2024 August

By Lauraine Langreo, Staff Writer,  Education Week — August 28, 2024  

There have been “promising” declines in high school students’ overall use of illicit substances, concludes a report from the federal Centers for Disease Control and Prevention.

Since 2013, the percentage of students who reported drinking alcohol, using marijuana, or using select illicit drugs at any point has decreased. Since 2017 and 2019, respectively, the percentage of students who had ever misused or currently are misusing prescription opioids decreased, according to the CDC’s Youth Risk Behavior Survey.

That survey draws on data collected every two years among a nationally representative sample of U.S. high school students. The 2023 survey had more than 20,000 respondents and was conducted in the spring.

Still, many students continue to use substances and the lack of progress in some areas is concerning, according to the report.

The findings come as schools continue to face challenges in curbing students’ substance abuse, which could negatively affect learning, memory, and attention, according to experts. It could also be a sign of mental health challenges.

___________________________________________________________________________________________________________

Teen substance use

Percentage of high school students who ...

*Question introduced in 2017.
**Question introduced in 2019.

DATA SOURCE: CDC

____________________________________________________________________________

While student substance abuse isn’t a new challenge for school districts, the substances that adolescents are experimenting with now are much more dangerous, said Darrell Sampson, the executive director of student services for the Arlington public schools in Virginia.

“It’s not necessarily that more kids are using substances than in prior years,” Sampson said. “It’s the lethality of the substance itself that has caused higher levels of concern.”

Research has shown rising overdose deaths among teens even as their substance use is declining. Those deaths have been linked to the increase in illicit fentanyl and other synthetic opioids. School districts have been pursuing several strands of legal action against companies that manufactured and marketed addictive opioids that have led to tens of thousands of deaths and countless more addiction struggles in the last two decades.

Beyond the legal actions, schools also continue to provide prevention and education programming for students and families, Sampson said. There’s “a glimmer of hope” that those measures are working, he said, based on the declines in the CDC data.

Experts recommend starting education about substance abuse as early as possible

In the Arlington, Va., district, students in grades 6 through 10 learn about substance abuse challenges as part of the health curriculum, Sampson said. The district has also slowly expanded that program to 5th and 4th grades and are looking into whether there’s capacity to start that education as early as 3rd grade.

“We know that the more we can at least open that conversation with our families and our students, the better off our students are going to be,” Sampson said. “It’s not just a message [they’re hearing] starting in middle school, but it’s a message [they’re hearing] over time.”

The district is expanding programming with 11th and 12th graders, too, because the information they got when they were in 10th grade could be outdated by then, Sampson said.

In addition, the district has substance abuse counselors who meet with students and try to explore the reasons they might be using substances, Sampson said.

Experts say it’s also important to think about how to incorporate student voice in any prevention or intervention programming.

Teens are more than twice as likely to go to their friends or peers for help or support when experiencing distress from their substance use than they are to go to a behavioral health provider or a family member, according to a survey from the Bipartisan Policy Center conducted in June among 932 teens (13- to 17-year-olds) and 1,062 young adults (18- to 26-year-olds). More than a quarter of teens said they didn’t go to anyone for help or support when they experienced distress from substance use.

Sophie Szew, a junior at Stanford University and the Bipartisan Policy Center’s mental health and substance use task force youth adviser, said those survey results “really underscore the importance of investing in those peer support networks and resources.”

______________________________________________________________________________________________

Teenagers who have experienced distress from substance use

Who have teens gone to for help/support when experiencing distress from substance use?

Category Percent

Friend/peer                                                             43

Behavioural health provider                                 19

Parent, care givers, other family members        18

Primary care provider                                              9

Religious/spiritual leader                                       9

School counsellor                                                     8

Teacher                                                                       6

Coach/mentor                                                           6

Crisis services (988, crisis text line)                     5

Virtual app or website services                             4

Other adult n the community                               8

Other                                                                         2

No one                                                                    27

____________________________________________________________________________
Source: https://www.edweek.org/leadership/teen-substance-use-is-declining-but-more-dangerous-drug-abuse-is-emerging/2024/08

NIH:       National Institute on Drug Abuse

Premium Reports August 27, 2024 Updated:August 28, 2024

Officials are finding houses riddled with residual nerve agent pesticides from China that aren’t in any U.S. chemical library …

LOS ANGELES—On a recent summer morning, a caravan of unmarked state police vehicles and white hazmat trucks crept past strip malls and wide intersections, making its way toward a pair of modest homes in a remote suburb north of Los Angeles.

A command came from the officers in the front of the black-and-white: “Seat belts off—in case we start taking fire.”

But there was no shootout. Just a tense half hour as a phalanx of two dozen state police—agents from the Department of Cannabis Control (DCC)—kept snipers trained on the house, waiting for the second of two suspects to emerge.

When she finally did, petite and barefoot in a black dress, the effect was mercifully anticlimactic.

Police officers arrest people while raiding an illegal cannabis site in Lancaster, Calif., on Aug. 14, 2024.

John Fredricks/The Epoch Times

Illegal cannabis cultivation operations, or “grows,” are a multi-billion-dollar-a-year industry in California, dominated by a mix of transnational criminal organizations that authorities believe are symbiotic, if adversarial.

When agents serve a warrant, they often find human trafficking victims, automatic weapons, booby traps and, increasingly, banned toxic pesticides smuggled from China.

This particular raid, in Lancaster, netted around 1,020 plants—a modest haul compared with the herculean grows that have become common across California’s booming black market.

But such mild suburban tableaus belie a sleeping, sinister threat.

“What we have right now is organized criminal enterprises literally destroying the city building by building as they modify them for illegal cultivation,” Mike Katz, a Lancaster code enforcement officer who heads the city’s cannabis unit, told The Epoch Times.

“They’re endangering the families who will occupy those buildings in the future, they are lowering the value of neighboring properties and dragging the whole community down,” he said.

‘Super Toxic’

Buildings contaminated by illegal grows are dangerous because the harsh pesticides growers use permeate every surface—ceilings, walls, floors, vents and drywall.

Toxic black mold blooms in the 75 percent humidity needed to grow marijuana. The massive amounts of water and electricity required to sustain an operation can result in structural damage to vents and sunken floors, overloaded transformers and corroded wiring just itching for a fire.

Katz, whom the city’s chief of police refers to as the department’s “Swiss Army knife,” has been a firefighter, reserve police officer, and now, an unarmed code enforcement official. He approaches the job with a certain zeal, devouring scientific studies and how-to books on cultivation, and generally making it his mission to stop grow houses from slipping through the cracks.

Owners can often get away with making cosmetic fixes—“candy coating,” as one inspector puts it—if local governments don’t intervene before they start concealing the damage.

Working and middle-class families migrate to bedroom communities like Lancaster, where you can still find a single-family home with a backyard for around $500,000—about half the median price in Los Angeles, according to Redfin. You may find one for even less if a grower has been busted and is offloading at a discount.

The injustice of it rankles Katz. He imagines families struggling to buy a home, and their toddlers probing surfaces tainted with insecticides—potent carcinogens, endocrine disruptors, nerve agents and others no one even knows how to identify.

“They are super toxic, but very effective,” he said. “One we just learned of last week has a 14-year half-life. We did a search warrant back in January and didn’t get test results until this week. I’m having to tell all the detectives and everyone involved that we were exposed to these chemicals.”

Low-cost housing also attracts sophisticated criminal enterprises looking for ways to launder money and turn a profit. Often, illegal growers can do that after just one harvest. Typically, an operation can turn four to six harvests a year.

Wholesale value for the plants seized in the modest raid we accompanied—they were days away from a second harvest—is more than $540,000.

 

To avoid detection and stay a step ahead of authorities, growers are continually adapting.

“There are probably a lot more growing indoors that we don’t know about,” Jennifer Morris, a code enforcement officer with Riverside County and former head of its cannabis unit, told The Epoch Times. “But they’re pretty good at keeping themselves looking very nondescript.”

From the outside, the houses look normal, and it typically takes a fire, robbery, or neighbors reporting electrical theft to tip off law or code enforcement, Morris said. Growers also build walls to conceal grow rooms, and sometimes install a resident worker or a dog to give the appearance of normality.

Because the entire industry is clandestine, no one can accurately estimate the extent of the problem. Many communities might not even be aware it’s happening.

“I’ve talked to cities where they say, ‘We don’t have a problem,’” said David Welch, an attorney who contracts as a special counsel with cities in Los Angeles County that want “a more aggressive” approach to narcotics enforcement. “Then law enforcement will hit a grow in that city.”

Where there is one, there are likely more. But perpetrators are opportunistic, itinerant.

“We have seen the same owners of properties in different counties that have had illegal cultivation on them,” Morris said.

Wilson Linares, who leads the Department of Cannabis Control’s Los Angeles County law enforcement unit, said it’s hard to pinpoint which players are tied to which territories. “They’re just everywhere. It doesn’t really stay in that area, they just go wherever they can master operations.”

Growers, he said, “do a good job of layering their operation. I don’t think they even know they’re working for the same organization sometimes.”

That makes it difficult to go after the few bigger fish, to which, some insiders say, all these operations are ultimately “funneling up.”

Those caught at the grows are inevitably low-level employees, if not forced labor, and are typically interviewed and released. Illegal cultivation—anything more than six plants per person, whether it’s 10 or 10,000—is a misdemeanor in California.

“Sometimes our investigations do a good job at digging to make sure we’re eradicating the problem,” Linares said. “But sometimes they cut losses and move on and go somewhere else. We have to follow and chase them. It takes a lot of effort and time to conduct these investigations.”

Like meth houses of decades past, there are residential grows too damaged to flip.

But it’s the moderate ones, the ones that are at risk of selling at a discount to families, that keep Katz up at night.

 

While they can’t prevent the sale, or in many cases, habitation, building inspectors and code enforcement officers use “red tagging” and other methods to compel compliance—like creating liens to cloud the title, or disconnecting utilities. And in some cases, those costs and headaches transfer to new owners.

California law gives local government broad authority to abate “public nuisances”—which include dangerous and contaminated buildings, Katz said. But enforcing compliance can often depend on a municipality’s ability to pay for things like civil lawsuits.

If public safety officials don’t discover a grow before property owners start hiding the damage, it’s often too late.

“There is no roadmap,” Katz said. “These sociopaths are buying and selling these houses.”

‘I Didn’t Know Anything’

There were signs. Two dozen large bags of what Virginia Aceres thought was ordinary grass fertilizer and canisters of chemicals bearing designs of spiders and worms that the previous owner left behind. He offered to pay her $500 to get rid of them.

In two months, a $10,000 electricity bill.

Aceres said she moved from Los Angeles to the Antelope Valley because she didn’t want her kids hanging out with people who use drugs. She nabbed a five-bedroom house for $535,000, $15,000 below asking. “It’s super big—we thought, oh wow, this is perfect.”

But she found out after moving in that it had been used by the previous owners to grow weed.

“Every afternoon the upstairs smells of marijuana and it gives me a raging headache,” she told The Epoch Times. When a city inspector came by and pointed out a meter wired to steal electricity and stains on the bathroom ceilings from burned chemicals, she said, “Now I understand.”

The five bedrooms were originally three, she discovered; the previous owner had added two and it was up to her to register the additions with the city.

When property owners obtain permits to modify buildings but don’t follow up to call for a final inspection of the work, this can tip off code enforcement and form part of the basis for a warrant. So too can electrical fires or electricity theft.

But Aceres said she bought her house without any compliance obligations that would arise from a pre-sale code enforcement; inspectors came after she moved in and pointed out the damage.

The circuit breakers at Aceres’ house are constantly blowing, especially if electronics are running at the same time, and electricians tell her she has to completely redo the wiring.

“My daughter relies on a machine to help her breathe,” Aceres said, referring to a nebulizer that delivers oxygen and liquid steroids. “We had to buy a generator. She’s 9; she can’t ride a bike, can’t walk more than 20 minutes, can’t run. At night she has panic attacks, she comes to my door in pain, she can’t breathe, so I connect the machine and give her medicine.”

A neighbor warned her the previous owner had installed multiple, massive air conditioners and there were fires. People cruise by the house. Someone showed up looking to collect on a debt. The IRS, the police and city inspectors have all visited.

“For all this, I’d like to move—because they’re going to confuse us and they’re going to think that we sell drugs or have something to do with all that. But we haven’t been able to sell the house because of all these problems,” she said. “If a buyer asks questions we’re obligated to tell them the truth.”

 

Banned Pesticides

Labor and sex trafficking, animal abuse, gun violence and rampant environmental crimes have long been associated with illegal marijuana cultivation.

The prevalence of indoor grows and collateral impacts on residential buildings are not new or limited to California. In 2017 Denver police estimated one in 10 homes was being used to cultivate, leaving the city with a dangerous mold problem.

But the influx of banned toxic insecticides in California’s illicit operations is relatively novel, according to those on the front lines.

“About a year ago we started seeing these banned pesticides—they’ve made their way into most of the cultivation sites,” said Jeremiah LaRue, sheriff of Siskiyou County.

LaRue oversees a mountainous swath of Northwest California bordering Oregon, notorious for flourishing outdoor grows. Last year, the DCC confiscated more marijuana in Siskiyou than any other county aside from Alameda.

While operations have moved from federal lands to private property in recent years, LaRue said these days it’s a mix of outdoor grows, “hoop houses” and some converted residential homes.

Linares said he noticed an uptick in pesticides as some producers transitioned from outdoor to indoor.

“They’re easier to operate in that they can control the environment a lot better. So that’s why at least in the Los Angeles County area you see quite a few indoor grows,” he said, pointing to the Antelope Valley as a primary SoCal hotspot, along with the San Fernando Valley and Frazier Park in Kern County.

It may seem counterintuitive that indoor operations are increasingly relying on contraband pesticides, but the lack of natural predators inside means spider mites, aphids, mildew and black rot or fungus can easily take hold, explained Josh Wurzer, CEO and cofounder of SC Labs, a cannabis testing and research lab based in Santa Cruz, with outlets in Colorado, Arizona, Oregon, and Michigan.

“Once you get a single fungus spore or any tiny spider mite into a grow and it starts to proliferate, they take root and it takes off. There are no birds to eat them or natural controls to keep pests in check like there are outdoors.”

Morris, with Riverside County Code Enforcement, said she has observed a lot of indoor grows using fumigated miticides.

‘They tend to have a problem with spider mites, and I think some of the problem is someone tending several house grows, they get mites on them and take them to the next location.”

In the regulated market, growers have adopted organic solutions—such as neem oil, predatory insects, and sterile environments, Wurzer said. But on the black market, where there is no testing and no regulation, the point is to make money as fast as possible.

“If no one is checking, if consumers won’t know the difference, people will do what is easiest,” said Wurzer. “And the easiest solution is to spray all kinds of pesticides so there are no problems with pests and you get the highest yield and make as much money as possible.”

The California Department of Pesticide Regulation publishes a pocket guide for law and code enforcement officers, listing more than two dozen insecticides, fungicides, miticides, rodenticides, and plant growth regulators to look out for in mitigation operations. Several are banned in the United States.

Increasingly, officers say, they are finding chemicals they aren’t familiar with or can’t identify.

‘No One Is Going to Find It’

At recent raids, Katz’s team found endrine, a highly toxic pesticide with neurological, developmental, and reproductive effects that was discontinued in the United States in 1986 and has been shown to persist in soil for 14 years or more. They also found endosulfan sulfate, a similarly toxic pesticide known to be an endocrine disruptor, that was phased out in the United States by 2010 and globally banned under the 2011 Stockholm Convention.

“All kinds of chemicals are being found. The ones from China, they’re not even in any chemical library,” said Katz, noting they’re having to send samples to an “extremely expensive” lab in Sacramento.

“The EPA got involved. We’ve found all kinds of nerve agent pesticides, and they’re not listed in any of these libraries for the machines that read this stuff.”

When it comes to testing for pesticides on the regulated market, Wurzer said a proper lab can find any chemical eventually—if they’re looking for it and they know it exists.

“But we’re not as good at finding things we’re not looking for. If someone develops a new pesticide, until people realize it’s being used, no one is going to be looking for it, so no one is going to find it.”

That problem extends to products consumers buy in state-regulated dispensaries. While Wurzer says less than 3 percent of regulated cannabis samples his lab tests contain pesticides, growers are getting “really creative,” using compounds they know won’t show up in panels in order to circumvent regulation. “A lot of these line up with what we find in illegal grows—pesticides with Chinese origin,” he said.

After a recent investigation found “alarming” levels of toxic pesticides in regulated products, Wurzer said he’s begun offering an expanded testing panel that includes some of these known black market pesticides. But there are plenty of disreputable labs, he said, that will produce results their clients want to see.

On illegal grow sites, some pesticides look like wood chips, burned in halved soda cans as a fumigant; others come in bottles that are mixed and repurposed, leaving public safety teams to guess.

“They started bringing them into indoor grows, and it’s really hard for us to identify all the banned pesticides because they start taking labels off, they start mixing the canned products with other items, and it’s really hard to pinpoint exactly which items are from where, or if we’re finding the same items somewhere else,” Linares said.

The fact that these compounds are inhaled—either by unsuspecting consumers who think they’re smoking regulated cannabis, or by unsuspecting residents who move into a former grow house—exacerbates the harm.

As Wurzer explains, when the plant is inhaled rather than eaten, it goes directly into the lungs, bypassing many of the body’s natural defense mechanisms, like the digestive system and the liver, which filter toxins.

“Any pesticide deemed harmful on a food crop in the U.S. would be extra harmful when it’s inhaled,” Wurzer said.

“I can only imagine anyone who moves into these houses where they’ve been spraying indoors for years and years—certainly there would be off-gassing of these pesticides and the people living there would be breathing them in.”

Nor do they disappear when you stop using them. Wurzer recalled when growers using pesticides to cultivate medical marijuana at indoor facilities tried to transition after legalization but kept failing tests even though they’d phased out the chemicals.

“This was a huge issue. … Because these pesticides permeate every surface and are leeching out of the walls and ceilings,” he said. “The drywall absorbed them, the paint had absorbed them. The grow lights and the heat—now they were continuing to off-gas. The contaminated plants would fail pesticide tests a year later.”

At high enough levels, those agents can be just as toxic to humans as they are to bugs, he said, recalling the history of companies like Monsanto and Bayer, which repurposed compounds originally developed as chemical warfare during WWII for the agricultural market.

Similar to the challenge of regulating performance enhancing drugs in sports, he said, pesticide producers can create new compounds that will evade existing test panels.

‘It’s Just Pot’

California is home to one of the largest legal cannabis markets in the world. But since legalization the state’s black market has only grown, dwarfing and infecting its regulated sales.

“The bargain that was given to voters was—we’ll give out licenses, collect taxes to fund government services and smash the illegal market and the criminal organizations would go away,” Katz said. “That’s not happening. And these collateral issues are something they hadn’t even thought about.”

Recent raids have netted tens of thousands of plants and millions of dollars of product from subterranean operations the size of football fields. The state, touting ramped up enforcement, has seized more than $120 million worth of illegal cannabis so far this year.

In early August, the DCC reported the state’s Unified Cannabis Enforcement Task Force had served 309 warrants since its inception in 2022, and the agency reported serving 386 search warrants since it was formed in 2021, in operations that overlap with the task force’s. A representative for DCC said its enforcement division has served 250 warrants related to indoor grows since forming in 2021.

But some say soft laws, a patchwork approach, and regulatory blind spots—as well as a lack of interest from federal authorities and local prosecutors—are allowing the black market to wreak havoc.

Tom Lackey, a California assembly member whose district includes the Antelope Valley, thinks the dangers are underestimated, in part because of a prevailing misconception that “it’s just pot.”

 

He points to the fact that black market marijuana comprises some 80 percent of total sales in California, , and licensed growers pressured by high taxes and the cost of compliance are taking shortcuts to survive. Various industry analyses over the past several years have estimated between one half and two thirds of California sales are from illegal sources. According to a 2023 report by New Frontier Data, an estimated $77 billion—or 72 percent of all U.S. sales in 2022—were from illicit sources.

“We’ve overdone it. It’s well-intentioned but we’ve done very little to go after these illicit players. The majority of our focus is directed toward those trying to comply, which is ironic,” Lackey said.

When the state does go after illicit players, it’s costly and time-consuming, and labor-intensive intelligence gathering and warrants can lead to dead ends.

During the recent Lancaster raid, the city’s new assistant chief of police, Chris Roberts, gestured at the two dozen highly trained agents in tactical gear and said, “There’s a lot that goes into this. This isn’t cheap.”

Since voters passed Proposition 64 in 2016, illegal cultivation is a misdemeanor. Violating the six-plant-per-person limit carries the same penalty, regardless of how many plants you have. And while the law is written to include jail time for certain cultivation, possession, and other crimes, most communities have neither the appetite nor the space to incarcerate people for marijuana offenses.

“The court system would not, in my opinion, be locking someone up for six months,” Sheriff LaRue said, referring to the penalty for cultivating more than six plants.

“The jails are so impacted in most communities, there is just no space for people committing misdemeanors. To be housed in jail for any substantive time, it needs to be serious or violent. And marijuana possession, even if it’s thousands of plants, is still a minor crime. It would never happen because it’s not viewed as serious enough,” he said.

Some municipalities appear to be more aggressive, as in the Kern County sheriff’s recent raid of a massive underground grow that seized 17,650 plants and resulted in the arrest of three Chinese nationals. And in some cases a state agency like Fish and Wildlife will serve a warrant that leads to felony environmental crimes.

But that’s less likely to happen in the residential raids that tend to result in misdemeanor referrals to the district attorney, those familiar with the issue say.

“If they’re not going to charge you for dealing drugs, why would they charge you for environmental crimes? Typically drugs are a higher priority,” Welch says.

He estimates L.A. County’s illegal marijuana trade is “90 percent unenforced—and that might actually be somewhat forgiving.”

Previously, he told The Epoch Times that also applies even when there are narcotics or guns involved at the locations. “I’ve seen enough of these cases to know they’re not being filed,” he said.

An inquiry to the L.A. County District Attorney’s Office requesting total referrals for cannabis-related crimes, filings, and rejections was not returned.

Linares said it’s far more common for offenders to get fined, or informal probation. “I have not seen any jail sentences for the misdemeanors.”

Lackey suggested the relaxed penalties are in part because of a misconception–a “‘70s marijuana attitude”–about what the illicit industry really is.

“Everybody thinks people in this business look like Zig-Zag,” he said. “No—these are white collar, brilliant people making billions and billions of dollars. Our system is not taking them seriously.”

The environmental destruction and impacts of pesticides are super toxic—everyone knows this, Lackey said. “Some of these illicit grows, law enforcement finds deceased animals all over the place. The residential impact, molds, cancer, fertility issues—all sorts of human threats. But they turn a blind eye because it’s weed.”

While fentanyl deserves to be “front and center,” he said, “we can walk and chew gum at the same time.”

Chinese Dominance

At scale, the two problems are inextricably linked.

The uneasy mix of crime syndicates running illicit marijuana in California, according to law enforcement officials, includes Chinese and Hmong groups, Mexican cartels and Latin American street gangs, and Chaldean and Armenian organizations.

 

San Bernardino County Sheriff’s deputies review documents inside a home during a raid of an illegal cannabis farm in Newberry Springs, Calif., on March 29, 2024. Robyn Beck/AFP via Getty Images

While the DCC’s Linares says these groups are not all working together, they maintain a kind of territorial detente.

But according to the Drug Enforcement Administration (DEA), Mexican cartels and Chinese groups continue to dominate the state’s black market. And in recent years, federal investigations have unearthed how Chinese crime networks have risen to global prominence, in part by laundering cartel drug money.

Ray Donovan, the DEA’s former chief of operations, has described how networks supplying fentanyl precursor chemicals to Mexican cartels were also laundering fentanyl money and reinvesting it in illicit marijuana. Testifying before the House’s Select Committee on the CCP in April, he outlined how these groups operate with at least tacit support from the Chinese communist regime.

At a Senate drug caucus hearing later that month, William Kimbell, current chief of operations for the DEA, said his agency has found Chinese organizations have “taken over” marijuana cultivation in 23 states, some of which are “legitimate” but still staffed by people controlled by Chinese money laundering organizations.

A 2024 DEA report noted the recent uptick in the number of illicit grows linked to Chinese and other Asian organized crime groups, with “Asian investors” emerging as a new funding source of illegal marijuana production in the U.S.

“Asian drug trafficking organizations have been involved in illegal marijuana cultivation for decades, operating industrial-scale indoor marijuana grows in residential homes, primarily in the western United States,” the report states.

The federal government has kept its eye on California’s Central Valley, which stretches from the Sacramento Valley to the Tulare Basin; in 2017 more than 58 percent of 3.4 million marijuana plants the DEA eradicated in the United States were located in this region.

In 2018, an operation involving hundreds of federal and local agents raided 75 houses in the Sacramento area used for cultivation by Chinese drug traffickers, and filed civil forfeiture against more than 100 houses, making it one of the largest residential forfeitures in U.S. history.

In its announcement, the U.S. Justice Department said patterns had begun to emerge during years-long investigations of indoor grows in residential neighborhoods—including financing and distribution methods.

In 2019, a grand jury indicted six Chinese nationals on money laundering counts alleging they used funds from China to buy grow houses in Sacramento and Placer counties.

‘It’s All Connected’

“The fentanyl, the money laundering, the marijuana grows—it’s all connected,” Leland Lazarus, associate director of national security at Florida International University’s Jack D. Gordon Institute for Public Policy, told The Epoch Times in an email.

These syndicates, Lazarus said, typically employ illegal Chinese migrants, who are often subjected to forced labor or criminality, terrible working conditions, and even sexual violence.

Sheriff LaRue pointed to an instantly recognizable structure—as if growers had been given a manual—at Chinese-led grows, which dominate Siskiyou County.

“They’re almost cookie-cutter, they all look the same. Even the houses are the same. It’s almost a prescribed thing: This is what you’re going to use, this is what you’re going to have,” the sheriff said. “You can almost go on a site and say, ‘This is Chinese.’”

Lazarus notes U.S. law enforcement agencies have been tracking “the vast Chinese money laundering networks” across 22 states for years, but the problem remains “a lack of significant resources, language skills and cultural knowledge to truly dismantle these networks.”

LaRue conducted a recent raid in which his team encountered 28 people onsite—all of them elderly women. “We couldn’t talk to any of them. One that spoke English, she was not about to let anyone open their mouth. That bothers me,” he said. “What is really going on there?”

The women were released from custody while LaRue’s office continues its investigation.

Some of Lazarus’s recent research has focused on the vast reach of these organizations, far beyond California grow houses, or even the East Coast, where federal authorities say they are anchored.

“Like other transnational criminal organizations, Chinese illegal gangs operate around the globe. You’re seeing some of the same illicit activities in Southeast Asia, Europe, and even Latin America,” Lazarus said.

“And it’s hard to imagine that China—which is the largest surveillance state in the world—isn’t aware of these activities. That’s why we need a truly international effort to deal with the scourge of global Chinese organized crime.”

Path Forward

In a 2013 memorandum, then Deputy Attorney General James M. Cole outlined priorities for federal prosecutors in pursuing marijuana-related crimes, in large part deferring to state authority and taking a hands-off approach in jurisdictions that had legalized the drug.

Such guidance, Cole reasoned, relied on an expectation that those jurisdictions “will implement strong and effective regulatory and enforcement systems that will address the threat those state laws could pose to public safety, public health, and other law enforcement interests.”

To many working to contain the collateral fallout of California’s illegal marijuana trade, that has not happened.

“The feds are hands-off on anything involving cannabis,” said Katz, while also pointing to a lack of appetite among local prosecutors. “My guess would be they’re a little gun-shy about jury nullification. … A jury will be like, ‘Who cares? It’s just cannabis.’”

Lackey, the assembly member, is hopeful a DEA proposal to reclassify marijuana from a Schedule I drug to a Schedule III drug will loosen restrictions that, for example, prevent the legal market from using banks.

Meanwhile, he said, California needs to take the lead in stronger prosecution efforts and be able to mete out consequences.

“The reason we’re struggling in California is we’ve relaxed consequences, and of course that’s going to increase evasion and it’s going to create victims,” Lackey said. “It really has been a hurtful experience for me to have a front row seat to watch this mistake being made.”

For Katz and Morris, the key to navigating the no-man’s land between the state and the feds, between lax prosecution and the absence of a standardized mandate, remains collaboration.

