere and nothing will be done, other than assistance for you if things go pear shaped!’

It’s this message, and not demand and supply reduction vehicles which is empowering ongoing drug use.

It’s time to change the narrative around this ever-permissive drug culture – if not for the sake of people’s lives, then for the emerging generation who are watching this model set them up for engagement, not avoidance of illegal drug use.

Genuine compassion driven anti-drug Harm Reduction must always be about the cessation and/or exiting from drug use and any policy or policy interpretation that fosters a contrary outcome is not good drug policy. The drug policy/strategy interpretation narrative has meant that the term ‘harm reduction’ and ‘harm minimisation’ are now interchangeable terms. Essentially this ensures that Harm Reduction becomes the only pillar of the three-pillar strategy is in play.

This has worked marvellously at convincing even anti-drug citizens, that there is only one option available. Time will not permit to table every encounter we’ve had, but the following statement reflects numbers we have heard…

“Pity we can’t use your harm prevention education program, because it’s illegal. We are only allowed to teach harm reduction in schools!” Head of a State Government Regional Education group, Victoria.

Of course, this is patently false, as Demand Reduction and prevention are not only best practice models, but mandated in the NDS, particularly for the demographic with the developing brain – 12-28-year-old! The Key questions that must be asked about illicit drug policy, are the following;

* Does the policy (or interpretation – harm reduction only) lead to an exit from or cessation of drug use, or does it enable, endorse, empower or equip on going drug use?

* Does the policy (or interpretation) increase or reduce demand for illicit drugs?

* Does the policy (or interpretation) undermine or support the other two pillars? (i.e. increase or reduce Demand or Supply for drugs)

If the policy use/interpretation is creating cognitive dissonance in implementation and leads to a conflagration, rather than collaboration of all three pillars, then the strategy is going to have difficulty in effectively moving a culture away from drug use.

Well, perhaps that is exactly the agenda of the pro-drug lobbyists who have inordinate and disproportionate influence in drug policy implementation? I hear even genuine and compassionate harm reductionists, who actually want to stop drug use and see people recover, railing against supply reduction pillar as ‘waste of resources’. And staggeringly many of these same good people are silent on Demand Reduction, the key to seeing change. These two modes of thinking are the key elements of ensuring only one ‘pillar’ of the NDS is focused on, for genuine or disingenuous purposes. Again, one must ask, does the drug policy interpretation facilitate:

Reducing – Remediating – Recovery from drug use?

Or does the policy instead facilitate the:

Enabling – Empowering – Equipping of drug use?

This interpretative matrix needs to be applied to all drug categories and types – for example, do the following strategies lend themselves more to Enabling or Reducing on going drug use?

* Injecting rooms

* Needle Syringe Programs

* Pill Testing

* 12 Step Programs

* Therapeutic Communities

THE LOW-DOWN ON ‘DIRTY’ SYRINGES 29/5/17 (Anex)

People who inject drugs in Australia can appear to be well provided for with regard to sterile needles and syringes. Across the country there are 3500 needle and syringe programs (NSPs) which distribute almost 50 million pieces of equipment a year. But the international best practice for injecting drugs of a fresh needle for every injection is far from reality. People who inject drugs reuse syringes, share equipment like spoons, water and tourniquets, and a small proportion continue to share injecting equipment with others

. A 20-year survey by the Australian NSP Survey showed that…. Since 2011 the reuse had hovered around 21-25 per cent. The percentage of people who inject drugs who reported they shared syringes with others was also steady at 15-16 per cent from 2011-2015. And the sharing of equipment other than needles remained stable at 28-31 per cent.

This article in a recent ANEX update – notice the nonchalant manner that ‘best practice’ is used and the blithely mentioned MILLIONS of tax-payers funded syringes being unaccountably handed out, yet having 30% of injecting drug users STILL sharing equipment with 16% still sharing needles!

Of course, this proliferation of unaccountable injecting gear has been a key element in the rabid rise in street use and syringe/needle discarding. So, what may be the answer? Will we need to have 3500 injecting rooms open 24/7 for convenience of use and ease of access? Facilities too, with absolute zero accountability as there is absolutely NO potential ‘stigma bestowing’ process permitted that might challenge the behaviour of the self-harming drug taker!

If every injecting episode for every Intravenous drug user was to take place in an injecting room and a sunset clause on such behaviour, ensuring a transitioning to drug use exiting measures, then this might have some merit, as catastrophically expensive and unmanageable as that would be. However, the data tells us that for every single injecting episode that occurs ‘under supervision’, there are over 90 that happen elsewhere!

The appalling ‘health care’ logic, or lack of, is very concerning! It becomes even more so when policy caveats of ‘non-judgemental’ attitudes (whatever that this subjective descriptor can mean) are foisted upon, even the NSP staff – However, NO SUCH MORAL COMMENTARY can be levelled, what-so-ever, at the person who is the self-harming, law breaking, body destroying, and no doubt, family grieving drug taker! This at best is

‘moral’ hypocrisy – at worst unconsumable! (Of course, that last sentence itself is viewed as counterproductive and stigmatizing and thus not permitted in the discourse!)

“The perpetual permission of harm reduction only policies, NOT prohibition is putting lives at risk!” Dalgarno Institute.

Injecting Rooms

Gary Christian, Secretary for Drug Free Australia, has pointed to the lack of success by the Kings Cross Injecting Centre (MSIC) in reducing overdose deaths in the Kings Cross area. He said, “Tracking of overdose deaths in the Kings Cross area from 5 years before the injecting room opened compared with the 9 years after the injecting room was opened showed no change whatsoever in the percentage of deaths in the area as compared to the rest of NSW. The KPMG review showed that Kings Cross had 12% of NSW opiate deaths before the commencement of the MSIC, and in the 9 years after it remained at 12%, such has been its failure to make any difference.”

Evidence given to the NSW Parliament indicates that overdoses in the Kings Cross injecting room are 32 times higher than the overdose histories of those entering the injecting room, indicating that clients are experimenting with higher doses of opiates and cocktails of drugs knowing that if they should overdose in their experimentation, someone will bring them around. NSW Hansard records testimony from ex-clients of the injecting room who were rehabilitating from drugs that experimentation with higher doses of drugs is the reason for the inordinately high overdose rate in the room.

The question now appears to not be about ‘best practice’, but simply what emotive or socio-political drivers dictate when it comes to drug policy – So, where do you land? If you’re all for drug use, then another conversation and investigation in to the why of that is your priority. However, the disturbing reality for the tens of thousands of ex-users who already know the ultimate outcome of illicit drug use is. The reality is, those conversations and investigations are near impossible for a person using the substance in a culture that passively, no, actively permits it!

Any enterprise that inadvertently enables, empowers or equips ongoing illicit drug use has already breached best health care practice. Harm Reduction can never be about the support of on-going, health diminishing substance use. Caring, responsible and civic minded clinicians and policy makers will always be focused on movement toward exit from, and cessation of drug use. Mechanisms that enable any government agency to send a message to the community that we are not only supporting, but enabling tax payer funded illicit drug use, not only breaches care for the illegal drug user, but breaches international conventions. It also demonstrates a lack of concern for most of the non-drug using community.

I trust a thorough ‘best practice’ consideration of any drug policy ‘strategy’ will always seek to reduce demand for and use of any illicit drug, if not for the sake of the drug user, then for the wider community, who the vast majority of are illicit drug free. Our emerging generation need proactive and protective mechanisms to give them best chance to live drug free lives.

Let us be very clear, we are not conducting a ‘war against drugs’. We are however fighting for the brains, potentials, and in many instances, the very future of an entire emerging generation. (Dr Bertha Madras – Harvard) That for any caring civic minded human being is a fight worth having, and one worth joining!

Source: dbrecoveryresources.com/2018/04/permission-empowered-drug-policy-interpretations-drive-demand-for-drug-use/ Dalgarno Institute

Filed under: Harm Reduction including HIV (Papers),Social Affairs (Papers) :

July 2017 Revised January 2018

Injury Prevention Centre: Who we are

The Injury Prevention Centre (IPC) is a provincial organization that focuses on reducing catastrophic injury and death in Alberta. We act as a catalyst for action by supporting communities and decision-makers with knowledge and tools. We raise awareness about preventable injuries as an important component of lifelong health and wellness. We are funded by an operating grant from Alberta Health and we are housed at the School of Public Health, University of Alberta.

Injury in Alberta

Injuries are the leading cause of death for Albertans aged 1 to 44 years. In 2014, injuries resulted in 2,118 deaths, 63,913 hospital admissions and 572,653 emergency department visits. Of all age groups, young adults, 20 to 24 years old had the highest percentage of injury deaths with 84.9%. Youth, 15 to 19 years of age had the second highest percentage of injury deaths with 76.4%.

1. Alberta is spending an estimated $4 billion annually on injury – that amounts to $1,083.00 for every Albertan.

2. Potential impact of cannabis legalization on injury in Alberta In 2018, the Government of Canada will legalize the use of cannabis for recreational purposes. In the United States, some jurisdictions have similarly legalized cannabis for recreational use and have collected data on the changes in injuries due to cannabis use. Jurisdictions that have legalized the use of recreational as well as medical cannabis have experienced increases in injuries due to burns (100%), pediatric ingestion of cannabis (48%), drivers testing positive for cannabis and/or alcohol and drugs (9%), drivers testing positive for THC (6%) and drivers testing positive for the metabolite caboxy-THC (12%) when comparing pre- and post-legalization numbers.

3. (pg. 149) Of greatest concern are the traffic outcomes. “Fatalities substantially increased after legislation in Colorado and Washington, from 49 (in 2010) to 94 (in 2015) in Colorado, and from 40 to 85 in Washington. These outcomes suggest that after legislation, more people are driving while impaired by cannabis.”

4. (pg.155) Alberta can expect to see similar changes in injuries when the new laws take effect. The objective of this document is to recommend policies for inclusion in the Alberta Cannabis Framework that will minimize negative impacts of cannabis legalization on injuries to Albertans. Our focus is on:

* Preventing Cannabis-Impaired Driving

* Preventing Poisoning of Children by Cannabis

* Preventing Burns due to Combustible Solvent Hash Oil Extraction

* Preventing Other Injuries due to Cannabis Impairment

* Developing Surveillance to Identify Trends in Cannabis-Related injury

* Implementing a Comprehensive Public Education Plan

Injuries due to cannabis impairment in Alberta can be expected to rise following the legalization of recreational cannabis use. To mitigate the negative effects of legalization on injuries in Alberta, the Injury Prevention Centre recommends the Government of Alberta take the following actions for:

Preventing Cannabis-Impaired Driving

Impose administrative sanctions at a lower limit than Criminal Code impairment

Mandate a lower per se levels for THC/alcohol co-use

Increase sanctions for co-use of alcohol and cannabis

Separate cannabis and alcohol outlets by the creation of a public retail system for the distribution of cannabis products

Support Research to Improve Enforcement Tools

Apply sufficient resources to training and enforcement

Conduct public education regarding cannabis-impaired driving .

Preventing Poisoning of Children by Cannabis

Uphold federal legislation regarding packaging

Support public education on cannabis poisoning’

Preventing Burns due to Combustible Solvent Hash Oil Extraction

Prohibit the production of cannabis products using combustible solvents if it fails to appear in federal Bill C45.

Implement public education regarding the dangers of producing cannabis products using combustible solvents

Preventing Other Injuries due to Cannabis-Impairment

Inform the public about the risks of other activities when impaired

Develop Surveillance to Identify Trends in Cannabis-Related injury

Collect and analyze emergency department, hospital admission and death data for injuries involving cannabis impairment

Develop and implement a comprehensive public education campaign about the safe use of cannabis

Source: https://injurypreventioncentre.ca/downloads/positions/IPC%20-%20Cannabis%20Legalization Jan. 2018

Filed under: Canada,Global Drug Legalisation Efforts,Political Sector,Prevention (Papers) :

The Sun’s brief item describing a frightening new threat in Maryland’s drug addiction crisis (“Person who used synthetic marijuana suffers bleeding,” April 6) reveals the necessity of a renewed focus on substance abuse prevention and public education.

On April 4, the National Drug Early Warning System at the University of Maryland issued an alert about the detection of rat poison (brodifacoum) in synthetic marijuana in Illinois that resulted in two deaths and 81 emergencies. This drug, known on the street as spice or K2, causes severe bleeding, vomiting of blood, and other painful side effects. Two days later, as The Sun reports, this potentially-fatal fake weed arrived in Baltimore. The implication from this news calls for a renewed emphasis on prevention as part of Maryland’s overall response to the opioid crisis.

Specifically, while it’s essential that policymakers, health care and treatment providers, and related organizations stay steadfast in increasing the number of treatment beds, outpatient facilities, sober living houses, medication-assisted treatment and other evidence-based strategies, it also is vital to understand the treatment medications like Vivitrol, Suboxone, and Methadone are not effective in treating synthetic marijuana analogs like spice and K2.

This is another aspect of the tragedies and family horror stories caused by substance use disorder, the clinical term for drug addiction. Medications that are effective with one drug are ineffective with a different drug. This devastating dynamic requires that everyone in their respective communities work together to spread and reinforce prevention strategies and activities.

Source: http://www.baltimoresun.com/news/opinion/readersrespond/bs-ed-rr-addiction

Filed under: Synthetics :

The following video is long – 52 minutes, but it is essential viewing to help people understand some of the consequences of legalisation for both medicinal and recreational use of cannabis in the USA. Make yourself a cup of coffee and watch this in its entirety.

Subject: Marijuana X https://m.facebook.com/story.php?story_fbid=10156320599628035&id=670743034&ref=content_filter

Filed under: Global Drug Legalisation Efforts :

Public health officials say the nerve pain medication gabapentin is being found in an increasing number of overdose deaths, according to CBS News.

Gabapentin is a non-narcotic drug used to treat seizures and pain associated with shingles. Doctors have been prescribing it for a growing number of other conditions, as a way to offer pain relief without opioids. A study published last year found that for people who use heroin, the combination of opioids with gabapentin potentially increases the risk of overdose death.

