With no age restrictions on its use, some people – even children – are likely consuming CBD on a very frequent basis.

While a growing chorus of voices recommend CBD oil for all manner of ailments with glowing reviews and assurances of its safety, consumers would be wise to think very carefully before jumping on the bandwagon.

This article seeks to pull back the curtain on the CBD story and reveal the very real potential dangers of use by otherwise healthy people so that you can make a truly informed decision for your family.

Please note that I am not disputing the benefits of cannabis in this article. I know it helps a lot of very sick people manage their illness in a comfortable way without the need for pharmaceuticals. What I am presenting is the other side of the story that is usually not discussed – even glossed over in favor of aggressive marketing to otherwise healthy people.

What is CBD Oil?

CBD oil is an alternative remedy for inflammation, pain, seizures and many other conditions. It is gaining widespread popularity over pharmaceutical drugs to treat the same ailments.

Manufacturers make CBD oil by diluting the active ingredient cannabidiol with a carrier fat such as coconut oil. Depending on what carrier oil is used (i.e., saturated fats or vegetable oils), the remedy then appeals to a wider variety of people. In other words, CBD fans can find an oil that fits their particular food philosophy on fats.

Cannabidiol

You might be surprised to learn that cannabidiol is one of over a hundred compounds known as cannabinoids. The buds, flowers, leaves and stalks (not seeds) of the hemp plant contain them. Other common names for this plant are marijuana or cannabis.

Tetrahydrocannabinol, better known as THC, is another well known cannabinoid in hemp plant matter. It is best known for its mind altering effects, which pot smokers experience firsthand. (1)

Fans of CBD oil claim that cannabidiol is safe because it has zero inherent psychoactive properties like THC. However, this is disputable, if not downright false, in light of research on both animals and humans. More on this later.

Hash (Cannabis) Oil vs CBD Oil vs Hemp Seed Oil

It is important to understand the key differences between the three primary oils derived from the hemp or marijuana plant. These characteristics determine whether the oil is used as food or medicine and, in turn, whether it is even legal or not.

CBD oil falls in the gray area, which is why it is so confusing and potentially dangerous for anyone except those who are gravely ill with few other treatment options. Hopefully, the discussion below will help clear things up for you!

Cannabidiol (CBD) Oil

As described above, manufacturers create medicinal CBD oil by blending cannabidiol with a carrier oil. This active ingredient is either isolated or alcohol extracted from whole cannabis plant matter.

CBD was legalized in all 50 states by the 2014 Farm Bill, which served as the springboard for its explosive growth. However, this approval came with an important caveat. The legislation required extraction of CBD for academic research or under a state pilot program. Since then, a number of states broadened this narrow definition, which legalized other CBD manufacturing processes. (2)

Hemp Seed Oil

CBD oil is vastly different from hemp seed oil, which is a food and not medicine. It is made by cold pressing the seeds on the cannabis plant. The resulting oil is high in inflammatory omega-6 fats. Hemp seeds contain no THC and hence the oil should technically not contain any either.

Some countries require testing for THC in hemp seed oil to verify purity. Typical requirements are that there are no more than 5-10 or even zero parts per million (ppm) detected in the final product.

Hemp Oil (Hash or Cannabis Oil)

In comparison, hash or cannabis oil does contain high inducing THC. It is also misleadingly known as honey oil.

It comes from aerial parts of the marijuana plant except the seeds. This medicinal or recreational oil can be made from any of the three sub-species of the cannabis plant – Cannabis sativa, Cannabis indica, and more rarely Cannabis ruderalis.

Hash oil is illegal for recreational use in most states but is approved for medicinal use by a growing list of others. It is usually consumed by eating or smoking. It is also sold in cartridges for use in vaping pens.

In summary, while hemp seed oil is widely recognized as safe and available on healthfood store shelves all across the country, hemp oil is still regulated as as a medicinal only drug in some states and completely outlawed in others. CBD oil falls in the gray area somewhere between the two.

The question that remains to be answered is its safety. Does the narrow legalization of CBD in the 2014 Farm Bill guarantee its safety? Or is it actually more risky than consumers have been led to believe?

CBD Oil Risks

The side effects of consuming cannabidiol are very real though commonly glossed over by those selling it.

Drug Contraindications

CBD oil may potentially interact in a negative way with anti-epilepsy drugs. As of now, only in vitro (test tube) observations exist with no living organism testing proving safety. Drugs that may interact include: (3)
•carbamazepine (Tegretol)
•phenytoin (Dilantin)
•phenobarbital (Luminal, Solfoton, Tedral)
•primidone (anti-seizure)

Side Effects

According to a review of existing research by the journal Cannabis and Cannabinoid Research, the most common side effects of consuming CBD or CBD oil include:
•fatigue
•nausea or vomiting
•diarrhea
•dizziness
•anxiety or depression
•changes in appetite/weight
•Psychosis

While there is a well known link between psychotic disorders and pot, CBD is generally regarded as anti-psychotic. (4)

How can this be if a CBD side effect is psychosis? (5)

Perhaps this common belief is simply not true!

Psychoactive Effects of Cannabinoids

Perhaps cannabinoid oil purveyors tend to ignore the well established reactions because the side effect profile of CBD is better than pharmaceutical drugs used to treat similar conditions.

In addition, proponents of CBD oil use insist on its safety because cannabidiol is not mind altering like its cousin cannabinoid THC.

Research from the 1970s seems to confirm that CBD is well tolerated up to 600 mg without psychotic episodes. (6)

However, more recent research disputes this assumption.

Conversion of CBD to THC

Researcher Kazuhito Watanabe, PhD and his team at Daiichi College of Pharmaceuticals, Japan discovered a disturbing problem with cannabidiol. (7)

They found that CBD converts into THC, the same psychosis inducing substance found in weed. In addition, CBD converted into two other THC-like cannabinoids known as HHCs (hexahydroxycannabinols). All three produced high inducing symptoms in mice.

This research indicates that THC is not the only mind altering cannabinoid in hemp. It also suggests the possibility that a person can be exposed to brain altering, high inducing substances by simply consuming CBD.

Getting High on CBD?

Acidity is necessary for the conversion of CBD to THC and the two psychoactive HHCs. Researchers performed this conversion using artificial digestive juices. The change accelerated in the presence of some kind of sugar (or alcohol).

In people consuming CBD oil, this would parallel as acidity in the stomach. Since people commonly consume CBD oil in sugary lattes, candy, goodies, smoothies or alcoholic beverages, this situation mimics the reality of many people who use it.

Effects of THC Derived from CBD

To test the effects of these components, the researchers then injected mice with small quantities of the THC and HHCs converted from CBD. The researchers tested for the four most common symptoms of THC exposure including:
•Catalepsy – loss of sensation or consciousness
•Hypothermia – drop in body temperature
•Prolonged sleep
•Reduced pain perception

Mice injected with small amounts of THC and HHCs converted in artificial gastric juices from CBD tested positively for all 4 pot exposure symptoms.

Human Studies

Follow-up research in 2016 published in the journal Cannabis and Cannabinoid Research gives additional pause.

More than 40% of epileptic children orally administered CBD exhibited adverse events, with THC like symptoms the most common. In their conclusion, researchers challenged the accepted premise that CBD is not high-inducing.

Gastric fluid without enzymes converts CBD into the psychoactive components Δ9-THC and Δ8-THC, which suggests that the oral route of administration may increase the potential for psychomimetic adverse effects from CBD. (8)

Is CBD Oil Safe for Children?

The takeaway of existing research as of this writing seems to indicate extreme caution when it comes to ingestion of CBD oil especially by children.

Research definitively shows that THC exposure affects their developing brains in a negative way – perhaps permanently. The important point here is that consuming CBD or CBD infused oil can initiate this THC exposure – not just smoking or vaping pot. The Journal of Current Pharmaceutical Design warns:

The literature not only suggests neurocognitive disadvantages to using marijuana in the domains of attention and memory that persist beyond abstinence, but suggest possible macrostructural brain alterations (e.g., morphometry changes in gray matter tissue), changes in white matter tract integrity (e.g., poorer coherence in white matter fibers), and abnormalities of neural functioning (e.g., increased brain activation, changes in neurovascular functioning). (9)

CBD During Pregnancy

The Journal Future Neurology warns that cannabis exposure crosses the placenta. “Human epidemiological and animal studies have found that prenatal cannabis exposure influences brain development and can have long-lasting impacts on cognitive functions.” (10)

Since CBD partially converts to THC under acidic conditions, women who consume CBD oil for morning sickness or other discomforts of pregnancy should understand that use may mimic using pot directly. Just because CBD oil is natural and works effectively to alleviate symptoms does not mean it is safe for your baby.

Always discuss any supplemental foods with a practitioner before use!

CBD from Hops and Other Non-Cannabis Plants

Some CBD products and oil come from plants other than cannabis. Hops is one that is popular currently. (11)

People that use non-cannabis CBD mistakenly believe that they are safe from THC. False marketing of these products encourages this line of thinking.

Be warned that no matter where CBD comes from, the potential for conversion of CBD to THC in the digestive tract exists. CBD is ultimately a cannabinoid no matter what plant it comes from. Thus, unless the CBD is applied transdermally or intravenously to avoid the acidic conditions within the digestive tract, the risk for THC exposure and brain-altering effects still exists.

To give you a example of how this works, consider how beta carotene converts to Vitamin A in the digestive tract. It doesn’t matter if the beta carotene comes from carrots, peppers or squash. This nutrient will still potentially convert to Vitamin A. The same principle applies to CBD that is consumed orally. The digestive process can result in conversion to THC no matter what plant is the source of the CBD.

Is CBD Safe for Anyone?

Consumers desperately need more research about the high-inducing effects of CBD-to-THC that could manifest as a result of the digestive process.

The half life of oral CBD in the body is about 2 days. Thus, depending on how much a person consumes and how often, the potential risk of psychosis could increase over time depending on individual metabolism.

It seems that, as of this writing, the prudent course of action for the cautious consumer is to adopt a wait and see attitude toward CBD and CBD oil products pending further research on the very real potential for mind altering, pot-like effects.

Some companies are already working to develop synthetic transdermal CBD. Such a drug would bypass the gastrointestinal tract and avoid bioconversion to psychoactive THC and/or HHCs. Of course, this treatment likely has its own set of yet unknown dangers!

While the risks of THC exposure from CBD oil and other products are likely of little concern for gravely ill people who desperately need it, for otherwise healthy people and children, beware! It seems wise until further research is concluded to treat CBD oil, candy, and other products just like any other high inducing drug. Just. Say. No.

Sarah Pope MGA

Since 2002, Sarah has been a Health and Nutrition Educator dedicated to helping families effectively incorporate the principles of ancestral diets within the modern household.

Sarah was awarded Activist of the Year at the International Wise Traditions Conference in 2010.

Sarah received a Bachelor of Arts (summa cum laude, Phi Beta Kappa) in Economics from Furman University and a Master’s degree in Government (Financial Management) from the University of Pennsylvania.

Mother to three healthy children, blogger, and best-selling author, her work has been covered by USA Today, The New York Times, National Review, ABC, NBC, and many others.

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Comments (115)

Anna

Well, by now Healthline has corrected the article you reference as evidence for CBD causing psychosis, after I (and maybe others, who knows) pointed out to them that they had mistakenly put the side effects of THC for those of CBD. Now it lists only diarrhoea, changes in appetite and fatigue. Time for you to follow suit? You both reference the same scientific article, and now that this is the only remaining reference to back up your claim, I think it is time you actually looked at it and realised that it does not support your claim either. Could you then still go on and claim to have truth on your side, knowing that your claim is based on nothing at all? And keep on calling people who disagree with you biased? It’s pretty clear to me who is the biased one here, and probably to most others as well.
Sarah, you may have good intentions but you are not making the world a better place by publishing misinformation. Maybe a few people will be kept from trying CBD due to reading it, but most people will realise right away how ridiculous it is. It will just contribute to their mistrust of official information and authority figures on the subject of drugs. Because fact is that a lot of fairly harmless drugs have been needlessly demonised along with the genuinely dangerous ones since Nixon started his war on drugs. You might believe otherwise, but people who try them know better. And the more misinformation they see around them, the more they will be inclined to disbelieve also the genuine warnings about those drugs which can actually be really harmful. Especially now in this age of ‘fake news’ where people are more and more unsure of what information they can trust. People actually end up harming themselves much more due to ignorance than they would if they had full knowledge of the whole subject in advance! Proper education is the way to reduce the harm from drugs the most, not waging a war against them with misinformation – isn’t it obvious by now that this war has totally failed, because it is unwinnable?

April 20th, 2019 2:14 pm Reply

Sarah Pope MGA

I actually cited a scientific study about CBD converting to THC in the gut! You are welcome to believe anything you like, but the fact is that some people do experience psychosis from CBD. Read through the comments and read the referenced research study.

April 22nd, 2019 7:39 am Reply

rooislangwtf

The effort the Japanese study went to, to convert cbd to thc makes me wonder what the likelihood is of it actually happening in the human body (ph of 1.2 that’s lower than normal gastric acid and then a heck of a lot of purification). The epilepsy study didn’t go past observation to indicate thc effects (urine tests would’ve helped).

So the real conclusion to draw is until more tests are done:
Dont take cbd with alcohol or a lot of sugars or get a way to take cbd non orally (a patch or a suppository maybe).

April 10th, 2019 7:34 pm Reply

PATRICIA DONOVAN

I believe you picked and chose your so-called info from a multitude of sources without validating ANY of it. You are doing an extreme dis-service to those who use CBD effectively. People have to do their own research and find what works for them. Not all brands are created equal. I could write a book, with VALID sources, disputing virtually every point you made.

February 13th, 2019 1:06 pm Reply

Sarah Pope MGA

I find it amusing that people who disagree with an article frequently get in a huff and claim that “all” the sources/references are invalid and that they could “write a book” disputing every point. LOL Go read a site then that confirms all your biases. You don’t want the truth .. you want an article validating your belief system.

February 13th, 2019 1:37 pm Reply

Tim Wolford

I believe failed to include that the types of CBD oils in question are the Full Spectrum which has THC properties. The two other types will NOT produce THC and they are Broad Spectrum and Isolate Spectrum. The majority of CBD oils on the market today are Full Spectrum with THC compounds, however when the THC is extracted from the CBD Oils you have a Broad Spectrum product which may cost more, but will NOT have THC period! Do your homework and don’t always believe everything you read, especially when the Spectrums were never discussed

February 12th, 2019 11:23 am Reply

Sarah Pope MGA

Please read the article. You have apparently missed the point completely as have several other commenters. There is NO BRAND of CBD oil that is safe. ANY cannabidiol even if from another plant (like hops) will potentially trigger a conversion to THC in the gut. When NYC just banned CBD from edibles sold at restaurants, healthfood stores etc, there was NO distinction between “full spectrum” and isolate spectrum.

February 13th, 2019 8:56 am Reply

Dela Baldwin

Not all CBDs are created equal. Not all CBD has THC. A lot have trace amounts however not all. My company is 100% 0.00000 % THC free.

February 5th, 2019 9:52 am Reply

Sarah Pope MGA

I don’t think you understood the article! I am not suggesting that any CBD oil has THC in it … it DOESN’T MATTER how your CBD oil is produced … some CAN AND DOES CONVERT to small amounts of THC in the acidity of the digestive tract when consumed. Some people have a HUGE negative reaction to this.

Beta carotene partially converts to Vitamin A in the digestive tract too as do many other substances.

February 5th, 2019 10:26 am Reply

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Tens of thousands of people are ending up in hospital with cannabis-related health problems, official figures have revealed.

There were 27,501 admissions linked to cannabis in England in 2016/17, a 15 per cent rise in just two years from 23,866 in 2014/15.

Labour MP Jeff Smith, who requested the figures on cannabis-related hospitalisations, said the large increase was ‘a concern’.

The influential medical journal The Lancet has just taken the unprecedented step of branding cannabis a ‘huge risk to health’.

Mr Smith, an ex-DJ who has admitted taking drugs, said: ‘It could be that the rise in hospital admissions is associated with rises in particular types of cannabis being used – street cannabis now tends to be more “skunk”.’

‘Skunk’ has a high concentration of the main psychoactive compound THC, which is strongly linked to increased risk of psychosis.

A recent study based on drugs seized by police found that 94 per cent of cannabis now sold on UK streets is ‘skunk’. Academics say this super-strength cannabis could be behind the rise in mental health problems linked to the drug.

Now,The Lancet has warned in a hard-hitting editorial that with the ‘increasing liberalisation of laws’, users need to be made ‘aware of risks to their health and wellbeing.

The journal was reflecting on results from the 2018 Global Drug Survey, which asked 130,000 people in 44 nations about their use of drugs. The Lancet said: ‘Globally, cannabis is still the top illicit drug used and, with the concurrent use of tobacco, remains a huge health risk.’

Its position is in marked contrast to 1995 when it stated: ‘The smoking of cannabis, even long-term, is not harmful to health.’

Mr Smith claimed: ‘Legalisation and regulation is a better way of reducing harm than leaving the trade in the hands of criminals.’

Source: Mail Online July 11th 2018

Mass Illness from Marijuana Edibles in San Francisco There’s more potential for overdose from edibles than smoked marijuana, although the teen in Seattle who jumped to his death last December did it after smoking pot for the first time.  Two shocking incidents in California suggest that overdose emergencies will increase if that states vote to legalize marijuana in November.  Here’s a summary of recent cases of toxicity from edibles:

· 19 people were hospitalized in San Francisco on August 7 from THC, after attending a quinceañera party.  The source is believed be marijuana-infused candies, perhaps gummy bears. Several children were among those poisoned, one as young as six.  A 9-year-old had severe difficulty breathing.

· Pot brownies sent a bachelorette party to the emergency room in South Lake Tahoe over the weekend of July 30-31. Eight of the 10 women were admitted to the hospital according to the City of South Lake Tahoe’s website.

· A JAMA Paediatrics article explains the dramatic rise in children’s hospitalizations related to marijuana in Colorado since legalization.  In 10 cases, the product was not in a child-resistant container; in 40 scenarios (34%) there was poor child supervision or product storage.  Edible products were responsible for 51 (52% ) of exposures.  The report claimed that child-resistant packaging has not been as effective in reducing kids’ unintended exposure to pot as hoped.

· The report mentions the death of one child, an 11-month-old baby.  Nine of the children had symptoms so serious that they ended up in the intensive care unit of Colorado Children’s Hospital.  Two children needed breathing tubes.

· The state of Washington has a similar problem with edibles, as reported on the King County Health Department’s website.  From 2013 to May 2015, there were 46 cases of children’s intoxications related to marijuana edibles reported in Washington.  However, reporting is voluntary and the state estimates that number could be much higher.

·  In May, a father plead guilty to deliberately giving his 4-year-old daughter marijuana-laced cake in Vancouver, Washington.  He was sentenced to two years in prison.

Intoxication from marijuana edibles has risen steadily since legalization. Source: King County Department of Health. Top photo: AP

· In Hingham, MA, there was a 911 related to teen girl who ingested marijuana edibles.  The candies were in a package labelled Conscious Creations, which didn’t disclose ingredients.   Massachusetts has a medical marijuana program, but it is not clear how or to whom they were sold or dispensed.

· July, 2016: Two California teens were hospitalized after eating a marijuana-laced cookie. The teens reported purchasing the cookie from a third teenager who was subsequently arrested.

· July, 2016: A California man was arrested for giving candy laced with marijuana to a 6-year-old boy and an 8-year-old boy; the 6-year-old was hospitalized for marijuana poisoning.

· July, 2016: Police in Arizona arrested a mother for allegedly giving her 11- and 12-year-old children gummy candy infused with marijuana. Police say the marijuana-infused candy was originally purchased by an Arizona medical marijuana user, but was illegally transferred to the mother in question.  (State medical marijuana programs have poor track records of assuring the “medicine” goes to whom it is intended.)

· On April 27, a Georgia woman was arrested after a 5- year-old said he ate a marijuana cake for breakfast.  The child was taken to the hospital for treatment following the incident; according to officials, his pulse was measured at over 200 beats per minute.

· Last year there were more than 4,000 treatments at hospitals and poison center treatments in the US related to marijuana toxicity in children and teens.

Growth of marijuana edibles intoxication by age. Source: King County, Washington

Edible marijuana poses a “unique problem,” because “no other drug is infused into a palatable and appetizing form” – such as cookies, brownies and candy.    Many household items cause poisonings, but marijuana edibles are different because they’re made to look appealing and they appeal to children.

Source:  http://www.poppot.org/2016/08/08/latest-child-dangers-marijuana-e

Patterns of illicit drug use in each UK country analysed in annual report

An overview of illicit drug use across the whole of the UK in 2016 has been published by the Home Office.

The ‘United Kingdom Drug Situation: Focal Point Annual Report 2016’ has collated data across all four home nations and includes specific analysis of policy, prevention, treatment, drug-related deaths, infectious diseases and drug markets.

Key points relating to the UK as a whole:

· Prevalence in the general population is lower now than ten years ago, with cannabis being the main driver of that reduction. However, there has been little change in recent years.

· Seizures data suggests that herbal cannabis has come to dominate the market. While resin was involved in around two-thirds of cannabis seizures in 2000, it was involved in only five per cent in 2015/16.

· Using the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) definition, which refers to deaths caused directly by the consumption of at least one illicit drug, the total number of drug-related deaths in the UK during 2014 was 2,655; a five per cent increase from 2013 and the highest number reported to date.

· Over the last decade the average age of death has increased from 37.6 years in 2004 to 41.6 in 2014, with males being younger than females (40.3 years and 44.6 years respectively). The largest proportion of deaths in the UK in 2014 was in the 40–44 years age group.

· There were 124,234 treatment presentations in the UK in 2015. This total includes for the first time, data from individuals presenting to treatment services in prisons in England.

· Benzodiazepines were cited as a primary problem substance in far greater proportion of cases in Scotland and Northern Ireland than in England or Wales, whereas Wales had a far higher proportion of clients citing amphetamines/methamphetamines than in any of the other countries.

· National Take-Home Naloxone programmes continue to supply naloxone to those exiting prison in Scotland and Wales: there were 932 kits issued by NHS staff in prisons in Scotland, and 146 in Wales, in 2015/16.

· There were 50 new diagnoses of HIV among people who inject drugs reported from Scotland, compared with 17 in 2014. This increase was due to an outbreak of HIV in people who inject drugs in Glasgow.

Source:  http://www.sdf.org.uk/patterns-illicit-drug-use-uk-country-analysed-annual-report/

HUNTINGTON, W.Va. — Officer Sean Brinegar arrived at the house first — “People are coming here and dying,” the 911 caller had said — and found a man and a woman panicking. Two people were dead inside, they told him.

Brinegar, 25, has been on the force in this Appalachian city for less than three years, but as heroin use has surged, he has seen more than his fair share of overdoses. So last Monday, he grabbed a double pack of naloxone from his gear bag and headed inside.

A man was on the dining room floor, his thin body bluish-purple and skin abscesses betraying a history of drug use. He was dead, Brinegar thought, so the officer turned his attention to the woman on a bed. He could see her chest rising but didn’t get a response when he dug his knuckle into her sternum.