Morris pointed to Riverside’s creation of a roundtable bringing together 43 jurisdictions each quarter to discuss what agents are seeing on the ground.

“We found there were a lot of the same players, especially in our sister counties like San Bernardino. … There’s a lot of money in this, so they change tactics,” she said. Learning how growers in Kern County were burying shipping containers to house grows, for example, helped Riverside stay ahead of the game, she said.

Katz says his department immerses itself in the issue, cross-training with other disciplines, attending Environmental Protection Agency trainings and medical conferences. In the absence of leadership, or a standard approach, they cobble it together.

“A lot of cities are not investing that kind of effort into combatting this problem, so they don’t even know what they don’t know,” he said.

Ultimately, he says, the battle has nothing to do with the morality of cannabis—“that’s not the war we’re waging”—and everything to do with preventing a multi-billion-dollar criminal industry from sickening and killing residents.

“They don’t care if the pesticides they apply in the house poisons a family. They don’t care about the people who consume their contaminated cannabis. Money is all that matters to them.

“Only a sociopath would allow other human beings into buildings that might kill them. That’s what we’re combatting.”

Source:

NIH:       National Institute on Drug Abuse – Premium Reports August 27, 2024

Parents Opposed to Pot Report on 312 Child Deaths Linked to Marijuana
News reports of child deaths since November 2012 show adult marijuana use harms minors. Violent neglect
includes marijuana DUI (35), guns (17). The last column includes infants (28) in the care of pot using moms

Please find the details below:

021424-Child-dangers-fact-sheet-FINAL

Source: https://poppot.org/wp-content/uploads/2024/02/021424-Child-dangers-fact-sheet-FINAL.pdf February 2024

  • A 48-year-old woman in California developed meningitis after between three and six medical marijuana blunts contaminated by a fungus daily
  • Meningitis causes potentially fatal brain and spinal cord inflammation 
  • This is the first known case of meningitis coming from cannabis 
  • The soil in Bakersfield, where the woman lived is known to be contaminated with another fungus that causes the flu-like ‘valley fever’ 
  • The dispensary and area soil are being investigated, though similar infections are unlikely for healthy people who smoke smaller quantities    

A 48-year-old woman in California contracted a potentially deadly meningitis infection in 2016 from smoking her favourite medical marijuana strain three to six times a day, according to a British Medical Journal case study report published last month. 

The infection came from a fungus, called cryptococcus, that most people contract from inhaling contaminated dust or eating food that mouse faeces have touched. 

Meningitis is the most common illness to develop from exposure to cryptococcus, and causes potentially fatal inflammation in the brain and spinal cord. 

Dr Bryan Shapiro, who treated the woman, says that cannabis smokers in California should be sure to know where their marijuana came from, especially if their immune systems are compromised in any way, as meningitis could be lethal for them. 

The unnamed woman’s sister brought her to the Cedars-Sinai Medical Center (CSMC) in Los Angeles, California. She had ‘strange symptoms,’ Dr Shapiro said, including being dizzy, tired, struggling to recall even her own name, and behaving aggressively. 

In fact, her behaviour had become so erratic that she was fired from her job as an administrative assistant before being admitted to the hospital. 

At CSMC, the emergency room team could not figure out what was ailing the otherwise healthy patient. When she assaulted a nurse, the team called in the psychiatric department.  

‘We thought it might be catatonia [abnormal movement triggered by mental issues], and it took us some time to rule out a psychiatric illness,’ Dr Shapiro said. 

Still unable to diagnose her, they took a sample of her brain fluid, which tested positive for Cryptococcus neoformans, ‘a rare fungal infection usually only seen in people with late stage HIV or transplant patients,’ Dr Shapiro explained. 

But the woman was otherwise in reasonably good health. The only things that stood out in her medical history were high blood pressure and a significant marijuana habit. 

‘She said she had smoked between three and six marijuana blunts about daily since her teenage years,’ Shapiro said, ‘I’ve never known a patient who smokes that heavily and wondered if there could be a link between her heavy cannabis use for a lifetime.’ 

They treated the woman for meningitis, but if they hadn’t done so ‘prudently…there is a strong possibility she would have died, she was very, very severe at the time we saw her,’ he says. 

As she was recovering, Dr Shapiro and his team investigated her favourite medical marijuana dispensary in Bakersfield where she always purchased one of the shop’s cheaper strains, which was grown locally outdoors.

DNA sequencing of nine samples revealed small amounts of the rare fungus. 

‘That lent credibility to the idea that the cryptococcus in the cannabis may have caused the woman’s systemic malfunction, and smoking might actually predispose someone to invasive fungal infection,’ Dr Shapiro said. 

Fungus spores are actually grow on cannabis quite commonly. 

A study conducted last year identified evidence of mould, pesticides and other contaminants on much of the weed grown in the state.  

More than 90 percent of the marijuana plants tested were contaminated with pesticides, and crops from 20 farms were positive for mold. 

The soil in Bakersfield and the surrounding Central Valley area is known to be a breeding ground for another fungus called Coccidioides immitis, which is to blame for a slew of cases of an infection, dubbed ‘valley fever.’ 

Valley fever is a potentially sever lung infection and its symptoms can mirror those of the flu that has killed nearly 100 people in California since the start of the year. 

The prevalence of the valley fever fungus – which causes infection when it is inhaled – in the area ‘raised suspicions’ for Dr Shapiro and his team that the soil could harbour cryptococcus as well. 

The spores of these fungi are very heat resistant, so they survive even as the weed they are attached to is smoked. 

Even so, it is rare for someone with an otherwise healthy immune system to get such an infection, and Dr Shapiro points to other research that has suggested that THC – the psychoactive component of weed – may itself suppress the immune system. 

‘So, the more you smoke, the greater the exposure [to the fungus and] the more likely it is that your body is unable to fight off the infection,’ he says. 

Dr Shapiro was unable to disclose the name of the particular dispensary that the contaminated marijuana came from, but said that it is under investigation.

This case was the first of its kind that Dr Shapiro or his team had seen, so it’s too early to make formal recommendations, he says, but advises: ‘Make sure you know where your marijuana is coming from. 

‘I recommend buying indoor-grown strains and, for people who are immuno-compromised like those with HIV or other infections, I would recommend avoiding inhaled marijuana products,’ he says. Edible products, on the other hand are probably safer for consumption.     

Source: https://www.dailymail.co.uk/health/article-5327367/California-woman-caught-meningitis-CANNABIS.html January 2018

How much should we worry?

American parents have been warning teenagers about the dangers of marijuana for about 100 years. Teenagers have been ignoring them for just as long. As I write this, a couple of kids are smoking weed in the woods just yards from my office window and about a block and a half from the local high school. They started in around 9 A.M., just in time for class.

Exaggerating the perils of cannabis—the risks of brain damage, addiction, psychosis—has not helped. Any whiff of Reefer Madness hyperbole is perfectly calibrated to trigger an adolescent’s instinctive skepticism for whatever an adult suggests. And the unvarnished facts are scary enough.

We know that being high impairs attention, memory and learning. Some of today’s stronger varieties can make you physically ill and delusional. But whether marijuana can cause lasting damage to the brain is less clear.

A slew of studies in adults have found that nonusers beat chronic weed smokers on tests of attention, memory, motor skills and verbal abilities, but some of this might be the result of lingering traces of cannabis in the body of users or withdrawal effects from abstaining while taking part in a study. In one hopeful finding, a 2012 meta-analysis found that in 13 studies in which participants had laid off weed for 25 days or more, their performance on cognitive tests did not differ significantly from that of nonusers.

But scientists are less sanguine about teenage tokers. During adolescence the brain matures in several ways believed to make it more efficient and to strengthen executive functions such as emotional self-control. Various lines of research suggest that cannabis use could disrupt such processes.

For one thing, recent studies show that cannabinoids manufactured by our own nerve cells play a crucial role in wiring the brain, both prenatally and during adolescence. Throughout life they regulate appetite, sleep, emotion, memory and movement—which makes sense when you consider the effects of marijuana. There are “huge changes” in the concentration of these endocannabinoids during the teenage years, according to neurologist Yasmin Hurd of the Icahn School of Medicine at Mount Sinai, which is why she and others who study this system worry about the impact of casually dosing it with weed.

Brain-imaging studies reinforce this concern. A number of smallish studies have seen differences in the brains of habitual weed smokers, including altered connectivity between the hemispheres, inefficient cognitive processing in adolescent users, and a smaller amygdala and hippocampus—structures involved in emotional regulation and memory, respectively.

More evidence comes from research in animals. Rats given THC, the chemical that puts the high in marijuana, show persistent cognitive difficulties if exposed around the time of puberty—but not if they are exposed as adults.

But the case for permanent damage is not airtight. Studies in rats tend to use much higher doses of THC than even a committed pothead would absorb, and rodent adolescence is just a couple of weeks long—nothing like ours. With brain-imaging studies, the samples are small, and the causality is uncertain. It is particularly hard to untangle factors such as childhood poverty, abuse and neglect, which also make their mark on brain anatomy and which correlate with more substance abuse, notes Nora Volkow, director of the National Institute on Drug Abuse and lead author of a superb 2016 review of cannabis research in JAMA Psychiatry.

To really sort this out, we need to look at kids from childhood to early adulthood. The Adolescent Brain Cognitive Development study, now under way at the National Institutes of Health, should fill the gap. The 10-year project will follow 10,000 children from age nine or 10, soaking up information from brain scans, genetic and psychological tests, academic records and surveys. Among other things, it should help pin down the complex role marijuana seems to play in triggering schizophrenia in some people.

But even if it turns out that weed does not pose a direct danger for most teens, it’s hardly benign. If, like those kids outside my window, you frequently show up high in class, you will likely miss the intellectual and social stimulation to which the adolescent brain is perfectly tuned. This is the period, Volkow notes, “for maximizing our capacity to navigate complex situations,” literally building brainpower. On average, adolescents who partake heavily wind up achieving less in life and are unhappier. And those are things a teenager might care about.

Source: https://www.scientificamerican.com/article/what-pot-really-does-to-the-teen-brain/ December 2017

Open Access: https://en.wikipedia.org/wiki/Open_access
The article as uploaded shows link to tables e.g.(Table X) which, for brevity, have been deleted. Please therefore ignore these links!

Summary

Background

Cancer, coronary heart disease, dementia, and stroke are major contributors to morbidity and mortality in England. We aimed to assess the economic burden (including health-care, social care, and informal care costs, as well as productivity losses) of these four conditions in England in 2018, and forecast this cost to 2050 using population projections.

Methods

We used individual patient-level data from the Clinical Practice Research Datalink (CPRD) Aurum, which contains primary care electronic health records of patients from 738 general practices in England, to calculate health-care and residential and nursing home resource use, and data from the English Longitudinal Study on Ageing (ELSA) to calculate informal and formal care costs. From CPRD Aurum, we included patients registered on Jan 1, 2018, in a CPRD general practice with Hospital Episode Statistics (HES)-linked records, omitting all children younger than 1 year. From ELSA, we included data collected from wave 9 (2018–19). Aggregate English resource use data on morbidity, mortality, and health-care, social care, and informal care were obtained and apportioned, using multivariable regression analyses, to cancer, coronary heart disease, dementia, and stroke.

Findings

We included 4 161 558 patients from CPRD Aurum with HES-linked data (mean age 41 years [SD 23], with 2 079 679 [50·0%] men and 2 081 879 [50·0%] women) and 8736 patients in ELSA (68 years [11], with 4882 [55·9 %] men and 3854 [44·1%] women). In 2018, the total cost was £18·9 billion (95% CI 18·4–19·4) for cancer, £12·7 billion (12·3–13·0) for coronary heart disease, £11·7 billion (9·6–12·7) for dementia, and £8·6 billion (8·2–9·0) for stroke. Using 2050 English population projections, we estimated that costs would rise by 40% (39–41) for cancer, 54% (53–55) for coronary heart disease, 100% (97–102) for dementia, and 85% (84–86) for stroke, for a total of £26·5 billion (25·7–27·3), £19·6 billion (18·9–20·2), £23·5 billion (19·3–25·3), and £16·0 billion (15·3–16·6), respectively.

Interpretation

This study provides contemporary estimates of the wide-ranging impact of the most important chronic conditions on all aspects of the economy in England. The data will help to inform evidence-based polices to reduce the impact of chronic disease, promoting care access, better health outcomes, and economic sustainability.

Introduction

Public health initiatives and the development of cardioprotective medications have led to an increase in life expectancy in the past six decades, giving rise to an ageing population.

This ageing population is suffering from a different set of medical issues than the population a century ago, with cancer, coronary heart disease, dementia, and stroke being the four leading causes for mortality and morbidity in England.

In 2019, these four conditions accounted for 59% of all deaths and 5·1 million disability-adjusted life-years in England.

Research investment is essential to combat major public health challenges, facilitating the development of new treatments and interventions that can improve rates of prevention, treatment, or management of diseases, enhancing quality of life and reducing their economic burden. However, it is important that the distribution of research funding across diseases is proportionate to their respective impact on society. In 2008, a UK study (Dementia 2010) evaluated the economic costs of, and research investment into dementia, and compared these costs and investments with those for cancer, coronary heart disease, and stroke.

Such estimates are important to inform health policy and identify diseases in need of greater investment,

with successive UK Governments having placed a greater priority for research funding in dementia.

However, previous studies that quantified the costs of these four chronic conditions had several important limitations, including that care resource use for each of the four conditions was apportioned based on assumptions and estimates from the literature, with methods differing between conditions. With representative cohorts from England, we are now able to estimate the economic burden of these conditions using individual patient-level data and a consistent methodology across conditions. Therefore, we aimed to estimate the economic burden of cancer, coronary heart disease, dementia, and stroke in England in 2018, and forecast this cost to 2050 using population projections.
Research in context
Evidence before this study
We conducted a systematic review of the literature to identify studies evaluating the costs of dementia. We searched MEDLINE, Embase, Cochrane Database of Systematic Reviews, Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, EconLit, Cost-Effectiveness Analysis Registry, Turning Research Into Practice, NHS Economic Evaluation Database, Science Citation Index, Research Papers in Economics, and OpenGrey Repository from Jan 1, 2000, to Aug 31, 2023. Search terms included “dementia”, “Alzheimer’s disease”, “cognitive impairment”, “costs”, and “resources”, among others. Except for one study conducted for the year 2008, we did not find any current study evaluating and contrasting the costs of the four chronic conditions with the highest mortality and morbidity burden in England—namely, cancer, coronary heart disease, dementia, and stroke. This study found that the total costs of dementia in England were £23·4 billion, followed by cancer (£12·0 billion), coronary heart disease (£7·8 billion), and stroke (£5·0 billion). However, these estimates were not estimated concurrently, with methodologies and sources of data varying considerably across conditions, including from generally small studies, which did not capture the impact of comorbidities on the levels of care provided. Therefore, results for each of the four conditions are probably not comparable.
Added value of this study
Our study assesses the total costs of cancer, coronary heart disease, dementia, and stroke, concurrently using patient-level data from two representative English cohorts: the Clinical Practice Research Datalink Aurum and the English Longitudinal Study on Ageing. We show that cancer, coronary heart disease, and dementia had similar overall health-care and social care costs, but when other costs were included, cancer had the highest overall economic burden. Using age-specific and gender-specific population projections to 2050, we found that the costs of the four conditions increased by 64% due to population ageing alone, with social care costs increasing by 104% between 2018 and 2050.
Implications of all the available evidence
Our study sheds light on the significant consequences of the four most important chronic conditions in terms of mortality and morbidity in England on various sectors of the economy. The data we present not only emphasise the magnitude of the economic burden caused by cancer, coronary heart disease, dementia, and stroke but also provide valuable insights for public health decision makers. By identifying the specific areas that require targeted interventions, our findings can guide policy makers in implementing strategic measures to alleviate the economic burden of these four conditions. With a projected increase in costs of 64% by 2050, our research findings can aid in directing governmental research expenditure to areas that hold the greatest potential for advancing the prevention, diagnosis, and treatment of disease, further reducing its economic impact on England.

Methods

Analysis framework and data sources

We adopted a societal perspective for our analyses, with inclusion of the following costs: health care, social care (defined as residential and nursing home, and formal care costs), informal care, and productivity losses. We used an annual timeframe that included all costs for 2018, irrespective of the time of disease onset. We obtained England-specific aggregate resource use data on health and social care, mortality, morbidity, and prevalence of disease. To apportion aggregate data on health, and residential and nursing home resource use to each of the four conditions, we analysed individual patient-level data from the Clinical Practice Research Datalink (CPRD) Aurum linked to National Health Service Hospital Episode Statistics (HES).

CPRD Aurum is a large database of routinely recorded primary care electronic health records of patients from 738 general practices in England (10% of practices), covering 13% of the population.

The database contains information on symptoms, diagnoses, prescriptions, referrals, tests, immunisation, and medical staff. Primary care and secondary care diagnosis codes were used to identify the four conditions of interest. CPRD Aurum codes used to diagnose patients in primary care are reported in the appendix (pp 2–55). CPRD records were then linked to secondary care records contained in HES using Aurum (version 2.3) from August, 2019. In secondary care records, cancer was defined by ICD-10 category codes I00–I99, coronary heart disease by codes I20–I25, dementia by codes F00–F03 and G30, and stroke by codes I60–I69. The use of CPRD Aurum for this study was approved by the independent scientific advisory committee for CPRD research (protocol reference CPRD00120051). CPRD obtains annual research ethics approval from the UK’s Health Research Authority Research Ethics Committee (05/MRE04/87) to receive and supply patient data for public health research. No further ethical permissions were required for the analyses of these anonymised patient-level data. The analysis was based on 4 161 588 patients registered on Jan 1, 2018, in a CPRD general practice with HES-linked records, omitting all children younger than 1 year (appendix pp 56–57).

Informal and formal care information was obtained from the English Longitudinal Study on Ageing (ELSA).

ELSA collects data from people older than 50 years, with spouses from age 40 years also included, to understand all aspects of ageing in England. More than 18 000 people have taken part in the study since it started in 2002, with the same people re-interviewed every 2 years. For this study, we used information on wave 9 (2018–19; appendix pp 58–59). Access to ELSA, through the UK Data Service, was obtained as part of the UK Access Management Federation. ELSA has been approved by the National Research Ethics Service (London Multicentre Research Ethics Committee [MREC/01/2/91]).

Health-care resource costs

Primary care consisted of visits with general practitioners and practice nurses in health-care facilities or in patients’ homes. Accident and emergency care consisted of all hospital emergency visits. Outpatient care consisted of specialist consultations and treatments in outpatient wards, clinics, or patients’ homes. Hospital care consisted of hospital admissions, including day cases and inpatient stays. Pharmaceutical expenditure included the costs of all prescriptions dispensed in the community (eg, pharmacies), but excluded costs of medications administered in secondary care settings, which were included in the costs of inpatient care.
We obtained the overall total number of all-cause health-care contacts with each type of service and medication expenditure in England (table 1; appendix p 60). Patient-level data from CPRD Aurum with HES linkage were then used to apportion all-cause health-care contacts and pharmaceutical expenditure in England to cancer, coronary heart disease, dementia, and stroke. All resource use was valued using relevant unit costs.

Nursing and residential care home costs

We included resources associated with living in a nursing home (requiring 24 h nursing care) or residential home (accommodation supporting people who are not able to manage everyday tasks).

Of the more than 10 million people in England aged 65 years or older in 2018, 5% were living in a nursing or residential care home.

Using patient-level data from CPRD Aurum, we apportioned the proportion of people living in a nursing or residential care home in England due to cancer, coronary heart disease, dementia, and stroke (table 1; appendix pp 65–66). Nursing and residential home care home cost was valued at £837 per week,

taking into account the relative proportions of people living in nursing and residential homes,

and the local authority, not-for profit, and profit sector provision case mix.

Informal and formal care

Informal care costs were equivalent to the opportunity cost of unpaid care (ie, the time [work, leisure, or both] that carers forgo), valued in monetary terms, to provide unpaid care for relatives or friends with cancer, coronary heart disease, dementia, or stroke, and based on the conservative assumption that only patients limited in daily activities received care. We valued informal care using the proxy good method, in which an hour of informal care provided was valued using the labour market price of a close market substitute

(i,e. the mean hourly wage for a home care assistant [£7·85]).

Hence, for informal care, we multiplied the age-specific and gender-specific products of age-specific and gender-specific prevalence of cancer, coronary heart disease, dementia, and stroke in England;

the probability of living in the community (appendix p 66); the probability of being severely limited in daily activities as a result of each of the four conditions under study (appendix p 67); the probability of receiving informal care conditional on being limited in daily activities (appendix p 67); and the hours of informal care received, conditional on being limited in daily activities and receiving informal care (appendix p 67).

Formal care costs included the costs associated with paid care for patients living in the community, which was valued at £27·00 per h.

For formal care, we multiplied the age-specific and gender-specific products of age-specific and gender-specific prevalence of cancer, coronary heart disease, dementia, and stroke in England;

the probability of living in the community (appendix p 66); the probability of receiving formal care (appendix p 68); and the hours of formal care received, conditional on receiving formal care (appendix p 68).

Given that ELSA had no participants younger than 40 years, care was only estimated for those aged 40 years or older.

Morbidity losses

Morbidity losses were determined to be the cost associated with temporary or permanent absence from work in patients with cancer, coronary heart disease, dementia, or stroke.

Annual days off sick were obtained from the European Working Conditions Surveys.

To the total number of days of work due to sickness, we applied the proportion of absence that was attributable to cancer, coronary heart disease, dementia, and stroke, which was obtained from the UK Department of Works and Pensions (personal communication).

To calculate permanent absence from work due to sickness or disability, information on the numbers of working-age individuals receiving incapacity or disability benefits and not being able to work was obtained, including recipients of the disability living allowance, employment support allowance (ESA), and incapacity benefit by condition.

Given that recipients of ESA can work up to 45·82% of their time, we only included the proportion of time that was not worked.

Days of absence from work due to sickness or disability were multiplied by mean daily earnings.

Furthermore, for permanent absence, we used the friction period approach because absent workers are likely to be replaced, whereby only the first 90 days of work absence were counted.

Mortality losses

We assumed an initial working age of 15 years and a maximum age of retirement of 79 years. Age-specific and gender-specific deaths due to cancer, coronary heart disease, dementia, and stroke were obtained.

The number of potential working years lost was then estimated as the difference between the age at death and maximum age of retirement. Each lost year of working life was valued using average annual earnings.

However, not all of the population is economically active until age 79 years; hence, age-specific and gender-specific unemployment and activity rates

were applied to the potential foregone earnings. Following UK-recommended guidelines, future earnings lost due to mortality were discounted to present values using a 3·5% annual rate.

Statistical analysis

CPRD Aurum data analyses informed the age-specific and gender-specific health-care resource use and nursing or residential care home use associated with cancer, coronary heart disease, dementia, and stroke. ELSA data analyses were used to derive the age-specific and gender-specific estimates needed to inform the calculations of informal and formal care received associated with the four conditions. To achieve this, we used regression analyses (Poisson, logistic, and generalised linear models) for each type of resource use, adjusting for history of cancer, coronary heart disease, dementia, or stroke; Elixhauser comorbidity index; age; and gender. Together with data on disease prevalence, we used the derived models to estimate the total costs associated with each condition. For more details, see the appendix (pp 60–68).

Finally, we projected the costs estimated for 2018 to 2050 based on future projections of the population alone,

excluding other factors such as epidemiological trends of the four conditions under investigation, risk factor prevalence rates, and life expectancy.

For this, we applied age-specific and gender-specific rates of resource use, prevalence, mortality, and disability observed in 2018 to the predicted distribution of the population in 2050. We valued resource use in 2050 using 2018 costs. For more details, see the appendix (pp 69–71).

Total resource use estimates and costs are reported alongside 95% CIs, which were derived using 1000 bootstrap estimates of all resource use regressions undertaken in CPRD Aurum and ELSA. Given that country-wide productivity loss estimates were obtained (eg, disease-specific working days lost, disability claims, and deaths), sampling uncertainty was not required, and these cost estimates are provided as point estimates. Population projections were not provided with uncertainty levels so these are also treated as point estimates. Significance was set at a p value of less than 0·05.
All analyses were conducted in STATA (version 15, 64-bit).

Role of the funding source

The funder of the study had no role in the study design; the collection, analysis, and interpretation of data; the writing of the report; or in the decision to submit the paper for publication.

Results

The analyses to apportion total all-cause health-care and nursing and residential care home resource use in England to cancer, coronary heart disease, dementia, and stroke was based on 4 161 558 patients in CPRD Aurum with linked HES data (mean age 41 years [SD 23]), with 2 079 679 (50·0%) men and 2 081 879 (50·0%) women. Of these patients, 174 942 (4·2%) had a history of cancer either in primary or secondary care records, 191 603 (4·6%) of coronary heart disease, 52 862 (1·3%) of dementia, and 61 509 (1·5%) of stroke (appendix p 56).
To estimate total hours of formal and informal care in England due to cancer, coronary heart disease, dementia, and stroke, analyses were based on 8736 patients in ELSA (mean age 68 years [SD 11]), with 4882 (55·9%) men and 3854 (44·1%) women. Of these patients, 744 (8·5%) had a history of cancer, 423 (4·8%) of coronary heart disease, 211 (2·4%) of dementia, and 313 (3·6%) of stroke (appendix p 58).
Of all admissions to hospitals (including day cases and inpatient stays) in 2018, 2 164 000 (95% CI 2 083 000–2 243 000) admissions were found to be associated with patients with cancer, followed by coronary heart disease (1 081 000 [1 053 000–1 110 000]), stroke (517 000 [497 000–535 000]), and dementia (234 000 [224 000–244 000]; table 2). The condition with the highest prescribed pharmaceutical expenditure was coronary heart disease (£982 million [95% CI 968–998]), followed by cancer (£925 million [909–940]), stroke (£451 million [437–464]), and dementia (£277 million [269–285]). Overall, the health-care costs associated with these conditions in England were £8·1 billion (95% CI 8·0–8·2) for cancer, £6·7 billion (6·6–6·7) for coronary heart disease, £1·5 billion (1·5–1·6) for dementia, and £3·4 billion (3·4–3·5) for stroke.
About 133 000 (95% CI 126 000–141 000) people older than 65 years with dementia were living in residential or nursing homes in 2018. This estimate was higher than for stroke (75 000 [95% CI 70 000–80 000]), coronary heart disease (52 000 [49 000–54 000]), and cancer (33 000 [31 000–35 000]). Living in residential or nursing homes accounted for costs of £5·8 billion (95% CI 5·5–6·1) for dementia, £3·2 billion (3·1–3·4) for stroke, £2·2 billion (2·1–2·4) for coronary heart disease, and £1·4 billion (1·4–1·5) for cancer (table 2).
Overall health-care and social care costs were £9·7 billion (95% CI 9·5–9·9) for cancer, £8·9 billion (8·8–9·0) for coronary heart disease, £8·0 billion (7·3–8·6) for dementia, and £6·9 billion (6·6–7·1) for stroke (table 2). This resulted in costs of £174 (95% CI 171–178) per capita for cancer, £162 (158–164) for coronary heart disease, £144 (132–155) for dementia, and £124 (120–129) for stroke (appendix p 72). Per person with the condition, the highest health-care and social care costs were associated with stroke at £12 923 (95% CI 12 491–13 399), followed by dementia at £11 641 (10 680–12 558), cancer at £6660 (6526–6803), and coronary heart disease at £5530 (5437–5625).
Friends and family spent a total of 115 million h (95% CI 62–175) providing informal care for patients with cancer; 95 million h (46–137) for those with coronary heart disease, 461 million h (224–561) for those with dementia, and 75 million h (37–110) for those with stroke (table 2). Total informal care costs were £905 million (95% CI 486–1374) for cancer, £748 million (365–1758) for coronary heart disease, £3619 million (1758–4405) for dementia, and £587 million (291–865) for stroke.
More than 271 000 working years were lost due to cancer, 80 000 due to coronary heart disease, 3000 due to dementia, and 37 000 due to stroke, with corresponding mortality losses of £7·8 billion, £2·6 billion, £0·1 billion, and £0·8 billion, respectively (table 2). Losses due to temporary and permanent absence from work due to illness and disability for the conditions under study were £497 million for cancer, £378 million for coronary heart disease, £49 million for dementia, and £362 million for stroke. Overall, productivity losses were highest for cancer (£8·3 billion), followed by coronary heart disease (£3·0 billion), stroke (£1·2 billion), and dementia (£0·1 billion).
The overall costs in England in 2018 were £18·9 billion (95% CI 18·4–19·4) for cancer, £12·7 billion (12·3–13·0) for coronary heart disease, £11·7 billion (9·6–12·7) for dementia, and £8·6 billion (8·2–9·0) for stroke (table 2). Per case, patients with dementia had the highest costs at £17 145 (95% CI 13 998–18 604), followed by stroke at £16 224 (15 482–16 954), cancer at £13 031 (12 681–13 393), and coronary heart disease at £7857 (7599–8068; appendix p 72).
The way costs were distributed among cost categories varied considerably by condition (table 2; figure 1). The proportion of total costs due to health care varied from 52% (£6·7 billion) for coronary heart disease to 13% (£1·5 billion) for dementia. Although productivity losses accounted for 44% (£8·3 billion) of the total costs for cancer, for dementia these accounted for 1% (£145 million) of total costs.
Figure 1 – Distribution of total costs in patients with cancer, coronary heart disease, dementia, and stroke in England in 2018

 

The population of England, excluding those younger than 1 year, is expected to increase from 55 million in 2018 to 65 million in 2050 (18% increase), with the population aged 65 years or older projected to increase by 49% (from 10 million to 15 million).

