The legalization of recreational marijuana is associated with an increase in its abuse, injury due to overdoses and car accidents, according to a study of 28million hospital records by University of California San Francisco.

 

The legalization of recreational marijuana is associated with an increase in its abuse, injury due to overdoses, and car accidents, but does not significantly change health care use overall, according to a study by researchers at UC San Francisco.

In a review of more than 28 million hospital records from the two years before and after cannabis was legalized in Colorado, UCSF researchers found that Colorado hospital admissions for cannabis abuse increased after legalization, in comparison to other states. But taking the totality of all hospital admissions and time spent in hospitals into account, there was not an appreciable increase after recreational cannabis was legalized.

The study, appearing online May 15, 2019, in BMJ Open, also found fewer diagnoses of chronic pain after legalization, consistent with a 2017 National Academy of Sciences report that concluded substantial evidence exists that cannabis can reduce chronic pain.

“We need to think carefully about the potential health effects of substantially enhancing the accessibility of cannabis, as has been done now in the majority of states,” said senior author Gregory Marcus, MD, MAS, a UCSF Health cardiologist and associate chief of cardiology for research in the UCSF Division of Cardiology.

“This unique transition to legalization provides an extraordinary opportunity to investigate hospitalizations among millions of individuals in the presence of enhanced access,” Marcus continued. “Our findings demonstrate several potential harmful effects that are relevant for physicians and policymakers, as well as for individuals considering cannabis use.”

According to the 2014 National Survey on Drug Use and Health, more than 117 million Americans, or 44.2 percent of all Americans, have used cannabis in their lifetime, and more than 22 million Americans report having used it within the past 30 days. While its use is a federal crime as a controlled substance, 28 states and the District of Columbia now allow it for treating medical conditions. Nine of those states have legalized it for recreational use.

To understand the potential shifts in health care use resulting from widespread policy changes, Marcus and his colleagues reviewed the records of more than 28 million individuals in Colorado, New York and Oklahoma from the 2010-2014 Healthcare Cost and Utilization Project, which included 16 million hospitalizations. They compared the rates of health care utilization and diagnoses in Colorado two years before and two years after recreational marijuana was legalized in December 2012 to New York, as a geographically distant and urban state, and to Oklahoma, as a geographically close and mainly rural state.

The researchers found that after legalization, Colorado experienced a 10 percent increase in motor vehicle accidents, as well as a 5 percent increase in alcohol abuse and overdoses that resulted in injury or death. At the same time, the state saw a 5 percent decrease in hospital admissions for chronic pain, Marcus said.

“There has been a dearth of rigorous research regarding the actual health effects of cannabis consumption, particularly on the level of public health,” said Marcus, holder of the Endowed Professorship of Atrial Fibrillation Research in the UCSF School of Medicine. “These data demonstrate the need to caution strongly against driving while under the influence of any mind-altering substance, such as cannabis, and may suggest that efforts to combat addiction and abuse of other recreational drugs become even more important once cannabis has been legalized.”

The study findings may be beneficial in guiding future decisions regarding cannabis policy, the researchers said.

“While it’s convenient and often most compelling to simplistically conclude a particular public policy is ‘good’ or ‘bad,’ an honest assessment of actual effects is much more complex,” Marcus said. “Those effects are very likely variable, depending on each individual’s idiosyncratic needs, propensities and circumstances. Using the revenues from recreational cannabis to support this sort of research likely would be a wise investment, both financially and for overall public health.”

The researchers could not explain why overall health care utilization remained essentially neutral, but said the harmful effects simply may have been diluted among the much larger number of total hospitalizations. They said it also may be that some beneficial effects, either at the individual or societal level, such as violent crime, counterbalanced the negatives.

Source:  https://www.eurekalert.org/pub_releases/2019-05/uoc–lmr051319.php

 

Is addiction a biological disease that is driven by environmental factors or not

Posted Mar 11, 2019

It will come as no surprise to you that childhood trauma, particularly unresolved trauma, can lead to mental health issues and addiction later in life. While less was known about the specific correlation in decades past, today we have a pretty good understanding of just how damaging adverse childhood experiences (ACEs) can be on development and coping.

The first few years of life are full of many important developmental milestones in terms of brain pathways, attachment, coping mechanisms and in generally learning how to relate to others and to stress. Those who experience trauma in their early years often develop survival mechanisms that are less than helpful in adulthood. For some people, such interference early on can even drive them towards addiction.

This is an area of addiction that I like to talk about, because people with an addiction are often judged at face-value by who they are right now, without any compassion or understanding of where they have come from or what has happened to them (for more on this mistake see HERE and HERE). Understanding these underlying issues however, becomes KEY in unlocking the secrets of addiction recovery.

“Treat people with respect instead of blaming or shaming them. Listen intently to what they have to say. Integrate the healing traditions of the culture in which they live. Use prescription drugs, if necessary. And integrate adverse childhood experiences science: ACEs.”  – Dr. Daniel Sumrok

What are ACEs?

Adverse Childhood Experiences (ACEs) are traumatic events that occur in childhood.