Brinegar gave the woman a dose of injected naloxone, the antidote that can jumpstart the breathing of someone who has overdosed on opioids, and returned to the man. The man sat up in response to Brinegar’s knuckle in his sternum — he was alive after all — but started to pass out again. Brinegar gave him the second dose of naloxone.

Maybe on an average day, when this Ohio River city of about 50,000 people sees two or three overdoses, that would have been it. But on this day, the calls kept coming.

Two more heroin overdoses at that house, three people found in surrounding yards. Three overdoses at the nearby public housing complex, another two up the hill from the complex.

From about 3:30 p.m. to 7 p.m., 26 people overdosed in Huntington, half of them in and around the Marcum Terrace apartment complex. The barrage occupied all the ambulances in the city and more than a shift’s worth of police officers.

By the end of it, though, all 26 people were alive. Authorities attributed that success to the cooperation among local agencies and the sad reality that they are well-practiced at responding to overdoses. Many officials did not seem surprised by the concentrated spike.

“It was kind of like any other day, just more of it,” said Dr. Clay Young, an emergency medicine doctor at Cabell Huntington Hospital.

But tragic news was coming. Around 8 p.m., paramedics responded to a report of cardiac arrest. The man later died at the hospital, and only then were officials told he had overdosed. On Wednesday, authorities found a person dead of an overdose elsewhere in Cabell County and think the death could have happened Monday. They are investigating whether those overdoses are tied to the others, potentially making them Nos. 27 and 28.

It’s possible that the rash of overdoses was caused by a particularly powerful batch of heroin or that a dearth of the drug in the days beforehand weakened people’s tolerance. But police suspect the heroin here was mixed with fentanyl, a synthetic opioid that is many times more potent than heroin. A wave of fatal overdoses signaled fentanyl’s arrival in Huntington in early 2015, and now some stashes aren’t heroin laced with fentanyl, but “fentanyl laced with heroin,” said Police Chief Joe Ciccarelli. Another possibility is carfentanil, another synthetic opioid, this one used to sedate elephants. Police didn’t recover drugs from any of the overdoses, but toxicology tests from the deaths could provide answers.

A battle-scarred city

In some ways, what happened in Huntington was as unremarkable as the spurts in overdoses that have occurred in other cities. This year, fentanyl or carfentanil killed a dozen people in Sacramento, nine people in Florida, and 23 people in about a month in Akron, Ohio. The list of cities goes on: New Haven, Conn.; Columbus, Ohio; Barre, Vt.

But what happened in Huntington stands out in other ways. It underlines the potential of a mysterious substance to unleash wide-scale trauma and overwhelm a city’s emergency response. And it suggests that a community that is doing all the right things to combat a worsening scourge can still get knocked back by it.

“From a policy perspective, we’re throwing everything we know at the problem,” said Dr. James Becker, the vice dean for governmental affairs and health care policy at the medical school at Marshall University here. “And yet the problem is one of those that takes a long time to change, and probably isn’t going to change for quite a while.”

Surrounded by rolling hills packed with lush trees, Huntington is one of the many fronts in the fight against an opioid epidemic that is killing almost 30,000 Americans a year. But this city, state, and region are among the most battle-scarred. West Virginia has the highest rate of fatal drug overdoses of any state and the highest rate of babies born dependent on opioids among the 28 states that report data. But even compared with other communities in West Virginia, Huntington sees above-average rates of heroin use, overdose deaths, and drug-dependent newborns. Local officials estimate up to 10 percent of residents use opioids improperly.

The heroin problem emerged about five years ago when authorities around the country cracked down on “pill mills” that sent pain medications into communities; officials here specifically point to a 2011 Florida law that arrested the flow of pills into the Huntington area.

As the pills became harder to obtain and harder to abuse, people turned to heroin. It has devoured many communities in Appalachia and beyond.

In Huntington, law enforcement initially took the lead, with police arresting hundreds of people. They seized thousands of grams of heroin. But it wasn’t making a dent. So in November 2014, local leaders established an office of drug control policy.

“As far as numbers of arrests and seizures, we were ahead of the game, but our problem was getting worse,” said Jim Johnson, director of the office and a former Huntington police officer. “It became very obvious that if we did not work on the demand side just as hard as the supply side, we were never going to see any success.”

The office brought together law enforcement, health officials, community and faith leaders, and experts from Marshall to try to tackle the problem together.

Changes in state law have opened naloxone dissemination to the public and protected people who report overdoses. But the city and its partners have gone further, rolling out programs through the municipal court system to encourage people to seek treatment. One program is designed to help women who work as prostitutes to feed their addiction. Huntington has eight of the state’s 28 medically assisted detox beds, and they’re always full.

Also, in 2014, a center called Lily’s Place opened in Huntington to wean babies from drugs. Last year, the local health department launched this conservative state’s first syringe exchange. The county, health officials know, is at risk for outbreaks of HIV and hepatitis C because of shared needles, so they are trying to get ahead of crises seen in other communities afflicted by addiction.

“Huntington just happens to have taken ownership of the problem, and very courageously started some programs … that have been models for the rest of the state,” said Kenneth Burner, the West Virginia coordinator for the Appalachia High Intensity Drug Trafficking Areas program.

‘A revolving door’

While paramedics in the area have carried naloxone for years, it was this spring that Huntington police officers were equipped with it. Just a few officers have administered it, but Monday was Brinegar’s third time reviving overdose victims with naloxone.

Paramedics, who first try reviving victims by pumping air with a bag through a mask, had to administer another 10 doses of naloxone Monday. Three doses went to one person, said Gordon Merry, the director of Cabell County Emergency Services. During the response, ambulances from stations outside Huntington were called into the city to assist the eight or so response teams already deployed.

Merry was clearly proud of the response, but also frustrated. He was tired, he said, of people whom emergency crews revived going back to drugs. Because of the power of their disease, saving their lives didn’t get at the root of their addiction.

“It’s a revolving door. We’re not solving the problem past reviving them,” he said. “We gave 26 people another chance on life, and hopefully one of those 26 will seek help.”

In the part of town where half the overdoses happened, some homes are well-kept, with gardens, bird feeders, and American flags billowing. “Home Sweet Home,” read an engraved piece of wood above one front door; in another front yard, a wooden sculpture presented a bear holding a fish with “WELCOME” written across its body.

But many structures are decrepit and have their windows blacked out with cardboard and sheets. At one boarded-up house, the metal slats that once made up an overhang for the front porch split apart and warped as they collapsed, like gnarled teeth. On the plywood that covered a window frame was a message spelled out in green dots: GIRL SCOUTS RULE.

In and around the public housing complex, which is made up of squat two-story brick buildings sloping up a hill, people either said they did not know what had happened Monday, or that “lowlifes” in another part of the complex sparked the problem. Even as paramedics were responding to the overdoses, police started raiding residences as part of their investigation, including apartments at the complex, the chief said.

Just up the hill, a man named Bill was sitting on a recliner on his front porch with his cat. He said he saw the police out in the area Monday, but doesn’t pay much attention to overdoses anymore. They are so frequent.

Bill, who is retired, asked to be identified only by his first name because he said he has a son in law enforcement. He has lived in that house for five decades and started locking his door only in recent years. His neighbors’ house had been broken into, and he had seen people using drugs in cars across the street from his house. He called the police sometimes, he said, but the users were always gone by the time the police arrived.

“I hate to say this, but you know, I’d let them die,” Bill said. “If they knew that no one was going to revive them, maybe they wouldn’t overdose.”

Even here, where addiction had touched so many lives, it’s not an uncommon sentiment. Addiction is still viewed by some as a bad personal choice made by bad people.

“Some folks in the community just didn’t care” that 26 of their fellow residents almost died, said Matt Boggs, the executive director of Recovery Point.  Recovery Point is a long-term recovery program that teaches “clients” to live a life without drugs or alcohol. Boggs himself is a graduate of the program, funded by the state and donations and grants.

The clients live in bunk rooms at the facility for an average of more than seven months before graduating. The program says that about two-thirds of graduates stay sober in the first year after graduation, and about 85 percent of those people are sober after two years.

Local officials praise Recovery Point, but like many other recovery programs, it is limited in what it can do. It has 100 beds for men at its location in Huntington, and is expanding at other sites in the state, but Boggs said there’s a waiting list of a couple hundred people.

Mike Thomas, 30, graduated from the main part of the program a month ago and is working as a peer mentor there as he transitions out of the facility. Thomas has been clean since Oct. 15, 2015, but has dreams about getting high or catches himself thinking he could spare $100 from his bank account for drugs.

Thomas hopes to find a full-time job helping addicts. His own recovery will be a lifelong process, one that can be torn apart by a single bad decision, he said. He will always be in recovery, never recovered.    “I’m not cured,” he said.

A killer that doesn’t discriminate

As heroin has bled into communities across the country, it has spread beyond the regular drug hotbeds in cities. On a 2004 map of drug use in Huntington — back then, mostly crack cocaine — a few blocks of the city glow red. Almost the entire city glows in yellows and reds on the 2014 map.

In 2015, there were more than 700 drug overdose calls in Huntington, ranging from kids in their early teens to seniors in their late 70s. In 2014, it was 272 calls; in 2012, 146. One bright spot: fatal overdoses, which stood at 58 in 2015, have ticked down so far this year.

“I used to be able to say, ‘We need to focus here,’” said Scott Lemley, a criminal intelligence analyst at the police department. “I can’t do that anymore.”

Heroin hasn’t just dismantled geographic barriers. It has infiltrated every demographic “It doesn’t discriminate.   Prominent businessmen, their child. Police officers, their child. Doctors, their child,” Merry said. “The businessman and police officer do not have their child anymore.”

The businessman is Teddy Johnson. His son, Adam, died in 2007 when he was 22, one of a dozen people who died in a five-month period because of an influx of black-tar heroin. The drug hadn’t made its full resurgence into the region yet, but now, Johnson sees the drug that killed his son everywhere.

Teddy Johnson lost his son, Adam, in 2007 to a heroin overdose. He has several tattoos dedicated to Adam’s memory.  He runs a plumbing, heating, and kitchen fixture and remodelling business. From his storefront, he has witnessed deals across the street.

Adam, who was a student at Marshall, was a musician and artist who hosted radio shows. He was the life of any party, his dad said.

Johnson was describing Adam as he sat at the marble countertop of a model kitchen in his business last week. With the photos of his kids on the counter, it felt like a family’s home. Johnson explained how he still kept Adam’s bed made, how he kept his son’s room the same, and then he began to cry.

“The biggest star in the sky we say is Adam’s star,” he said. “When we’re in the car — and it can’t be this way — but it always seems to be in front of us, guiding us.”

Adam’s grave is at the top of a hill near the memorial to the 75 people — Marshall football players, staff, and fans — who died in a 1970 plane crash. It’s a beautiful spot that Johnson visits a few times each week, bringing flowers and cutting the grass around his son’s grave himself. Recently a note was left there from a couple Johnson knows who

just lost their son to an overdose; they were asking Adam to look out for their son in heaven.

But even here, at what should be a respite, Johnson can’t escape what took his son. He said he has seen deals happen in the cemetery, and he recently found a burnt spoon not more than 20 feet from his son’s grave.

Johnson keeps fresh flowers on his son’s grave and cuts the grass around the grave himself.

“I’ve just seen too much of it,” he said.

If Huntington doesn’t have a handle on heroin, at least the initiatives are helping officials understand the scale of the problem. More than 1,700 people have come through the syringe exchange since it opened, where they receive a medical assessment and learn about recovery options. The exchange is open one day a week, and in less than a year, it has distributed 150,000 clean syringes and received 125,000 used syringes.

But to grow and sustain its programs, Huntington needs money, officials say. The community has received federal grants, and state officials know they have a problem. But economic losses and the collapse of the coal industry that fueled the drug epidemic have also depleted state coffers.

“We have programs ready to launch, and we have no resources to launch them with,” said Dr. Michael Kilkenny, the physician director of the Cabell-Huntington Health Department. “We’re launching them without resources, because our people are dying, and we can’t tolerate that.”

In some ways, Huntington is fortunate. It has a university with medical and pharmacy schools enlisted to help, and a mayor’s office and police department collaborating with public health officials. But what does that herald then for other communities?

“If I feel anxious about what happens in Huntington and in Cabell County, I cannot imagine what it must be like to live in one of these other at-risk counties in the United States, where they don’t have all those resources, they don’t have people thinking about it,” said Dr. Kevin Yingling, the dean of the Marshall University School of Pharmacy.

Yingling, Kilkenny, and others were gathered on Friday afternoon to talk about the situation in Huntington, including the rash of overdoses. But by then, there was already a different incident to discuss.

A car had crashed into a tree earlier that afternoon in Huntington. A man in the driver seat and a woman in the passenger seat had both overdosed and needed naloxone to be revived. A preschool-age girl was in the back seat.

Source:    https://www.statnews.com/2016/08/22/heroin-huntington-west-virginia-overdoses/ 22.08.16

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

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

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

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

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

Hence the bad week.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Centers for Disease Control and Prevention (CDC) stated that 33,091 people died from opioid overdoses in 2015, which accounts for 63 percent of all drug overdose deaths in the same year. A recent report from the CDC found that drug deaths from fentanyl and other synthetic opioids, other than methadone, rose 72 percent in just one year, from 2014 to 2015. Last year, the death of music icon Prince was linked to fentanyl and the prescription drug has become a source of concern for government agencies and law enforcement officials alike, as death rates from fentanyl-related overdoses and seizures have risen across the country.

What exactly is fentanyl?

According to the National Institute on Drug Abuse, fentanyl is a powerful synthetic opioid analgesic that is similar to morphine – but is 50 to 100 times more potent. It is a schedule II prescription drug, and it is typically used to treat patients with severe pain or to manage pain after surgery. It is also sometimes used to treat patients with chronic pain who are physically tolerant to other opioids. In its prescription form, fentanyl is known by such names as Actiq®, Duragesic® and Sublimaze®. Like heroin, morphine and other opioid drugs, fentanyl works by binding to the body’s opioid receptors, which are found in areas of the brain that control pain and emotions.

When opioid drugs bind to these receptors, they can drive up dopamine levels in the brain’s reward areas, producing a state of euphoria and relaxation. But fentanyl’s effects resemble those of heroin and include drowsiness, nausea, confusion, constipation, sedation, tolerance, addiction, respiratory depression and arrest, unconsciousness, coma and death.

So why is abuse and misuse of fentanyl so dangerous?

When prescribed by a physician, fentanyl is often administered via injection, transdermal patch or in lozenges. However, the fentanyl and fentanyl analogs associated with recent overdoses are produced in clandestine laboratories.

This non-pharmaceutical fentanyl is sold in the following forms: as a powder; spiked on blotter paper; mixed with or substituted for heroin; or as tablets that mimic other, less potent opioids. Fentanyl sold on the street can be mixed with heroin or cocaine, which markedly amplifies its potency and potential dangers.

Users of this form of fentanyl can swallow, snort or inject it, or they can put blotter paper in their mouths so that the synthetic opioid is absorbed through the mucous membrane. Street names for fentanyl or for fentanyl-laced heroin include Apache, China Girl, China White, Dance Fever, Friend, Goodfella, Jackpot, Murder 8, TNT, and Tango and Cash.

Can misuse of fentanyl lead to death?

Opioid receptors are also found in the areas of the brain that control breathing rate. High doses of opioids, especially potent opioids such as fentanyl, can cause breathing to stop completely, which can lead to death. The high potency of fentanyl greatly increases risk of overdose, especially if a person who uses drugs is unaware that a powder or pill contains fentanyl.

The United States Drug Enforcement Administration issued a nationwide alert in 2015 about the dangers of fentanyl and fentanyl analogues/compounds. Fentanyl-laced heroin is causing significant problems across the country, particularly as heroin use has increased in recent years.

Source: http://drugfree.org/newsroom/news-item/overdose-deaths-fentanyl-rise-know/   Jan 18th 2017

I totally agree that we all need to let Attorney General Jeff Sessions know that the majority of Americans suffer because of marijuana …. whether they choose to use it or not.  It is a factor in crime, physical and mental health, academic failure, lost productivity, et al.  American cannot be great again if we continue to allow poison to be grown and distributed to the masses.

The President has taken a position that “medical marijuana” should be a State’s right, because he is not yet enlightened on the reality of what that means.  If asked to define “medical marijuana” that has helped his friends, I doubt that he would say gummy bears, Heavenly brownies and other edibles with 60 to 80% potency, sold in quantities that are potentially lethal; smoked pot at 25% THC content; or waxes and oils used for dabbing and vaping that are as high as 98% potency that cause psychotic breaks, mental illness, suicides, traffic deaths and more.

Further, if states are to have a right to offer “medical marijuana”, it has to be done under tightly controlled conditions and the profit motive eliminated.  Privately owned cultivation and dispensaries must be banned … including one’s ability to grow 6 plants at home.  6 plants grown hydroponically with 4 harvests a year could generate 24 lbs of pot, the equivalent of about 24,000 joints. That obviously would not be for personal use.  We would just have thousands of new drug dealers, with more crime, more child endangerment, more BHO labs blowing up, more traffic deaths, et al.

Source:   Letter from Roger Morgan to DrugWatch International  Feb. 2017

FRAMINHAM, Mass. – A Framingham middle school student was hospitalized Monday after he and another student ate a marijuana edible on the school bus, according to a letter released by Fuller Middle School.   School officials are trying to find out who brought the edibles on the bus and how to make sure it doesn’t happen again.

Stacy Velasquez says her 12-year-old son was riding the bus to school Monday morning when he found a container of gummy bears that got him very sick.   He called her crying.

“He said, ‘I ate something.’ I said, ‘what did you eat?’ He said candy. Where did you get it? He said he found it on the bus,” Velasquez explained.   When she arrived at Fuller Middle School, she says he was in a trance-like state, barely able to speak. She rushed him to the emergency room, snapping a video of his behavior.

“Once the tox screen came back, they said they’d never seen this before in a child so small, like an overdose so to speak of marijuana, but basically it would run its course and he would sleep it off.  And that’s what he did last night,” said Velasquez.

The district superintendent says they have no comment in regards to what happened, just that the police are now investigating.   Though marijuana is now legal in the state of Massachusetts, it’s not legal for anyone under the age of 21 to handle or ingest the drug.

“I would just like someone to make sure the school is doing their part and the bus drivers are doing their part to make sure the children get to and from school safely and that something like this doesn’t happen to someone else’s child,” Velasquez said. “I think the teenager involved [should be charged], because right now, it’s expected to be one of the high schoolers.”

Velasquez said her son is doing fine, he’s just embarrassed about what happened.   As for possible charges, police are looking through video taken on the bus to see who the edibles link back to.

Source:  http://www.fox25boston.com/news/framingham-middle-schooler-hospitalized-after-eating-marijuana-edible-on-school-bus/483211673?utm_source=January 11th 2017

Fentanyl is a painkiller that is 50 times stronger than heroin. It has already killed thousands, including Prince. Chris McGreal reveals why so many are playing Russian roulette with this lethal drug Natasha Butler had never heard of fentanyl until a doctor told her that a single pill had pushed her eldest son to the brink of death – and he wasn’t coming back. “The doctor said fentanyl is 100 times more potent than morphine and 50 times more potent than heroin. I know morphine is really, really powerful. I’m trying to understand. All that in one pill? How did Jerome get that pill?” she asked, her voice dropping to a whisper as the tears came. “Jerome was on a respirator and he was pretty much unresponsive. The doctor told me all his organs had shut down. His brain was swelling, putting pressure on to the spine. They said if he makes it he’ll be a vegetable.”

Painkiller addiction claims more lives in the US than guns, cutting across class, race and region

The last picture of Jerome shows him propped immobile in a hospital bed, eyes closed, sustained only by a clutch of tubes and wires. Natasha took the near impossible decision to let him die.  “I had to remove him from life support. That’s the hardest thing to ever do. I had him at 15 so we grew together. He was 28 when he died,” she said. “I had to let him die but after that I needed some answers. What is fentanyl and how did he get it?” That was a question asked across Sacramento after Jerome and 52 other people in and around California’s capital overdosed on the extremely powerful synthetic opioid, usually only used by hospitals to treat patients in the later stages of cancer, over a few days in late March and early April 2016. Twelve died.

Less than a month later, this mysterious drug – largely unheard of by most Americans – killed the musician Prince and burst on to the national consciousness. Fentanyl, it turned out, was the latest and most disturbing twist in the epidemic of opioid addiction that has crept across the United States over the past two decades, claiming close to 200,000 lives. But Prince, like almost all fentanyl’s victims, probably never even knew he was taking the drug.

“The number of people overdosing is staggering,” said Lieutenant Tracy Morris, commander of special investigations who manages the narcotics task force in Orange County, which has seen a flood of the drug across the Mexican border. “It is truly scary. They don’t even know what they’re taking.” The epidemic of addiction to prescription opioid painkillers, a largely American crisis, sprung from the power of big pharmaceutical companies to influence medical policy. Two decades ago, a small family-owned drug manufacturer, Purdue Pharma, unleashed the most powerful prescription painkiller yet sold over the pharmacist’s counter. Even though it was several times stronger than anything else on the market, and bore a close relation to heroin, Purdue claimed that OxyContin was not addictive and was safe to treat even relatively minor pain. That turned out not to be true.

It spawned an epidemic that in the US claims more lives than guns, cutting across class, race and geographic lines as it ravages communities from white rural Appalachia and Mormon Utah to black and Latino neighbourhoods of southern California. The prescription of OxyContin and other painkillers with the same active drug, oxycodone, became so widespread that entire families were hooked. Labourers who wrenched a back at work, teenagers with a sports injury, just about anyone who said they were in pain

was put on oxycodone. The famous names who ended up as addicts show how indiscriminate the drug’s reach was; everyone from politician John McCain’s wife Cindy to Eminem became addicted.

Clinics staffed by unscrupulous doctors, known as “pill mills”, sprung up churning out prescriptions for cash payments. They made millions of dollars a year. By the time the epidemic finally started to get public and political attention, more than two million Americans were addicted to opioid painkillers. Those who finally managed to shake off the drug often did so only at the cost of jobs, relationships and homes.

After the government finally began to curb painkiller prescriptions, making it more difficult for addicts to find the pills and forcing up black market prices, Mexican drug cartels stepped in to flood the US with the real thing – heroin – in quantities not seen since the 1970s. But, as profitable as the resurgence of heroin is to the cartels, it is labour intensive and time-consuming to grow and harvest poppies. Then there are the risks of smuggling bulky quantities of the drug into the US.

The ingredients for fentanyl, on the other hand, are openly available in China and easily imported ready for manufacture. The drug was originally concocted in Belgium in 1960, developed as an anaesthetic. It is so much more powerful than heroin that only small quantities are needed to reach the same high. That has meant easy profits for the cartels. The Drug Enforcement Administration (DEA) has said that 1kg of heroin earns a return of around $50,000. A kilo of fentanyl brings in $1m.

At first the cartels laced the fentanyl into heroin to increase the potency of low-quality supplies. But prescription opioid painkillers command a premium because they are trusted and have become increasingly difficult to find on the black market. So cartels moved into pressing counterfeit tablets.  But making pills with a drug like fentanyl is a fairly exact science. A few grammes too much can kill. “It’s very lethal in very small doses,” said Morris. “Even as little as 0.25mg can be fatal. One of our labs had a dime next to 0.25mg and you could barely see it. It’s about the size of the head of a pin. Potentially that could kill you.”