Assuming no changes in age-specific and gender-specific prevalence rates, this population increase will increase the number of people with cancer by 39% (2·0 million), coronary heart disease by 45% (2·3 million), dementia by 81% (1·2 million), and stroke by 41% (0·8 million; appendix p 69).

These increases in the overall disease prevalence will result in cost increases between 2018 and 2050 of 40% (95% CI 39–41) to £26·5 billion (25·7–27·3) for cancer, 54% (53–55) to £19·6 billion (18·9–20·2) for coronary heart disease, 100% (97–102) to £23·5 billion (19·3–25·3) for dementia, and 85% (84–86) to £16·0 billion (15·3–16·6) for stroke (table 3). Costs with the highest increases are those related to social care, which are projected to rise between 2018 and 2050 by 88% (95% CI 86–90) to £2·9 billion (2·7–3·3) for cancer, 91% (90–92) to £4·4 billion (4·1–4·6) for coronary heart disease, 110% (109–111) to £13·5 billion (12·1–14·8) for dementia, and 109% (107–108) to £7·1 billion (6·6–7·5) for stroke (figure 2).

Figure 2 – Total costs of cancer, coronary heart disease, dementia, and stroke in England in 2018 and the projected costs in 2050 due to demographic change alone

Discussion

Whereas a previous study has assessed the overall costs of chronic conditions, our study made use of individual patient-level data to generate more precise cost estimates for cancer, coronary heart disease, dementia, and stroke, using the same methodology and sources across conditions. Previously the total costs of dementia in the UK were calculated as £23·4 billion, followed by cancer (£12·0 billion), coronary heart disease (£7·8 billion), and stroke (£5·0 billion).

These estimates are not comparable with the findings in this study, possibly due to methodologies and sources of data varying considerably across conditions.

Our results show that the areas of the economy bearing these costs differed substantially by disease area. For example, health-care costs of dementia accounted for 13% (£1·5 billion) of the total, with most costs being borne by the social care system (£6·4 billion, 55% of total costs). By contrast, in cancer, the majority of costs were borne by the labour market, with £8·3 billion in lost productivity (44% of total costs). These findings are notable in that they further emphasise the need for interventions designed to prevent or screen for early-stage disease. For cancer and, to a lesser extent, coronary heart disease, with so much of the cost borne by the labour market, interventions that prevent the disease will not only increase the health of the population and reduce health-care costs, but also improve labour productivity. However, these findings also raise important questions about perceived fairness and equality.

In the UK, about 90% of hospital cases, which according to our findings is where most of the care of patients with cancer or coronary heart disease takes place, is funded by the government (data are from the Eurostat database). By contrast, for dementia and, to a lesser extent, stroke, most of the care takes place in either the social care system, of which 60% is funded by the government, or by relatives and friends through informal care (data are from the Eurostat database). Therefore, patients with dementia and stroke are substantially at higher risk of having to fund their care themselves than those with cancer or coronary heart disease.

Our study also shows the effect of the projected population ageing over the coming decades. On the basis of demographic change alone, we project that the costs of cancer will increase by 40%, those of coronary heart disease by 54%, those of dementia by 100%, and those of stroke by 85%. With the population aged 65 years or older projected to increase by 49%, the costs with the fastest projected rise will be, averaged across all four conditions, for social care, with a 104% projected increase in costs, and informal care, with a projected increase of 78%. Therefore, research funding into interventions aimed to prevent, treat, and care for disease are required as a way to help to reduce or mitigate this projected increase in costs and improve health, especially in those conditions—ie, stroke and dementia—seeing the fastest increase in costs, and that historically have received the lowest levels of research funding.

The limitations of this study should be noted. Our results are based on diagnostic coding from both primary and secondary care records, rather than on careful ascertainment of patients through multiple and overlapping methods such as in population-based cohort studies. Therefore, our results might not reflect the absolute prevalence and costs of disease. Given that there is no single and simple diagnostic test for dementia, this under-ascertainment of disease in routinely collected health data or surveys might be most prevalent in dementia.

The failure to identify these undiagnosed cases might explain the relatively low levels of health-care resource use identified in CPRD Aurum due to dementia.

For diseases affecting cognitive ability, such as dementia and stroke, supervision will be a major component of any informal care provided.

However, in ELSA, respondents were not explicitly asked for supervisory activities received, with our results likely to be an underestimate. We were unable to quantify the costs of formal and informal care in people younger than 40 years. This will, inevitably, have reduced our total estimates of costs, especially for cancer and stroke, where people younger than 40 years account for 6% (110 000) and 8% (60 000) of cases, respectively, compared with 2% (41 000) for coronary heart disease and less than 1% (5000) for dementia.

Finally, our projection of costs from 2018 to 2050 was based on future projections of the population alone, and might be considered simplistic. Our projections did not include other factors, such as epidemiological trends of the four conditions under investigation or the predicted rise in comorbidities predicted for England.

For example, analyses based on ELSA have projected the costs of dementia in the future based on current trends in cardiovascular disease incidence rates.

In addition, new treatments that prevent, slow progression, or successfully treat the four conditions under study, will undoubtedly affect the projected costs estimated in this study.

In conclusion, our study sheds light on the substantial consequences of the four most important chronic conditions in terms of mortality and morbidity in England on various sectors of the economy. These data not only emphasise the magnitude of the economic burden but also provide valuable insights for public health decision makers. By identifying the specific areas that require targeted interventions, our findings can guide policy makers in implementing strategic measures to alleviate the economic burden of these four conditions and improve patient health outcomes. With a projected increase in costs of more than 60% across the four conditions by 2050, our research findings can aid in directing governmental research expenditure in areas that hold the greatest potential for advancing the prevention, diagnosis, and treatment of disease, further reducing its economic impact.

Source: https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(24)00108-9/fulltext

Highlights

  • “Kratom” commonly refers to an herbal substance that can produce opioid- and stimulant-like effects. Kratom and kratom-based products are currently legal and accessible in many areas, though U.S. and international agencies continue to review emerging evidence to inform kratom policy.
  • While there are no uses for kratom approved by the U.S. Food and Drug Administration, people report using kratom to manage drug withdrawal symptoms and cravings (especially related to opioid use), pain, fatigue and mental health problems. NIDA supports and conducts research to evaluate potential medicinal uses for kratom and related chemical compounds.
  • NIDA also supports research towards better understanding the health and safety effects of kratom use. Rare but serious effects have been reported in people who use kratom, including psychiatric, cardiovascular, gastrointestinal and respiratory problems.
  • Compared to deaths from other drugs, a very small number of deaths have been linked to kratom products and nearly all cases involved other drugs or contaminants.

 

Research topics

To access these references below, go to https://nida.nih.gov/research-topics/kratom#references

What is kratom?

How does kratom affect the body?

How do kratom compounds work in the brain?

How is NIDA advancing research on kratom?

What is the scope of kratom use in the United States?

Why do people use kratom?

Is kratom safe?

How does kratom use affect pregnancy?

Is kratom addictive? Do people experience kratom withdrawal?

How are withdrawal and substance use disorder symptoms related to kratom use treated?

Could kratom be used as medicine?

Is kratom legal?

Find More Resources on Kratom

Source: https://nida.nih.gov/research-topics/kratom#references

 

Filed under: Kratom,USA :

 

Mothers of children who died via fentanyl poisoning champion NC’s new death-by-distribution law and continue to advocate for awareness

BY GALE MELCHER   The CityBeat 

JULY 20TH, 2024

On a billboard off of Battleground Avenue in Greensboro, 20 smiling faces flash grins through the screen — smiles that will forever be contained in pictures and their families’ memories. All 20 people pictured on the billboard passed away after taking drugs they didn’t know were laced with fentanyl, a synthetic opioid drug that is being mass-produced and added to other illicit drugs to increase their potency. This often results in death — in North Carolina, 183 deaths occurred this March.

Next to the faces a message reads: “Hidden in so-called ‘recreational’ drugs, fentanyl steals families.”

On July 6 around noon, families gathered around Elizabeth’s Pizza facing the billboard to remember their loved ones and raise awareness about the dangers of illicit drugs.

Deborah Peeden lost her granddaughter Ashley in October 2021 and shared her story with TCB last year.

In 2023, the Drug Enforcement Administration seized more than 80 million fentanyl-laced fake pills. This year, that number has reached more than 28.1 million and is still climbing. Additionally, seven out of 10 pills seized by the DEA contain lethal doses of fentanyl.

 

Deborah Peeden stands next to an image of her granddaughter, Ashley, who thought

she was doing cocaine with friends when she died from fentanyl poisoning at age 23.

(Photo by Gale Melcher)

In an interview, Peeden said that she felt it was important to put the billboard up to highlight the memory of locals lost to fentanyl. For the past two years, Peeden has paid for a billboard in memory of Ashley. Peeden is now an ambassador for Facing Fentanyl, a campaign that provides prevention education and opioid-reversal kits to schools.

“Some days I’m good, and other days it just hits out of the blue,” Peeden said. “She’s on my mind 24/7 every single minute of every single day. She’s got her birthday coming up on August 1.”

Peeden explained that when dates like birthdays come around, she “can feel that tsunami wave coming.”

“You feel like you’re drowning,” she said.

On July 6, TCB spoke with other mothers who have lost their children to fentanyl poisoning;  TCB is not publishing their names as their childrens’ cases are still active. Many of the families have connected via support groups and bonded over their losses. One mother tugged at the layers of colorful bracelets on her wrist before finding the name of Thomas Lamb etched into a plastic bracelet. Thomas died from fentanyl poisoning in September 2022. She’s friends with Thomas’s mother, Amy Lamb, who still celebrates his birthday every year with his friends and family.

 

A bracelet etched with the name of Thomas Lamb. In September 2022, Thomas, age 18,

purchased a pill to help him sleep; he thought it was Xanax. It was fentanyl.

(Photo by Gale Melcher)

A small child bobbed through the crowd, stopping to point at their loved one’s face on the billboard and shout out their name. Some of the families are hopeful that they will be able to see some form of justice through North Carolina’s death-by-distribution law, passed in 2019 and recently updated on Dec. 1.

The older version of the law stated that a person is guilty of death by distribution if all of the following requirements are met: the person unlawfully sold at least one controlled substance such as an opioid, cocaine or methamphetamine, that the substance they sold caused the death of the user and that the person who sold the drug did not act with malice. The crime was a Class C felony, which usually results in a 5-12 year prison sentence with a maximum sentence of 19 years.

The updated version of the law removes the malice requirement or proof that the drug was sold. Under the new law, perpetrators can be charged with a Class C felony if they simply distribute a drug such as methamphetamine, fentanyl or cocaine that leads to a victim’s death. If the perpetrator did act with malice, they could be charged with a Class B2 felony.

In an email to TCB, the Greensboro Police Department’s Public Information Coordinator Patrick DeSota explained that in response to the updated law, the police department “instituted internal procedural changes in [their] response to suspected overdose deaths” in an effort to further these types of investigations. DeSota added that they have implemented screening questions specific to suspected overdose investigations.

Peeden was a vocal critic of GPD and the way they handled Ashley’s case, and said she’s “glad” the law has been updated.

“I’m hoping that that will make a big difference,” Peeden said. “With Ashley’s case, they just never did anything with hers. Nothing more than a police report.”

 

Posters warn of the dangers of fentanyl.

(Photo by Gale Melcher)

Still, communications specialist for Guilford County Sheriff’s Office Bria Evans wrote that the change in law “does not directly affect [their] investigative procedures” but that it does “make it easier for [them] to criminally charge individuals” because they no longer have to “prove the actual ‘sell’ of the substance.”

Another anonymous mother TCB spoke to said that she hopes the updated law will send “shockwaves” to drug dealers, reverberating the message that selling drugs could have serious consequences.

One silver lining is that NC deaths from fentanyl appear to be declining according to data collected by the state Department of Health and Human Services. Since December, which totaled 264 deaths, monthly deaths have dropped to 220 in January, 207 in February and 183 in March. And awareness of the drug is key, Peeden explained.

“It can happen to anybody’s child, and if you don’t think it can happen to you, think again,” Peeden said.

And while Peeden and the other families have been advocating for their loved ones for years, the pain “doesn’t get easier,” she said.

“I’ve had someone tell me ‘Debbie, you’ve done enough, just stop, you’ve done enough, you need to quit.’ I’m like no, I can’t quit,” Peeden said. “We’ve got too many kids out there who don’t know, we have too many parents out there that don’t know, and we want to try to save the lives of other kids so that these parents go through the nightmare that we’re going through.”

 

Thomas Lamb, who died in September 2022 from fentanyl poisoning,

will forever be 18 to his family and friends.

(Photo by Gale Melcher)

 

Source: Gale Melcher, Citybeat Reporter (She/They) gale@triad-city-beat.com

By Kalleen Rose Ozanic, Staff Writer  July 20, 2024

 

NORWALK — While drug overdoses have decreased year over year in the Nutmeg state, the city’s Family and Children’s Agency is concerned about how new popular substances will impact the state and its clients.

Two substances in particular, xylazine and kratom, worry Jess Vivenzio, behavioral health director at Family and Children’s Agency. She said nearly half of the clients in its outpatient program self-reported using kratom, a U.S Food and Drug Administration-unregulated substance associated with five Connecticut overdoses last year, a state Department of Public Health representative said.

And about three of the clients’ drug screens were positive for xylazine, also known by street name “tranq;” they were shocked to learn their drugs had been cut with it, she said.

“Very surprised, scared, concerned,” Vivenzio said. “A lot of them do have some trust in who they’re purchasing their drugs from, and so sometimes there’s a lot of feelings of guilt and shame there, as well.”

Xylazine caused 284 deaths statewide last year and over 100 people have overdosed from the drug from January to May this year, DPH data show.

Kratom is a powdery substance made from a tropic tree grown in Southeast Asia, the U.S. Drug Enforcement Agency reports. Because the substance isn’t regulated by the FDA, it can easily be purchased at gas stations, convenience stores, smoke and vape shops.

“Just because it’s natural doesn’t mean it’s safe,” Vivenzio said.

Family and Children’s Agency is a charitable nonprofit that aids children and families throughout Fairfield County with after-school and summer programming, foster care, and intensive psychiatric services, education, family guidance, adoption, mental health counseling, substance abuse treatment, and homelessness prevention through wraparound support and partnerships with other local aid groups.

Vivenzio said increasing awareness about both xylazine and kratom are among FCA’s priorities this year, in hopes of limiting its harms and preventing more overdoses.

Project Reward

FCA’s outpatient program, Project Reward, aids its 27 clients in their journeys to sobriety with treatment recommendations, referrals, medication management, intervention, drug and alcohol screens, early intervention programming, and a 10-week intensive outpatient program where patients meet for nine hours of group therapy each week, Vivenzio said.

“We’re a gender-specific and trauma-informed, co-occurring substance use and mental health treatment program for women,” Vivenzio said. “We really provide as much wraparound support as possible, connecting (clients) with other resources and recovery support.”

The program, over everything, prioritizes trust, she said. Many women in the program have histories fraught with trauma, abuse and domestic violence.

Project Reward reveals the frequent intersection of drug abuse and other traumas, Vivenzio said; no patients were available to speak with Hearst Connecticut Media Group in the interest of protecting their privacy and not interrupting their progress in the recovery program.

Much of the program revolves around psychoeducation, which is “really just a fancy word for information, but it’s a little bit more therapeutic,” Vivenzio said.

Program staff equip patients with the resources and knowledge to approach sobriety as well as educate them on the risks of drugs, including substances like xylazine and kratom.

‘Kratom is not something we should be sleeping on’

Chris Boyle, Department of Public Health communications director, said that last year kratom was the sole cause of one overdose death last year and was among other substances in four other overdose deaths.

“Kratom use affects the central nervous system and causes mind-altering symptoms,”  Boyle said in an email. “The symptoms include dizziness; drowsiness; hallucinations; delusions; depression; trouble breathing; confusion, tremors and seizures.”

Users report that kratom acts as a stimulant, according to Mayo Clinic. It can also produce opioid-like effects in high doses, the Centers for Disease Control and Prevention report.

“Kratom is more along the lines of alcohol, in that it is legal, but that doesn’t mean that it’s not addictive, and that doesn’t mean that it can’t cause a problem for some people,” Vivenzio said. “(That) can make it more dangerous, because you can use it responsibly. And so people need to understand that there is the risk that your responsible use will turn into something that you can’t control.”

She’s concerned that increased kratom use can cause tragic outcomes, like that of a Florida father that overdosed and died, leaving a high-needs daughter and wife behind.

In data the CDC referenced from July 2016 to December 2017, 152 overdoses where at least kratom was reported in the toxicology report were identified; in 91 of them, kratom was determined to be a cause of death.

“Kratom is not something we should be sleeping on,” Vivenzio said.

Boyle said that DPH has no current efforts with prevention of kratom associated overdoses, but directed Hearst to the state’s Department of Mental Health and Addiction Services.

While Krystin DeLucia, DMHAS communications and legislative program manager, did not articulate any kratom-specific programming in an email, she said that the department is aware of the drug and monitors its impact.

“The Department of Mental Health and Addiction Services routinely reviews the state of knowledge about the impact of Kratom on mental health and its potentially dangerous adverse effects, as well as how to identify and manage Kratom withdrawal,” the DMHAS statement said. “DMHAS remains vigilant to identify trends related to the devastating crisis of opioid misuse and overdose in our state.”

Xylazine in Connecticut

Vivenzio said xylazine use is among FCA’s top priorities and Boyle said the state tracks its use.

“DPH shares updated surveillance and trend data on xylazine-involved drug overdose deaths with state stakeholders, opioid task forces and local health departments to create awareness about the dangers of using xylazine,” he said.

“Tranq” can extend the “high” that results from fentanyl — a drug that lasts a shorter time compared to heroin and other opioids, Boyle said.

He echoed Vivenzio’s concerns about clients not knowing their drugs contain xylazine.

“Not everyone who uses fentanyl is intentionally seeking out xylazine,” Boyle said. “In many cases, people are not aware that xylazine is in the drugs they are buying and using.”

Now, the Connecticut Public Health Lab is testing urine from those who report to emergency rooms in the state for nonfatal overdoses for xylazine, among other illicit substances, Boyle said.

Vivenzio said that the drug is “across the board, it’s incredibly risky,” especially because it is not an opioid and its effects cannot be reversed with Narcan.

The drug is responsible for 1,252 overdose deaths from 2015 to 2025, DPH reports — with five in Norwalk.

To address the harms of drug use in Connecticut and in FCA’s resident city, Vivenzio said programs like Project Reward need more funding to increase advocacy efforts, harm reduction tools and intervention strategies.

Kalleen Rose Ozanic

Reporter

Kalleen Rose Ozanic is a local reporter at the Norwalk Hour. She covers health, business, cannabis and education. She previously covered cannabis at WSHU Public Radio in Fairfield, Connecticut. She graduated with a B.A. and M.S in Journalism in 2022 and 2023 from Quinnipiac University. She loves to read, snorkel, try new foods and go to Mets games.

 

Source: https://www.ctinsider.com/news/article/norwalk-family-childrens-agency-kratom-xylazine-19564963.php

Key topics

 

Overdose prevention services should be offered through HIV care

National Institute on Drug Abuse Director Nora Volkow explains the need to leverage the successes of HIV care to prevent overdose deaths. HIV and substance use are inextricably linked. An analysis of the New York City HIV surveillance registry found that in 2017, rates of overdose deaths for people with HIV were more than double overall overdose death rates for the city, but that 98% of those who died of overdose had been linked to HIV care after their HIV diagnosis and that more than three-quarters had been retained in care. This highlights an overlooked opportunity to save lives. Drug overdose claims more lives of people with HIV than HIV-related illness. Volkow says 81% of people who received an HIV diagnosis in 2019 in the U.S. were linked to HIV care within a month, 66% received care and 50% were retained in care. It is sometimes hard to reach people who use drugs with substance use treatment or harm reduction, but when people with HIV seek and receive treatment for HIV, it presents a promising opportunity to deliver addiction services. Delivering naloxone and overdose education in HIV care settings is a relatively easy way to prevent overdose deaths.

 

Hemp legalization opened the door to intoxicating products

Lawmakers who backed hemp legalization in the 2018 Farm Bill expected the plant to be used for textiles and nonintoxicating supplements. They did not realize that, with some chemistry, hemp can get you high. People anywhere in the U.S. can use hemp-derived THC without breaking federal law. Hemp and marijuana are varieties of the same plant species. Marijuana is defined by its high content of delta-9 THC. Hemp contains very little delta-9 THC but can contain a large amount of CBD, a cannabinoid that does not get you high. The Controlled Substances Act explicitly outlawed both hemp and marijuana. The Farm Bill defines hemp in a way that allows the plant and products made with it as long as they contain less than 0.3% delta-9 THC, making it seemingly legal to convert CBD into delta-8 THC as long as the process started with a plant that contained less than 0.3% delta-9 THC. The Farm Bill also appears to authorize the creation of hemp-based delta-9 THC products as long as the total delta-9 content is 0.3% or less of the product’s dry weight. The hemp-derived cannabinoid industry is now worth billions of dollars, and hemp-derived intoxicants are available at vape shops and gas stations, but they are not regulated.

 

Federal news

 

Expanded access to methadone is needed

National Institute on Drug Abuse Director Nora Volkow highlights the need to expand access to methadone. Only a fraction of people who could benefit from medications for opioid use disorder receive them, due to a combination of structural and attitudinal barriers. In 2023, the federal government eliminated the waiver requirement for buprenorphine. This year, it changed methadone regulations to make permanent the increased take-home doses of methadone established during the COVID emergency, along with other provisions aimed to broaden access. Changes implemented during COVID have not been associated with adverse outcomes, and patients reported significant benefits. Recent trials of models of methadone dispensing in settings other than methadone clinics have not supported concerns that making methadone more widely available will lead to harms. Data suggest that counseling is not essential for reducing overdoses or retaining patients in care, though it can be beneficial for some. It will also be critical to pursue other ways that methadone can safely be made more available to a wider range of patients.

 

CDC defends overdose prevention work before House committee

Several top Centers for Disease Control and Prevention (CDC) officials testified before the House Energy and Commerce Committee to defend their agency’s programs. The hearing comes after House Republicans passed a budget that would cut CDC funding by 22%. Republicans claimed the agency has failed to fulfill its responsibilities and lost the public’s trust. Republicans accused the CDC of straying from its core mission of keeping the public healthy and said the agency is spending too much time on programs some GOP lawmakers deemed unnecessary or duplicative. The CDC program directors pushed back, citing work they deemed critical to public health. They emphasized three areas of focus – improving readiness and response to disease outbreaks, improving mental health and supporting young families. Allison Arwady, director of the National Center for Injury Prevention and Control, which would be eliminated under the proposed funding bill, spoke about why the center’s work on overdose prevention is necessary.

Source: CDC Defense (Politico); CDC fields GOP criticism at E&C hearing (Politico)

 

Task force releases recommendations to protect youth from social media harms

The federal Kids Online Health and Safety Task Force released a report with recommendations and best practices for safer social media and online platform use for youth. The report provides a summary of the risks and benefits of social media on the health, safety and privacy of young people; best practices for parents and caregivers; recommended practices for industry; a research agenda; and suggested future work, including for the federal government. In collaboration with the Task Force, the Center of Excellence on Social Media and Youth Mental Health is launching a variety of new web content, including best practices resources; age-based handouts for parents that pediatricians and others can distribute at well-check visits; new clinical case examples for pediatricians and other clinicians demonstrating how to integrate conversations about media use into health consultations with teens; and expanded content for teens. The report outlines 10 recommended practices for online service providers.

 

FDA allows sale of tobacco-flavored Vuse e-cigarettes

The Food and Drug Administration (FDA) authorized sales of certain tobacco-flavored Vuse Alto e-cigarette products from R.J. Reynolds. Vuse is the top-selling e-cigarette brand in the country, comprising more than 40% of the market. The marketing authorization applies to six tobacco-flavored pods, which are sealed, prefilled and nonrefillable. Last year, the FDA banned the sale of Vuse Alto menthol and fruit-flavored e-cigarettes, citing increasing popularity among kids.

 

State and local news

 

Montana plans to install harm reduction vending machines

Montana health officials are considering a new strategy to make naloxone more accessible. Drawing on a pool of behavioral health funds set aside by lawmakers in 2023, health officials have proposed installing two dozen naloxone and fentanyl test strip vending machines around the state at behavioral health drop-in centers and service locations for homeless people. The $400,000 plan to build, stock and maintain 24 vending machines for a year has not yet been approved by the governor. Different versions of the harm reduction vending machine model are being tried in at least 33 states, becoming increasingly popular especially in places with hard-to-reach populations. Some local public health groups in Montana have already begun using vending machines to distribute free naloxone, drug testing strips and other supplies, using public grants or private philanthropy, but these would be the first vending machines in Montana being directly funded by the state.

 

Iowa providing $13 million to expand addiction treatment and recovery housing

Iowa Governor Reynolds announced that the state’s opioid treatment and recovery providers can begin applying for $13 million in grants to expand or improve facilities or develop sober living housing options. The funding opportunities were announced in May as part of a larger $17.5 million investment to help address the opioid crisis. The $10 million Iowa Opioid Treatment and Recovery Infrastructure Grant will assist opioid treatment and recovery providers with physical infrastructure and capacity building. The Iowa Recovery Housing Fund includes $3 million for grants for nonprofit organizations to develop sober recovery housing. The grants leverage federal American Rescue Plan Act funds. An additional $1.5 million will be used for programs focused on prevention, including a $1 million education initiative for health care providers to support opioid-alternative pain management and $500,000 for a comprehensive multimedia opioid overdose prevention campaign. The remaining $3 million will support the completion of a residential addiction treatment center for adolescents.

 

LAPPA releases model state laws to minimize harms of incarceration

The Legislative Analysis and Public Policy Association released two pieces of model state legislation. The first would require a state department of health and human services to apply for a Medicaid Reentry Section 1115 demonstration waiver to allow a state Medicaid program to cover pre-release services for Medicaid-eligible incarcerated individuals for up to 90 days prior to release and to require the department to conduct comprehensive monitoring and evaluation of the demonstration if the waiver is approved. The second is focused on reducing collateral consequences of conviction. It would establish a process for the identification, collection and publication of collateral consequences that impact individuals convicted of crimes; establish a process by which an individual can obtain a certificate of relief from certain collateral consequences before records are eligible to be sealed or expunged; establish mechanisms for the automatic sealing and expungement, as well as a process for petitioning; prohibit certain entities from inquiring into an individual’s criminal history; etc.

 

Other news in addiction policy

 

Mobile treatment vans can help expand methadone access

Some public health experts hope that mobile treatment programs will help increase access to methadone. Addiction experts say methadone is particularly important as the strength of street fentanyl has lessened the effectiveness of other medications and approaches for some. The mobile vans were approved by the federal government in 2021, lifting a moratorium on their use that had been in place since 2007. Their goal is to reach some of the millions of Americans with opioid use disorder that methadone clinics cannot. While the vans make treatment more accessible, the cost and ongoing restrictions limit the number of people that they can help, as well. Constructing and outfitting a methadone van costs about $375,000. They have to replicate the high-security environments of clinics, with a security guard, 360-degree cameras and a safe for the medication. There are now 42 vans registered nationally, though not all are operational yet.

