2024 July

(Slip Opinion)

The approach that the Drug Enforcement Administration currently uses to determine whether a drug has a “currently accepted medical use in treatment in the United States” under the Controlled Substances Act is impermissibly narrow. An alternative, two-part inquiry proposed by the Department of Health and Human Services is sufficient to establish that a drug has a “currently accepted medical use” even if the drug would not satisfy DEA’s current approach.

Under 21 U.S.C. § 811(b), a recommendation by HHS that a drug has or lacks a “currently acceptable medical use” does not bind DEA. In contrast, the scientific and medical determinations that underlie HHS’s “currently acceptable medical use” recommendation are binding on DEA, but only until the initiation of formal rulemaking proceedings to schedule a drug. Once DEA initiates a formal rulemaking, HHS’s determinations no longer bind DEA, but DEA must continue to accord HHS’s scientific and medical determinations significant deference, and the CSA does not allow DEA to undertake a de novo assessment of HHS’s findings at any point in the process.

Neither the Single Convention on Narcotic Drugs nor the CSA requires marijuana to be placed into Schedule I or II of the CSA. Both the Single Convention and the CSA allow DEA to satisfy the United States’ international obligations by supplementing scheduling decisions with regulatory action, at least in circumstances where there is a modest gap between the Convention’s requirements and the specific restrictions that follow from a drug’s placement on a particular schedule. As a result, DEA may satisfy the United States’ Single Convention obligations by placing marijuana in Schedule III while imposing additional restrictions pursuant to the CSA’s regulatory authorities.

April 11, 2024

NDPA EXPLANATORY: GUIDANCE TO ASSISTANT ATTORNEY GENERAL’S FULL COMMENT:

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DOJ.OLC.Rescheduling opinion

Source: MEMORANDUM OPINION FOR THE ATTORNEY GENERAL – by  CHRISTOPHER C. FONZONE –  Assistant Attorney General, Office of Legal Counsel

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

SUMMARY: The Department of Justice (“DOJ”) proposes to transfer marijuana from schedule
I of the Controlled Substances Act (“CSA”) to schedule III of the CSA, consistent with the view
of the Department of Health and Human Services (“HHS”) that marijuana has a currently
accepted medical use as well as HHS’s views about marijuana’s abuse potential and level of
physical or psychological dependence. The CSA requires that such actions be made through
formal rulemaking on the record after opportunity for a hearing. If the transfer to schedule III is
finalized, the regulatory controls applicable to schedule III controlled substances would apply, as
appropriate, along with existing marijuana-specific requirements and any additional controls that
might be implemented, including those that might be implemented to meet U.S. treaty
obligations. If marijuana is transferred into schedule III, the manufacture, distribution,
dispensing, and possession of marijuana would remain subject to the applicable criminal
prohibitions of the CSA. Any drugs containing a substance within the CSA’s definition of
“marijuana” would also remain subject to the applicable prohibitions in the Federal Food, Drug,
and Cosmetic Act (“FDCA”). DOJ is soliciting comments on this proposal.

NDPA EXPLANATORY: GUIDANCE TO THE ATTORNEY GENERAL’S COMMENT:

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Scheduling NPRM 508

Source:

21 CFR Part 1308 – Docket No. DEA-1362; A.G. Order No. 5931-2024 – DEA USA.
‘Schedules of Controlled Substances: Rescheduling of Marijuana’

Filed under: Cannabis/Marijuana,Political Sector,Social Affairs,USA :

OPENING STATEMENT BY THE AUTHOR – JOHN COLEMAN

To Whom It May Concern:

As a former DEA assistant administrator for operations and current president of Drug
Watch International, Inc. a 501c3 non-profit global organization of unpaid volunteers
dedicated to reducing drug abuse in the world through education, prevention, and
treatment, I wish to submit the following public comment in opposition to the rescheduling
of marijuana from Schedule I to Schedule III, as described in a Notice of Proposed
Rulemaking (NPRM), issued by U.S. Attorney General Merrick B. Garland on May 16,
2024, and published in the Federal Register on May 21, 2014.

Synopsis of Our Grounds in Opposition:

The Summary of the Attorney General’s NPRM provides the following rationale for proposing
rescheduling marijuana from Schedule I to Schedule III of the Controlled Substances Act (CSA):
The Department of Justice (‘‘DOJ’’) proposes to transfer marijuana from schedule
I of the Controlled Substances Act (‘‘CSA’’) to schedule III of the CSA, consistent
with the view of the Department of Health and Human Services (‘‘HHS’’) that
marijuana has a currently accepted medical use as well as HHS’s views about
marijuana’s abuse potential and level of physical or psychological dependence.

Speaking on behalf of the members of Drug Watch International, Inc., we disagree with the
rationale offered by the Attorney General in support of rescheduling marijuana. While our specific
objections will be addressed in greater detail below, it suffices here to state that procedures for
drug scheduling, rescheduling, and removing drugs and other substances from scheduling are
actions defined by federal statute, specifically, Title II of the Comprehensive Drug Abuse
Prevention and Control Act of 1970 (Public Law 91-513), also known as the Controlled Substances
Act (CSA), U.S. Code, Section 801, et seq.

In sum, the justification cited by the Attorney General in the NPRM for rescheduling marijuana 

does not comport with the statutory requirements of the CSA, specifically at 21 U.S.C. § 811 & § 812, 

for rescheduling controlled substances.

The view of HHS, as mentioned in the NPRM, that marijuana has a currently accepted medical
use (CAMU) is inaccurate and is based solely on redefining court-tested, statutorily-based, and
longstanding approved methods for determining CAMU. These methods are derived from the
Food, Drug, and Cosmetic Act (FDCA) and the CSA, not from or based on popular appeal, and
they are intended to evaluate the safety and efficacy of medicinal drugs submitted to the Food and
Drug Administration (FDA) for approval. The proposed action of the Attorney General, as
described in the NPRM, would set aside statutes and regulations intended to protect public health
and public safety to accommodate political constituents and the profiteers of a cannabis industry
that already has seriously harmed many Americans – especially, as we will show, children and
young adults. The modest medicinal benefits that some purport marijuana to have pale by
comparison with the significant risks posed by this powerful intoxicant.

Throughout the NPRM, DEA’s consistent response to the HHS analyses is to suggest a need to
consider additional information. We interpret the DEA’s carefully nuanced wording to mean that
the agency has misgivings as to the appropriateness of rescheduling marijuana. This, added to the
NPRM’s seeking of comments on the practical consequences of rescheduling marijuana, reflects,
we believe, the rank and file’s uncertainty with this radical proposal.

Of additional note is that the Attorney General – not the DEA Administrator, the Attorney General’s
lawful delegate for drug scheduling actions – signed the NPRM as “A.G. Order No. 5931-2024.”3
The Department’s Office of Legal Counsel (OLC) released a slip opinion that was published by
the Department at the same time as this order.

This opinion begins with the following sentence:

“The approach that the Drug Enforcement Administration currently uses to determine whether a
drug has a ‘currently accepted medical use in treatment in the United States’ under the Controlled
Substances Act is impermissibly narrow.” [emphasis added]

The OLC opinion is essential in this discussion because everything else – mainly, the scheduling
recommendation of the HHS Assistant Secretary and the Attorney General’s decision to accept it
– depends on redefining the heretofore accepted and agreed-upon meaning of the expression,
“currently accepted medical use” (CAMU) to mean something other than what Congress intended.
CAMU, we will show, is a specific criterion in the CSA that separates a Schedule I controlled
substance from a controlled substance in any of the other four schedules. We will show that the
convenient redefinition of CAMU by HHS, OLC, and the Attorney General is not only arbitrary
and capricious, but also contrary to pertinent provisions of the CSA and FDCA.

In this public comment, we will show that the proposal to reschedule marijuana is without merit,
conflicts with specific provisions of the CSA and the FDCA, and sacrifices the safety and efficacy
of the nation’s medicinal drug supply to satisfy a political agenda of the President to benefit the
commercial cannabis industry. The misgivings expressed by the DEA, along with the overt
political contrivances of OLC to support the President’s wishes, lead us to conclude that bringing
this proposal to a Final Rule would not be done by carefully considering statutory requirements –
as the law requires – but, instead, by furthering a political goal in a way that is arbitrary, capricious,
an abuse of statutory intent as well as an abuse of agency discretion. For these reasons and more,
we believe that this proceeding should be halted and a Final Rule should not be issued to reschedule
marijuana.

NDPA EXPLANATORY: GUIDANCE TO JOHN COLEMAN’S FULL COMMENT:

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Public Comment.06.10.24

Source: John Coleman, formerly with the DEA (USA) – authored these comments.

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

BY LAUREN IRWIN – 06/01/24 1:10 PM ET

 

Containers depicting OxyContin prescription pill bottles rest on the ground amid a protest over over-prescription of opioids, Friday, April 5, 2019, in front of the Department of Health and Human Services’ headquarters in Washington, D.C. (AP Photo/Patrick Semansky)

Roughly one in every three Americans have reported knowing someone who has died of a drug overdose, a new survey found.

The poll, conducted by researchers at Johns Hopkins Bloomberg School of Public Health, found that 32 percent of people have known someone who has died of a drug overdose. Those who reported knowing someone who has passed away from drug use were also more likely to support policy aimed at curbing addition, per the poll.

The survey results, published Friday in JAMA Network, suggest that an avenue for enacting greater policy change for addiction may be by mobilizing those who lost someone due to drug addiction, researchers wrote.

Experts also noted that opioids — often prescribed by doctors for pain management — especially with the proliferation of powerful synthetic drugs like fentanyl and polysubstance, have accelerated the rising rate of overdose deaths in recent years.

Since 1999, more than 1 million people have died of a drug overdose in the United States and while studies are still being conducted on the reasoning, researchers noted that there’s not much known about the impacts on the family or friends of the deceased.

The survey also found that personal overdose loss was more prevalent among groups with lower incomes but did not differ much across political parties.

Nearly 30 percent of Democrats said they lost someone to overdose, while 33 percent of Republicans and 34 percent of independents said the same.

“This cross-sectional study found that 32% of US adults reporting knowing someone who died of a drug overdose and that personal overdose loss was associated with greater odds of endorsing addiction as an important policy issue,” the researchers wrote. “The findings suggest that mobilization of this group may be an avenue to facilitate greater policy change.”

A similar study examined overdose deaths from 2011 to 2021 and estimates that more than 321,000 children in the U.S. have lost a parent to drug overdose.

According to the Centers for Disease Control and Prevention (CDC), U.S. drug overdose deaths dropped slightly in 2023, the first annual decrease in overdose deaths since 2018. Still, the overall number of deaths is extremely high, with more than 107,000 people dying in 2023 due to the overuse of drugs.

 

Source: https://thehill.com/tag/overdose-deaths/

Filed under: Drug Specifics,Drug use-various effects,USA :

By Carole Tanzer Miller HealthDay Reporter

MONDAY, June 10, 2024 (HealthDay News) — Though overdose deaths continue to surge, there is no approved medication to treat methamphetamine use disorder.

Now, an experimental two-drug therapy has yielded promising results, UCLA researchers report.

“These findings have important implications for pharmacological treatment for methamphetamine use disorder,” said researcher Dr. Michael Li, an assistant professor-in-residence of family medicine at the David Geffen School of Medicine at UCLA, adding that methamphetamine-involved overdoses have surged.

His team published its findings June 10 in the journal Addiction.

In urine tests for methamphetamine, drug-free results rose 27% among participants who received a combination of injectable naltrexone plus extended-release oral buproprion. Negative tests rose only 11%, meanwhile, in a control group.

Methamphetamine abuse is a growing problem around the world, with an estimated 34 million users in 2020 compared to 33 million 10 years earlier. In the United States alone, overdose deaths rose fivefold between 2012 and 2018.

The National Institute on Drug Abuse Clinical Trials Network has supported various trials, including this one, to evaluate different treatments for methamphetamine use disorder.

This trial, known as ADAPT-2, ran from May 2017 to July 2019 at eight sites. More than 400 participants were included, including 109 who received the experimental drug therapy in the first phase. That demonstrated that the combo worked at six weeks.

The new findings are from the trial’s second phase, which looked at a longer period. Partipants were drug-tested at weeks seven and 12 and again, after treatment, at 13 and 16 weeks.

While their results were encouraging, researchers said further study is needed to find out if the treatment lasts longer than 12 weeks and leads to further reductions in drug use.

“Prior stimulant use disorder treatment trials suggest that change in use is gradual [consistent with our findings], unlikely to result in sustained abstinence in a typical 12-week trial, and dependent on treatment duration,” the researchers said in a UCLA news release. “This warrants future clinical trials to quantify changes in [methamphetamine] use beyond 12 weeks and to identify the optimal duration of treatment with this medication.”

Source: https://www.medicinenet.com/two_drug_treatment_could_curb_meth_addiction/news.htm

 

Filed under: Drug Specifics,Treatment and Addiction,USA :

The new European Union Drugs Agency (EUDA), to be soon launched, will have more powers to face current and future challenges
The European Union Drugs Agency (EUDA) will replace the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) on July 2, 2024. The EUDA will have a new mandate and stronger role in addressing drug-related issues in the EU – adapted from photo by Antoine Schibler on Unsplash
By the Editorial Team – The European body that centralizes information on drugs and drug addiction celebrated its thirtieth anniversary last year. With the creation of the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) in 1993, the European Union committed itself for the first time to developing drugs policies based solely on data collection and scientific evidence.

New mandate, new agency

This year marks another milestone in the history of European action on drugs. On 2 July, the EMCDDA will officially become EUDA, the European Union Drugs Agency (the acronym ‘EUDA’ remaining the same in all languages). The Agency’s new regulation, which repeals and replaces the EMCDDA’s, already entered into force in July 2023, but it has taken a whole year of intensive work to prepare for EUDA’s formal launch and to transform the body from a monitoring centre into an agency, with the power to act.

The EMCDDA was originally set up to provide the Member States with objective and comparable information on the prevalence and trends in drugs and drug addiction and their consequences at European level, in order to adequately inform the development of drugs policies. This objective has not changed. What is changing, however, is the scope of the mandate given to the EUDA and the increased powers conferred on it to enable it to meet current and future challenges in the field of drugs and drug addiction.

And it’s not just a change of name or brand identity. With a new mandate that is far more proactive and adapted to the current situation, the Agency will have greater powers and a larger budget to support decision-makers in three key areas: monitoring, preparedness and competence development for better interventions.

EUDA will be better equipped to help the EU and its Member States deal with emerging drug problems

In addition to its work in collecting, analysing and disseminating data on drugs and drug addiction, the new agency will also be responsible for, among other things: developing threat assessment capabilities in the areas of health and security; issuing alerts, through a new European drug alert system, when high-risk substances appear on the market; monitoring and addressing poly-substance use, an increasingly widespread problem; and developing and promoting evidence-based interventions and best practices.

Cooperation with civil society

An important aspect of EUDA’s new mandate is the emphasis now placed on cooperation with civil society. The EMCDDA has always had trust-based, cordial relationships with civil society organizations (CSOs). However, these relationships have been merely informal, consisting of occasional exchanges on various drug-related issues – such as the online meetings set up during the COVID-19 crisis to assess access to services – without there being any formal exchange mechanism.

Article 55 of the new Regulation requires the Agency to establish cooperation with relevant CSOs, at national, EU or international level, for the purposes of consultation, exchange of information and pooling of knowledge. For this purpose, the Agency should designate a single point of contact for this purpose to ensure that CSOs are regularly informed of its activities. The EUDA should also allow CSOs to submit data and information relating to its activities.

Furthermore, the Agency’s new mandate requires it to work with all civil society actors concerned by the drugs phenomenon, i.e. CSOs, but also communities affected by drug-related crime, and communities of people who use drugs or have a lived experience of drug use.

Intensive preparatory work in 2023

This is a major step forward for the European organisation, which has logically guided much of its work in 2023, as its General Activity Report 2023 shows. The development of new concepts and services had to be initiated, some in close collaboration with the organization’s European partners. Various preparatory works were launched with a view to a significant expansion of the organization’s operations, and finally, a new project was launched to redefine the organization’s brand identity.

To these considerable efforts made by the organisation in 2023 must be added the core mission of the former EMCDDA: to provide European and national decision-makers with high quality services and publications, including, among others, the European Report on Drugs 2023 and the joint EMCDDA and Europol study: EU Drug Markets: In-depth Analysis.

Finally, we wish EUDA a successful launch and, above all, a productive journey. At a geopolitical moment in Europe when populist ideologies are on the rise and turning their backs on the inclusion of the most vulnerable communities, at a time when many Member States seem to be leaning more and more towards supply reduction and repression, rather than demand reduction, public health and the well-being of the communities concerned, it is up to  civil society as a whole, in partnership with the agencies, to present a united front in defence of human rights.

All of us, civil society organizations and other stakeholders, must commit to and support the work of the Agency in order to defend and promote drug policies based on health, human rights, the fight against stigma, and social justice.

Source: https://www.dianova.org/news/emcdda-becomes-euda-more-powers-and-cooperation-with-civil-society/

Filed under: Europe,Political Sector,Social Affairs :

By Priyanjana Pramanik, MSc.Jun 11 2024

Reviewed by Lily Ramsey, LLM

In a recent study published in JAMA Network Open, researchers explored whether cannabis use is linked to mortality from all causes, cancer and cardiovascular disease (CVD).

Their findings indicate that heavy cannabis use is associated with a significantly higher risk of CVD mortality among females. However, they observed no association between cancer and all-cause mortality among the entire sample of males and females.

Background

Cannabis is the most commonly used illegal drug worldwide, and its increasing legalization underscores the need to understand its health impacts.

Previous research has suggested potential cardiovascular risks associated with cannabis use, but these studies often focused on specific populations, limiting the generalizability of their findings.

Furthermore, there has been a lack of research examining the differential effects of cannabis on males and females. Although cannabis use for medical purposes is expanding, its safety and efficacy for various conditions remain unclear.

Some studies have suggested a link between heavy cannabis use and increased all-cause and cardiovascular mortality. Still, others have found no such associations, often constrained by methodological limitations like small sample sizes, short follow-up periods, or limited age ranges of participants.

Only one prior study explored the relationship between cannabis use and cancer mortality, finding no significant link.

About the study

This study addressed existing gaps by examining sex-stratified links of lifetime cannabis use to CVD, cancer, and all-cause mortality in a large general population sample.

The cohort study utilized data from the UK Biobank, a large-scale biomedical database comprising 502,478 individuals aged 40 to 69, recruited from 2006 to 2010 from 22 cities across the UK.

Participants provided detailed health information through questionnaires, interviews, physical assessments, and biological samples, and their data was linked to mortality records up to December 19, 2020.

Pittcon Highlights: Cannabis & Psychedelic eBook Check out the highlights from Pittcon in the Cannabis & Psychedelic industriesDownload the latest edition

Cannabis use was self-reported and categorized into never, low, moderate, and heavy use based on lifetime frequency.

The study assessed the association between cannabis use and mortality using Cox proportional hazards regression models, adjusting for clinical and demographic variables.

Analyses were stratified by sex to address potential differences between males and females. Mortality outcomes were defined using codes from the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, and various covariates such as age, education, income, smoking history, alcohol use, hypertension, diabetes, dyslipidemia, body mass index (BMI), prior CVDs, and antidepressant use were included in the models.

The study employed Kaplan-Meier survival analyses, considering two-sided P values less than 0.05 as significant.

Findings

The study analyzed 121,895 UK Biobank participants, aged 55.15 years on average for females and 56.46 years for males.

Among the participants, 3.88% of males and 1.94% of females were heavy cannabis users. Over a median follow-up of 11.8 years, there were 2,375 deaths, including 440 due to cancer and 1,411 due to CVD.

Heavy cannabis use in males was associated with an increased risk of all-cause mortality, with a hazard ratio (HR) of 1.28, but not significantly with CVD or cancer mortality after adjusting for all factors.