“Unfortunately, we now need to worry about it because people are abusing it,” Dr. James Patrick Murphy, a pain and addiction specialist in Kentucky, told the Louisville Courier-Journal. “Alone, it’s not something that will stop your breathing or your heart,” he said. “But if you take it along with a drug like heroin or fentanyl, together it might be enough to make you stop breathing and put you over the edge.”

Source: https://drugfree.org/learn/drug-and-alcohol-news/nerve-pain-medication-gabapentin April 5th 2018

Filed under: Health,Heroin/Methadone,Prescription Drugs :

EXECUTIVE SUMMARY

The objectives of this risk assessment were to:

· ascertain the state of the science in research into the potential health effects of low levels of tetrahydrocannabinol (THC) and other cannabinoids found in Cannabis sativa;

· identify key health hazards that may be associated with the presence of THC and other cannabinoids in consumer products made with industrial hemp (C. sativa cultivars with <0.3% (w/w) THC);

· assess the human health safety of the Canadian limit of 10 ug/g THC for raw materials and products made from industrial hemp; and

· to identify uncertainties and critical data gaps in the risk assessment.

Of the more than 60 cannabinoids identified in C. sativa, the toxicity of THC is the best characterized. Limited toxicity data have been reported for two other cannabinoids, cannabidiol (CBD) and cannabinol (CBN), but there are no toxicity data on the remaining cannabinoids.

Two key hazards of cannabinoid exposure are neuroendocrine disruption and neurological impairment. Neuroendocrine disruption by low levels of cannabinoids during developmental stages (perinatal, prepubertal, pubertal) leads to permanent adverse effects on brain and reproductive system development in animals. The lowest observed effect level (LOEL) for neuroendocrine disruption by THC was 1 ug/kg/d derived from a study in rats (no suitable human studies were available). Such effects could occur in humans. Similarities in the types of adverse effects, the cannabinoid receptor distribution in the brain, and the pharmacokinetics and metabolism of cannabinoids among humans and animal species support the extrapolation from animal data to humans for the purposes of risk assessment. Neurological impairment is manifested as deficits in performance with respect to cognitive and motor skills. The LOEL for neurological impairment by THC was 70 ug/kg based on data from a dose-response study in which human subjects who had a history of marihuana use received a single oral dose of THC, and cognitive and motor skills and perception of psychoactive effects were measured.

It was not deemed possible to develop a tolerable daily intake (TDI) due to the lack of a no observed effect level (NOEL), lack of data on chronic exposure and lack of data on the potential contribution of other cannabinoids to the adverse effects. Potential health risks of foods made with industrial hemp ingredients were characterized by estimating the amount of food from various food categories that would need to be eaten to reach a dose of THC equal to the LOELs for neurological impairment in humans and neuroendocrine effects in animals. Potential health risks from use of cosmetics and personal care products and nutraceuticals made with industrial hemp oil were characterized by comparing exposure to

THC through product use with the LOELs for neurological impairment in humans and neuroendocrine effects in animals. These exposure estimates were based on the assumption that the THC concentration in industrial hemp-based in ingredients was 10 ug/g, the current Canadian guideline.

The direct comparison of exposure results with the LOELs does not address:

· the bioaccumulative potential of THC with repeated dosing or consumer use;

· the lack of an identified NOELfor THC for neuroendocrine disruption or neurological impairment;

· the potential that some individuals may be more sensitive to THC than the adults with a history of marihuana use for which the LOEL of 70 ug/g for neurological impairment was observed;

· the possibility that humans could be more sensitive to THC than the rats in the study used to derive the LOEL of 1 ug/kg for neuroendocrine disruption; and,

· the potential for neuroendocrine disruption or neurological impairment by other cannabinoids (i.e. CBD, CBN and others) that would be present in industrial hemp-based products (concentrations of these have not been measured).

In consideration of the above uncertainties, the conclusions from the risk characterization were as follows:
Food: Risk of neuroendocrine disruption: Likely.

Risk of neurological impairment and psychoactivity: Likely, particularly for children.

With respect to neurological impairment, the amount of each food type that would need to be consumed to deliver a dose of THC equal to the LOEL exceeded the mean daily intake and "serving size" which may suggest an absence of risk. In the case of the child; however, some foods (dairy substitutes and candy) were identified that could be consumed in sufficient quantities on occasion in a single day or a single sitting to cause neurological impairment, or even psychoactive effects. For example 2.3 ice cream bars could deliver a dose of THC of 70 ug/kg (the LOEL for neurological impairment) and 4.6 ice cream bars could deliver a dose of 140 ug/kg (the LOEL for psychoactivity) for a 33.9 kg child.

Cosmetics: Risk of neuroendocrine disruption: Possible

Risk of neurological impairment: Unlikely

The risk of neurological impairment cannot be excluded entirely, particularly in the case of children without further information on the relative sensitivities of children vs adults, the relative sensitivities of marihuana users vs non users, the effects of repeated exposure over a long time period, the effects and concentrations of cannabinoids other than THC and the extent of dermal penetration and systemic exposure of topically applied cannabinoids under conditions of actual product use.

Nutraceuticals: Risk of neuroendocrine disruption: Likely

Risk of neurological impairment: Possible, particularly in children.

Major shortcomings related to key data gaps identified in the assessment that preclude the development of definitive conclusions regarding the degree of potential risk are:

· the inability to consider the potential contribution of cannabinoids other than THC (limited toxicity data for other cannabinoids indicate their ability to cause neuroendocrine disruption) to the overall health risks;

· the inability to consider the long term effects of bioaccumulation of THC over time from repeated low dose exposure due to lack of chronic low level toxicity studies and lack of data on the steady-state pharmacokinetics of THC;

· the inability to consider the effects of THC and other cannabinoids after multi-generation long term exposure;

· the inability to determine the degree of exposure to the developing fetus and nursing infant; and

· the lack of analytical data for THC and other cannabinoid concentrations, at detectable levels, in raw materials and finished products made from industrial hemp.

Filed under: Effects of Drugs (Papers) :

Abstract

Metabolic and behavioural effects of, and interactions between Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) are influenced by dose and administration route.

Therefore we investigated, in Wistar rats, effects of pulmonary, oral and subcutaneous (sc.) THC, CBD and THC+CBD. Concentrations of THC, its metabolites 11-OH-THC and THC-COOH, and CBD in serum and brain were determined over 24h, locomotor activity (open field) and sensorimotor gating (prepulse inhibition, PPI) were also evaluated.

In line with recent knowledge we expected metabolic and behavioural interactions between THC and CBD. While cannabinoid serum and brain levels rapidly peaked and diminished after pulmonary administration, sc. and oral administration produced long-lasting levels of cannabinoids with oral reaching the highest brain levels.

Except pulmonary administration, CBD inhibited THC metabolism resulting in higher serum/brain levels of THC. Importantly, following sc. and oral CBD alone treatments, THC was also detected in serum and brain. S.c. cannabinoids caused hypolocomotion, oral treatments containing THC almost complete immobility.

In contrast, oral CBD produced mild hyperlocomotion. CBD disrupted, and THC tended to disrupt PPI, however their combination did not.

In conclusion, oral administration yielded the most pronounced behavioural effects which corresponded to the highest brain levels of cannabinoids. Even though CBD potently inhibited THC metabolism after oral and sc. administration, unexpectedly it had minimal impact on THC-induced behaviour.

Of central importance was the novel finding that THC can be detected in serum and brain after administration of CBD alone which, if confirmed in humans and given the increasing medical use of CBD-only products, might have important legal and forensic ramifications.

Source:  https://pubmed.ncbi.nlm.nih.gov/29129557/ Eur Neuropsychopharmacol. 2017 Dec;27(12):1223-1237. doi: 10.1016/j.euroneuro.2017.10.037. Epub 2017 Nov 10.

Filed under: Cannabis/Marijuana,Effects of Drugs (Papers) :

A growing number of drug overdose deaths are due to cocaine laced with fentanyl, NPR reports. Fentanyl is 50 to 100 times more potent than heroin. The image above shows two potentially fatal dosages of fentanyl and heroin

According to the Drug Enforcement Administration (DEA), 7 percent of cocaine seized in New England in 2017 included fentanyl, up from 4 percent the previous year. In Connecticut, the number of deaths involving fentanyl-laced cocaine has increased 420 percent in the last three years. Massachusetts officials say an increasing amount of fentanyl-laced cocaine is changing hands on the streets. The DEA, in its National Drug Threat Assessment, says people typically add fentanyl to cocaine for the purpose of “speedballing,” which combines the rush of cocaine with a drug that depresses the nervous system, such as heroin. Some experts told NPR fentanyl may be mixed with cocaine accidentally during packaging. Others say drug cartels are adding fentanyl to cocaine to expand the market of people who are addicted to opioids.

How Can I Protect My Child from Fentanyl? 5 Things Parents Need to Know

Deaths from fentanyl and other synthetic opioids (not including methadone), rose a staggering 72 percent in just one year, from 2014 to 2015. Government agencies and officials of all types are rightly concerned by what some are describing as the third wave of our ongoing opioid epidemic.

As a concerned parent, whose top priority is keeping your child safe — and alive — the following are the most important things to understand about fentanyl.

1. Fentanyl is 50 to 100 times more potent than heroin or morphine. It is a schedule II prescription drug typically used to treat patients with severe pain or to manage pain after surgery. It is also sometimes used to treat patients with chronic pain who are physically tolerant to other opioids. In its prescription form, fentanyl is known by such names as Actiq®, Duragesic® and Sublimaze®.

2. It is relatively cheap to produce, increasing its presence in illicit street drugs. Dealers use it to improve their bottom line. According to a report from the Office of National Drug Control Policy, evidence suggests that fentanyl is being pressed into pills that resemble OxyContin, Xanax, hydrocodone and other sought-after drugs, as well as being cut into heroin and other street drugs. A loved one buying illicit drugs may think they know what they’re getting, but there’s a real risk of it containing fentanyl, which can prove deadly.

3. Naloxone (Narcan) will work in case of overdose, but extra doses may be needed. Because fentanyl is far more powerful than other opioids, the standard 1-2 doses of naloxone may not be enough. Calling 911 is the first step in responding to any overdose, but in the case of a fentanyl-related overdose the help of emergency responders, who will have more naloxone, is critical. Learn more about naloxone and responding to opioid overdose >>

4. Even if someone could tell a product had been laced with fentanyl, it may not prevent their use. Some individuals claim they can tell the difference between product that has been laced with fentanyl and that which hasn’t, but overdose statistics would say otherwise. Some harm reduction programs are offering test strips to determine whether heroin has been cut with fentanyl, but that knowledge may not be much of a deterrent to a loved one who just spent their last dollar to get high.

5. Getting a loved one into treatment is more critical than ever. If you need help in determining a course of action, please reach out to one of our parent counselors on our free Parent Helpline. Learn more about all the ways you can connect with our free and confidential services and begin getting one-on-one help.

Source: https://drugfree.org/parent-blog April 2017

Filed under: Drug use-various effects,Health,Heroin/Methadone,USA :

Abstract

Background

Marijuana is a widely used recreational substance. Few cases have been reported of acute myocardial infarction following marijuana use. To our knowledge, this is the first ever study analyzing the lifetime odds of acute myocardial infarction (AMI) with marijuana use and the outcomes in AMI patients with versus without marijuana use.

Methods

We queried the 2010-2014 National Inpatient Sample (NIS) database for 11-70-year-old AMI patients.

Pearson Chi-square test for categorical variables and Student T-test for continuous variables were used to compare the baseline demographic and hospital characteristics between two groups (without vs. with marijuana) of AMI patients. The univariate and multivariate analyses were used to assess and compare the clinical outcomes between two groups. We used Cochran–Armitage test to measure the trends. All statistical analyses were executed by IBM SPSS Statistics 22.0 (IBM Corp., Armonk, NY). We used
weighted data to produce national estimates in our study.

Results

Out of 2,451,933 weighted hospitalized AMI patients, 35,771 patients with a history of marijuana and 2,416,162 patients without a history of marijuana use were identified. The AMI-marijuana group consisted more of younger, male, African American patients. The length of stay and mortality rate were lower in the AMI-marijuana group with more patients being discharged against medical advice.

Multivariable analysis showed that marijuana use was a significant risk factor for AMI development when adjusted for age, sex, race (adjusted OR 1.079, 95% CI 1.065-1.093, p<0.001); adjusted for age, female, race, smoking, cocaine abuse (adjusted OR 1.041, 95% CI 1.027-1.054, p<0.001); and also when adjusted for age, female, race, payer status, smoking, cocaine abuse, amphetamine abuse and alcohol abuse (adjusted OR: 1.031, 95% CI: 1.018-1.045, p<0.001). Complications such as respiratory failure (OR 18.9, CI 15.6-23.0, p<0.001), cerebrovascular disease (OR 9.0, CI 7.0-11.7, p<0.001), cardiogenic shock (OR 6.0, CI 4.9-7.4, p<0.001), septicemia (OR 1.8, CI 1.5–2.2, p<0.001), and dysrhythmia (OR 1.8, CI 1.5-2.1, p<0.001) were independent predictors of mortality in AMI-marijuana group.

Conclusion

The lifetime AMI odds were increased in recreational marijuana users. Overall odds of mortality were not increased significantly in AMI-marijuana group. However, marijuana users showed higher trends of AMI prevalence and related mortality from 2010-2014. It is crucial to assess cardiovascular effects related to marijuana overuse and educate patients for the same.

Source: Desai R, Patel U, Sharma S, et al. (November 03, 2017) Recreational Marijuana Use and Acute Myocardial Infarction: Insights from Nationwide Inpatient Sample in the United States . Cureus 9(11): e1816. DOI 10.7759/cureus.1816

Filed under: Cannabis/Marijuana,Drug use-various effects,Health :

While writing, I wondered what kind of details I should publish about the previous lives of people in the marijuana industry. Virgil Grant, one of the article’s subjects, told me stories about how he would sell marijuana from his family grocery store in Compton in the 1980s and 1990s by putting the weed in empty boxes of Lucky Charms. He mentioned, without much elaboration, that would-be competitors in Compton regretted going up against him.

It’s an awkward and confusing transition period in the marijuana industry. What was illegal yesterday in California may be legal today, but that’s of course not the way the federal government sees it. Mr. Grant has spent time in both federal and state prisons.