 

Source: https://drugfree.org/drug-and-alcohol-news/policy-news-roundup-july-25-2024/

A group of men gather in a semi-circle around the pitch, squinting under the hot sun. Though music thumps in the background, the men are quiet, their focus on one figure in the center.

In mock solemnity, the man walks up to the soccer ball placed in the center, eyeing the goal. With a grin and a flourish, he turns around and kicks the ball backwards into the net.

“GOAL!” shout the onlookers, jumping and laughing.

This scene, a testament to the power of sports to bring joy, is all the more remarkable because it happened in a prison, the Otukpo Medium Security Custodial Center in Benue, Nigeria.

Prisoners Matter

Prisoners are often a forgotten population. Many might think about them as separate from the rest of society – but they’re not. The vast majority of prisoners will eventually be released. Therefore, what happens to people during their imprisonment matters – to public safety, our health, our community finances, and our human dignity.

When it comes to sports in prison settings, research shows that they contribute to the physical and mental health of prisoners, reducing stress, depression, and anxiety. They also have wider social and psychological benefits and support the social reintegration and rehabilitation process, including through sport programmes that aim to create linkages and connect the prisons with the society and community services and support ex-offenders into education and employment opportunities.

What’s more, international guidance, including the UN Standard Minimum Rules for the Treatment of Prisoners (the Nelson Mandela Rules); the UN Rules for the Treatment of Women Prisoners and Non-custodial Measures for Women Offenders (the Bangkok Rules); and the United Nations Rules for the Protection of Juveniles Deprived of their Liberty (the Havana Rules), all refer to the value of sport and physical activity. Similarly General Assembly resolutions A/RES/74/170 and A/RES/76/183,   on “Integrating sport into youth crime prevention and criminal justice strategies” call Members States to take further steps on using sport in supporting social reintegration and prevent recidivism of young offenders.

From guidance to reality

Yet this is easier said than done. Scant resources; a lack of facilities; security and safety concerns; insufficient capacities amongst prison officials and more can all make implementing sports programmes difficult in prisons.

In other cases, the prisoners themselves may be suffering from poor mental and physical health or a lack of motivation. Certain populations, like older prisoners, women, those with mental and physical disabilities or substance abuse issues are sometimes excluded, raising important issues around equity of access to exercise.

To address these challenges in Nigeria, the UN Office on Drugs and Crime (UNODC) provides capacity building and technical assistance to the Nigerian Correctional Service, so that they can effectively use sports in correctional facilities.

UNODC recently organized a three-day Training of Trainers Workshop for prison officers, civil society organizations, and volunteers. Participants played different sports to build their capacities to engage with prisoners during sports and developed draft sports programmes to implement in their respective institutions.

One participant, the Dream Again Foundation, has already made use of the training at the Medium Security Custodial Center in Otukpo, where they organized the football tournament.

“Hope comes back to them”

“I personally witnessed the novelty football match,” Ondoma Godwin Aduma, Information Officer at the Nigerian Correctional Service in Otukpo, says, adding that it made a lasting impact on the prisoners.

“Sports in prison can go a long way to reducing crime in our society,” Ondoma reflects, adding that they can also support prisoners after release. “It helps reduce their mental stress and the pains of imprisonment (…) and hope comes back to them.”

Ondoma hopes that initiatives like these will expand and continue to promote social inclusion while preventing violence and crime, both within prisons and in the broader community.

“We are here for reformation and reintegration, to make the inmates better people, and sport programmes can help.”

Deputy Superintendent Of Corrections Agbo Edache Amusa, reflecting on the impact of the tournament, agrees that sports, when properly used, can really transform the lives of prisoners and improve prison conditions.

“I never experienced that before,” he says. “It brings unity, it brings love, it brings the understanding between the inmates and the staff “.

Leveraging use of sport for rehabilitation and social inclusion

A growing body of research indicates that sport and sport-based programming when properly used can effectively support social reintegration of offenders, especially juveniles and young offenders, and prevent recidivism.

The UN General Assembly High-level Debate on “Crime Prevention and Sustainable Development through Sport”that took place in June 2024 also underlined the importance contribution that sport can have in social reintegration of offenders and highlighted good practice.

UNODC promotes and support the evidence-based use of sport as a crime prevention tool at community and detention settings, in line with UN standards and norms and the integration of sport in relevant strategies and programme.

Source: https://www.unodc.org/unodc/frontpage/2024/July/supporting-social-reintegration-through-sport-in-prisons.html

Biden’s drug czar is in West Virginia this week.

This story was originally published by Mountain State Spotlight. Get stories like this delivered to your email inbox once a week; sign up for the free newsletter at mountainstatespotlight.org/newsletter

CHARLESTON — Dr. Rahul Gupta is back in West Virginia. The state’s former health officer has ventured west of Washington this week, hosting seven public discussions in Martinsburg and Charleston as part of his new role as White House Office of Drug Control Policy Director.

Over the last three years, Gupta and the Biden administration have taken significant steps to address the country’s devastating overdose crisis. They’ve promoted harm reduction aggressively, even finding ways to test out hard-sell, evidence-based strategies like safe injection sites.

Still, the addiction crisis continues to ravage U.S. families, especially in Gupta’s former state. Last year, about four West Virginians died of a drug overdose every day.

As the nation’s “drug czar,” Gupta is in a better position to advocate for addiction-related changes than just about anyone else.

Here are five steps the federal government could take to help abate West Virginia’s overdose crisis.

Change opioid treatment program restrictions

West Virginia has policies and regulations that restrict access to opioid addiction treatment. The state makes it difficult for some people with opioid use disorders to receive medications like methadone, which is considered a “gold standard” of treatment. Since 2007, West Virginia has limited the number of methadone clinics, the only places methadone can be prescribed to treat addiction, to nine locations.

But while that’s a state law, federal law is the reason methadone can only be prescribed for treating substance use disorder at these clinics.

People who research addiction have called on Congress to change this policy to allow doctors to prescribe methadone for addiction treatment outside of specialized clinics. Because West Virginia’s moratorium is focused on methadone clinics and not the medication itself, that type of change could make the treatment more accessible to state residents.

Last winter, when Gupta was asked in an interview about a federal bill that would accomplish parts of this goal, he stopped short of endorsing the proposed legislation. Instead, he said it’s important for Congress to “let the science and the data guide policy-making.”

Change restrictions on treatment for methamphetamine addiction

A decade ago, less than 5% of West Virginia fatal overdoses were related to methamphetamine. But that’s changed dramatically; last year, more than 50% of the state’s nearly 1,400 drug deaths involved meth.

That presents a difficult public health problem for West Virginia. Scientists have yet to develop reliable medications for treating methamphetamine addiction.

Of the available treatments, the most effective options are behavior training programs, also known as contingency management. These types of programs reward people regularly with money or other incentives for abstaining from a drug.

Dr. Philip Chan, an addiction and infectious disease researcher at Brown University, said if he could provide patients with $400 to $500 every two to three months, it would be more effective at keeping them from using meth. But the federal government caps contingency management payments at $75 a year.

Repeal the federal funding ban for syringes and needles

West Virginia has many restrictions around needle exchanges. In 2021, the Legislature passed a law that forces syringe service programs to offer a variety of other harm reduction services, and it instructs them to deny service to those who don’t have valid state IDs or return their used needles.

The additional requirements led many programs across the state to shutter. For the ones that remain, restrictions at the national level make it even more difficult to operate.

Needle exchanges are already prohibited from using federal funds to purchase clean needles and syringes. And there have been pushes, including from West Virginia Senator Joe Manchin, to extend the prohibition to safe smoking devices as well.

Nikki Dolan, the Greenbrier Health Department administrator, said this policy makes it more difficult to fund her county’s only syringe service program.

“We’ve been doing harm reduction since 2018 and have never been able to purchase needles with grant funding,” she said.

Include West Virginia in the Ending the HIV Epidemic initiative

West Virginia’s recent drug-related HIV outbreaks have been among the worst in the nation. In 2019, the U.S. Centers for Disease Control and Prevention stepped in to help with a Cabell County outbreak. A couple years later, the agency returned to address cases in Kanawha County, with one top health official calling the outbreak the “most concerning in the United States.”

West Virginia HIV cases have decreased over the last two years, but many doctors and researchers worry about undetected spread, especially in rural parts of the state.

Despite the national attention, no West Virginia counties are included in the federal government’s Ending the HIV Epidemic initiative. The program is designed to direct additional funding and resources to communities heavily impacted by the infectious disease.

Gregg Gonsalves, a Yale University School of Public Health professor who studies HIV transmission, said he was surprised to learn West Virginia and its counties weren’t included in the program.

He said Gupta, using his position in the federal government, could ask Health and Human Services Secretary Xavier Becerra and CDC Director Mandy Cohen to include West Virginia or some of its counties in the initiative.

More funding for recovery residences

Even if state residents with addictions find and receive treatment, sustaining recovery can be challenging. West Virginians in recovery can struggle to find places to live where they aren’t around drugs or alcohol.

Recovery residences, also known as sober living houses, can help with that. The state and federal governments have said the housing units can help people in recovery avoid relapsing.

But in West Virginia, recovery residences often face financial barriers. A survey of state sober living homes last year found that the biggest challenge the organizations faced was financial resources, and the surveyed organizations said only 12% of their revenue comes from federal grants.

Jon Dower, the executive director of West Virginia Sober Living, said the federal government could make these grants easier for recovery residences to win, especially for people who are looking to start state-certified homes.

“If we look at what’s most needed in the recovery housing space in West Virginia, in my opinion it’s capacity,” he said.

Reach reporter Allen Siegler at allen@mountainstatespotlight.org

Source: https://www.timeswv.com/news/west_virginia/bidens-drug-czar-is-in-west-virginia-this-week-here-are-five-things-the-federal/article_43e1fe42-4b80-11ef-8ce1-6b4a5826d699.html

The number of drug overdoses in this country went down in 2023. But not enough.

Key points

  • While overdoses from fentanyl went down in 2023, overdoses from cocaine and methamphetamine went up.
  • Increased availability of Narcan, harm-reduction practices, and drug seizures likely decreased deaths.
  • The best way to save lives and end the opioid epidemic is to prevent addiction in the first place.

With this tragic news just in, there are several important things to say about the drug overdose situation in this country.

The first is this: It is important that we don’t talk about the more than 107,000 overdose deaths in the United States last year like it’s just a statistic.

These are people’s lives that ended, people like you and me. People with friends and loved ones who cared about them, and who wanted them to succeed.

Evidence of an ongoing tragedy

This is where we are with the continuing drug epidemic, according to the recently released Centers for Disease Control and Prevention (CDC) data from 2023:

  • 107,543 people died from drug overdose deaths compared to 111,029 in 2022. That is a 3 percent decline.
  • 2023 witnessed the first annual decrease in five years (since 2018).
  • Indiana, Kansas, Maine, and Nebraska each saw overdose deaths decrease by at least 15 percent. Note: We need to determine what’s working in those states, and replicate it elsewhere.
  • Alaska, Oregon, and Washington each saw overdose deaths increase by at least 27 percent. Note: We need to determine what’s not working in those states, and figure out solutions including by sharing best practices from states with lower overdose rates.)
  • While overdoses from fentanyl (the main driver of drug deaths) went down in 2023, overdoses from cocaine and methamphetamine went up.

Three developments that are helping to reduce deaths

1. Greater availability of Narcan: I’m a huge advocate for this overdose reversal drug, which is naloxone in nasal spray form. I have argued often that it should be as ubiquitous as the red-boxed automated external defibrillators (AEDs) you now see in malls, hotel lobbies, schools, airports, and workplaces.

The U.S. Food and Drug Administration (FDA) took a big and meaningful step in that direction when it approved Narcan for over-the-counter use in March 2023. I have no doubt the increased availability of Narcan has helped bring the overdose numbers down, since Narcan targets opioids like fentanyl and heroin.

2. The stepping up of harm-reduction efforts: Harm reduction means reducing the health and safety dangers around drug use. The goal is to save lives and protect the health of people who use drugs through such measures as fentanyl test strips, overdose prevention sites, and sterilized injection equipment and services.

Harm reduction was a key plank of the White House’s 2022 National Drug Control Strategy aimed directly at the overdose epidemic. Countless harm-reduction efforts have gained traction at the local and state level as well. Again, this continued push may have helped bring down the overdose numbers last year.

3. Increased efforts around law enforcement drug seizures: Of the 107,543 people who overdosed in 2023, 74,702 (70 percent) of them did so after using the synthetic opioid fentanyl, which is many times more potent than heroin. For the first time in years, that number of deaths was lower than the year before.

Why? No doubt in part because 115 million pills containing fentanyl were seized by law enforcement in 2023. That compared to 71 million fentanyl-laced pills seized in 2022. These seizure efforts seem to be working, and they need to be stepped up even more.

Drug use prevention efforts must increase also

Ultimately, the best way to save lives, end the opioid epidemic, and halt the spread of substance use disorder is to stop people from becoming addicted in the first place.

The big news: Statistics show that drug use may be trending down among young people. Even delaying the onset of addiction can change the trajectory of the problem, says Nora Volkow, MD, director of the National Institute on Drug Abuse.

When asked recently about the lower number of overdose deaths last year, Volkow said: “Research has shown that delaying the start of substance use among young people, even by one year, can decrease substance use for the rest of their lives. We may be seeing this play out in real time [in 2023]. The trend is reassuring.”

Final thoughts on turning the tide of addiction

As the antismoking campaign that began in the 1960s showed us, massive and well-coordinated public health efforts can work.

Surgeon General warning labels, hard-hitting public service announcements, school-based programs—all of those had a cumulative effect on smoking habits in this country, especially among young people. Those efforts all targeted one thing: prevention.

We need to do much more of that in 2024 around opioids, methamphetamines, cocaine, and other lethal drugs. Lives depend on it.

Source: https://www.psychologytoday.com/us/blog/use-your-brain/202407/a-closer-look-at-107543-lives-lost-to-drug-overdoses

July 29, 2024

This blog was also published in the American Society of Addiction Medicine (ASAM) Weekly on July 24, 2024.

Over the past several years, the increasing prevalence of fentanyl in the drug supply has created an unprecedented overdose death rate and other devastating consequences. People with an opioid use disorder (OUD) urgently need treatment not just to protect them from overdosing but also to help them achieve recovery, but highly effective medications like buprenorphine and methadone remain underused. Amid this crisis, it is critical that methadone, in particular, be made more accessible, as it may hold unique clinical advantages in the age of fentanyl.

Growing evidence suggests that methadone is as safe and effective as buprenorphine for patients who use fentanyl. In a 2020 naturalistic follow-up study, 53% of patients admitted to methadone treatment who tested positive for fentanyl at intake were still in treatment a year later, compared to 47% for patients who tested negative. Almost all (99%) of those retained in treatment achieved remission. An earlier study similarly found that 89% of patients who tested positive for fentanyl at methadone treatment intake and who remained in treatment at 6 months achieved abstinence.

Methadone may even be preferable for patients considered to be at high risk for leaving OUD treatment and overdosing on fentanyl. Comparative effectiveness evidence is emerging which shows that people with OUD in British Columbia given buprenorphine/naloxone when initiating treatment were 60% more likely to discontinue treatment than those who received methadone (1). More research is needed on optimal methadone dosing in patients with high opioid tolerance due to use of fentanyl, as well as on induction protocols for these patients. It is possible that escalation to a therapeutic dose may need to be more rapid.

It remains the case that only a fraction of people who could benefit from medication treatment for OUD (MOUD) receive it, due to a combination of structural and attitudinal barriers. A study using data from the National Survey on Drug Use and Health (NSDUH) from 2019—that is, pre-pandemic—found that only slightly more than a quarter (27.8%) of people who needed OUD treatment in the past year had received medication to treat their disorder. But a year into the pandemic, in 2021, the proportion had dropped to just 1 in 5.

Efforts have been made to expand access to MOUD. For instance, in 2021, the U.S. Department of Health and Human Services (HHS) advanced the most comprehensive Overdose Prevention Strategy to date. Under this strategy, in 2023, HHS eliminated the X-waiver requirement for buprenorphine. But in the fentanyl era, expanded access to methadone too is essential, although there are even greater attitudinal and structural barriers to overcome with this medication. People in methadone treatment, who must regularly visit an opioid treatment program (OTP), face stigma from their community and from providers. People in rural areas may have difficulty accessing or sticking with methadone treatment if they live far from an OTP.

SAMHSA’s changes to 42 CFR Part 8 (“Medications for the Treatment of Opioid Use Disorder”) on January 30, 2024 were another positive step taken under the HHS Overdose Prevention Strategy. The new rule makes permanent the increased take-home doses of methadone established in March 2020 during the COVID pandemic, along with other provisions aimed to broaden access like the ability to initiate methadone treatment via telehealth. Studies show that telehealth is associated with increased likelihood of receiving MOUD and that take-home doses increase treatment retention.

Those changes that were implemented during the COVID pandemic have not been associated with adverse outcomes. An analysis of CDC overdose death data from January 2019 to August 2021 found that the percentage of overdose deaths involving methadone relative to all drug overdose deaths declined from 4.5% to 3.2% in that period. Expanded methadone access also was not associated with significant changes in urine drug test results, emergency department visits, or increases in overdose deaths involving methadone. An analysis of reports to poison control centres found a small increase in intentional methadone exposures in the year following the loosening of federal methadone regulations, but no significant increases in exposure severity, hospitalizations, or deaths.

Patients themselves reported significant benefits from increased take-home methadone and other COVID-19 protocols. Patients at one California OTP in a small qualitative study reported increased autonomy and treatment engagement. Patients at three rural OTPs in Oregon reported increased self-efficacy, strengthened recovery, and reduced interpersonal conflict.

The U.S. still restricts methadone prescribing and dispensing more than most other countries, but worries over methadone’s safety and concerns about diversion have made some physicians and policymakers hesitant about policy changes that would further lower the guardrails around this medication. Methadone treatment, whether for OUD or pain, is not without risks. Some studies have found elevated rates of overdose during the induction and stabilization phase of maintenance treatment, potentially due to starting at too high a dose, escalating too rapidly, or drug interactions.

Although greatly increased prescribing of methadone to treat pain two decades ago was associated with diversion and a rise in methadone overdoses, overdoses declined after 2006, along with methadone’s use as an analgesic, even as its use for OUD increased. Most methadone overdoses are associated with diversion and, less often, prescription for chronic pain; currently, 70 percent of methadone overdoses involve other opioids (like fentanyl) or benzodiazepines.

Recent trials of models of methadone dispensing in pharmacies and models of care based in other settings than OTPs have not supported concerns that making methadone more widely available will lead to harms like overdose. In two feasibility studies, stably maintained patients from OTPs in Baltimore, Maryland and Raleigh, North Carolina who received their methadone from a local pharmacy found this model to be highly satisfactory, with no positive urine screens, adverse events, or safety issues. An older pilot study in New Mexico found that prescribing methadone in a doctor’s office and dispensing in a community pharmacy, as well as methadone treatment delivered by social workers, produced better outcomes than standard care in an OTP for a sample of stably maintained female methadone patients.

Critics of expanded access to methadone outside OTPs sometimes argue that the medication should not be offered without accompanying behavioural treatment. Data suggest that counselling is not essential. In wait-list studies, methadone treatment was effective at reducing opioid use on its own, and patients stayed in treatment. However, counselling may have benefits or even be indispensable for some patients to help them improve their psychosocial functioning and reduce other drug use. How to personalize the intensity and the level of support needed is a question that requires further investigation.

Over the past two decades, the opioid crisis has accelerated the integration of addiction care in the U.S. with mainstream medicine. Yet methadone, the oldest and still one of the most effective medications in our OUD treatment toolkit, remains siloed. In the current era of powerful synthetic opioids like fentanyl dominating the statistics on drug addiction and overdose, it is time to make this effective medication more accessible to all who could benefit. The recent rules making permanent the COVID-19 provisions are an essential step in the right direction, but it will be critical to pursue other ways that methadone can safely be made more available to a wider range of patients with OUD. Although more research would be of value, the initial evidence suggests that providing methadone outside of OTPs is feasible, acceptable, and leads to good outcomes.

Source: https://nida.nih.gov/about-nida/noras-blog/2024/07/to-address-the-fentanyl-crisis-greater-access-to-methadone-is-needed

It’s become one of the most startling signs of the fentanyl crisis happening across California: Seemingly zombified drug users slumped over in awkward positions. 

Alternately called “the fentanyl fold” or “the fentanyl bend over,” videos and photos of people reportedly using the drug have spread through social media.

What is the ‘fentanyl fold’?

If you have ever witnessed what looks like seemingly intoxicated people bent over or frozen in place on sidewalks or in parks, you might be seeing someone in the throes of opioid use.

But why do the people look hunched over or moving like zombies?

“It’s a degree of loss of consciousness and a degree of lost muscular control,” Dr. Daniel Ciccarone, a UCSF professor of addiction medicine, told ABC7 San Francisco.

The “fentanyl fold” effect can reportedly kick in within two or three minutes after taking the drug, Ciccarone said.

And how long will the awkward body position last?

“Fentanyl can be a short-action drug and a long-acting drug. So some people they’re back upright in 45 minutes to an hour. Some people could be longer than that,” Ciccarone said.

Fentanyl abuse isn’t the only opioid that can cause the awkward body reaction, Ciccarone said. Any opioid can have the same effect on users.

How many people have died of fentanyl poisoning in California and the United States?

Deaths related to fentanyl began to rise around 2019, according to the California Department of Health. In the last detailed study in 2022, the CDPH estimated nearly 6,000 opioid-related overdose deaths in California.

Nationwide, the Center for Disease Control and Prevention numbers show 84,181 opioid overdose deaths in 2022 to 81,083 and 81,083 in 2023. 

What are the signs of a fentanyl overdose?

The CDPH advises people who suspect a friend or family of opioid abuse should look at for:

  • Falling asleep or losing consciousness 
  • Not responding to stimuli like shouting, a pinch or sternum rub
  • Slow, weak or no breathing 
  • Choking or gurgling sounds 
  • Limp body 
  • Cold and/or clammy skin 
  • Discolored skin (especially in lips and nails)  
  • ​​​​Small, constricted “pinpoint pupils” ​

The CDPH and doctors advise people who use opioids or suspect family or friends are abusing opioids to carry Naloxone, a nasal spray medication that can reverse an opioid overdose.

Naloxone is safe and easy to use and works almost immediately, the CDPH says. It is available over the counter, without a prescription at pharmacies and other stores.

Source: https://eu.desertsun.com/story/news/nation/california/2024/07/19/what-is-the-fentanyl-fold-how-to-treat-opioid-overdoses/74471357007/ July 2024

Overdose deaths are a widespread problem North Carolinians have been struggling to combat in recent years.

According to the state health department, American Indian/Indigenous and Black communities are the most at risk. From 2019 to 2021, both populations saw reports of overdoses more than double. The number of overdoses is up 117% for the Indigenous population and 139% for Black people. Overdoses increased 53% among white people during the same timeframe.

The problem has only been exacerbated by a rise in illegally manufactured fentanyl.

Estimates from the North Carolina Office of the Chief Medical Examiner show roughly 11.4 people died each day from overdoses in 2023.

In Wake County in 2023:

  • Wake County EMS responded to 1,268 suspected overdoses
  • Wake County EMS administered 1,578 doses of Narcan
  • Wake County EMS left behind 132 Narcan overdose reversal kits

The danger of fentanyl not only lies in its widespread availability state-wide, but in the drug’s potency itself.

According to the U.S. Drug Enforcement Administration, fentanyl is considered 100 times more potent than morphine.
How quickly the drug can lead to an overdose largely depends on how fentanyl gets into someone’s body. Your body may take more time to absorb the drug than if
fentanyl is inhaled or injected.
The National Institute on Drug Abuse reports synthetic fentanyl is illegally sold in several ways including as a powder, eye drops, nasal spray, pills or dropped onto blotted paper.
Once fentanyl gets into your system, the drug binds to opioid receptors in the brain. These receptors control things like emotions and pain.
Fentanyl can then keep your brain from telling your vital organs how to function properly by depressing the central nervous system and respiratory function, according to the Centers for Disease Control and Prevention.

When someone’s lungs aren’t told to expand and contract properly, their body starts to lack sufficient oxygen supply.

Without enough oxygen, someone can lose consciousness in a matter of seconds. Studies of patients who have needed help breathing after a traumatic brain injury or stroke found the brain uses about 20% of the body’s oxygen.

Without enough oxygen supply, the brain can shut down within minutes. This can then lead to permanent brain damage or death once other organs stop functioning properly due to a lack of blood flow.

The medication naloxone has emerged as a powerful antidote for opioid overdoses.

The CDC reports that naloxone can reduce the effects of several opioids including, fentanyl, morphine, heroin, oxycodone, methadone, hydrocodone, codeine and hydromorphone.

When the overdose-reversal medication was first approved, it was sold under the brand name Narcan.
Naloxone works by binding to opioid receptors in the brain and essentially blocks and reverses the effects of other opioids.

The medication allows for the body’s response system to switch back ‘on’ and restore normal breathing.

The medication comes in two FDA-approved forms: a nasal spray or an injection. Naloxone is available for over-the-counter purchase.
North Carolina has 50 Syringe Service Programs across 58 counties. The state health department reports the programs collectively distributed over 109,000 naloxone kits from 2022-2023.

During the same timeframe, the state tells WRAL News there were nearly 17,000 overdose reversal reports.

Naloxone will not harm someone who hasn’t taken an opioid, so it is recommended even when it is unclear what kind of drug a person has taken.

More than one dose may be needed because some opioids, like fentanyl, can take a stronger hold on the opioid receptors.

Narcan may only work for 30-90 minutes, but some opioids remain in the body for a longer time. Those administering naloxone are highly encouraged to call 911, because someone may once experience the effects of an overdose again after the medication wears off.
North Carolina became the first state in the country to begin an EMS Naloxone Leave-Behind Program in 2018. The initiative allows first responders to leave a naloxone kit with an individual who refuses the option to go to a hospital after an overdose.
Other states, including Arizona, and cities like San Franscico, have since molded similar programs on North Carolina’s success.

Other states, including Arizona and San Franscico, have since molded similar programs on North Carolina’s success.

Source: https://www.wral.com/amp/21525957/ July 2024

Illicit use of the veterinary tranquilizer xylazine continues to spread across the United States. The drug, which is increasingly mixed with fentanyl, often fails to respond to the opioid overdose reversal medication naloxone and can cause severe necrotic lesions.

A report released by Millennium Health, a specialty lab that provides medication monitoring for pain management, drug treatment, and behavioral and substance use disorder treatment centers across the country, showed the number of urine specimens collected and tested at the US drug treatment centers were positive for xylazine in the most recent 6 months.

As previously reported by Medscape Medical News, in late 2022, the US Food and Drug Administration (FDA) issued a communication alerting clinicians about the special management required for opioid overdoses tainted with xylazine, which is also known as “tranq” or “tranq dope.”

Subsequently, in early 2023, The White House Office of National Drug Control Policy designated xylazine combined with fentanyl as an emerging threat to the United States.

Both the FDA and the Drug Enforcement Administration have taken steps to try to stop trafficking of the combination. However, despite these efforts, xylazine use has continued to spread.

The Millennium Health Signals report showed that the greatest increase in xylazine use was largely in the western United States. In the first 6 months of 2023, 3% of urine drug tests (UDTs) in Washington, Oregon, and California were positive for xylazine. From November 2023 to April 2024, this rose to 8%, a 147% increase. In the Mountain West, xylazine-positive UDTs increased from 2% in 2023 to 4% in 2024, an increase of 94%. In addition to growth in the West, the report showed that xylazine use increased by more than 100% in New England — from 14% in 2023 to 28% in 2024.

Nationally, 16% of all urine specimens were positive for xylazine from late 2023 to April 2024, up slightly from 14% from April to October 2023.

Xylazine use was highest in the East and in the mid-Atlantic United States. Still, positivity rates in the mid-Atlantic dropped from 44% to 33%. The states included in that group were New York, Pennsylvania, Delaware, and New Jersey. East North Central states (Ohio, Michigan, Wisconsin, Indiana, and Illinois) also experienced a decline in positive tests from 32% to 30%.