In females, heavy use of cannabis was associated with a higher risk of mortality from CVD (HR 2.67) and a non-significant increase in all-cause and cancer mortality after full adjustment.

Notably, among female tobacco users, heavy cannabis use significantly increased risks for all-cause mortality (HR 2.25), CVD mortality (HR 2.56), and cancer mortality (HR 3.52).

In contrast, male tobacco users saw an increased risk only for cancer mortality (HR 2.44). Excluding participants with comorbidities showed no significant associations between heavy use of cannabis and mortality.

The findings suggest a sex-specific impact of heavy cannabis use on mortality, particularly in females.

Conclusions

This study diverges from previous research that largely examined all-cause mortality among younger populations, showing a heightened risk associated with cannabis use.

Few studies addressed the link between cannabis use and CVD mortality, with mixed findings. Some studies indicated a significant association, while others did not.

The study’s strengths include a large sample size and standardized data collection protocols from the UK Biobank. However, the cross-sectional design limits causal inference, and the low response rate might introduce participant bias.

The study’s focus on middle-aged UK participants limits generalizability to other demographics.

Self-reported data on cannabis use and lack of recent usage patterns, dosage information, and follow-up on cannabis use during the study period are significant limitations.

Future research should involve longitudinal studies to explore the possible causal impact of cannabis use on mortality, with a focus on precise measurements of cannabis use, including frequency, dosage, and methods of consumption.

These studies should also aim to understand the sex-specific impacts and the links between of cannabis use and cancer mortality, given the ambiguous current evidence.

 

Source: https://www.news-medical.net/news/20240611/Heavy-cannabis-use-increases-the-risk-of-cardiovascular-disease-for-women-study-finds.aspx

Filed under: Cannabis/Marijuana,Drug use-various effects,Effects of Drugs :

COVID-19 pandemic and increasingly dangerous drug supply among factors that may have contributed to diminished impact of intervention

A data-driven intervention that engaged communities to rapidly deploy evidence-based practices to reduce opioid-related overdose deaths – such as increasing naloxone distribution and enhancing access to medication for opioid use disorder – did not result in a statistically significant reduction in opioid-related overdose death rates during the evaluation period, according to results from the National Institutes of Health’s HEALing (Helping to End Addiction Long-Term) Communities Study. Researchers identified the COVID-19 pandemic and increased prevalence of fentanyl in the illicit drug market – including in mixtures with cocaine and methamphetamine – as factors that likely weakened the impact of the intervention on reducing opioid-related overdose deaths.

The findings were published in the New England Journal of Medicine and presented at the College on Problems of Drug Dependence (CPDD) meeting on Sunday, June 16, 2024. Launched in 2019, the HEALing Communities Study is the largest addiction prevention and treatment implementation study ever conducted and took place in 67 communities in Kentucky, Massachusetts, New York, and Ohio – four states that have been hard hit by the opioid crisis.

Despite facing unforeseen challenges, the HEALing Communities Study successfully engaged communities to select and implement hundreds of evidence-based strategies over the course of the intervention, demonstrating how leveraging community partnerships and using data to inform public health decisions can effectively support the uptake of evidence-based strategies at the local level.

“This study brought researchers, providers, and communities together to break down barriers and promote the use of evidence-based strategies that we know are effective, including medications for opioid use disorder and naloxone,” said NIDA director, Nora D. Volkow, M.D. “Yet, particularly in the era of fentanyl and its increased mixture with psychostimulant drugs, it’s clear we need to continue developing new tools and approaches for addressing the overdose crisis. Ongoing analyses of the rich data from this study will be critical to guiding our efforts in the future.”

NIH launched the HEALing Communities Study, a four-year, multisite research study to test a set of evidence-based interventions for reducing overdose deaths across health care, justice, and behavioral health settings. Over 100,000 people are now dying annually of a drug overdose, with over 75% of those deaths involving an opioid. Numerous evidence-based practices have been proven to prevent or reverse opioid overdose, but these strategies are gravely underused due to a number of barriers.

As part of the intervention, researchers collaborated with community coalitions to implement evidence-based practices for reducing opioid overdose deaths from the Opioid-Overdose Reduction Continuum of Care Approach. These evidence-based practices focus on increasing opioid education and naloxone distribution, enhancing access to medication for opioid use disorder, and safer opioid prescribing and dispensing. The intervention also included a series of communication campaigns to help reduce stigma and increase the demand for evidence-based practices.

Communities were randomly assigned to either receive the intervention (between January 2020 and June 2022) or to the control group (which received the intervention between July 2022 and December 2023). To test the effectiveness of the intervention on reducing opioid-related overdose deaths, researchers compared the rate of overdose deaths between the communities that received the intervention immediately with those that did not during the period of July 2021 and June 2022.

Between January 2020 and June 2022, intervention communities successfully implemented 615 evidence-based practice strategies (254 related to overdose education and naloxone distribution, 256 related to medications for opioid use disorder, and 105 related to prescription opioid safety).

Despite the success in deploying evidence-based interventions in participating communities, between July 2021 and June 2022, there was not a statistically significant difference in the overall rate of opioid-involved overdose deaths between the communities receiving the intervention and those that did not, (47.2 opioid-related overdose deaths per 100,000 people in the intervention group, versus 51.7 in the control). The study team is also examining data on the impact of the intervention on total overdose deaths and examining specific drug combinations, such as stimulants and opioids, and on non-fatal opioid overdoses, among other study outcomes.

“The implementation of evidence-based interventions is critical to addressing the evolving overdose crisis,” said Miriam E. Delphin-Rittmon, Ph.D., HHS Assistant Secretary for Mental Health and Substance Use and the leader of SAMHSA. “This study recognizes there is no quick fix to reduce opioid overdose deaths. Saving lives requires ongoing commitment to evidence-based strategies. The HEALing Communities Study facilitated the implementation of 615 evidence-based practice strategies, with the potential to yield lifesaving results in coming years.”

The authors highlight three specific factors that likely weakened the impact of the intervention on reducing opioid-related overdose deaths. First, the intervention launched two months before the COVID-19 shutdown which severely disrupted the ability to work with health care, behavioral health, and criminal legal systems in implementing evidence-based practices. Indeed, due in large part to the emergence of the COVID-19, only 235 of the 615 strategies (38%) were implemented before the comparison period began in July 2021.

Second, after communities selected which evidence-based practices they wanted to implement, they only had 10 months to implement them before the comparison period began. The authors note that this was not enough time to robustly recruit necessary staff, change clinical practice workflows, or develop new collaborations across agencies and organizations. They note more time to implement these strategies, and more time between implementation and measuring results, may be needed to observe the full impact of the intervention.

Lastly, significant changes in the illicit drug market could have impacted the effectiveness of the intervention. Fentanyl increasingly permeated the illicit drug supply, and was increasingly mixed or used in combination with stimulant drugs like methamphetamine and cocaine, or in counterfeit pills made to look like prescription medications. The increasing use of fentanyl, as well as xylazine, over the study period posed new challenges for treatment of opioid use disorder and opioid-related overdose.

“Even in the face of a global pandemic and worsening overdose crisis, the HEALing Communities Study was able to support the implementation of hundreds of strategies that we know save lives,” said Redonna Chandler, Ph.D., director of the HEALing Communities Study at NIDA. “This is an incredible feat for implementation science, and shows that when we provide communities with an infrastructure to make data-driven decisions, they are able to effectively implement evidence-based practices based on their unique needs.”

The HEALing Communities Study was supported and carried out in partnership between the National Institute of Health’s National Institute on Drug Abuse (NIDA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) through the NIH HEAL Initiative.

Source: https://nida.nih.gov/news-events/news-releases/2024/06/nih-funded-intervention-did-not-impact-opioid-related-overdose-death-rates-over-evaluation-period

Filed under: Effects of Drugs,Prevention and Intervention,Social Affairs,USA :

Cultural, systemic and historical factors have converged to create the perfect storm when it comes to Black overdose deaths.

By Liz Tung – June 14, 2024

Reporter at The Pulse

WHYY (PBS) 14th June 2024

A recent study from the Pennsylvania Department of Health has found that Black people who died from opioid overdoses were half as likely as white people to receive the life-saving drug naloxone, otherwise known as Narcan. The study also found that Black overdose deaths in Pennsylvania increased by more than 50% between 2019 and 2021, compared with no change in white overdose deaths.

In an email, a representative with the Department of Health said that similar rises in overdose deaths are being seen across the country, especially among Black, American Indian and Alaska Native populations. But researchers are still investigating what’s behind the spike.

“There does not appear to be a single reason why rates are increasing for Black populations and holding steady among white populations,” the statement reads. “The volatile and rapidly changing drug supply certainly has been a challenge as fentanyl is now found in every type of drug. Inequities in terms of treatment for substance use disorder may also play a factor as white people are more likely to have better access to the most evidence-based treatments and are more likely to stay in treatment.”

Fear of arrest

Abenaa Jones, an epidemiologist and assistant professor of human development and family studies at Penn State who was not involved in the study, has conducted similar research in Baltimore. She agreed that fentanyl-contaminated drugs — which are more common in lower-income neighborhoods — and less access to health care are likely factors in the growing number of overdose deaths among Black populations.

Jones said the criminal justice system, and its unequal treatment of Black people, also plays a role.

“We know that the intersection of criminal justice and substance use, and criminalization of drug use and how that disproportionately impacts minorities, can limit the accessibility of harm reduction services to racial-ethnic minorities for fear of harassment by police for drug paraphernalia,” Jones said, adding that even syringes obtained through needle-exchange programs can be considered illegal paraphernalia.

Fear of arrest, in turn, leads more people to using drugs in isolation.

“That may protect you from criminal legal involvement, but then in the event of an overdose, you may not have someone to help you,” Jones said. “So it could be that by the time the EMS come, it’s been too long for them to even consider administering naloxone.”

Contaminated drug supplies

An unexpected observation that Jones made in the course of her research could also be a factor in rising death rates — the fact that many of the Black people dying of opioid overdoses are older.

“For any other racial groups, overdose deaths peak around midlife — 35, 45,” she said. “For Black individuals, it’s more like 55, 64, and we were wondering what was going on with that.”

After investigating that question, Jones and her colleagues formulated a working theory.

“The running hypothesis for us is that this is a cohort effect,” she said. “Individuals who’ve been using drugs over time, particularly Black individuals back from the ‘80s and ‘90s with the cocaine epidemic, never stopped using.”

Those individuals may have remained relatively stable until fentanyl began to contaminate their drug supply without them knowing.

“So whatever harm reduction tools that you were using for so many years that’s been helping you, when fentanyl’s involved, it’s a different game,” Jones said. “You have to use less, but you have to also know that you have fentanyl in your drugs, right?

It’s a problem that Marcia Tucker, the program director of Pathways to Recovery — a partial hospitalization program focused on co-occurring substance use and mental health challenges — sees frequently among their mostly Black clients.

“If you come into treatment saying that I’m a cocaine user, or I’m a crack cocaine user, or I use marijuana, you’re not even thinking that an opioid overdose or fentanyl overdose could possibly happen to you,” Tucker said. “And it does happen.”

Fear, stigma and miseducation

In fact, Tucker said, she’s seen more of these kinds of overdoses over the past two years than in the three decades she’s spent working in addiction treatment. Despite that, there’s still a lack of education — and even stigma — surrounding both medication-assisted treatments (MATs) for opioid addiction, and the use of naloxone.

“I think sometimes culturally with the African American community, as far as MATs are concerned, there are some taboos about getting that extra help when they decide to come into treatment and get clean,” she said. “A lot of people feel like they want to do it from the muscle. They see it as another form of using.”

She said others may not know how to use naloxone, what kinds of effects it has or how to get it.

“I think a lot of folks don’t even know that they can walk into a pharmacy and get naloxone — you don’t have to have a prescription for that,” Tucker said. “And I think that information is just not always presented to communities, especially poor communities that don’t have a lot of resources.”

Other sources of hesitation are more immediate. Aaron Rice, a therapist at Pathways to Recovery, said that many of their clients fear naloxone because of its physical effects.

“I think they associate it with precipitated withdrawal at times,” Rice said, referring to the rapid-onset withdrawal that can cause symptoms including anxiety, pain, seating, nausea, vomiting and diarrhea.

“The only thing they’re thinking about is feeling better. And that feeling is going to supersede logic at that moment. It always does.”

Overcoming disparities in health care and mistrust of the system

The Department of Health acknowledged that the study only paints a partial picture, as it doesn’t include individuals whose overdoses were reversed by naloxone, and added that during the years of the study (2019–2021), naloxone was available by prescription only — a fact that likely played into the race-based disparity.

“There are recognized inequities in access to health care among persons of color, the concept of which likely extends to access to naloxone,” the Department of Health statement reads. “Historically, many public health materials and messaging more narrowly focused on persons using opioids. With people now taking two or more drugs together (whether intentionally or unintentionally), public health materials and messaging need to be more inclusive of all persons using drugs, regardless of the type.”

The study, researcher Abenaa Jones, Marcia Tucker and Aaron Rice all agreed on at least one intervention that could increase Black people’s access to naloxone — relying on trusted community leaders and institutions, like churches, to help educate residents and distribute the overdose-reversing drug.

“I just can’t stress enough how it’s a lifesaver — it’s the difference between life and death,” Tucker said. “I think people who aren’t medical professionals and find themselves in a situation where it might need to be used would probably be a little fearful — fearful about how to use it or how the person is going to react or whether it’s really going to work — just know that you’re better off with it and trying it. You don’t want to have to second guess yourself later and say, ‘I wish we had it. I wish we had gotten it,’ or, ‘I wish we had used it.’”

 

Source: https://whyy.org/articles/black-pennsylvanians-overdoses-naloxone-less-likely-to-receive/

Filed under: Drug Specifics,Prevention and Intervention,Social Affairs,Treatment and Addiction,USA :

by Eric W. Dolan

June 16, 2024

A new study published in the journal Psychological Medicine has found that teens who use cannabis are at an elevenfold higher risk of developing a psychotic disorder compared to those who do not use the drug. This finding underscores the potential mental health risks associated with cannabis use among adolescents, suggesting the association may be stronger than previously thought.

Cannabis, commonly known as marijuana, is a plant that has been used for both medicinal and recreational purposes for thousands of years. It contains numerous chemical compounds called cannabinoids, with tetrahydrocannabinol (THC) being the most well-known for its psychoactive effects.

THC is the substance primarily responsible for the “high” that users experience, as it interacts with the brain’s endocannabinoid system, influencing mood, perception, and various cognitive functions. Another major cannabinoid is cannabidiol (CBD), which is non-psychoactive and often touted for its potential therapeutic benefits.

The potency of cannabis, particularly in terms of its THC content, has significantly increased over the past few decades. In the 1980s, the average THC content in cannabis was around 1%. However, due to selective breeding and advanced cultivation techniques, modern strains can contain THC levels upwards of 20%, and some extracts can even exceed 90% THC.

This dramatic increase in potency has raised concerns among health professionals about the potential for more severe and widespread adverse health effects, especially among young users whose brains are still developing.

“My interest in this topic was initially driven by the legalization of recreational cannabis in Canada, which happened largely in the absence of solid evidence on the risks of cannabis use,” said study author André McDonald, a CIHR Postdoctoral Fellow at the Peter Boris Centre for Addictions Research and the Michael G. DeGroote Centre for Medicinal Cannabis Research at McMaster University.

“One of the big questions related to cannabis is its link with psychotic disorders, particularly during youth. Most studies on this topic have used data from the 20th century when cannabis was significantly less potent than today in terms of THC, so we were also curious whether using more recent data would show a stronger link.”

To conduct their study, the researchers linked population-based survey data from over 11,000 youths in Ontario, Canada, with health service use records. These records included hospitalizations, emergency department visits, and outpatient visits. The survey data came from the Canadian Community Health Survey (CCHS) cycles from 2009 to 2012, while the health service data was obtained from ICES.

The sample included non-institutionalized Ontario residents aged 12 to 24 years. To ensure the accuracy of their findings, the researchers excluded respondents who had used health services for psychotic disorders in the six years before their survey interview. This exclusion was intended to reduce the risk of reverse causation, where individuals might have started using cannabis to self-medicate for already existing psychotic symptoms.

Respondents were asked whether they had ever used cannabis and, if so, whether they had used it in the past 12 months. The primary outcome measured was the time to the first outpatient visit, emergency department visit, or hospitalization related to a psychotic disorder. The researchers also adjusted for various sociodemographic and substance use confounders to isolate the effect of cannabis use on the development of psychotic disorders.

Teens who reported using cannabis in the past year were found to be over eleven times more likely to be diagnosed with a psychotic disorder compared to non-users. Interestingly, this elevated risk was not observed in young adults aged 20 to 24, indicating that adolescence is a particularly vulnerable period for the mental health impacts of cannabis.

The data also showed that among the teens diagnosed with a psychotic disorder, the vast majority had a history of cannabis use. Specifically, about 5 in 6 teens who were hospitalized or visited an emergency department for a psychotic disorder had previously reported using cannabis. This finding supports the neurodevelopmental theory that the adolescent brain is especially susceptible to the effects of cannabis, which may disrupt normal brain development and increase the risk of severe mental health issues.

“People should be aware of the risks associated with using cannabis at an early age. This study estimates that teens using cannabis are at 11 times higher risk of developing a psychotic disorder compared to teens not using cannabis,” McDonald told PsyPost.

“It’s important to acknowledge that the vast majority of people who use cannabis will not develop a psychotic disorder, but this study suggests that most teens who develop a psychotic disorder have a history of cannabis use. This is important information to convey to teens but also parents of teens, who may not be aware that cannabis products today are different and may be more harmful than the ones that were around when they were teens. ”

While the study provides compelling evidence of a strong link between adolescent cannabis use and psychotic disorders, it still has some limitations. The potential for reverse causation remains, as early symptoms of psychosis could lead some teens to use cannabis as a form of self-medication before seeking formal medical help. Additionally, the study could not account for genetic predispositions, family history of mental health issues, or trauma — all factors that could influence both cannabis use and the risk of psychotic disorders.

Nonetheless, the findings heighten concerns about early cannabis use.

“As commercialized cannabis products have become more widely available, and have a higher THC content, the development of prevention strategies targeting teens is more important than ever,” said senior author Susan Bondy, an affiliate scientist at ICES and associate professor at the University of Toronto’s Dalla Lana School of Public Health.

McDonald added: :Canadian youth are among the heaviest users of cannabis in the world. If we follow the precautionary principle, the bottom line is that more needs to be done to prevent early cannabis use.”

 

Source: https://www.psypost.org/exclusive/drugs/marijuana-research/

Filed under: Canada,Cannabis/Marijuana,Mental Health,Youth :
Original Investigation – Substance Use and Addiction
July 17, 2024

Melinda Campopiano von Klimo, MD1; Laura Nolan, BA1; Michelle Corbin, MBA2; et alLisa Farinelli, PhD, MBA, RN, CCRP, OHCC2; Jarratt D. Pytell, MD3; Caty Simon4,5,6; Stephanie T. Weiss, MD, PhD2; Wilson M. Compton, MD, MPE2

Article Information
JAMA Netw Open. 2024;7(7):e2420837. doi:10.1001/jamanetworkopen.2024.20837
Key Points

Question  What reasons do physicians give for not addressing substance use and addiction in their clinical practice?

Findings  In this systematic review of 283 articles, the institutional environment (81.2% of articles) was the most common reason given for physicians not intervening in addiction, followed by lack of skill (73.9%), cognitive capacity (73.5%), and knowledge (71.9%).

Meaning  These findings suggest effort should be directed at creating institutional environments that facilitate delivery of evidence-based addiction care while improving access to both education and training opportunities for physicians to practice necessary skills.