Since legalization of recreational sales came into effect in California in January, there have been stories about cities and counties that banned marijuana. But I had never seen reporting on the bigger picture. So I reached out to a company called Weedmaps, a website that hosts online reviews of cannabis businesses. When they added it up, the data surprised me: Only 14 percent of California’s cities and towns authorize the sale of recreational marijuana. By contrast, Proposition 64, the ballot measure that allowed marijuana legalization, passed with 57 percent voter approval in 2016, a seemingly solid majority.

The low acceptance of marijuana businesses strikes me as part of the liberal, not-in-my-backyard paradox in California. Yes, Californians want shelters for the homeless, but just not across the street. Yes, Californians want more housing built, but not if it changes the character of the neighborhood. A marijuana dispensary? Sure, preferably in the next town.

A New York Times reporter wanted to find out why California cities are taking such different approaches to legal pot. Previously, he covered a story about why California growers are so reluctant to leave the black market and seek a state license to become legitimate. He found that only about 10 percent have done so. The other 90 percent remain in black market. California is the nation’s biggest producer and consumer of marijuana. One estimate projects the state produces seven times the amount of pot it consumes and exports the surplus to non-legal states. Pursuing this story took the reporter to Compton, in Los Angeles County, where residents voted in January to ban marijuana businesses by a 3-to-1 margin. He compared this to Oakland, near San Francisco, which has embraced the marijuana industry. It’s as if the two cities had been asked the same question and come up with completely different answers, he opined. To get a bigger picture, he consulted Weedmaps to find out how common industry bans are. He was surprised to find that only 14 percent of California’s cities and towns authorize marijuana sales, even though legalization passed in 2016 with 57 percent voter approval.

It’s still early days — it’s been less than three months since legal sales started — but for now the trend is that larger cities like Oakland, San Francisco, Los Angeles, Sacramento and San Diego are the hubs of the marijuana industry, while smaller cities and towns are ambivalent or outright hostile to the idea of opening marijuana dispensaries. Orange County, in Southern California, is a recreational marijuana desert, with only a handful of dispensaries allowed.

California has a reputation for very tolerant attitudes toward pot, and it’s the biggest consumer and producer of the drug in the United States by a wide margin. It is also the nation’s premier exporter to other states: By one estimate, the state produces seven times more than it consumes.

But the visit to Compton helped peel back another, more conservative set of attitudes toward marijuana.

At the Compton airport, Shawn Wildgoose, a former enlisted Marine who lives in Compton and works in the construction industry, told me he wanted to see the city focusing on its homeless problem and reducing crime, which is sharply down from previous decades.

Legal marijuana?

“Compton has other issues,” Mr. Wildgoose said. “We don’t need that distraction.”

Source: National Families in Action’s The Marijuana Report nfia@nationalfamilies.org 21st March 2018

Filed under: Brain and Behaviour,Global Drug Legalisation Efforts,Legal Sector,USA :

Hamilton County Coroner Dr. Lakshmi Kode Sammarco released 2017 drug statistics Tuesday.

Last fall, the coroner said overdoses in Hamilton County had surpassed the total of last year, with 427 suspected deaths – and three months remaining in 2017, making the toll the worst since the heroin epidemic began. in the Tri-State.

Most overdose deaths have been due to fentanyl or chemically similar drugs, Sammarco said.

The county reported 403 overdose deaths in 2016 – up 30 percent, overdose deaths were totalled at 529 for 2017.

Sammarco described the increasing number of cases as “scary.” She said drug prevention efforts can only do so much without the help of the public.

“We can’t do this alone. Everybody here is busting their butt to try to get a handle on not just the supply, but to get help for the addicts and families. But we need the communities to step up, we need every neighborhood to keep an eye on their neighborhood. To try and help us get the dealers off the street, to try and get help to the addicts. You see something, say something.”

Sammarco noted the death toll was reduced by Narcan.

“The number of lives being saved is huge,” she said. “There’s no doubt they would’ve been double or triple what they were without Narcan.”

The coroner said 30,000 items were turned into the office’s drug section in 2017. Hfour drug analysts each processed well over 7,000 items, which 2.5 times higher than any other lab in Ohio.

Prevention First, a local non-profit aimed at reducing substance abuse released their findings from this year’s student drug-use survey.

They said of the more than 30,000 students grades 7 through 12 surveyed, nearly 14 percent have admitted to using alcohol in the past 30 days.

Tobacco use was only reported in five percent of students. Marijuana usage was slightly higher at more than eight percent.

Prescription drug abuse was reported in only 2.4 percent of students.

Commissioners said aside from marijuana use, the statistics have been trending downward since 2000.

“Hats off to Prevention First for leading the charge on that and for providing all of this really important information when it comes to prevention and what young people are doing in this community because this is the tip of the spear,” Commissioner Denise Driehaus said.

The survey, which is given every two years by Prevention First, was distributed to 80 public and private schools in six southwest Ohio counties.

To try to top overdoses before they happen, the Hamilton County Heroin Coalition is launching a Quick Response Teams early next month, on April 3.

The coalition is uniting with fire departments, law enforcement and social workers to create a team that follows up with overdose victims and offers them same-day addiction treatment. according to a prepared statement.

Modelled on an effort in Colerain Twp., the team will try to find overdose survivors using a database maintained by the Greater Cincinnati Fusion Center, a public safety data collecting agency.

Heroin Coalition commander and Norwood Police Lt. Tom Fallon told Hamilton County commissioners Monday the database would help locate overdose survivors who are otherwise hard to find.

The team will also use “predictive analysis” to track drug activity to target potential overdoses in with the help of University of Cincinnati’s Institute of Crime Science.

The effort is funded by a $400,000 grant from the U.S. Department of Justice funded through the Comprehensive Addiction and Recovery Act.

Source: http://www.fox19.com/story/37764381/hamilton-county-coroner

Filed under: Cannabis/Marijuana,Health,USA :

The mechanism by which dopamine cells in the brain signal the passage of time has received some new light via a recent study from researchers at University of Texas at San Antonio. To make decisions about the salience of a potential reward is mediated by small group of neurons in the midbrain that release dopamine.

The amount of dopamine released can influence our decisions by telling us how good a reward will be in the future. For example, more dopamine is released in response to the smell of turkey baking relative to the smell of leftovers.

But does the length of time between the anticipatory release of dopamine and the actual reward mediate the release and volume of dopamine? To answer this question, investigators used voltammetry to record dopamine release in rodents trained by Pavlovian conditioning.

This novel experiment utilized different audible tones that predicted the delivery of food. One tone was presented only after a short wait time— while the other tone was presented only after a long wait time.

The data showed that more dopamine was released during the short wait tone compared to the long wait tone. These results show that imminent reward is associated with dopamine release in the midbrain.

This is not unlike telling a 6-year-old child that her next birthday party is tomorrow versus telling her it won’t occur for two months. The time differentiation will predict the amount of excitement the child experiences.

Why Does This Matter?

We established many years ago the power of simply showing a recovering cocaine addict a piece of their drug paraphernalia. The release of dopamine is triggered by this visual cue and is also related to the amount of abstinence and how soon a drug reward could be attained. Monitoring via drug testing is one way that addicts are able to think through their behavioral choices when craving is induced.

For persons in early recovery from substance use disorder, anticipatory cues trigger the release of dopamine, cause craving and increase the risk of relapse. Continuing care planning for recovering addicts must address the power of anticipatory reward and help each recovery person set up obstacles that deter and delay access to a mood altering substance and avoid environmental drug cues.

Source: Fonzi KM, Lefner MJ, Phillips PEM, Wanat MJ. Dopamine Encodes Retrospective Temporal Information in a Context-Independent Manner. Cell Rep. 2017 Aug 22;20(8):1765-1774. doi: 10.1016/j.celrep.2017.07.076.

Filed under: Brain and Behaviour :

All creatures great and small are being poisoned by the pesticides and rodenticides in the water they drink, and in the food they eat. This polluted water from northern California marijuana grows eventually flows to much of the State. The lawless pot industry is nothing less than purveyors of poison. The recent scientific study “Cultivating Disaster: The Effect of Cannabis Cultivation on the Environment of Calaveras County,” points out that the cultivation of the drug was allowed by the State without adequate understanding of the impact on the environment and public health, welfare and safety. The chemicals that flow from the grow sites to the watershed had never been approved for these crops.

California does not regulate marijuana as a medicine because it is a Schedule 1 Controlled Substance under Federal Law, rather it is classified as an agricultural product. However, pot growers do not have to meet the same stringent requirements for chemicals and fertilizers as do all other farmers. Though there is limited testing being conducted by local water providers to determine if dangerous chemicals are leaching into water supplies or waste treatment systems, independent water experts testing water samples in Calaveras County found two thirds of the samples contained chemicals proven to be deadly poison to humans, fish and animals.

Of particular concern is carbofuron, an extremely toxic, water soluble granular pesticide banned in the U.S. but used among Mexican cartels. It is reported that an eighth of a teaspoon would kill a 300 lb black bear. In 2017, UC Davis researchers found harmful bacteria and deadly mold and Aspergillus fungi on marijuana in grows and dispensaries. This critical threat from marijuana grows to our environment and the human population is just beginning to surface.

The damaging effects of marijuana (cannabis), often considered a hallucinogenic drug, have long been known. High level THC, the mind-altering chemical in marijuana, is being grown and sold today as a “medicine.” It is long acting and addictive, causing brain damage, loss of intellect, psychotic breaks, suicides, mental illness, and birth defects and leads to other social costs from higher crime rates, highway deaths, excessive high school dropouts, and increased ER admissions, among others.

This lawless Big Marijuana Industry follows the playbook of Big Tobacco: GET KIDS HOOKED – ADDICTION OFTEN FOLLOWS. Their advertisements include images of Santa Claus, kids’ movies and cartoons, and they sell “edibles,” pot infused candy, lollipops and gummy bears with THC levels 50-70%. Many products are advertised as being 94-95% THC. Now there is crystalline THC that is 99.99% THC, known as “the strongest weed in the world.” Unfortunately, the public perception of marijuana is based on marijuana of the past – with 1- 5% THC.

The Calaveras Study estimates 1200 grows sites in that county; U.S. Forest Service estimates a tag of 2 billion to reclaim these sites. An estimated 50,000 grow sites in California would cost 50 – 80 billion to reclaim. The California Department of Fish and Wildlife says, “We are aware of the seriousness of the problem, but (we) do not know who is going to help clean it up.”

U.S. Attorney General Sessions has indicated his willingness to enforce our federal food and drug and environment laws when it comes to marijuana. Our California U.S. Attorneys must prosecute those who have broken federal, state, and county ordinances and explore funding to pay for cleanup of the land. This is not just a California issue, the U.S. Supreme Court

has ruled that federal marijuana laws preempt state laws and that marijuana control is a federal matter, not a states’ rights matter. There is no time to waste. Our future is at stake.

Source: Press Release Californians Against Legalisation of Marijuana Feb.6th 2018

Filed under: Cannabis/Marijuana,Environment,Social Affairs :

BATON ROUGE — When a classmate died of a drug overdose, Symmes Culbertson bought a black suit for the funeral.

“It didn’t feel right to wear a blue sports jacket,” the 23-year-old political science major said.

What he didn’t count on was how many more funerals of classmates he would attend — six since he began attending Louisiana State University in 2013. “The number of people that I have known by name or in passing that have died from prescription drug overdoses, just in my college years, is well into the teens,” Culbertson said.

These kinds of events have become increasingly common at U.S. colleges, where many students view mixing pills and chasing them with alcohol as a rite of passage, rather than a dangerous and often deadly practice.

“It’s a dirty secret,” said April Rovero, whose son, Joey, a student at Arizona State University, overdosed in 2009 after taking prescription opioids, benzodiazepines and alcohol. (Dr. Lisa Tseng, who prescribed the drugs that led to the deaths of him and two other young men, is now serving a 30-years to life prison sentence for illegally prescribing the medication.)

In the year that followed, she said nine more students from there also died at the hands of drugs.

National addiction expert Dr. Drew Pinsky said one thing that is killing many students is mixing opioids with benzodiazepines, such as Xanax — something he says doctors should never prescribe together because it can be lethal.

Since 1999, drug overdose deaths of those 15 to 24 have quadrupled to 5,376 a year, far surpassing the number of those dying from alcohol-related accidents.

“These are perfectly healthy young people,” said Rovero, who founded the National Coalition Against Prescription Drug Abuse. “Every one of these deaths is avoidable.”

‘A Perfect Storm’

Ken Hale, associate director of the Higher Education Center for Alcohol and Drug Misuse Prevention and Recovery on the Ohio State University campus, said “a perfect storm” has hit college campuses and the nation, starting with “the drug-taking culture in which we live. We use more medication than any other country.”

In 2016, the nation filled more than 4.5 billion prescriptions, including antibiotics, cancer drugs and other drug treatment protocols — an average of more than 14 per person.

But Hale said many of those prescriptions are the powerful and often addictive opioids. Even though the U.S. makes up less than 5 percent of the world’s population, it consumes 80 percent of opioids.

As a result, these drugs are easily available to students through family members or friends, he said.

With these prescription drugs come misperceptions about safety and legality, he said. Of those addicted to heroin, 80 percent started on prescription drugs.

“If I go to a party and someone says, ‘Here’s some heroin,’ flags go up, but if someone hands me a Vicodin (an opioid painkiller), they don’t,” he said.

College campuses have become incubators for the bigger problem, where students “may not hit the wall in college, but they start behaviors that led to the problem we have,” he said.

Hale noted that the No. 1 cause of death of those under 50 is drug overdose and that fact has contributed to the U.S. seeing life expectancy decline for two years in a row for the first time since the 1950s.

Ohio State is one of more than 100 colleges that have recovery centers, where students can live, Hale said. “College dormitories are not a good environment for someone trying to get sober.”

Funeral for a friend

Culbertson grew up in Greenville, a fast-growing small town in South Carolina. “In high school, the most hardcore thing was weed,” he said.

By 2014, pills had begun to seep into college life, no longer just for the weekend parties.

Students took Adderall, the stimulant used to treat Attention Deficit Hyperactivity Disorder, if they needed to study or take a test.

And students who didn’t have classes till the afternoon might visit the bar and get Xanax, sometimes chasing that tranquilizer with alcohol — what can be a deadly combination.