The South Atlantic states, which include Maryland, Virginia, West Virginia, North and South Carolina, Georgia, and Florida, had a 17% increase in positivity — from 22% to 26%.

From April 2023 to April 2024 state-level UDT positivity rates were 40% in Pennsylvania, 37% in New York, and 35% in Ohio. But rates vary by locality. In Clermont and Hamilton counties in Ohio — both in the Cincinnati area — about 70% of specimens were positive for xylazine.

About one third of specimens in Maryland and South Carolina contained xylazine.

“Because xylazine exposure remains a significant challenge in the East and is a growing concern in the West, clinicians across the US need to be prepared to recognize and address the consequences of xylazine use — like diminished responses to naloxone and severe skin wounds that may lead to amputation — among people who use fentanyl,” said Millennium Health Chief Clinical Officer Angela Huskey, PharmD, in a press release.

The Health Signals Alert analyzed more than 50,000 fentanyl-positive UDT specimens collected between April 12, 2023, and April 11, 2024. Millennium Health researchers analyzed xylazine positivity rates in fentanyl-positive UDT specimens by the US Census Division and state.

Source: https://www.medscape.com/viewarticle/emerging-threat-xylazine-use-continues-spread-across-united-2024a1000d1h July 2024

Filed under: Fentanyl,Health :

Cannabis or more commonly known as marijuana, is one of the most frequently used drugs in the United States. In 2022, marijuana became more popular than alcohol as the preferred daily drug of use among Americans. In the same year, it was found that 30 out of every 100 high school age students reported using the drug within the past 12 months, and 3 of every 50 reported using it daily.

Marijuana is often perceived as harmless, which has influenced its increased use by a factor of 15 within the past three decades, but this substance can have severe physical and mental health effects.

This blog will share the heart-wrenching stories of Brant Clark and Shane Robinson, as told by their families, along with a recent article by Alton Northup editor-in-chief of KentWired. Their lives were tragically cut short by marijuana induced psychosis.

Brant Clark

Ann Clark shares the heartbreaking story of her 17-year-old son, Brant, who experienced cannabis-induced psychosis leading to his tragic suicide. She recounts his rapid descent into hopelessness and the devastating impact on their family to raise awareness about the dangers of marijuana use on mental health.

Ann Clark shares the heartbreaking story of her 17-year-old son, Brant, who experienced cannabis-induced psychosis leading to his tragic suicide. She recounts his rapid descent into hopelessness and the devastating impact on their family to raise awareness about the dangers of marijuana use on mental health.

Brant Clark (pictured) was a happy and bright 17-year-old who reported using marijuana socially. However, during his last high school winter break, after smoking marijuana at a party with friends, he experienced a psychotic break believed to have been triggered by smoking a large amount of potent marijuana.

After the party Brent expressed to his mother his feelings of “emptiness and hopelessness”, and deep regret, lamenting his decision to smoke marijuana. Within two days of the onset of symptoms, Brant was admitted to the ER and psychiatric care unit. Tragically, three weeks later, he ended his own life, leaving behind a note revealing his intense mental anguish and regret.

Brant’s doctor diagnosed him with Cannabis-Induced Psychosis, a condition where marijuana use leads to severe mental disturbances. Brant’s case highlights how this condition can manifest suddenly and with tragic consequences. Ann, Brant’s mother, recalls the happiness her son brought to her life, and the pain that lingers after his loss.

 Shane Robinson

In 2009, Lori Robinson’s son faced a similar fate. Shane, a vibrant 23-year-old, turned to marijuana for pain relief after a knee injury. Despite his parents’ concerns, Shane believed that the drug was a safe alternative to pain medication. However, Shane’s behavior changed drastically. He began to experience hallucinations and delusions. After being hospitalized several times and a prolonged struggle with mental health, Shane took his own life at the age of 25.

Lori, Shane’s mother, shared that the psychologists who treated her son questioned marijuana’s role in Shane’s mental illness, but neither Shane nor Brant had any prior history of mental illness, and their symptoms rapidly emerged after using marijuana.

Cannabis-Induced Psychosis would finally be added as a recognized mental health diagnosis in the year of 2013.

 

Medical and Scientific Insights

Although research still has a long way to go and should continue to examine how mental health disorders are affected by marijuana use independently, it should also focus on understanding the physiological mechanisms, as well as the effects of increased potency and contaminants in marijuana. The progress that has been made is enough to encourage the continuation of this field of research. Recent studies have shown strong associations between cannabis use disorder (CUD) and psychotic episodes. One study showed that 5 out of every 6 teenagers who sought help for a psychotic episode had used marijuana and that they were 11 times more likely to experience psychotic episodes compared to non-users of the drug. Another study showed a 30% increase in schizophrenia cases among men aged 21-30 were associated with CUD.

Dr. David Streem from the Cleveland Clinic shared with the editor of KentWired that he has observed a dramatic increase in psychosis cases over the past decade, which aligns with the increase in marijuana potency from less than 10% in the 90s to 30% or more today.

Advocating for Prevention

Ann Clark and Lori Robinson have become advocates, raising awareness about the dangers of cannabis-induced psychosis. Despite facing skepticism and opposition, they courageously continue to share their son’s stories to educate others about the potential risks of marijuana use.

As marijuana becomes widely legalized, Ann believes that “it only gives our young people a lower perception of harm, and a false sense of security and safety”. However, increased levels of THC and the building body of evidence linking marijuana to mental health conditions, call for greater public health education and regulations.

The tragic stories of Brant and Shane underscore the urgent need for awareness about cannabis-induced psychosis as the use of marijuana becomes more prevalent among younger populations.

Source: https://kentwired.com/120770/news/cannabis-induced-psychosis-cost-their-sons-their-lives-more-could-be-next/

Never before in history has the supply of drugs been as bounteous, as reliable, as cheap, and as high-quality as in the London of 2024. Any interested customer may, at little risk to themselves, conveniently obtain any herb, mushroom, powder, or pharmaceutical they fancy. The British appetite for drugs dwarfs our consumption of tea and coffee. The number of organised criminals is equivalent to the staffing of a large government department.

It is possible that no city on earth consumes as many drugs as London. Britain accounted for 36% of the EU drug market, and London consumed a disproportionate amount of the drugs within the UK — an outlier within an outlier. Debates about ‘decriminalisation’ have taken on a surreal quality: London is now saturated with drugs and gangs, and possession has been quietly decriminalised for many years already.

This change has come as crime reporting has been suppressed. Shrinking budgets pulled reporters out of court rooms. Judge-invented privacy laws banned the naming of suspects before they are charged. The longest lasting impact of the Leveson Inquiry has been the loss of almost all Fleet Street sources within the police. The Met, despite its astounding lack of competence in fighting crime, has been able to cut off the flow of tips and gossip from within its own ranks. What passes for crime reporting nowadays usually consists of reposting official press releases. As such, the law-abiding might only be able to sense what has been happening through the omnipresent smell of cannabis and the occasional sight of police tape, but the black market shapes and reshapes our city nonetheless.

Multiculturalism is never on clearer display than when we examine the drug market. The Albanian domination of the powder cocaine market is extensively documented. Britain’s welcome to Kosovar refugees has been rewarded with a new and unwelcome ethnic mafia. They have professionalised the cocaine trade and now dominate the entire supply chain, from importation to customer. Reliable customer service is paired with the ruthless application of horrible violence. They have nonetheless kept out of the popular imagination: rather than stabbing each other on the high street, they prefer to kidnap, torture, murder, and dismember far from public view. The result for the consumer is excellent. Much like in the rest of Europe, it is likely that, over the past decade or so, while cocaine prices have remained stable or even slightly fallen, purity has risen considerably. Suppliers are easily found via a search on Telegram. If you want cocaine at three in the morning, it will be quickly dispatched to you by an Albanian in an uninsured BMW. It is no wonder that, despite their small numbers in Britain, Albanians make up the largest foreign contingent in our prisons — and that is after many of them are deported back to Albania to serve their sentences.

The power of the Albanian Mafia has not yet reached its apex. The Albanians also increasingly dominate the cannabis farms, forcing out the Vietnamese (at least they have nail bars to fall back on). Cannabis farming is an innovation only a few decades old. It turns out that, given low energy costs (through tampered electrics), no taxes, and low (very low!) labour costs, British domestic production can outcompete foreign imports. Despite the cost of land in London, the farms proliferate in domestic houses, in secret underground caverns, and abandoned police stations. It is likely that there is more agriculture in London today than at any point in the last century.

Not that the Albanians are the only ethnic mafia in London. The Turks have their own, which is distinguished by their fondness for heroin, shootings, and corrupting public officials. The Iranians specialise in methamphetamines: the Islamic Republic is the main source for a drug used here almost entirely for gay sex parties. Even the Chinese appear, importing a cornucopia of chemicals from their home country, and playing a key role in money laundering (‘No card, we cash only’).

“The British, if they think of their Chinese neighbours at all, may be vaguely aware of a demographic division. Firstly, there are the Cantonese-speaking Hong Kongers, who mostly arrived in two waves in the ’90s and ’20s, and have settled here permanently. Then there are the Mandarin-speaking Mainlanders, usually wealthy students who keep to themselves and never seem sure why they are here. But least known of all are the poor Fujianese, only ever glimpsed in kitchens and building sites. Their numbers cannot easily be gauged, but illegal Chinese immigrants in London come almost entirely from Fujian.”

As we move down the supply chain and into less profitable substances, the demographics change and the professionalism erodes. The junkies and crackheads don’t get the full Deliveroo service. Local dealers buy in powder cocaine and heroin, and the former is converted to crack with little more than a pyrex and a microwave. At this point, the official vocabulary changes from ‘Organised Crime Group’ to ‘Urban Street Gang’, although the barriers to entry are so low that some dealers are effectively self-employed. Marketing is rudimentary: a common technique is sending out hundreds of SMS messages a day to local addicts. These are the most visible drug dealers: nowadays, the stereotype of a young black man in a tracksuit with a rambo knife in his bag is really only found at this level. They carry by far the most risk, both of arrest and injury. The daylight stabbings that have become part of daily life are both perpetrated and suffered at this tier. They are the easiest for the police to catch, in no small part because this demographic don’t simply see dealing as a job, but as an aspirational lifestyle. It is almost impossible for a normal Briton to comprehend the myopia of the typical Roadman. London’s council estates are not ‘cosmopolitan’ or ‘world-wise’ but insular in the extreme. When the world does not exist outside of the M25, it makes far more sense to stab another child who is from the wrong postcode.

The street dealer also serves up cannabis, sending out menus via WhatsApp. These customers are certainly nicer to deal with. For the discerning customer, a more convenient option has lately emerged. Nobody who walks London’s streets can have failed to notice the plethora of posters and stickers advertising websites selling cannabis. Gone are the days of darknet markets, requiring the customer to download Tor and make a risky purchase in cryptocurrency. Nowadays, should you scan a QR code, you will be directed to a professional website that could as well be selling t-shirts. Add the product to your basket, check out, and cannabis will arrive in the next post. Better than Amazon!

Legalisation in the United States has allowed manufacturers to conduct exciting experiments in ‘What can we put cannabis in next?’. The British marijuana user has access to an astonishing range of cannabis products: oils, crystals, waxes, chocolates, soaps, fruits — even gummies, which tend to be popular among young school children, resulting in occasional mass hospitalisations. Its stench has supplanted London’s smog: several visitors from the East have remarked to me that it is the city’s least pleasant aspect. On the other hand, the mass demonstration of its stultifying cognitive effects has obliterated the old stereotype about enhanced creativity. The astonishingly brazen advertising tactics used by these networks makes it clear that the Met are either unwilling or unable to act.

Decriminalisation is increasingly de jure as well as de facto. Take cannabis. If you are caught in possession of cannabis, you will be given a Community Resolution: essentially, no further action. If you are caught a second time, you would be issued a Penalty Notice for Disorder, of little more consequence than a parking ticket. Being caught a third time, you may have to attend a police station to receive a formal caution. Only if you are caught in possession of cannabis four times — an incredibly unlikely circumstance, considering that there are no police operations targeting users — do you risk prosecution. And even if that freakish turn of events did come to pass, 97% of the time you walk free from court.

Even the suppliers increasingly find there is little to worry about. Fewer and fewer criminals are arrested, and fewer and fewer of those arrested are charged. Theresa May’s Modern Slavery Act 2015 — despite stiff competition, one of the worst pieces of legislation passed in the last ten years — handed a ‘Get Out Of Jail Free’ card to any dealer unlucky enough to be caught. Even a report by the Slavery Commissioner, hardwired to defend the existing legislation, found that:

…criminals are enabled in their efforts to exploit others by the statutory defence and are coaching victims and associates alike to exploit the protections the trafficking defence offers. You have the perfect storm; motivated traffickers who know how to abuse vulnerable victims and how to exploit the statutory defence — and the systemic weaknesses enabling them to do so.

The same report contained some typical examples:

A 15 year old is frequently being arrested but is still dealing drugs on the street. He has openly told Police that they ‘can’t touch him’ since the NRM decision [identifiying him as a victim of Modern Slavery] ended the prosecution against him. He sustained significant injuries after being attacked with a machete…

This is an individual who historically [was identified as victim of Modern Slavery] (aged 15 years) but has since continued to grow their local drug network to now becoming a suspected operator of their own county line. The issue here is that this non-recent NRM decision is still bought into play when they come to our attention today and this makes the securing of a criminal justice outcome difficult. This person (now 17 years) is now believed to no longer be in any duress.

Defendants playing the ‘Modern Slavery’ defence don’t need to inform on their supposed bosses, or give any detail identifying them. A vague account of duress is often enough to see a prosecution abandoned.

Even if a dealer is unlucky enough to end up in jail, they often find their lifestyle can continue substantially unaltered. The Prison Service is shot through with corruption: smartphones proliferate, cell blocks stink of cannabis, and many female guards (and even governors) are happy to provide sexual favours. Some jailed drug dealers are even able to carry on controlling their drug lines from jail, directing runners from the safety and comfort of His Majesty’s Prison.

We have arrived at the worst of all possible worlds: untrammelled demand and rampant criminal supply. On the last estimate (seven years ago), £9.4 billion was spent on drugs each year in England and Wales, triple national spending on tea and coffee. The cost to society of drugs was estimated at £19 billion. From 2012/13 to 2017/18, 56% of London’s homicides were drug-related.

Crime certainly pays: even low-level drug dealers have a tax free salary that can beat much of the respectable middle class. Dealers can go decades without being troubled by the police. Washing dirty money is made easy by Companies House’s extraordinarily lax system of company creation, which charges almost nothing for registering a company, has no identity checks whatsoever for directors (meaning you can just use a fake identity), does not require proof that you own or have the right to use the registered office address, and is in fact legally not even permitted to try to comply with anti-money laundering checks. The main difficulty tends to come with buying a home: stiffer (or at least existent) anti-money laundering checks at this point can mean that even fairly successful drug dealers are still stuck in their baby-mumma’s council flat, or renting in Royal Arsenal Woolwich or New Providence Wharf. Nonetheless, those further up the chain are usually able to invest in Home County houses, flats in Dubai, and villas in their homelands. Those at the bottom of the food chain have a far more grim existence: illegal immigrants locked in a warehouse watering cannabis plants, or young teens ordered to stuff gear into an orifice, travel down to some god-forsaken town, and serve up from a traphouse.

Laundering their reputations is easier still. The rapper ‘Digga D’, at time of writing in prison for drug importation, is due to headline the Wireless festival later in July. His peer, ‘Skrapz’, is set to perform at Reading festival, despite having been convicted of covering up a murder a few months ago. The journalistic, cultural, and political mainstream has developed a dangerous fetish for professional criminals.

The full scale of organised crime in London can be hard to picture. But occasionally we get glimpses. Four years ago, the French and Dutch police hacked EncroChat, an encrypted communications network used exclusively by organised crime. For months, they were able to read and capture the messages sent on the network. In Britain alone, over 3,000 people have been arrested so far, and the cases continue to pop up in court. One of those caught was Nana Oppong, who had used the device to plan the murder of a rival. Oppong had been tried for three previous murders, and had gotten off each time. The EncroChat hack is one of the most audacious and successful in the history of policing, unearthing thousands of hitmen and mob bosses. Yet its scope was narrow, looking at only one communications network for a matter of months. It is unsettling to think about how many more gangsters remain untouched.

The situation is bad, and it is getting worse. We should not, however, pretend that our problems are insoluble. As with almost all of Britain’s issues, this is the result of political decisions. We must not indulge in coping mechanisms: ‘Well, every country has crime’; ‘Prohibition never works’; ‘It could be worse, just look at [country X]’. As many countries have demonstrated, it is perfectly possible to reduce drug use and the associated criminality to the point of irrelevance. Better things are possible.

A government interested in solving this problem would have, broadly speaking, two paths to choose from. The first is legalisation: creating a controlled, regulated market for drugs. We could abrogate the various UN treaties that require prohibition, and return Britain to the state of affairs prior to the First World War, when cocaine and opium could be bought from the local chemist. This has a certain libertarian appeal. There may also be financial benefits: police resources could be directed towards other crimes, and the newly legalised drugs could be heavily taxed, much like tobacco and alcohol. Perhaps conveniently available amphetamines would resolve our ‘productivity puzzle’.

These are some very real upsides. But experiments with decriminalisation in North America have also made the downsides obvious. The streets of cities on the West Coast now overflow with human beings decaying alive. During our last era of legal drugs, individuals had fuller responsibility for their own health, housing, and behaviour. Today, the taxpayer would be unable to bear the cost of the inevitable increase in drug consumption. Legalisation would have to be paired with a radical reordering of our social safety net and criminal justice system — something that, while not impossible, is unlikely to happen any time soon.

The alternative is suppression. Contrary to tired arguments about Prohibition and Al Capone, it is perfectly possible to stamp out drug use. The requisite policy is significant penalties for possession. For decades our approach has been to go after the dealers, the higher up the chain the better. This is appealing on a moral level. Addicts are usually pretty pitiable characters, and it feels right to devote resources to those who profit from human misery. This has been a total failure. Draconian punishments for suppliers are a necessary but insufficient precondition for success. Consider the market dynamic. Demand drives supply. When a drug dealer drops off — into prison, fleeing to Dubai, or stabbed — the opportunity for profit will inevitably tempt another to step into their place. If a drug user stops — due to punishment, overdose, or a change in habits — there is no equivalent. A young man might choose to start selling heroin if the local big man goes to prison; nobody is so drawn to taking drugs.

Targeting drug users would be a radical shift. Initially, it would probably be unpopular. For decades there has been a real effort to destigmatise drug use. Locking up users will attract outrage from the NGO-media-legal class that must be overcome. The courts and the police — on which responsibility implementing such policies will fall — will also most likely push back. On a purely practical level, the number of crack and heroin users is more than three times the current prison population, and prisons are currently filled with drugs anyway. The immediate priority for any government who wants Britain to kick its habit is to fix the prisons: firstly, through a massive expansion of the estate; and secondly, by purging the corrupt elements in the prison service. Crack and heroin represent 86% of the costs associated with drug use.

On strategic grounds, the campaign should start here. A Progressive regime should begin its reform programme with long sentences for for ‘petty’ acquisitive crimes such as shoplifting or burglary — crimes which are overwhelmingly committed by the worst addicts — before expanding to the penalisation of the more general anti-social behaviour associated with users. The asylums must also be expanded. As state capacity is rebuilt, the campaign could gradually broaden out to punishing simple possession. Each drug will need to be stigmatised and eliminated in turn.

What happens if we do not change course towards either legalisation or suppression, and instead continue along our current route of ‘decriminalisation’? This is the path Labour is almost certain to follow: the new Minister for Prisons has praised the Dutch approach to incarceration. The Netherlands has always been Europe’s most futuristic country: every trend emerges there first. The omens are grim. Holland is now home to truly terrifying organised crime networks which the state struggles to contain. Efforts to bring one mob boss, Ridouan Taghi, to justice cost the lives of bloggers, journalists, relatives of witnesses, and lawyers. Decriminalisation invariably puts billions of pounds into the pockets of organised crime, and eats away at society from within. The Netherlands has become a narco-state, but at least at least their prison population is lower than ours, eh?

Crime is an open goal for any political movement. The British public are bloodthirsty when it comes to criminals; the costs to society are tremendous; and, above all, it is the right thing to do. Drugs are a tempting problem to ignore. Droning on about it makes you sound like Peter Hitchens on one of his more boring days. Many of us have used drugs and enjoyed them. Yet solving this problem — whatever form that solution takes — is essential to breaking the power of organised crime and making the British people secure in their person and property once more.

Source:  2024 Pimlico Journal
548 Market Street PMB 72296, San Francisco, CA 94104

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.

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.

Forget Moisturizer, This 1 Household Item Helps “Smooth” WrinklesSponsored by New Beauty Discovery

Urologist Urges Seniors With A Leaky Bladder To Do This Every MorningSponsored by Prostate Revelation

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

GMP is to launch a pilot scheme in which officers would carry an ‘antidote’ to super-strength drugs containing nitazenes, which have been linked to 100 deaths across the UK since last summer.

Nitazenes are a group of synthetic opiate drugs which can be more potent than fentanyl, and their use is spreading across Europe and North America, the United Nations drug agency has warned. They have been detected in the UK, US, Slovenia, Estonia, Latvia, Belgium and Canada, the UN Office on Drugs and Crime (UNODC) wrote last month in its latest World Drug Report.

In April the government classified 15 types of nitazenes as Class A drugs, with the Advisory Council on the Misuse of Drugs warning they are highly addictive and pose a greater risk of overdose.

It is feared the substances may be bought and consumed unwittingly by people who think they are purchasing prescription drugs like diazepam from suppliers in countries such as China.

And now it can be revealed that Greater Manchester Police is expected to launch a pilot aimed at saving lives.

Detective Superintendent Joe Harrop told the M.E.N: “GMP is to launch a pilot scheme in which officers would carry an ‘antidote’ to super-strength drugs containing nitazenes, which have been linked to 100 deaths across the UK since last summer.

Nitazenes are a group of synthetic opiate drugs which can be more potent than fentanyl, and their use is spreading across Europe and North America, the United Nations drug agency has warned. They have been detected in the UK, US, Slovenia, Estonia, Latvia, Belgium and Canada, the UN Office on Drugs and Crime (UNODC) wrote last month in its latest World Drug Report.

In April the government classified 15 types of nitazenes as Class A drugs, with the Advisory Council on the Misuse of Drugs warning they are highly addictive and pose a greater risk of overdose.

It is feared the substances may be bought and consumed unwittingly by people who think they are purchasing prescription drugs like diazepam from suppliers in countries such as China.

And now it can be revealed that Greater Manchester Police is expected to launch a pilot aimed at saving lives.

Detective Superintendent Joe Harrop told the M.E.N: “We have launched a drug strategy which is about prevention, treatment and diversion. We are looking at launching a pilot where some officers in high risk drug areas would carry naloxone which is an antidote to opioids. At the moment there is little evidence to say nitazenes use is widespread in Manchester but there is a national issue with it. I do imagine it will get more widespread.”

In May the Manchester Evening News reported how experts in the city are bracing themselves for the impact on Manchester’s drug scene of nitazenes – which can be hundreds of times more potent than heroin.

One heroin user, who spoke to the Manchester Evening News anonymously, told us he feared he had inadvertently taken it recently.

“It’s in town now,” he said. “People ’round the gardens [Piccadilly Gardens] are worried about it because you can’t tell until you’ve had it. It’s horrible. It makes your heart start beating too fast. You feel sick. You feel like you’re overdosing straight away. It’s too strong.”

Meanwhile, back in March, Harry Durose, 21, was found dead at his supported accommodation in Hyde, Tameside, on March 3. Drugs containing nitazenes were also discovered inside the address, and the M.E.N understands Greater Manchester Police is investigating whether his death was linked to the synthetic opioids.

Officers are currently awaiting the results of a post-mortem examination that will determine whether he had taken drugs containing nitazenes, and if that resulted in his death.

Harry’s mother, Amy Durose, said she believed her son had unknowingly taken the drug after buying items he believed to be diazepam on the black market, having previously been prescribed diazepam to treat a chronic joint condition.

“They just posted it to him and nobody had any idea,” said Ms Durose. “I just wish he had told me. He was very clued up on prescription drugs. If he had known these nitazenes existed, he would not have risked it.”

As previously reported in the M.E.N, Detective Superintendent Joe Harrop’s team is targeting the international postal trade in drugs, following a surge in packages delivered to Greater Manchester addresses.

“There is a risk – people think they are ordering diazepam, valium, or other controlled drugs online that they are buying from China, that’s not necessarily what they are getting in the post, which does link in with the nitazenes threat,” Det Supt Harrop said.

He added: “We are seeing a lot of cannabis coming in from North America, where it is legal to buy in some parts, and the Netherlands for the same reason. An emerging area is Thailand. China is more your prescription medication – and the threat of synthetic opioids.”

“There are different risks,” he went on. “If you avoid that face to face conversation with a criminal you don’t know what you are getting. You are still giving your address, credit card details to international criminals – so you are leaving yourself open to being a victim of other types of crime.”

In December it was reported that 30 overdose fatalities in Birmingham were being examined for the involvement of nitazenes and the sedative xylazine, after a coroner concluded nitazenes were the primary cause of death of two drug addicts in one night at a hostel in the city.

Det Supt Harrop added: “West Midlands have had quite a large number of nitazenes linked deaths. We have not yet. But we have a specific strategy to deal with nitazenes – if we identify them we will put something in place straight away.

Nitazenes were first developed in the 1950s, but never approved for sale. Their re-emergence has been put down to China’s crackdown on fentanyl, a synthetic opioid estimated to have caused 75,000 deaths in the US in 2022, and problems with heroin supplies caused by the Taliban’s ban on harvesting opium poppies in Afghanistan.

Speaking back in April, then-Home Secretary James Cleverly said: “We are highly alert to the threat from synthetic drugs and have been taking a range of preventative action, learning from experiences around the globe, to keep these vile drugs off our streets. Placing these toxic drugs under the strictest controls sends a clear message that the consequences for peddling them will be severe.”

While GMP and agencies are alive to the threat, confirmed sightings and recoveries of nitazenes remain rare.

Back in May, Dr Oliver Sutcliffe, director of Manchester-based drugs testing agency MANDRAKE, said no evidence of nitazenes had been found in any of the samples analysed in Greater Manchester.

“We’re not saying it’s not out there, we just haven’t detected it,” he said. “If it’s in other parts of the UK, it’s likely to be somewhere within the wider supply. The pragmatic approach is to make sure the people who might be exposed to it that they are at least offered the chance to test their heroin.

“We also need education to explain it could be in the supply. But we are not just waiting for a nitazene death – we are testing samples and we will continue to do so.”

Meanwhile, Michael Linnell, who runs Greater Manchester’s Local Drug Information System, said drugs services and the authorities were ‘prepared for the worst’.

It is a concern,” said Michael. “It’s certainly something we are taking very seriously. It’s not unusual for heroin users to overdose and die. It’s not unusual for heroin to be adulterated But it is unusual for it to be adulterated with something that’s stronger than the heroin itself.”

“We could get 20 deaths tomorrow. Anyone who tells you they know what’s going to happen is not telling the truth. We have to plan for the worst, so we are planning for adulterants in heroin and for nitazene to be substituted for heroin. That’s our worst fear.

“The information about how potent nitazenes are are guesstimates. But some of them are thought to be 150 times stronger than heroin. You only need a tiny bit and it would be very, very easy to get the mix wrong.”

Source: https://www.manchestereveningnews.co.uk/news/greater-manchester-news/gmp-officers-carry-antidote-super-29513328 July 2024

More than 110 experts gathered on 17 April 2024 in an effort to strengthen regional initiatives for combatting illicit trafficking in opiates originating in Afghanistan at the Expert Working Group of the United Nations Office on Drugs and Crime’s (UNODC) Paris Pact Initiative hosted by the OSCE. The Paris Pact initiative is an international coalition for combatting illicit trafficking in opiates originating in Afghanistan.

Participants discussed the latest trends and the impact of the opium ban introduced in 2022 by the de facto authority in Afghanistan. They also explored ways to improve law enforcement networks for countering the threat of drugs from Afghanistan, build counter-narcotics capacity through training and other assistance, address financial aspects of drug-related crimes, promote regional co-operation and better understand the links between drug trafficking and other forms of organized crime.