The authorities liken buying black market pills to playing Russian roulette. “These pills sold on the street, nobody knows what’s in them and nobody knows how strong they are,” said Barbara Carreno of the DEA.

After Prince died, investigators found pills labelled as prescription hydrocodone, but made of fentanyl, in his home, suggesting he bought them on the black market. The police concluded he died from a fatal mix of the opioid and benzodiazepine pills, a particularly dangerous combination. It is likely Prince did not even know he was taking fentanyl.  Others knowingly take the risk. In his long battle with addiction, Michael Jackson, used a prescription patch releasing fentanyl into his skin among the arsenal of drugs he was fed by compliant doctors. Although it was two non-opioids that killed him, adding fentanyl into the mix was hazardous.

Jerome Butler, a former driver for Budweiser beer who was training to be a security guard, thought he was taking a prescription pill called Norco. His mother’s voice breaks as she recounts what she knows of her son’s last hours. Natasha said she was aware he used cannabis, but had no idea he was hooked on opioid painkillers. She said her son at one time had a legitimate prescription and may have become addicted that way. She has since discovered he was paying a doctor, well known for freely prescribing opioids, to provide pills.  “I didn’t even know,” she said. “You find stuff out after. It’s killing me because they’re saying, ‘Well, yeah, Jerome was taking them pills all the time.’ And I’m like, ‘He was doing what?’”

Jerome may have had a prescription, but like many addicts he will have needed more and more. The pill that killed him was stamped M367, a marking used on Norco pills made of an opioid, hydrocodone. It was a fake with a high dosage of fentanyl.   This is fentanyl. The first time you take it you’re not coming back. You’re gone

“If Jerome had known it was fentanyl he would never have took that,” said Natasha. “This ain’t like crack or a recreational drug that people been doing for so many years and survived it but at 60 or 70 die from a drug overdose because their heart can’t take it no more. This is fentanyl. The first time you take it you’re not coming back. You’re gone.”

That wasn’t strictly true of the batch that hit Sacramento. It claimed 11 other lives. The youngest victim was 18-year-old George Berry from El Dorado Hills, a mostly white upscale neighbourhood. The eldest was 59. But others survived. Some were saved by quick reactions; doctors were able to hit them with an antidote before lasting damage was done. Others swallowed only enough fentanyl to leave them seriously ill but short of death.

It was a matter of luck. When investigators sent counterfeit pills seized after the Sacramento poisonings for testing at the University of California, they found a wide disparity in the amount of fentanyl each contained. Some pills had as little as 0.6mg. Others were stuffed with 6.9mg of the drug, which would almost certainly be fatal. The DEA thinks the difference was probably the result of failing to mix the ingredients properly with other powders, which resulted in the fentanyl being distributed unevenly within a single batch of counterfeit pills.

That probably explains the unpredictable mass overdosing popping up in cities across the US. In August, 174 people overdosed on heroin in six days in Cincinnati, which has one of the fastest-growing economies in the Midwest. Investigators suspect fentanyl because the victims needed several doses of an antidote, Naloxone, where one or two will usually suffice with heroin. The same month, 26 people overdosed on fentanyl-laced heroin in a four-hour period in Huntington, a mostly white city in one of the poorest areas of West Virginia. In September seven people died from fentanyl or heroin overdoses in a single day in Cuyahoga County, Ohio.

The US authorities don’t know for sure how many people fentanyl kills because of the frequency with which it is mixed with heroin, which is then registered as the cause of death. The DEA reported 700 fatalities from fentanyl in 2014 but said it is an underestimate, and rising. In 2012, the agency’s laboratory carried out 644 tests confirming the presence of fentanyl in drug seizures. By 2015, the number of positive tests escalated to 13,002.

The police did not have to look far for the source of the drug that killed Jerome. He and his girlfriend were staying at the house of her aunt, Mildred Dossman, while they waited for their own place to live. Jerome was smoking cannabis and drinking beer with Dossman’s son, William. Shortly before 1am, William went to his mother’s bedroom and came back with the fake Norco pill. Jerome took it and said he was going to bed.  Jerome’s girlfriend was in jail after being arrested for an unpaid traffic fine and so he was alone with their 18 month-old daughter, Success, lying next to him.

“The doctors explained to me that within a matter of minutes he went into cardiac arrest,” said his mother. “Then as he lay there that’s when time progressed for the organs to be poisoned by fentanyl. He was dying with his daughter next to him.” Natasha said other people in the house heard her son in distress, complaining his heart was hurting. But they did nothing because they were afraid that calling an ambulance would also bring the police.

It was not until 10 hours later that the Dossmans finally sought help from a neighbour who knew Jerome. He tried CPR and then called the medics. The police came, too, and in time Mildred Dossman, 50, was charged with distributing fentanyl and black market opioid painkillers. She was the local dealer.

The DEA is tightlipped about the investigation into the Sacramento deaths as its agents work on persuading Dossman to lead them to her suppliers. But it is likely she was getting the pills from Mexican cartels using ingredients from labs in China where production of fentanyl’s ingredients is legal.  Carreno said some Mexican cartels have long relationships with legitimate Chinese firms which for years supplied precursor chemicals to make meth amphetamine.

Packages of fentanyl are often moved between multiple freight handlers so their origins are hard to trace. Larger shipments are smuggled in shipping containers. Last year, six Chinese customs officials fell ill, one of them into a coma, after seizing 72kg of various types of fentanyl from a container destined for Mexico. American police officers have faced similar dangers. In June, the DEA put out a video warning law enforcement officers across the US that fentanyl was different to anything they have previously encountered and they should refrain from carting seizures back to the office.   “A very small amount ingested, or absorbed through the skin, can kill you,” it said.   A New Jersey detective appears in the video after accidentally inhaling “just a little bit of fentanyl puffed into the air” during an arrest: “It felt like my body was shutting down… I thought that was it. I thought I was dying.”

Along with the Mexican connection, a home-grown manufacturing industry has sprung up in the US. Weeks after Jerome died, agents arrested a married couple pressing fentanyl tablets in their San Francisco flat.

Candelaria Vazquez and Kia Zolfaghari made the drug to look like oxycodone pills. They sold them across the country via the darknet using Bitcoin for payment – on one occasion Zolfaghari cashed in $230,000. The couple shipped the drugs through the local post office. Customers traced by the DEA thought they were buying real painkiller pills. The couple ran the pill press in their kitchen. According to a DEA warrant, a dealer said Zolfaghari made large numbers of tablets: “He could press 100 out fast as fuck.”

The pair made so much money that agents searching their flat found luxury watches worth $70,000, more than $44,000 in cash and hundreds of “customer order slips” which included names, amounts and tracking numbers. The flat was stuffed with designer goods. The seizure warrant described Vazquez’s shoe collection as “stacked virtually from floor to ceiling”. Some still had the $1,000 price tags on them. Zolfaghari was arrested carrying a 9mm semi-automatic gun and about 500 pills he was preparing to post. The dealers made so much money that their flat was stuffed with luxury goods and cash.

Even as Americans are getting their heads around fentanyl, it is being eclipsed. In September, the DEA issued a warning about the rise of a fentanyl variant that is 100 times more powerful – carfentanil, a drug used to tranquilise elephants.

“Carfentanil is surfacing in more and more communities,” said the DEA’s acting administrator, Chuck Rosenberg. “We see it on the streets, often disguised as heroin. It is crazy dangerous.”

The drug has already been linked to 19 deaths in Michigan. Investigators say that with its use spreading, it is almost certainly claiming other lives. Dealers are also getting it from China, where carfentanil is not a controlled drug and can be sold to anyone.

Natasha Butler is still trying to understand the drug that killed her son. She wants to know why it is that it took Jerome’s death for her to even hear of it. She accuses the authorities of failing to warn people of the danger, and politicians of shirking their responsibilities.   A bill working its way through California’s legislature stiffening sentences for fentanyl dealing died in the face of opposition from the state’s governor, Jerry Brown, because it would put pressure on the already badly crowded prisons.

“I’m so dumbfounded. How does that happen?” says Natasha. Her tears come frequently as she sits at a tiny black table barely big enough to seat three people. She talks about Jerome and the tragedy for his three children, including Success, who she is now raising.

But some of the tears are to mourn the devastating impact on her own life. “Look where I’m at. I was in Louisiana. I had a house. I had a job. I had a car. I had a life. I worked every day. I was a manager for a major company. I came here, I became homeless. I had to move into this apartment to help out my granddaughter,” she said. “You see me. This is what my kitchen table is. My son is dead. He had three kids and those two mothers of those kids are depending on me to be strong. I want answers and help. I say, you got the little fish. Where did they get it from? How did they get it here? You are my government. You are supposed to protect us.”

Source:  https://www.theguardian.com/global/2016/dec/11/pills-that-kill-why-are-thousands-dying-from-fentanyl-abuse–

The surgeon general’s recent report is a much-needed call to arms around a public health crisis.

On Nov. 17, Dr. Vivek Murthy, a vice admiral of the U.S. Public Health Service Commissioned Corps and U.S. surgeon general, issued a timely and much-needed report on what has become a public health crisis and menace in this country – namely, misuse and addiction to legal and illegal psychoactive drugs.

In the report preface, Murthy remarks that before starting his current job he stopped by the hospital where he had practiced. It was the nurses who said to him, he writes, “please do something about the addiction crisis in America.” He knew they were right, and he took their wise counsel.

Why are they right? Substance use disorders, where a person is functionally impaired and often physically dependent on a drug, affect nearly 21 million Americans annually – the same number of people who have diabetes and 150 percent of those with a cancer diagnosis, of any type.

In 2015, about 67 million people reported binge drinking in the past month, and 48 million were using illegal drugs or misusing prescribed drugs. In the past year, 12.5 million Americans reported misusing prescription pain relievers. In 2014, 47,055 people died from a drug overdose, with more than half of those using an opioid (like OxyContin, Percodan, Vicodin, methadone and heroin).

The numbers chill the mind, and yet with the widespread use, abuse and potentially deadly consequences, only 1 in 10 of those with a substance use disorder obtain any treatment. The nurses to whom Murthy spoke were surely seeing the consequences of drug misuse in their emergency rooms, clinics and inpatient units. They also were likely seeing the consequences among their family, friends and co-workers. (Health professionals are prone to misuse alcohol and drugs.)

What distinguishes the surgeon general’s report is its call for a long overdue shift in alcohol and drug policy – away from a criminal justice approach to a clinical or public health approach. What also distinguishes every cover note and chapter is a spirit of hope, that substance use can be prevented, detected early, effectively treated and its manifold adverse impacts mitigated.

To start, the surgeon general urges that we begin by “improving public awareness of substance misuse and related problems.” Negative attitudes, critical judgments and moral invective towards people with addiction not only interfere with delivering good care they deter people who need services from getting them.

But the report also makes clear that there is no single solution or path, nor should we expect one with problems this broad and deep. The heart of the report then, chapter by chapter, speaks to comprehensive policy action: prevention, early intervention, ongoing treatment, so-called wellness activities, identifying and reaching out to high-risk populations and supporting research efforts.

Central to the report is that we must integrate health care services with substance use treatment: not by referral from one to the other but by embedding screening and basic forms of treatment into primary care and family practice. We screen for hypertension, lipids, diabetes and much more; why aren’t we screening for problem alcohol and drug use where these problems are most likely to appear? Screening, Brief Intervention and Referral for Treatment, or SBIRT, is perhaps the best-known and most effective means of extending substance screening and management into the general health system.

Of course, all these efforts must be financed. A powerful argument can be made that it costs more to not treat these conditions than to treat them. Substance use disorders cost the U.S. more than $400 billion every year on health care expenses, criminal justice costs, social welfare consequences and lost workplace productivity. However, our health, social welfare and criminal justice systems are simply too siloed, (separated) and we pay the human and financial price of not reaching across the ersatz boundaries of government and community agencies.

Still, some laws are making inroads to improve care. The Affordable Care Act requires treatment for substance use disorders to be an “essential benefit,” no different from any other illness. The 2008 Federal Parity Act, now finally with regulations, also requires insurers to not discriminate against people with addictions. The policy and legislative pillars are there, and we need to keep using them.

The surgeon general ends his report with a vision for the future. He is deeply sanguine that we can disrupt the addiction epidemic that has seized our country. The path is a public health one, as I have illustrated above, but the report talks also of what individuals and families can do: reach out to those we see in trouble, withhold judgment, support those in recovery, and, for parents, talk to your child about alcohol and drugs. “Making [these changes] will require a major cultural shift in the way Americans think about, talk about, look at, and act toward people with substance use disorder,” the report reads. “For example, cancer and HIV used to be surrounded by fear and judgment, but they are now regarded by most Americans as medical conditions like many others.”

We owe a great thanks to the surgeon general and the many experts and advocates who put together this call for how we can respond to what is now a public health crisis. We can do that. It will be hard, but the alternative of not taking collective action will be far harder to bear.

Source: http://www.usnews.com/opinion/policy-dose/articles/2016-11-21/surgeon-general-is-right-to-target-the-public-health-crisis-of-addiction

VICTORIAN paramedics are being called to an average of almost 60 alcohol-related and 25 drug-affected patients a day.

A surge in ice-related call-outs is a main cause of an increase in attendances of almost 30 per cent on the year before.

Prescription medication — mostly sleeping tablets and anti-anxiety medication benzodiazepines — continue to be involved in more ambulance call-outs than illicit drugs.

But a Turning Point report shows that the proportion of illicit drug misuse has dramatically increased.

Attendances for crystal methamphetamine or “ice” almost doubled in 2014-2015. The 2271 attendances a year, or six a day, is an eightfold increase since 2010-2011.

The Ambo Project, a summary of Victoria’s drug and alcohol related ambulance attendances, shows that alcohol-related harm is the most common problem: there were 21,602 call-outs compared with 9038 for illicit drugs and 9941 for prescription medications.

The number of alcohol-related cases increased almost threefold in the past six years; paramedics now attend 57 cases daily; in 49, it is the only drug involved.

Turning Point lead researcher Belinda Lloyd said ambulance call-outs for prescription medications, including antidepressants, anti-psychotics and painkillers, were higher in regional areas per rate of population.

“This is no longer a problem for major cities and entertainment precincts,” Ms Lloyd.

“We need more awareness about how to minimise the harm from drugs.”

Ambulance Victoria general manager of emergency operations Mick Stephenson, said the increase in drug call-outs, particularly amphetamines, meant paramedics more frequently sedated patients to prevent self-harm and protect health workers.

“They take this stuff at their peril because they don’t know what’s in it and nor do we.”

Minister for Mental Health Martin Foley said training of almost 40,000 frontline health workers in dealing with ice-affected patients started today.

Opposition health spokeswoman Mary Wooldridge said alcohol and drug-fuelled harm continued to put paramedics and others at risk.

Source:  http://www.heraldsun.com.au/news/victoria/ambulance-callouts-soar  7th Nov 2016

In  2014, an estimated 22.2 million Americans aged 12 years or older had used marijuana in the past month.1

Under federal law, marijuana is considered an illegal Schedule I drug. However, over the last 2 decades, more than half of the states have allowed limited access to marijuana or its components, Δ9-tetrahydrocannabinol (THC) and cannabidiol, for medical reasons.2 More recently, 4 states and the District of Columbia have legalized marijuana for recreational purposes.

Currently, evidence for the therapeutic benefits of marijuana are limited to treatment and improvements to certain health conditions (eg, chronic pain, spasticity, nausea).3 Recreational use of marijuana is established by patterns of individual behaviors and lifestyle choices. In either case, use of marijuana or any of its components, especially in younger populations, is associated with an increased risk of certain adverse health effects, such as problems with memory, attention, and learning, that can lead to poor school performance and reduced educational and career attainment, early-onset psychotic symptoms in those at elevated risk, addiction in some users, and altered brain development.4- 7

In September 2016, the Substance Abuse and Mental Health Services Administration and the Centers for Disease and Control and Prevention (CDC) released an issue of the CDC’s Morbidity and Mortality Weekly Report—Surveillance Summary describing historical trends in marijuana use and related indicators among the non-institutionalized civilian population aged 12 years or older using 2002-2014 data from the National Survey on Drug Use and Health (NSDUH).8

During the last 13 years, marijuana access (ie, perceived availability) and use (ie, past-month marijuana use) have steadily increased in the United States, particularly among people aged 26 years or older, increasing from 54.9% in 2002 to 59.2% in 2014 and from 4.0% in 2002 to 6.6% in 2014, respectively. The factors associated with the national behavior patterns of marijuana use cannot be attributed solely to the heterogeneous body of state laws and policies that vary considerably with respect to year of enactment, implementation lag time, and access stipulations.

However, as state laws and policies continue to evolve, these data will be useful as a baseline to monitor changes in patterns of use and associated variables. Monitoring behavioral patterns is important given the possible increased risk of adverse health consequences due to potency changes—higher concentrations of THC (the psychoactive compound)—of the cannabis plant in the United States in the last 2 decades.9

Estimates from NSDUH data suggest that in 2014, 2.5 million persons aged 12 years or older had used marijuana for the first time within the past 12 months; this projected estimate suggests that there is an average of about 7000 new users each day (approximately 1000 more new users each day in 2014 compared with in 2002). In 2014, mean age at first use of marijuana was 19 years among persons aged 12 years or older and was 15 years among persons aged 12 to 17 years.8

During 2002-2014, the estimated prevalence of marijuana use in the past month, in the past year, and daily or almost daily increased among persons aged 18 years or older but

not among those aged 12 to 17 years, while the perceived risk from smoking marijuana decreased across all age groups. Conversely, the estimated prevalence of past-year marijuana dependence decreased from 1.8% in 2002 to 1.6% in 2014 among all persons aged 12 years or older and from 16.7% in 2002 to 11.9% in 2014 among past-year marijuana users.

Overall, the perceived availability to obtain marijuana among persons aged 12 years or older increased, and acquiring marijuana by buying the drug and growing it increased vs obtaining marijuana for free and sharing the drug. The percentage of persons aged 12 years or older perceiving that the maximum legal penalty for the possession of 1 oz or less of marijuana in their state of residence is a fine and no penalty increased vs perceptions that penalties included probation, community service, possible prison sentence, and mandatory prison sentence.8

These findings on perceived availability to obtain marijuana and fewer punitive legal penalties (eg, no penalty) for the possession of marijuana for personal use may play a role in the observed increased prevalence in use among adults in the United States. However, surveillance data do not reveal causal relationships; therefore, more granular research is needed.

As states adopt policies that increase legal access to marijuana, new indicators will be needed to understand trends in marijuana use and the risk of health effects. Questions regarding mode of use (eg, smoked, vaped, dabbed, eaten, drunk), frequency of use, potency of marijuana consumed, and reasons for use (ie, medical use, recreational use, or both) could be added to existing surveillance systems or launched in new systems.

Traditionally, understanding factors underlying the trends in marijuana use have been assessed by looking at 1 or 2 indicators (eg, perception of harm risk or dependence or abuse). A multivariable approach that includes environmental (eg, law enforcement, laws/policies) and cultural (eg, religion, individual choice) factors might be required to understand the relationship between the perceptions and attitudes toward marijuana and use behavior.

The health effects associated with marijuana use are still widely debated. Nonetheless, marijuana use during early stages of life, when the brain is developing, poses potential public health concerns, including reduced educational attainment, addiction in some users, poor education outcomes, altered brain structure and function, and cognitive impairment.4- 7

Given these potential health and social consequences of marijuana use, additional data sources at the federal and state levels may be required to assess the public health effects of marijuana use. These sources may include data from sectors such as health care (eg, emergency department data), criminal justice (eg, law enforcement data), education (eg, school attendance and performance data), and transportation (eg, motor vehicle injury data).

Assessing the prevalence and public health effects of marijuana use in the United States remains important given the evolving policies for marijuana for medical or recreational use at the state level. Therefore, it is vital to continue to monitor key traditional marijuana indicators but also to enhance public health surveillance to include monitoring of indicators that assess emerging issues so that public health actions could prevent adverse health consequences.

Given that legislation, types of products, use patterns, and evidence for potential harms and benefits of marijuana and its compounds are all evolving, clinicians need to understand the magnitude of marijuana use and associated behaviors so they can provide informed answers to patient questions, screen, counsel, treat, and refer patients to community treatment or counseling centers if abuse or adverse effects are identified.

Source: JAMA. 2016;316(17):1765-1766. doi:10.1001/jama.2016.13696

As a parent and grandparent, I believe legalizing recreational marijuana would result in serious harm to public health and safety, and urge my fellow Californians to vote “No” on Proposition 64 on Nov. 8.

Marijuana is a complicated issue. I support its medicinal use and have introduced federal legislation to make it easier to research and potentially bring marijuana-derived medicines to the market with FDA approval.

I also recognize that our nation’s failure to treat drug addiction as a public health issue has resulted in broken families and overcrowded prisons. That’s why I support the sentencing reform that would reduce the use of mandatory minimum sentences in certain drug crimes, give judges more flexibility to set sentences and promote treatment programs to address the underlying addiction.

But Proposition 64 would allow marijuana of any strength to be sold. It could make it easier for children to access marijuana and marijuana-infused foods. It could add to the already exorbitant costs of treating addiction. And it does not do enough to keep stoned drivers, including minors, off the roads.

With 25 million drivers in our state, that should set off alarm bells. While we do not fully understand how marijuana affects an individual’s driving ability, we do know that it significantly impacts judgment, motor coordination and reaction time.

In Washington, deaths in marijuana-related car crashes have more than doubled since legalization. In Colorado, 21 percent of 2015 traffic deaths were marijuana-related, double the rate five years earlier – before marijuana was legalized.

In California, even without recreational legalization, fatalities caused by drivers testing positive for marijuana increased by nearly 17 percent from 2005 to 2014. While the presence of marijuana does not prove causation, these numbers are concerning. A study on drugged driving and roadside tests to detect impairment required by Proposition 64 should be completed before, not after, legalization goes into effect.

Proposition 64 does not limit the strength of marijuana that could be sold. Since 1995, levels of THC – the psychoactive component of marijuana – have tripled. Increased strength can increase the risk of adverse health effects, ranging from hallucinations to uncontrollable vomiting.

We’ve already seen examples of harm. This summer in San Francisco, 13 children, one only 6 years old, were taken to hospitals after ingesting marijuana-infused candy – a product permitted under Proposition 64.

The combination of unlimited strength and the ability to sell marijuana-edibles should concern all parents. So should the risk of increased youth access. Age restrictions don’t prevent youths from using alcohol; marijuana will not be any different.

Nearly 10 million Californians are under age 18. Studies show that marijuana may cause damage to developing brains, and one in six adolescents who uses marijuana becomes addicted.

While more research on prolonged use is needed, a large-scale study found that people who began using heavily as teens and developed an addiction lost up to eight IQ points, which were not recoverable.

This means that a child of average intelligence could end up a child of below-average intelligence, a lifelong consequence.

The proposition could also allow children to see marijuana advertisements, making it more enticing for them to experiment.