Abstract

Importance  The overdose epidemic continues in the US, with 107 941 overdose deaths in 2022 and countless lives affected by the addiction crisis. Although widespread efforts to train and support physicians to implement medications and other evidence-based substance use disorder interventions have been ongoing, adoption of these evidence-based practices (EBPs) by physicians remains low.

Objective  To describe physician-reported reasons for reluctance to address substance use and addiction in their clinical practices using screening, treatment, harm reduction, or recovery support interventions.

Data Sources  A literature search of PubMed, Embase, Scopus, medRxiv, and SSRN Medical Research Network was conducted and returned articles published from January 1, 1960, through October 5, 2021.

Study Selection  Publications that included physicians, discussed substance use interventions, and presented data on reasons for reluctance to intervene in addiction were included.

Data Extraction and Synthesis  Two reviewers (L.N., M.C., L.F., J.P., C.S., and S.W.) independently reviewed each publication; a third reviewer resolved discordant votes (M.C. and W.C.). This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and the theoretical domains framework was used to systematically extract reluctance reasons.

Main Outcomes and Measures  The primary outcome was reasons for physician reluctance to address substance use disorder. The association of reasons for reluctance with practice setting and drug type was also measured. Reasons and other variables were determined according to predefined criteria.

Results  A total of 183 of 9308 returned studies reporting data collected from 66 732 physicians were included. Most studies reported survey data. Alcohol, nicotine, and opioids were the most often studied substances; screening and treatment were the most often studied interventions. The most common reluctance reasons were lack of institutional support (173 of 213 articles [81.2%]), knowledge (174 of 242 articles [71.9%]), skill (170 of 230 articles [73.9%]), and cognitive capacity (136 of 185 articles [73.5%]). Reimbursement concerns were also noted. Bivariate analysis revealed associations between these reasons and physician specialty, intervention type, and drug.

Conclusions and Relevance  In this systematic review of reasons for physician reluctance to intervene in addiction, the most common reasons were lack of institutional support, knowledge, skill, and cognitive capacity. Targeting these reasons with education and training, policy development, and program implementation may improve adoption by physicians of EBPs for substance use and addiction care. Future studies of physician-reported reasons for reluctance to adopt EBPs may be improved through use of a theoretical framework and improved adherence to and reporting of survey development best practices; development of a validated survey instrument may further improve study results.

Introduction
NDPA WEBSITE:  Note – In the interests of relative brevity, the References have been omitted from this published version.

Overdose is a leading cause of injury-related death in the US,1 with 107 941 such deaths occurring in 20222 and annual deaths due to alcohol exceeding 140 000 from 2015 to 2019.3 The more than 46.3 million people in the US with a past-year substance use disorder4 and a nationwide economic impact of alcohol misuse and illicit drug use that tops $442 billion5 further evidences the magnitude of this crisis.

A variety of safe and effective evidence-based practices (EBPs) to identify, reduce the morbidity and mortality of, and treat substance use disorders exist. Examples include screening, brief intervention, and referral to treatment,6–10 as well as behavioral therapies and pharmacotherapies for nicotine, alcohol, and opioid use disorders.11–13 Furthermore, harm reduction approaches (eg, naloxone training and coprescribing, drug checking and testing, and syringe service programs) offer significant individual and public health benefits for people who use drugs and for those who do not have abstinence-based treatment goals.14–16

Clinician adoption of EBPs is necessary; however, screening for substance use disorders remains low,7 creating missed opportunities to intervene in harmful substance use or recognize and discuss potential progression to a severe disorder. Treatment capacity is inadequate to meet demand,17 with only 6.3% of people with a past-year substance use disorder receiving treatment in the US in 2021.4 Our goal is to summarize published data on physician-described barriers to adoption of EBPs for addiction in clinical practice and recommend actions to address them.

Methods
Data Sources and Searches

This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. The search strategy was developed iteratively with a National Library of Medicine informationist specializing in systematic reviews. We applied this strategy on October 4, 2021, to PubMed, Embase, and Scopus and on October 5, 2021, to medRxiv and SSRN Medical Research Network. In addition, a gray literature search of relevant government and nongovernment websites was conducted on October 5, 2021. We found no previous similar systematic reviews. The systematic review protocol was registered in PROSPERO (CRD42022286208) and accepted on January 14, 2022.

Study Selection

A 12-person team used Covidence to apply exclusion criteria first to the title and abstract of each study then to the full text of studies not already excluded. Two people (L.N., M.C., L.F., J.P., C.S., and S.W.) reviewed each study in both rounds. Discordant opinions were resolved by a third reviewer (M.C. and W.C.). To be included, the study had to present data on: (1) physicians at any practice level; (2) any substance use intervention(s) (Box); and (3) physician reasons for reluctance to intervene in addiction. Studies not in English, letters, editorials, narrative reviews, and commentaries were excluded. Data collection on reasons for reluctance were systemized using the theoretical domains framework (TDF),18,19 a comprehensive approach for identifying behavioral determinants and for assessing implementation problems (eg, clinicians’ behavior) to inform intervention development. The team created a data extraction template with 10 reluctance reason categories (Box). We did not formally assess risk of bias in included studies because few used experimental or controlled study designs. Due to patterns observed during data extraction, the team approved the ad hoc collection of data on factors (eg, using a theoretical framework, obtaining target audience input in survey design, and piloting surveys) that could affect the internal validity of individual studies or precision of results. We conducted a limited exploration of facilitators because we observed that many included studies provided at least some data on possible facilitators of intervention in addiction.

Definitions of Intervention Type and Reluctance Reasons

Intervention type and definition

  • Harm reduction: syringe services, overdose prevention, naloxone, or drug user health.

  • Screening and assessment: screening, assessment of positive screening, or diagnosis.

  • Treatment: brief intervention, medication management, or behavioral services.

  • Recovery support: care coordination, care integration, or relapse prevention.

Reason and definitiona

  • Knowledge: beliefs about having the necessary knowledge, awareness, or understanding, including knowledge of condition or scientific rationale, procedural knowledge, or knowledge of task environment.

  • Institutional environment: beliefs about support from institution or employer, including material resources, organizational culture, competing demands.

  • Skills: beliefs about having the necessary skills, ability, or proficiency to deliver the intervention.

  • Cognitive capacity: beliefs about the cognitive capacity to manage a level of expected complexity of care, possibly related to cognitive overload and mental fatigue.

  • Expectation of benefit: beliefs about the likelihood of the patient benefiting or the course of the disease being altered due to the intervention.

  • Social influences: beliefs about public or community acceptance or support for the intervention, including willingness to allocate or develop needed resources.

  • Emotion: feelings of fear, dislike, worry, negative judgement, worthiness of patient population.

  • Relationship: concern about harming or losing the patient-physician relationship by causing offense, provoking avoidance, or other negative consequence.

  • Reinforcement: beliefs about the adequacy of reimbursement, professional rewards, and other positive reinforcement.

  • Professional role/identity: beliefs about professional role, boundaries, and group identity, excluding the intervention.

a Reasons are derived from the theoretical domains framework, a comprehensive approach for identifying behavioral determinants and assessing implementation problems (eg, clinicians’ behavior) to inform intervention development.

 

Data Analysis

We conducted a series of quantitative analyses using SPSS, version 27 (IBM). Analyses were selected based on their purpose; independent variable; dependent variable; and statistical requirements, including measurement levels. We examined reasons for reluctance by specialty, intervention, drug type, and year and common combinations of reasons for reluctance using bivariate analysis and cross-tabulation. We conducted a regression analysis of reasons for reluctance by year. Statistical significance was considered a 2-sided P value less than .05. The exploratory analyses of ad hoc study quality data were not part of the planned analysis and are descriptive only. We used Atlas.ti version 24 (Atlas.ti) to conduct thematic analysis to examine facilitators using the following themes: knowledge and skills, intrapersonal and interpersonal factors, infrastructure, and regulation reform.

Results
Study Characteristics

Our search yielded 9308 studies published between January 1, 1960, and October 5, 2021, with 1280 remaining after removal of duplicates and 552 assessed for eligibility (eFigure 1 in Supplement 1). Of 283 studies20–302 included (eTable 1 in Supplement 1), 97.30% were published in 2000 or later (Table 1). The number of studies increased over time. For example, 4 studies89,156,184,236were published in 2000 and 2133,48,49,66,68,75,77,79,93,107,108,113,139,142,148,240,251,255,302,306,313 in 2021, with a high of 31 8,27,47,50,52,54,69,74,92,100,114,121,146,147,161,165,174,182,191,193,199,204,206,209,221,247,263,270,275,287,300 in 2020 (eTable 2, eTable 3, eTable 4, eTable 5, and eFigure 2 in Supplement 1). Together, the included studies describe the views of 66 732 physicians who largely practiced general practice, internal medicine, or family medicine primarily in an office setting in the US. Most studies reported survey-based research results. Of the 4 general categories of addiction interventions (Table 2), treatment was most often addressed, followed by screening and assessment, with harm reduction and recovery support least discussed. Some studies addressed more than 1 intervention. Alcohol (86 studies20,21,23,25,26,29,31,34,36,38,41,44,51,53,54,57,59,60,62,69–72,81,82,86,88,89,94,95,103,105,111,113,117,119,123–127,131,132,138,141,150,153,155,158,160,162,164,168,170,171,173,176,191–193,196–201,204,205,210,219,235,237,248,250,254,256,258,271,281,283,285,291,294,296,299,300), nicotine (30 studies28,40,48,49,52,61,73,85,97,109,118,129,134,140,142,149,179,188,190,212,218,223,231,249,252,265,270,286,288,298), and opioids (104 studies30,32,33,35,37,42,46,47,50,55,56,58,64,66,74–80,83,84,87,90–92,98–100,104,106–108,110,112,114,115,121,122,130,133,135,137,139,143,144,146–148,151,152,154,156,163,165,167,172,174,180,182,184,186,189,202,203,206,207,213–216,221,222,225–228,238–240,242–245,247,251,253,255,257,259,262,269,272,275,277,280,282,284,287,290,292,293,302) were most often studied alone. Among studies reporting on multiple drugs (44 studies22,39,43,45,63,65,67,68,93,96,101,102,116,120,136,145,166,181,183,185,194,195,208,209,217,220,230,232–234,241,246,260,263,264,267,268,273,274,278,279,289,295,297), alcohol was included most often (38 studies45,63,65,67,68,93,96,101,102,116,120,136,145,166,181,183,194,195,208,209,217,230,232–234,241,246,260,264,267,268,273,274,278,279,289,295,297). Other substances were often reported as “other” or merely “drugs.” Cross-tabulations of each reason for reluctance with each of the most common specialties, interventions, and drugs produced no significant results; consequently, no P values are reported (Table 2). While this systematic review is of physician reluctance, 110 studies20,23–25,28,30,31,33,34,39,42,44,47,48,50,52,54,57,59,63,64,66–70,87,88,90,92,93,95,99,101,103–107,109,111–113,116,120,122,123,126,129,134,136,138,139,143,146,147,151,156,157,159,162,166,167,169,173,174,177,178,183,186,189,190,192,194,195,199–201,203,205,206,209,211,217,221,225,229,235,236,243–245,251,257,260,261,266,269,270,275,277,280,283,286,287,290,291,297,299,302 mentioned possible facilitators of physician engagement.

Physician Reluctance

Most studies did not gather or report data on all reasons. When queried, institutional environment (173 of 213 articles [81.2%]20,22,25–27,30–33,35,37,38,40–44,46,47,49–51,54–64,66,68,74–78,80,82–84,86,87,89–93,95,97,99,100,104,106–110,112–114,116,117,121–124,126,127,129,134–139,143,144,146–148,150,151,153–155,157–159,161–165,167,169–176,179,180,182,183,185,186,189,192,195,198,199,201–204,206,207,209,211,216–221,223,226,228–230,232–234,236,238,239,241–243,245,247,251,252,257–261,263–265,268,269,271,272,275,277,280,284,287,290,291,293,295,299,301,302) was the most common reason, followed by lack of skill (170 of 230 articles [73.9%]20–22,24–33,35,37–39,47–49,51,53–55,58,59,61,63–68,75,76,78,80–82,84,85,88,89,91–93,95,97–100,102–107,109–114,116–121,123–125,130–132,134,136,138,139,142,143,145,147,149,150,152,154,159–161,167,168,172–174,176,178,180,182,183,186,188,190,191,193,194,197–202,204,206–211,213,214,216,218–221,224–226,229,231,233,235,236,238,241,242,246,247,249,256,259,264–266,268,269,271,273,274,276–279,281–283,285–287,290–295,297,298,301,302), cognitive capacity (136 of 185 articles [73.5%]22,25,26,30,32,34,37,40,41,47–49,52,55,58–61,63–66,68,69,71,74,75,77,78,80,82,85,87–91,93,95,97,100,101,104–107,109–114,116,117,119,120,122–126,129,134–136,138,139,142,146–151,154–156,159–162,167,172,174,180,181,185–187,190–192,196–199,205,206,209,211,213,214,216,217,219,225,229–232,235,237,239,241–243,254,256,260,264,265,268–270,272,275,277,283,286,287,290–292,299,301,302), and knowledge (174 of 242 articles [71.9%]20–22,25–33,36,37,39,42,43,49,53–59,61,62,64–66,68–70,73,76,78,81,82,84,85,91–93,95,97–100,102–107,109,110,113,114,116–121,126,128,130,131,136,138,139,141–143,147,149–152,154,155,157,159–161,163,166–168,170–174,176–180,182–186,188,190–194,197–204,206–210,212–215,219,221,224,226,236–238,241,242,244,246,247,251,252,256–258,264,266–269,271,273,274,276–281,283–288,292–295,297–302); and social influences (121 of 184 articles [65.8%]26,27,30–32,41,42,46,47,49,51,57,58,60,62,63,68,71,77,79,80,82,83,88,90,92,95,99,101,102,106–110,112–114,118,121–124,126,127,129,134–138,146,147,151,153,155,157–159,161,165,167,169,170,176,177,180,182,185,189,195,197–208,210–212,216,217,219,221,223,227,228,233–235,238,242,245,247,249,254,255,257,260,261,264,266,268,269,282,283,286,287,289,291,296–298,301,302) (Table 2). We conducted bivariate analyses of reasons for reluctance and specialty, drug type, intervention, and time (Table 2; eFigure 3 in Supplement 1). Too few studies of recovery support existed to conduct a bivariate analysis with reasons for reluctance. Analysis of combinations of the top 4 reasons for reluctance found the most often paired reluctance reasons were knowledge and skill (135 of 221 articles [61.1%]20–22,25–33,37,39,49,53–55,58,59,61,64–66,68,76,78,81,82,84,85,91–93,95,97–100,102–107,109,110,113,114,116–121,130,131,136,138,139,142,143,147,149,150,152,154,159–161,167,168,172–174,176,178,180,182,183,186,188,190,191,193,194,197–202,204,206–210,213,214,219,221,224,226,236,238,241,242,246,247,256,264,266,268,269,271,273,274,276–279,281,283,285–287,292–295,297,298,301,302), followed by cognitive capacity and institutional environment (99 of 165 articles [60.0%]22,25,26,30,32,37,40,41,47,49,55,58–61,63,64,66,68,74,75,77,78,80,82,87,89–91,93,95,97,100,104,106,107,109,110,112–114,116,117,122–124,126,129,134–136,138,139,146–148,150,151,154,155,159,161,162,167,172,174,180,185,186,192,198,199,206,209,211,216,217,219,229,230,232,239,241–243,260,264,265,268,269,272,275,277,287,290,291,299,301,302) (Table 3). Institutional environment appeared in combination with other reasons more often than any other reason (7 of 12 pairings). Reasons not in our data extraction template were described in a few studies, including lack of demand (13 articles87,92,112,122,143,167,171,214,216,232,257,280,292), cost to the patient (8 articles58,69,148,155,171,174,288,292), and patient refusal (6 articles61,146,170,174,182,206). Analysis of the trend over time for each reason for reluctance revealed a significant increase in identification of social influence (F1,20 = 4.91; P = .04) and relationship (F1,20 = 4.54; P = .046) (eFigure 3 in Supplement 1). We extracted exemplar text from included studies for the top 4 reasons for reluctance (Table 4), discussed in the following section.

Institutional Environment

Reasons for reluctance related to the institutional environment included lack of trained staff66,154,167,182,186,207,242,260 or resources to train staff,59,92,221 acceptance of addiction interventions by staff107,259 or leadership,57,80,155,169,175,261,275 and clinician backup.54,56,64,75,76,90 Regulatory and liability concerns were frequently reported,32,35,50,75,76,87,90,99,107,163,165,167,174,245,259,261 as were record-keeping or confidentiality concerns207,259,275 and staff time required for prior authorizations.92 Often mentioned were also cost to the patient or lack of insurance coverage,148,155,170,171,173,174,182 along with medication unavailability at pharmacies95,144,148,170 and the absence of population-specific patient education materials.260,291 Less frequently cited but noteworthy reasons for reluctance include contractual limitations,291 nonexistent or unimplemented treatment algorithms,99,287 mental health programs not accepting patients with addiction,264 addiction treatment programs rejecting patients deemed insufficiently ready to change or having difficulty matching the level of care needed,229 and difficulty obtaining records from addiction treatment programs.107 Reimbursement can be viewed as a component of institutional environment. In the TDF, reimbursement is 1 part of reinforcement as a reason for reluctance (Box). While reinforcement was 1 of the 2 least often identified reasons for reluctance, data specific to reimbursement was extracted because it is a perennial point of concern in adopting evidence-based interventions for addiction. Physician reimbursement was viewed as insufficient to cover both the staff time necessary to intervene in addiction and the expense of additional staff training.174,207,277 Medicaid reimbursement was specifically highlighted as inadequate.186 In some cases, physicians perceived the reimbursement to be inadequate but were not certain of the reimbursed amount.56

Lack of Knowledge

In studies identifying lack of knowledge as a reason for reluctance, knowledge was more deficient for treatment than for screening or diagnosis and for drug use more than for alcohol or tobacco use.20,65,70,93,99,102,117,152,194,221,252,273 Physicians were unfamiliar with the evidence for substance use disorders as biomedical conditions,119,138,199,257 harm reduction strategies,58,154 and screening for risky substance use.59,161 Some physicians lacked awareness of the extent of substance use by their patients.256

Lack of Skill

Physicians reported lacking skills to conduct interventions effective enough to produce behavior change, including counseling21,38,51,59,117,291 and brief intervention.93,209,229 They also described a lack of skill needed to initiate or manage treatment,92,152,221,273 especially for substance use disorders other than alcohol or tobacco.63,194 In some studies, they equated their lack of skill with lack of experience with observing or delivering a substance use disorder intervention under supervision.22,75,91,238,256 Inabilities to assemble or demonstrate naloxone administration devices58,277 or to deliver appropriate training in its use to patients99 were also noted.

Lack of Cognitive Capacity

Lack of cognitive capacity was not often characterized beyond a general sense of overwhelm with clinical tasks (eg, “just too busy”)64,291 and the need to prioritize patients’ competing needs.58,107,109,268 In some cases, physicians perceived intervening in addiction as too time-consuming, both during the appointment and for monitoring,69,87,90,93,287 or that addiction treatment demand would be too great.66,75,91 Even delegating screening to other clinical team members was viewed as diverting time from the physician visit229; available tools were considered time-consuming.260 Some physicians expected meeting the care needs of patients with addiction to be too time-consuming.

Facilitators

We analyzed 4 main themes related to facilitators. First, physicians need the knowledge and skills to intervene; they need adequate education and training in areas like managing pharmacology. Second, intrapersonal and interpersonal factors exist that facilitate physician intervention. Intrapersonal factors include physician characteristics (eg, work experience, confidence, and practice type) and motivation (eg, desire to improve patient outcomes, reimbursement, and understanding addiction as within their scope of practice). Interpersonal factors include the physician-patient relationship, specifically the patient characteristics that may compel the physician to intervene (eg, the patient is receptive to help). Third, an infrastructure is needed that supports physician interventions and includes institutional changes at the practice level to implement protocols to standardize care (eg, screening and improved technology). An environment that fosters collaboration with other professionals or entities (eg, multidisciplinary teams and referral systems) and offers resources that would support the intervention (eg, materials or tools for use with patients, follow-up care, or treatment facilities) is also essential. Finally, regulation reforms (eg, eliminating prior authorization requirements, expanding substance use disorder insurance coverage, and simplifying laws and policies governing prescribing and medication distribution to patients) would facilitate physician intervention.