When 2015 came, so did news about a high school classmate, a former cross-country track star who became hooked on opioids after hurting his back and blowing out his ACL.

His sister, Callie, had helped him get sober, letting him live with her for six months.

Callie Culbertson, the older sister of Symmes Culbertson, graduated in December from LSU with a degree in animal science, history and psychology. She knows of eight young people from her hometown of Greenville, South Carolina, who have died of drug overdoses. (Photo: SCOTT CLAUSE/USA TODAY Network)

Afterward, she kept in touch by telephone. One morning she learned on Facebook that he had overdosed — news that stunned her because she had just spoken to him the night before.

She and Culbertson attended the funeral, and she couldn’t believe that so many people attending were high, doing the same drugs that killed her friend.

Since that funeral, she knows of eight people from her hometown who have died of overdoses.

“Everybody knows somebody this has touched,” she said. “The problem is no one is changing.”

‘He only took five’

Culbertson returned to LSU, and the next funeral of someone he knew took place just a few months later.

The environment has become “so accepting of the drugs,” he said. “If you don’t enjoy them, then you’re the a–hole — at least if you speak up about it.”

More funerals followed, and last January, he got a call that a friend of his had just overdosed.

Culbertson had just seen his friend the night before, taking Xanax in a bar. “We were with him at midnight,” he said.

When it was obvious he needed help getting home, friends took him there. He never woke up.

Word came that he had died of fentanyl, a drug up to 50 times stronger than heroin, and that fentanyl may have been mixed with the Xanax pills.

After this death, Culbertson said some slowed down in their drug taking, but no one quit.

Months later, he heard of a classmate back home who had been hooked on opioids before secretly moving to heroin and overdosing.

On Oct. 14, hours after LSU defeated Auburn University in football, Culbertson and his friends met at a bar.

After midnight, a friend informed him that he had just stolen a bottle of liquor from the bar, and that he was going back to his place to celebrate with his girlfriend.

The next morning, a friend called him in tears, letting him know their friend was dead.

“That’s crazy,” Culbertson replied. “He only took five (Xanax) sticks last night.”

As soon as he hung up, he realized the insanity of his own words, nonchalantly saying that his friend had taken five Xanax bars.

“And I thought that was completely normal,” he said. “And that’s what has come to scare me — the culture here is so accepting of it that even me, who doesn’t do any of this stuff, it’s normalized to me. My thinking had gotten as distorted as anybody engaging in the culture.”

He wore the dark suit for his friend’s funeral in New Orleans and returned home to write out an idea for a short film, based on what he had experienced.

The next day, he pitched his idea to his film class. His movie proposal, “Only the Good,” resonated with his fellow students.

“I just wanted to tell the story about my peers that shows everybody thinks they’re having a good time, and while that’s true 90 percent of the time, there’s that 10 percent of the time where you not only do, you die from it, but it devastates the lives of the people that care about you.”

Turning a blind eye

Rovero would like to see learning about medicine safety start in kindergarten, saying schools and colleges need to do a better job of educating students.

“Colleges should be educating students about how addictive and dangerous these drugs can be, especially mixed with other drugs and alcohol, and about the risk factors and signs of addiction and overdose,” she said.

Students should be trained to aid those in trouble, she said. “Parents should work with their administrators to have resident assistants have a naloxone rescue kit on hand in dorm settings, just in case, and everyone with a kit needs to be trained to use it.”

All incoming LSU freshman receive orientation regarding alcohol, drug use and sexual violence prevention. University officials say they continue to work with students to identify and reduce high-risk drinking, providing addiction programs and services, including the Anxiety and Addictive Behaviors Clinic.

Culbertson praised LSU for its all of its efforts, including education, outreach and support groups.

But there is a huge hurdle, he said. “There’s not much a support group can do when people aren’t looking for support. Nobody feels like they have a problem.”

The problem is one of perception, he said. “Students don’t really identify themselves as drug addicts, and everybody else is turning a blind eye.”

Source: https://www.clarionledger.com/story/news/2018/02/05

Filed under: Drug use-various effects on foetus, babies, children and youth,Heroin/Methadone,Youth :

New Hampshire’s Heroin Crisis Takes Toll with Record Overdose Deaths 2:24

LONDONDERRY, New Hampshire — Nearly a decade later, Susan Allen-Samuel still vividly remembers the moment that she first realized her son Joe was a heroin addict.

“It took my breath away,” Allen-Samuel told NBC News.

Allen-Samuel says that she began to notice all the metal spoons — typically used by users to melt down the heroin — in her kitchen were disappearing. She says she suspected heroin but admits that she couldn’t fully accept that Joe had been caught up in what she calls the “heroin epidemic” sweeping New Hampshire. “I was that person: ‘It’s not gonna happen, I’m a good mom,'” said Allen Samuel. “Wow, I got a wake-up call.”

At the time, Joe was just a teenager. He had recently switched from abusing opiates in pill form— primarily pain killers like OxyContin – to using heroin. The reason, he says, was purely financial. One OxyContin pill can cost as much as $80 on the black market. Joe says he was spending roughly $400 a day on his addiction. “They [the pills] were so expensive,” said Joe, 26. “You can’t afford a habit.”

At just $10-15 a bag, heroin was cheaper and more readily available. A short-drive to nearby Lawrence, Massachusetts — just across the state border — and he and his friends could purchase the drug on just about every street corner. Three overdoses and two arrests later, Joe’s life was forever altered by the deadly drug known as the “Big H.”

A State at the Center of a Heroin Crisis

The lush, rolling hills and idyllic red barns here can transform you to another time. Every town’s main street sprinkled with mom-and-pop shops and glistening white church steeples provide a backdrop to the scene of a Norman Rockwell painting, the personification of New England nostalgia.

In 2016, however, New Hampshire finds itself on the front lines of a heroin crisis that, critics warn, is unravelling the state’s social fabric. The numbers, alone, are daunting.

Last year, there were roughly 400 drug-overdose related deaths in New Hampshire — the most in the state’s history. With a population of roughly 1.4 million, the Granite State has one of the highest per-capita rates of addiction in the country.

As the problem has worsened over the last decade, however, access to substance abuse treatment has not improved. According to a 2014 report from the U.S. Department of Health and Human Services, the state is second to last — ahead of only Texas — in access to treatment programs. New Hampshire does not fund any methadone treatment programs and relies on a network of privately-run for-profit clinics to treat the thousands of addicts across the state. “There’s a stigma out there for users,” said Diane St. Onge, director of the Manchester Comprehensive Health Center — one of only eight clinics in the state that provides methadone treatment for heroin addiction. “We need more treatment options. People’s lives are at stake.”

In 2013, St. Onge’s clinic had 250 patients. Today, it has 540 patients and a two-week long waiting list. On a recent weekday, the clinic’s waiting room was teeming with weary

patients, most appearing middle-aged, and young children whose parents were there to receive their daily dose of methadone, the drug that reduces the withdrawal symptoms in people addicted to heroin or other narcotic drugs.

Outside, amid the political paraphernalia and live-shots being set up by crews ahead of Tuesday’s New Hampshire primary, patients sat on benches waiting to go inside. The juxtaposition was striking.

A Town under Siege

Situated along the I-93 interstate between the state’s two largest cities of Manchester and Nashua, the small town of Londonderry is at the center of a drug-trafficking route where heroin cuts across socio-economic and political lines.

Ed Daniels has worked with the Londonderry Fire Department for 11 years. For most of that time, he says, he saw one or two overdose cases a year. He says he now sees at least one every shift. He says the victims he treats come from all demographics. “There’s no rhyme or reason to it,” said Daniels.

Daniels says the numbers began to spike last summer and have continued to rise, unabated. He blames the increase on fentanyl — an extremely potent pain killer drug that is now commonly cut with heroin to produce a more intense high — and feels, at times, that there is little long-term that he can do for his patients. “They can leave the hospital,” said Daniels. “[But] once they have the addiction, where can they go for help?”

For Londonderry Fire Department Chief Darren O’Brien, who has lived his entire life in Londonderry, “it’s hard to see what’s going on in a community you grew up in.” O’Brien noted that there were 82 reported overdoses last year — nearly three times the 31 reported cases in 2014. “I’m hoping we can get a handle on it,” he said.

Joe’s heroin addiction lasted nearly a decade, a time that Allen-Samuel says she was fearful to come home to confront her son. “It’s a hell of a ride, it’s devastating,” she said. Allen-Samuel tried everything to help Joe. On one occasion, after he had been placed in jail for a minor offense, she had officers keep him there for months knowing that he’d likely not have access to any drugs inside. Meanwhile, she says, Joe’s childhood friends were dying one-by-one from overdose.

Joe says he had periods of sobriety but ultimately relapsed. It was not until his second stint in jail, he says, where he vowed to fight back. “That was probably my lowest point,” he said. He sought treatment and, ultimately, got clean.

He says losing his closest friends was motivation for him to be there for his girlfriend and young children. He has been sober for more than two years. “I’m just thankful,” said Joe. “[Before] I wasn’t able to be a dad. I’m glad I’m able to be here and experience it now.”

For Allen-Samuel, the unfolding crisis in New Hampshire should be an impetus for reform. Heroin addiction, she says, is a disease that should be dealt with the same way society treats cancer or any other deadly illness. “Our families are dying,” said Allen-Samuel. “What’s going on in our community is a war.” Source: http://www.nbcnews.com/nightly-news/our-families-are-dying-new-hampshire-s-heroin-crisis-n510661?cid=sm_fb Feb.2016

Filed under: Heroin/Methadone,Social Affairs :

Marijuana has always been seen as the laid-back drug. It might make you crave ice cream and chocolate cake or induce you to fall asleep, but it certainly wasn’t dangerous.

Yet, as governments in Britain and Canada consider decriminalizing the drug, medical researchers are warning that smoking cannabis increases the risk of lung disease and, more disturbingly, that its use can exacerbate psychosis and that it is linked with the onset of schizophrenia in adolescents.

“We have the evidence of cannabis and its dangers,” said Dr. Richard Russell, a respiratory specialist and a spokesman for the British Lung Foundation, which published a report this week on the dangers of cannabis.

“What we really want to avoid is the situation we had in the 1930s, ’40s and ’50s with cigarettes, where doctors were recommending tobacco as being good for you.”

In its report, the lung foundation warns that cannabis is more harmful to the lungs than tobacco. It says smoking three joints a day can cause the same damage as 20 cigarettes, and tar from marijuana contains 50 per cent more carcinogens than that from tobacco.

Persistent users are risking lung cancer, emphysema, bronchitis and other respiratory illnesses, it says.

One of the major problems is posed by the way users smoke marijuana and hashish: They take puffs that are almost twice as large as those tobacco smokers take and hold the smoke in four times as long. “This means that there is a greater respiratory burden of carbon monoxide and smoke particulates such as tar than when smoking a similar quantity of tobacco.”

The foundation also noted that in the 1960s, the average marijuana joint contained about 10 milligrams of tetrahydrocannabinol (THC), which accounts for the drug’s psychoactive properties. Because of sophisticated cultivation techniques, the average joint today has 150 mg of THC, a 15-fold increase.

Dr. Russell, the respiratory specialist, worries that young people think cannabis is a “cool drug” that is risk-free. A survey carried out this year showed that 79 per cent of British children believe cannabis is safe.

The Canadian government indicated in its Speech from the Throne last month that it is considering the decriminalization of marijuana possession.

Already, it gives exemptions to drug laws to allow sick people to have marijuana. On the other hand, pot grown for medicinal purposes in an abandoned Manitoba mine with Ottawa’s sanction sits in storage.

In Britain, under a proposal due to become law next year, simple possession of a small amount of cannabis will no longer result in an automatic arrest although police will still be able to go after users in “aggravated” circumstances, such as smoking in the presence of children. Cannabis trafficking will also continue to bring a prison sentence.

Meanwhile, clinical studies on the use of marijuana for medicinal purposes are under way with HIV patients in Canada and with people suffering from multiple sclerosis in Britain.

The British Lung Foundation says it is not trying to get involved in the debate over whether cannabis should be legalized, leaving that to politicians. “Our report is not about the moral rights and wrongs of cannabis, but simply making sure everyone is completely clear about the respiratory health risks involved,” said Dr. Mark Britton, chairman of the foundation.

Dr. Russell says he recently saw a 40-year-old patient in his clinic with “severe end-stage emphysema” and has about 18 months to live. The patient has been smoking three joints a day for the past 25 years, the equivalent of smoking 60 cigarettes a day from the age of 15, he says.

Studies of heavy cannabis smoking among Rastafarians in the Caribbean have also pointed to increased danger of early lung cancer, Dr. Russell says.

Les Iversen, a professor of pharmacology at King’s College in London and an expert on cannabis, agrees that smoking marijuana poses dangers, but he says the report’s findings are exaggerated.

There is no specific evidence linking cannabis smoking with lung cancer, Prof. Iversen says.

He says it’s absurd to say smoking three joints is equivalent to smoking 20 cigarettes because joints come in different sizes and strengths as do commercial cigarettes.

Although he adds, “I don’t think any drug is safe.”

Psychiatrists have also linked cannabis use to schizophrenia.

“People with schizophrenia do not take more alcohol, heroin or ecstasy than the rest of us, but they are twice as likely to smoke cannabis regularly,” says Dr. Robin Murray, a professor of psychiatry at the Institute of Psychiatry in London.

Dr. Murray says cannabis, along with cocaine and amphetamines, encourage the release of dopamine in the brain, which in turn leads to increased hallucinations.

He notes that the incidence of schizophrenia in south London has doubled in the past 40 years, and he says increased use of both cannabis and cocaine could be at fault.

Dr. Murray cites a study that interviewed 50,000 conscripts to the Swedish Army about their drug use and followed up later. Heavy users of cannabis at the age of 18 were six times as likely to be diagnosed with schizophrenia by the time they were 33 than those who kept away from the drug.

Another study, this one in the Netherlands, interviewed 7,500 people about their consumption of drugs and looked at their behaviour over the next three years. Regular users of cannabis were more likely to develop psychosis than those who did not use the drug.