In fact, Superior Court Judge Shelleyanne Chang ruled that Proposition 64 “could roll back” the prohibition of smoking ads on television. Even though it is against federal law, the proposition explicitly permits television and other advertisements, provided that three in four audience members are “reasonably expected” to be adults.

We need criminal justice reform and a renewed focus on treatment. But legalizing marijuana is not the answer, particularly in the nation’s largest state. Proposition 64 fails to adequately address the public health and safety consequences associated with recreational marijuana use.

Sen. Dianne Feinstein is the senior senator from California.

Source:  http://www.sacbee.com/opinion/op-ed/article104501076.html#storylink=cpy

Born in Massachusetts, our son started out life with a very bright future.  As a toddler he was interested in things with wheels, and anything his big sister was doing. As he got older, Lego was his obsession. In his early school days he tended to get really into a subject, even those of his own choosing. For a while it was Russian language and then it was the Periodic Table.  He begged me to buy him a 2½-inch thick used Chemistry textbook before he was a pre-teen. I did.

I was able to be a stay-at-home parent until our son was 8. I tried to do all the right things. We played outside, limited screen time, and got together with other little ones and their moms for play groups. I read to him and his sister every night until they both reached middle school and wouldn’t let me anymore. Our son routinely tested in the 99th percentile on standardized tests and at least 3 grade levels above. Now, at age 17, he has dropped out of high school.

My husband and I both have Master’s degrees, and my husband is a public school administrator. His father is a retired architect. My mother is a retired elementary school teacher. Our family believes in education, we believe in learning and growing.     When asked why he continues to use drugs, mostly marijuana, my son said, “I think it’s because of the people we’re around.”

In reflecting back on “What happened?”   I blame marijuana. We now live in Colorado, where marijuana is legal and widely available to everyone.  What if we had never moved here?

How it All Began

My son’s first time using was in 7th grade when marijuana was legal only if used medicinally with a “Red Card,” if recommended by a physician.   Coloradans voted on legalization in November 2012 and marijuana stores opened in January, 2014. But back in 2012, he and some buddies got it from a friend’s older brother who had a Red Card.  From what I can tell, the use just kept escalating until his junior year in high school when he was using at least once a day…and when he attempted suicide.

Between that first incident in 2012 and the suicide attempt in 2015, his father and I waged an all-out battle on the drug that was invading our home. We grounded him; I took to sleeping on the couch outside his bedroom because he was sneaking out in the middle of the night; we yelled and screamed; I cried, we cajoled and tried to reason with him: ”You have a beautiful brain! Why are you doing things that will hurt your brain?”

We did weekly drug tests, we enlisted the school’s support, we enlisted our family’s support and we even tried talking to his friends.

But nothing worked. Our son was in love with marijuana. Our sweet, smart, funny, sarcastic, irreverent, adorable boy was so enamoured with this drug that nothing we did — NOTHING — made any difference. And we slowly lost him.

At the same time I was battling marijuana at home, I was also leading a group in our community to vote against legalizing it in our small town.  I had teamed with a local business-owner and a physician and the three of us got the support of many prominent community members, including the school superintendent, the police chief, and the fire chief. We ran a full campaign, complete with a website where you could donate money, a Facebook page, and yard signs.

Why does he continue to use marijuana? “I think it’s because of the people we’re around.”

My son’s use isn’t the reason I got involved. I had started advocating against marijuana legalization long before I even realized he had a problem. My background is in health communication and I work in the hospital industry.  I sit on our local Board of Health, so allowing retail stores to sell an addictive drug just doesn’t make any sense. I did think about my children; what I was modeling for them; what kind of community we were raising them in, and the kind of world I envisioned for their future. Those are the reasons I got involved. My son’s use is actually the reason that I’ve pulled away from any sort of campaigning.

Unfortunately, we lost our fight. So in 2014, it became legal in our small town to purchase pot without a Red Card. And the following year, his junior year, he almost slipped away from us forever.

It Got Scarier and Scarier

His use by then had escalated to daily (and I suspect often more than once a day). Pot seemed to be everywhere! We found it hidden all over the house — in the bathroom, on top of the china cabinet, in his closet, outside, even in his sister’s bedroom. It’s a hard substance to hide because of the strong smell. Even in the “pharmacy” bottles and wrapped in plastic bags, the skunk stench still manages to seep out. But it sure seemed easy for a young boy to get!

He started leaving school in the middle of the day, or skipping school altogether, and his grades plummeted. Where he was once an A/B student and on the varsity cross-country team, he was now failing classes and not involved in anything. This boy who had tested in the 99th percentile was failing high school. And this boy who had once been the levity in our home, who used to make me laugh like no one else could or has since, this boy became a stranger.

Our son withdrew from everything except his beloved drug. His circle of friends (never big in the first place), was reduced to only those who could supply him with marijuana.

His relationship with his older sister all but disappeared. And his relationship with his father has been strained beyond almost all hope of repair.

Then in late 2015 our son attempted suicide. He was hospitalized, first overnight at the very hospital where I work, and then for a 3-day locked psychiatric unit stay. I remember very little from this difficult (and surreal) time except learning that it wasn’t his first attempt, and that he blamed us for how awful he felt. He started taking an antidepressant and after he was released we took him to a drug counselor for a total of three visits but after that he refused to go — he threatened to jump out of the car if we tried to take him. We tried a different counselor and that only lasted for one visit.

Changing Strategies and a Truce

At this point I convinced my husband that we had to approach things differently, because obviously what we were doing wasn’t working. We stopped the weekly drug tests (we knew he was using so there seemed to be no point anyway). We stopped yelling and punishing. And basically my husband stopped talking to our son altogether — they are both so angry and hurt that any communication turns toxic very quickly. He refused to go back to school so we agreed that he could do online classes.

More and more, our son is feeling isolated from the rest of his family.

There is an uneasy truce in our home right now. Now it just feels like waiting. Waiting for what will happen next. Waiting for the other shoe to drop.

Our son, 17, still lives with us.  His sister left for college this past summer. I acknowledge that he uses pot and doesn’t want to quit, but I continue sending the message that it’s not good for his brain. The one thing my husband and I won’t bend on is no drugs on our property. He has started five different online classes, but has so far finished only one. He doesn’t feel any pressure to finish school — he says he’ll get a GED, but hasn’t made any effort towards that end. He doesn’t drive and doesn’t express any desire to learn, which is probably good because I doubt he could be trusted to drive sober. He started working at a local restaurant recently and has been getting good feedback from his managers, which I take to be a positive sign.   (I’ll take any positive signs at this point!)

Trying Something Else and Blacking Out

I don’t know if the suicide attempt and hospitalization were rock bottom for our family, but I suspect not. Just this past weekend our son came home and I could tell he was on something — and it wasn’t marijuana or alcohol. I checked him periodically throughout the night and in the early morning he was awake and asked me how much trouble he was in. I replied that it depended on what he had taken. He said Xanax. He also said that he had blacked out and couldn’t remember anything that had happened from about an hour after he took it.

Later in the morning, when we were both more awake, I asked him about the Xanax (he got it from someone at the restaurant) and the pot use and what he saw for his future. He has no plans to stop using, but said that he probably wouldn’t take Xanax again (he didn’t like blacking out). He said that he’s very happy with his life right now, that he knows a lot of people who didn’t go to college who work two or three jobs and live in little apartments, and that he’s happy with that kind of future for himself.

I tried not to cry.  Imagine that as the goal for a boy who started life with so much curiosity and such a desire to learn.

It’s not that I don’t think he can have a good and decent life without a college education. But I know that he’ll have a much harder life. Statistically, Americans with fewer years of education have poorer health and shorter lives (partly due to lack of adequate health insurance), and Americans without a high school diploma are at greatest risk.   It’s not just life without a college education, but it is life with a brain that has been changed by marijuana.  Will he be able to give up pot?  If he does give up pot, will he recover the brain he had at one time?  Will he lose motivation?

I asked him why he used pot when he knew how his father and I felt about it and when we had tried so hard to steer him in a different direction.

He said: “I think it’s because of the people we’re around. And all the drugs that are around.”

I’ve finally accepted that his use is not in the range of normal teenage experimentation, and I’m barely surviving on the hope that he’ll eventually grow out of it…and that he doesn’t do any permanent damage.  In the meantime, I’m sorry that we ever moved here.

Parents Opposed to Pot is totally funded by private donations, rather than industry or government. If you have an article to submit, or want to support us, please go to Contact or Donate page.

Source:  http://www.poppot.org/2016/09/19/colorado-move-larger-forces-she-cant-control/#comments

BY JOIN TOGETHER STAFF

September 25th, 2013

The club drug “Molly” is often laced with other synthetic drugs such as bath salts, making it more dangerous, according to law enforcement officials.

Molly, a club drug blamed for several recent deaths among young people attending music festivals, is sold as a pure form of Ecstasy, or MDMA. Drug dealers are now selling a variety of potentially more dangerous drugs under the name Molly, according to The Wall Street Journal.

Jeff Lapoint, an attending physician at Kaiser Permanente in San Diego, says while Molly generally leads to feelings of empathy, bath salts “are potent stimulants and tend to induce paranoia and hallucinations. It’s like the worst combination: While they’re agitated, now they’re seeing things, too.”

“Molly is just a marketing tool,” said Rusty Payne, a spokesman for the Drug Enforcement Administration, told the newspaper. “It could be a whole variety of things.”

MDMA is difficult to manufacture, so some drug makers get bath salts ingredients and repackage them as Molly, explained James Hall, an epidemiologist at the Center for Applied Research on Substance Use and Health Disparities in Miami. Payne noted bath salts ingredients, such as methylone, are much less expensive than MDMA. Molly is suspected of causing two deaths at a recent New York City music festival. A19-year-old girl in Boston died of a suspected overdose of Molly following a concert, and a man in Washington state died after taking the drug, with dozens more treated for Molly overdoses.

Source:  http://www.drugfree.org/news-service/bath-salts-often-added-to-molly-making-the-drug-more-dangerous-officials/  25th Sept. 2013

Industry Taking Advantage of Opiate Problem to Entrap More People

Medical marijuana proponents have a nationwide effort to add opiate addiction to the list of conditions for medical marijuana.  They aren’t just saying medical marijuana is a replacement for opiates; they are now pitching it as a medical treatment for opiate addiction.  The marijuana industry’s savvy marketing campaign is bigger, trickier and even more devious than Big Tobacco and Big Pharma ever dreamed.   Yet people who get addicted to opiates were already addicted to drugs via marijuana. Mixing marijuana with other drugs is becoming so routine that “drugged and stoned” is a new normal.  When Pennsylvania college student Garet Schenker of Bloomsburg University recently died, it was the combination of marijuana wax and Xanax that killed him.   References to  his death and the toxicology report have been removed from the Internet.  Just because another person didn’t die  from doing  “dabs” and mixing it with Xanax doesn’t mean we shouldn’t warn our children of this dangerous practice. Justin Bondi, one of the young men who died in Colorado last year, was a hiker and adventurer who also mixed marijuana with Xanax and other drugs.   In fact, marijuana users have such an affinity for Xanax that doctors should be questioning patients about marijuana use  and wonder if marijuana is the primary cause of the anxiety. The addiction-for-profit industry, i.e., the marijuana industry, is trying every tactic imaginable to promote drug usage.  The current propaganda that pretends marijuana is treatment to opiate abuse is EVIL.  We condemn those shameless promoters who encourage people to use marijuana based on the theory that it doesn’t cause toxic overdose deaths.   Recent deaths have put a dent into that theory, however.   In Seattle, Hamza Warsame jumped six stories to his death, after he the first time he tried marijuana in December, 2015. Drugged and Stoned Many marijuana driving fatalities are caused by drivers on a cocktail of drugs in addition to pot.  The driver that killed two and injured several others in Santa Cruz had marijuana and an unnamed prescription drug.  The driver responsible for a 3-car crash in Indiana had marijuana, Xanax and drug paraphernalia on him.

Demolished building in Philadelphia, July, 2013. A crane operator was impaired from mixing marijuana with codeine. Six died and 13 were injured in the accident. Photo: AP  A crane operator in Philadelphia killed 6 people while high on marijuana and a codeine painkiller pill, in July 2013.  This accident highlights the inability to see accurate perception of depth when stoned.  The crane operator hit the wall of the Salvation Army thrift store next to the  building he was demolishing. He had no intention to harm people.  Operating any type of heavy machinery under the influence of drugs puts all of us in danger. Diane Schuler  The worst car accident by a driver in recent memory was caused by a driver who used both marijuana and alcohol.  Driver Diane Schuler killed 8, including 5 children, in the Taconic State Parkway crash in New York on July 26, 2009.   It appears that the driver was in pain.  Schuler, three of her nieces, her 2-year old daughter and three men in the oncoming minivan died.   Schuler used marijuana regularly to deal with insomnia.  (Insomnia is a condition promoted by medi-pot advocates.)  Marijuana lobbyists try to portray marijuana customers as single drug users.  This is an entirely false characterization.   Multi-substance addiction is the norm today.   STOP THE LIES! Parents Opposed to Pot is totally funded by private donations, rather than industry or government. If you have an article to submit, or want to support us, please go to Contact or Donate page.

Source:  http://www.poppot.org/2016/05/23/drugged-stoned-deadly-combination/

A drug so powerful that it is normally used to tranquillize large animals like elephants has turned up in the streets of Ohio, West Virginia, Indiana, Kentucky, and Florida.

The drug, carfentanil, is thought to be the cause for a record spike in drug overdoses there. It can be manufactured inexpensively and easily laced with other drugs such as heroin. Officials in Ohio have declared this a public health emergency, and the U.S. Drug Enforcement Administration (DEA) warns that communities everywhere should be on alert about this dangerous drug.

Carfentanil is a synthetic opioid in the same drug class as heroin, fentanyl, and prescription drugs like Oxycodone. The drug is so strong that just a few granules the size of grains of table salt can be lethal. It is 100 times more potent than fentanyl, the prescription painkiller which led to the recent death of the pop star, Prince.

In the past few years, drug traffickers increasingly substituted fentanyl for heroin and other opioids. But now carfentanil, which the DEA says is most probably imported illicitly from China, is being sold on American streets, either mixed with heroin or pressed into pills that look like prescription drugs. Many users don’t realize that they are buying carfentanil, and this has led to deadly consequences.

“Instead of having four or five overdoses in a day, we’re seeing 20, 30, 40, maybe even 50,” said Tom Synan, Chief of Police in Newtown, Ohio, and who also directs the Hamilton County Heroin Coalition Task Force in Southwest Ohio.  Synan said in a NPR article that carfentanil turned up in Cincinnati in July, and that the number of overdoses has overwhelmed first responders.

Hamilton County Health Commissioner Tim Ingram further explained in the same article that, “It can take hours for the body to metabolize carfentanil, far longer than for other opioids. That means a longer-lasting high. But it also means that when someone overdoses, it is more difficult to revive them with naloxone, the emergency medication used to block the effects of opioids.” Ingram has received reports that emergency rooms are using two or three doses to bring people back, and therefore are trying to distribute a more concentrated version of naloxone.

There is no approved human use for carfentanil, and in fact, it is highly restricted even for veterinarians, who can use it legally only to sedate large animals. First responders and emergency room workers are being told to wear protective gloves and masks because carfentanil is so potent, that it can be dangerous to someone who simply touches or inhales it.

Learn more about the abuse of this drug: CBS News’ Dozens of Ohio Overdoses blamed on heroin mixed with elephant tranquilizer

Source:   Newsletter CADCA September 2016

These are some of the voices (videos) from attendees at a conference in Colorado

who are speaking about legalization of marijuana in Colorado and what it is doing to their youth.  The negative impact has been appalling for many neighbourhoods – children are hospitalized from using edibles,  youth in schools are using in classrooms and their grades are dropping dramatically.   Big money has commercialized this substance to the detriment of the local population and in particular the children and youth.

http://smartcolorado.org/community-voices/ Sept 2016

By Christopher Ingraham

Source: Washington Post

USA — An appeals court ruled last week that a federal law prohibiting medical marijuana cardholders from purchasing guns does not violate their Second Amendment rights, because marijuana has been linked to “irrational or unpredictable behavior.”

The ruling came in the case of a Nevada woman who attempted to purchase a handgun in 2011, but was denied when the gun store owner recognized her as a medical marijuana cardholder, according to court documents. S. Rowan Wilson maintained that she didn’t actually use marijuana, but obtained a card to make a political statement in support of liberalizing marijuana law.

Federal law prohibits gun purchases by an “unlawful user and/or an addict of any controlled substance.” In 2011, the Bureau of Alcohol, Tobacco and Firearms clarified in a letter that the law applies to marijuana users “regardless of whether [their] State has passed legislation authorizing marijuana use for medicinal purposes.” Though a growing number of states are legalizing it for medical or recreational use, marijuana remains illegal for any purpose under federal law, which considers the drug to have a high potential for abuse and no accepted medical use.

The U.S. Circuit Court of Appeals for the 9th Circuit ruled that the federal law passes muster with the Constitution, as “it is beyond dispute that illegal drug users, including marijuana users, are likely as a consequence of that use to experience altered or impaired mental states that affect their judgment and that can lead to irrational or unpredictable behavior.”

The court then concluded that it is reasonable to assume that a medical marijuana cardholder is a marijuana user, and hence reasonable to deny their gun purchase on those grounds.

From a legal standpoint, the nexus between marijuana use and violence was established by the U.S. Court of Appeals for the 4th Circuit in Virginia, in the 2014 case of United States v. Carter. That case cited a number of studies suggesting “a significant link between drug use, including marijuana use, and violence,” according to the 9th Circuit’s summary.

In the words of the 4th Circuit, those studies found that: “Probationers who had perpetrated violence in the past were significantly more likely to have used a host of drugs — marijuana, hallucinogens, sedatives, and heroin — than probationers who had never been involved in a violent episode.”

“Almost 50% of all state and federal prisoners who had committed violent felonies were drug abusers or addicts in the year before their arrest, as compared to only 2% of the general population.”

“Individuals who used marijuana or marijuana and cocaine, in addition to alcohol, were significantly more likely to engage in violent crime than individuals who only used alcohol.”

Among adolescent males, “marijuana use in one year frequently predicted violence in the subsequent year.” The 4th Circuit argued that, on the link between drug use and violence, the question of correlation vs. causation doesn’t matter: “Government need not prove a causal link between drug use and violence” to block firearms purchases by drug users. A simple link between drug use and violence, regardless of which way the causality runs, is grounds enough. Still, the 9th Circuit did suggest causation was part of its decision, saying that irrational behavior can be “a consequence” of marijuana use.

This argument — that substance use increases risky behavior — applies to plenty of other drugs, too, and not just illegal ones. For instance, drug policy researchers Mark Kleiman, Jonathan Caulkins and Angela Hawken have pointed out that tobacco users also are more likely to engage in crime relative to the general population. “Compared with nonsmokers, cigarette smokers have a higher rate of criminality,” they wrote in their 2011 book Drugs and Drug Policy: What Everyone Needs to Know. “Smoking in and of itself does not lead to crime, but within the population of smokers we are more likely to find individuals engaged in illicit behavior.”

The authors also point out that there’s a much stronger link between violent behavior and alcohol than there is for many illegal drugs: “There is a good deal of evidence showing an association between alcohol intoxication and pharmacologically induced violent crime,” they write. They added: “There is little direct association between marijuana or opiate use and violent crime. … it is also possible that for some would-be offenders, the pharmacological effect of certain drugs (marijuana and heroin are often given as examples) may actually reduce violent tendencies.”

Christopher Ingraham writes about politics, drug policy and all things data. He previously worked at the Brookings Institution and the Pew Research Center.

Source: Washington Post (DC) September 7, 2016: 

Latest statistics show 305 admissions were diagnosed as drugs misuse in the year 2011/12 — compared to 97 in 2007/08.

Across NHS Tayside as a whole the number has more than doubled, with an increase from 244 five years ago to 512 last year.  Doctors have warned there is now a “constant background level of recreational drug use” in the region’s Accident and Emergency departments.

A&E consultant Dr Julie Ronald said people come in with drugs-related problems most weekends.  She said: “We deal with a lot of drugs-related admissions. It can be very time consuming — especially if patients cause disruption to the rest of the department.

“It’s something we see most weekends of some variety. The vast majority are brought in by ambulance.  Usually someone has been with the patient or found them and decided they require medical attention.”

Across Tayside, opioids — such as heroin — were the cause for more than 80% of admissions over the period.  Of these, 60 were categorised as resulting from multiple drugs or other less common drugs.

And 468 — more than 90% — were classed as emergency admissions. Also last year, 28 of the admissions were for cannabis-type drugs, nine were for cocaine, eight for sedatives or hypnotics and seven were for other sedatives.

Dr Ronald, who works in the A&E departments at Ninewells Hospital and Perth Royal Infirmary, said there has been a noticeable increase in younger patients for drugs misuse .She said: “There is a constant background level of recreational drug use. We’re always coming into contact with it. We do see heroin misuse. What we have certainly seen is more recreational legal high-type drugs.   A lot of teens and people in the younger age groups are coming in who have taken party drugs, such as bubbles or MCAT.”

Some 89 of the admissions for 2011/12 had to stay in hospital for a week or longer. Dr Ronald said: “A&E look after the vast majority of people coming in with recreational drug misuse. We tend to keep them in for a few hours for observation, or overnight if they need to be monitored for longer.”

Source:  www.eveningtelegraph.co.uk   15th June 2013

Two groups of legal highs that imitate the hallucinogenic effects of LSD and of heroin are to be banned as class A drugs on the recommendation of the government’s drug advisers.

The home secretary, Theresa May, is expected to confirm that AMT, which acts in a similar way to LSD, should be banned along with other chemicals known as tryptamines that have been sold at festivals and in head shops with names including “rockstar” and “green beans”.

The Advisory Council on the Misuse of Drugs (ACMD) said the tryptamine group of chemicals had become widely available in Britain. The experts said four deaths in 2012 and three deaths in 2013 in Britain were attributed to tryptamines. The ACMD also said a synthetic opiate known as AH-7921, sometimes sold as “legal heroin”, should be class A. It follows the death last August of Jason Nock, 41, who overdosed on AH-7921 after buying the “research chemical” on the internet for £25 to help him sleep.

Professor Les Iversen, the ACMD chair, said the substances marketed as legal highs could cause serious damage to health and, in some cases, even death.

He said the ACMD would continue to review new substances as they were picked up by the forensic early warning system in Britain.

“The UK is leading the way by using generic definitions to ban groups of similar compounds to ensure we keep pace within the fast moving marketplace for these drugs,” said Iversen.

Source:   theguardian.com 10^th June 2014

The foremost authority on drugs in the US just smashed a huge misconception about addiction.    If drug addiction is a disease like cancer or Alzheimer’s, how do you explain the seemingly amoral behaviour — the lying, cheating, and hiding — that has come to be linked with so many addicts?

The answer has less to do with morality and much more to do with physical changes in the brains of those who become addicted, as National Institute on Drug Abuse director Dr. Nora Volkow perfectly explains in a recent PBS episode of “The Open Mind,” on addiction.

It makes a lot of sense — especially when explained with chocolate.  Volkow is a chocolate lover, you see. She has a special weakness for dark varieties. Most of the time, she can control her cravings. But occasionally — usually when she’s frustrated or tired or bored — she gives in. Then she’ll overdo it, eating too much of the stuff.