Discussion

The number and growth of publications meeting inclusion criteria for this systematic review demonstrates increasing interest in the perceived and actual barriers to physician engagement with addiction in clinical practice. The significant increase in social influence and relationship as reasons for reluctance over time may indicate increased awareness of stigma and associated social harms. Regarding intervention types, the availability of effective alcohol use disorder and opioid use disorder pharmacotherapies likely accounts for the literature’s focus on those therapies, corresponding with efforts to increase access to medications for opioid use disorder and to promote the adoption of screening, brief intervention, and referral to treatment practices. As the evidence base for a wider array of harm reduction strategies grows, it will be important to understand and address physicians’ perceived and actual barriers to their acceptance and adoption of those strategies. Information is limited on the adoption of recovery support interventions by physicians, a finding that also merits investigation.

That institutional environment is associated with physician reluctance to intervene may not surprise practicing clinicians. The pairing of institutional environment and cognitive capacity may signify the cost in time physicians expend overcoming institutional barriers to EBP for addiction (eg, inefficient workflows and communication and coordination of care across silos). The association of institutional environment with treatment and opioids may reflect the push to increase buprenorphine access despite regulatory impediments and health systems being unprepared for this responsibility.

Strategies to reduce physician reluctance related to institutional environment include greater commitment by health systems to make essential workflow and staffing changes, the breaking down of barriers between addiction services and both medical and mental health care, and commitment by insurers to provide reimbursement that covers the actual cost of providing addiction interventions. The analysis of facilitators supports a specific need for protocols to adequately intervene with patients with either at-risk substance use or substance use disorders. Institutional environment changes (eg, investing in staffing and staff training, implementing standard practices or protocols, and conducting addiction-specific quality assurance) could also facilitate intervention.

Lack of knowledge and skill are top reasons for reluctance, both separately and combined. It is unclear whether survey respondents understood knowledge and skill as the researchers intended because these terms were rarely defined in the studies. Only a few studies allowed for future replication by including objective measures of knowledge or skill (eg, counting successfully delivered services and interviewing patients).

True lack of knowledge and skill can be understood in several ways, including as a manifestation of the volume of information practicing clinicians are required to possess, acquire, and update. For example, physicians need updated information on dosing, pharmacology, and overall efficacy of interventions and medications. This challenge is made harder if interventions (eg, screening practices, initiating pharmacotherapy) are insufficiently adapted for different practice settings. Delivering these interventions effectively, efficiently, and in a nonstigmatizing manner requires skill mastery. Physicians, like other clinicians, acquire their skills by observing and then practicing under supervision. Medical education and postgraduate training have only recently begun to prepare physicians for these tasks.303,304

Ongoing training is critical for physicians to acquire and apply advanced skills in the care of this patient population,305–307 but few opportunities exist to observe and be observed practicing new skills once required medical training is complete. The analysis of facilitators suggests skill training should focus on brief intervention (eg, screening or assessment) and on communication with patients. Trainings accessible to physicians (eg, free or incentivized, hands-on, or delivered in clinical settings) and delivered by specialized trainers and/or mentors would facilitate the growth of a pool of experts to intervene in substance use. Physicians who expand their knowledge and skills should be eligible for continuing medical education credits and increased compensation.

Other reasons for reluctance (eg, negative social influences, negative emotions toward people who use drugs, and fear of harming the relationship with the patient by discussing substance use) could each be viewed as manifestations of stigma associated with substance use disorder and its treatment. Lack of demand may also reflect stigma if it is a manifestation of unwillingness on the part of patients to seek help due to fear of social, legal, and moral judgement or a presumption by the physician that there is no addiction in their community.

These reasons may diminish if effective public and professional education, in particular those developed and led by patient groups or by people who use drugs,308–312 are delivered to counter stigma.313 The analysis of facilitators suggests the following may be helpful: educational materials for patients and families, community outreach, and public health campaigns promoting nonstigmatizing language.

Reducing stigma will not be enough to address fear of harming the patient relationship, especially for physicians who care for minors and other populations that may be subject to punitive consequences of addiction. These physicians must consider additional confidentiality requirements, and their fear of harming the patient by triggering negative social and legal consequences may be more of a deterrent than previously considered. Interpersonal aspects of the patient-physician relationship and how they create reluctance or facilitate intervention are not well understood, although the analysis of facilitators shows that physicians may be motivated to intervene in substance use disorders when they have an established relationship with the patient, the patient is receptive to help, and/or the desire to improve patient outcomes is strong. Future research should examine unintended impacts of increased physician intervention in addiction like strain on the physician-patient relationship, less opportunity to meet other health care needs, and stigmatizing interactions with other health care clinicians due to the substance use disorder diagnosis being more widely documented.

Limitations

This study has limitations. Inconsistent use of terms across included studies increased the complexity and interpretation of this analysis, but analysis of a sample this size can still inform research and policy. Studies were often developed without the benefit of a theoretical framework. Survey development lacked or failed to report participation of the audience of focus and/or was not piloted, raising concerns about the validity and applicability of results. During the years this systematic review covered, new medications and formulations became available, making comparison across decades challenging. The unregulated drug market also evolved, resulting in changes to illicit substances, methods of using them, and the regulatory environment in which clinicians address substance use. This review was limited to physicians, some of whom may have participated in more than 1 survey or focus group in the included studies. Although the results are relevant to the practice environment of many clinicians, including those specializing in addiction, they do not reflect the unique challenges that may be encountered by specific disciplines. Although we collected and described data about facilitators, the original search was not designed specifically to retrieve publications about facilitators of intervention in addiction.

Conclusions

These data suggest that policy, regulatory, or accreditation changes are needed to systematically address institutional barriers, as well as increases to physician reimbursement and opportunities for clinically relevant training that provides both skill development and knowledge gain. Another systematic review of facilitators and reluctance among other clinical disciplines may refine the recommendations presented here. Future studies of clinician reluctance to adopt EBPs for addiction need to be of higher quality. They, at a minimum, should employ a theoretical framework and adhere to survey development best practices or use a validated survey instrument.

Article Information

Accepted for Publication: May 7, 2024.

Published: July 17, 2024. doi:10.1001/jamanetworkopen.2024.20837

Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2821497

Filed under: Addiction,Health,Prevention and Intervention,USA :

Israel, now the largest per capita consumer of opioids, faces a rising crisis. Learn about the challenges, responses from health authorities, and the need for improved treatment and prevention.

By Judy Siegel-Itzkovich
When in 2021, the US Centers for Disease Control and Prevention counted the deaths of over a million Americans from overdosing with opioids – synthetic, painkilling prescription drugs including fentanyl (100 times more powerful than morphine), oxycodone, hydrocodone and many others – Israel’s Health Ministry was asked whether it could happen here. No, its spokesperson said, even though nearly every negative and positive phenomenon in North America inevitably arrives here within a couple of years.

The epidemic began about 25 years ago when drug and healthcare companies began to enthusiastically promote these very-addictive chemicals, claiming they were effective in relieving suffering and did not cause dependency.

A study published this past May by researchers at the Johns Hopkins Bloomberg School of Public Health found that one out of every three Americans have lost someone – a relative or a friend – to an opioid or other drug overdose. The US National Institute on Drug Abuse found that more than 320,000 American children have lost parents from overdoses in the past decade, and the annual financial costs to the US of the opioid crisis is $1 trillion.

Largest consumers of opioids per capita

Incredibly, Israelis today are the largest consumers per capita in the world of opioids, and an untold number of them are addicted or have already died. No one knows the fatality figures here, as the causes of death are described as organ failures, seizures, heart attack or stroke – not listed by what really caused them.

Is this another example of a “misconception” – wishful thinking on the scale of the belief by the government, the IDF, and the security forces that Hamas would “behave” if regularly paid off with suitcases full of cash? Is Israel headed to where the US already is? Perhaps. What is clear is that our various health authorities now have to somehow clean up the opioid mess.

The scandal has been indirectly embarrassing for Israel because among the most notorious companies involved in the opioid disaster is the Sackler family, who own the Purdue Pharma company that manufactured and promoted the powerful and addictive opioid OxyContin and who are now drowning in huge lawsuits. Tel Aviv University’s Medical Faculty that was for decades known as the Sackler Faculty has deleted it from its name.

Last year, the Knesset Health Committee met to discuss the rise in opioid consumption here, with testimony from Ben-Gurion University of the Negev School of Public Health dean and leading epidemiologist Prof. Nadav Davidovitch, who is also the principal researcher and chairman of the Taub Center Health Policy Program. He stressed that inappropriate use of strong pain medications leads to addiction and other severe negative consequences and noted that while most of the rise in consumption is among patients of lower socioeconomic status, the well-off are also hooked. Davidovitch called for the launching of serious programs to treat addicted Israelis based on the experiences of other countries with the crisis.

Opioids attach themselves to opioid-receptor proteins on nerve cells in the brain, gut, spinal cord, and other parts of the body. This obstructs pain messages sent from the body through the spinal cord to the brain. While they can effectively relieve pain, they can be very addictive, especially when they are consumed for more than a few months to ease acute pain, out of habit, or from the patients’ feeling of pleasure (they make some users feel “high”). Patients who suddenly stop taking them can sometimes suffer from insomnia or jittery nerves, so it’s important to taper off before ultimately stopping to take them.

The Health Ministry was forced in 2022 to alter the labels on packaging of opioid drugs to warn about the danger of addiction after the High Court of Justice heard a petition by the Physicians for Human Rights-Israel and the patients’ rights organization Le’altar that claimed the ministry came under pressure from the pharmaceutical companies to oppose this. After ministry documents that showed doctors knew little about the addictions caused by opioids were made public by the petitioners, psychiatrist Dr. Paola Rosca – head of the ministry’s addictions department – told the court that the synthetic painkillers cause addiction. She has not denied the claim that the ministry was squeezed by the drug companies to oppose label changes.

No special prescription, no time limit, no supervision

In an interview with The Jerusalem Post, Prof. Pinhas Dannon – chief psychiatrist of the Herzog Medical Center in Jerusalem and a leading expert on opioid addiction – noted that anyone with a medical degree can prescribe synthetic painkillers to patients. “There is no special prescription, no time limit, no supervision,” he said.

“A person who undergoes surgery who might suffer from serious pain is often automatically given prescriptions for opioids – not just one but several,” Dannon revealed. “Nobody checks afterwards whether the patient took them, handed them over to others (for money or not), whether they took several kinds at once, or whether they stopped taking them. They are also prescribed by family physicians, orthopedists treating chronic back pain, urologists, and other doctors, not only by surgeons.”

Dannon, who runs a hospital clinic that tries to cure opioid addiction, said there are only about three psychiatric hospitals around the country that have small in-house departments to treat severely addicted patients. “Not all those addicted need inpatient treatment, but when we build our new psychiatry center, we would be able to provide such a service.”

Since opioids are relatively cheap and included in the basket of health services, the four public health funds that pay for and supply them have not paid much attention. Once a drug is in the basket, it isn’t removed or questioned. Only now, when threatened by lawsuits over dependency, have the health funds begun to take notice and try to promote reductions in use.

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Dannon declared that the health funds, hospitals, and pharmacies must seriously supervise opioid use by tracking and be required by the ministry to report who is taking them, how much, what ages, and for how long. Opioids are meant for acute pain, not for a long period. “The Health Ministry puts out fires but is faulty in prevention and supervision,” he said.

A Canadian research team has just conducted a study at seven hospital emergency departments in Quebec and Ontario to determine the ideal quantity of prescription opioids to control pain in discharged patients and reduce unused opioids available for misuse.

They recommended that doctors could adapt prescribing quantity to the specific condition causing pain, based on estimates to alleviate pain in 80% of patients for two weeks, with the smallest quantity for kidney or abdominal pain (eight tablets) and the highest for back pain (21 tablets) or fractures (24 tablets), and add an expiry date for them. Since half of participants consumed even smaller quantities, pharmacists could provide half this quantity to further reduce unused opioids available for misuse.

No medical instruction on the issue

Rosca, who was born in Italy where she studied medicine and came on aliyah in 1983, has worked in the ministry since 2000; in 2006, she became head of the addictions department.

“In Italy, every psychiatrist must learn about alcohol and other drug addictions including opioids,” she said. “Here, there is no mandatory course in any medical school on the subject. We tried to persuade the Israel Medical Association and its Scientific Council, which decides on curricula and specializations, but we didn’t succeed. Maybe now, in the face of the crisis, it will change its mind. We run optional courses as continuing medical education for physicians who are interested.”

Her department wanted pharmacists to provide electronic monitoring of opioid purchases, but “the Justice Ministry opposed it on the grounds that it would violate privacy. I wasn’t asked for my opinion.”

She concedes that the ministry lacks statistics on the number of addicted people, and Arabs have been excluded from estimates until now. “We’re doing a study with Jerusalem’s Myers-JDC-Brookdale Institute to find out how many. Some say one percent, some say five percent. We hope that by December, we will get more accurate figures. Before the COVID-19 pandemic, the ministry set up a committee on what to do about opioids, but its recommendations were never published, and there was no campaign,” Rosca recalled.

In 1988, the government established the statutory Anti-Drug Authority that was located in Jerusalem’s Givat Shaul neighborhood. It was active in fighting abuse and shared research with foreign experts, but seven years ago, its name was changed to the National Authority for Community Safety and became part of the Ministry for National Security, losing much of its budgets – and, according to observers, its effectiveness as well.

The Health Ministry used to be responsible for setting up and operating clinics for drug rehabilitation, but it handed this over in 1997 to a non-profit organization called the Israel Public Health Association, which employs numerous former ministry professionals. Its director-general, lawyer Yasmin Nachum, told the Post in an interview that the IPHA is very active in fighting drug addiction.

“Israel can’t deny anymore that we are in a worrisome opioid epidemic like that in the US: We are there,” he said. “We see patients every day. Some used to take heroin and other street drugs, but with the easy access and low price, they have switched to opioids. If they are hospitalized for an operation and don’t use all the prescriptions they are given, they sell them to others. We want to have representation in every hospital to warn doctors and patients.”

Of a staff of 1,100, the IPHA has 170 professionals – narcotics experts, social workers, occupational therapists, and others working with 3,000 addicted patients every day. Its other activities include mental health, ensuring safety of food and water, and rehabilitation.

Stopping after six months

“We work in full cooperation with the ministry,” Nachum said. “Our approach is that when opioids are taken for pain for as long as six months, it’s the time to stop taking them. The doctors provide addicted patients with a drug called buprenorphine, sold under the brand name Subutex, which is used to treat opioid-use disorder, acute pain, and chronic pain.”

Buprenorphine is a mixed opioid agonist and antagonist. That means it has some of the effects of opioids but also blocks some of their effects. Before the patient can take it under direct observation, he must have moderate opioid-withdrawal symptoms. The drug relieves withdrawal symptoms from other opioids and induces some euphoria, but it also blocks the efficacy of many other opioids including heroin, to create an effect.

Buprenorphine levels in the blood stay consistent throughout the month. Nachum said the replacement drug is relatively safe, with some side effects, but fortunately, there is no danger of an overdose.

NARCAN (NALOXDONE) is another prescription drug used by some professionals to fight addiction. Not in Israel’s basket of health services, it blocks the effects of opioids by temporarily reversing them, helping the patient to breathe again and wake up from an overdose. While it has saved countless lives, new and more powerful opioids keep appearing, and first responders are finding it increasingly difficult to revive people with it.

Now, US researchers have found an approach that could extend naloxone’s lifesaving power, even in the face of continually more dangerous opioids by using potential drugs that make naloxone more potent and longer lasting. Naloxone is a lifesaver, but it’s not a miracle drug; it has limitations, the team said.

After the Nova massacre on October 7, when significant numbers of participants who were murdered were high on drugs, the IPHA received a huge number of calls. In December, Nachum decided to open a hotline run by professionals about addiction that has been called monthly by some 300 people. “We also hold lectures for pain doctors, family physicians, and others who are interested, because there has been so little awareness.”

All agree that the opioid crisis has been seriously neglected here and that if it is not dealt with seriously and in joint efforts headed by healthcare authorities, it will snowball and add to Israel’s current physical and psychological damage.

Source: https://www.jpost.com/health-and-wellness/article-811126

Filed under: Addiction,Drug Specifics,Drug use-various effects,Health,Others (International News),Prevalence :

Everyone knows illicit drug use in Australia is worsening, but wouldn’t it be helpful if we had precise numbers for gauging the scale of the problem? How useful it would be if we could measure consumption, perhaps even knowing just how much of each substance was being used in what locations and how patterns were changing.

In fact, we do have those figures, through analysis of wastewater; we’re just not paying enough attention to them. They show our current means of minimising harm from drug use isn’t working. We must look beyond treating it as a mainly law enforcement problem.

The Australian Criminal Intelligence Commission released its 21st National Wastewater Drug Monitoring Program report last month. It found that ‘more than 16.5 tonnes of methylamphetamine, cocaine, heroin and MDMA combined was consumed between August 2022 and August 2023 representing a 17 per cent increase in consumption of these drugs from the previous year’.

Reports from the commission’s National Wastewater Drug Monitoring Program ought to be the most consequential inputs for developing illicit drug policy and law enforcement strategy in Australia. Seven years ago, on the eve of the release of the first report, one of Australia’s most senior law enforcement leaders at the time confided to this writer that the program would show, as it has shown, that our law enforcement strategy was having no impact on the availability of illicit drugs. It would show a failure of policy and strategy, that officer said.

Yet, the reports generally result in several print media reports and quickly fade from public and policymaking attention.

The program is a sophisticated initiative focused on gathering intelligence about drug consumption patterns across Australia. It involves collecting and analysing sewage samples from various places, including cities and regional areas, to detect and monitor the presence of illicit drugs and pharmaceuticals in wastewater. By examining the levels of substances such as methamphetamine, cocaine, MDMA, and opioids, it offers valuable insights into drug use trends, geographical distribution and changes in consumption patterns.

It uses advanced analytical techniques to quantify the concentration of targeted substances. By monitoring drug use at a population level it should help identify emerging drug threats, assess the effectiveness of existing interventions and guide efficient allocation of resources to address public health concerns related to substance abuse.

The latest report reveals several trends in drug consumption. One is continued high use of methamphetamine in many urban and regional areas, indicating ongoing challenges in reducing its availability. Additionally, the program has detected fluctuations in consumption of other drugs, such as cocaine, MDMA, and prescription opioids. Drug use patterns are dynamic.

The findings underscore the importance of targeted interventions and evidence-based strategies to address substance abuse, especially the need for a comprehensive approach that combines law enforcement efforts with public health initiatives.

The program’s findings are not mere statistics; they are revelations that should reverberate through policymaking and public-health administration. Outstanding performance by our law enforcement and border officers, with their record levels of drug seizures and arrests, is clearly having negligible effect on drug availability, use or price.

Some argue that, if not for these efforts, the problem would be worse. It’s a hollow argument. Our enforcement strategy aims not to prevent things from worsening but to improve them. In short, the Wastewater Monitoring Program provides seven years of evidence of the need for a paradigm shift in our approach to illicit drugs.

The data should empower policymakers to sculpt interventions that transcend rhetoric, go beyond traditional law enforcement and embrace a comprehensive strategy where public health, harm reduction and treatment intertwine.