“Any public debate on cannabis needs to take account of the risks as well as the pleasure,” Dr. Murray says. “Pro-marijuana campaigners claim, extrapolating from their Saturday-night joint, that cannabis is totally safe. Yet they would be unlikely to claim that a bottle of vodka a day is healthy on the basis of sharing a bottle of Chablis over dinner.

“No drugs that alter brain chemistry are totally safe,” he says. “Just as some who drink heavily become alcoholic, so a minority of those who smoke cannabis daily go psychotic.”

A major study on the links between cannabis and schizophrenia is due to be published in the British Medical Journal next week by Louise Arsenault, a biomedical researcher at the Institute of Psychiatry who was trained at the University of Montreal.

Research made public last year by Dr. Arsenault showed that young men who regularly smoke cannabis are five times more likely to be violent than those who avoid the drug. Using data from a study of 961 young adults in Dunedin, New Zealand, she discovered that one-third of those with a cannabis habit had a court conviction for violence by the time they hit 21 or had displayed violent behaviour. That was three times the level of those who drank excessive amounts of alcohol.

The warnings about marijuana have not deterred members of Britain’s Legalize Cannabis Alliance, who say the report is merely a selective study of existing medical literature, which ignores studies that discount the health threats posed by the drug.

“I’ve used it for 30 years and it doesn’t seem to have affected my health,” says Alun Buffry, the alliance’s national co-ordinator.

“I stopped tobacco three or four years ago and I have noticed that since then my health has improved. My general level of energy has improved and I get more of a high from cannabis than the sleepiness I used to get, which I think had to do with tobacco.”

Mr. Buffry argues that it would be best to legalize cannabis to control the quality of what is sold and eliminate “dirty supplies” that may include potentially harmful glues, fillers and colouring agents.

“I would argue that it would be far more dangerous illegal than it would be legalized,” he says. “Even if cannabis were the most dangerous substance in the world, it is still consumed by millions of people.”

Alan Freeman is The Globe and Mail’s European correspondent.

Source:

https://www.theglobeandmail.com/incoming/theres-a-reason-they-call-it-getting-wasted/article1028091/  Mar. 21 2009

Filed under: Cannabis/Marijuana,Global Drug Legalisation Efforts :

SIXTY people have died in the UK in the past eight months, in circumstances believed to be linked to a drug more potent than heroin, it has been revealed.

The National Crime Agency (NCA), which is investigating the use of the potentially deadly fentanyl and its variants, warned the toll could rise as they await further toxicology results.

Tests on heroin seized by police since November found traces of the synthetic drug, with more than 70 further deaths pending toxicology reports, the NCA.

The toxic synthetic opioid is being mixed with heroin and in some cases proving fatal, the agency said, as it accused dealers of playing “Russian roulette” with users’ lives.

The NCA’s deputy director Ian Crouton said recent investigations have uncovered that fentanyl and its chemical derivatives are being both supplied in and exported from the UK.

He said: ”We believe the illicit supply from Chinese manufacturers and distributors constitutes a prime source for both synthetic opioids and the pre-cursor chemicals used to manufacture them.”

Fentanyl, which can be legally prescribed as a painkiller sometimes in the form of a patch or nasal spray, is around 50 times more potent than heroin, according to America’s Drug Enforcement Agency (DEA).

A variant known as carfentanyl – which is often used to anaesthetise large animals like elephants – can be up to 10,000 times stronger than street heroin.

The potency means investigating officers often have to wear protective clothing to handle the substance.

Health officials and police have warned drug users to be “extra careful” as heroin and other class A drugs were being laced with synthetic drugs like fentanyl.

The 60 victims, whose post mortem examination results indicated their drug-related deaths were known to be linked to fentanyl or one of its chemical variants, were predominantly men and a range of ages, although no person was younger than 18.

Detective Superintendent Pat Twiggs, of West Yorkshire Police, said: “People are playing Russian roulette with their lives by taking this stuff, that’s why we would strongly recommend to the drug-using community to stay away from it.

“The business is not done under lab conditions, it’s not done by scientists, it’s done in a very uncontrolled way by people seeking out profit – this is why we’re concerned when you’re dealing with such toxic chemicals.”

Following links between fentanyl and deaths this year in the north of England, Public Health England (PHE) said it began an urgent investigation.

Pete Burkinshaw, the organisation’s alcohol and drug treatment and recovery lead, said the “sharp increase” in overdoses that had been feared did not appear to have materialised.

He said: “We have been working with drug testing labs and local drug services to get more information on confirmed and suspected cases.

“We do not have a full picture, but the deaths in Yorkshire do appear to have peaked earlier in the year and fallen since our national alert and, encouragingly, our investigations in other parts of the country suggest we are not seeing the feared sharp increase in overdoses.

“Investigations are ongoing and plans are in place for a scaled-up response if necessary.”

PHE is working with the Local Government Association to increase the availability of naloxone, an overdose antidote, to drug users and at hostels and outreach centres.

A raid at a drug-mixing facility in Morley, Leeds, in April resulted in three people being charged with conspiracy to supply and export class A drugs.

The NCA said it had identified 443 customers of that “criminal enterprise” – 271 overseas, and 172 within the UK.

A fourth man was charged on Monday night, following a separate investigation in May, after police said they identified him using the so-called dark web to buy fentanyl or synthetic opioids.

Kyle Enos, of Maindee Parade in Gwent, is accused of importing, supplying and exporting class A drugs.

The 25-year-old, who is in custody, is due at Cardiff Crown Court for a hearing on August 29.

The death of US pop star Prince was linked to an overdose of fentanyl in 2016.

The opioid was first made in 1960 by Belgian doctor Paul Janssen and introduced in hospitals as an intravenous anaesthetic.

Last November, 18-year-old Briton Robert Fraser died after unintentionally overdosing on the drug.

Robert’s mother Michelle said: “It shouldn’t be on the streets, this sort of stuff.

“These days there is too much and its too easily accessible for teenagers especially as we have mobile phones and the internet.

“It’s kids giving it to kids a lot of the time – they don’t know what they are giving.”

Source:

https://www.express.co.uk/news/uk/835794/Fentanyl-heroin-painkiller-overdose-60-dead-NCA-PHE-carfentanyl

Filed under: Europe,Heroin/Methadone :

Click on the images to enlarge the detail.

Source:

https://www.intervenenow.com/breaking-the-stigma-of-recovery/

Filed under: Alcohol,Cannabis/Marijuana,Nicotine,Prescription Drugs,Treatment and Addiction :

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

So who are these anti-marijuana legalization crusaders?

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

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

Here is a list of the most significant:

  1. Calvina Fay

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

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

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

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

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

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

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

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

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

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

  1. Kevin Sabet

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

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

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

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

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

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

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

  1. Bill Bennett

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

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

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

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

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

“Medical science now proves it,” he added.

  1. Patrick Kennedy

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

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

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

  1. Joseph Califano

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

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

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

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

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

  1. Stuart Gitlow

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

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

About ASAM’s attitudes toward marijuana, he said:

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

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

Why did he get involved in this?

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

  1. David Murray

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

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

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

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

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

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

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

  1. John Walters

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

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

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

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

  1. Robert DuPont

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

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

  1. Bertha Madras

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

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

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

  1. Carla Lowe

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

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

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

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

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

 

  1. Christian Thurstone

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

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

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

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

  1. Peter Bensinger

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

  1. David Evans

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

  1. Pope Francis

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

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

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

  1. Dennis Prager

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

  1. Mel and Betty Sembler

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

  1. Seth Leibsohn

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

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

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

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

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

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

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

  1. Alexandra Datig

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

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

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

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

  1. Monte Stiles

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

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

 

Filed under: Cannabis/Marijuana,Global Drug Legalisation Efforts,Political Sector :

LONDONDERRY, New Hampshire — Nearly a decade later, Susan Allen-Samuel still vividly remembers the moment that she first realized her son Joe was a heroin addict.

“It took my breath away,” Allen-Samuel told NBC News.

Allen-Samuel says that she began to notice all the metal spoons — typically used by users to melt down the heroin — in her kitchen were disappearing. She says she suspected heroin but admits that she couldn’t fully accept that Joe had been caught up in what she calls the “heroin epidemic” sweeping New Hampshire.   “I was that person: ‘It’s not gonna happen, I’m a good mom,'” said Allen Samuel. “Wow, I got a wake-up call.”

Joe sits outside his home in Londonderry. Joe suffered from heroin addiction for the better part of a decade. He is now two years sober. NBC News

At the time, Joe was just a teenager. He had recently switched from abusing opiates in pill form— primarily pain killers like OxyContin – to using heroin. The reason, he says, was purely financial. One OxyContin pill can cost as much as $80 on the black market. Joe says he was spending roughly $400 a day on his addiction.  “They [the pills] were so expensive,” said Joe, 26. “You can’t afford a habit.”

At just $10-15 a bag, heroin was cheaper and more readily available. A short-drive to nearby Lawrence, Massachusetts — just across the state border — and he and his friends could purchase the drug on just about every street corner. Three overdoses and two arrests later, Joe’s life was forever altered by the deadly drug known as the “Big H.”

A State at the Center of a Heroin Crisis

The lush, rolling hills and idyllic red barns here can transform you to another time. Every town’s main street sprinkled with mom-and-pop shops and glistening white church steeples provide a backdrop to the scene of a Norman Rockwell painting, the personification of New England nostalgia.

In 2016, however, New Hampshire finds itself on the front lines of a heroin crisis that, critics warn, is unravelling the state’s social fabric. The numbers, alone, are daunting.

Last year, there were roughly 400 drug-overdose related deaths in New Hampshire — the most in the state’s history. With a population of roughly 1.4 million, the Granite State has one of the highest per-capita rates of addiction in the country.

As the problem has worsened over the last decade, however, access to substance abuse treatment has not improved. According to a 2014 report from the U.S. Department of Health and Human Services, the state is second to last — ahead of only Texas — in access to treatment programs.  New Hampshire does not fund any methadone treatment programs and relies on a network of privately-run for-profit clinics to treat the thousands of addicts across the state. “There’s a stigma out there for users,” said Diane St. Onge, director of the Manchester Comprehensive Health Center — one of only eight clinics in the state that provides methadone treatment for heroin addiction. “We need more treatment options. People’s lives are at stake.”

In 2013, St. Onge’s clinic had 250 patients. Today, it has 540 patients and a two-week long waiting list. On a recent weekday, the clinic’s waiting room was teeming with weary patients, most appearing middle-aged, and young children whose parents were there to receive their daily dose of methadone, the drug that reduces the withdrawal symptoms in people addicted to heroin or other narcotic drugs.

Outside, amid the political paraphernalia and live-shots being set up by crews ahead of Tuesday’s New Hampshire primary, patients sat on benches waiting to go inside. The juxtaposition was striking.

A Town under Siege

Situated along the I-93 interstate between the state’s two largest cities of Manchester and Nashua, the small town of Londonderry is at the center of a drug-trafficking route where heroin cuts across socio-economic and political lines.

Ed Daniels has worked with the Londonderry Fire Department for 11 years. For most of that time, he says, he saw one or two overdose cases a year. He says he now sees at least one every shift. He says the victims he treats come from all demographics. “There’s no rhyme or reason to it,” said Daniels.

Daniels says the numbers began to spike last summer and have continued to rise, unabated. He blames the increase on fentanyl — an extremely potent pain killer drug that is now commonly cut with heroin to produce a more intense high — and feels, at times, that there is little long-term that he can do for his patients.  “They can leave the hospital,” said Daniels. “[But] once they have the addiction, where can they go for help?”

For Londonderry Fire Department Chief Darren O’Brien, who has lived his entire life in Londonderry, “it’s hard to see what’s going on in a community you grew up in.” O’Brien noted that there were 82 reported overdoses last year — nearly three times the 31 reported cases in 2014. “I’m hoping we can get a handle on it,” he said.

Joe’s heroin addiction lasted nearly a decade, a time that Allen-Samuel says she was fearful to come home to confront her son. “It’s a hell of a ride, it’s devastating,” she said.   Allen-Samuel tried everything to help Joe. On one occasion, after he had been placed in jail for a minor offense, she had officers keep him there for months knowing that he’d likely not have access to any drugs inside. Meanwhile, she says, Joe’s childhood friends were dying one-by-one from overdose.

Joe says he had periods of sobriety but ultimately relapsed. It was not until his second stint in jail, he says, where he vowed to fight back. “That was probably my lowest point,” he said. He sought treatment and, ultimately, got clean.

He says losing his closest friends was motivation for him to be there for his girlfriend and young children. He has been sober for more than two years.  “I’m just thankful,” said Joe. “[Before] I wasn’t able to be a dad. I’m glad I’m able to be here and experience it now.”

For Allen-Samuel, the unfolding crisis in New Hampshire should be an impetus for reform. Heroin addiction, she says, is a disease that should be dealt with the same way society treats cancer or any other deadly illness.  “Our families are dying,” said Allen-Samuel. “What’s going on in our community is a war.” 

Source:  

http://www.nbcnews.com/nightly-news/our-families-are-dying-new-hampshire-s-heroin-crisis-n510661?cid=sm_fb    Feb.2016

 

Filed under: Crime/Violence/Prison,Heroin/Methadone :

BY DAVID HILL — 05/27/14 08:03 PM EDT 310

THE VIEWS EXPRESSED BY CONTRIBUTORS ARE THEIR OWN AND NOT THE VIEW OF THE HILL

I was recently moderating several nights of focus groups in Denver when the subject of marijuana suddenly and unexpectedly broke into the conversation.

At the beginning of each group I asked respondents to introduce themselves, stating their favorite hobbies or leisure time interests, and one thing they would change about Colorado. I’ve been doing this for decades and am used to hearing “the usual suspects” when it comes to what respondents want to change. Fix the traffic. Improve the schools. Stop the influx of new residents, particularly those from California and Texas. I even got a few mentions of the oddly standard, “I wish we had an ocean and a beach.”

But this time, in every group, someone mentioned he or she would go back on the state’s wholesale legalization of marijuana. I probed Coloradans some on the topic this trip, and the buyers’ remorse is palpable. People didn’t really know what they were getting into.I wrote about the possibility of second thoughts on marijuana previously, in early April; ordinarily I wouldn’t circle back so quickly, but I am seeing too much evidence to ignore the growing backlash.