Sound familiar?

If so, that’s because it’s a fairly common type of experience. Most of us can abstain some of the time and give in occasionally, but more often than not, most of us easily follow the rule of moderation. But in people who are vulnerable to addiction (via a mesh of factors including genetics, environment, behaviour, and exposure), this is where things start to look different, Volkow explains. And it’s at this point where the long-held notion that addiction is merely a problem of a lack of self-control begins to crumble.

“When you transition from that stage where most of the time you are able to self-regulate the desires and control and manage your behaviour even though you want to do it, you say it’s not a good idea — when you lose that capacity consistently, that’s when you start to get into the transition of addiction,” she says.

But, as she continues to explain, the problem is not simply a behavioural one. It’s also influenced by physical changes that happen in the brain — changes that produce marked differences between the brains of people who are addicted and those who are not.

One of those differences, Volkow says, is a dysfunction in areas of the frontal cortex, a part of the brain that plays a key role in helping us analyse situations and make decisions. “But if these areas of the brain are not functioning properly, which is what repeated drug use [can do] to your brain, it [can erode] the capacity of frontal cortical areas.”

When that happens, your ability to say no to that chocolate bar gets diminished, or in Volkow’s words, “your ability to make optimal decisions gets dysfunctional.”

Volkow’s ideas are bolstered by decades of research, including a 2011 review of studies that she co-authored for the journal Nature. The authors of a 2004 paper built upon similar research, concluding that addiction is a learned behaviour linked with fundamental changes to the brains of addicts.

For this reason, it’s not as simple as just choosing to use drugs — or, in Volkow’s example, overdo it on the chocolate. And the more we know about the neurological basis of addiction, the better we will be able to treat it.   See  the full “Open Mind” episode on PBS:

Source:    

http://uk.businessinsider.com/watch-nora-volkow-explain-addiction-with-chocolate-2016-6

Dublin city coroner Dr Brian Farrell is to write to the Department of Health to highlight a link between methadone use and heart failure following an inquest into the death of a 30-year-old man.   Philip Wright of Celbridge, Co Kildare, died on December 13th, 2011, having collapsed after taking heroin.

He had discharged himself on December 12th from Connolly Hospital Blanchardstown where he had been taken off methadone, a heroin replacement drug, because of the dangerous effect it was having on his heart. Mr Wright had attended the hospital on December 9th after collapsing at home. He was also on antibiotics for a chest infection.

Dr Joseph Galvin, consultant cardiologist at the hospital, told the coroner an electrocardiogram (ECG) carried out on Mr Wright picked up a problem with his heart and his methadone was stopped on December 11th. He said the drug could put the heart out of rhythm by changing its electrical properties “in a dangerous way”.

Mr Wright’s heart returned to normal after he was taken off methadone, he said. Recent studies had shown up to 18 per cent of people on methadone had experienced the same heart problems, he said.   The doctor recommended that anyone who collapsed while using methadone should have an ECG carried out. “It is not as benign a drug as was first thought,” Dr Galvin said.

He also said he had recommended an alternative drug for Mr Wright to replace the methadone: buprenorphine.  By lunchtime on Monday, December 12th, Mr Wright had not received the drug. His father, James Wright, told the coroner his son feared he would go into severe withdrawal without it.  He discharged himself from hospital against medical advice and obtained heroin. He died of respiratory failure in the bathroom of his parents’ home the following day having injected the heroin.

Evidence was also given that the pharmacy in the hospital did not receive a request for buprenorphine for Mr Wright and there were issues around access to the drug.

There was also a recommendation that there should be an interval between the time methadone is stopped and buprenorphine is given.  Returning a verdict of death by misadventure, Dr Farrell said he would write to the department and to methadone maintenance authorities and clinics about the potential cardiac effects of methadone.

He would also raise the issue of availability of buprenorphine.

Source: www.irishtimes.com Sat. 5th Jan

More than 200 people in Colorado who smoked synthetic marijuana during a 1-month period last summer developed altered mental status severe enough to require emergency care, according to a state public health investigation.

The investigation was prompted by several hospitals that contacted the Colorado Department of Public Health and Environment (CDPHE). Increasing numbers of patients had come to their emergency departments with aggression, agitation, confusion, and other symptoms after smoking the synthetic drug. The CDPHE asked all Colorado emergency departments to report through a Web-based system any patients treated with altered mental status who used synthetic marijuana between August 21 and September 18.

Source:   JAMA. 2014;311(5):457. doi:10.1001/jama.2014.47.

Imagine for a minute a world in which marijuana is available in a vending machine or corner grocery store near you — like any other snack machine — pot-infused lollipops, gummy candies, baked goods and beverages available at the push of a button.

As futuristic as this farfetched tale sounds, this is Colorado’s reality, a state with the dubious distinction of becoming the first to legalize marijuana, which has helped spawn legalization efforts across the U.S., including in New Jersey.   And while Colorado’s experiment has sparked heated debate over drug legalization, a critical and unbiased look at the data clearly shows that marijuana legalization has serious and far-reaching consequences that far outweigh any of its alleged benefits.

Strong emotions on both sides of this issue should not obscure the facts. Marijuana is an addictive substance that is harmful to users, especially to its younger users. As a teen’s brain development is disturbed by chronic marijuana use, the risk for physical and psychological dependency grows exponentially.

In addition to permanently affecting brain functioning, marijuana use can lead to a wide array of negative consequences, ranging from lower grades and isolation from family to an increased risk of psychotic symptoms, depression and suicide.

According to the Office of National Drug Control Policy, legalization will cause a substantial increase in economic and social costs.  The expansion of drug use will increase crime committed under the influence of drugs, as well as family violence, vehicular crashes, work-related injuries and a variety of health-related problems. These new costs will far outweigh any income from taxes on drugs.

Few would argue that a drug that can cause such destruction is something that we should counsel people to avoid. However, legalization efforts do just the opposite. In fact, experience has shown that when drugs are legalized, drug use increases because the perception of harm is reduced.

Moreover, the Drug Enforcement Agency has estimated that legalization could double or even triple the amount of marijuana users.

While it is hard to fathom the societal impact of an additional 17 million to 34 million marijuana users, it is safe to assume that those who profit from legalization have calculated the impact on their bottom line.

Those in favor of legalization often fail to tell you that levels of drug use have gone down substantially since the 1970s when the “war” on drugs began. This is not to say that our drug laws, including those governing marijuana, are not in need of reform.

For instance, the effort to place more drug users into treatment instead of prison is a positive development, both for those struggling with addiction and for taxpayers.

However, reforming and improving our drug laws does not mean we should abandon our fight against the use of illegal drugs like marijuana.

On the contrary, the more we learn about effective methods of combating drug use, the more we learn that legalization is not the answer, and is, in fact, very much part of the problem.

Source:  Source:  www.njassemblyrepublicans.com  Daily Record 13 Apr 2014

I continue to be puzzled by an attitude that if something is difficult to enforce then we should abandon attempts and just legalize it. That is apparently the attitude of Oregon’s politicians (Republican and Democrat alike) and is reflected in the comments of the official spokesman for the government elites – The Oregonian – in its August 23 edition:

“Oregon has had a wink-wink, nudge-nudge relationship with recreational marijuana use since 1998, when legalization for medical purposes created a wide, open system that distributes pot cards to just about anyone with a vague medical claim and the signature of a compliant physician. We’re not suggesting that marijuana has no palliative value to those with genuine medical problems. But let’s be honest: Recreational marijuana is all but legal in Oregon now and has been for years. Measure 91, which deserves Oregonians’ support, would eliminate the charade and give adults freer access to an intoxicant that should not have been prohibited in the first place.”

There it is. The marijuana advocates foisted a canard on Oregonians by exploiting the plight of those benefiting from the use of medical marijuana. Having convinced Oregonians that those is need should not be denied, they set up a system that guaranteed abuses and then urged others to look the other way when the abuses became obvious and widespread. Wink, wink, nod, nod. There’s a solid foundation for change. (For those of you forced to endure a teachers union led education in Portland public schools, that is what is meant by “sarcasm”.)

And now the second canard is upon us with the assertion that “everyone is already doing it” and that recreational marijuana is not harmful. When the push began, those supporting it chanted “nobody has ever died from marijuana.” And that folks, is just plain bulls—t.

A New York Times article on May 31, 2014, noted:

“Five months after Colorado became the first state to allow recreational marijuana sales, the battle over legalization is still raging.

“Law enforcement officers in Colorado and neighboring states, emergency room doctors and legalization opponents increasingly are highlighting a series of recent problems as cautionary lessons for other states flirting with loosening marijuana laws.

“There is the Denver man who, hours after buying a package of marijuana-infused Karma Kandy from one of Colorado’s new recreational marijuana shops, began raving about the end of the world and then pulled a handgun from the family safe and killed his wife, the authorities say. Some hospital officials say they are treating growing numbers of children and adults sickened by potent doses of edible marijuana. Sheriffs in neighboring states complain about stoned drivers streaming out of Colorado and through their towns.”

On May 24, 2014, Newsweek reported:

“Wednesday’s move in Colorado to tighten rules on edible goods made with pot comes after two adult deaths possibly linked to such products. Meanwhile, a Colorado children’s hospital said it has seen an uptick in the number of admissions of children who ingested marijuana-laced foods since the start of the year.

“’Since the … legalization of recreational marijuana sales, Children’s Colorado has treated nine children, six of whom became critically ill from edible marijuana,’ the statement from Colorado Children’s Hospital said.”

And The Raw Story reported on April 2, 2014:

“A Wyoming college student visiting Colorado on spring break is the first reported death related to the legal sale of recreational marijuana.

“Levy Thamba, a student at Northwest College, fell to his death last month from the balcony of a Holiday Inn in Denver.

“Autopsy results released Monday showed the 19-year-old Thamba, who was also known as Levi Thamba Pongi, died from multiple injuries caused by the fall. But the coroner also listed ‘marijuana intoxication’ from a pot-infused cookie as a significant contributor to the student’s death.”

And finally, CBS reported from Seattle on February 4, 2014:

“According to a recent study, fatal car crashes involving pot use have tripled in the U.S.

‘Currently, one of nine drivers involved in fatal crashes would test positive for marijuana,’ Dr. Guohua Li, director of the Center for Injury Epidemiology and Prevention at Columbia, and co-author of the study told HealthDay News.”

But the Oregonian is undeterred by the mounting evidence of harm:

“Opponents of the measure are right about a couple of things. Allowing retail sales of recreational marijuana inevitably will make it easier for kids to get their hands on the stuff, as will Measure 91′s provision allowing Oregonians to grow their own. It’s also true that outright legalization will increase the number of people driving under the influence, which is particularly problematic given the absence of a simple and reliable test for intoxication. There is no bong Breathalyzer.

“As real as these consequences are, Oregonians should support outright legalization. . .”

We have imposed safety requirements on a whole host of things including guns, automobiles, golf carts, children’s toys and food products that have a lower incident rate of death and injury than is being currently compiled by the unrestricted use of marijuana. Oregon is now tying itself in knots trying to eliminate the use of genetically modified organisms (GMO) with no scientific evidence of harm and only a speculation as to what might become. But there is no apparent concern about the modification of marijuana to increase its potency which has resulted in numerous adverse health issues with children and adults alike.

And while the Oregonian acknowledges that there is no “simple and reliable test for marijuana intoxication” it fails to note that there is similarly no simple and reliable test for testing potency. There are no labeling requirements and no guidelines as to the limits of consumption and impairment. Contrast that with the liquor industry that has defined limits and labeling on the alcohol content of various beers, wine and liquors. There are exacting studies that demonstrate the effects of alcohol on a person given weight variations.

And yet the Oregonian ignores that in favor of addressing it sometime in the future – maybe.

And Oregon’s politicians are even less helpful because they are fixated on tax revenue opportunities from the unrestricted use of marijuana. Little thought is

being given to the problems that will be caused. Their sole focus is upon using regression analysis to determine how high the tax can be without seriously reducing the volume of consumption – it is the same myopic view used when determining the tax on tobacco. That amount of tax will increase over time as the use becomes more widespread and the dependency becomes more pronounced and as state government becomes more dependent on the revenue generated, the ability to correct the abuses of marijuana will be marginalized – just like tobacco.

In the end, this is all about the “me generation” and that pervasive attitude that “if it feels good, do it.” It furthers the myth of life without consequences. The only upside is for those who eschew getting high in favor of getting hired – your prospects for getting a good job and routine promotion are greatly enhanced.

Source: www.oregoncatalyst.com 27th August 2014

Shootings in New York City have gone up nearly 20 percent in the past year, NYPD Commissioner Bill Bratton announced on March 3, saying that marijuana legalization and the loosening of restrictions across the United States are partly to blame.

Bratton referred to marijuana as “the seemingly innocent drug that’s been legalized around the country,” and says that yes, it’s connected to a rise in shootings. He’s not off the mark. In Colorado, Pueblo County Sheriff Kirk Taylor in Colorado noticed an uptick in crimes, and he’s now tracking the link between crimes and marijuana.

In New York City, marijuana is not legalized, but it has been decriminalized to some degree and the NYPD has stopped arresting people with small amounts of marijuana on their person.

“It is ironic that in a city which is a transfer point for huge amounts of drugs . . . heroin, cocaine, hallucinogens, that one drug [that] is actually the causal factor in so much of our shootings and murder is marijuana,” Bratton said. “We just see marijuana everywhere when we make these arrests, and get the guns off the street.”

Watch WABC’s report, along with Bratton’s remarks, in the video.

Murders revolving around marijuana occur in Washington and Colorado. A week ago in Steamboat Springs, a man with an indoor marijuana grow was robbed and murdered. Two have been charged. The black markets are also alive and well in both Washington and Colorado, as a New York Times article explains.

Please share this post with every concerned parent you know! Spread the Word about Pop Pot! Parents Opposed to Pot is a non-partisan grassroots campaign started by parents concerned about the commercial pot industry and its devastating impact on youth and communities. We write anonymously to explore these important issues and protect the privacy of our bloggers. We are totally funded by private donations, rather than industry or government. If you have an article to submit, or want to support us, please go to Contact or Donate page

Source: http://www.poppot.org/2015/03/09 9th March 2015

Among the 137 people who completed the study, the number of seizures fell by an average of 54 percent, according to a team led by Dr. Orrin Devinsky, of New York University Langone Comprehensive Epilepsy Center in New York City.

Keep in mind that Epidiolex is VERY different than the so-called low THC strains of marijuana (also known as Charlotte’s Web) that are being grown and sold in several states. Unlike Epidiolex, the strains of marijuana are not cloned and the end products vary widely. Most importantly, these strains contain varying levels of THC whereas Epidiolex is virtually pure CBD.

Liquid Medical Marijuana Shows Promise for Epilepsy

A liquid form of medical marijuana may help people with severe epilepsy that does not respond to other treatments, according to a new report.

The study included 213 child and adult patients with 12 different types of severe epilepsy. Some of them had Dravet syndrome and Lennox-Gastaut syndrome, which are types of epilepsy that can cause intellectual disability and lifelong seizures.

The patients took a liquid form of medical marijuana, called cannabidiol, daily for 12 weeks.

Among the 137 people who completed the study, the number of seizures fell by an average of 54 percent, according to a team led by Dr. Orrin Devinsky, of New York University Langone Comprehensive Epilepsy Center in New York City.

Among the 23 patients with Dravet syndrome who completed the study, the number of convulsive seizures fell by 53 percent, the investigators found. The 11 patients with Lennox-Gastaut syndrome who finished the study also had a 55 percent decline in the number of attacks called “atonic” seizures, which cause a sudden loss of muscle tone.

The drug wasn’t always easy to take, however, and 12 patients stopped taking it due to side effects, the researchers said. The types of side effects seen in more than 10 percent of the patients included drowsiness (21 percent), diarrhea (17 percent), tiredness (17 percent) and decreased appetite (16 percent).

The study was supported by drug maker GW Pharmaceuticals. The findings are scheduled to be presented next week at the annual meeting of the American Academy of Neurology (AAN) in Washington, D.C. Experts note that findings presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal

Devinsky agreed that larger, placebo-controlled studies are needed to assess the effectiveness of the drug.

“So far there have been few formal studies on this marijuana extract,” he said in an AAN news release. “These results are of great interest, especially for the children and their parents who have been searching for an answer for these debilitating seizures.”

One expert unconnected to the study called the findings “very exciting.”

“Prior to this study, there were mainly anecdotal reports and very few formal studies evaluating cannabidiol, a component of cannabis, in treating seizures,” explained Dr. Scott Stevens, director of Advanced Clinical Experience in Neurology at North-Shore-LIJ Health System in Manhasset, N.Y.

Stevens believes that “these results stand as a stepping stone toward further studies evaluating the use of marijuana in the treatment of epilepsy.”

Source:http://www.webmd.com/epilepsy/news 13/04/2015 (HealthDay News

Funded by a five-year, $7 million federal grant, the University of Illinois at Chicago College of Medicine will create a new center, the first of its kind, to study the effect of long-term alcohol exposure on genes.

The National Institute on Alcohol Abuse and Alcoholism, one of the National Institutes of Health, awarded the funding to establish a Center for Alcohol Research in Epigenetics (CARE). Subhash Pandey, UIC professor of psychiatry, will direct the center.

“Epigenetics” refers to chemical changes to DNA, RNA, or specific proteins, that change the activity of genes without changing the genes themselves. Epigenetic changes can occur in response to environmental or even social factors, such as alcohol and stress — and these changes have been linked to changes in behavior and disease.  Epigenetics plays a role in the development and persistence of neurological changes associated with alcoholism, says Pandey, who is director of neuroscience alcoholism research at UIC and research career scientist at the Jesse Brown VA Medical Center.

The CARE researchers will investigate how alcohol-related epigenetic changes influence gene expression and “synaptic remodelling” — the networking of nerve cells to each other. They will also look closely at how these changes correlate with behavior, such as anxiety and depression, and whether epigenetics may play a role in the withdrawal symptoms that make abstinence difficult.

“This award will allow the College of Medicine to build on Professor Pandey’s exemplary research on chronic alcohol use and alcoholism in addition to bolstering our leadership in understanding the causes of alcoholism as well as finding new ways to treat this devastating disease,” said Dr. Dimitri Azar, dean of the University of Illinois College of Medicine.

In a recent study using an animal model, Pandey and colleagues at UIC found that epigenetic changes resulting from exposure to alcohol during adolescence were associated with abnormal brain development and anxiety and alcohol preference in adulthood. In earlier work, the researchers were able to show that reshaping of the DNA scaffolding that supports and controls the expression of genes in the brain may play a major role in alcohol withdrawal symptoms, particularly anxiety.

Several brain regions play a crucial role in regulating both the positive and negative emotional states associated with alcohol addiction. Pandey said the center will look at the circuitry involved in reward and pleasure, depression, cognition, and anxiety.  CARE researchers will study disease using preclinical animal models and post-mortem examination of human brain. Investigators will also do neuroimaging of patients diagnosed with alcohol abuse and dependence and search for “biomarkers” of alcoholism — measurable indicators in blood that correlate with alcohol addiction.

There are two causes of dependence on alcohol, said Pandey — people may drink to get pleasure, or to self-medicate to relieve depression or anxiety. But alcohol addiction may itself cause depression and anxiety, feeding into a cycle.

“Ultimately, we hope these studies may lead to the identification of molecular cellular targets and gene networks which can be used to develop new pharmacotherapies to treat or prevent alcoholism,” Pandey said.

UIC’s CARE is the only NIH-funded alcohol research center in Illinois, said Dr. Anand Kumar, Lizzie Gilman Professor and head of psychiatry, and is “well positioned to perform state-of-the-art basic translational and clinical research in alcoholism.”

In addition to its research projects, CARE will provide resources for training and community outreach. Based in the UIC psychiatry department, it includes collaborators from biophysics and physiology, anaesthesiology, the Jesse Brown VA Medical Center, and the University of Illinois Urbana-Champaign campus.

Source: http://www.newswise.com/articles/view/632573/?sc=dwtn   13th April 2015

Those using strong strains of illegal drugs such as cannabis skunk, or the illegal use of prescription drugs are risking their mental health and the lives of others. Suicidal thoughts are not unknown and this letter from a doctor discusses the problems of confidentiality versus life saving – of the patient or others.

To the Clinicians of the Co-Pilot of Germanwings Flight 9525

Dear German Medical Colleagues,

Please bear with me through this rather long letter. There is so much that I have been wondering and worrying about—including you.

I may never know who you are, but if you provided medical or psychiatric care for Andreas Lubitz, co-pilot of Germanwings Flight 9525, we are colleagues. Whether you saw Mr Lubitz years ago or more recently, or whether you saw him privately or as an airline-appointed medical examiner, you had some responsibility for his care.

And you too are his victims, of sorts. I hope your reputation does not suffer unduly. I hope PTSD does not develop as a result of his apparent suicide. If you provided ethical care (ie, competent care), I hope you are not scapegoated. “Monday morning quarterbacking”—an American football saying about reviewing a game the day after it is played—is always so much easier than preventing problems in real time.

After all, if reports of Mr Lubitz taking an injectable antipsychotic during training in 2009 are true, that doesn’t for sure mean that he had an ongoing or intermittent psychosis. Maybe, just maybe, it could have been a short-acting injection for acute agitation due to extreme stress and/or drug abuse. Similarly, treatment back then for an “episode” of “severe” depression could have seemed to be a one-time episode.

On the other hand, there are reports that Lubitz saw psychotherapists “over a long period of time.” Those psychotherapists probably knew the patient best, especially if he had a particular personality disorder or significant traits of concern (eg, undue narcissism, paranoia).

We have not yet heard anything about whether Lubitz had PTSD, but people with this disorder can appear normal. Perhaps the co-pilot dissociated as he crashed the airplane, which would have allowed him to ignore for minutes the passengers’ screams and the banging on the door of the cockpit. That could account for the fact that voice recording picked up no triumphal shouts, only his steady breathing.

This analysis is all speculation, of course. Maybe it’s the kind of “wild analysis” that Freud so deplored.

I do not know how prominent so-called “anti-psychiatrists” are in Germany, but if they are anything like they are here in the US, they are likely to blame psychiatric medication for the co-pilot’s bizarre and tragic behavior. Of course, they could well have a point. Some antidepressants, which can cause visual side effects, were prescribed for Mr Lubitz, agents perhaps, that we don’t in the US.

We know he was concerned about his vision, but speculation so far is that this complaint was psychosomatic. In addition, sudden withdrawal from some antidepressants can lead to increased agitation. Moreover, antidepressants can trigger a (hypo)manic episode, although of course a manic episode can occur that leads to grandiosity and agitation. On the other hand, no one seems to have described such changes in Mr Lubitz before the crash.

Therefore, I hope your medical documentation was good—better than mine usually was. I hope you documented your risk assessment adequately. If you were unsure of what to do, I hope you obtained consultation and/or supervision. If you worked in a system of care, I hope they adequately monitored the quality of care you provided.