“The importance of cross-border co-operation in counter-narcotic operations takes on heightened significance, particularly in the challenging context of Afghanistan. As the discussions at this Expert Working Group meeting underscore, collaborative efforts play a vital role in the global fight against the illicit drug trade,” said Jean-Luc Lemahieu, Director of the UNODC Division for Policy Analysis and Public Affairs.

Collaboration is at the heart of the Paris Pact, said Riku Lehtovuori, UNODC’s Paris Pact Initiative Coordinator. “Over the years, the representatives of Paris Pact partners have worked together to provide updated recommendations across all four thematic pillars of the Paris Pact, drawing from the principles outlined in the Vienna Declaration adopted in 2012.” The four pillars focus on enhancing co-operation for regional initiatives, detecting and blocking drug-related financial flows, prevention related to manufacturing of opiates, and reduction of drug abuse and dependency.

“The threat of smuggling opiates and synthetic drugs from Afghanistan is very serious. The world drug problem remains a major challenge for the international community, threatening security and undermining human, economic and social development in many regions of the world,” said Alena Kupchyna, Co-ordinator of OSCE’s Activities to Address Transnational Threats. She underscored how the OSCE continues working closely with its participating States in Central Asia to address the security impact of the situation in Afghanistan, including through an OSCE cross-dimensional project, run in close co-ordination with UNODC, on enhancing youth crime and drug use prevention through education on legality and awareness campaigns addressing threats of organized crime and corruption.

Source: https://www.osce.org/secretariat/566953 April 2024

Press Release: Ambassador Linda Thomas-Greenfield Launches Alliance to Prevent Drug Harms in Collaboration with United Nations and Tech Industry

Today, Ambassador Linda Thomas-Greenfield, Representative of the United States to the United Nations, launched the Alliance to Prevent Drug Harms (Prevent Alliance), alongside representatives from the United Nations and the tech industry, including Meta, Snap Inc., and X Corp.

“Two out of every five Americans know someone who has died of an opioid overdose…in every corner of the world…we’re seeing a rapid rise in synthetic drug use, dependence, and overdose death,” said the Ambassador. “This is an international crisis…we’ve seen the criminal groups that produce these drugs adapt quickly.”

That adaptation includes the use of technology platforms, including social media, to promote the illicit use of non-medical synthetic drugs.

“This alliance between the United States, the United Nations, and our partners in the private sector, holds immense potential to make a meaningful difference. To disrupt this crisis, both here in the United States and all across the globe, and adapt with the same agility, the same resourcefulness, of those we’re up against. This is a good step, but we all know much more needs to be done to address this problem.” Ambassador Thomas-Greenfield continued.

The Prevent Alliance, a public-private partnership effort, is committed to ending the use of online platforms to aid the flow of illicit substances. Through a framework for cross-industry cooperation, the Prevent Alliance will work to disrupt the availability of synthetic drugs online, promote drug-prevention content across platforms, and enables cross-sector communication establishing the best evidence-based practices for drug-prevention campaigns.

The alliance builds upon the work of the Global Coalition to Address Synthetic Drug Threats, a multilateral effort to combat the threats posed by synthetic drugs launched by Secretary Blinken last year, and the U.S.-led adoption of new controls targeting the synthetic drug manufacturing process at the UN Commission on Narcotic Drugs earlier this year.

Maggie Nardi, the Deputy Assistant Secretary of State of the Bureau for International Narcotics and Law Enforcement Affairs (INL), said, “Governments alone cannot shield people from the dangers of synthetic drug misuse; we must forge stronger alliances with public health, civil society, affected communities, academics, and industry to combat their illicit manufacture, distribution, and promotion.”

Under the Biden Administration, the United States is dedicating more resources to tackle the demand for drugs, including more resources for public awareness, health interventions and services to prevent and reduce the implications of drug use, as well as measures to prevent, detect, and stop the illicit manufacturing and trafficking of drugs. These efforts include support for the UN Office on Drugs and Crime (UNODC) and Commission on Narcotic Drugs, as well as U.S. leadership in rallying countries around the Global Coalition to Address Synthetic Drug Threats.

“Evidence-based prevention is key to respond to the drug use situation globally, especially in a rapidly digitalized world. Social media nowadays carries an important influence on the individual. To harness this influence positively, science can help,” said Delphine Schantz, director of UNODC’s New York office. “UNODC together with WHO reflected on that science through the International Standards on Drug Use Prevention. This science aims at creating a healthy and safe environment for children and youth, fostering resilient generations against drugs and any risky social and health behaviors. Working through this science, social media could be one of those added layers of prevention.”

“Families and communities around the world are struggling with the opioid crisis,” said Nell McCarthy, Vice President of Trust and Safety at Meta. “From governments to the private sector, and health care systems to civil society organizations, we must all do our part to combat this crisis, which is why Meta is proud to be part of the Prevent Alliance.”

Source: https://usun.usmission.gov/ambassador-linda-thomas-greenfield-launches-alliance-to-prevent-drug-harms-in-collaboration-with-united-nations-and-tech-industry/ July 2024

Abstract

Studies examining lifestyle and cognitive decline often use healthy lifestyle indices, making it difficult to understand implications for interventions. We examined associations of 16 lifestyles with cognitive decline. Data from 32,033 cognitively-healthy adults aged 50-104 years participating in prospective cohort studies of aging from 14 European countries were used to examine associations of lifestyle with memory and fluency decline over 10 years. The reference lifestyle comprised not smoking, no-to-moderate alcohol consumption, weekly moderate-plus-vigorous physical activity, and weekly social contact. We found that memory and fluency decline was generally similar for non-smoking lifestyles. By contrast, memory scores declined up to 0.17 standard deviations (95% confidence interval= 0.08 – 0.27) and fluency scores up to 0.16 standard deviations (0.07 – 0.25) more over 10 years for those reporting smoking lifestyles compared with the reference lifestyle. We thus show that differences in cognitive decline between lifestyles were primarily dependent on smoking status.

Source: https://www.nature.com/articles/s41467-024-49262-5 June 2024

More than 178 000 people died from excessive alcohol use in the US during 2020 to 2021, surpassing deaths from the overdose epidemic.1 Excessive drinking is now the leading cause of preventable death in the US.1 Alcohol use disorder (AUD) most commonly begins during adolescence, although rarely is it identified and treated at this age.2 We urgently need interventions that allow us to better identify those young people at risk of developing AUD and alcohol-related complications later in adulthood. In their study of alcohol use among youths with a chronic medical condition (CMC), Weitzman et al3 describe a novel approach for alcohol prevention in a population of youths with medical vulnerability. Youths with a CMC are particularly susceptible to the effects of alcohol and warrant particular attention. Although the rate of alcohol use among these youths is similar to that of their peers, youths with a CMC have higher rates of progression to heavy alcohol use and AUD.4 Weitzman et al3 found that high-risk alcohol use occurred in more than 1 of 10 youths (aged 14-18 years) with a CMC seen in the specialty clinics included in their study. These youths also have an increased risk of treatment nonadherence and potential medication reactions with alcohol as a result of the underlying disease, worsening the potential effects of high-risk alcohol exposure in this population.4

Given these disparities, Weitzman et al3 designed a randomized clinical trial aimed at evaluating the effects of the Take Good Care (TGC) alcohol use prevention intervention over 12 months among youths with a CMC. In the specialty clinic setting, youths in the intervention group received a brief, personalized intervention consisting of a self-administered slide deck on an electronic tablet. Slides were disease tailored, and they included specific effects of alcohol use on disease processes, treatment safety, and efficacy as well as motivational information on health-protecting decisions and behaviors. Although there was no change among youths reporting no or minimal (low-risk) alcohol use, there was a 40% relative reduction in self-reported frequency of alcohol use among those receiving the TGC intervention who reported high-risk alcohol use at baseline compared with those who received treatment as usual.

The study by Weitzman et al3 highlights the potential importance of brief interventions in changing youth behavior, particularly among a group of youths who are medically vulnerable. Although a shocking 11.5% of youths with a CMC in this study reported high-risk alcohol use at baseline, nationally only a quarter of pediatricians report using validated screening tools to assess alcohol use among adolescents and only 11% of pediatricians correctly use the Screening, Brief Intervention, and Referral to Treatment (SBIRT) tool recommended by the American Academy of Pediatrics.5 Despite growing evidence supporting the benefit of SBIRT for pediatric populations, barriers to implementation include insufficient time and need for clinician training5; both of these barriers are ameliorated with the use of the self-administered, electronic intervention described by Weitzman et al.3 This study adds to the growing database highlighting the effectiveness of SBIRT in identifying and intervening in instances of substance use among youths. It presents a tool easily adopted by clinicians, with an impact on those youths at greatest risk of developing problematic alcohol use.

Considering the prevalence of alcohol use among youths with CMCs, an important aspect of the study by Weitzman et al3 is its low-touch intervention that can be easily adapted and implemented in a variety of clinical settings. Weitzman et al3 show the value of even simple, low-touch interventions in changing youth behavior. From the patient perspective, the use of an electronic tablet enhances privacy when answering questions and allows for flexibility in time spent on each piece of content. From the clinician perspective, the use of an electronic tablet requires minimal additional effort or training, standardizes the content provided, and allows for intervention completion outside of face-to-face appointment time. Yet despite its simplicity, the low-touch TGC intervention has been shown to exert a substantial effect on adolescent behavior. At 12 months, the reduction in alcohol use frequency among youths with a CMC and high-risk alcohol use represents not only a meaningful behavioral change but also an enduring one.

In contrast with traditional fear-based messages around alcohol prevention, Weitzman et al3 demonstrate the impact of a strengths-based model that engages the normal adolescent quest for independence and the examination of choice in larger contexts. The TGC intervention educated youths with a CMC on disease-specific processes, treatments, and effects of alcohol, thereby encouraging reflection around alcohol-related choices. In presenting this information for youths to consider, the intervention relayed respect for patients’ ability to engage in their own health care and health behaviors. Additionally, disease-tailored content paired with motivational information on health-protecting behaviors encouraged patients’ sense of autonomy and independence. The statistically significant effects of this approach suggest that personalized intervention resonates with youths with CMCs and is an effective tool for behavioral change. Furthermore, this delivery model allows for content to be tailored based on disease or other aspects of youths’ lived experience. Content adjusted to the needs of specific subpopulations of youths creates interventions that they connect with and are thus most greatly affected by, in both depth and longevity of impact.

Finally, key to the study by Weitzman et al3 is the intervention location; utilization of the specialty care setting for an alcohol use prevention intervention is novel and effective. Many youths with a CMC receive the majority of their care in the specialty care setting and, accordingly, often develop stronger therapeutic relationships with their specialty care physician than their primary care physician. In 41.3% of visits to their specialists, youths with a CMC present for routine preventative care,6 yet specialists screen for substance use at alarmingly low rates compared with their primary care counterparts (self-reported 8% vs 38%, respectively).7 Interventions within the specialty clinic space allow for greater potential to reach more youths with CMCs at critical moments in their health journeys, thereby curbing heavy alcohol use, its associated medication nonadherence, and potential interaction with medications. By doing so, this method of intervention may decrease disease-associated complications and mortality in addition to alcohol-associated complications and mortality among youths with CMCs, and by extension, the adults that they become. The TGC intervention and its broader application represent an exciting new paradigm for future practice.

Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2820973 July 2024

A silent revolution is taking place in the heart of Pakistan where communities are tightly knit and traditions run deep. Grassroots and community-based initiatives are emerging as beacons of hope in the fight against drug abuse, transforming lives and fostering resilience in ways top-down approaches often cannot achieve.

Pakistan faces a significant drug abuse problem, with millions affected by the scourge of addiction. The United Nations Office on Drugs and Crime estimates that 40 per cent of all heroin and morphine trafficked out of Afghanistan transits through Pakistan. This has contributed to a rise in addiction rates and related health issues, including the spread of HIV. Health professionals report an increasing number of new HIV positive cases each year, emphasising the urgent need for effective intervention strategies.

The International Narcotics Control Board annual report stresses the importance of governments giving greater attention to fighting drug abuse, particularly the rising use of date-rape drugs. The INCB has called for the implementation of a 2009 resolution to combat the misuse of pharmaceutical products for sexual assault and to remain vigilant about the increase in date-rape drug abuse.

Amidst this crisis, numerous grassroots organisations have sprung up, leveraging the power of community and local knowledge to combat drug abuse. These initiatives are often founded by passionate individuals who have witnessed the devastating effects of addiction firsthand. Their work is characterised by personalised care, cultural sensitivity and a deep understanding of the local context.

One such initiative is Nai Zindagi (New Life). The organisation has been at the forefront of drug rehabilitation and harm reduction since 1989. Nai Zindagi focuses on providing health and social services to people who inject drugs (PWID) and their families. Their approach includes needle exchange programmes; HIV testing and counseling; and vocational training to help individuals reintegrate into society.

Through community outreach and peer-led education, Nai Zindagi has significantly reduced the spread of HIV among the PWID. Their model emphasises dignity and respect, fostering an environment where individuals feel safe and supported in their journey towards recovery.

At the forefront of these efforts is Akmal Ovaisi, head of Tanzeem-al Fajr, a prominent NGO in Pakistan. Under his leadership, Tanzeem-al Fajr has become a pivotal force in drug prevention efforts across the country. Ovaisi’s vision and dedication have galvanised a movement, bringing together diverse organisations to tackle drug abuse through a unified approach.

Akmal Ovaisi believes in the power of community involvement in addressing drug abuse. By engaging local leaders, volunteers and affected families, Tanzeem-al Fajr creates a support system that fosters recovery and prevention.

Ovaisi prioritises educational campaigns to raise awareness about the dangers of drug abuse. These campaigns target schools, colleges and community centres, aiming to reach young people before they fall into the trap of addiction.

Recognising that no single organisation can combat drug abuse alone, Ovaisi has built a strong network of NGOs that collaborate and share resources. This network enhances the capacity to deliver comprehensive services, from rehabilitation to vocational training.

Ovaisi actively engages with policymakers to advocate for stronger drug prevention policies and better support systems for addicts. His efforts have been instrumental in shaping national strategies that reflect the needs of those on the ground.

Aghaz-i-Nau (New Beginning) is another remarkable community-based initiative dedicated to drug abuse prevention and rehabilitation. Located in Islamabad, Aghaz-i-Nau has a holistic approach to addiction treatment, combining medical care, psychological support and spiritual healing. Their residential treatment programme is tailored to meet the needs of each individual, ensuring that recovery is sustainable.

Aghaz-i-Nau also works extensively on awareness campaigns, targeting schools and colleges to educate young people about the dangers of drug abuse. By fostering a dialogue on addiction and breaking down stigmas, they empower communities to tackle the issue head-on.

Rozan, a non-profit organisation based in Islamabad, addresses the psychological and emotional aspects of drug abuse. Their programmes are designed to build emotional health and resilience, particularly among vulnerable populations such as women and children. Rozan’s community-based approach involves training local volunteers to provide psychological first aid and support to individuals affected by drug abuse.

Through workshops, counselling sessions and community events, Rozan helps individuals develop coping mechanisms and rebuild their lives. Their work highlights the importance of addressing the root causes of addiction, such as trauma and mental health issues, in order to achieve lasting recovery.

The success of these grassroots initiatives lies in their ability to mobilise community resources and create networks of support. Unlike large-scale interventions, which can often feel impersonal, community-based programs are deeply embedded in the local context. This allows them to respond more effectively to the specific needs and challenges of their communities.

These initiatives often adopt a multi-faceted approach, addressing not just the symptoms of addiction but also its underlying causes. By providing education, vocational training and emotional support, they help individuals build a foundation for a healthier, drug-free life.

Despite their successes, grassroots organisations in Pakistan face numerous challenges. Limited funding, societal stigma and bureaucratic hurdles can often obstruct their efforts. However, their resilience and innovation continue to inspire hope.

There is a pressing need for greater collaboration between government bodies, international organisations and community-based initiatives. By pooling resources and sharing best practices, it is possible to create a more coordinated and effective response to drug abuse.

In the fight against drug abuse, Pakistan’s grassroots and community-based initiatives are making a profound difference. Through their dedication, empathy and ingenuity, they are transforming lives and creating a ripple effect of positive change. As these pioneers continue their work, they remind us that the strength of a community lies in its ability to come together and support its most vulnerable members.

Support these initiatives by volunteering, donating or spreading awareness about their work.

Source: https://www.thenews.com.pk/tns/detail/1204770-pioneering-drug-abuse-prevention-and-support

It seems as if every community, big or small, has been impacted by the problems associated with substance use and drug overdose. Within communities, these problems can extend into the family unit, with people often becoming addicted and dying because of drugs.

However, community drug education and prevention programs can be a first line of defense. 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.

In California, the California Department of Education offers information on resources for health services, student assistance programs and alcohol and substance abuse prevention. The California School-Based Health Alliance provides school-based health centers and wellness centers to prevent and treat substance use.

Fortunately, more and more people are seeking treatment. According to the California Health Care Almanac, between 2017 and 2019, the number of facilities offering residential care for substance use treatment grew by 68%, and the number of facilities offering hospital inpatient care more than doubled.

The more people who seek treatment and become aware of the dangers, the more people are saved from an overdose. According to drug abuse statistics, there is an average of 6,100 drug overdose deaths per year in the state. Overdose deaths increased at an annual rate of 10.37% over the last three years. However, this remains below the national average death rate.

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, and this could potentially lead to other drug use.

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. Much of their use is linked to 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 can seem like an easy escape from the problems of life.

Additionally, environment and family history are contributing factors. Children, for example, 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 nonprofit organizations providing prevention and education.

Additionally, 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 is a mother of two with a passion for helping others. She currently works as a community outreach coordinator for DRS to help spread awareness of the dangers of drugs and alcohol. She can be reached at jboulay@addicted.org.

 

Source: https://eu.desertsun.com/story/opinion/contributors/valley-voice/2024/07/01/parents-talk-to-your-kids-about-drugs-and-alcohol/74233477007/

By: Imtiyaz Maqbool Banday @ KI News

As we continue to grapple with the scourge of drug abuse, it’s essential to reexamine our approach to prevention and treatment. While raising awareness about the dangers of drugs is crucial, we must also consider if our efforts are inadvertently glamorizing drug use. Islam teaches us to avoid excess and extravagance (Israaf) and seek refuge in Allah from harmful substances (Khabeeth).

The Glamorization of Drugs: A Contravention of Islamic Values

By constantly talking about drugs, we may be inadvertently glamorizing them, which goes against Islamic values. Young Muslims, in particular, may be drawn to the thrill and excitement associated with drug use, neglecting the Islamic emphasis on self-care and preservation (Hifz).

The Danger of Glamorization

Glamorizing drug addiction can have severe consequences, including:

– Normalizing drug use among young people

– Encouraging experimentation and risky behavior

– Creating a culture of sympathy for drug users, rather than support for recovery

– Distracting from the real issues and solutions

Instead of perpetuating the glamorization of drug addiction, we must focus on promoting a culture of recovery, support, and Islamic values.

A New Approach: Promoting Islamic Values and Support

Rather than solely focusing on the dangers of drugs, let’s shift our attention to promoting Islamic values and supporting those who have overcome addiction. By sharing stories of hope and resilience, we can create a more positive narrative and inspire others to seek help. This approach acknowledges the complexities of addiction and offers a more comprehensive solution, aligned with Islamic principles:

– Tawakkul (Trust in Allah): Encouraging individuals to trust in Allah’s mercy and guidance

– Sabr (Patience): Supporting individuals in their struggles and recovery

– Shukr (Gratitude): Fostering gratitude for health and well-being

– Ihsan (Excellence): Promoting self-care and personal growth

Additional Content:

– The Prophet Muhammad (peace be upon him) said, “A person who guides others to virtue will receive a reward similar to that of the one who follows it, without lessening the reward of either.” (Muslim)

– Islam teaches us to care for our physical and mental health, as part of our duty to preserve our faith (Deen) and our bodies (Badaan)

– The Quran emphasizes the importance of seeking help and support from others, saying, “And help one another in goodness and righteousness.” (5:2)

By incorporating these Islamic principles and values, we can create a more comprehensive and effective approach to drug abuse prevention and recovery.

Conclusion

Let us work together to create a society that values recovery, support, and Islamic principles, rather than perpetuating the cycle of drug abuse. We must avoid glamorizing drug use, promote a culture of recovery and support, encourage seeking help and guidance, foster gratitude for health and well-being, and support individuals in their struggles and recovery. By adopting a more balanced approach, we can create a brighter future for all, free from the shackles of drug abuse.

Kashmir Images is an English language daily newspaper published from Srinagar (J&K), India. The newspaper is one of the largest circulated English dailies of Kashmir and its hard copies reach every nook and corner of Kashmir Valley besides Jammu and Ladakh region.

Source: https://thekashmirimages.com/2024/07/04/rethinking-our-approach-to-drug-abuse-prevention-an-islamic-perspective/

July 7, 2024 6:05 am

The Glamorization of Drugs: A Contravention of Islamic Values

By constantly talking about drugs, we may be inadvertently glamorizing them, which goes against Islamic values. Young Muslims, in particular, may be drawn to the thrill and excitement associated with drug use, neglecting the Islamic emphasis on self-care and preservation (Hifz).

The Danger of Glamorization

Glamorizing drug addiction can have severe consequences, including:

– Normalizing drug use among young people

– Encouraging experimentation and risky behavior

– Creating a culture of sympathy for drug users, rather than support for recovery

– Distracting from the real issues and solutions

Instead of perpetuating the glamorization of drug addiction, we must focus on promoting a culture of recovery, support, and Islamic values.

Promoting Islamic Values and Support

Rather than solely focusing on the dangers of drugs, let’s shift our attention to promoting Islamic values and supporting those who have overcome addiction. By sharing stories of hope and resilience, we can create a more positive narrative and inspire others to seek help. This approach acknowledges the complexities of addiction and offers a more comprehensive solution, aligned with Islamic principles:

– Tawakkul (Trust in Allah): Encouraging individuals to trust in Allah’s mercy and guidance

– Sabr (Patience): Supporting individuals in their struggles and recovery

– Shukr (Gratitude): Fostering gratitude for health and well-being

– Ihsan (Excellence): Promoting self-care and personal growth

Additional Content

– The Prophet Muhammad (peace be upon him) said, “A person who guides others to virtue will receive a reward similar to that of the one who follows it, without lessening the reward of either.” (Muslim)

– Islam teaches us to care for our physical and mental health, as part of our duty to preserve our faith (Deen) and our bodies (Badaan)

– The Quran emphasizes the importance of seeking help and support from others, saying, “And help one another in goodness and righteousness.” (5:2)

By incorporating these Islamic principles and values, we can create a more comprehensive and effective approach to drug abuse prevention and recovery.

Source: https://www.greaterkashmir.com/opinion/islamic-perspective-to-drug-abuse-prevention/

 

360info: 05/07/2024 23:30 MYT

Countries are looking at evidence-based alternatives, with a shift towards public health strategies, to fight the drug scourge – Michael Joiner/360info
THE UN’s annual World Drug Report warns of a rise in drug use and trafficking globally.
The report, released in conjunction with the International Day against Drug Abuse and Illicit Trafficking, or World Drug Day on June 26, found the number of drug users reached 292 million in 2022, with cannabis being the most common drug used.
However, the emergence of new synthetic opioids such as nitazenes is causing concern due to their potency and potential for overdose deaths.
The report also highlighted how drug cartels in Southeast Asia are weaving themselves into a web of illegal activities, including wildlife trafficking and deforestation. This devastates the environment and displaces communities. Increased cocaine production fuels violence along transportation routes, while high-THC cannabis legalisation in some countries is associated with a rise in attempted suicides.
The traditional criminal justice approach, prioritising arrests and punishment, is proving ineffective. Countries are looking at evidence-based alternatives, with a shift towards public health strategies.
This week, Malaysia tabled new amendments to the Drug Dependants (Treatment and Rehabilitation) Act 1983 which would empower officers from the country’s drug agency to arrest, treat, and rehabilitate “drug dependants or misusers” in a bid to ease overcrowding in prisons.
The bill is seen as a step away from the country’s draconian anti-drug laws, shifting the focus from locking up people who use drugs to treatment and rehabilitation. But experts are worried about making rehabilitation mandatory for all and whether the current rehabilitation centres are well equipped to accommodate the influx of patients.
Australia offers a fascinating case study on the complexities of drug policy reform. While the government allocates significant resources to law enforcement, harm reduction and prevention programmes receive a fraction of the funding. This imbalance raises questions about the effectiveness of the current approach.
Pill testing will be introduced in the state of Victoria later in the year, aimed at reducing the risk of overdose deaths, especially at music festivals. It follows similar schemes in the Australian Capital Territory and Queensland which have so far shown to save lives. This has encouraged the state of New South Wales to implement a similar approach.
Australia has also taken a progressive step by making naloxone, a life-saving medication that reverses opioid overdoses, free and available without a prescription, although uptake has been slow.
The illegal drug trade poses a significant threat to national security in some countries. India’s northeast states, bordering Myanmar, serve as a stark example. The drug trade fuels violence and instability, highlighting the need for a comprehensive approach that addresses security concerns and public health.
The situation in Punjab also struggles with widespread substance use and trafficking. Addressing the underlying factors that contribute to drug use, such as lack of economic opportunities, is crucial to tackling this issue effectively.
This year’s World Drug Day theme acknowledges that it is crucial to adopt a scientific evidence-based approach that prioritises prevention and treatment as a step for drug policy reform.
A public health approach that prioritises harm reduction, treatment, prevention, and dismantling accessibility barriers offers a more promising path forward, promoting public health and safety while fostering global stability.

By Shahirah Hamid: Senior Commissioning Editor at 360info Southeast Asia

Source: https://www.astroawani.com/berita-dunia/rethinking-drug-policy-punishment-public-health-477633

By FOX TV Digital Team

Published  July 8, 2024 7:26am EDT

 

Demand for high-potency marijuana causing concerns

Cary Quashen, Owner of Action Family Counseling, joins LiveNOW’s Austin Westfall to dive deep into concerns over the rising demand for high-potency marijuana.

As marijuana use becomes more prevalent, a severe illness linked to frequent cannabis use is also on the rise. 

Cannabinoid (or Cannabis) hyperemesis syndrome, also known as CHS, is an often debilitating condition that affects a small but growing number of chronic marijuana users. 

People with CHS experience severe nausea and vomiting, in some cases 20-24 times a day. It can last days or even weeks and is hard to control – often the only thing that brings relief is a hot shower or bath. 

RELATED: Frequent marijuana use linked to increase in heart attack and stroke risk

Signs of cannabis hyperemesis syndrome

In National Library of Medicine literature, doctors outlined the following criteria for diagnosing CHS: 

  • Long-term cannabis use (often daily)
  • Cyclic nausea and vomiting
  • Relief when stopping marijuana
  • Hot showers/baths relieve symptoms
  • Abdominal pain

RELATED: Teen use of delta-8, an unregulated marijuana alternative, is rising

Ironically, marijuana is often used to treat two key symptoms of CHS: Recent data compiled by the U.S. Food and Drug Administration concluded there is “credible scientific support” for the use of marijuana to treat pain, anorexia, nausea and vomiting. 

Doctors are seeing a rise in serious illness linked to heavy marijuana use (Photo by Lauren DeCicca/Getty Images)

Three cycles of cannabis hyperemesis syndrome

There are three phases of CHS, according to Connecticut state’s Adult Cannabis Use website: 

  • Prodromal – Nausea and vomiting following long-term cannabis use. This often leads to a person using more cannabis to reduce nausea.
  • Hyperemetic – Triggered by increased cannabis use, nausea, abdominal pains and vomiting increase
  • Recovery – Once a person stops using cannabis, symptoms may take several weeks to decrease and disappear until they begin using again, which starts the cycle over.

What causes cannabis hyperemesis syndrome?

Researchers are still early in their exploration of what causes CHS. Dr. Sushrut Jangi, a gastroenterologist at Tufts Medical Center, told The Boston Globe it has something to do with the “somewhat mysterious” endocannabinoid system, which regulates critical bodily functions like sleep, mood, pain control, immune response, appetite and more. 

READ MORE: Michigan dog attacks, nearly kills owner after being fed THC gummy

A lot of receptors in the brain and the gut bind to THC, the substance in cannabis that makes people feel high. Those receptors evolve after long-term cannabis use, Jangi told The Globe. 