Alternatives to a strictly law enforcement approach to illicit drugs focus on public health, harm reduction and treatment strategies. Drug possession for personal use should be treated as a civil offence or a minor infraction rather than a crime. This approach aims to reduce the negative consequences of drug use, such as incarceration and stigma, while prioritising public health interventions. It was introduced in Canberra in 2024 and has not resulted in an influx of drug tourists or a marked increase in organised crime.

Harm reduction programs, such as needle exchanges, safe injecting rooms, and pill testing, are crucial. These initiatives improve the wellbeing of drug users and reduce the spread of infectious diseases without necessarily focusing on drug prohibition.

Investing in accessible and effective drug treatment and rehabilitation programs is also necessary. These efforts should include counselling, detoxification services, medication-assisted treatment (such as methadone or buprenorphine for opioid use disorder) and mental health support. Emphasising treatment over punishment can help individuals overcome addiction and reintegrate into society.

Prevention efforts should continue to aim at reducing drug-use initiation and promoting healthy behaviour. This includes education campaigns in schools and communities, raising awareness about the risks of drug use and focusing on harm.

These alternatives often complement each other, forming a comprehensive approach that acknowledges the complexity of drug use and addiction while prioritising public health and harm reduction.

Law enforcement still has a place in our national illicit drug strategy. It must continue to focus on reducing the availability of illicit drugs and disrupting organised crime. Its success here should not be assessed based on arrests and seizures but by the Wastewater Monitoring Program’s evidence base.

The Australian government’s approach to illicit drugs is shaped by a complex interplay of factors, including political dynamics, international obligations, evidence-based practices, resource considerations and public perceptions. Any changes to drug strategies are typically considered within this broader context to ensure a comprehensive and sustainable approach to addressing drug-related challenges. However, we must recognize what the evidence shows.

AUTHOR

John Coyne is the head of ASPI’s Northern Australia Strategic Policy Centre and strategic policing and law enforcement program.

Source:  https://www.aspistrategist.org.au/our-drug-policies-arent-working-the-evidence-is-in-wastewater/

Filed under: Australia,Crime/Violence/Prison,Health :

BY DR. JEFFREY LIEBERMAN

Lieberman is The Constance and Stephen Lieber Professor of Psychiatry at Columbia University Vagelos College of Physicians and Surgeons, and President of the ARETE INSTITUTE for Health, Well-Being and Human Potential. He is also the author of SHRINKS: The Untold Story of Psychiatry (Little Brown, 2015) and MALADY OF THE MIND: Schizophrenia and the Path to Prevention (Scribner-Simon and Schuster, 2023)

In a dramatic example of government yielding to public opinion the Senate has introduced legislation to legalize cannabis on the federal level. Though passage before the November election is unlikely, this long overdue legislative action seeks to update a statute stemming [pun intended] from marijuana’s demonized image as depicted in the 1936 documentary film “Reefer Madness” and better reflect public opinion and liberal social trends. Currently, under the Federal Controlled Substances Act (CSA) of 1970, cannabis is considered to have “no accepted medical use” and a high potential for abuse and physical or psychological dependence. This Federal statute contrasts with the claims of therapeutic benefits of cannabis’ biochemical constituents such as cannabidiol and THC (tetra-hydro-cannabinol) when the sole FDA indication for their use is a rare childhood (Lennox-Gasteau) seizure disorder.

While the scientific information to officially endorse cannabis products as having therapeutic benefits is lacking, a recent Pew Research Center Survey found that 88 percent of Americans felt that marijuana should be legal for medical or recreational use. This wave of popular opinion has led to marijuana’s approval in 38 states for medical use, in 24 states for recreational use and decriminalization in an additional seven states.

Americans now have access to a recreational intoxicant that is arguably no more dangerous than alcohol or tobacco without fear of the disproportionately severe punishments previously meted out to those apprehended for possession and use. But at the same time, there are numerous inconsistencies and cross-purposes integral to the legalization and commercialization of cannabis products. The most obvious of these is the fact that Federal law considers the use, sale, and possession of cannabis illegal.

The consequence of the latter was not just that the exaggerated therapeutic claims were not born out by scientific research, but that it served as a “Trojan Horse” to galvanize public opinion and advance cannabis advocates ultimate goal of unfettered access. This came to fruition when the state legislatures of Colorado and Washington voted to legalize the commercial production and sale of cannabis products in 2012. This triggered a stunning demonstration of states’ rights in which a majority of states followed suit by liberalizing their cannabis laws despite Federal prohibitions.

In a glaring recent example of governmental missteps, on March 17, Gov. Kathy Hochul declared New York State’s commercialized cannabis licensing and distribution system “a disaster” and announced “a top-to-bottom review of the NYS Cannabis Control Board and its system for regulating legalized cannabis products.” The main purpose of the review was to process applications faster and enable more cannabis vendors to open. Just weeks before  Hochul’s executive order which was intended to give New Yorkers greater access to cannabis, the American Heart Association had issued a warning on the higher risks of cardiovascular events associated with heavy cannabis use. This was based on a National Institutes of Health (NIH)-funded study of nearly 435,000 American adults reported last November which found that “Daily use of cannabis –– was associated with a 25% increased likelihood of heart attack and a 42% increased likelihood of stroke when compared to non-use of the drug.”

Such health hazards are not some abstract possibility or unconfirmed scientific speculation, but a growing current reality. As a practicing psychiatrist I have witnessed these effects first-hand as a burgeoning number of cannabis-induced medical and mental disturbances—particularly in young people—show up in our hospital emergency rooms and are referred to me for consultation.  And while the rising numbers of adverse effects occurring in the wake of legislative reform are disturbing, they are not surprising. Rather, they were anticipated.

At the start of the movement to liberalize access to cannabis in 2014, Roger Dupont, the founding director of the National Institute of Drug Abuse, and I published an article in the medical journal Science that predicted such adverse effects.“The debates over legalization, decriminalization, and medical uses of marijuana in the United States are missing an essential piece of information: scientific evidence about the effects of marijuana on the adolescent brain,” we wrote. “Much is known about the effects of recreational drugs on the mature adult brain, but there has been no serious investigation of the risks of marijuana use in younger users.”

This was revealed in an NBC News report on states enacting legislation to legalize cannabis in April 2022: “We were not aware when we were voting [in 2012] that we were voting on anything but the plant,” said Dr. Beatriz Carlini, a research scientist at the University of Washington’s Addictions, Drug & Alcohol Institute. She has led the effort in Washington state to research high-potency pot and is now exploring policy options to limit access. Her team concluded in 2020 that “high-potency cannabis can have lifelong mental health consequences.”

So while possible therapeutic value has been the lever, tax revenue for states and profits for new industries—resulting from broad access—has clearly become the goal with unsuspecting users as the potential victims. This is the template now driving rapid legalization of a host of previously prohibited recreational drugs including MDMA (ecstasy) and psychedelics.

Source: https://time.com/6973962/health-hazards-of-legalizing-marijuana/

Filed under: Cannabis/Marijuana,Legal Sector :

By Killian Meara

For National Fentanyl Awareness Day, Drug Topics talked with Scott H. Silverman about how public health leaders can address the fentanyl crisis and the best ways to educate the public on the dangers of fentanyl use.

The opioid epidemic in the United States stretches back to the 1990s, when the synthetic opioid oxycodone hydrochloride was first introduced as a medication to treat moderate to severe pain and chronic pain. Since then, opioid overdose deaths in the country have skyrocketed, with data from the CDC showing there were over 109000 in 2022, with nearly 70% due to synthetic opioids.1

The primary driver behind the rise in synthetic opioid-related overdose deaths is fentanyl. Used to treat complex pain conditions and pain related to surgery, fentanyl is 50 times stronger than heroin and 100 times stronger than morphine.2 That means even a small dose of the synthetic opioid can be potentially lethal for people who have no tolerance.

According to some research, while fentanyl use is now widespread, a majority of users do not intend to use it.This is largely because its introduction into other illicit substances has become pervasive. The synthetic opioid has been found in heroin, cocaine, methamphetamines, opioid analgesics, amphetamines, and benzodiazepines.3 Because of the increased threat of overdose fentanyl poses, it is critical to bring awareness to the drug and to implement harm reduction services to mitigate risk.

National Fentanyl Awareness Day, held annually on May 7, aims to educate the public about the dangers of fentanyl use. This year, Drug Topics talked with Scott H. Silverman, a crisis coach, behavioral health consultant, and team lead for the substance abuse recovery program Confidential Recovery, about how public health leaders can address the fentanyl crisis, challenges in accessing treatment and support, and the best ways to educate the public on the dangers of fentanyl use.

Drug Topics: What do you believe are the most important priorities for policymakers, healthcare providers, and community leaders to address in the fentanyl crisis?

Scott H. Silverman:The most important priority for the fentanyl crisis is to make it as important as the COVID-19 pandemic. If we don’t, the morbidity rate will continue to grow and the fentanyl distributors will see that the US doesn’t really care, so they will continue to target us.

Real-time data is crucial to make changes. For example, the medical examiners should be communicating on a national level to share what percentage of the overdoses are solely from fentanyl or fentanyl-laced drugs. We need real-time demographics because we can’t wait 18 months to find out the statistics and what happened in 2022. We must find out as quickly as possible to address this crisis head-on. It must be made a priority by federal, state and local governments, because they are the only ones that can help put a stop to this. Overall, data-driven information in a time-sensitive manner is going to be critical.

Drug Topics: From your perspective, what are the most pressing challenges in accessing effective treatment and support services for individuals struggling with opioid addiction?

Silverman: I don’t believe the insurance industry understands what they’ve got in front of them. It’s a benefit-driven industry, and the industry needs to take a good look at themselves and figure out how they are going to really help people. We’ve seen the current President reduce the cost of pharmaceuticals and pharmaceutical companies are still doing fine, so they know how to create systemic change, but it needs to become a priority.

Drug Topics: How can communities, organizations, and individuals work together to prevent opioid-related overdoses and deaths?

Silverman: Education and prevention. Right now, the big conversation is around [naloxone (Narcan)], the drug that reverses overdoses. The issue is we are giving a lot of people that drug after they overdose, but how do we work hard to educate and incentivize people who are making a conscious decision to not put something in their body? That’s going to require a ton of education and a ton of prevention, which social media could really help make the change that’s needed for young people specifically. Kids are getting iPhones and iPads now in the single-digit ages, so why not make social media a learning opportunity to educate and save lives?

Drug Topics: What do you think are the most effective ways to educate the public about the dangers of fentanyl misuse?

Silverman: Common sense messaging is the most effective way to educate the public. Using simple messages like, “one pill can kill,” can really make a difference. The DEA came up with that phrase knowing that it’s a poison and the people that make it don’t care if their consumer dies. The government is trying to tell people about this issue, but the real question for consumers is,“Are you listening and are you seeking the knowledge?” So, how do we incentivize and find creative ways to reach them? This commonsense messaging doesn’t need to be wrapped into your dinner napkin every night, but it should be a part of the discussion every week with the family. The education aspect really comes with family discussion.

Drug Topics: Looking ahead, what do you hope to see in terms of progress and awareness surrounding fentanyl misuse and overdose prevention?

Silverman: I hope the morbidity rate declines. I would love to stop going to funerals and we shouldn’t say, “That’s sad, but it’s somebody else’s kid.” The data shows that 42% of adults in the country know somebody or know of somebody who died of an overdose. There’s no other disease that has that high of a morbidity rate that people know about. If it’s that high of a morbidity rate, why aren’t we doing more? Whatever that’s defined as and putting more strength at the border, although we have multiple borders, you can ship these drugs over in a parachute, float it in with a drone, bring it in through the mail and you can even make it now. There’s a lot of money around it too, a lot of young people are buying these materials on the dark web and making it themselves.

Source:  https://www.drugtopics.com/view/fentanyl-education-prevention-key-to-ending-crisis-in-us

Filed under: Education Sector,Fentanyl,Prevention and Intervention,USA :

The web-based and social media campaigns aim to educate youth, families and adults about the dangers of fentanyl and risk of overdose deaths and addiction

BY:  – MAY 7, 2024 4:02 PM
A national nonprofit organization released a new program on Tuesday to help families navigate the hazards of fentanyl and prevent deaths of young people as Oregon continues to battle the lethal drug epidemic.

Song for Charlie, a nonprofit focused on raising awareness about fake fentanyl pills, launched The New Drug Talk Oregon, an educational web-based platform with free information about the risks of fentanyl and the dangers of self-medication and experimentation. The program also gives families guidance on how to discuss the drug, which is highly lethal and commonly found in counterfeit prescription drugs and sold illegally.

The campaign was one of several in Oregon to start on Tuesday and coincides with National Fentanyl Awareness Day. The Oregon Health Authority launched a five-week campaign to educate Oregonians about fentanyl risks, harm reduction strategies like fentanyl test strips and how to respond to an overdose. The state’s campaign will unfold on the health authority’s English and Spanish-language Facebook accounts.

Multnomah County also launched a fentanyl awareness campaign, called Expect Fentanyl, targeting Portland-area youth.

More information

For more information about the educational program for families, visit thenewdrugtalk.org/oregon.

Visit the Oregon Health Authority site for a list of syringe and needle exchange services available in Oregon.

More than 300 young Oregonians 15 to 24 years old have died of drug overdoses in the last five years, many of them from fentanyl, according to Centers for Disease Control and Prevention data. The rate of teen drug-related deaths has increased in the state nearly sixfold, and Oregon now has the fifth-worst per capita rate of drug deaths among teenagers, according to CDC data compiled by Song for Charlie.

Meanwhile, a survey of Oregon parents and youth commissioned by Song for Charlie found persistent gaps in how families are responding to the crisis. Nearly three-quarters of Oregon parents said they talked to their children about the dangers of prescription pills laced with fentanyl. But only about 40% of young people said they remember having this conversation.

And just three in five Oregon youth – teenagers and young adults – consider the misuse of prescription pills a serious issue. The survey, completed in the spring, is based on interviews of more than 1,300 teenagers, young adults and parents in Oregon, and has a margin of error of 4 to 5.65 percentage points.

‘Ongoing conversations’

The New Drug Talk Oregon program was backed by a $1 million grant from Trillium Community Health Plan, a Medicaid insurer for about 90,000 people on the Oregon Health Plan in the Portland area and Lane County. That funding means the Song for Charlie’s program is available to Oregonians at no cost.

A Washington County resident, Jennifer Epstein, director of strategic programs for Song for Charlie, is involved with the program. She became an advocate to increase awareness and education about fentanyl after her 18-year-old son Cal died in 2020 after he ingested a counterfeit pill with fentanyl.

“What we want to do is encourage parents to have ongoing conversations with young people,” Epstein said in an interview.

The program’s site has articles and videos that guide parents through talking to their children about fentanyl, staying safe on social media or the death of someone from an overdose.

Epstein said if the resource had been available before her son died, it could have saved his life.

“I certainly think that this could have changed what happened to our family if we had been able to have conversations about fentanyl and the risks it poses and the danger of self-medicating,” Epstein said.

Source:  https://oregoncapitalchronicle.com/2024/05/07/fentanyl-awareness-campaigns-kick-off-in-oregon-amid-an-overdose-epidemic/

Filed under: Drug use-various effects,Education,Fentanyl,USA :

Federal study shows lives lost from overdose crisis are felt across generations, emphasizing need to include children and families in support

May 8, 2024

An estimated 321,566 children in the United States lost a parent to drug overdose from 2011 to 2021, according to a study published in JAMA Psychiatry. The rate of children who experienced this loss more than doubled during this period, from approximately 27 to 63 children per 100,000. The highest number of affected children were those with non-Hispanic white parents, but communities of color and tribal communities were disproportionately affected. The study was a collaborative effort led by researchers at the National Institutes of Health’s (NIH) National Institute on Drug Abuse (NIDA), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Centers for Disease Control and Prevention (CDC).

Children with non-Hispanic American Indian/Alaska Native parents consistently experienced the highest rate of loss of a parent from overdose from 2011 to 2021 – with 187 per 100,000 children affected in this group in 2021, more than double the rate among non-Hispanic white children (76.5 per 100,000) and among non-Hispanic Black children (73 per 100,000). While the number of affected children increased from 2011 to 2021 across all racial and ethnic populations, children with young non-Hispanic Black parents (18 to 25 years old) experienced the highest – roughly 24% – increase in rate of loss every year. Overall, children lost more fathers than mothers (192,459 compared to 129,107 children) during this period.

“It is devastating to see that almost half of the people who died of a drug overdose had a child. No family should lose their loved one to an overdose, and each of these deaths represents a tragic loss that could have been prevented,” said Nora Volkow, M.D., NIDA director. “These findings emphasize the need to better support parents in accessing prevention, treatment, and recovery services. In addition, any child who loses a parent to overdose must receive the care and support they need to navigate this painful and traumatic experience.”

From 2011 to 2021, 649,599 people aged 18 to 64 died from a drug overdose. Despite these tragic numbers, no national study had previously estimated the number of children who lost a parent among these deaths. To address this gap, researchers used data about people aged 18 to 64 participating in the 2010 to 2019 National Surveys on Drug Use and Health (NSDUH) to determine the number of children younger than 18 years living with a parent 18 to 64 years old with past-year drug use. NSDUH defines a parent as biological parent, adoptive parent, stepparent, or adult guardian.

The researchers then used these data to estimate the number of children of the nearly 650,000 people who died of an overdose in 2011 to 2021 based on the national mortality data from the CDC National Vital Statistics System. The data were examined by age group (18 to 25, 26 to 40, and 41 to 64 years old), sex, and self-reported race and ethnicity.

The researchers found that among the estimated 321,566 American children who lost a parent to overdose from 2011 to 2021, the highest numbers of deaths were among parents aged 26 to 40 (175,355 children) and among non-Hispanic white parents (234,164). The next highest numbers were children with Hispanic parents (40,062) and children with non-Hispanic Black parents (35,743), who also experienced the highest rate of loss and highest year-to-year rate increase, respectively. The racial and ethnic disparities seen here are consistent with overall increases in overdose deaths among non-Hispanic American Indian/Alaska Native and Black Americans in recent years, and highlight disproportionate impacts of the overdose crisis on minority communities.

“This first-of-its-kind study allows us to better understand the tragic magnitude of the overdose crisis and the reverberations it has among children and families,” said Miriam E. Delphin-Rittmon, Ph.D., HHS Assistant Secretary for Mental Health and Substance Use and the leader of SAMHSA. “These data illustrate that not only are communities of color experiencing overdose death disparities, but also underscore the need for responses to the overdose crisis moving forward to comprehensively address the needs of individuals, families and communities.”

Based on their findings, the researchers emphasize the importance of whole-person health care that treats a person with substance use disorder as a parent or family member first and foremost, and provides prevention resources accordingly to support families and break generational cycles of substance use. The study also points to the need to incorporate culturally-informed approaches in prevention, treatment, recovery, and harm reduction services, and to dismantle racial and ethnic inequities in access to these services.

“Children who lose a parent to overdose not only feel personal grief but also may experience ripple effects, such as further family instability,” said Allison Arwady, M.D., M.P.H., director of CDC’s National Center for Injury Prevention and Control. “We need to ensure that families have the resources and support to prevent an overdose from happening in the first place and manage such a traumatic event.”

Reference:

About the National Institute on Drug Abuse (NIDA): NIDA is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world’s research on the health aspects of drug use and addiction. The Institute carries out a large variety of programs to inform policy, improve practice, and advance addiction science. For more information about NIDA and its programs, visit www.nida.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

About substance use disorders: Substance use disorders are chronic, treatable conditions from which people can recover. In 2022, nearly 49 million people in the United States had at least one substance use disorder. Substance use disorders are defined in part by continued use of substances despite negative consequences. They are also relapsing conditions, in which periods of abstinence (not using substances) can be followed by a return to use. Stigma can make individuals with substance use disorders less likely to seek treatment. Using preferred language can help accurately report on substance use and addiction. View NIDA’s online guide.