I understand that your medical privacy laws are much more stringent than our patchwork of state and national privacy laws are here in the US, both in life and in death. I heard that you can be imprisoned for up to 5 years for not following strict standards of patient confidentiality. Perhaps that prevented you from contacting Lufthansa instead of just giving the patient an unfit-for-work note, which he subsequently tore up. That, and other reasons, may be causing you to bite your tongue to offer further explanation.

I wonder if your stringent privacy laws are a reaction to the breaches of physicians when the Nazis ruled, as well as the subsequent invasion of privacy in East Germany. Are they an overreaction that needs some degree of correction? After all, airline safety is good, and this may have been a perfect confluence of various factors. Further, to exacerbate our existential anxiety, we have the unexplained disappearance of the Malaysian airliner from just about 2 years ago. Was there a copycat aspect to the Germanwings crash?

All medical colleagues must weigh risk to others against the need for patient confidentiality. This can include whether to divulge patient information such as highly contagious diseases like AIDS or Ebola; abuse of a minor or domestic violence; driving while impaired; carrying a gun; running a nuclear power plant; and being responsible for all kinds of public transportation and safety.

Maybe you wish you could talk and give condolences to those who lost family and friends on the doomed airliner. That would be the human thing to do, but perhaps you can’t?

As psychiatrists, suicide and homicide are essentially our only life and death challenges. So when a patient commits suicide and kills 149 others at the same time, what could feel professionally worse?

Yet we all know that we are not particularly successful at predicting actual suicide or homicide. Complicating that, someone troubled who decides that his or her solution is suicide and/or homicide often seems surprisingly well right before the act. He or she is relieved, having decided on the solution to his problems. We must appreciate our limitations.

Everyone wants to know the co-pilot’s motivation. So do I. But nothing is convincing yet about why he would make sure to kill everyone on board. Way back when, I was taught that in general, suicide was motivated by a desire to die, to kill, and/or be killed. This is a rare example of all—a triple play.

We may need system and cultural changes to how we approach some aspects of mental illness, such as the Air Force Suicide Prevention Program in the US. This program has significantly reduced suicide attempts as well as violence to others.

We and our psychiatric patients are stigmatized in many countries. If such stigma can cause inadequate attention to mental health in routine annual check-ups, no wonder mental health examinations are inadequate for airline pilots.

Complicating our work is the denial, lack of insight, and/or loss of memory among some of our patients. The people that we (clinicians and the public) need to fear most (ie, sociopaths) can be the best at hiding the risk they pose. Periodic research about faking psychiatric symptoms in the emergency department indicates how easily we, in our quest to be helpful, can be fooled. We don’t have corroborating lab tests to fall back on, unlike in other areas of medicine.

During my career, I evaluated and treated a fair number of pilots. Almost always, we grappled with the implications of getting treatment and taking medication. What might help their mental problems might, at the same time, cost them their job, and thereby worsen their mental health. No wonder so many pilots hide psychiatric treatment from their employers.

Who knows? Maybe some of you who treated him didn’t even know that Andreas Lubitz was a pilot. We often know little about the real day to day lives of our patients. Maybe we need to know more.

About a century ago, Freud concluded that his was “an impossible profession.” This may well still be so. The burnout rate of physicians and psychiatrists in the US is over 50%. Know that.

I appreciate why we may never hear your side of the story. That may be a shame, for you probably have much to teach us and can transform some of our fantasies into reality.

In terms of our ethical responsibilities to each other, we are indeed our brothers’—and sisters’—keepers. In that regard, let me know if there is anything more I should know or do.

Your colleague,
H. Steven Moffic, MD (Steve)

Source: Psychiatric Times psychiatrictimes@email.cmpmedica-usa.com 16^th April 2015

Almost one in 500 babies in hospitals in England is born dependent on substances their mother took while pregnant, a BBC investigation has found.

Of 72 NHS hospital trusts who responded to a Freedom of Information request, the average rate for babies born with neonatal abstinence syndrome was 0.2%.

It is caused by women taking legal and illegal drugs while pregnant.  Health experts say it is a declining trend.

BBC’s Look North and the English regions data unit asked NHS hospital trusts to provide details about the number of babies born who were addicted to drugs between 2011 and 2015.  The figures show a wide geographical variation in the number of newborns who were dependent on harmful substances.

One in 100 babies born at Bedford Hospital in 2015 displayed signs of neonatal abstinence syndrome. In contrast, Leicester General had one of the lowest rates with one in every 5,000 babies born addicted to a harmful substance.  In Leeds, around one in 250 babies was born with the condition.

Lisa Batty, 37, from Bradford, gave birth to four children who were addicted to heroin.

“I didn’t care that my kids were addicted to drugs, I was more concerned about where I was getting my next fix from. I know it’s selfish but that’s how it felt at the time,” she said.

“I remember visiting my children in hospital as they suffered withdrawal symptoms from the methadone they were being given as part of their treatment. I remember seeing them trembling and shaking in their cots. I admit I was a bad mum but I’ve turned my life around now”.

Lisa has now recovered from drug addiction and has become involved with the charity Narcotics Anonymous to help others.

The data for England also shows that over the past four years there has been general decline in the number of babies being diagnosed with neonatal abstinence syndrome.   Those working to treat mothers and babies with a drug addiction say the majority of parents they deal with come from a disadvantaged socio-economic background, with most cases involving an abuse of drugs like heroin, cocaine or alcohol.

Susan Flynn is a specialist midwife in Leeds who helps treat mothers who have a drug addiction.   “I have seen the numbers begin to fall slightly in the past three years,” she said. “I don’t think we can say there is one single reason for the decline but maybe the message is getting out there that it’s not right to take drugs or alcohol whilst you’re pregnant.

“There are of course people who say that women who take drugs whilst they’re pregnant should have their children removed from them, but for me I believe everyone should have the chance to turn their life around.”

Liz Butcher, from Public Health England in Yorkshire and the Humber, said: ‘It is particularly important pregnant women who use drugs get supportive, collaborative care

to reduce the risks to the health of their babies.      Many places in the region have specialist staff and well-established training to make sure that happens.”

 Source:  http://www.bbc.co.uk/news/uk-england-36703939    5th July 2016

Tamara D. Warner, PhD1, Dikea Roussos-Ross, MD2, and Marylou Behnke, MD1

Tamara D. Warner: warnertd@peds.ufl.edu; Dikea Roussos-Ross: kroussos@ufl.edu; Marylou Behnke: behnkem@peds.ufl.edu

1University of Florida, Department of Pediatrics, P.O. Box 100296, Gainesville, FL 32610-0296, (352) 273-8985

2University of Florida, Department of Obstetrics and Gynecology, P.O. Box 100294, Gainesville, FL 32610-0294, (352) 273-7660

SYNOPSIS

Pro-marijuana advocacy efforts exemplified by the “medical” marijuana movement, coupled with the absence of conspicuous public health messages about the potential dangers of marijuana use during pregnancy, could lead to greater use of today’s more potent marijuana, which could have significant short- and long-term consequences. This article will review the current literature regarding the effects of prenatal marijuana use on the pregnant woman and her offspring.

INTRODUCTION

Societal attitudes towards marijuana use in the United States are undergoing an historical shift. In the 1960s, a generation of young people embraced marijuana for personal recreational use. Today, “medical” marijuana (cannabis sativa) has been approved for use in 22 states and the District of Columbia either by legislation or by popular vote in statewide referenda or ballot initiatives; 15 of the 22 legal actions were passed in the last decade (since 2004).1 As of May, 2014, another seven states have pending legislation or ballot measures to legalize medical marijuana.2 In addition, two states, Colorado and Washington state, have legalized marijuana for recreational use. The attitudinal shift is apparent not just among adults but among teens as well. The most recent annual survey of adolescent drug use indicates that the annual prevalence of marijuana use has been trending upward since 2008 for 8th, 10th, and 12th graders; perhaps more importantly, the perceived risk of regular marijuana use has declined sharply in recent years, a trend that started in 2005.3

Source:  Clin Perinatal 2014 December 41(4):  877-894  doi 10.1016/j.clp  2014.0.009

Roll Call Video Advises Law Enforcement to Exercise Extreme Caution

DEA has released a Roll Call video to all law enforcement nationwide about the dangers of improperly handling fentanyl and its deadly consequences.  Acting Deputy Administrator Jack Riley and two local police detectives from New Jersey appear on the video to urge any law enforcement personnel who come in contact with fentanyl or fentanyl compounds to take the drugs directly to a lab.

“Fentanyl can kill you,” Riley said. “Fentanyl is being sold as heroin in virtually every corner of our country. It’s produced clandestinely in Mexico, and (also) comes directly from China. It is 40 to 50 times stronger than street-level heroin. A very small amount ingested, or absorbed through your skin, can kill you.”

Two Atlantic County, NJ detectives were recently exposed to a very small amount of fentanyl, and appeared on the video.

Said one detective: “I thought that was it. I thought I was dying. It felt like my body was shutting down.”

Riley also admonished police to skip testing on the scene, and encouraged them to also remember potential harm to police canines during the course of duties.

“Don’t field test it in your car, or on the street, or take if back to the office. Transport it directly to a laboratory, where it can be safely handled and tested.”

The video can be accessed at: http://go.usa.gov/chBWW

More on Fentanyl:

On March 18, 2015, DEA issued a nationwide alert on fentanyl as a threat to health and public safety.

Fentanyl is a dangerous, powerful Schedule II narcotic responsible for an epidemic of overdose deaths within the United States. During the last two years, the distribution of clandestinely manufactured fentanyl has been linked to an unprecedented outbreak of thousands of overdoses and deaths. The overdoses are occurring at an alarming rate and are the basis for this officer safety alert.

Fentanyl, up to 50 times more potent than heroin, is extremely dangerous to law enforcement and anyone else who may come into contact with it. As a result, it represents an unusual hazard for law enforcement.

Fentanyl, a synthetic opiate painkiller, is being mixed with heroin to increase its potency, but dealers and buyers may not know exactly what they are selling or ingesting. Many users underestimate the potency of fentanyl.

The dosage of fentanyl is a microgram, one millionth of a gram – similar to just a few granules of table salt. Fentanyl can be lethal and is deadly at very low doses.

Fentanyl and its analogues come in several forms including powder, blotter paper, tablets, and spray.

Risks to Law Enforcement

Fentanyl is not only dangerous for the drug’s users, but for law enforcement, public health workers and first responders who could unknowingly come into contact with it in

its different forms. Fentanyl can be absorbed through the skin or accidental inhalation of airborne powder can also occur. DEA is concerned about law enforcement coming in contact with fentanyl on the streets during the course of enforcement, such as a buy-walk, or buy-bust operation.

Just touching fentanyl or accidentally inhaling the substance during enforcement activity or field testing the substance can result in absorption through the skin and that is one of the biggest dangers with fentanyl. The onset of adverse health effects, such as disorientation, coughing, sedation, respiratory distress or cardiac arrest is very rapid and profound, usually occurring within minutes of exposure.

Canine units are particularly at risk of immediate death from inhaling fentanyl.

In August 2015, law enforcement officers in New Jersey doing a narcotics field test on a substance that later turned out to be a mix of heroin, cocaine and fentanyl, were exposed to the mixture and experienced dizziness, shortness of breath and respiratory problems.

If inhaled, move to fresh air, if ingested, wash out mouth with water provided the person is conscious and seek immediate medical attention.

Narcan (Naloxone), an overdose-reversing drug, is an antidote for opiate overdose and may be administered intravenously, intramuscularly, or subcutaneously. Immediately administering Narcan can reverse an accidental overdose of fentanyl exposure to officers. Continue to administer multiple doses of Narcan until the exposed person or overdose victim responds favorably.

Field Testing / Safety Precautions

Law enforcement officers should be aware that fentanyl and its compounds resemble powered cocaine or heroin, however, should not be treated as such.

If at all possible do not take samples if fentanyl is suspected. Taking samples or opening a package could stir up the powder. If you must take a sample, use gloves (no bare skin contact) and a dust mask or air purifying respirator (APR) if handling a sample, or a self-contained breathing apparatus (SCBA) for a suspected lab.

If you have reason to believe an exhibit contains fentanyl, it is prudent to not field test it. Submit the material directly to the laboratory for analysis and clearly indicate on the submission paperwork that the item is suspected of containing fentanyl. This will alert laboratory personnel to take the necessary safety precautions during the handling, processing, analysis, and storage of the evidence. Officers should be aware that while unadulterated fentanyl may resemble cocaine or heroin powder, it can be mixed with other substances which can alter its appearance. As such, officers should be aware that fentanyl may be smuggled, transported, and/or used as part of a mixture.

Universal precautions must be applied when conducting field testing on drugs that are not suspected of containing fentanyl. Despite color and appearance, you can never be certain what you are testing. In general, field testing of drugs should be conducted as appropriate, in a well ventilated area according to commercial test kit instructions and training received. Sampling of evidence should be performed very carefully to avoid spillage and release of powder into the air. At a minimum, gloves should be worn and the use of masks is recommended. After conducting the test, hands should be washed with copious amounts of soap and water. Never attempt to identify a substance by taste or odor.

Historically, this is not the first time fentanyl has posed such a threat to public health and safety. Between 2005 and 2007, over 1,000 U.S. deaths were attributed to fentanyl – many of which occurred in Chicago, Detroit, and Philadelphia.

The current outbreak involves not just fentanyl, but also fentanyl compounds. The current outbreak, resulting in thousands of deaths, is wider geographically and involves a wide array of individuals including new and experiences abusers.

In the last three years, DEA has seen a significant resurgence in fentanyl-related seizures. In addition, DEA has identified at least 15 other deadly, fentanyl-related compounds. Some fentanyl cases have been significant, particularly in the northeast and in California, including one 12 kilogram seizure. During May 2016, a traffic stop in the greater Atlanta, GA area resulted in the seizure of 40 kilograms of fentanyl – initially believed to be bricks of cocaine – wrapped into blocks hidden in buckets and immersed in a thick fluid. The fentanyl from these seizures originated from Mexican drug trafficking organizations.

Recent seizures of counterfeit or look-a-like hydrocodone or oxycodone tablets have occurred, wherein the tablets actually contain fentanyl. These fentanyl tablets are marked to mimic the authentic narcotic prescription medications and have led to multiple overdoses and deaths.

According to DEA’s National Forensic Lab Information System, 13,002 forensic exhibits of fentanyl were tested by labs nationwide in 2015, up 65 percent from the 2014 number of 7,864.  The 2015 number is also about 8 times as many fentanyl exhibits than in 2006, when a single lab in Mexico caused a temporary spike in U.S. fentanyl availability.  This is an unprecedented threat

Source:  U.S. Drug Enforcement Administration dea@public.govdelivery.com  11th June 2016

Guilt-stricken drug dealer pictured in tearful mug shot after handing himself into police because he’d ‘had enough’

Manchester Crown Court heard Heath’s extraordinary confession came after his own addiction brought him to the point where he was living in a drug den with only a coat to his name

Sean Heath

With tears in his eyes guilt-stricken drug dealer Sean Heath poses for his mugshot moments after handing himself into police because he’d ‘had enough’.

The addict stunned officers, who didn’t even know he was dealing drugs, when he turned up at Little Hulton police station, placed 36 wraps of heroin on the counter and told the custody sergeant: ““I’m dealing drugs and I don’t want to do it anymore.”

Manchester Crown Court heard Heath’s extraordinary confession came after his own addiction brought him to the point where he was living in a drug den with only a coat to his name.

Over an eight month period he had been buying crack and heroin and selling to other users to feed his long-term, £200 a day habit.

Now Heath, of no fixed abode, has been jailed for two years and four months, after pleading guilty to possessing class A drugs with intent to supply, reports the Manchester Evening News .

As he was sentenced he said: “Half my life’s gone on drugs – I have just had enough.”

Prosecutor Neil Beckwith told court that Heath handed himself in to police after midnight on May 3, giving officers 36 wraps of a greyish powder which he revealed was heroin.

Interviewed, he said on a typical day he sold 36 wraps of heroin and 56 wraps of cocaine. During Heath’s sentencing hearing, Alistair Reid, defending, said: “This is the first time in my professional career I have had a defendant who has knocked on the door of police, surrendered himself and handed over a class A drug worth over £700 in street value. That goes to show his mindset. He tells me he’s been using illicit drugs since the age of 14, and prior to his remand in custody, would describe himself as an alcoholic.”

Mr Reid said Heath’s drug and drink problems had begun and escalated against a backdrop of family and relationship difficulties, leaving him penniless.

The defence lawyer added: “He has no assets whatsoever to his name – he informs me the only item he has is a coat. He has nothing else in the world in terms of material goods.

“He is, tragically, an indication of the harm illicit drugs cause in society. He sees this as an opportunity he needs to put drug misuse and alcohol misuse behind and move forward – he is determined to completely abstain from drugs.”

Sentencing, Recorder Andrew Jefferies QC said of Heath: “I don’t think you can get any clearer indication of remorse than going to the police station and handing yourself in.”

Source: http://www.mirror.co.uk/news/uk-news/guilt-stricken-drug-dealer-pictured-8113171

Addiction Science & Clinical Practice

Katherine A Belendiuk1, Lisa L Baldini2 and Marcel O Bonn-Miller345^*

• *Corresponding author: Marcel O Bonn-Miller Marcel.Bonn-Miller@va.gov

Author Affiliations

¹Institute of Human Development, University of California, 1121 Tolman Hall #1690, Berkeley 94720, CA, USA

²Palo Alto University, 1791 Arastradero Road, Palo Alto 94304, CA, USA

³Center of Excellence in Substance Abuse Treatment and Education, Philadelphia VA Medical Center, 3900 Woodland Avenue, Philadelphia 19104, PA, USA

⁴Center for Innovation to Implementation and National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park 94025, CA, USA

⁵Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3440 Market Street, Philadelphia 19104, PA, USA

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Addiction Science & Clinical Practice 2015, 10:10 doi:10.1186/s13722-015-0032-7

The electronic version of this article is the complete one and can be found online at:http://www.ascpjournal.org/content/10/1/10

© 2015 Belendiuk et al.; licensee BioMed Central.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Abstract

The present investigation aimed to provide an objective narrative review of the existing literature pertaining to the benefits and harms of marijuana use for the treatment of the most common medical and psychological conditions for which it has been allowed at the state level. Common medical conditions for which marijuana is allowed (i.e., those conditions shared by at least 80 percent of medical marijuana states) were identified as: Alzheimer’s disease, amyotrophic lateral sclerosis, cachexia/wasting syndrome, cancer, Crohn’s disease, epilepsy and seizures, glaucoma, hepatitis C virus, human immunodeficiency virus/acquired immunodeficiency syndrome, multiple sclerosis and muscle spasticity, severe and chronic pain, and severe nausea. Post-traumatic stress disorder was also included in the review, as it is the sole psychological disorder for which medical marijuana has been allowed. Studies for this narrative review were included based on a literature search in PsycINFO, MEDLINE, and Google Scholar. Findings indicate that, for the majority of these conditions, there is insufficient evidence to support the recommendation of medical marijuana at this time. A significant amount of rigorous research is needed to definitively ascertain the potential implications of marijuana for these conditions. It is important for such work to not only examine the effects of smoked marijuana preparations, but also to compare its safety, tolerability, and efficacy in relation to existing pharmacological treatments.

Keywords:

Cannabis; Medical marijuana; Marijuana; Medicine; Treatment; Alzheimer’s disease; ALS; Cachexia; Cancer, Crohn’s disease; Epilepsy; Seizures; Glaucoma; Hepatitis C virus; HCV; HIV; AIDS; Multiple sclerosis; MS; Pain; Nausea; Vomiting; Post-traumatic stress disorder; PTSD

Introduction

National estimates suggest that 5.4 million people in the United States above the age of 12 have used marijuana daily or regularly within the past year [1]. This represents an increase of approximately 74.2 percent since 2006 [1]. Similar increases have also been noted among vulnerable populations in the U.S. (e.g., veterans and adolescents) [2],[3].

Marijuana is currently illegal in every country in the world. In 2012, Uruguay voted to legalize state-controlled marijuana sales but implementation of the law has been postponed until 2015. The policy in the Netherlands is mixed, with permissible retail sale of marijuana at coffee shops, but restrictions on production and possession. Notably, as the concentration of THC in marijuana has increased, Dutch coffee shops have begun to close, as perception of marijuana as a “soft” drug transitions to perceptions of marijuana as a “hard” drug.

Like the Netherlands, the United States currently has a mixed drug policy; marijuana is an illegalSchedule I drug under U.S. Federal law. However, marijuana policies vary by state, with some states (e.g., Colorado and Washington) legalizing the use of recreational marijuana (i.e., allowing the legal possession and use of marijuana under state law), and other states decriminalizing marijuana (i.e., reducing the penalties for possession and/or use of small amounts of marijuana to fines or civil penalties). Furthermore, as of this review, 23 states and the District of Columbia have passed legislation allowing medical marijuana (i.e., individuals can defend themselves against criminal charges related to marijuana possession if a medical need is documented) for the treatment of a variety of medical and psychological conditions. Though the list of conditions for which medical marijuana has been allowed varies at the state level, the majority of states agree on its use for Alzheimer’s disease (AD), amyotrophic lateral sclerosis (ALS), cachexia/wasting syndrome, cancer, Crohn’s disease (CD), epilepsy and seizures, glaucoma, hepatitis C virus (HCV), human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), multiple sclerosis (MS) and muscle spasticity, severe and chronic pain, severe nausea, and post-traumatic stress disorder (PTSD).

The aim of the present review is to provide a summary of the existing empirical literature regarding the effects of marijuana/cannabinoids on each of the above-noted conditions. Though some recent work has reviewed the adverse effects of marijuana [4] or the efficacy of marijuana for certain conditions (e.g., neurologic) [5], there has yet to be a comprehensive review of the effects of marijuana for each of the medical and psychiatric conditions for which it is currently used.

Methods

The list of all conditions for which medical marijuana is allowed, according to the legislation of each U.S. state for which medical marijuana has been approved, was obtained and examined [6]. From this list, common conditions for which medical marijuana is allowed (i.e., those conditions shared by at least 80 percent of medical marijuana states) were identified as: AD, ALS, cachexia/wasting syndrome, cancer, CD, epilepsy and seizures, glaucoma, HCV, HIV/AIDS, MS and muscle spasticity, severe and chronic pain, and severe nausea. Though not presently a qualifying condition in at least 80 percent of states with medical marijuana laws, PTSD was also included in the review, as it is rapidly gaining attention and recognition as the sole psychological disorder for which medical marijuana is allowed.

Studies for this narrative review were included based on a literature search in the following databases: PsycINFO, MEDLINE, and Google Scholar. Within each database, each combination of the following key marijuana terms and the above-listed conditions were used to conduct a search: cannabis, marijuana, marihuana, cannabinoid, delta-9-tetrahydrocannabinol, THC, cannabidiol, CBD, cannabinol, cannabigerol, Marinol, dronabinol, Sativex, Nabilone, and Nabiximols. References within each obtained article were also examined to assure that no studies were overlooked. Only published, English-language studies were included in this review.