Jangi said although it’s hard to calculate, he estimates somewhere between 5% and 20% of chronic marijuana users will experience CHS. 

According to the National Library of Medicine, after Colorado legalized recreational marijuana, ER visits for cyclic vomiting nearly doubled.

 

Source: https://www.livenowfox.com/tag/cannabis

The city is gripped in an opioid crisis worse than America’s. Locals say overly liberal drug laws have sparked a catastrophe

“Yes, I feel fine,” she replies.

“Okay, hold still.”

Eyes wide and hands trembling, Larry, 32, flicks the syringe’s needle before crouching over his friend and injecting a mixture of fentanyl and benzodiazepines into a prominent vein in her neck.

Hailey, 38, is lying on a grimy pavement, surrounded by graffiti, filth, and other drug users. She inhales deeply, curls into a foetal position, and sucks on her thumb to hold her breath.

As the discoloured liquid enters her bloodstream, her body relaxes and her eyes lose focus.

“June 7th,” she murmurs. “I’m counting down the days until I can finally go to detox.”

Hailey and Larry are two of approximately 5,000 active drug users who reside in Vancouver’s Downtown Eastside, a 10-block corridor that runs through the heart of the city along Hastings Street.

Walking the half-mile stretch is profoundly shocking. Bodies lie scattered on the tree-lined streets, some scarcely breathing. Discarded needles are everywhere, and the detritus from makeshift encampments – tents, cardboard, sleeping bags – clutter alleys and verges. The scream of sirens is unrelenting.

The crisis is being fuelled by fentanyl, a synthetic opioid that is 50 times stronger than heroin. Manufactured in numerous illicit labs in Canada’s wilderness, fentanyl is now so common in Vancouver’s Downtown Eastside that you can literally pick it up off the street.

Vancouver once topped the charts of the world’s “most desirable places to live”. Its reputation is that of a city which provides the perfect balance – a metropolis “perched on the edge of nature” combining “outdoor recreation and a great cultural diversity”, as one local website puts it.

But a landmark experiment to decriminalise the possession of certain drugs in public – including fentanyl, heroin, cocaine, methamphetamines, and ecstasy – has allowed an opioid crisis to take hold that surpasses even the epidemic in the United States.

In April, David Eby, British Columbia’s premier announced that halfway into the three-year trial, the province would recriminalise drug use in public spaces.

With a severe backlash from police, politicians, and the public showing no sign of abating, Mr Eby is now under pressure to scrap the pilot scheme altogether.

Since last month, police once again have the power to approach and arrest drug users in hospitals, restaurants, parks, and beaches. But people are still able to legally consume 2.5 grams of hard drugs in their homes and in designated public shelters. It also remains unclear how the revised rules will be meaningfully enforced by the police.

Despite the province’s best efforts, opioid overdoses have become the leading cause of death for people aged 10-59 in British Columbia, and now account for more deaths than homicides, suicides, accidents, and natural diseases combined.

Last year, the province recorded 2,511 drug-related overdoses, 87 per cent of them down to fentanyl. The death rate in Vancouver itself now stands at 56 per 100,000 people – nearly three times the national average. And in the Downtown Eastside, the rate is nearly 30 times higher than the rest of the country.

For comparison, England and Wales have a drug-related mortality rate of 8.4 per 100,000 people. In Scotland – the worst in Europe – it stands at 19.8. The only G7 country with anything close to a comparable rate is the United States, at 32.6 per 100,000 people.

With the city gripped in an opioid epidemic nearly twice as fatal as America’s, the Downtown Eastside is becoming a key battleground for the province’s decriminalisation debate. As overdose numbers continue to rise, many view the liberal rollout as fuel to the fire. Yet others argue there are wider societal issues at play that are far more insidious than fentanyl.

Now entrenched in a public health emergency, Canadians of nearly all political stripes are asking, “How did we get here?”

Decriminalisation ‘not about drugs anymore’

In the first year of British Columbia’s decriminalisation rollout, public drug use exploded – with reports of people injecting heroin on family beaches and smoking crack in maternity wards.

Fiona Wilson, the deputy chief constable of the Vancouver Police Department, says the experiment has tied the hands of police across the city, leaving the wider community at risk. Despite having seized over 1,000 kilos of fentanyl from dealers in 2023 alone, officers are powerless to intervene when they see it used on the streets.

“Decriminalisation has been a massive challenge for the police because it’s taken away our ability to arrest someone. We don’t have any grounds to approach a person who is publicly using illicit drugs in the absence of any other criminality,” she says.

“If someone is sitting at a coffee shop and wants to snort a line of cocaine, we don’t have any authority to intervene in that situation. This presents a real problem because families don’t necessarily want to sit next to somebody in a restaurant who’s shooting up fentanyl.”

On the other side of the debate, left-wing advocates for liberalisation have sought to frame the debate around privilege and class.

Brittany Graham, the executive director of the Vancouver Area Network of Drug Users (VANDU), says bigger societal issues – namely, a lack of housing and inadequate welfare services – are to blame.

“Decriminalisation will always exist for the upper class. When someone has enough money to snort cocaine in the privacy of their own home, the police are never going to get them. What we are witnessing right now is a homelessness crisis on top of a toxic and unregulated drug supply.

“The right-wing is blaming everything on decriminalisation, but the reality is Vancouver has seen a 32 per cent increase in homelessness since the beginning of Covid. But the government continues to label poor drug users as the scapegoats for everything wrong in our province.

“Decriminalisation is not about drugs anymore, it’s about power and control. Drugs have been killing people for decades, now it’s toxic politics.”

Elenore Sturko, the shadow minister for mental health and addictions, says decriminalisation has been a “dangerous and disastrous” policy failure.

“The entire policy was politically motivated. Clearly, the government didn’t do the work on decriminalisation. In fact, they ignored the advice of the police. Now, we end up where we are today – not only failing to reduce death and overdoses, but actually causing increased harm.”

‘I never wanted to use fentanyl’

Beyond the issue of decriminalisation, British Columbia has introduced a raft of “harm reduction” measures in a bid to solve the public health emergency – but these too have proved controversial.

The backbone of the province’s harm reduction project revolves around “safe injection sites” where users can access clean needles and a regulated supply of drugs. In these government-run locations, drug users are able to consume their illicit substance of choice – predominantly fentanyl – while being monitored by healthcare workers with an opioid antidote on hand.

Tiffany, 37, says VANDU’s safe injection site has saved her life many times over. Shortly after moving to Vancouver at 15, she got hooked on heroin. Now, almost two decades later, fentanyl is her drug of choice.

“I never wanted to switch over to fentanyl, but it’s everywhere,” says Tiffany, preparing her needle at VANDU’s site. She’s already crushed and melted down her mixture of benzodiazepines and fentanyl.

“I use drugs as a way of coping with my emotions, and being separated from my son. But I do love myself – that’s why I can’t do this anymore. I refuse to become another statistic,” she says.

Vancouver has long been a pioneer in harm reduction. Over 30 years ago, during the heroin and HIV epidemic, the city opened its first safe injection facility in the Downtown Eastside – the only one of its kind in North America.

But what once helped stem the tide of HIV does not appear to be working now.

Some policymakers claim that harm reduction initiatives have become politicised and are perpetuating the problems of addiction, homelessness, and public disorder – specifically in the Downtown Eastside, which they argue has become a death trap for drug users.

Ms Graham from VANDU accepts that harm reduction can be hard to quantify, but continues to believe Vancouver’s clinics do some good.

“In principle, harm reduction is meeting a person where they’re at, no matter what substance they’re using or harm they’re causing. Inherently, we know that drugs are harmful, so it’s crucial to help them mitigate that harm – for example, providing clean needles and a sanitary space,” she says.

Tiffany shoots up twice in the VANDU facility before slumping over. As the mix of fentanyl and benzodiazepines takes control of her senses, she whispers, “The high feels like a warm hug.”

‘No question’ of drug diversion

While many users like Tiffany in the Downtown Eastside source their drugs from the street, the government has launched a “safer supply” program which allows users to receive pharmaceutical-grade opioids free of charge from a physician.

The initiative is “preventing overdoses, saving lives, and connecting drug users to health and social services”, the province says.

But according to those on the ground, safer supply has created many unexpected consequences. The Vancouver Police Department says a significant portion of the opioids being freely prescribed by doctors are not actually being consumed by their intended recipients.

Instead, the drugs are being resold on the black market at rock-bottom prices – in a process called “diversion” – typically to fund the ongoing purchase of fentanyl.

Deputy Wilson says “there is no question” that these drugs are being diverted to the streets, specifically the Downtown Eastside. In fact, she says that 50 per cent of hydromorphone seizures in British Columbia have originated from the government.

Not only are safer supply drugs being diverted to active users, there are also reports of these powerful opioids falling into the hands of children. Ms Sturko explains that highly addictive drugs are freely going out into every corner of the community, allowing new users to develop opioid use disorders.

“Parents in Vancouver are telling me stories of their children using high quantities of dillies [hydromorphone] because they thought the opioid was ‘safe’ under the government’s label of ‘safer supply’,” she says.

“It’s horrifying. It makes me angry because we’re talking about the lives of our children who may start experimenting with an opioid that won’t kill them, but it eventually leads them to use fentanyl which will kill them.

“It’s a potential pathway of serious addiction. These safer supply drugs are subsidising the fentanyl market.”

But Ms Graham from VANDU claims that banning safer supply drugs is not the answer. She says removing government-regulated opioids from the system would taint the drug supply to an even greater degree.

“It’s clear that stamping out the [regulated] drug supply doesn’t stop people from using the substances. It just makes the quality of the substances they can access less reliable.”

Ms Graham goes as far as to claim that the police are against a regulated drugs market and because it threatens their jobs.

“We need to solve the toxic drugs crisis by providing the substances,” she insists.

Stuck in a ‘detox limbo’

Andrew, a paramedic in the Downtown Eastside, has responded to hundreds – if not thousands – of overdose calls during his time as a first responder. In his view, the government is “subsidising and enabling” the fentanyl crisis by throwing money at it instead of solving it.

He says he can only speak anonymously, as the local health authority has cracked down on interviews in the lead up to the provincial election later this year.

“This is all our fault. We’ve created a system where people can wake up and get high everyday – why would they want to leave the Downtown Eastside? It’s a free ride in life that’s funded by taxpayers.

“You would never see anything like this in a poor country. The government is giving people enough slack so they don’t have to change – this perpetuates the problem that will never be solved.

“The Downtown Eastside is like a warzone. It’s unbelievable the depravity people will endure to simply exist.”

But getting clean is certainly not easy.

Mark Ng Shun from Vancouver Detox explains that “walk-ins” are not permitted in government-funded locations. Instead, drug users are told to join a waiting list that can average anywhere from three to six weeks.

To secure a spot, it’s mandatory to call every day, and users must start detoxing before being admitted.

“Vancouver’s detox system is not working for those who need it the most,” says Mr Ng Shun.

“Many Downtown Eastside residents are stuck in the ‘detox limbo’ – they have a desire to seek a different kind of life, but they’re told they have to wait six weeks. Many people can give up during that time.

“Plus, there is still a stigma attached to Downtown Eastside residents who are seeking help. The services themselves are tailored towards upper- and middle-class white people.

“Only certain lives are supported in detox. The system is oppressive. People who are the least advantaged have the least access to it.”

Lisa Weih lost her 29-year-old daughter, Renée, to an opioid overdose in 2020. She says the city’s detox and recovery systems are inadequate.

“Renée never stopped trying to get better. She put herself through the tortures of detox several times, but there was nothing there for her afterwards… our leaders want to get away with murder.”

On the frontlines of Vancouver’s fentanyl crisis, there is not much sign of change.

Ms Graham, who witnesses the carnage of the Downtown Eastside on a daily basis, says hope is the one thing she can’t afford to lose sight of.

“I’ve lost a school bus full of people to opioids. But there is a way forward, and it’s increased harm reduction,” she insists.

“This isn’t a political debate, it’s a human rights debate.”

Source:  https://www.telegraph.co.uk/global-health/climate-and-people/vancouver-opioid-crisis-drug-addiction-british-columbia-canada/

The overdose crisis is claiming lives across the United States, but it reaches new depths of despair in the criminal justice system. Overdose is the leading cause of death among people returning to their communities after being in jail or prison. Providing addiction treatment in these settings could change that.Roughly 60% of people who are incarcerated have a substance use disorder, in many cases an opioid use disorder. When people with addiction leave prison or jail and return to their communities, they are at very high risk of returning to drug use and overdosing. Their tolerance to drugs has diminished during incarceration, and fentanyl is pervasive in the street drug supply. Even one relapse could be fatal.It remains a common belief that simply stopping someone from taking drugs while in jail or prison is an effective approach to treatment. But that belief is inaccurate and dangerous. As scientists, we look to research to guide us. And when research shows strategies with clear benefits, they should be deployed.The Food and Drug Administration has approved three medications for opioid use disorder: methadone, buprenorphine, and naltrexone. All three are effective, safe, and lifesaving. But they are woefully underused, particularly in criminal justice settings.

A 2020 study in Rhode Island estimated that overdose deaths could be reduced by 30% in the state if jails and prisons made all three medications available to those who needed them. Studies also show that people who receive these medications while in jail or prison are less likely to return to substance use and more likely to continue with treatment in the community afterward.

Less than half of jails nationwide, and fewer than 10% of state prisons, offer all three medications. While 96% of jails did provide the overdose reversal drug naloxone to staff, only 1 in 3 provided naloxone and training on how to use it to decarcerated citizens during the critical period when they were returning to their communities.

Neglecting to provide access to these lifesaving treatments and harm-reduction measures creates deadly gaps for people when they leave jail or prison. The repercussions reverberate throughout communities and generations. They deepen racial inequities and overrepresentation of communities of color within the criminal justice system. They cause devastation for children and families.

Providing medications for opioid use disorder in jails and prisons benefits public health and public safety. It’s cost–effective. It can help break the cycle of recidivism. It can reduce the burden on the wider health care system, including emergency departments.

Programs across the country are underway to offer naloxone and medications for opioid use disorder in jails and prisons, paired with instruction, training, and social support. Federal agencies have launched programs to help people manage withdrawal in jails and provide financial health care support for people who are about to reenter the community. A recently published revised methadone rule now allows any jail or prison registered as a hospital or clinic to dispense medications for opioid use disorder in certain circumstances.

Law enforcement leaders are starting to see how addiction treatment increases safety for everyone. Chris Donelan, the sheriff of Franklin County, Mass., has partnered with researchers to study what happens when jails offer all three FDA-approved opioid use disorder medications. His jail became one of the few in the nation to be licensed as an opioid treatment program.

“When someone is booked into our facility, often we are the first treatment provider the person has seen in years,” Donelan told his University of Massachusetts research partners. “These treatments save lives and help people enter into recovery. Treatment makes the work of our facility much easier. We have less fights, less contraband, and a much safer facility.”

Since 2019, the National Institutes of Health has funded partnerships across the country to figure out how to link people with addiction to care during and after their time in the corrections system. These researchers are poised to share new evidence as it emerges that will help other communities make data-driven changes so they can implement what is most efficient in justice settings.

There is still a long way to go. A dangerous supply of street drugs, fragmented treatment systems, lack of funding, lack of training, pervasive stigma, and complex logistics all work against people with substance use disorders as they work to rebuild their lives after incarceration. Support in recovery and continuity of care are essential during this vulnerable time.

Fundamentally, an individual’s best or only option to receive addiction treatment should not have to be during incarceration. In an ideal world, treatment and prevention systems in the U.S. would proactively address social drivers of health and mental health needs to stop the cycle between addiction and incarceration. Moving away from criminalization of substance use disorders toward a public-health approach would remove a key structural practice that perpetuates inequalities. It would improve lives for people and their families.

The Authors

Nora D. Volkow, M.D., is a psychiatrist, scientist, and director of the National Institute on Drug Abuse, which is part of the National Institutes of Health.

 

Tisha Wiley, Ph.D., is a social psychologist, associate director for justice systems at NIDA, and leads the NIH Justice Community Opioid Innovation Network initiative, which studies approaches to increase high-quality care for people in justice settings with opioid misuse or opioid use disorder.

Source: https://www.statnews.com/2024/07/09/providing-addiction-treatment-prisons-jails/

By Kevin A. Sabet

PUBLISHED: June 30, 2024 at 6:00 a.m.

This month, Gov. Wes Moore pardoned more than 175,000 prior marijuana convictions, impacting more than 100,000 individuals. This comes 18 months after the Old Line State voted to legalize recreational marijuana, which went on sale exactly one year ago on July 1. While the pordons were a good move, the move was a too-little-too-late acknowledgement that marijuana legalization isn’t about social justice, and pot profiteers aren’t necessary to end the criminalization of small possession of marijuana.

Moore’s decision to pardon these prior marijuana convictions should be commended. The charges related to low-level possession and paraphernalia. He followed in the steps of President Joe Biden, who in 2022 pardoned federal convictions for the low-level possession of marijuana.

Moore called it “the most sweeping state level pardon in any state in American history.” Yet nobody will be released from prison, just as nobody was released from federal prison because of Biden’s pardons. The pardons in Maryland will also not expunge the criminal records of those with prior convictions.

These recent steps highlight the false dichotomy between the criminalization of marijuana and the legalization of today’s highly potent THC drugs. While nobody should be in jail for the use of marijuana, the alternative policy need not legalize dangerous psychoactive drugs and usher in a for-profit marijuana industry, as was done in Maryland. Removing criminal penalties could address concerns related to the criminal justice system, while not giving the marijuana industry free rein to do as it pleases.

Indeed, when polls ask voters about the specific policy they prefer for marijuana, they do not come out in support of a full-scale commercial industry. A national poll in 2022 from Emerson College found that only 38% of Americans prefer full legalization, with the remaining 62% majority favoring decriminalization of marijuana, or continued prohibition — among other options. Americans remain wary of legalization.

This trend is also playing out in Maryland, with some voters having second thoughts about legalization. According to a Washington Post/University of Maryland poll, only 31% of voters have a positive view of legalization. Notably, Black Marylanders were more likely to say it’s been bad than good, at 32% vs 28%, respectively. Opposition comes across party lines, with 63% of Democrats and 76% of Republicans saying legalization has not been good for the state.

The same poll also asked people whether they support allowing a dispensary to open in their community. Statewide, half of Marylanders opposed this proposition. In Prince George’s County specifically 59% of poll respondents opposed it. Voters recognize the difference between the harms of criminalization and the harms of the addiction-for-profit industry. Marylanders don’t want people in prison for marijuana, but they also don’t want pot shops in their neighborhood.

Moore’s pardons come amid calls for a shift in national marijuana policy. The Biden Administration is actively working to reclassify marijuana as a Schedule III substance, a move that would be a boon for the industry. Politicians should know better by now. They should know to distrust the industry and prioritize public health and public safety — they’ve gone through the same routine with the tobacco industry.

Despite promises that commercial pot sales would improve racial equity, we have seen that Black Americans continue to be disproportionately harmed, now by a predatory industry and its mind-altering products. Black Americans were 4x more like to have marijuana-related emergency department visits than white Americans. Additionally, in 2022, Black minors between the ages of 12 and 17 were 25% more likely to have used marijuana in the past month, compared to white minors and they were 31% more likely to have a cannabis use disorder.  Pot shops are disproportionately concentrated in low-income communities and communities of color, helping to explain the concentration of these harms.

The marijuana industry uses arguments about racial equity as a guise to advance its financial interests. It’s a myth not supported by an honest assessment of the industry and its practices.

Moore’s actions are proof positive it is possible to advance racial equity without legalizing marijuana, a drug associated with numerous mental health harms, including anxiety, depression and schizophrenia. A good first step to protect Marylanders would be curbing public use, educating young people about the risks, requiring product labels with science-based warnings, and enacting strong regulations on the industry. The governor should turn his pulpit to these real concerns before more Marylanders get hurt.

Dr. Kevin Sabet (info@learnaboutsam.org) is the president of Smart Approaches to Marijuana (SAM), the nation’s leading nonpartisan voice for health and safety-based marijuana policy, and a three-time White House drug policy advisor.

 

International Day against Drug Abuse and Illicit Trafficking on June 26:

June 23, 2024 1:05 am

By Resolution 42/112 of 7 December 1987, the General Assembly decided to observe June 26 as the International Day against Drug Abuse and Illicit Trafficking as an expression of its determination to strengthen action and cooperation to achieve the goal of an international society free of drug abuse. No country has been spared of the drug menace, though some countries have been disproportionately affected. While most countries nab and rehabilitate drug users, the big-time dealers and smugglers often go scot free, leading to a vicious cycle.

Supported each year by individuals, communities, and various organisations all over the world, this global observance aims to raise awareness of the major problem that illicit drugs represent to society.

Challenges

The global drug problem presents a multifaceted challenge that touches the lives of millions worldwide. From individuals struggling with substance use and associated disorders to communities grappling with the consequences of drug trafficking and organised crime, the impact of drugs is far-reaching and complex. Central to addressing this challenge is the imperative to adopt a scientific evidence-based approach that prioritises prevention and treatment.

The International Day against Drug Abuse and Illicit Trafficking, or World Drug Day, is marked to strengthen action and cooperation in achieving a world free of drug abuse. This year’s (2024) World Drug Day campaign recognises that effective drug policies must be rooted in science, research, respect for human rights, compassion, and a deep understanding of the social, economic, and health implications of drug use.

Together, all should be determined to combat the global drug problem, guided by the principles of science, compassion, and solidarity.

Continued record illicit drug supply and increasingly agile trafficking networks are compounding intersecting global crises and challenging health services and law enforcement responses, according to the World Drug Report 2023 launched by the UN Office on Drugs and Crime (UNODC). This year’s report will be launched next week.

New data put the global estimate of people who inject drugs in 2021 at 13.2 million, 18 percent higher than previously estimated. Globally, over 296 million people used drugs in 2021, an increase of 23 percent over the previous decade. The number of people who suffer from drug use disorders, meanwhile, has skyrocketed to 39.5 million, a 45 percent increase over 10 years.

Latest findings

The World Drug Report also highlights how social and economic inequalities drive – and are driven by – drug challenges; the environmental devastation and human rights abuses caused by illicit drug economies; and the rising dominance of synthetic drugs.

The demand for treating drug-related disorders, including mental conditions, remains largely unmet, according to the report. Only one in five people suffering from drug-related disorders was in treatment for drug use in 2021, with widening disparities in access to treatment across regions and countries.

Youth are the most vulnerable to using (or rather abusing) drugs and are also more severely affected by substance use disorder in several regions. In Africa, 70 percent of people in treatment are under the age of 35.

Public health, prevention, and access to treatment services must be prioritised worldwide, the report argues, or drug challenges will leave more people behind.

The report underscores the need for law enforcement responses to keep pace with agile criminal business models and the proliferation of cheap synthetic drugs that are easy to bring to market. Criminals producing methamphetamine – the world’s dominant illegally manufactured synthetic drug – evade law enforcement and regulatory responses through new synthesis routes, bases of operation, and non-controlled precursors.

Fentanyl has drastically altered the opioid market in North America with dire consequences. In 2021, the majority of the approximately 90,000 opioid related overdose deaths in North America involved illegally manufactured fentanyls.

Local situation

In Sri Lanka, the single most significant drug problem is the trafficking of heroin for local consumption. Sri Lanka serves as a transshipment hub for heroin trafficked into the country mainly from South Asian and West Asian locations. It is estimated that there are about 45,000 regular users of heroin and about 600,000 users of cannabis in the country. The recent Yukthiya operation netted a large number of addicts and pushers. Moreover, several drug lords who were hiding abroad have been brought down and produced before courts.

In fact, the nexus between organised crime and drug trafficking is rather well-known. Central and South American drug cartels are best known for extreme violence. In Sri Lanka too, most of the motorcycle killings (turf wars) have been attributed to rivalry between different drug dealing gangs. Underworld factions, sometimes, led by leaders living in exile in the Middle East, depend mainly on the drug business for their survival. Even prison and law enforcement officers have been caught dealing with or assisting notorious drug barons who are behind bars.

It is vital to nab the “big fish” who control the flow of drugs into the country and their distribution within the country. All drug addicts must be rehabilitated, instead of being sent to prison. This, after all, is one reason for the overcrowding of prisons. Another factor is that otherwise innocent drug users come into contact with hardened criminals inside the prison and could take to crime.

Our Security Forces must be equipped with the latest surveillance devices including long range drones to detect any incoming vessels smuggling drugs. This is important because the Navy and the Coastguard cannot cover the entire Exclusive Economic Zone. However, even amidst equipment and manpower issues, the Sri Lanka Navy has been successful in busting several drug smuggling rings that operate in and around Sri Lanka.

Enforcing the law against drug trafficking is important, but in keeping with this year’s World Drug Day theme, prevention is even more essential. This should begin from home or school, with students being warned on the dangers posed by illicit drugs of all types (this does not mean that legally available drugs such as tobacco are any better). Even some legal OTC pharmaceuticals can be abused if taken in abnormal quantities.

Drug trafficking is a complex global problem that demands global solutions with the active participation of all countries. That is essential to save the future generations from this scourge.

Source: https://www.sundayobserver.lk/2024/06/23/impact/25805/focus-on-preventing-drug-abuse/

US President Joe Biden’s plan to downgrade marijuana, whether politically motivated or empathic, is a regressive step in the global fight against drugs, say Tan Chong Huat and Narayanan Ganapathy from Singapore’s National Council Against Drug Abuse.

23 Jun 2024 06:00AM(Updated: 23 Jun 2024 07:40AM)

Under the move, marijuana – which has been classified since 1970 as a Schedule I drug alongside heroin, LSD and ecstasy – will be downgraded to a Schedule III drug, putting it in the same category as drugs like testosterone or painkillers containing codeine. Schedule III drugs are deemed to have a “moderate to low potential” of dependence.

“No one should be in jail merely for using or possessing marijuana,” US President Joe Biden said in a video on May 17. “Far too many lives have been upended because of failed approach to marijuana and I’m committed to righting those wrongs.”

Earlier this week, Maryland pardoned more than 175,000 marijuana convictions, becoming the latest state to do so after similar mass pardons by Massachusetts and Oregon, among others.

Research reported in The American Journal of Drug and Alcohol Abuse highlights that prolonged cannabis abuse can disrupt brain function, particularly during critical developmental stages.

Similarly, the Singapore Medical Journal featured local research that attests to these findings, showing that early initiation of cannabis use leads to greater long-term negative impacts.

The reclassification of marijuana at the federal level could legitimise the cannabis industry and accelerate the normalisation of recreational cannabis use at the state level, despite concerns about the risks.

RISING CONCERNS ABOUT DRUG USE AMONG SINGAPOREAN YOUTHS

In Singapore, recent data highlights growing concerns about drug use among youths.

The 2022 Health and Lifestyle survey by the Institute of Mental Health (IMH) revealed that the mean age of drug initiation in Singapore is 15.9 years.

Drug-related arrests are also on the rise, increasing by 10 per cent to 3,122 cases last year. Notably, there was a 17 per cent increase in cannabis abusers arrested. Amongst new cannabis abusers arrested, close to two in three were below the age of 30.

These statistics reflect a troubling trend that underscore the need for more robust and concerted drug prevention measures. Despite Singapore’s comprehensive demand and supply reduction efforts, endorsed by strong public opinion, misconceptions about cannabis are prevalent among youths.

In the 2023 National Drug Perception Survey by the National Council Against Drug Abuse (NCADA), 90.4 per cent of youths agreed that “drug-taking should remain illegal in Singapore”, but only 79.3 per cent supported the continued criminalisation of cannabis.

Qualitative interviews revealed that some youths believe cannabis use can be personally regulated, while young adults in their early 30s often view cannabis as a “soft” drug suitable for recreational use without addiction risks.

But research invalidates the perception that cannabis is less harmful than other drugs. In a study published in the Singapore Medical Journal last year, researchers found that almost half of the 450 participants surveyed progressed to using other illicit drugs after trying cannabis, with 42 per cent progressing to heroin.

The distorted knowledge among youths is unfortunately compounded by social media and pop culture. The task of combating misinformation about drugs is made more difficult by the vast digital landscape, where young people encounter a wide array of information, some of which can potentially fuel drug-abusing behaviours.

THE INTERGENERATIONAL IMPACT OF DRUG ABUSE

The repercussions of drug abuse extend far beyond individual abusers, deeply affecting their families and the community.