Source: www.nih.gov.  NIH…Turning Discovery Into Health®

Filed under: Drug use-various effects,Parents,USA :

May 09, 2024

WASHINGTON – Today, DEA Administrator Anne Milgram announced the release of the 2024 National Drug Threat Assessment (NDTA), DEA’s comprehensive strategic assessment of illicit drug threats and trafficking trends endangering the United States.

 

For more than a decade, DEA’s NDTA has been a trusted resource for law enforcement agencies, policy makers, and prevention and treatment specialists and has been integral in informing policies and laws. It also serves as a critical tool to inform and educate the public.

 

DEA’s top priority is reducing the supply of deadly drugs in our country and defeating the two cartels responsible for the vast majority of drug trafficking in the United States. The drug poisoning crisis remains a public safety, public health, and national security issue, which requires a new approach.

 

“The shift from plant-based drugs, like heroin and cocaine, to synthetic, chemical-based drugs, like fentanyl and methamphetamine, has resulted in the most dangerous and deadly drug crisis the United States has ever faced,” said DEA Administrator Anne Milgram. “At the heart of the synthetic drug crisis are the Sinaloa and Jalisco cartels and their associates, who DEA is tracking world-wide. The suppliers, manufacturers, distributors, and money launderers all play a role in the web of deliberate and calculated treachery orchestrated by these cartels. DEA will continue to use all available resources to target these networks and save American lives.”

Drug-related deaths claimed 107,941 American lives in 2022, according to the Centers for Disease Control and Prevention (CDC). Fentanyl and other synthetic opioids are responsible for approximately 70% of lives lost, while methamphetamine and other synthetic stimulants are responsible for approximately 30% of deaths.

 

Fentanyl is the nation’s greatest and most urgent drug threat. Two milligrams (mg) of fentanyl is considered a potentially fatal dose. Pills tested in DEA laboratories average 2.4 mg of fentanyl, but have ranged from 0.2 mg to as high as 9 mg. The advent of fentanyl mixtures to include other synthetic opioids, such as nitazenes, or the veterinary sedative xylazine have increased the harms associated with fentanyl.

Seizures of fentanyl, in both powder and pill form, are at record levels. Over the past two years seizures of fentanyl powder nearly doubled. DEA seized 13,176 kilograms (29,048 pounds) in 2023. Meanwhile, the more than 79 million fentanyl pills seized by DEA in 2023 is almost triple what was seized in 2021. Last year, 30% of the fentanyl powder seized by DEA contained xylazine. That is up from 25% in 2022.

 

Social media platforms and encrypted apps extend the cartels’ reach into every community in the United States and across nearly 50 countries worldwide. Drug traffickers and their associates use technology to advertise and sell their products, collect payment, recruit and train couriers, and deliver drugs to customers without having to meet face-to-face. This new age of digital drug dealing has pushed the peddling of drugs off the streets of America and into our pockets and purses.

 

The cartels have built mutually profitable partnerships with China-based precursor chemical companies to obtain the necessary ingredients to manufacturer synthetic drugs. They also work in partnership with Chinese money laundering organizations to launder drug proceeds and are increasingly using cryptocurrency.

 

Nearly all the methamphetamines sold in the United States today is manufactured in Mexico, and it is purer and more potent than in years past. The shift to Mexican-manufactured methamphetamine is evidenced by the dramatic decline in domestic clandestine lab seizures. In 2023, DEA’s El Paso Intelligence Center (EPIC) documented 60 domestic methamphetamine clandestine lab seizures, which is a stark comparison to 2004 when 23,700 clandestine methamphetamine labs were seized in the United States.

 

DEA’s NDTA gathers information from many data sources, such as drug investigations and seizures, drug purity, laboratory analysis, and information on transnational and domestic criminal groups.

Click here to read the DEA’s Threat Assessment report

Source: https://www.dea.gov/press-releases/2024/05/09/dea-releases-2024-national-drug-threat-assessment

Filed under: Drug Specifics,Drug use-various effects,Environment,Prevalence,USA :

Young people who smoked marijuana in the 1960s were seen as part of the counterculture. Now the cannabis culture is mainstream. A 2022 survey sponsored by the National Institutes of Health found that 28.8% of Americans age 19 to 30 had used marijuana in the preceding 30 days—more than three times as many as smoked cigarettes. Among those 35 to 50, 17.3% had used weed in the previous month, versus 12.2% for cigarettes.

While marijuana use remains a federal crime, 24 states have legalized it and another 14 permit it for medical purposes. Last week media outlets reported that the Biden administration is moving to reclassify marijuana as a less dangerous Schedule III drug—on par with anabolic steroids and Tylenol with codeine—which would provide tax benefits and a financial boon to the pot industry.

Bertha Madras thinks this would be a colossal mistake. Ms. Madras, 81, is a psychobiology professor at Harvard Medical School and one of the foremost experts on marijuana. “It’s a political decision, not a scientific one,” she says. “And it’s a tragic one.” In 2024, that is a countercultural view.

Ms. Madras has spent 60 years studying drugs, starting with LSD when she was a graduate student at Allan Memorial Institute of Psychiatry, an affiliate of Montreal’s McGill University, in the 1960s. “I was interested in psychoactive drugs because I thought they could not only give us some insight into how the brain works, but also on how the brain undergoes dysfunction and disease states,” she says.

In 2015 the World Health Organization asked her to do a detailed review of cannabis and its medical uses. The 41-page report documented scant evidence of marijuana’s medicinal benefits and reams of research on its harms, from cognitive impairment and psychosis to car accidents.

She continued to study marijuana, including at the addiction neurobiology lab she directs at Mass General Brigham McLean Hospital. In a phone interview this week, she walked me through the scientific literature on marijuana, which runs counter to much of what Americans hear in the media.

For starters, she says, the “addiction potential of marijuana is as high or higher than some other drug,” especially for young people. About 30% of those who use cannabis have some degree of a use disorder. By comparison, only 13.5% of drinkers are estimated to be dependent on alcohol. Sure, alcohol can also cause harm if consumed in excess. But Ms. Madras sees several other distinctions.

One or two drinks will cause only mild inebriation, while “most people who use marijuana are using it to become intoxicated and to get high.” Academic outcomes and college completion rates for young people are much worse for those who use marijuana than for those who drink, though there’s a caveat: “It’s still a chicken and egg whether or not these kids are more susceptible to the effects of marijuana or they’re using marijuana for self-medication or what have you.”

Marijuana and alcohol both interfere with driving, but with the former there are no medical “cutoff points” to determine whether it’s safe to get behind the wheel. As a result, prohibitions against driving under the influence are less likely to be enforced for people who are high. States where marijuana is legal have seen increases in car accidents.

One of the biggest differences between the two substances is how the body metabolizes them. A drink will clear your system within a couple of hours. “You may wake up after binge drinking in the morning with a headache, but the alcohol is gone.” By contrast, “marijuana just sits there and sits there and promotes brain adaptation.”

That’s worse than it sounds. “We always think of the brain as gray matter,” Ms. Madras says. “But the brain uses fat to insulate its electrical activity, so it has a massive amount of fat called white matter, which is fatty. And that’s where marijuana gets soaked up. . . . My lab showed unequivocally that blood levels and brain levels don’t correspond at all—that brain levels are much higher than blood levels. They’re two to three times higher, and they persist once blood levels go way down.” Even if people quit using pot, “it can persist in their brain for a while.”

Thus marijuana does more lasting damage to the brain than alcohol, especially at the high potencies being consumed today. Levels of THC—the main psychoactive ingredient in pot—are four or more times as high as they were 30 years ago. That heightens the risks, which range from anxiety and depression to impaired memory and cannabis hyperemesis syndrome—cycles of severe vomiting caused by long-term use.

There’s mounting evidence that cannabis can cause schizophrenia. A large-scale study last year that examined health histories of some 6.9 million Danes between 1972 and 2021 estimated that up to 30% of young men’s schizophrenia diagnoses could have been prevented had they not become dependent on pot. Marijuana is worse in this regard than many drugs usually perceived as more dangerous. “Users of other potent recreational drugs develop chronic psychosis at much lower rates,” Ms. Madras says. When healthy volunteers in research experiments are given THC—as has been done in 15 studies—they develop transient symptoms of psychosis. “And if you treat them with an antipsychotic drug such as haloperidol, those symptoms will go away.”

Marijuana has also been associated with violent behavior, including in a study published this week in the International Journal of Drug Policy. Data from observational studies are inadequate to demonstrate causal relationships, but Ms. Madras says that the link between marijuana and schizophrenia fits all six criteria that scientists use to determine causality, including the strength of the association and its consistency.

Ms. Madras says at the beginning of the interview that she was operating on three hours of sleep after crashing on scientific projects. Yet she is impressively lucid and energized. She peppers her explanations with citations of studies and is generous in crediting other researchers’ work.

Another cause for concern, she notes, is that more pregnant women are using pot, which has been linked to increased preterm deliveries, admissions of newborns into neonatal intensive care units, lower birth weights and smaller head circumferences. THC crosses the placenta and mimics molecules that our bodies naturally produce that regulate brain development.

“What happens when you examine kids who have been exposed during that critical period?” Ms. Madras asks. During adolescence, she answers, they show an increased incidence of aggressive behavior, cognitive dysfunction, and symptoms of ADHD and obsessive-compulsive disorders. They have reduced white and gray matter.

A drug that carries so many serious side effects would be required by the Food and Drug Administration to carry a black-box warning, the highest-level alert for drugs with severe safety risks. Marijuana doesn’t—but only because the FDA hasn’t cleared it.

The agency has selectively approved cannabis compounds for the treatment of seizures associated with Lennox-Gastaut or Dravet syndrome, nausea associated with chemotherapy for cancer, and anorexia associated with weight loss in AIDS patients. But these approved products are prescribed at significantly less potent doses than the pot being sold in dispensaries that are legal under state law.

What about medicinal benefits? Ms. Madras says she has reviewed “every single case of therapeutic indication for marijuana—and there are over 100 now that people have claimed—and I frankly found that the only one that came close to having some evidence from randomized controlled trials was the neuropathic pain studies.” That’s “a very specific type of pain, which involves damage to nerve endings like in diabetes or where there’s poor blood supply,” she explains.

For other types of pain, and for all other conditions, there is no strong evidence from high-quality randomized trials to support its use. When researchers did a “challenge test on normal people where they induce pain and tried to see whether or not marijuana reduces the pain, it was ineffective.”

Ms. Madras sees parallels between the marketing of pot now and of opioids a few decades ago. “The benefits have been exaggerated, the risks have been minimized, and skeptics in the scientific community have been ignored,” she says. “The playbook is always to say it’s safe and effective and nonaddictive in people.”

Advocates of legalization assert that cannabis can’t be properly studied unless the federal government removes it from Schedule I. Bunk, Ms. Madras says: “I have been able to study THC in my research program.” It requires more paperwork, but “I did all the paperwork. . . . It’s not too difficult.”

Instead of bankrolling ballot initiatives to legalize pot, she says, George Soros and other wealthy donors who “catalyzed this whole movement” should be funding rigorous research: “If these folks, these billionaires, had just taken that money and put it into clinical trials, I would have been at peace.”

It’s a travesty, Ms. Madras adds, that the “FDA has decided that they’re going to listen to that movement rather than to what the science says.” While the reclassification wouldn’t make recreational marijuana legal under federal law, dispensaries and growers would be able to deduct their business expenses on their taxes. The rescheduling would also send a cultural signal that marijuana use is normal.

Ms. Madras worries that “it sets a precedent for the future.” She points to the movement in states to legalize psychedelic substances, for whose medicinal benefits there also isn’t strong scientific evidence. Meantime, she says it makes no sense that politicians continuously urge more spending on addiction treatment and harm reduction while weakening laws that prevent people from becoming addicted in the first place.

Her rejoinder to critics who say the war on drugs was a failure? “This is not a war on drugs. It’s a defense of the human brain at every possible age from in utero to old age.”

Source:  https://www.wsj.com/articles/what-you-arent-reading-about-marijuana-permanent-brain-damage-biden-schedule-iii-9660395e

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

First, the good news: According to the U.S. Centers for Disease Control and Prevention, the number of fatal overdoses in the U.S. decreased last year — down 3% from 2022.

Now, the not so great news: That’s still 107,500 people who died at the hands of a decades-long substance abuse epidemic; and those same CDC researchers say the last time there was such a decrease, the number of fatal overdoses increased dramatically in the following year.

Further, Brandon Marshall, a Brown University researcher who studies overdose trends, offered some less-than-comforting reasons for the decrease that have little to do with winning the fight against this monster.

Shifts in the drug supply and use habits (smoking or mixing with other drugs rather than injecting, for example) could be one reason for the change. Another is simply that the epidemic has killed so many people already there are fewer to die.

That doesn’t mean prevention and recovery support efforts are not vital. And it does not mean there is any less need to support the families of those who have lost loved ones to this plague.

The Journal of the American Medical Association — Psychiatry, reported earlier this month that more than 321,000 U.S. children lost a parent to fatal drug overdose from 2011 to 2021.

“These children need support,” and are at a higher risk of mental health and drug use disorders themselves, said Dr. Nora Volkow, director of the National Institute on Drug Abuse. “It’s not just a loss of a person. It’s also the implications that loss has for the family left behind.”

Meanwhile, the fact that so many experts are reluctant to be optimistic about a small decrease could mean they understand something continues to fuel this epidemic. Yes, there is as much supply as demanded. That is one part of the problem. But the other is understanding what drives so many into the arms of this beast. How do we provide people the economic, mental health and social hope and support to break cycles? How do we encourage them to embrace a bright future, rather than being unable to see past a bleak present they can hardly bear?

“My hope is 2023 is the beginning of a turning point,” said Dr. Daniel Ciccarone of the University of California, San Francisco.

Imagine the possibilities if we all took a comprehensive, informed, compassionate approach to actually making that happen.

Source: https://www.journal-news.net/journal-news/imagine-the-possibilities/article_330d84dc-7bbb-557f-ab5d-2eff8bd12fc5.html

Filed under: Drug Specifics,Drug use-various effects,Social Affairs,USA :

Forbes Staff : Ty Roush is a breaking news reporter based in New York City.

May 22, 2024,10:18am EDT

Teens who use cannabis have a significantly higher risk of developing a psychotic disorder compared to those who don’t, according to a study published in the journal Psychological Medicine Wednesday, the latest research linking the drug to mental health disorders among young adults.

Other research has linked the drug to mental health disorders in young adults.

KEY FACTS

Teens aged 12 to 19 who used cannabis had an 11 times higher risk of developing a psychotic disorder compared to teens not using cannabis, according to an analysis of health data for 11,000 teens and young adults aged 12 to 24.

The study did not find an association between cannabis use and psychotic disorders in people aged 20 to 33.

The data—pulled from the annual Canadian Community Health Survey from 2009 to 2012—looked into hospitalizations, emergency room visits and outpatient visits, and researchers followed up with the participants for additional visits to the doctor, the emergency room or other hospitalizations in the nine years after the survey.

Among the teens who visited the emergency room or were hospitalized for psychotic disorders, about 5 in 6 reported using cannabis previously, researchers said.

Teens who use cannabis might be at a higher risk of developing psychotic disorders because the drug disrupts the endocannabinoid system, which helps regulate bodily functions like sleep or mood, resulting in symptoms like hallucinations, according to the study.

Though there is a strong yet age-dependent association between cannabis use and psychotic disorders, researchers noted it’s hard to say whether there is a direct link, as it’s possible the teens were self-medicating with cannabis to treat symptoms of psychotic disorders before they were clinically diagnosed.

Get Forbes Breaking News Text Alerts: We’re launching text message alerts so you’ll always know the biggest stories shaping the day’s headlines. Text “Alerts” to (201) 335-0739 or sign up here.

BIG NUMBER

29%. That’s the percentage of high school seniors in the U.S. who reported using cannabis over the previous year, according to the annual Monitoring the Future Survey in 2023, which reports drug and alcohol use among adolescent students.

KEY BACKGROUND

Other studies in recent years have linked psychotic disorders in young adults to cannabis. In a study published last year, researchers found young men who used cannabis have an increased risk of developing schizophrenia compared to young women. A year earlier, researchers found there was “considerable evidence” linking cannabis use and depression among adolescents. The study also suggested the link was caused by a disruption of the endocannabinoid system. In 2018, researchers called for additional drug prevention programs targeting cannabis use in teens, after data indicated cannabis use could result in increased anxiety.

TANGENT

Last week, the Justice Department moved to reclassify marijuana—listed as a Schedule I drug like heroin, LSD and ecstasy—as a Schedule III drug under the federal Controlled Substances Act. The designation, if approved, recognizes marijuana as having potential medical benefits, which could allow for future studies on the drug’s potential benefits. The proposal still requires approval from the Drug Enforcement Administration.

 

Source:  https://www.forbes.com/sites/tylerroush/2024/05/22/teens-using-cannabis-are-at-higher-risk-of-psychosis-study-suggests/

Filed under: Cannabis/Marijuana,Mental Health,USA,Youth :
A new national state scorecard confirms dramatic inequities, finds regional variations
NICK BUDNICK

|THE LUND REPORT PREMIUM

APRIL 23, 2024

Racial disparities are vast across the nation and in Oregon, a new report shows. But the statistics reveal some surprising differences among states.

In some statistics that measure outcomes for different racial and ethnic groups, Oregon, like Washington, does better than most states. In other measures, it does worse.

For the first time in three years, The Commonwealth Fund, a nonprofit health care research and advocacy group, has issued its state-by-state measurements of health care disparities. The report compiled data on 25 health care measures tracking outcomes, quality, access and use of services by five different racial and ethnic groups — Black, white, Hispanic, American Indian and Alaska Native, as well as Asian American, Native Hawaiian and Pacific Islander. Researchers then aggregated them to create what amounts to a scorecard.

The report is called Advancing Racial Equity in U.S. Health Care: The Commonwealth Fund 2024 State Health Disparities Report. Its findings are similar to earlier research from 2021 that found the performance of Oregon’s health system as experienced by different groups tended to be better in some measures than most states.

But there are still major problems, according to David Radley, the longtime leader of The Commonwealth Fund’s scorecard project. Two years ago he joined the Center for Evidence-Based Policy at Oregon Health & Science University as its director of data and analytics.

“There are still big disparities” in Oregon, he said. “There’s still a lot of improvements to be made.”

For instance? For Black people in Oregon, the rate of deaths before age 75 for causes that are treatable through health care is 141 per 100,000. For white people, however, the rate is slightly less than half that: 69 per 100,000.

Meanwhile, the proportion of people who reported skipping needed health care due to cost was 7% for white people, but double that or more for people who are Black, Hispanic or American Indian and Alaska Native.

The statistics are more complex than they seem on the surface, according to Radley. In effect, they measure not just the provision of health care but the effects of social factors that contribute to health outcomes, such as access to healthy food and stable housing. Other reports, by The Commonwealth Fund as well as the Coalition of Communities of Color in Oregon, have focused on issues like structural racism.

Asked about the study, state Rep. Ricki Ruiz, a Gresham Democrat, said he thinks improvements need to be a priority in access to primary care, affordability and interpreter services. With parents that moved to the United States from Mexico, he served as the family interpreter with health care providers starting when he was six years old — and not exactly fluent in health care terms.

 “As a first-generation citizen, one of the things we always struggled to navigate was the health care system,” he said. “Disparities still exist. And that is something that is alarming. That is something we need to continue to study—  to be able to minimize that as much as we can.”

State measures show ranking

The report provides a state-by-state overview of statistics and their rankings among states (and Washington, D.C.) where sufficient data was available in all categories for that group.

It found that Oregon and Washington score similarly to one another when it comes to measures broken down by race and ethnicity. And they do better than most other states.