Though the primary focus of this review is on studies of marijuana plant effects, as these are most relevant to recent medical marijuana legislation, synthetic or plant-derived cannabinoids (e.g., dronabinol, Nabilone) were also included due to the general dearth of marijuana plant studies for a number of conditions. Indeed, for purposes of the review, references to oral administrations of marijuana constitute a pharmaceutical grade extraction administered in tablet or liquid form (e.g., dronabinol, Nabilone, Nabiximols), while references to smoked administration of marijuana constitute the inhalation of smoke from burned marijuana leaves and flowers. Finally, the present review is organized alphabetically by condition for which marijuana is allowed, rather than in order of disorder for which it is most to least commonly recommended, or strength of the evidence. We chose this approach as there is currently only state-level data [7]-[9], rather than national, representative data on the primary conditions for which medical marijuana is used or recommended, and the existing literature and state of the evidence for many conditions remains relatively poor.

Results

Alzheimer’s disease

AD, the leading form of dementia in the elderly, is a progressive, age-related disorder characterized by cognitive and memory deterioration [10]. AD has several neuropathological markers, including neuritic plaques and neurofibrillary tangles [11]. Although several researchers have suggested dronabinol and Nabilone may act on these mechanisms to confer therapeutic effects for patients with AD [12],[13], a recent Cochrane systematic review found no evidence that dronabinol was effective in reducing symptoms of dementia [14]. The authors of a placebo-controlled crossover study of 15 patients with AD who were refusing to eat suggest that dronabinol increases weight gain and decreases disturbed behavior [15], but there is insufficient quantitative data to support this conclusion [14], and one study participant had a grand mal seizure following dronabinol administration [15]. Another pilot study of two patients with dementia found that dronabinol reduced nocturnal motor activity [16]. No studies have examined the effects of smoked marijuana in patients with AD. In sum, there is insufficient evidence to recommend marijuana for the treatment of AD. Future directions should include conducting randomized controlled trials (RCTs) comparing both smoked and oral marijuana to placebo and existing treatments, with sample sizes large enough to detect treatment effects and the safety and tolerability of marijuana.

Amyotrophic lateral sclerosis

ALS is a fatal neurological disease with symptoms that include weakness, spasticity, and respiratory difficulties. Cannabinoids are hypothesized to act in the regions of established pathophysiology for ALS [17] and could be used for symptom management (e.g., pain, spasticity, wasting, respiratory failure, dysphagia, negative mood, and dysautonomia) [18]. Although there is limited evidence from a survey of patients with ALS that marijuana consumed in a variety of forms (i.e., oral, smoked, vaporized, and eaten) improves speech and swallowing [19], the anti-salivatory components of marijuana may reduce the risk of aspiration pneumonia, while also increasing patient comfort [18],[19]. These survey findings indicate that up to 10 percent of patients use marijuana for symptom management, and these self-reports suggest efficacy in increasing appetite and mood and decreasing pain, spasticity, and drooling. However, as is consistent with the half-life of smoked marijuana, the beneficial effects of marijuana on symptoms of ALS were fewer than 3 hours in duration [19]. The only randomized, double-blind, placebo-controlled crossover trial of marijuana in patients with ALS has a small sample size (N = 27) and indicates that while 5 mg of dronabinol is well-tolerated, there was no effect on number or intensity of cramps, quality of life, appetite, sleep, or mood [20]. There is currently insufficient clinical evidence in humans with ALS to recommend cannabinoids as primary or adjunctive therapy.

Cachexia/wasting syndrome

Cachexia is the general wasting and malnutrition that occurs in the context of chronic diseases such as HIV/AIDS and cancer. In patients with HIV or cancer, smoked marijuana and dronabinol have been shown to increase weight gain [21],[22] and food intake [22],[23] compared to placebo. In a within-subject, double-blind, staggered, double-dummy study of nine individuals with muscle mass loss, dronabinol resulted in significantly greater calorie consumption than smoked marijuana [24]. A within-subject, double-blind, placebo-controlled trial with seven HIV-positive marijuana smokers taking antiretroviral medications found that compared to placebo, dronabinol increased caloric intake [25]. Additional studies indicate that dronabinol administration increases appetite, decreases nausea, and protects against weight loss [26], with effects on appetite and weight stability enduring in long-term follow-up [27].

Both dronabinol and smoked marijuana increase the number of eating occasions [22],[25], and smoked marijuana may also affect weight gain and calorie intake by modulating appetite hormones [28]. Importantly, weight gain in one study was greater than would have been expected based on increased calorie consumption alone [23], which may be particularly relevant for those who have impaired food intake and/or nausea. These studies demonstrate that marijuana has positive effects on cachexia resulting from a medical condition, but are largely limited by small sample sizes. Additionally, studies comparing THC to FDA-approved medication (i.e., megestrol) indicate that THC is less effective in promoting appetite and weight gain [29]. In sum, there is moderate support for the use of cannabinoids for cachexia/wasting, and dronabinol has been FDA-approved for anorexia associated with weight loss in individuals with AIDS. Additional studies with larger sample sizes that examine the efficacy of marijuana compared to nutritional support/calorie augmentation in the treatment of cachexia are indicated.

Cancer

Cancer is a qualifying medical condition in every state that has approved marijuana for medical use [30]. The majority of clinical research examining the relation between THC and cancer has evaluated the effect of smoked THC on the risk for cancer, or the palliative effects of THC on chemotherapy-related nausea and emesis, chronic pain, and wasting (reviewed in respective sections); few studies have studied the effect of marijuana in any form on the treatment of primary cancer pathology. In vitro and in vivo research suggests that cannabinoids inhibit tumor growth [30] via several proposed mechanisms (e.g., suppression of cell proliferation, reduced cell migration, increased apoptosis) [31]; however, in vitro and in vivo studies also have shown that THC increases tumor growth due to reduced immune response to cancer [32]. The only clinical trial of THC on cancer examined intracranial administration of THC to nine patients with recurrent glioblastoma multiforme who had failed surgical- and radiotherapy, and results indicated that THC decreased tumor growth, while being well-tolerated with few psychotropic effects [33]. This study is limited by lack of generalizability, and clinical trials with larger representative samples that examine oral or smoked administration of THC are essential to elucidate the effects on cancer pathology. There is currently insufficient evidence to recommend marijuana for the treatment of cancer, but there may be secondary treatment effects on appetite and pain.

Crohn’s disease

CD is an inflammatory bowel disease (IBD) that has no cure; treatment targets include reducing inflammation and secondary symptoms. Between 16 percent and 50 percent of patients use marijuana to relieve symptoms of IBD [34]-[36], and patients using marijuana for 6 months or longer are five times more likely to have had surgery for their IBD [34]; whether marijuana exacerbates disease progression or more severe disease results in self-medication is unclear. Only one placebo-controlled study of the effects of marijuana in patients with CD has been conducted[37]. This study found that there was no difference between placebo and smoked marijuana on CD remission (defined as a CD Activity Index (CDAI) of less than 100), and that marijuana was superior to placebo in promoting clinical response (a decrease in CDAI score greater than 100), reducing steroid use, and improving sleep and appetite [37]. Importantly, this study did not include objective measurement of inflammatory activity, and there was no significant difference in placebo and treatment groups 2 weeks after treatment cessation [37]. Until clinical trials with objective measurement of treatment effects over an extended period of time are conducted to examine the safety and efficacy of marijuana for the treatment of IBD, there is insufficient evidence for the use of marijuana for the treatment of IBD.

Epilepsy and seizures

The known effects of cannabinoids on epilepsy and seizures are largely from animal studies, surveys, and case studies. Several animal studies indicate that marijuana and its constituents exhibit anticonvulsant effects [38]-[41] and reduce seizure-related mortality [39], but there is also evidence that cannabinoids can lower the threshold for seizures [42], and THC withdrawal increases susceptibility for convulsions [42]. Cross-sectional surveys indicate that 16–21 percent of patients with epilepsy smoke marijuana [43],[44], with some reporting positive effects (e.g., spasm reduction) and a belief that marijuana is an effective therapy [44], and others reporting increased seizure frequency and intensity [43]. Based on a Cochrane review, the few RCTs that have been conducted in humans include a total of 48 participants [45] and only examine treatment with cannabidiol. These trials exhibited heterogeneity of effects: some indicated a reduction in seizure frequency [46],[47], while others demonstrated no effect compared to placebo [48]. In addition, none of the studies examined response at greater than 6-month follow-up [45]. Systematic reviews of the literature have concluded that there is insufficient clinical data to support or refute the use of cannabinoids for the treatment of epilepsy and seizures [5],[45].

Glaucoma

Glaucoma is a neurodegenerative eye disease that can cause blindness by damaging retinal ganglion cells and axons of the optic nerve. Intraocular pressure (IOP) can influence both onset and progression of glaucoma and is often a target for intervention. Small samples have demonstrated reduced IOP following smoked marijuana [49],[50], but the effect is only present in 60–65 percent of individuals [51] and lasts for 3–4 hours, requiring repeated dosing throughout the day [52]. Furthermore, patients discontinue marijuana use due to side effects (e.g., dizziness, anxiety, dry mouth, sedation, depression, confusion, weight gain, and distortion of perception[53]), and this treatment discontinuity may exacerbate optic nerve damage and obviate the benefits of reduced IOP [54]. Limited research and documented toxicity have resulted in the American Glaucoma Society [54], Canadian Opthalmological Society [55], and the American Academy of Ophthalmology’s Complementary Therapies Task Force [52] determining that there is insufficient evidence to indicate that marijuana is safer or more effective than existing pharmacotherapy or surgery for the reduction of IOP. Development of eye drops for topical application of THC would minimize psychoactive and other side effects but is complicated by the high lipophilicity and low water solubility of cannabinoids [52],[56]. Additionally, the distance from the application site to the retina may be too great to afford neuroprotective benefits [52], given that only 5 percent of an applied dose penetrates the cornea to the intraocular space [56].

Hepatitis C virus

There have been no RCTs examining the use of cannabinoids on HCV infection. Of the studies that have been conducted, one longitudinal study demonstrates that smoked marijuana has no effect on HCV progression in individuals with HIV [57]. In contrast, individuals with HCV who smoke marijuana have a higher fibrosis progression rate [58] and more severe steatosis [59], with daily smokers having a more rapid rate of progression and greater severity [60] than occasional marijuana users [58],[59]. Marijuana may have independent negative effects on steatosis [59], but because none of these findings were in the context of a clinical trial, these correlations are not causal and it is possible that individuals who use marijuana do so to manage greater symptom severity [60].

There may be secondary effects of cannabinoids on HCV treatment side effects: dronabinol and Nabilone stabilized treatment-induced weight-loss [61]; and dronabinol, Nabilone, and marijuana procured from a marijuana club (dose and method of administration unspecified) increased HCV treatment duration and reduced post-treatment virological relapse [61],[62]. However, there is also a potential drug-drug interaction between ribavirin, a traditional HCV treatment, and marijuana due to shared cytochrome 450 metabolism [63]. Because 90 percent of HCV infections are the result of injection drug use [64], treatment of symptoms with marijuana may be contraindicated for this subpopulation, particularly because marijuana use in the context of other substance use (i.e., alcohol) has multiplicative effects on the odds of fibrosis severity [60]. Given that newer treatments for HCV (e.g., sofosbuvir) are replacing ribavirin, there will likely be less need for use of marijuana in management of treatment-related side effects. In sum, there is currently insufficient empirical support to recommend marijuana for the treatment of HCV.

HIV/AIDS

Marijuana use in HIV-infected patients is typically for the management of side effects (e.g., nausea) of older antiretroviral treatments and AIDS-related symptoms, including weight-loss and HIV-associated neuropathy (covered in cachexia and pain sections, respectively). Survey studies indicate that 23 percent of patients with HIV/AIDS smoked marijuana in the past month and do so largely to improve mood and appetite and reduce pain [65]; these patients may exhibit tolerance and need higher doses of THC than are currently approved by the FDA for use in clinical trials [25] to experience treatment effects. The few RCTs that have been conducted in a small number of patients with HIV/AIDS largely examined the effects of marijuana (synthetic or natural marijuana that is smoked or ingested) on symptoms (e.g., nausea and appetite) over a short treatment window (21–84 days; see [66] for systematic review). Studies examining the effects of marijuana on the pharmacokinetics of antiretroviral medication demonstrated that neither smoked marijuana nor dronabinol affects short-term clinical outcomes (e.g., viral load, CD4 and CD8 counts [67]), influences the efficacy of antiretroviral medication [68], or indicates that dose adjustments for protease inhibitors are necessary [21]. However, individuals who are dependent on marijuana have demonstrated poorer medication adherence and greater HIV symptoms and side effects than nonusers and nondependent users [69]. Furthermore, while some studies have no participant withdrawal due to adverse events [21],[70],[71], others reported treatment-limiting adverse events [26],[72],[73]. Finally, because drug use is a risk factor for HIV infection [74], treatment of symptoms with marijuana may be contraindicated for this subpopulation. In sum, there is variability in short-term outcomes and insufficient long-term data addressing the safety and efficacy of marijuana when used to manage symptoms of HIV/AIDS and its role in those also using newer, better-tolerated antiretroviral agents.

Multiple sclerosis and muscle spasticity

Muscle spasticity, a common feature of MS, is disordered sensorimotor control that leads to involuntary muscle activation [75] that results in pain, sleep disturbance, and increased morbidity[76]. The majority of studies examining spasticity have compared oral or sublingual forms of cannabinoids to placebo and found reduced spasm severity [77]-[84], with symptom improvement enduring at long-term follow-up [85]-[87], and also reduced spasm frequency and spasm-related pain and sleep disturbances [77],[88],[89]. With regard to smoked marijuana, one study found reductions in muscle spasticity [90]; however, another study showed that smoking marijuana impaired posture and balance in individuals with spasticity [91], so there is currently insufficient evidence to determine the efficacy of smoked marijuana on spasticity [5].

Surveys of patient populations show that between 14 and 16 percent of patients with MS report using marijuana for symptom management [92],[93] and that compared to non-marijuana-using individuals with MS, marijuana-using individuals with MS have decreased cognitive functioning[90],[94],[95]. Because cognitive dysfunction is present in 40–60 percent of individuals with MS before marijuana administration [96], marijuana use may further compromise impaired cerebral functioning in a neurologically vulnerable population. Additionally, future studies should carefully consider outcome assessment. The primary methods of measuring spasticity, the Ashworth Scale and patient self-report, may not be appropriate measures because antispastic drugs do not decrease Ashworth ratings, and patient-reported spasticity severity may be poorly correlated with patient functioning (i.e., a patient whose spasticity compensated for motor weakness may be unable to ambulate with reduced spasticity) [97]. Importantly for both MS and other neurological disorders, the American Academy of Neurology does not advocate the use of marijuana for the treatment of neurological disorders, due to insufficient evidence regarding treatment efficacy [98].

Post-traumatic stress disorder

There has been a recent emergence of empirical studies of the effects of marijuana on symptoms of PTSD, borne primarily out of the observation that individuals with PTSD report using marijuana to cope with PTSD symptoms; specifically, hyperarousal, negative affect, and sleep disturbances[99]-[101]. Empirical work has consistently demonstrated that the endocannabinoid system plays a significant role in the etiology of PTSD, with greater availability of cannabinoid type 1 receptors documented among those with PTSD than in trauma-exposed or healthy controls [102],[103]. Though the use of marijuana and oral THC [104],[105] have been implicated as a potential mechanism for the mitigation of many PTSD symptoms by way of their effects on the endocannabinoid system, some researchers caution that endocannabinoid activation with plant-based extracts over extended periods may lead to a number of deleterious consequences, including receptor downregulation and addiction [102].

There have been no RCTs of marijuana for the treatment of PTSD, though there has been one small RCT of Nabilone that showed promise for reducing nightmares associated with PTSD [106]. One unpublished pilot study of 29 Israeli combat veterans showed reductions in PTSD symptoms following the administration of smoked marijuana, with effects seen up to one year post-treatment[107]. Remaining studies have been primarily observational in nature, documenting that PTSD is associated with greater odds of a cannabis use disorder diagnosis [108] and greater marijuana craving and withdrawal immediately prior to a marijuana cessation attempt [109]. Indeed, sleep difficulties (a hallmark of PTSD) have been associated with poor marijuana cessation outcomes[110],[111], while cannabis use disorders have been associated with poorer PTSD treatment outcomes [112]. Given the lack of RCTs studying marijuana as a treatment for PTSD, there is insufficient scientific evidence for its use at this time.

Severe and chronic pain

Clinical trials have examined smoked and oral administration of cannabinoids on different types of pain (e.g., neuropathic, post-operative, experimentally induced) in multiple patient populations (e.g., HIV, cancer, and fibromyalgia). Two meta-analyses have been conducted examining the association between marijuana and pain. In the first, 18 RCTs demonstrated that any marijuana preparation containing THC, applied by any route of administration, significantly decreased pain scores from baseline compared to placebo [113]. The second examined 19 RCTs of smoked marijuana in individuals with HIV, which also indicated greater efficacy in reducing pain (i.e., sensory neuropathy) compared to placebo [114]. Importantly, the first meta-analysis showed that marijuana increased the odds of altered perception, motor function, and cognition by 4 to 5 times[113], and the second study did not recommend marijuana as routine therapy [114]. Dosage is an important factor to consider for administration of cannabinoids for pain management, as some studies have found that higher doses of smoked marijuana are associated with improved analgesia[115], whereas other studies show that higher doses of smoked marijuana increase pain response[116]. Because the analgesic effects of marijuana are comparable to those of traditional pain medications [117], future research should aim to identify which analgesics provide the lowest risk profile for the management of severe and chronic pain. Although there is preliminary support to suggest that marijuana may have analgesic effects, there is insufficient research on dosing and side effect profile, which precludes recommending marijuana for the management of severe and chronic pain.

Severe nausea

The majority of research related to the effects of marijuana on severe nausea has involved oral administration of marijuana to individuals with chemotherapy-induced nausea and vomiting (CINV). Oral marijuana (i.e., THC suspension in sesame oil and gelatin) has been shown to be more effective in reducing CINV than placebo [118], including the number and volume of vomiting episodes, and the severity and duration of nausea [119]. When compared to traditional anti-emetics, some meta-analytic reviews indicate that oral THC is more effective in reducing CINV[120]-[123], others find no significant difference [122],[124]-[126], and another suggests that combining both is the most effective at reducing the duration and severity of CINV than either alone [127]. Recent advances in both anti-emetic agents and the mechanisms of cannabinoid administration (i.e., sublingual application) warrant future research.

Importantly, patients receiving cannabinoids for severe nausea reported toxicities, including paranoid delusions (5%), hallucinations (6%), and dysphoria (13%) [122]. Additionally, cannabinoid hyperemesis syndrome has been documented, in which persistent and regular marijuana use (i.e., daily or weekly use for more than 1 year) is associated with cyclic vomiting (i.e., episodic nausea and vomiting) [128] and nonresponse to treatment for cyclic vomiting [129]. Dronabinol has been FDA-approved for CINV in individuals who have not shown a treatment response to traditional anti-emetics, but in line with recommendations from the American Society of Clinical Oncology [130] and the European Society for Medical Oncology [131], cannabinoids should not be utilized as a first-line treatment for nausea and vomiting.

Conclusions

The reviewed literature highlights the dearth of rigorous research on the effects of marijuana for the most common conditions for which it is currently recommended. It is paramount that well-designed RCTs with larger sample sizes be conducted to determine the actual medical benefits and adverse effects of marijuana for each of the above conditions. Indeed, recent reviews [4],[132] comprehensively discuss adverse events associated with marijuana use, and while it is beyond the scope of the current paper to review these effects in-depth, they are important to consider when evaluating whether or not to recommend marijuana for a medical or psychiatric disorder in place of other existing treatment options.

Given the extensive literature speaking to the harms associated with marijuana use, research on the comparative safety, tolerability, efficacy, and risk of marijuana compared to existing pharmacological agents is needed. The present literature also illuminates the need for research into the effects of isolated cannabinoids (e.g., THC, CBD) as well as species of smoked marijuana (e.g., indica and sativa), as the majority of medical marijuana users ingest marijuana by smoking the marijuana plant [133],[134], which contains a wide variety of phytocannabinoids at varying potencies [135],[136]. Furthermore, improved and objective measurement of clinical outcomes should be implemented in clinical trials to determine treatment efficacy. Finally, little research has considered the issues of dose, duration, and potency. If research identifies a therapeutic effect of marijuana for medical or psychiatric conditions, there will need to be revisions in marijuana policy to increase quality control so that dose and potency are valid and reliable. Additionally, risk of abuse and diversion can be decreased by developing prescribing practices with continued supervision of a medical professional, creating prescription monitoring programs to reduce the risk of “doctor shopping”, and identifying provisions for the safe disposal of unused cannabinoids. In sum, the current literature does not adequately support the widespread adoption and use of marijuana for medical and psychiatric conditions at this time.

Source: :http://www.ascpjournal.org/content/10/1/10 21^st April 2015

Abbreviations

THC: Δ⁹-tetrahydrocannabinol

HIV: Human immunodeficiency virus

AIDS: Acquired immunodeficiency syndrome

RCTs: Randomized controlled trials

IOP: Intraocular pressure

MS: Multiple sclerosis

CINV: Chemotherapy-induced nausea and vomiting

HCV: Hepatitis C virus

ALS: Amyotrophic lateral sclerosis

CD: Crohn’s disease

IBD: Inflammatory bowel disease

AD: Alzheimer’s disease

PTSD: Post-traumatic stress disorder

CB1: Cannabinoid type 1

CBD: Cannabidiol

Competing interests

Dr. Belendiuk holds stock in Shire Pharmaceuticals.

Authors’ contributions

Dr. KAB synthesized the literature and authored sections of the manuscript. Ms. LLB assisted with the literature search and synthesis. Dr. MOB-M conceived the review, assisted in the search and synthesis of existing literature, and authored sections of the manuscript. All authors read and approved the final manuscript.

Acknowledgements

Dr. Belendiuk’s salary was supported by National Institute of Mental Health R01 MH40564.

Dr. Bonn-Miller’s salary was supported by the VA Center of Excellence for Substance Abuse Treatment and Education.

Literature review and synthesis was supported by a grant from the VA Substance Use Disorder Quality Enhancement Research Initiative (SUDQ-LIP1410).

The above funding agencies played no role in the writing of the manuscript or decision to submit the manuscript for publication. The expressed views do not necessarily represent those of the Department of Veterans Affairs.

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Do manualized psychosocial interventions help reduce relapse among alcohol-dependent adults treated with naltrexone or placebo? A meta-analysis.

Agosti V., Nunes E.V., O’Shea D. et al.

Unable to obtain a copy by clicking title? Try asking the author for a reprint by adapting this prepared e-mail or by writing to Dr Agosti at agostiv@pi.cpmc.columbia.edu.

Supplementing the medication naltrexone with psychosocial relapse-prevention therapies has not helped prevent relapse among alcohol-dependent patients. However, these therapies have elevated outcomes among placebo patients to the level of those prescribed naltrexone.

SUMMARY Medications such as naltrexone and acamprosate are used in the treatment of alcohol dependence to combat frequent relapse to heavy drinking, but their impact has overall been modest, and many patients leave treatment early or do not take medication as intended. Researchers have tried to address these shortcomings by supplementing medication with psychosocial interventions. The featured review assessed whether these attempts have been successful by conducting a meta-analytic synthesis of results from studies which used psychosocial relapse-prevention interventions (typically cognitive-behavioural in approach) to support adult, alcohol-dependent patients who had achieved abstinence, and then randomly been allocated either to naltrexone or a placebo. Relapse was defined as a return to drinking at least 70g alcohol a day for men or 56g for women.