This may include:

• Abuse (physical, emotional, sexual) and/ or neglect
• Exposure to parental domestic violence
• Household dysfunction e.g. parent with an untreated mental health condition or substance use disorder
• Parental separation or divorce
• Loss of parent through death, deportation, incarceration or being removed from the family home by child protection services

Stressful experiences in childhood may also stem from outside the family home, for example: bullying, witnessing violence, racism, being an immigrant, homelessness, living in a war zone and moving house often (such as in the case of military families).

A substantial portion of the people I’ve worked with over the past 11 years have experienced at least one of these ACEs. Most have experienced two or more.

What does research say about ACEs and long-term

Much of the research has stemmed from the original CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study, the most prominent investigation to date into childhood abuse and neglect and its impact on adult health and wellbeing. Data was collected between 1995 to 1997 from over 17,000 participants.

The ACE study looks at types of early trauma and the long-term outcomes for these children in later life. Participants were required to answer ten questions about specific forms of childhood trauma and mark whether they had experienced this or not. For each type of trauma, they received a score of 1, the highest being 10. For example, a person who was sexually abused, was exposed to domestic violence and had a parent with a substance use disorder, would have an ACE score of three.

The study found that a person with an ACE score of 4 has nearly double the risk of cancer and heart disease than someone without an adverse childhood experience. What’s more, the likelihood of developing an alcohol use disorder increases 7-fold percent and the likelihood of suicideincreased 12-fold.

People who have had an ACE are two to four times more likely to start using alcohol or drugs at an early age, compared to those without an ACE score. People with an ACE score of 5 or higher are up to ten times more likely to experience addiction compared with people who haven’t experienced childhood trauma.

The research has also revealed that people with higher ACE scores are more likely to experience chronic pain and misuse prescription medication, and are at increased risk of serious health conditions such as:

• Heart disease
• Cancer
• Depression
• Substance abuse
• Liver or lung disease
• Stroke
• Diabetes

In the United States, 60% of adults had experienced at least one traumatic event in their childhood and 25% had experienced at least 3 ACEs.

How do we make sense of all the research?

There’s an overwhelming amount of evidence supporting this notion: the majority of people currently experiencing mental health or addiction problems have a history of adverse childhood experiences. That’s not to say that all children who experience trauma will go on to have a substance use disorder, because there are a lot of other factors at play, but it is a nearly-necessary component of a person’s history that requires serious consideration in treatment.

“Ritualized compulsive comfort-seeking (what traditionalists call addiction) is a normal response to the adversity experienced in childhood, just like bleeding is a normal response to being stabbed.” – Dr. Daniel Sumrok, director of the Center for Addiction Sciences at the University of Tennessee Health Science Center’s College of Medicine.

It’s also important to note that the ACE study simply reports on correlations, not causal links. We cannot say that experiencing physical abuse or a messy divorce in childhood will directly lead to a substance use disorder.

What we do know is this: Adverse childhood experiences are bad for your emotional and physical health and wellbeing in adulthood.

We must also consider all the other factors that influence a person’s behavior including socioeconomic factors such as income, education and access to resources.

Now, I don’t want to overwhelm you with all the research that points toward the power of our trauma histories. Your ACE score is not destiny. With help, you can learn healthy coping mechanisms, and how to have healthy relationships. We also need to account for genetic, environmental and spiritual factors that influence our behavior.

And while the research sheds light on how powerful childhood trauma can be in our life’s trajectory, it also helps inform government, communities and individuals about the importance of compassion. The link between adverse childhood experiences and later health problems is even more of a reason to reduce stigma and shame associated surrounding addiction. Children do not have control over their home environment, so therefore, we cannot expect them to overcome their difficulties as adults without compassion and support.

How can we help people with ACEs overcome addiction?

We need to focus on providing resources to the people at greatest risk and making sure those resources go into programs that reduce or mitigate adversity.

Dr. Daniel Sumrock says we can do these things to help people change addiction by:

• Address a person’s unresolved childhood trauma through individual and/ or group therapy
• Treat people with compassion and respect
• Use harm minimization principles such as providing medication treatments for addiction (such as buprenorphine or methadone)
• Help people with an addiction find a ‘ritualized compulsive comfort-seeking behavior’ (addiction) that is less harmful to their health.

IGNTD Recovery takes ACEs into account, getting to the “why” of the addiction, not just putting a Band-Aid on the compulsive seeking symptom. Indeed, we believe that focusing on the symptoms is harmful.

So if this is something you’d like to address either for yourself or for someone you know then find out more about my approach to addiction at IGNTD Recovery or in my book The Abstinence Myth.

Read more about the ACE study:

• https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/abo…
• https://acestoohigh.com/got-your-ace-score/
• https://www.samhsa.gov/capt/practicing-effective-prevention/prevention-b…
• https://jamanetwork.com/journals/jamapediatrics/article-abstract/2702204
• https://acestoohigh.com/2017/05/02/addiction-doc-says-stop-chasing-the-d…

Source:  https://www.psychologytoday.com/ca/blog/all-about-addiction/201903/linked-adverse-childhood-experiences-health-addiction