It’s not just ordinary voters who now are second-guessing the move. Leaders are wondering aloud whether they should have done more to fight against approval of the referendum. Colorado’s mainstream civic elite, which ordinarily and routinely organizes large coalitions to fight ballot measures it deems bad for the state, generally chose to stand aside during the two referenda — one on medical marijuana and the other on leisure use — leaving the opposition to movement to conservative groups alone.

The problem with new policies enacted through the referendum process is that there are always unintended consequences. I spotted one on this last trip to Mile High country. Some voters now think that the marijuana trade, and the associated tax revenue, is such a financial bonanza that it should pay for most everything. It’s going to be a lot harder to pass any increases in general sales or property taxes because voters will instead want pot tax dollars to carry the burden.

It may be only a statistical margin of error quirk, but looking at the latest CBS News polling on marijuana legalization, I am wondering if there is a larger doubting of the wisdom of legalization.

For the first time in any time series I’ve monitored, support for legalization actually declined in mid-May’s CBS poll.

CBS found that just 48 percent of Americans believe marijuana should be legal, down from 51 percent in two earlier polls taken by CBS in January and February. Given that each study interviewed samples of approximately 1,000 adults, for a 3 percent margin of error, a 4-point drop in legalization support is just outside the margin — and more importantly, it’s a rare drop of any magnitude in momentum for legalization. For more than a decade, every successive poll saw rising support for marijuana. The latest CBS numbers are a throwback to a poll the organization took in 2012. That’s a serious regression for marijuana advocates.

Pot’s regress since January in the CBS polling is most noteworthy among the middle-aged (45-64) population (-13 percentage points in support for legalization) and by liberals (-9 points in support). Frankly, I am not at all surprised by the latter. Overall, support by liberals still stands at a stout 63 percent, but if I had deeper crosstabs, I’d expect that some green liberals with children under the age of 18 are starting to have some reservations about pot, just as many do about tobacco.

Pollsters will be keeping a close watch on these numbers. Is the trend in rising support for marijuana reaching a ceiling? Could there even be a growing pushback? Could the backlash be more about health and air quality than about conservative ideology? 

Hill is a pollster who has worked for Republican campaigns and causes since 1984.

Source:

http://thehill.com/opinion/david-hill/207342-david-hill-buyers-remorse-on-marijuana

Filed under: Cannabis/Marijuana,Global Drug Legalisation Efforts,USA :

Behavioral Health Is Essential To Health • Prevention Works • Treatment Is Effective • People Recover In Brief

Fall 2014 • Volume 8 • Issue 3 An Introduction To Co-Occurring Borderline Personality Disorder And Substance Use Disorders

This In Brief is for health and human services professionals (e.g., social workers, vocational counselors, case managers, healthcare providers, probation officers). It is intended to introduce such professionals to borderline personality disorder (BPD)—a condition with very high rates of suicide and self-harm that often co-occurs with substance use disorders (SUDs).

This In Brief presents the signs and symptoms of BPD, with or without a co-occurring SUD, alerts professionals to the importance of monitoring clients with BPD for self-harm and suicidal behavior, and encourages professionals to refer such clients for appropriate treatment.

This In Brief is not meant to present detailed information about BPD or treatment guidelines for BPD or SUDs. How Common Is BPD?1 Estimates of BPD prevalence in the U.S. population range from 1.6 percent to 5.9 percent. BPD affects approximately 10 percent of all psychiatric outpatients and up to 20 percent of all inpatients.

What Is Borderline Personality Disorder?

BPD is one among several personality disorders (e.g., narcissistic personality disorder, paranoid personality disorder, antisocial personality disorder). According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5),1 personality disorders are generally characterized by:

■ Entrenched patterns of behavior that deviate significantly from the usual expectations of behavior of the individual’s culture.

■ Behavior patterns that are pervasive, inflexible, and resistant to change.

■ Emergence of the disorder’s features no later than early adulthood (unlike depression, for example, which can begin at any age).

■ Lack of awareness that behavior patterns and personality characteristics are problematic or that they differ from those of other individuals.

■ Distress and impairment in one or more areas of a person’s life (often only after other people get upset about his or her behavior).

■ Behavior patterns that are not better accounted for by the effects of substance abuse, medication, or some other mental disorder or medical condition (e.g., head injury).

BPD is a complex and serious mental illness. Individuals with BPD are often misunderstood and misdiagnosed. A history of childhood trauma (e.g., physical or sexual abuse, neglect, early parental loss) is more common for individuals with BPD.1,2 In fact, many individuals with BPD may have developed BPD symptoms as a way to cope with childhood trauma. However, it is important to note that not all individuals with BPD have a history of childhood trauma. It is also important to note that some of the symptoms of BPD overlap with those of several other DSM-5 diagnoses, such as bipolar disorder and posttraumatic stress disorder (PTSD).

Therefore, a diagnosis of BPD should be made only by a licensed and experienced mental health professional (whose scope of practice includes diagnosing mental disorders) and then only after a thorough assessment over time. Individuals with BPD often require considerable attention from their therapists and are generally considered to be challenging clients to treat.3,4,5 However, BPD may not be the chronic disorder it was once thought to be.

In Brief BPD often respond to appropriate treatment and may have a good long-term prognosis,1,5 experiencing a remission of symptoms with a relatively low occurrence of relapse.6,7 The DSM-5 indicates that BPD is diagnosed more often in women than in men (75 percent and 25 percent, respectively).1 Other research, however, has suggested that there may be no gender difference in prevalence in the general population,5,6 but that BPD is associated with a significantly higher level of mental and physical disability for women than it is for men.6 In addition, the types of co-occurring conditions tend to be different for women than for men. In women, the most common co-occurring disorders are major depression, anxiety disorders, eating disorders, and PTSD. Men with BPD are more likely to have co-occurring SUDs and antisocial personality disorder, and they are more likely to experience episodes of intense or explosive anger.8,9

What Are the Symptoms of BPD?

The DSM-5 classifies mental disorders and includes specific diagnostic criteria for all currently recognized mental disorders. It is a tool for diagnosis and treatment, but it is also a tool for communication, providing a common language for clinicians and researchers to discuss symptoms and disorders. According to the DSM-5, the symptoms of BPD include:1

■ Intense fear of abandonment and efforts to avoid abandonment (real or imagined).

■ Turbulent, erratic, and intense relationships that often involve vacillating perceptions of others (from extremely positive to extremely negative).

■ Lack of a sense of self or an unstable sense of self

■ Impulsive acts that can be hurtful to oneself (e.g., excessive spending, reckless driving, risky sex).

■ Repeated suicidal behavior or gestures or self-mutilating behavior. (See the section below on suicide and nonsuicidal self-injury.)

■ Chronic feelings of emptiness

■ Episodes of intense (and sometimes inappropriate) anger or difficulty controlling anger (e.g., repeated physical fights, inappropriate displays of anger)

■ Temporary feelings of paranoia (often stress-related) or severe dissociative symptoms (e.g., feeling detached from oneself, trancelike).

Anyone with some of these symptoms may need to be referred to a licensed mental health professional for a complete assessment. Exhibit 1 presents some examples of how a person with BPD might behave. Suicide and nonsuicidal self-injury BPD is unique in that it is the only mental disorder diagnosis that includes suicide attempts or self-harming behaviors among its diagnostic criteria.3 The risk of suicide is high among individuals with BPD, with as many as 79 percent reporting a history of suicide attempts10 and 8 percent to 10 percent dying by suicide—a rate that may be 50 times greater than the rate among the general population.11 More than 75 percent of individuals with BPD engage in deliberate self-harming behaviors known as nonsuicidal self-injury (NSSI) (e.g., cutting or burning themselves).12 Unlike suicide attempts, NSSI does not usually involve a desire or intent to die. Sometimes the person with BPD does not consider these behaviors harmful.4 One study involving 290 patients with BPD found that 90 percent of patients reported a history of NSSI, and over 70 percent reported the use of multiple methods of NSSI.10 Reasons for NSSI vary from person to person and, for some individuals, there may be more than one reason. The behaviors may be: 4,13,14

■ A way to express anger or pain

■ A way to relieve pain (i.e., shifting from psychic pain to physical pain)

■ A way to “feel” something.

■ A way to “feel real.”

■ An attempt to regulate emotions.

■ A form of self-punishment.

■ An effort to get attention or care from others. NSSI may include: 4,13,14

■ Cutting.

■ Burning.

■ Skin picking or excoriation.

■ Head banging.

■ Hitting.

■ Hair pulling

Exhibit 1. Examples of Symptomatic Behavior (BPD)

■ Patterns of intense and unstable relationships

John comes in to see his case manager, George, and announces that he plans to marry a woman he met at a speed-dating event the night before. George has heard this same story from John at least once a month for the past 4 months.

■ Emotions that seem to change quickly from one extreme to another

Suzie has been working with a vocational rehabilitation counselor, Tony, for 2 weeks to prepare for job retraining. One day, just after Tony gets everything set up for Suzie to begin her training, Suzie storms out of the office screaming at him, “You’re just trying to get rid of me! You don’t understand me at all! I hate you!” Later, when Tony calls to suggest that maybe Suzie would prefer to work with another counselor, Suzie begins to cry and says, “Please don’t drop me, Tony! I need you!”

■ Evidence of self-harm or self-mutilation

José is a probation officer. During his weekly appointment with his client, Annie, José notices a pattern of recent cuts across her left forearm. José asks her about them, and Annie becomes defensive and says, “Okay, I cut myself sometimes, so what? It’s none of your business. I’m not hurting anybody!”

■ Pattern of suicidal thoughts, gestures,* or attempts

Maria is a nurse. As she looks over the health history of her new patient, Sally, she notices that Sally has been hospitalized three times in the past 4 years after suicide attempts, and that she has seen six different therapists. Sally tells her, “Yeah, I get suicidal sometimes. I just can’t seem to find the right therapist who can help me.”

■ Intense displays of emotion that often seem inappropriate or out of proportion to the situation

Regina is a social worker at a domestic violence shelter. She notices one of her clients, Elena, sitting in the living room with a sketchpad in her lap. Regina asks if she can see what Elena is drawing. Elena turns the sketchpad around to reveal a beautiful, detailed drawing of the shelter house. Regina admires it and says how beautiful it is, then says, “That’s funny, I thought that the house number was on the right side of the door.” Elena, who had been smiling, takes the sketchpad from Regina, looks at the drawing, then rips it from the pad and begins tearing it up, saying, “You’re right, it’s all wrong! I’ll have to start all over again!”

*Regarding the word gestures: It is dangerous to dismiss or label any suicidal behavior as a gesture. Anyone who exhibits suicidal thoughts or behaviors of any kind needs to be assessed by a licensed mental health professional.

What Are the Symptoms of SUDs?

SUDs involve patterns of recurrent substance use that result in significant problems, which fall into the following categories:1

■ Impaired control—taking more of the substance than intended, trying unsuccessfully to cut down on use, spending an increasing amount of time obtaining and using the substance, craving or having a strong desire for substance use

■ Social impairment—failing to fulfill obligations at work, school, or home; continuing substance use in spite of the problems it causes; giving up or reducing other activities because of substance use

■ Risky use—using the substance(s) in situations in which it may be physically dangerous to do so (e.g., driving) or in spite of physical or psychological problems that may have been caused or may be made worse by substance use (e.g., liver problems, depression)

■ Pharmacological criteria—displaying symptoms of tolerance (need for increased amounts of the substance to achieve the desired effect) or withdrawal (a constellation of physical symptoms that occurs when the use of the substance has ceased)

What Is the Relationship Between BPD and SUDs?

One study15 found that the prevalence of BPD among individuals seeking buprenorphine treatment for opioid addiction exceeded 40 percent, and another16 found that nearly 50 percent of individuals with BPD were likely to report a history of prescription drug abuse. A large survey6 found that 50.7 percent of individuals with a lifetime diagnosis (i.e., meeting the criteria for a diagnosis at some point during the individual’s life) of BPD also had a diagnosis of an SUD over the previous 12 months. This same survey found that for individuals with a lifetime diagnosis of an SUD, 9.5 percent also had a lifetime diagnosis of BPD. This is a significantly higher incidence of BPD than that in the general public, which ranges from 1.6 percent to 5.9 percent.1

One longitudinal study17 found that 62 percent of patients with BPD met criteria for an SUD at the beginning of the study. However, over 90 percent of patients with BPD and a co-occurring SUD experienced a remission of the SUD by the time of the study’s 10-year follow-up. (Remission was defined as any 2-year period during which the person did not meet criteria for an SUD.) The authors also looked at whether there were recurrences of SUDs after periods of remission and found that the rate of recurrence was 40 percent for alcohol and 35 percent for drugs. The rate of new onsets of SUDs, while lower than expected, was still 21 percent for drugs and 23 percent for alcohol.

Another study18 found that individuals with BPD had higher rates of new SUD onsets even when their BPD symptoms improved (compared with new SUD onsets for individuals with other personality disorders). A client with BPD and a co-occurring SUD presents some particular challenges. BPD is difficult to treat, partly because of the pervasive, intractable nature of personality disorders and partly because clients with BPD often do not adhere to treatment and often drop out of treatment. The impulsivity, suicidality, and self-harm risks associated with BPD may all be exacerbated by the use of alcohol or drugs.19 In addition, the presence of BPD may contribute to the severity of SUD symptoms,20 and the course of SUD treatment may be more complicated for clients who also have BPD.21

Who Can Best Provide Treatment for People With BPD and SUDs?

Individuals who display some of the symptoms of BPD (as described above) should be referred to an experienced licensed mental health professional for a thorough mental health assessment and possible referral to treatment. It is important to know whether referral sources have experience treating clients with BPD. If individuals display symptoms of substance misuse, they should also be assessed for a co-occurring SUD. Individuals with BPD sometimes trigger intense feelings of frustration and even anger in their therapists and other providers.12

Clients with BPD often have difficulty developing good relationships, including productive working relationships with therapists and other providers (e.g., healthcare workers, case managers, vocational counselors). Some individuals with BPD may move from therapist to therapist (or other professionals) in an effort to find “just the right person.” Individuals who have an SUD may receive treatment from an individual counselor or therapist or from an outpatient treatment program. However, a co-occurring diagnosis of BPD may complicate SUD treatment. It is important for the professionals treating the person for either diagnosis to work in consultation with each other.