For people who are Asian American, Native Hawaiian, and Pacific Islander:

  • In health outcomes, Washington ranked 13th and Oregon 19th. among 33 states.
  • In health care access, Washington ranked 5th and Oregon 7th among 34 states.
  • In health care quality, Washington ranked 15th and Oregon 16th among 41 states.

For people who are American Indian and Alaska Native:

  • In health outcomes, Washington ranked 4th among 10 states while Oregon data was insufficient.
  • In health care access, Washington ranked 3rd among 11 states while Oregon data was insufficient.
  • In health care quality in 11 states, Washington ranked 8th among 11 states while Oregon data was insufficient.

For people who are Black:

  • In health outcomes, Washington ranked 4th and Oregon 9th among 40 states..
  • In health care access, Washington ranked 19th and Oregon 22nd  among 40 states.
  • In health care quality, Oregon ranked 11th and Washington 28th among 41 states.

For people who are Hispanic:

  • In health outcomes, Oregon ranked 3rd and Washington 9th  among 49 states. .
  • In health care access, Washington ranked 18th and Oregon 22nd among 48  states.
  • In health care quality, Oregon ranked 10th and Washington 21st among 48  states.

For people who are White:

  • In health outcomes, Washington ranked 12th and Oregon 21st among 50 states plus Washington, D.C.
  • In health care access, Washington ranked 15th and Oregon 26th among 50 states plus Washington, D.C.
  • In health care quality, Washington ranked 14th and Oregon 24th among 50 states plus Washington, D.C.

According to Radley, the findings for Oregon call for making health care more affordable, while also focusing on strengthening the state’s provision of primary care.

That includes ensuring access to care with community health workers and providers that speak the same language as the patient.

“That’s one of the best tools we have to fight these kinds of disparities,” he said.

Source:  https://www.thelundreport.org/content/oregon-performs-better-health-equity-disparities-remain?

Filed under: Health,Social Affairs,USA :

April 24, 2024

The Australian community deserve a clear picture of all persons whose Mental Health has come to the attention of the police, hospitals and the community.

When cannabis genotoxicity effects are added to cannabis neurotoxicity effects the argument against the widespread use of cannabis for everything becomes very robust indeed.

The drug prevention taskforce outlines below our real concerns regarding the Stabbing rampage at Sydney.  It does appear that here in Australia our State and Federal Medical Department has been testing toxic factors using blood and not using the much better hair test.

Most of the cannabis (80-90%) is excreted within 5 days as hydroxylated and carboxylated metabolites. See attached (Chemistry and Toxicology of cannabis).

Because 90% of THC is gone in 80 minutes from blood. Please demand hair testing of the subject for marijuana use (blood test may not be positive due to rapid clearance).  This is very indicative of cannabis induced psychosis most of the cannabis (80-90%) is excreted within 5 days as hydroxylated and carboxylated metabolites . There are eighteen acidic metabolites as per Goulle JP, Saussereau E, Lacroix C. [Delta-9-tetrahydrocannabinol pharmacokinetics]. Ann Pharm Fr 2008; 66: 232-244. Studies attached.

Drug Free Australia is seeking to bring urgent attention to Australian whether Federal or State, regarding extremely important research relating to Mental Health and cannabis use.  It appears that Australian public policies have moved from concern for the health and wellbeing of society – by improving and promoting good health – to pushing unnecessary drug use for profiteers while charging the tab to society-at-large.  DFA believes that it is time for governments worldwide to promote research and media publicity which avoids the cherry-picked faux studies used by those wanting to legalise cannabis.  Rather, the focus should be on its serious harms to mental and physical health particularly related to early use.

TOP 15 RISKS OF MARIJUANA ON HEALTH   https://iasic1.org. The Drug Free Australian paper (MENTAL HEALTH AND CANNABIS USE) see attached.  (A Panel Study of the Effect of Cannabis Use on Mental Health, Depression and Suicide in the 50 States)see attached.

 EXCLUSIVE: Regular cannabis use in people’s mid-20s can cause permanent damage to the brain development and legalizing the drug has WRONGLY presented it as harmless, drug safety expert Dr Nora Volkow, director of the National Institute on Drug Abuse, warned cannabis use among young adults was a ‘concern’. She called for ‘urgent’ research into the potential health risks of the drug. Several papers have suggested regular use could be damaging mental development and affecting users’ social life

But these often also include people regularly using alcohol and tobacco, making it difficult to deduce whether cannabis is behind the changes. About 48million Americans use cannabis annually, a number that is rising. https://www.dailymail.co.uk/health/article-11138001/Taking-cannabis-mid-20s-damages-cognitive-development-NIH-expert-warns.html

  1. Prohibition has worked globally for more than 100 years since the UN Drug Conventions began. These have kept illicit drug use down to 5% use worldwide, whereas legalised tobacco and alcohol have much higher rates.
  2. Legalising and decriminalizing substances inevitably gives a green light for use (as we have seen with increased use of cannabis in parts of the United States where it has been made legal.
  3. Global illicit drug industries are responsible for an enormous amount of environmental destruction

(Illegal Marijuana growers poison forests-these people fight back) https://www.nationalgeographic.com/environment/article/illegal-marijuana-growing-threatens-california-national-forests (Green But Not Green: How Pot Farms Trash the Environment) http://www.slate.com/articles/news_and_politics/uc_breakthroughs_2014/2014/04/green_but_not_green_how_pot_farms_trash_the_environment.html

 

RECOMMENDATIONS THAT CAN HELP PREVENT THE AUSTRALIAN “LOST GENERATION DYING”

 All Australian Governments and community leaders need to take this evidence regarding Mental Health very seriously.  The issue of cannabis-caused violence needs to be addressed. For example, the Australian Government must consider organising several Mental Health teams working 24/7 to evaluate the mental health and wellbeing of those involved in animal cruelty, road rage, spousal abuse and child fatalities. These teams should have the authority to place these individuals into detox and rehabilitation centres for three to twelve months according to their progress. They will also need to be constantly reminded that they are very important to the Australian community’s future.  Here in Queensland, we have one centre available. .and a third that could be built. They could be equipped at minimum cost and run with existing staff for this mental health program.

The Australian National Drug Strategy 2017-2026 identifies cannabis as a priority substance for action, noting 20% of Australian drug and alcohol treatment services are provided to people identifying cannabis as their principal drug of concern. DFA believes that the number is higher for those under 25 years of age.

We greatly appreciate your time in responding to these extremely important matters in terms of community health, welfare and safety and would value your response early Should you require further information and/or a face-to-face meeting we would be very pleased to accommodate.

Kind Regards

Herschel Baker, International Liaison Director,

>>>>>>>>>>>>>>>>>>>>>>>

Please click on the links below to read the reports:

  • When you click on the link an image of the report cover will appear
  • Then please click on the report cover image to open the report.
  1. DFA Mental Health Cannabis Use 18-08-22
  2. DFAF-Study-FINAL-A-panel-study-of-the-effect-of-cannabis-use-on-mental-health-depression-and-suicide-in-the-50-states-3
  3. Hair testing test for THC OH 2018 Drug Testing and Analysis Franz
  4. Paddock hair toxicology results
  5. Postmortum diagnosis and toxicology validation of illicit substance use hair sampling Addict Biol 2008 Huestis
Filed under: Australia,Cannabis/Marijuana,Drug use-various effects,Health,Mental Health :
A Research Letter published in the Journal of the American Medical Association (JAMA) raises alarms about administering melatonin gummies to children. Between 2012 and 2021, reports to U.S. poison control centers regarding pediatric melatonin ingestions surged 530% and were linked with 27,795 emergency department and clinic visits, 4,097 hospitalizations, 287 intensive care admissions, and tragically, 2 fatalities. Investigation into melatonin products’ labels revealed widespread inaccuracies relating to the presence of both melatonin and cannabidiol (CBD).

 

An examination of 25 melatonin gummy products obtained from the National Institutes of Health’s Dietary Supplement Label Database revealed that a staggering 88 percent of these products had inaccurate labels, ranging from one product containing no melatonin to the others containing anywhere from 74 percent to 347 percent of the stated amount. Among the five products containing CBD, the measured CBD amounts varied from 104 percent to 118 percent of the labeled quantity.

 

This is extremely concerning as administering melatonin gummies to children can expose them to enormously high amounts of melatonin and CBD. Combining melatonin and CBD can lead to potential moderate interactions, intensifying effects like dizziness, drowsiness, confusion, and difficulty concentrating. These products often claim to aid in sleep, stress, and relaxation, making it imperative to inform parents and caregivers that despite product claims, neither melatonin nor CBD has received approval from the U.S. Food and Drug Administration (FDA) for use in healthy children.

 

Reference:

https://jamanetwork.com/journals/jama/fullarticle/2804077

https://www.drugs.com/interactions-check.php?drug_list=1548-0,3919-0

Source:  email from Drug Free America Foundation  January 2024
Filed under: Drug use-various effects on foetus, babies, children and youth,Parents :

 

 

The initiative aims to reduce substance use-related harms among young people across Canada through the Icelandic Prevention Model, with support and expertise from Planet Youth.͏ ͏ ͏

 

No community in Canada has been left untouched by the substance use-related harms and the toxic illegal drug supply and overdose crisis. Efforts to prevent substance use, especially among youth, are critical, and by strengthening communities and environment of youth, they will be at lesser risk of initiating substance use.

 

On June 26, the Honorable Ya’ara Saks, Minister of Mental Health and Addictions and Associate Minister of Health, announced the Canadian government’s support for the Youth Substance Use Prevention Program (YSUPP). The event took place in Glace Bay, Novia Scotia in the Undercurrent youth center which provides leisure activities for the youth in the area. The initiative aims to reduce substance use-related harms among young people across Canada through the implementation of the Icelandic Prevention Model (IPM), with support and expertise from Planet Youth.

 

The initial stage of this initiative will secure funding for seven projects in British Columbia, Saskatchewan, Ontario, and Nova Scotia. Which will be added to the already started seven Planet Youth initiatives in other parts of Canada. These projects will focus on the Canadian adaptation and implementation of the Icelandic Prevention Model and its collaborative approach to preventing substance use harms among youth. With Planet Youth’s guidance, the IPM emphasizes a community-driven strategy to address the root causes of substance use.

 

These projects will engage diverse communities and sectors, including First Nations, schools, service providers, community leaders, and young people with lived and living experience. Their participation will be crucial in evaluating the IPM within the Canadian context, ensuring that the model is effectively tailored to meet the unique needs of Canadian youth.

 

Additionally, Renison University College, affiliated with the University of Waterloo, will receive funding to establish a new Knowledge Development and Exchange Hub for Youth Substance Use Prevention. Planet Youth experts will train the Hub to provide guidance and training on the IPM’s implementation in Canada. The Hub will lead a pan-Canadian youth substance use prevention community of practice, facilitating the sharing of information and best practices among various projects.

 

Preventing and reducing youth substance use through YSUPP is a key component of the Canadian Drugs and Substances Strategy. The Canadian government is committed to continuing this critical work in collaboration with all levels of government, partners, Indigenous communities, stakeholders, and local organizations. These efforts aim to reduce substance use-related harms, ensure comprehensive support for those in need, and ultimately, save lives.

 

Source: Public Health Canada

 

Links:

EHF Address: Planet Youth ehf. Lagmúla 6, 108, Reykjavik, Iceland.

Filed under: Canada,Prevention and Intervention,Youth :

By Jody Boulay on Friday, July 5, 2024

There is hope for the younger generations as they have more access to prevention and education resources to help them make informed decisions. In addition, more information is available for parents to equip them with the tools to help their kids understand the dangers and risks associated with drugs and alcohol.

Locally, Osceola County offers many addiction recovery resources, such as House of Freedom, Turning Point Counseling, and Park Place Behavioral Health in Kissimmee, as well as a substance abuse hotline in English (407-870-8282) and Spanish (407-240-1181).

Most importantly, amid the growing opioid epidemic, there is significant attention placed on preventing opioid overdose. In June, the Florida Department of Health in Osceola County hosted an event to help raise awareness about the dangers of overdosing called Revive Awareness Day, where free naloxone was available. (Residents can also find naloxone by calling the Osceola Department of Health at 407-343-2000.)

Drug education and prevention programs in Florida have made a significant impact, especially among youth. In addition to the long-term decline in alcohol and cigarette use, Florida students have also reported long-term reductions in the use of illicit drugs other than marijuana. However, while alcohol use is down, highrisk drinking behavior is still common.

Prevention and education information is valuable, especially during Fourth of July celebrations. Binge drinking around Independence Day is typical, and it is known as one of the heaviest drinking holidays of the year. In social settings, it becomes easy to consume too much alcohol.

Parents play an essential role when providing drug education. They can take the initiative to create an inclusive and supportive environment with their children. This can equip them with the tools they need to make knowledgeable decisions surrounding alcohol and drug use.

Teens and adults all use drugs and alcohol for different reasons—peer pressure, whether from peers, in a social setting, or in the case of someone they look up to who they see drinking or using drugs. Stress is also a common factor, and alcohol or drugs seem like an easy escape from the problems of life.

Additionally, environment and family history are contributing factors. Children who grow up in households with heavy drinking and recreational drug use are more likely to experiment with drugs.

Any parents wondering what to do should consider starting the conversation about alcohol and drug use early. It is also essential to be calm, loving, and supportive. Seek out specialized resources, such as those offered by county or non-profit organizations providing prevention and education. Parents want to focus on making it safe for their children to tell them anything and never end the conversation, keeping it going regardless of age.

Local drug education resources are here to help with the goal of helping people of all ages make knowledgeable decisions about drugs and alcohol.

Jody Boulay, a mother of two with a passion for helping others, works as a Community Outreach Coordinator for DRS to help spread awareness of the dangers of drugs and alcohol.

 

Source: https://www.aroundosceola.com/opinion/support-local-drug-education-and-prevention-programs

Filed under: Education,Prevention and Intervention,USA,Youth :
By Madeleine Cummings · CBC News · 
The City of Edmonton has stopped funding a pilot program that saw teams of nurses and outreach workers preventing and responding to overdoses on downtown streets.

Teams from Boyle Street Community Services had been assigned to walk around the Stanley Milner Library, downtown malls and pedways and the LRT system. Their duties focused on responding to drug poisonings but they also helped educate business owners, pick up needles and refer people to services.

The city funded the first phase of the pilot, which began in the spring of 2022, then extended its funding in December 2023, but Jen Flaman, deputy city manager of community services, told city council in a May 27 memo that there were no administrative funds available to extend it further.

The memo said the city submitted a funding request to the provincial government but was unsuccessful and has applied to a Health Canada program but has not heard back.

The pilot cost $3.3 million, and included funding for a data analyst at Boyle Street.

Marliss Taylor, who is Boyle Street’s director of Streetworks and health services and oversaw the pilot, said it was a success.

She said the teams responded to more than 440 drug poisonings, distributed more than 20,000 naloxone kits, disposed of more than 7,000 sharp objects, and referred 2,500 people to detox or supervised consumption services.

“We absolutely were able to save some lives and I think that’s critically important,” Taylor said.

‘It never gets easier,’ says overdose prevention nurse, Tabatha Plesuk, a nurse based at the Stanley Milner Library in Edmonton. She said the teams also helped security guards and demonstrated friendly, respectful ways of interacting with vulnerable people in public places.

EMS responses to opioid-related events surged in Edmonton in recent years and a record 1,867 people died in Alberta because of opioid poisoning last year.

Though the rate of drug poisoning deaths in the province has slowed since 2023, Taylor said the number of overdoses in Edmonton is still high. According to the province’s substance use surveillance data, there were 148 drug poisoning deaths in the city between January and March of this year.

Taylor said she is worried about what could happen if the overdose prevention teams stop running.

“What we don’t want is for people to be injured or die of an unintentional drug overdose in spaces where people are not sure how to react,” she said.

In an emailed statement, Michelle Steele, a city spokesperson, said the teams were funded as a response to the worsening drug poisoning crisis in 2022 “with the recognition that the funding was not permanent.”

The city memo said funding ended on June 30 and the team’s services would be closing, but Taylor said the teams are still working for now.

She said Boyle Street is seeking other funding sources, with help from nearby businesses and organizations.

Madeleine Cummings

Madeleine Cummings is a reporter with CBC Edmonton. She covers local news for CBC Edmonton’s web, radio and TV platforms. You can reach her at madeleine.cummings@cbc.ca.

Source: https://www.cbc.ca/news/canada/edmonton/edmonton-stops-funding-drug-overdose-prevention-pilot-1.7254667

Filed under: Canada,Drug use-various effects,Harm Reduction including HIV (Papers),Prevention and Intervention :
By  – News Agency of Nigeria

July 5, 2024

According to the World Health Organisation, substance abuse claims the lives of over 500,000 people annually, with a staggering 35 million people worldwide suffering from drug use disorders.

Perhaps the most heart breaking aspect of this crisis is its impact on the youth.

The United Nations Office on Drugs and Crime reports that approximately 5.6 per cent of the global population aged 15-64 has used drugs at least once in the past year, with the highest prevalence among those aged 18-25.

Today the impact of drug use manifests in the society in several ways including such violent crimes as kidnapping, assassination, armed robbery and insurgency.

One of the states where this is rampant is Katsina where wanton destruction of lives and herds, kidnapping, raping and invasion of communities by criminal elements is now almost the order of the day.

“We must get to the root of the problem, and the root of the problem is drug abuse by the teeming youths in the state. We know that these inhumane acts cannot be committed without the influence of drugs“, worried Gov. Dikko Radda said during a visit to NDLEA chairman, retired Brig-Gen Buba Marwa.

He has support from Ajentekebia Harry, Country Director of Logistics Nigeria, Continent Afrique, and NGO.

“Many of the criminal and terrorist activities you see today in Nigeria are drug induced. These drugs have the capacity to simulate unholy acts that can plunge the nation into chaos,” he said.

The consequences of substance abuse among youth are far-reaching, affecting academic performance, mental health, and future prospects.

According to the National Institute on Drug Abuse, U.S. teenagers who use drugs are at an increased risk of developing addiction later in life, as well as experiencing cognitive impairments and mental health issues

In the face of these staggering statistics, the role of good parenting emerges as a beacon of hope and a powerful catalyst for change. Numerous studies have demonstrated the protective influence of strong family bonds, open communication, and positive role modeling in preventing substance abuse among youth.

The Substance Abuse and Mental Health Services Administration, reports that children with involved parents are up to 50 per cent less likely to engage in substance abuse.

Furthermore, a study by the National Centre on Addiction and Substance Abuse found that teenagers who frequently have family dinners are 33 per cent less likely to use drugs, alcohol, or tobacco.

By fostering a nurturing environment, instilling resilience, and providing guidance, good parents can equip their children with the tools to navigate the challenges of life without resorting to substance abuse.

While the role of good parenting is undeniably crucial, addressing the pervasive issue of substance abuse requires a multifaceted approach that involves collaboration among families, communities, and policymakers.

By empowering families, strengthening community support systems, and implementing effective policies, we can forge a path towards a drug-free society – one where the next generation can thrive, unencumbered by the devastating consequences of substance abuse.

The Federal Government says it recognises the role of civil society organisations in combating drug abuse among young people.

Consequently, it is prepared to partner with Vanguard Against Drug Abuse (VGADA), to raise awareness against drug abuse.

It is also prepared to rehabilitate and provide skills for youths affected by substance abuse.

Ayodele Olawande, Minister of State for Youth Development, made the pledge in Abuja when he received Hope Omeiza, Executive Director of VGADA detox centre.

“There is also need to enlighten the parents, especially the mothers at the grassroots, so as to help educate children and youths on drug abuse and illicit trafficking,” he said.

He said that the ministry had been to 19 states and many local government areas to campaign against dangers of drugs, substance abuse and illicit trafficking.

“From our experience, we have two different types of young people today – the formal and the informal. The formal people know and are aware of the dangers of these drugs, but the informal are at the grassroots level.