A 2020 study by Singapore’s Ministry of Social and Family Development stated that children of parents who committed drug offenses are 5.18 times more likely than other children to have contact with the criminal justice system in the future.

Additionally, youth offenders from households with a history of substance abuse are 2.2 times more likely to join gangs.

Research shows that children of drug-abusing parents experience a range of social-psychological deficits including weakened social bonds to conventional institutions and role models.

The Biden administration’s decision to relax its stance towards marijuana has been lauded by advocates for addressing what they say is an uneven drug enforcement policy that has fuelled mass incarceration and disproportionately affected certain communities. However, this commendation appears contradictory, as it fails to recognise the potential adverse effects such a move could have on socio-economically deprived and disadvantaged communities already afflicted by the drug scourge.

Empirical evidence from countries that have adopted harm reduction approaches, such as Portugal, the Netherlands, Switzerland, Canada, and Australia, reveals mixed outcomes.

For instance, the Netherlands, known for its regulated sale of cannabis through so-called “coffeeshops”, continues to face issues of drug tourism and associated social ills where children as young as 14 years old are recruited as “cocaine collectors”. In January 2024, the Mayor of Amsterdam warned in an opinion piece published in the Guardian that the Netherlands risks becoming a “narco-state”.

In Sweden, the number of fatal shootings has more than doubled since 2013, reaching 391 in 2022, primarily due to gang-related drug and arms conflicts. A lawyer representing teenage shooting victims told the BBC in December that “children are using their own bags not to carry books, but to carry the drug markets of Sweden on their shoulders.

Similarly, Canada and Australia, despite their comprehensive harm reduction strategies, persistently encounter drug-related crime and health issues. In 2023, British Columbia decriminalised drugs to reduce overdose rates, but only to see it surge by 5 per cent, the BBC reported. BC authorities are now considering re-criminalising the use of hard drugs in public places.

Closer to home, Thailand is planning to relist cannabis as a narcotic, just two years after it became the first in Southeast Asia to decriminalise its recreational use.

These cases illustrate the complexities and potential negative consequences of relaxed drug policies, particularly for vulnerable populations.

It is precisely for this reason that Singapore maintains its unwavering commitment to shield vulnerable communities from the devastating effects of drug abuse and prevent the intergenerational cycle of crime, arrest, incarceration, and re-incarceration.

Singapore’s approach, guided by science and sensible considerations, prioritises harm prevention over harm reduction and serves as a robust framework for tackling this pervasive issue.

Tan Chong Huat is Chairman of National Council Against Drug Abuse (NCADA) and Associate Professor Narayanan Ganapathy is an NCADA member.

PHOENIX – The fentanyl and opioid crisis cost Arizona an estimated $58 billion for 2023, according to a Common Sense Institute Arizona report published Monday. The nonpartisan think tank’s report included the costs of fatalities, opioid use disorder, hospitalizations and border security.The report analyzed data from the Centers for Disease Control and Prevention, Arizona Department of Health Services and the National Institute on Drug Abuse, among others.

It showed a decline across the U.S. in opioid prescriptions over the past decade. In Arizona, drug-related seizures have decreased since 2020.

“Naively, you should be able to assume that there are fewer drugs, but that isn’t the case,” said Glenn Farley, lead author of the report, at a Monday news briefing.

The report cited the southern border migrant crisis as an underlying cause for more drugs making their way across the border, noting that Customs and Border Protection has been strained due to the increased number of individuals and fewer checkpoints. “As a result of these resource shifts, the ability of CBP to prevent the smuggling of drugs like fentanyl into the United States is likely compromised,” the report said.

Farley said the amount of fentanyl in the United States is unknown, but deaths from the highly addictive synthetic opioid continue to rise.

Fentanyl-related overdose deaths have increased drastically in the U.S. since 2014. The National Institute on Drug Abuse reported almost 74,000 deaths in 2022. Opioid deaths have hovered around 2,000 per year since 2020 in Arizona, according to ADHS.

Source: https://cronkitenews.azpbs.org/2024/06/24/report-estimates-fentanyl-crisis-costs-arizona-2023/

Filed under: Fentanyl,Prevalence,USA :

 By KEVIN A. SABET, PH.D., President of the Foundation for Drug Policy Solutions

June 25, 2024

From Oregon to Canada to Thailand, policymakers and the public alike are waking up to the consequences of lenient and irresponsible drug policies. Whether it is the commercialization of marijuana or the decriminalization of all other drugs, policymakers are learning the hard way that public health and safety must remain a jurisdiction’s priority. As we approach the International Day Against Drug Abuse and Illicit Trafficking, on June 26, policymakers elsewhere should learn from these lessons and avoid making these same mistakes.

 

Just over a year ago, British Columbia received an exemption from Canada’s Controlled Drugs and Substances Act, allowing the province to decriminalize the public use of dangerous illicit drugs, including fentanyl, methamphetamine, heroin, and cocaine. The public policy was viewed as a triumph by so-called “harm reduction” activists, who push dangerous perceptions that drug use should be normalized and condoned.

 

Parents were understandably outraged to witness people using drugs in a host of public spaces, including parks where their young children were playing. In short order, British Columbia saw a record 2,511 overdose deaths last year and the Deputy Chief of the Vancouver Police Department warned “there have been concerns from small businesses about problematic drug use,” among other consequences.  In turn, public pushback, alongside the pressure of an upcoming election, compelled policymakers to respond and reverse course.

 

Though this sounds like a common-sense move, officials in Canada have been misled into believing that mass decriminalization of drugs would somehow improve public health. The addiction-for-profit industry has fueled this belief via a massive misinformation campaign about the harms of marijuana and other drugs. Elected officials in BC were reminded about the importance of protecting the interests of non-users and the broader community.

 

Officials in Oregon, United States, recently learned a similar lesson, backtracking their experiment with the decriminalization of all illicit drugs. Passed under the guise of an activist-driven ballot measure in 2020, Oregon took a hands-off approach to its drugcrisis, allowing people to do as they pleased with drugs. Like in British Columbia, public drug use skyrocketed. Perhaps unsurprisingly, the number of overdose deaths increased, as did the prevalence of substance use and crime.

 

In April, acknowledging that this policy had not gone as promised, liberal Governor Tina Kotek signed legislation to repeal Measure 110 and recriminalize drug possession, despite promising to uphold Measure 110 just months before. In its place is a framework to increase access to treatment. Elected officials in Oregon were reminded about the importance of treatment.

 

Thailand, the first and only country in Asia to legalize recreational marijuana, is now backtracking and aims to ban recreational marijuana by the end of the year. Reuters reported, “tens of thousands of cannabis shops have sprung up.” Likewise, the illicit market has expanded, and numerous illicit marijuana shops have emerged throughout communities. And psychosis related to marijuana has doubled to more than 20,000 cases since legalization.

 

Officials in Thailand were alarmed to find the marijuana industry aggressively marketing its products, prioritizing its profits ahead of public health. The industry’s predatory practices have led to higher rates of marijuana use among minors. Elected officials in Thailand were reminded about how the interests of the profit-driven marijuana industry are at odds with public health and safety.

 

Policymakers elsewhere should learn from the unintended consequences of these experiments to implement better, safer drugpolicies. It should not be controversial to prohibit public drug use or to implement policies that guide people into treatment. It should not be controversial to say we distrust the motives of emerging addiction-for-profit industries. Countries continue to contemplate extreme policy measures like drug legalization and decriminalization, they would do well to heed the lessons learned by Thailand, British Columbia, Oregon, and more.

 

International Day Against Drug Abuse and Illicit Trafficking is also a fitting time to recognize the importance of supply reduction. Law enforcement agencies in the US and around the world should be commended for standing up to the cartels and their affiliates, and they should be further empowered to crack down on those trafficking dangerous psychoactive drugs.

 

We must recommit ourselves to implementing evidence-based drug policies focused on prevention, treatment, harm reduction, and recovery, as well as supply reduction. Doing so would help elected officials remember the importance of public health and oppose the for-profit interests of emerging industries. Oregon, British Columbia, and Thailand are reminders of what happens when these common-sense messages are forgotten or ignored.

Kevin A. Sabet, Ph.D. is  a former drug policy advisor to U.S. Presidents Obama, Bush and Clinton. 

 

Source: https://gooddrugpolicy.org/

Vienna, 26 June 2024

The emergence of new synthetic opioids and a record supply and demand of other drugs has compounded the impacts of the world drug problem, leading to a rise in drug use disorders and environmental harms, according to the World Drug Report 2024 launched by the UN Office on Drugs and Crime (UNODC) today.

“Drug production, trafficking, and use continue to exacerbate instability and inequality, while causing untold harm to people’s health, safety and well-being,” said Ghada Waly, Executive Director of UNODC. “We need to provide evidence-based treatment and support to all people affected by drug use, while targeting the illicit drug market and investing much more in prevention.”

The number of people who use drugs has risen to 292 million in 2022, a 20 per cent increase over 10 years. Cannabis remains the most widely used drug worldwide (228 million users), followed by opioids (60 million users), amphetamines (30 million users), cocaine (23 million users), and ecstasy (20 million users).

Nitazenes – a group of synthetic opioids which can be even more potent than fentanyl – have recently emerged in several high-income countries, resulting in an increase in overdose deaths.

Though an estimated 64 million people worldwide suffer from drug use disorders, only one in 11 is in treatment. Women receive less access to treatment than men, with only one in 18 women with drug use disorders in treatment versus one in seven men.

In 2022, an estimated 7 million people were in formal contact with the police (arrests, cautions, warnings) for drug offences, with about two-thirds of this total due to drug use or possession for use. In addition, 2.7 million people were prosecuted for drug offences and over 1.6 million were convicted globally in 2022, though there are significant differences across regions regarding the criminal justice response to drug offences.

The Report includes special chapters on the impact of the opium ban in Afghanistan; synthetic drugs and gender; the impacts of cannabis legalization and the psychedelic “renaissance”; the right to health in relation to drug use; and how drug trafficking in the Golden Triangle is linked with other illicit activities and their impacts.

Drug trafficking is empowering organized crime groups

Drug traffickers in the Golden Triangle are diversifying into other illegal economies, notably wildlife trafficking, financial fraud, and illegal resource extraction. Displaced, poor, and migrant communities are suffering the consequences of this instability, sometimes forced to turn to opium farming or illegal resource extraction to survive, falling into debt entrapment with crime groups, or using drugs themselves.

These illicit activities are also contributing to environmental degradation through deforestation, the dumping of toxic waste, and chemical contamination.

Consequences of cocaine surge

A new record high of 2,757 tons of cocaine was produced in 2022, a 20 per cent increase over 2021. Global cultivation of coca bush, meanwhile, rose 12 per cent between 2021 and 2022 to 355,000 hectares. The prolonged surge in cocaine supply and demand has coincided with a rise in violence in states along the supply chain, notably in Ecuador and Caribbean countries, and an increase in health harms in countries of destination, including in Western and Central Europe.

Impact of cannabis legalization

As of January 2024, Canada, Uruguay, and 27 jurisdictions in the United States had legalized the production and sale of cannabis for non-medical use, while a variety of legislative approaches have emerged elsewhere in the world.

In these jurisdictions in the Americas, the process appears to have accelerated harmful use of the drug and led to a diversification in cannabis products, many with high-THC content. Hospitalizations related to cannabis use disorders and the proportion of people with psychiatric disorders and attempted suicide associated with regular cannabis use have increased in Canada and the United States, especially among young adults.

Psychedelic “renaissance” encourages broad access to psychedelics

Though interest in the therapeutic use of psychedelic substances has continued to grow in the treatment of some mental health disorders, clinical research has not yet resulted in any scientific standard guidelines for medical use.

However, within the broader “psychedelic renaissance”, popular movements are contributing to burgeoning commercial interest and to the creation of an enabling environment that encourages broad access to the unsupervised, “quasi-therapeutic” and non-medical use of psychedelics. Such movements have the potential to outpace the scientific therapeutic evidence and the development of guidelines for medical use of psychedelics, potentially compromising public health goals and increasing the health risks associated with the unsupervised use of psychedelics.

Implications of opium ban in Afghanistan

Following the drastic decrease of Afghanistan’s opium production in 2023 (by 95 per cent from 2022) and an increase in production in Myanmar (by 36 per cent), global opium production fell by 74 per cent in 2023. The dramatic contraction of the Afghan opiate market made Afghan farmers poorer and a few traffickers richer. Long-term implications, including on heroin purity, a switch to other opioids by heroin users, and/or a rise in demand for opiate treatment services may soon be felt in countries of transit and destination of Afghan opiates.

Right to health for people who use drugs

The report outlines how the right to health is an internationally recognized human right that belongs to all human beings, regardless of a person’s drug use status or whether a person is imprisoned, detained or incarcerated. It applies equally to people who use drugs, their children and families, and other people in their communities.

Source: https://www.unodc.org/unodc/en/press/releases/2024/June/unodc-world-drug-report-2024_-harms-of-world-drug-problem-continue-to-mount-amid-expansions-in-drug-use-and-markets.html

Simantik Dowerah – First Post India• June 26, 2024

Social stigma and low awareness about available treatment options significantly impact treatment-seeking behaviours, professor at the Department of Psychiatry at NIMHANS Bangalore, Dr Prabhat Chand tells Firstpost
(File) Students take part in an awareness march to mark the International Day against Drug Abuse and Illicit Trafficking, in Patna. PTI

The International Day Against Drug Abuse and Illicit Trafficking, observed every year on 26 June, serves as a global reminder of the urgent need to combat the menace of drug abuse and illicit trafficking. This day aims to raise awareness about the severe impact of drug addiction on individuals, families and communities worldwide. It also emphasises the importance of prevention, treatment and rehabilitation efforts to address this complex issue.

Governments, organisations and individuals come together on this day to advocate for policies and actions that promote a drug-free world, supporting those affected by addiction and working towards sustainable development and peace. The day calls for solidarity and collective action to safeguard public health and build healthier, safer societies for all.

On the occasion of the International Day Against Drug Abuse and Illicit Trafficking, Firstpost interviewed Dr Prabhat Chand, professor at the Department of Psychiatry, Centre for Addiction Medicine & NIMHANS Digital Academy VKN ECHO, Bangalore to gain insights into drug abuse trends in India and its broader societal implications.

How grave is drug abuse in India and how have their usage patterns changed over time?

Drug abuse in India is a significant public health challenge affecting diverse populations across the nation. The most abused substances after alcohol are cannabis and opioids. According to national surveys, the prevalence of cannabis users is 3.1 crore and about 72 Lakh are problem users. The opioid use increased significantly from 0.7 per cent to 2.1 per cent (i.e., 2.3 crore) during the same period. Other substances such as sedatives (1.08 per cent), inhalants (0.7 per cent), cocaine (0.10 per cent), amphetamines (0.18 per cent), and hallucinogens (0.12 per cent) also contribute significantly to the drug abuse landscape. The International Day Against Drug Abuse and Illicit Trafficking on June 26th, 2024, with the theme ‘The evidence is clear: invest in prevention,’ underscores the urgency of this issue.

How do socio-economic factors influence vulnerability to substance abuse in India? What are the demographics mostly affected and at high risk?

Socio-economic factors such as peer influence, societal pressures, difficult childhood and lack of access to supportive environments significantly influence vulnerability to substance abuse in India. The demographics mostly affected and at high risk include young male adults aged 18-25, people from low socio-economic backgrounds and those with lower educational attainment. Over the years, the age of onset for first substance use has been decreasing consistently.

What are the primary challenges in accessing addiction treatment facilities across different tiers of cities in India?

Access to treatment facilities varies significantly across different regions and city tiers. The treatment gap for addictive disorders is as high as 75 per cent, as per various national surveys. It means 75 out of 100 people with addictive disorders do not have access to care. The challenge is twofold – 1. Accessibility of care 2. Quality of care. For example, for opioid use disorder, Opioid against treatment (OAT) is evidence-based care across the world. But in India, the supply of OAT is available in very few places. That means people have to travel far to access the care. It is well known that addiction is a chronic brain condition and needs good aftercare. These are compounded by strong social stigma and low awareness. This emphasises the need for significant investments to enhance treatment options and optimise resource allocation based on national survey evidence.

How does stigma impact treatment-seeking behaviours in rural areas compared to urban centres?

Social stigma and low awareness about available treatment options significantly impact treatment-seeking behaviours. This leads people with addictive disorders to seek treatment at the later stage of the addiction cycle. Also, the studies show that more than 50 per cent of patients likely have comorbid psychiatric disorders, which also makes care more challenging. Bridging this gap requires tailored health service information campaigns to inform users and the general population about the available treatment services.

What strategies are recommended to bridge the treatment gaps between urban and rural areas, especially in smaller pockets and villages?

To bridge the treatment gaps – 1. Increase access to care 2. Making knowledge the effective interventions to the health care providers 3. Early identification by physicians, nurses or healthcare providers 4. Identification of high-risk youth and provider of holistic support 5. Integrate common substance use along with routine care like hypertension or diabetes.

Integrated care models and effective coordination between drug supply control and entities focused on demand reduction and harm reduction are crucial. Additionally, targeted outreach and education programmes can help prevent substance abuse and identify people in need of treatment at an earlier stage.

Why is it crucial to address gender disparities in treatment-seeking behaviours?

Addressing gender disparities in treatment-seeking behaviours is crucial because men predominantly access services compared to women. Tailored health service information campaigns are necessary to engage women and marginalised communities effectively, ensuring equitable access to treatment and support services. By promoting inclusivity in treatment access, India can foster a supportive societal framework that empowers people affected by substance abuse.

How can integrated care models improve outcomes for people with co-occurring substance abuse and mental health disorders?

Integrated care models can improve outcomes by providing comprehensive services that address both substance abuse and co-occurring mental health disorders. This necessitates significant investments to enhance treatment options and ensure effective coordination between drug supply control, demand reduction, and harm reduction entities. Such models are essential for addressing the multifaceted nature of substance abuse and its associated mental health issues.

What role do government policies, healthcare providers, NGOs and communities play in tackling the drug abuse crisis in India and how can collaboration be enhanced to achieve better outcomes?

Government policies, healthcare providers, NGOs and communities play a crucial role in tackling the drug abuse crisis in India. Collaboration among these entities can be enhanced by fostering coordination between drug supply control and demand reduction efforts, expanding treatment accessibility, promoting inclusivity in treatment access, and implementing targeted outreach and education programmes. By prioritising evidence-based strategies and fostering a supportive societal framework, India can empower people affected by substance abuse to reclaim their lives and contribute meaningfully to society. Sustained efforts in prevention, treatment infrastructure expansion and effective policy formulation are essential to achieving better outcomes and paving the way towards a healthier, drug-free future for Indian citizens.

Healthcare providers like doctors can use the ‘Addiction Rx mobile app’ as a guidance tool for screening, assessment and intervention in addictive disorders. This app is developed as a part of the standard treatment guidelines by the Ministry of Health and Family Welfare DDAP Addiction Rx app: iOS and Android.

The doctors, counsellors and nurses can discuss the cases and enrol in certificate courses at the NIMHANS Digital Academy ECHO weekly tele-platform to learn best practices.

Source: https://www.firstpost.com/india/international-day-against-drug-abuse-a-significant-public-health-challenge-affecting-india-13786238.html

Published: Jun 28, 2024, 7:02 PM

It seems as if every community, big or small, has been impacted by the problems associated with substance use and drug overdose. Within these communities, these problems extend into the family unit, with people becoming addicted and dying because of drugs.

However, community drug education and prevention programs can be a first line of defense. 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, the Kansas Prevention Collaborative partners with several different states and educational institutions and provides agencies. Substance misuse prevention focuses on underage drinking, marijuana use, and other substances.

Additionally, they offer the “It Matters” campaign, which focuses on the power of perception to help youth and young adults avoid substance misuse. The behavioral health services and programs in the state are provided by the Kansas Department for Aging and Disability Services, which includes treatment, recovery, and prevention.

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 and experiment with illicit drugs that are potentially laced with opioids.

According to drug abuse statistics, an average of 156 people die from opioid overdose in one year in Kansas. Opioids are a factor in 45.2% of all overdose deaths in the state. The Kansas Department of Health and Environment reported the rate of drug overdose deaths in the state of Kansas almost tripled within the last year few years. Drug education and prevention can help.

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. Much of their use is linked to 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, for example, 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.

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

Source: https://www.gbtribune.com/opinion/local-drug-education-and-prevention-programs-are-here-help/

 Law and Crime Prevention

The UN agency tackling crime and drug abuse (UNODC) released its annual World Drug Report on Wednesday warning that there are now nearly 300 million users globally, alongside an increase in trafficking.

The International Day against Drug Abuse and Illicit Trafficking, or World Drug Day, is commemorated every year on June 26 and aims to increase action in achieving a drug-free world.

This year’s campaign recognises that “effective drug policies must be rooted in science, research, full respect for human rights, compassion, and a deep understanding of the social, economic, and health implications of drug use”.

Ghada Waly, Executive Director of UNODC, said that providing evidence-based treatment and support to all those affected by drug use is needed, “while targeting the illicit drug market and investing much more in prevention”.

New threat from nitazenes

Drug production, trafficking, and use continue to exacerbate instability and inequality, while causing untold harm to people’s health, safety and well-being.
— Ghada Waly

In the decade to 2022, the number of people using illicit drugs increased to 292 million, the UNODC report says.

It noted that most users worldwide consume cannabis – 228 million people – while 60 million people worldwide consume opioids, 30 million people use amphetamines, 23 million use cocaine and 20 million take ecstasy.

Further, UNODC found that there was an increase in overdose deaths following the emergence of nitazenes – a group of synthetic opioids potentially more dangerous than fentanyl – in several high-income countries.

Trafficking in the Triangle

The drug report noted that traffickers in the Golden Triangle, a region in Southeast Asia, have found ways to integrate themselves into other illegal markets, such as wildlife trafficking, financial fraud, and illegal resource extraction.

“Displaced, poor and migrant communities” bear the brunt of this criminal activity and on occasion are forced to engage in opium farming or illegal resource extraction for their survival; this can lead to civilians becoming drug users or fall into debt at the mercy of crime groups.

Environmental fallout

These illegal crimes contribute to environmental degradation via deforestation, toxic waste dumping and chemical contamination.

“Drug production, trafficking, and use continue to exacerbate instability and inequality, while causing untold harm to people’s health, safety and well-being,” UNODC’s Ms. Waly said.

The potency of cannabis has increased by as much as four times in parts of the world over the last 24 years.

Cocaine surge and cannabis legalisation

In 2022, cocaine production hit a record high with 2,757 tons produced – a 20 per cent increase from 2021.

The increase in supply and demand of the product was accompanied by a surge of violence in nations along the supply chain, especially in Ecuador and Caribbean countries. There was also a spike in health problems within some destination countries in Western and Central Europe.

Similarly, harmful usage of cannabis surged as the product was legalized across Canada, Uruguay, and 27 jurisdictions in the United States, much of which was laced with high-THC (delta9-tetrahydrocannabinol) content – which is believed to be the main ingredient behind the psychoactive effect of the drug.

This led to an increase in the rate of attempted suicides among regular cannabis users in Canada and the US.

The hope for World Drug Day

The UNODC report highlights that the “right to health is an internationally recognized human right that belongs to all human beings, regardless of a person’s drug use status or whether a person is imprisoned, detained or incarcerated”.

UNODC’s calls for governments, organizations and communities to collaborate on establishing evidence-based plans that will fight against drug trafficking and organized crime.

The agency also hopes communities will assist in “fostering resilience against drug use and promoting community-led solutions”.

 

26 June 2024

 

Drugs are at the root of immeasurable human suffering.

Drug use eats away at people’s health and wellbeing. Overdoses claim hundreds of thousands of lives every year.

Meanwhile, synthetic drugs are becoming more lethal and addictive, and the illicit drug market is breaking production records, feeding crime and violence in communities around the world.

At every turn, the most vulnerable people — including young people — suffer the worst effects of this crisis. People who use drugs and those living with substance abuse disorders are victimized again and again: by the drugs themselves, by stigma and discrimination, and by heavy-handed, inhumane responses to the problem.

As this year’s theme reminds us, breaking the cycle of suffering means starting at the beginning, before drugs take hold, by investing in prevention.

Evidence-based drug prevention programmes can protect people and communities alike, while taking a bite out of illicit economies that profit from human misery.

When I was Prime Minster of Portugal, we demonstrated the value of prevention in fighting this scourge. From rehabilitation and reintegration strategies, to public health education campaigns, to increasing investment in drug-prevention, treatment and harm-reduction measures, prevention pays off.

On this important day, let’s recommit to continuing our fight to end the plague of drug abuse and trafficking, once and for all.

 

Source: https://www.unodc.org/islamicrepublicofiran/en/the-secretary-general-message-on-the-occasion-of-the-international-day-against-drug-abuse-and-illicit-trafficking.html

By Leah Kuntz

Psychiatric Times Vol 41, Issue 6
Review tapering challenges and strategies for benzodiazepines in this Special Report article.

SPECIAL REPORT: ADVANCES IN PSYCHIATRY

Benzodiazepines, a controversial treatment widely prescribed for patients with anxiety and insomnia, carry a considerable risk of abuse. The poster “Mood Over Matter: Literature Review on Benzodiazepine Tapering, Current Practices and Updates on Adjunct Mood Stabilizers,” which was presented at the 2024 APA Annual Meeting, summarized a literature review of current benzodiazepine tapering practices, outpatient detoxification challenges, and potential barriers to discontinuation. The poster presenters also prioritized reviewing literature that highlighted mood stabilizer adjunct use.

Research demonstrates why clinicians should use caution when prescribing benzodiazepines. Results of a recent study revealed that between 2014 and 2016 an estimated 25.3 million (10.4%) adults in the United States reported using benzodiazepines, and approximately 17.2% of these individuals admitted to misuse.

Similarly, the National Institute on Drug Abuse documented that benzodiazepines were implicated in more than 14% of opioid overdose deaths in 2021. Furthermore, a report from the Centers for Disease Control and Prevention pinpointed benzodiazepines as a factor in nearly 7000 overdose deaths across 23 states from January 2019 to June 2020, constituting 17% of all drug overdose deaths. This time frame saw a staggering 520% surge in deaths related to illicit benzodiazepines, and fatalities from prescribed benzodiazepines rose by 22%.

The poster presenters stated that psychiatric and addiction- focused clinicians play an integral role in preventing benzodiazepine misuse and addiction.

To help patients taper benzodiazepines to discontinuation, clinicians must be up-to-date on practices; if clinicians mismanage tapering, sudden withdrawal can prove fatal. Challenges to tapering patients with chronic benzodiazepine use can be found in the Table.

Table. Challenges to Tapering Chronic Benzodiazepine Use

As for tapering strategies, the presenters suggested adjunct mood stabilizers such as carbamazepine and oxcarbazepine. Carbamazepine, when used as an adjunct or prophylactically, can help reduce intense withdrawal symptoms and thus keep patients on track for discontinuation. However, carbamazepine has received criticism regarding its efficacy, and it is well documented to have a series of concerning adverse effects such as skin reactions, agranulocytosis, leukopenia, and significant drug-drug interactions by nature of its metabolism. This makes some clinicians wonder: Are the risks worth the benefit?

Oxcarbazepine has also been proposed as an alternative. Results of some small-scale clinical trials noted moderate efficacy for oxcarbazepine in helping patients with detoxification, and it has fewer adverse effect concerns. The presenters suggested that other mood stabilizers, particularly those with antiepileptic effects, require further research for their potential help with benzodiazepine addiction.

“Through a more current literature review, we hope to increase the tools available to psychiatrists for more success in discontinuation and maintaining sobriety for patients,” the presenters wrote.

In a previous Psychiatric Times article, Steve Adelman, MD, of the University of Massachusetts Medical School in Boston, suggested 8 universal precautions adapted from Gourlay et al for use by psychiatrists who must decide whether to initiate or continue pharmacotherapy with benzodiazepines. They include making a diagnosis with an appropriate differential and creating and ratifying a treatment agreement. However, other clinicians, such as Daniel Morehead, MD, a Psychiatric Times columnist and featured cover author in this issue, suggest that although benzodiazepines carry risks, those risks are exaggerated by government officials, critics, and the public at large.

Source: https://www.psychiatrictimes.com/view/how-to-safely-and-effectively-taper-benzodiazepines

Back to top of page

Powered by WordPress