Treatment for BPD—especially with a co-occurring SUD— sometimes involves a team approach. Depending on the treatment plan, a person may have an individual therapist, a group therapist, a substance abuse counselor, a psychiatrist, and a primary care provider; treatment may need to be planned and managed through the coordinated efforts of all providers. Regular consultation among all providers can ensure that everyone is working toward the same goals from each of their professional perspectives. For example:

■ In individual therapy sessions, a therapist may help the client learn to tolerate gradually increasing levels of uncomfortable emotions (e.g., stress, anxiety) so that the client may begin to have more control over those emotions.

■ A psychiatrist may consider the use of medication for the client or evaluate currently prescribed medications to determine adherence and their effect on the client’s ability to engage in the emotional work of therapy.

■ A substance abuse counselor may work with the client to achieve abstinence, identify relapse triggers that may come up as the client does emotional work in therapy, and identify coping strategies for remaining abstinent.

■ A vocational counselor may need to work with the client on distress tolerance as it relates to employment issues, such as applying for jobs or beginning a new job. This may mean helping the client understand the importance of being at interviews, vocational training classes, or work on time (even if emotional problems make that difficult) and helping the client develop strategies to achieve a pattern of good work habits. Some people with BPD may consciously or unconsciously attempt to sabotage treatment by providing conflicting information to providers or by trying to turn one provider against another. Consultation among all providers can help deter this.

What Treatments Are Available for Individuals With BPD and SUDs?

Many studies have been done on treatment approaches for BPD or SUDs, but very few have involved participants with co-occurring BPD and SUDs.22,23,24 However, based on the studies that have been done on co-occurring BPD and SUDs, a few approaches seem to show promise.

Perhaps the most researched approach is Dialectical Behavior Therapy, which has been adapted for treatment of co-occurring BPD and SUDs (Dialectical Behavior Therapy-S [DBT-S]). It is important to note, however, that DBT-S and other promising approaches involve structured, manualized treatments that are quite intensive and require a significant amount of training and resources (e.g., staffing, space, finances) that may not be available in all areas.25 Many therapists work on their own with individuals who have BPD, using the best techniques that their training and experience have to offer—hopefully in regular consultation with an experienced clinical supervisor. Therapists often adapt psychotherapy to better meet the needs of an individual client, sometimes combining different therapeutic approaches or mixing techniques.4

However, for clients with both BPD and SUDs, the therapist may need to work with an SUD treatment provider to provide comprehensive care. Pharmacotherapy for BPD and SUDs The Food and Drug Administration (FDA) has not approved any medications for the treatment of BPD. However, individuals with BPD may take medications to alleviate some of their symptoms.11,22 For example, selective serotonin reuptake inhibitors may be prescribed for depressed mood, irritability, anger, and impulsivity.11 There are several FDA-approved medications for SUD treatment. For alcohol use disorder, these include acamprosate, disulfiram, and naltrexone.26

For opioid use disorder, approved medications include buprenorphine, a combination of buprenorphine and naloxone, methadone, and naltrexone.27 Some of these medications may be prescribed on a short-term basis (e.g., to ease withdrawal symptoms, lessen cravings), and others may be prescribed for long-term use (e.g., to facilitate longer periods of abstinence).26,27 Individuals may receive their prescriptions and medication management from a psychiatrist, from other types of healthcare providers, or from both (or, in the case of methadone, from an opioid treatment program). Individuals may take medication as one part of a treatment plan that also includes attending individual therapy, group therapy, group skill-building sessions, or a mutual-help group (e.g., 12-step program), or some combination of these.

What Are Some Things To Remember When Working With Someone Who Has Co-Occurring BPD and SUDs?

Some of the same guidelines that have been identified as necessary for mental health professionals who work with clients who have these two diagnoses may also be helpful for all human services professionals. Working with a client who has co-occurring BPD and SUDs requires:

■ Strong (but not rigid) professional boundaries—Be clear with the person about the expectations in the working relationship (e.g., length of appointments, level of support, contact outside regular appointments). Be aware of special requests to make exceptions to the usual rules for working with clients. These requests sometimes escalate over time. If in doubt about making an exception to the rules, discuss the situation with a supervisor who is knowledgeable about working with individuals who have BPD (within applicable confidentiality requirements).11

■ A commitment to self-care—If possible, schedule appointments with someone who has BPD right before lunch or before a break. Avoid scheduling back-to-back appointments with two individuals who have BPD. It is important to have some time between them to see clients with other diagnoses, to work on other tasks, or simply to take a break. Develop the habit of leaving work at work (i.e., don’t “replay” interactions with individuals who have BPD).

■ An awareness of how BPD may affect any kind of work with the individual—For example, fearing abandonment and avoiding abandonment are characteristics of BPD and may manifest in some unexpected ways. For example, if the professional relationship has focused on the person with BPD completing certain goals, that person may thwart his or her own progress to avoid the feelings of abandonment that would result from ending the working relationship.

■ Knowledge about what skills the individual who has BPD is learning in therapy—The person may need assistance applying those new skills to broader life situations. For example, perhaps one skill the person has learned is how to break down a seemingly overwhelming task into a series of small steps. Work with the person to apply that particular skill to the situation at hand.

Conclusions

It is important to remember that:

■ Most human services professionals will encounter clients with BPD in the course of their work.

■ Individuals with BPD often have co-occurring diagnoses (e.g., depression, SUDs). ■ BPD is often characterized by intense emotional displays and impulsive acts (e.g., self-harm, suicide attempts).

■ Working with an individual with BPD (with or without a co-occurring SUD) can be challenging.

■ Individuals with BPD (with or without a co-occurring SUD) deserve to receive appropriate treatment and deserve to be treated with compassion and respect.

■ Individuals with BPD often respond to appropriate treatment and experience a remission of symptoms with a relatively low occurrence of relapse.

■ Individuals with BPD (with or without a co-occurring SUD) may have a team of professionals who provide different aspects of care (e.g., therapist, psychiatrist).

■ It is important for all professionals involved in the care of an individual with BPD to communicate and work together.

Resources

SAMHSA resources

National Registry of Evidence-based Programs and Practices http://nrepp.samhsa.gov

Treatment Improvement Protocols (TIPs) (see back page for electronic access and ordering information)

TIP 36: Substance Abuse Treatment for Persons With Child Abuse and Neglect Issues

TIP 42: Substance Abuse Treatment for Persons With Co-Occurring Disorders

TIP 44: Substance Abuse Treatment for Adults in the Criminal Justice System

TIP 50: Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment Web resources

American Psychiatric Association http://www.psych.org

American Psychological Association http://www.apa.org

Borderline Personality Disorder Resource Center http://bpdresourcecenter.org

Behavioral Health Is Essential To Health • Prevention Works • Treatment Is Effective • People Recover 7 An Introduction to Co-Occurring Borderline Personality Disorder and Substance Use Disorders Fall 2014, Volume 8, Issue 3

National Education Alliance for Borderline Personality Disorder http://www.borderlinepersonalitydisorder.com

National Institute of Mental Health http://www.nimh.nih.gov

National Institute on Drug Abuse http://www.drugabuse.gov

Notes

1 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

2 Battle, C. L., Shea, M. T., Johnson, D. M., Yen, S., Zlotnick, C., Zanarini, M. C., et al. (2004). Childhood maltreatment associated with adult personality disorders: Findings from the Collaborative Longitudinal Personality Disorders Study. Journal of Personality Disorders, 18(2), 193–211.

3 Dimeff, L. A., Comtois, K. A., & Linehan, M. M. (2009). Cooccurring addiction and borderline personality disorder. In R. K. Ries, D. A. Fiellin, S. C. Miller, & R. Saitz (Eds.), Principles of addiction medicine (4th ed., pp. 1227–1237). Philadelphia: Lippincott Williams & Wilkins.

4 National Institute of Mental Health. (2011). Borderline personality disorder. NIH Publication No. 11‑4928. Bethesda, MD: Author.

5 Substance Abuse and Mental Health Services Administration. (2011). Report to Congress on borderline personality disorder. HHS Publication No. (SMA) 11‑4644. Rockville, MD: Substance Abuse and Mental Health Services Administration.

6 Grant, B. F., Chou, S. P., Goldstein, R. B., Huang, B., Stinson, F. S., Saha, T. D., et al. (2008). Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 69, 533–545.

7 Zanarini, M. C., Frankenburg, F. R., Hennen, J., Reich, D. B., & Silk, K. R. (2005). The McLean Study of Adult Development (MSAD): Overview and implications of the first six years of prospective follow-up. Journal of Personality Disorders, 19(5), 505–523.

8 Sansone, R. A., & Sansone, L. A. (2011). Gender patterns in borderline personality disorder. Innovations in Clinical Neuroscience, 8(5), 16–20.

9 Tadíc, A., Wagner, S., Hoch, J., Başkaya, Ö., von Cube, R., Skaletz, C., et al. (2009). Gender differences in axis I and axis II comorbidity in patients with borderline personality disorder. Psychopathology, 42, 257–263.

10 Zanarini, M. C., Frankenburg, F. R., Reich, D. B., Fitzmaurice, G., Weinberg, I., & Gunderson, J. G. (2008). The 10-year course of physically self-destructive acts reported by borderline patients and axis II comparison subjects. Acta Psychiatrica Scandinavica, 117, 177–184.

11 American Psychiatric Association. (2001). Practice guideline for the treatment of patients with borderline personality disorder. American Journal of Psychiatry, 158, 1–52.

12 Black, D. W., & Andreasen, N. C. (2011). Introductory textbook of psychiatry (5th ed.). Washington, DC: American Psychiatric Publishing.

13 Brown, M. Z., Comtois, K. A., & Linehan, M. M. (2002). Reasons for suicide attempts and nonsuicidal self-injury in women with borderline personality disorder. Journal of Abnormal Psychology, 111(1), 198–202.

14 Kleindienst, N., Bohus, M., Ludäscher, P., Limberger, M. F., Kuenkele, K., Ebner-Priemer, U. W., et al. (2008). Motives for nonsuicidal self-injury among women with borderline personality disorder. Journal of Nervous and Mental Disease, 196(3), 230–236.

15 Sansone, R. A., Whitecar, P., & Wiederman, M. W. (2008). The prevalence of borderline personality among buprenorphine patients. International Journal of Psychiatry in Medicine, 38(2), 217–226.

16 Sansone, R. A., & Wiederman, M. W. (2009). The abuse of prescription medications: Borderline personality patients in psychiatric versus non-psychiatric settings. International Journal of Psychiatry in Medicine, 39(2), 147–154.

17 Zanarini, M. C., Frankenburg, F. R., Weingeroff, J. L., Reich, D. B., Fitzmaurice, G. M., & Weiss, R. D. (2011). The course of substance use disorders in patients with borderline personality disorder and axis II comparison subjects: A 10-year follow-up study. Addiction, 106(2), 342–348.

18 Walter, M., Gunderson, J. G., Zanarini, M. C., Sanislow, C. A., Grilo, C. M., McGlashan, T. H., et al. (2009). New onsets of substance use disorders in borderline personality disorder over 7 years of follow-ups: Findings from the Collaborative Longitudinal Personality Disorders Study. Addiction, 104, 97–103.

19 van den Bosch, L. M. C., Verheul, R., & van den Brink, W. (2001). Substance abuse in borderline personality disorder: Clinical and etiological correlates. Journal of Personality Disorders, 15, 416–424.

20 Morgenstern, J., Langenbucher, J., Labouvie, E., & Miller, K. J. (1997). The comorbidity of alcoholism and personality disorders in a clinical population: Prevalence rates and relation to alcohol typology variables. Journal of Abnormal Psychology, 106(1), 74–84.

21 Center for Substance Abuse Treatment. (2005). Substance abuse treatment for persons with co-occurring disorders. Treatment Improvement Protocol (TIP) Series 42. HHS Publication No. (SMA) 13‑3992. Rockville, MD: Substance Abuse and Mental Health Services Administration.

22 Gianoli, M. O., Jane, J. S., O’Brien, E., & Ralevski, E. (2012). Treatment for comorbid borderline personality disorder and alcohol use disorders: A review of the evidence and future recommendations. Experimental and Clinical Psychopharmacology, 20(4), 333–344.In Brief In Brief, An Introduction to Co-Occurring Borderline Personality Disorder and Substance Use Disorders

23 Kienast, T., & Foerster, J. (2008). Psychotherapy of personality disorders and concomitant substance dependence. Current Opinion in Psychiatry, 21, 619–624.

24 Pennay, A., Cameron, J., Reichert, T., Strickland, H., Lee, N. K., Hall, K., et al. (2011). A systematic review of interventions for co-occurring substance use disorder and borderline personality disorder. Journal of Substance Abuse Treatment, 41(4), 363–373.

25 Zanarini, M. C. (2009). Psychotherapy of borderline personality disorder. Acta Psychiatrica Scandinavica, 120, 373–377.

26 Center for Substance Abuse Treatment. (2009). Incorporating alcohol pharmacotherapies into medical practice. Treatment Improvement Protocol (TIP) Series 49. HHS Publication No. (SMA) 13‑4380. Rockville, MD: Substance Abuse and Mental Health Services Administration.

27 Center for Substance Abuse Treatment. (2005). Medication-assisted treatment for opioid addiction in opioid treatment programs.

Treatment Improvement Protocol (TIP) Series 43. HHS Publication No. (SMA) 12‑4214. Rockville, MD: Substance Abuse and Mental Health Services Administration.

In Brief

This In Brief was written and produced under contract numbers 270-09-0307 and 270-14-0445 by the Knowledge Application Program, a Joint Venture of JBS International, Inc., and The CDM Group, Inc., for the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS). Christina Currier served as the Contracting Officer’s Representative.

Disclaimer: The views, opinions, and content of this publication are those of the authors and do not necessarily reflect the views, opinions, or policies of SAMHSA or HHS.

Public Domain Notice: All materials appearing in this document except those taken from copyrighted sources are in the public domain and may be reproduced or copied without permission from SAMHSA or the authors. Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA, HHS. Electronic Access and Copies of Publication: This publication may be ordered or downloaded from SAMHSA’s Publications Ordering Web page at http://store.samhsa.gov. Or, please call SAMHSA at 1-877-SAMHSA-7 (1-877-726-4727) (English and Español).