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“We are not engaging the informal people and that is why illicit drug use has been spreading widely to the towns, the villages, and to the grassroots. This is the reason you’ll see me in every community engaging with the stakeholders, the women especially.

“We believe that everything begins from the home; with the mothers talking to their children, it will help curtail the menace to the barest minimum,” he said.

Drawing example from Adamawa, the National Drug and Law Enforcement Agency (NDLEA) paints a grim picture of the drug situation in Nigeria, especially as it affects the youth population.

State Commander of NDLEA, Samson Agboalu, says it has arrested no fewer than 454 suspected illicit drug traffickers/peddlers from June 2023 till date.

Agboalu said the figure reflected a 9.38 per cent decrease from the 501 arrests made in the previous year. While those arrested decreased in Adamawa, drug seizures significantly rose, with a total of 4,732.128 kilogrammes of hard drugs confiscated.

”This is a 75 per cent increase from the 1,164.750 kg seized between June 2022 and June 2023.

“These seizures include a range of substances such as Cannabis Sativa, Methamphetamine (ice), Cocaine, Tramadol, Exol-5, Diazepam tablets, Codeine-based syrup, Rohypnol tablets, and Pentazocine injections.

The curve of conviction of drug offenders has witnessed an upward curve as prosecution efforts and forfeitures from June 2023 till date saw 148 individuals being convicted.

This is a major increase from 115 convictions recorded between June 2022 and June 2023.

“The highest sentences handed down were between10 and five years’ imprisonment, with the least six months.

“Monetary forfeiture recorded an increase, with the sum of N851, 153 forfeited to the Federal Government and deposited into the Treasury Single Account (TSA), compared to N729,480 in the previous year”, he said.

The NDLEA commander called for the adoption of preventive measures as a strategic approach in addressing drug abuse in the state.

While the civil society organisations and relevant government agencies battle drug abuse among youths, many stakeholder believe that winning the war would be a mirage without tackling it from the foundation of the society, the family.

On Feb. 12. NDLEA organised training on Drug Prevention Treatment and Care, DPTC, for spouses of state governors in Abuja.

The event offered the First Lady, Oluremi Tinubu to air her voice on what parents should do to stem drug abuse in the society.

“As mothers, we understand the profound impact that drug abuse can have on our children’s lives. Therefore, it is incumbent upon us to protect, nurture, and guide them towards a future free from the shackles of addiction’’, she said.

The First Lady’s position on the important role of parenting in curbing drug abuse among young people is re-echoed by a medical expert, Taiwo Malomo.

“As parents, especially as mothers, as a matter of urgency, we must rise up to tackle this menace“, says Malomo, a Principal Medical Office, ’’Surgical Emergency Department, University of Abuja Teaching Hospital, Gwagwalada.

Similarly, Dotun Ajiboye, a psycho-socialist, advises parents and guardians to consult a mental health professional immediately they noticed substance use in a child, to save them from drug addiction.

“It is very important for every parent and guardian to know the root cause of substance abuse in their children.

“Parents should give godly guide on how to avoid or live above these triggers,” Ajiboye said in a media report.

Source: https://businessday.ng/features/article/good-parenting-as-catalyst-for-drug-free-society/

 

Filed under: Others (International News),Parents,Prevention and Intervention :
Research shows how a major shift in the drug supply could be leading to an increasing amount of overdose deaths. Fentanyl continues to devastate American lives. Now, new research shows how a major shift in the drug supply could be leading to an increasing amount of overdose deaths. (Scripps News)
By: Vanessa Misciagna
Posted at 5:47 PM, Jul 05, 2024

A new study by NYU Langone, funded by the National Institutes of Health and the National Institute on Drug Abuse, shows how fentanyl has taken over America’s illegal drug supply. It has happened fast.

Law enforcement seizure data shows that illicit fentanyl seizures grew more than 1700% in the 6 year span from 2017 to 2023.

Fentanyl pills specifically made up nearly half of fentanyl seizures in 2023, at 49%. Compare that to 10% in 2017.

As much as 85% of these seizures are happening in the western part of the United States.

A lead researcher on the study, Dr. Joseph Palamar, said that though the numbers are staggering, they’re not surprising given recent trends.

“A couple of years ago, most fentanyl was in powder form. The way it began was fentanyl started creeping up into the heroin supply …then pills started coming around — particularly in the West, and pills introduced fentanyl in a whole different manner to people,” he said.

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Palamar says fentanyl in pill-form changes the game, so to speak, in terms of who is now able to obtain it.
Pills are easier to take or to smoke, so there’s no need to figure out how to use a needle. Also, because many fentanyl pills are meant to look like legitimate pills, it’s easier for people who don’t necessarily know they’re taking fentanyl to find it, ingest it and overdose.

“My fear in particular is that there are young people who are trying to get their hands on pills like Adderall or Oxy or Xanax and if they buy them illegally, they don’t know that they could have fentanyl in them — just a few milligrams is enough to kill a teenager,” Palamar said.

Rob Sullivan oversees multiple drug detox programs in northwestern Washington state, and has been in the industry for 20 years.

He says he and his colleagues have noticed that it takes longer for someone to detox from fentanyl — prompting requests to insurance companies to extend detox stays. He also says people have a harder time completing detox, and many times people detox without even realizing they’ve taken fentanyl.

“We see right now, we’re about 66% complete. And 44% don’t complete. Whereas we used to be higher when it was just regular opioids, because people knew what to expect, meaning clients, and also professionals knew what to expect,” Sullivan said.

“Whereas with fentanyl — so different, and so powerful — that it’s really, it’s a different ballgame than what it was,” he said.

Palamar hopes that these findings spark a stronger emphasis on drug use prevention

“We need people to be educated about fentanyl and the associated risks, particularly the people who have not used fentanyl. I worry about people starting fentanyl, and I also worry about people being unintentionally exposed to fentanyl — especially young people.”

Source: https://www.ktvq.com/us-news/new-study-shows-the-rising-prevalence-of-fentanyl-pills

Filed under: Cannabis/Marijuana,Fentanyl,Health,USA :

Mary Brett – in memoriam

Mary Brett, Former biology teacher (30 years at Dr Challoner’s Grammar School for boys, Amersham, Buckinghamshire. UK), Trustee of CanSS (Cannabis Skunk Sense), Member of PandA (Centre for Policy Studies) and former Vice President of Eurad. With regret, it is noted that Mary has recently died, in 2024, after a long illness – her expert contribution to the field of drug prevention and education is to be celebrated, and remembered for the quality of her work throughout.

The paper reproduced here below  is but one example of Mary’s expert contributions to the field.

Executive Summary

Prevention is the policy of this Government but harm-reduction organisations are being consulted for information and evidence—the Advisory Council on Misuse of Drugs (ACMD), Drugscope and the John Moores University Liverpool.

Information on cannabis from these sources is out-of-date, misleading, inaccurate, has huge omissions and is sometimes wrong. It does not stand comparison with current scientific evidence.

Children do not want to take drugs. They want reliable information to be able to refuse them.

Tips on safer usage and “informed choice” have no place in the classroom.

Prevention works.

  1. Current information about drugs being given to this government comes mainly, if not entirely, from harm-reduction organisations. I find this astonishing. The policy of this Coalition Government is prevention.
  2. I had long suspected, and had it confirmed by BBC’s Mark Easton’s blog 20 January 2011, that “Existing members of the council (ACMD) are avowed “harm-reductionists”. Drugscope, a drugs information charity paid for entirely by the taxpayer, has always had a harm reduction policy. We find statements like, “prevention strategies are not able to prevent experimental use” and “harm minimisation reflects the reality that many young people use both legal and illegal substances”. And the John Moores University in Liverpool has been at the forefront of the harm reduction movement since the eighties. Pat O’Hare, President of the International Harm Reduction Association (IHRA), said: “As founder of the first IHRA conference, which took place in Liverpool in 1990, it gives me a great sense of pride to see it coming “home” after being held all over the world in the intervening 20 years”.
  3. FRANK is the official government website providing information to the public, especially children 11–15. I have learned that the information for the recently re-launched FRANK website came from The John Moores University. A member of the FRANK team, Dr Mark Prunty was involved in a commissioned report, “Summary of Health Harms of Drugs” published in August 2011.
  4. Harm reduction has its place in the treatment of addiction, eg reducing the dose till abstinence is attained. But no place in the classroom where well over 90% of children have no intention of ever taking drugs. Harm reduction can and does sometimes act as a green light.
  5. This government says it wants to stop young people from ever starting to use drugs, but that’s not the aim of harm reductionists. They assume children will take drugs anyway, so give them “tips” on taking them more safely, and offer them “informed choice”. And for some reason I have never understood, they always downplay the harmful effects of cannabis—information is vague, inadequate, misleading, out-of-date and sometimes completely wrong.
  6. Brains are not fully developed till the 20s, the risk-taking part developing before the inhibitory area. Children from seven upwards are simply incapable of making the right decision. They need to be protected, not abandoned to make critical life choices. Only 30–40% will ever try drugs—a world away from regular use. What other illegal activities do we invite them to choose—pilfering, graffiti-spraying? Harm reduction advocates are so wrong. Children don’t actually want to take drugs. They want sound, reliable and full information to help them refuse drugs from peer group users who are pressuring them. I know—they’ve told me. Harm reduction policies are tantamount to condoning drug use.
  7. Prevention works. The prevention campaign in USA 1979–1991 saw illicit drug users drop from 23 to 14 million. Cannabis and cocaine use halved. Over 70% abstained from cannabis use because of concern over physical and/or psychological harm (P.R.I.D.E. survey USA 1983). In Sweden, 2010 “last month use” of cannabis was 0.5% (ages15 to 64), European average—3.7%.
  8. Overall, drug use may have fallen in the last 10 years but the last BCS reported that there had been a 1% increase in the “last year” use of cannabis among 16 to 24 year olds in the UK. This amounts to around 55,000 people—no room for complacency.
  9. At a meeting of the FRANK team, Dr Mark Prunty, asked me to send my large scientific report on cannabis (“Cannabis—A general view of its harmful effects”, written for The Social Justice Policy Group, in 2006, fully endorsed by eminent scientists, and regularly updated), and all new research papers that I received. He also had the two books I have written (“Drug Prevention Education” and “Drugs—it’s just not worth it”1). I wasted my time. Why is there no scientific researcher on the FRANK team or at least temporarily co-opted?
  10. One of the John Moore’s staff members, Dr Russell Newcombe helped to pioneer the harm-reduction movement in Merseyside from the mid-1980s and was Senior Researcher for Lifeline Publications & Research (Manchester, 2005–10). Lifeline literature on drugs, used in some schools, is hugely harm reduction based. Several leaflets and DVDs on “How to inject” are freely advertised on the Internet and can be easily accessed, as are needles, by children. Children are scared of injecting—now they needn’t worry!
  11. The last paragraph in Lifeline’s Big Blue Book of Cannabis says, “If we look at our crystal ball at the world of tomorrow what can we expect to see? More medical uses for cannabis; stronger types of weed appearing on the streets; more laws; more fiendish ways of catching users and the same old hysterical reactions to people smoking a plant”—That says it all!
  12. My analysis of the cannabis information in the “Summary of Health Harms of Drugs” pages 31–33 follows:
  13. “No cases of fatal overdose have been reported”. Isn’t it the same with tobacco? “No confirmed cases of human death”. “Stoned” drivers kill themselves/others. Cancers recorded, especially head and neck at young age (Donald 1993, Zang 1999). Serotonin, “happiness” neurotransmitter depleted (Gobbi 2009) causing depression—can lead to suicides (Fugelstad (Sweden) 1995). Violence from psychosis or during withdrawal, murders documented in the press and coroners’ reports. Teenagers have had strokes and died after bingeing (Geller 2004).
  14. Strength: No figures are given for Tetrahydrocannabinol (THC) content. Skunk now averages 16.2% but can range up to 46% THC, old herbal 1–2%, Hash 5.9% (Home Office Report 2008). No warning that skunk occupies 80% of the UK market, hash 20%. FRANK says that skunk is 2–4 times stronger than old herbal cannabis—wrong! They mislead the public by comparing it with hash. The enlightened Dutch, who know about drugs, have now banned any skunk with a THC content over 15%, equating it with cocaine and heroin. The vast bulk of our young users are smoking what amounts to a class “A” drug!
  15. 50% of THC will remain in cells for a week, 10% for a month. The John Moores report makes no mention of its persistence. Numerous studies show the adverse effects of this on academic results (Grade D student four times more likely to use cannabis than one with A grades, USA 2002) and personality. Users become inflexible, can’t plan their days, can’t find words or solve problems, development stalls, they remain childish. At the same time they feel lonely, miserable and misunderstood (Lundqvist 1995).
  16. Psychosis: Not reported is that anyone (with/without family history) taking cannabis can develop psychosis if they take enough THC (Morrison, Robin Murray team 2009). D’Souza (2007) had also shown this. Cannabis increases dopamine (pleasure neurotransmitter) in the brain. Excess dopamine is found in brains of schizophrenics. The first paper linking psychosis and cannabis was published in 1845! The report says: “Health effects of increases in the potency of cannabis products are not clear”. Skunk users have been found to be seven times more likely to develop psychosis than hash users ( Di Forte, Murray’s team 2009).
  17. No mention of absence of Cannabidiol (CBD) (anti-psychotic) in skunk, so psychotic THC is not counteracted! Old herbal cannabis had equal amounts CBD and THC. (McGuire 2008 and 2009, Morgan (2010), Demirakca (2011) etc. Dependence risks and psychotic symptoms are blamed on bingeing—regular use is enough! It is suggested that psychotic or schizophrenic patients may be self-medicating negative symptoms—disproved in several papers (Degenhardt 2007, Van Os 2005).
  18. They say that likelihood of progressing to other drugs is more to do with personality, lifestyle and accessibility than a gateway effect. Swedish research (Hurd 2006, Ellgren 2007) on animals finds THC primes the brain for use of others, and Fergusson (2006 and 2008) in a 25 year NZ study from birth found cannabis to be the single most significant factor for progressing.
  19. It is claimed that there is “no conclusive evidence that cannabis causes lung cancer” We don’t have conclusive proof for cigarettes and lung cancer! “Evidence for the effects on the immune system is limited”—over 60 references in my report! No warning that people should not drive within 24 hours of consumption (Leirer 1991).
  20. Children born to cannabis-using mothers may have “mild developmental problems”. Fried has followed child development since 1987. He has found cognitive impairment, behaviour and attention problems, babies twice as likely to use the drug at adolescence. Goldschmidt (2002) found delinquent behaviour, Bluhm (2006) warned of an increased risk of neuroblastoma, a childhood cancer.
  21. Now several recent papers demonstrate structural brain damage eg Welch (September 2011) loss of volume in thalamus, Solowij 2011 smaller cerebellum white matter volume, Ashtari (2011) loss in hippocampus volume, (Yucel 2008, Rais 2008).
  22. I have cited only a few references, there are well over 600 in my report.
  23. At least one piece of information in FRANK’s magic mushroom (Psilocybe—Liberty Caps) section is not in the Moore’s report, so where did it come from? The extremely poisonous familiar red/white spotted fungus, the Fly Agaric, is included. This is serious—it should not be there. Its inclusion is even more alarming as the amount used (1–5g) and the fact that it should not be eaten raw are given—blatant harm reduction advice! A child could die!
  24. New posters from FRANK:

www.homeoffice.gov.uk/publications/alcohol-drugs/drugs/frank/coke-poster

www.homeoffice.gov.uk/publications/alcohol-drugs/drugs/frank/meow-poster

www.homeoffice.gov.uk/publications/alcohol-drugs/drugs/frank/skunk-poster

My pupils would have used words like: pathetic, patronising, trite, useless and positively encouraging drug use—and so would I.

  1. I repeat—children don’t want to take drugs. They want a sound education and good grades, free from hassle and the pressure to take drugs.
  2. Drugscope’s cannabis information updated 2011 is even less reliable than FRANK’s. They continue to deny that cannabis can cause physical addiction, say “There are suggestions that the drug can in rare cases trigger psychosis, a factor that led to the government in 2009 to reclassify cannabis” (Drugscope disagreed with the reclassification), state that the strength of skunk is 12–14% THC when in 2008 it averaged 16.2%, and completely ignore all the Swedish and New Zealand evidence for the “Gateway Theory”. Professor Murray’s 2009 papers are not mentioned, and in a reply to me, the writer of Drugscope’s literature, seemed to think it was the THC that caused cancers, not the smoke.
  3. In 2006, Professor David Nutt said that LSD and Ecstasy probably shouldn’t be class A. In May 2008 I attended an open meeting of the ACMD at which a presentation (by Pentag) on ecstasy was given—a meta-analysis commissioned by the ACMD. I was concerned about their conclusions so contacted the foremost ecstasy researcher in Britain, Professor Andrew Parrott of Swansea University.
  4. Incredibly Professor Parrott knew nothing about the proposed down-grading of ecstasy by the ACMD until I alerted him. He was leaving for Australia to Chair an International Conference on Ecstasy and sent me his numerous publications. I passed them to the ACMD. When he returned, having missed the evidence—gathering meeting in September, I alerted him to the open meeting in November. He had to send three e-mails before they answered and allowed his presentation to go ahead. He was given a mere 20 minutes.

In an open letter to the ACMD on November 13 he wrote:

  1. 29. I cannot believe that I have spent the past 14 years undertaking numerous scientific studies into Ecstasy/MDMA in humans, then for the ACMD to propose downgrading MDMA without a full and very detailed consideration of the extensive scientific evidence on its damaging effects. My research has been published in numerous top quality journals, and can be accessed via my Swansea University web-page.
  2. Professor Nutt, who was Chairing the ACMD meeting on November 25 2008 for the first time was severely criticized by Professor Parrott. He said that Nutt made numerous factual errors, eg that there were zero dangers from injection of MDMA. Parrott said it was probably safer to inject heroin. Nutt said that ecstasy was not addictive, involved no interpersonal violence, was not responsible for road deaths, did not cause liver cirrhosis or damage the heart. Scientific work demonstrates that users show compulsive and escalating use, midweek aggression, that driving under its influence is extremely dangerous, that it is hepatotoxic—liver transplants have been needed in young people under 30, and profound cardiovascular effects. Professor Nutt did not defend himself in our presence. Nor to my knowledge has he since!
  3. Answers from Anne Milton, Minister for Public Health given to Parliamentary Questions from Charles Walker MP, October 2011 include:
  4. The Medical Research Council (MRC), funded by The Department of Business, Innovation and Skills, is supporting Professor Glyn Lewis in his research on adolescence and psychosis and Professor Val Curran’s research into the vulnerability of people to the harmful effects of cannabis.
  5. Professor Lewis, widely quoted on the Web by Peter Reynolds (CLEAR—Cannabis Law Reform) said that, “there is no certainty of a causal relationship between cannabis use and psychosis”, and announced that the risk of psychosis from cannabis use is at worst 0.013% and perhaps as little as 0.0030%. Professor Curran is a member of Professor Nutt’s Independent Scientific Committee on Drugs (ISCD).
  6. I find it incredible that there is essential sound accurate up-to-date scientific information about the effects of cannabis available in scientific journals and publicised in the press and the public is not being made aware of it by FRANK, the official Government website. Why has FRANK not been taken to task?
  7. While the harm reduction lobby are being consulted, persisting with their own agendas, and the preventionists supporting the Government’s New Strategy not listened to, nothing will change.
  8. Prevention is better than cure. Prevention is what every parent wants for their children. Prevention is common sense and it works.
  9. Meanwhile, while we wait for common sense to prevail, some children will become psychotic, addicted, move on to other drugs, drop out of education or even die. And the parents I work with will be left picking up the pieces.

January 2012

Source: Home Affairs  or visit http://www.parliament.uk/business/committees/committees-a-z/commons-select/home-affairs-committee/publications/

Filed under: Cannabis/Marijuana,Education,Education Sector,Health,Marijuana and Medicine,Prevention and Intervention :

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