Recommended Citation: Substance Abuse and Mental Health Services Administration. (2014). An Introduction to Co-Occurring Borderline Personality Disorder and Substance Use Disorders. In Brief, Volume 8, Issue 3. Originating Office: Quality Improvement and Workforce Development Branch, Division of Services Improvement, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, Rockville, MD 20857. HHS Publication No. (SMA) 14-4879 Printed 2014

Source:

https://store.samhsa.gov/product/An-Introduction-to-Co-Occurring-Borderline-Personality-Disorder-and-Substance-Use-Disorders/SMA14-4879

Filed under: Intervention (including testing) (Papers),Medical Studies :

By HAEYOUN PARK and MATTHEW BLOCH JAN. 19, 2016

Deaths from drug overdoses have jumped in nearly every county across the United States, driven largely by an explosion in addiction to prescription painkillers and heroin.

Some of the largest concentrations of overdose deaths were in Appalachia and the Southwest, according to new county-level estimates released by the Centers for Disease Control and Prevention.

The number of these deaths reached a new peak in 2014: 47,055 people, or the equivalent of about 125 Americans every day.

Deaths from overdoses are reaching levels similar to the H.I.V. epidemic at its peak.

The death rate from drug overdoses is climbing at a much faster pace than other causes of death, jumping to an average of 15 per 100,000 in 2014 from nine per 100,000 in 2003.

The trend is now similar to that of the human immunodeficiency virus, or H.I.V., epidemic in the late 1980s and early 1990s, said Robert Anderson, the C.D.C.’s chief of mortality statistics.

H.I.V. deaths rose in a shorter time frame, but their peak in 1995 is similar to the high point of deaths from drug overdoses reached in 2014, Mr. Anderson said. H.I.V., however, was mainly an urban problem. Drug overdoses cut across rural-urban boundaries.

In fact, death rates from overdoses in rural areas now outpace the rate in large metropolitan areas, which historically had higher rates.

Heroin abuse in states like New Hampshire make it a top campaign issue.

Drugs deaths have skyrocketed in New Hampshire. In 2014, 326 people died from an overdose of an opioid, a class of drugs that includes heroin and fentanyl, a painkiller 100 times as powerful as morphine.

Nationally, opioids were involved in more than 61 percent of deaths from overdoses in 2014. Deaths from heroin overdoses have more than tripled since 2010 and are double the rate of deaths from cocaine.

In New Hampshire, which holds this year’s first presidential primary, residents have repeatedly raised the issue of heroin addiction with visiting candidates.

“No group is immune to it — it is happening in our inner cities, rural and affluent communities,” said Timothy R. Rourke, the chairman of the New Hampshire Governor’s Commission on Alcohol and Drug Abuse.

Most of the deaths from overdose in the state are related to a version of fentanyl. “Dealers will lace heroin with it or sell pure fentanyl with the guise of being heroin,” Mr. Rourke said.  But fentanyl can be deadlier than heroin. It takes much more naloxone, a drug that reverses the effects of an opioid overdose, to revive someone who has overdosed on fentanyl.

Mr. Rourke said that high death rates in New Hampshire were symptomatic of a larger problem: The state is second to last, ahead of only Texas, in access to treatment programs. New Hampshire spends $8 per capita on treatment for substance abuse. Connecticut, for example, spends twice that amount.

Appalachia has been stricken with overdose deaths for more than a decade, in many ways because of prescription drug addiction among its workers.  West Virginia and neighboring states have many blue-collar workers, and “in that group, there’s just a lot of injuries,” said Dr. Carl R. Sullivan III, the director of addiction services at the West Virginia University School of Medicine.

“In the mid-1990s, there was a social movement that said it was unacceptable for patients to have chronic pain, and the pharmaceutical industry pushed the notion that opioids were safe,” he said.

A few years ago, as laws were passed to address the misuse of prescription painkillers, addicts began turning to heroin instead, he said. Because of a lack of workers needed to treat addicts, overdose deaths have continued to afflict states like West Virginia, which has the highest overdose death rate in the nation.

“Chances of getting treatment in West Virginia is ridiculously small,” Dr. Sullivan said. “We’ve had this uptick in overdose deaths despite enormous public interest in this whole issue.”

While New Mexico has avoided the national spotlight in the current wave of opioid addiction, it has had high death rates from heroin overdoses since the early 1990s.

Heroin addiction has been “passed down from generation to generation in small cities around New Mexico,” said Jennifer Weiss-Burke, executive director of Healing Addiction in Our Community, a non-profit group formed to curb heroin addiction. “I’ve heard stories of grandparents who have been heroin users for years, and it is passed down to younger generations; it’s almost like a way of life.”

Dr. Michael Landen, the state epidemiologist, said the state recently began grappling with prescription opioids. Addictions have shifted to younger people and to more affluent communities.

Ms. Weiss-Burke, whose son died from a heroin overdose in 2011, said it was much harder to treat young people. “Some young people are still having fun and they don’t have the desire to get sober, so they end up cycling through treatment or end up in jail,” she said.

Her center recently treated a 20-year-old man who was sober for five months before relapsing, then relapsed several more times after that.  “When you go right back to the same environment, it’s hard to stay clean,” she said. “Heroin craving continues to haunt a person for years.”

Source : https://www.nytimes.com/interactive/2016/01/07/us/drug-overdose-deaths-in-the-us.html

 

Filed under: Addiction,Heroin/Methadone,Prescription Drugs,USA :

It’s a question often raised in today’s heated discussion about the efficacy of drug policy in America: Do regulations outlawing certain drugs actually work?

Let’s go to the data. Here’s what the Nation’s largest, longest-running, and most comprehensive source on the state of drug use in America shows:

As you can see, the use of legal drugs like alcohol and tobacco far outpaces the use of illegal drugs. It is clear, then, that laws discouraging drug use do have an effect in keeping rates relatively low compared to rates for other drugs that are legal and therefore more available.  Even beyond this one-year snapshot, we know that significant progress has been made in the long term.  Since 1979, there has been a roughly 30 percent decline in the overall use of illicit drugs in America.

So our challenge is not that we’re powerless against the problem of substance use in America. The challenge is that rates of drug use – a behavior that harms too many of our fellow citizens — are still too high. That’s why the President’s National Drug Control Strategy supports innovative and proven programs that aim to reduce drug use and its consequences through a combination of public health and public safety interventions.

It boils down to simple arithmetic: The more Americans use drugs, the higher the health, safety, productivity, and criminal justice costs we all have to bear. And if sensible drug laws (in combination with a wide array of prevention, treatment, and other health interventions, of course) help keep those numbers down, then the answer is yes, they are working.

Source: www.whitehouse.gov   2013 ONDCP                                                                                                  

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Filed under: Alcohol,Global Drug Legalisation Efforts,Nicotine,USA :

Filed under: Global Drug Legalisation Efforts,Medicine and Marijuana :

Filed under: Marijuana and Medicine :

For decades, attorney Richard Blau focused his legal savvy on the high-stakes business of booze. Alcohol-industry law was an attorney’s dream, full of unresolved questions and deep-pocketed players clawing their way to the top.

So when Florida’s talk turned to marijuana, another storied pastime with its own dubious history, Blau’s titan of a law firm, GrayRobinson, jumped at the opportunity. Blau now leads a special practice for clients wanting to capitalize on medical cannabis — and bend the laws to their advantage.

“The playbook is to get in and lend a hand in crafting those rules, so they read the way our clients want them to read,” Blau said. “The powerful people are the ones to get in on the ground floor.”

Months before the state’s November vote to legalize medical marijuana, some of Florida’s biggest law firms are already staking their claims to the lucrative legal minefield of the budding weed industry.

Orlando-based GrayRobinson, which employs 101 attorneys in Tampa Bay and nearly 300 across the state, will devote a core of its “regulated products” group to the nuances of marijuana law.

Attorneys with Holland & Knight, a prominent firm in Tampa with more than 1,000 lawyers across the world, last week released an alert for clients on the “legal landscape (and) complex marketplace for marijuana-related businesses.”

And Akerman, the Miami-based corporate-law giant and largest law firm in the state, recently launched a “regulated substances task force” with nearly two dozen senior attorneys and public-policy professionals ready to advise, among others, cultivators, private-equity groups and dispensaries.

“The shifting interplay between state and federal laws presents new challenges and unprecedented opportunities for Akerman clients,” managing partner Richard Spees said in a statement, “and we are positioned to help them capitalize.”

Groups with ostensible legal ties have filed for Florida business licenses with names like Medical Marijuana Business Lawyers and the Cannabis Law Group, joining a wave of “ganjapreneurs” grabbing for a piece of industry profits.

But the introduction of these powerhouse firms ups the ante, helping squash the images of two-bit, Breaking Bad-style “Better Call Saul” legal operations and legitimizing what could be a landslide of million-dollar corporate disputes.

“We’re not the ‘pot lawyers.’ This is not ‘reefer madness.’ It’s 100 percent professional, 100 percent legitimate . . . and we take it 100 percent seriously,” said Troy Kishbaugh, a health care specialist serving on GrayRobinson’s regulated-products group. “We have a large health care base . . . and they want their patients to get the best care possible. And if medical marijuana happens to be part of that medical regimen, they want to make sure they’re doing it right.”

The state’s biggest firms bolstered their practices this spring after Florida lawmakers passed a “Charlotte’s Web” bill legalizing a non-high-producing cannabis strain used to treat cancer and epilepsy.

An even bigger fight comes in November, when voters could pass Amendment 2 and legalize weed for a much broader slate of medical uses. Its prospects seem increasingly upbeat: A Quinnipiac University poll last week found 88 percent of Florida voters support adult medical-cannabis use.

If the vote passes, Florida could follow California in becoming America’s second-biggest medical-weed state, with around 400,000 patients spending an average of $3,000 a year, estimates from state regulators and a national cannabis-industry trade group show.

State regulators have several months to decide on the law’s little details, leaving a huge window for “cannabusiness” interests pushing to find an unserved niche. The state Department of Health’s Office of Compassionate Use, which is drafting the rules, discussed at a public hearing Friday a range of potential enterprises, from medical-cannabis testing to home delivery.

Lawyers wise to food and alcohol regulation are shoo-ins for the firms’ legal-weed practices: Many of the rules facing Big Pot, attorneys argue, could look a lot like those governing Big Tobacco, Big Food and Big Booze.
Joining them are lawyers with a vast range of expertise:

• Health care experts to address hospital and physician groups on how to protect themselves while administering, storing and suggesting the use of a drug still illegal under federal law.
• Banking and financial gurus to advise on securing investment, handling money and saving on taxes in what has long been an all-cash business.
• Land use attorneys who can help resolve zoning and landlord disputes over where growers and distributors can operate from seed to sale.
• Even intellectual-property specialists with knowledge on how to protect and preserve cannabis companies’ strains, brands and reputations, in much the same way consultants have long advised Budweiser or Marlboro.

For precedent, attorneys here are analyzing the legal laboratories of the 23 states, plus Washington D.C., that have legalized medical cannabis, and the two states, Washington and Colorado, that have okayed weed for personal use.

They also are following in the footsteps of nationwide firms versed in guiding the emerging trade. Seattle’s Canna Law Group, launched by international law firm Harris Moure in 2011, proved “profitable almost instantly,” partner Dan Harris told the Puget Sound Business Journal last year, adding, “We were shocked at the demand.” One of the group’s attorneys, a young University of Miami graduate, was voted “Marijuana Industry Attorney of the Year” in 2013 by Dope Magazine.

For the finer details, attorneys said, firms are following their clients’ requests to lobby their way into influence. Litigation seems likely: A proposed rule limiting Florida’s medical weed to five nurseries, chosen by lottery, has already stirred up legal wrath.
Attorneys have likened their legal timing to representing alcohol outfits near the sunset of prohibition, a potentially historical chance to mold law and make nice with the grateful captains of a new industry.

But GrayRobinson’s Blau, whose practice group is taking on three new clients a week, stops short of supporting the “green rush” of small-time entrepreneurs. He compares the early days of legal Florida weed to that of the American gold rush, in which organized business interests, not excited ground troops, ended up with the most to gain.

“All those individual wannabe miners thought (they’d strike it rich) when they pushed forward to mine the Klondike … but very few emerged out of that with anything,” Blau said. “In reality, it was the established gold-mining companies who took the ground, and made it their own.”

Source: www.tampabay.com 1st August 2014

Filed under: Cannabis/Marijuana,Legal Sector,Marijuana and Medicine,USA :

Colorado middle schools reported a 24 percent increase in drug-related incidents last year, according to USA Today. School-based experts tell the newspaper they believe the jump is directly related to marijuana legalization. Recreational sales of marijuana began on January 1, 2014.

Schools do not report which kinds of drugs are involved in the incidents, the article notes. State legislators are now asking school districts to keep track of which drugs they are finding.

John Simmons, the Denver Public Schools’ Executive Director of Student Services, says schools in his city saw a 7 percent increase in drug incidents, from 452 to 482. Almost all of the incidents were related to marijuana, he said.

Middle schools across the state reported a total of 951 drug violations, the highest number in a decade. School officials say while marijuana use has long been a problem, more students are trying it now that it is more easily available and socially accepted.

“We have seen parents come in and say, ‘Oh that’s mine, they just took it out of my room,’ and that sort of thing,” said school resource officer Judy Lutkin of the Aurora Police Department. “Parents have it in their houses more often, and the kids just can take it from home.”

“Middle schoolers are most vulnerable to being confused about marijuana,” said Dr. Christian Thurstone, attending physician for the Denver Health Adolescent Substance Abuse Treatment program. “They think, ‘Well, it’s legal so it must not be a problem.’”

Meg Sanders, owner of MiNDFUL, a marijuana company that operates in Colorado, says her business is very careful not to market to children. “We feel it’s our responsibility as a responsible business to card not just once but twice for any recreational customer, and medical patients have to show several documents before they can purchase marijuana,” she said.

Source: http://www.drugfree.org/join-together/jump-colorado-school-drug-cases  19th Feb.  2015

Filed under: Cannabis/Marijuana,Education,Youth :

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