Key points

The review synthesised results from relevant studies to test whether supplementing the medication naltrexone with psychosocial relapse-prevention therapies helps prevent relapse among adult, alcohol-dependent patients.

It concluded this was not the case, though one finding suggested that psychosocial therapies can elevate outcomes for patients prescribed a placebo to the level of those prescribed naltrexone.

The implications of this and of other studies are that naltrexone can be a valuable supplement to medical counselling of dependent drinkers, especially when specialist therapies such as cognitive-behavioural therapy are refused or unavailable.

In some situations these therapies also work better when naltrexone is added. But if the core treatment is naltrexone, good quality medical care or counselling will on average be as effective as specialist structured psychosocial therapies.

Four of the 18 studies which met these criteria had also randomly allocated patients to cognitive-behavioural therapies versus a different approach – specifically either medical management or supportive psychotherapy. These direct tests of the impact of a cognitive-behavioural approach were analysed separately from the remaining 20 studies, in which all the patients were offered the same psychosocial therapies, either cognitive-behavioural or one typical of that type of service.

All 18 studies had recruited nearly 2,600 patients on average about 42 years old. Where this was known, three-quarters were men, 71% were employed, and about half were married.

Main findings

Within each of the four studies which had randomly allocated patients to these therapies, generally the proportions who relapsed when supported by cognitive-behavioural therapies were about the same as those who relapsed when supported in other ways. This was the case both among patients given naltrexone and those allocated to a placebo. When results from these studies were pooled, relapse rates among patients allocated to naltrexone or placebo were virtually the same regardless of the type of psychosocial support.

Among the remaining studies which each allocated all their patients to the same form of psychosocial support, results were available from seven in which this was a structured, manualised programme, usually cognitive-behavioural in nature. Across these studies, virtually the same proportion of patients (about half) relapsed whether prescribed naltrexone or placebo. In contrast, when support took a typical, less structured form such as counselling, fewer naltrexone patients relapsed (33%) than did patients prescribed a placebo (43%). This contrast was statistically significant, and was largely due to results from older studies published between 1992 and 1997. Another unexpected finding was that whether prescribed naltrexone or a placebo, fewer patients relapsed when the treatment was a typical approach than when it was a structured psychosocial therapy.

The authors’ conclusions

Results show that relative to other approaches, cognitive-behavioural therapy did not significantly decrease the likelihood of relapse to heavy drinking among patients prescribed naltrexone or among those prescribed a placebo, and did not augment the impacts of naltrexone relative to an inactive placebo. In the four studies which made direct comparisons, supportive psychotherapy and medical management interventions worked as well. Among the remaining studies, overall those which used a manualised programme such as cognitive-behavioural therapy actually recorded higher rates of relapse than studies which used a more typical, less structured approach.

These results should be viewed in the light of several major limitations. No adjustments could be made for important factors related to the chance of successful treatment such as severity of dependence, and relapse to heavy drinking was the only drinking outcome sufficiently commonly reported to be amalgamated across the studies. Also, the results derived from studies that required initial abstinence and excluded patients with major comorbid disorders, diminishing their applicability to routine practice.

Source: American Journal on Addictions: 2012, 21(6), p. 501–507. April 2015

COMMENTARY The weight of the evidence in respect of treating alcohol or drug dependence is that despite the prominence of cognitive-behavioural therapies, their theoretical pedigree, and an extensive research effort which has distilled them in to expert manuals (for example, 1 2), overall the advantage they confer over alternatives is minor, and especially so when added to a drug-based treatment. In respect of alcohol problems, an analysis has concluded that any variation in outcomes across different psychosocial therapies is likely to have been due to chance or to the allegiance of the researchers.

However, the large US COMBINE trial did find that supplementing inactive placebo pills with psychological therapy incorporating cognitive-behavioural elements raised outcomes to the level of patients prescribed naltrexone. A similar message emerged from another US study which found that as long as naltrexone was prescribed, primary care-style consultations were as effective as specialist cognitive-behavioural therapy in initiating and sustaining recovery from alcohol dependence. Without the medication, cognitive-behavioural therapy was the more effective option. A similar result emerged from the featured review’s analysis of studies which offered the same psychosocial support to all patients; when this was a structured therapy (generally cognitive-behavioural), it helped raise outcomes for placebo patients to the level of those prescribed naltrexone.

All these results suggest that structured therapies can elevate the outcomes of patients not prescribed an active medication to the level of those prescribed naltrexone – that either medication or structured therapy help relative no medication plus typical care. Combining the two does not augment the drug’s impacts – a surprise, since relapse-prevention therapies would be expected to have their own impacts and to give medication greater leverage by persuading more patients to complete treatment and take the pills as intended.

Even if adding structured cognitive-behavioural therapy to naltrexone does not help, the reverse may still be the case – that supplementing cognitive-behavioural therapy with naltrexone makes a more effective package. In several studies (described in these notes) this has indeed been the case. The findings are in line with guidance from the UK’s National Institute for Health and Clinical Excellence (NICE) that in addition to evidence-based psychological interventions, patients whose alcohol dependence is moderate or severe should also be able to access relapse prevention medication, including naltrexone.

Practice implications seem to be that naltrexone can be a valuable supplement to the medical counselling (by GPs or nurses) of dependent drinkers of the kind who might be treated in primary care, especially when specialist therapies such as cognitive-behavioural therapy are refused or unavailable. In some situations these therapies also work better when naltrexone is added. But if the core treatment is naltrexone, a good quality medical care approach or counselling will on average be as effective as specialist structured psychosocial therapies.

Last revised 17 April 2015. First uploaded 10 April 2015

By Jeanette McDougal, MM, CCDP, Chair
William R. Walluks, Member Hemp Committee, Drug Watch Intl.
August 2000

Fiber Cannabis hemp seed, though containing tetrahydrocannabinol (THC, the main psychoactive ingredient in hemp/marijuana) and other cannabinoid residue, is being heavily marketed and promoted by the hemp industry as a source of food, nutraceuticals, and cosmetics. The harmful effects of THC on humans and other animals is well documented. Hemp advocates, however, mimicking the tactics of tobacco industry apologist, challenge and “call into question” every statement substantiating harm caused by the use of Cannabis sativa L. hemp. (Where used in this paper, the term hemp refers to cannabis sativa, aka marijuana, and not to any of the numerous other plant fibers also commonly referred to as hemp.)

The campaign to use hemp fiber for paper, biomass, textiles, etc. has largely failed because hemp is neither economically viable nor technically feasible. However, because the handling, storage, and processing of hemp seed is more adaptable to present technologies than for hemp fiber, hemp seed production and products are now being aggressively promoted.

Low THC Cannabis sativa hemp that contains less than .3% (w/w) THC became legal to grow in Canada in March, 1998. THC and the other cannabinoids are found in food and other products made from fiber hemp seed. According to Canada’s national health department, Health Canada, “In theory the ripened seeds of Cannabis contain no detectable quantity of THC. However, because of the nature of the material it is almost impossible to obtain the seeds free from extraneous THC in the form of residues arising from other parts of the plant which are in close proximity to the seeds. Although it is required for the seeds to be cleaned before any subsequent use, the resinous nature of some of the material makes complete cleaning extremely difficult.” [1]

Since THC and the over 60 other cannabinoids are fat-soluble, i.e., store themselves in the fatty tissues of the brain and body, even a very small amount may be damaging, especially if ingested regularly. Fat-soluble substances accumulate in the body.

THC has a half-life of about seven days, meaning that one-half of the THC ingested or inhaled stays in the brain and body tissue for seven days. Traces can stay in body tissues for a month or more. The only important substance that exceeds THC in fat solubility is DDT. [2]

A risk assessment done for Health Canada states that, “New food products and cosmetics made from hemp – the marijuana plant – pose an unacceptable risk to the health of consumers. It also says that hemp products may not be safe because even small amounts of THC may cause developmental problems. “Those most at risk,” the study says, “are children exposed in the womb or through breast milk, or teen-agers whose reproductive systems are developing.” [3]

“Hazards associated with exposure to THC include acute neurological effects and long-term effects on brain development, the reproductive system and the immune system,” the study says. “Overall, the data considered for this assessment support the conclusions that inadequate margins of safety exist between potential exposure and adverse effect levels for cannabinoids (the bio-active ingredients) in cosmetics, food and nutraceutical products made from hemp.” [3]

The study reviewed the results of existing tests on lab animals. Health Canada may require warning labels or new regulations that could stop some products from being sold. It is considering new animal studies to examine the effects of low-level exposure to THC over several generations. [3]

To cast further doubt about safety, the Journal of Immunology (July 2000) recently reported that THC, the major psychoactive component of marijuana (hemp), “can promote tumor growth by impairing the body’s anti-tumour immunity system.” [4]

Another unknown is hemp as forage for animals. According to Stan Blade, a director of crop diversification for Alberta Agriculture, a program that will test hemp over the next year as feed for livestock is being considered in Canada. Forage hemp will be tested on cattle against a more traditional mixture of oats and barley. [5]

Buffalo, the common dairy animal of Pakistan, are allowed to graze on Cannabis sativa (hemp), which, after absorption, is metabolized into a number of psychoactive agents. These agents are ultimately excreted through the urine and milk, making the milk, used by the people of the region, subject to contamination. Depending on the amount of milk ingested and the degree of contamination, the milk could result in a low to moderate level of chronic exposure to THC and other metabolites, especially among the children raised on this milk. Analysis from the urine obtained from children who were being raised on the milk from these animals, indicated that 29% of them had low levels of THC-COOH (THC-carboxylixc acid, which is a major metabolite for THC) in their urine. This study indicates that the passive consumption of marijuana through milk products is a serious problem in this region where wild marijuana grows unrestricted, and that children are likely to be exposed more than adults.” [6]

Hemp use could compromise drug testing. In his book, “Fats that Heal, Fats that Kill,” Udo Erasmus warns that people whose jobs require mandatory drug screening should avoid the use of hemp products, since THC residues in hemp products can show up in urine tests. 7. THC-positive urine tests from hemp product use were also reported in the August 1997 Journal of Analytical Toxicology. 8. For drug-testing reasons, the U.S. Air Force, the Air Force National Guard, the New York Police Dept., and the U.S. Coast Guard have banned the use of hemp foods and health supplements by their personnel. [8. & 9]

“Dr. Hugh Davis, Acting Head of Microbiology and Cosmetics at Health Canada, is quoted as saying that he has been looking at studies on hemp and has found research showing hemp (i.e., fat soluble cannabinoids) is accumulative in the body because of its long half-life and has the same adverse physiological (but not hallucinatory) effects that smoking marijuana does. One study states that cannabinoids may postpone puberty. There are 60 known cannabinoids, only three of which have been widely studied. This means that the potential harmful aspects of the remaining 57 cannabinoids, when used in a cream or shampoo, are unknown.” [10]

John Bailey, Microbiology and Cosmetics Division, US-FDA, (US-Federal Drug Administration) is concerned as well, stating that there is no definitive information about THC in food and cosmetics. [10]

Dr. Mohmoud ElSohly, Ph.D., Marijuana Project Director, NIDA (National Institute of Drug Abuse), states that “Fiber hemp can have significant potential for narcotic application….The threshold THC concentration (below which Cannabis would have no significant psychoactive properties) has not been determined.” [11] [Emphasis added] Dr. Roy H. Hart, Clinical Psychiatrist and research chemist (ret.), asserts that it is possible to experience chronic intoxication without being high. [12]

In addition to THC, there are other bioactive, but non-psychoactive, cannabinoids [cannabinol (CBN), cannabidiol (CBD), and cannabigerol (CG)] in Cannabis sativa marijuana(hemp). [13] David West, Ph.D., pro-hemp activist (HI), claims that CBD blocks the effects of THC in the nervous system. [14] However, Dr. Carlton Turner, Director of the Federal NIDA Marijuana Project (1970-1981) and former US Drug Czar (1980s) counters that “CBD is abundant in hashish and if CBD blocked THC’s action, why would hashish be so popular? I know of no known definitive study that shows that CBD blocks THC’s affects. Fiber cannabis is rich in CBD with little THC. However, naive users can sometimes get high but regular users will not.” [15]

The non-psychoactive cannabinoids may be even more toxic than THC. According to Dr. Roy Hart, “Cannabidiol (CBD) exerts an important effect on the hippocampus which is part of the limbic system of the brain, a collection of inter-functioning units concerned with emotion. CBD produces a depression of hippocampal function…Thus far experimental evidence indicates that CBD is even more toxic to tissues than THC.” [16] [Emphasis added] Dr. Gabriel Nahas, Research Professor, New York University, states that cannabionids other than THC (CBN and CBD) also impair dividing cells, and “are even more potent than THC when it comes to inhibiting DNA production.” [17]

Dr. Hart further states that “Both the psychoactive and non-psychoactive cannabinoids occurring in nature interfere with protein synthesis, deoxyribonucleic acid (DNA) synthesis, and ribonucleic acid (RNA) synthesis. This is without doubt the most important statement to be made about marijuana(hemp) and is based upon the burgeoning literature of basic and applied research into cannabis. Cell-tissue-organ damage follows inevitably from these alternations occurring at the molecular level.” [18]

Longtime and internationally renowned Cannabis researcher, Dr. Gabriel Nahas says that research has shown that the most serious adverse consequences of consumption of THC and other cannabinoids have been observed at the earliest state of reproductive function, on the “gametes” or germ cells of man. These drugs cause damage to the genetic information contained in DNA, causing apoptosis (programmed cell death and deletion). This threatens future generations before they are conceived. [19]

A 1996 study conducted in the Ukraine (formerly Russia) showed that there are no varieties that completely lack(ed) cannabinoids. A rather high content of these substances (cannabinoids) was found in some varieties. The results obtained have shown that hemp cultivated in more northerly areas is naturally rich in cannabinoids. [20]

European Union (EU) hemp regulations for the year 2000 state that hemp subsidies will be paid on condition the farmer uses certified seed of hemp varieties with a THC content of less than 0.3%. From the years 2001/02, that upper limit will be lowered to 0.2%. [21]

The European Union (EU) too is concerned about any inclusion of hemp products’ in food, stating in their regulations, “…Hemp seed has one traditional but limited application as food for fish and birds. The oil from hemp seed can be used for specialist cosmetics applications. The use of hemp seed or the leafed parts of the plant for human consumption would, however, even in the absence of THC, contribute towards making the narcotic use of cannabis acceptable and, in any event, there is no nutritional justification for this. [Emphasis added] None of these products should be encouraged in their own right by Community aid….Moreover, the International Narcotics Control Board (INCB, a United Nations body) states that: ‘while illicit cannabis cultivation (sic) have soared, a considerable market for food products and beverages produced with cannabis has developed in the European Union (…). The health effects of these products have not been adequately researched.’(…) [Emphasis added] The wide and unrestricted availability of such products in shops, where cannabis candy bars can be sold to minors without restriction, contribute to the overall benign image of cannabis, a drug under international control.” [OICS note of 12.3.1999.] [21]

“It is therefore important to remain vigilant and step up controls to ensure that illegal crops do not tarnish the reputation of the sector producing hemp for fibre. To avert such dangers, the cultivation of hemp for fibre must be strictly controlled, which means the area cultivated will have to be restricted, and the uses to which it is put must NOT include human nutrition.” [Emphasis added] These EU regulations apply from July 1, 2000. [21]

The findings of the previously mentioned Health Canada THC Assessment are quite alarming from a consumer health and safety standpoint. Two key areas of health hazards to humans were reviewed, and the potential for risks from consumption of hemp products was characterized. [22]

One health area was neuroendocrine disruption during developmental states (perinatal, pre-pubertal and pubertal) that leads to permanent adverse effects on the brain and reproductive systems. The second area was neurological impairment manifested as deficits in cognitive and motor skills’ performance. [22]

The study could not, due to data gaps, develop definitive conclusions regarding the degree of potential risk from ingesting THC through hemp products. However, even without considering the bio-accumulative hazard potential of THC through repeated or multiple-product use, or the risk from chemicals other than THC in Cannabis sativa hemp, it nevertheless came to the following conclusions:

CHARACTERIZATIONS OF RISKS FROM THC
IN HEMP PRODUCTS FOR HUMAN USE & CONSUMPTION
HEALTH CANADA STUDY (DRAFT of November 23, 1999)

*Developing fetus, nursing infant, and prepubertal/pubertal child are at greatest risk of long-term effects. THC is rapidly transferred from mother to fetus within minutes of exposure. THC accumulates and is transferred via breast-milk. [22]

The in-depth Health Canada Risk Assessment on THC and Other Cannabinoids (in products) Made with Industrial Hemp (11/23/99) warns “On the basis of currently available data it is concluded that the present Canadian limit of 10ug/g (i.e.,10 ppm) THC in raw materials and products made from industrial hemp (Cannabis sativa cultivars with less than 0.3% THC) would likely not protect the Canadian consumer using industrial hemp-based food, cosmetic and personal care, and nutraceutical products from potential health risks of neurological impairment and neuroendocrine disruption associated with low level exposure to THC and other cannabinoids.” [22]

In the United States even salad oils must be examined and certified by the US-FDA as “generally recognized as safe.” This has not been done for hemp.

Allowing or introducing toxic chemicals in our food and cosmetic systems through use of THC-containing industrial hemp products is unthinkable. To do so would jeopardize public health and safety. U.S. citizens and government agencies and officials should do everything possible to prevent this from happening, thus protecting future generations from both known and unknown health and genetic hazards.

REFERENCES: THC in Food and Cosmetics

1. Industrial Hemp Technical Manual, Health Canada, Standard Operating Procedures for Sampling and Testing Methodology Basic Method for determination of THC in hempseed oil, 1998.

2. Hart, R.H.: Bitter Grass, The Bitter Truth About Marijuana, April 1980,13-14.

3. Mcilroy, A.: “Health Canada study says THC poses health risk,” Globe and Mail, Ottawa Canada, July 27, 1999.

4. Zhu,LX., Sharma,S., Stolina,M., Gardner,B., Roth,MD., Tashkin,DP., Dubinett,SM., -9-Tetrahydrocannabinol Inhibits Antitumor Immunity by a CB2 Receptor-Mediated, Cytokine-Dependent Pathway, The Journal of Immunology, 2000, 165: 373-380.

5. “Alberta Farmers Slow To Try Growing Hemp,” Calgary Herald, Calgary Canada, August 14, 1999.

6. Ahmad, GR; Ahmad, N., “Passive consumption of marijuana through milk: a low level chronic exposure to Delta-9-tetrahydrocannabinol (THC)., Journal of Toxicology, Clinical Toxicology, 1990,28:2,255-260;ref.

7. Erasmus, U., Fats that Heal, Fats that Kill, Alive Books, 1993, p. 287.

8. Pulley, J., Air Force Snuffs Out Hemp-Seed Extract, Air Force Times, 2/8/99.

9. Cooper, M., New Police Policy Takes On Hemp Oil!, New York Times, 7/22/99.

10. Begoun, P., “Hemp Claims Can’t be Confirmed,” Tampa Tribune (FL), February 4, 2000.

11. Report to the (KY) Governor’s Hemp and Related Fiber Crops Task Force, June 13, 1995, Letter from Mahmoud A. Elsohly, Project Director, NIDA, Marijuana Project, University of Mississippi, to Prof. M. Scott Smith, Ph.D., University of Kentucky College of Agriculture, 1995.

12. Hart, R.H.: Bitter Grass, The Bitter Truth About Marijuana, April 1980, p 17

13. Ibid, p 17.

14. West, DP., Hemp and Marijuana: Myths & Realities, North American Industrial Hemp Council, Inc., 1998, p5.

15. Personal Correspondence from: Carlton Turner, Ph.D., Carrington Laboratories, Inc., Irving, TX., March 22, 1999, to: Jeanette McDougal.

16. Hart, R.H.: Bitter Grass, The Bitter Truth About Marijuana, April 1980, p 18.

17. Nahas, GG, M.D., PhD., D.Sc., Keep Off The Grass; Paul S. Ericksson, Publisher, 1990, p148

18. Hart, R.H.: Bitter Grass, The Bitter Truth About Marijuana, April 1980, p 17.

19. Nahas, GG, M.D., PhD.,D.Sc., Keep Off The Grass; Paul S. Ericksson, Publisher, 1990, p282. and Stedman’s Medical Dictionary, Lippincott Williams & Wilkins, Baltimore 2000.

20. Virovets, V.G.: Selection for Non-Psychoactive Hemp Varieties (Cannabis sativa L.) In the CIS (former USSR), 1996, Journal of the International Hemp Association 3(1): 13-15.

21. Community preparatory acts, Document 599PC0576(02): Http://europe.eu.int/eur- lex/en/com/dat/1999/en_599PC0576_02.html

22. Tetrahydrocannabinol (THC) and Other Cannabinoids in Foods, Cosmetics and Nutraceuticals Made with Industrial Hemp – A risk Assessment – (Draft) Prepared for Health Canada, November 23, 1999 (available through Access of Information, Canada). Final Report due fall of 2000, available through Health Canada.

Source: www.drugwatch.org/resources Aug.2000

Introduction

This essay is about the drug problem in society, particularly in the United States. By “drug” I mean alcohol, tobacco, and illegal drugs such as marijuana, hallucinogens, stimulants, depressants, and opiates. In regard to youth, inhalants (household chemicals inhaled to get a “high”) are also included.

This is not about the struggles faced by individuals who are addicted, or who struggle with any of the many life problems that can arise from drug use. Others are well addressing those issues in the treatment programs they offer and the publications they write. That society should be more diligent in ensuring availability of treatment for all who need it has been well stated by others. This essay is not about people’s drug problems so much as society’s drug problem.

The problem is that drugs are significantly decreasing our collective quality of life: decreasing our capacity to solve the problems that we collectively face in living. Whether you turn to issues of economics, health, social justice, family life, or the strength of the work force, the magnitude of the damage done by drugs is striking:

• The number of deaths due to drugs in the United States alone each year exceeds 400,000 from tobacco, 100,000 from alcohol, and 35,000 from other drugs.
• The most recent estimate of cost to U.S. society (not to users) of alcohol and other drug abuse was 246 billion dollars: 148 billion from alcohol abuse and 98 billion from other drug abuse.
• A large percentage of health problems and health care costs are due to alcohol or other drugs.
• Substance abuse in a single year costs American businesses 37 billion dollars due to premature deaths and another 44.6 billion dollars due to employee illness. Drug dependence and alcohol together cost businesses 200 billion dollars. A majority of the alcohol problems are caused by light and moderate drinkers, rather than alcoholics.
• A high percentage of child abuse and neglect is associated with parental AOD (alcohol or other drug) abuse.
• A recent study of teen marijuana users found they were 4 times more likely than non-users to attack someone, 3 times more likely to destroy others’ property, and 5 times more likely to have stolen things.
• The combination of alcohol-related accidents, assaults, and suicides makes alcohol the leading risk factor for adolescent death and injury.

Whether or not you have directly experienced a drug problem in your life, society’s drug problem is shared by all of us. Most of the people who are aware of the impact of drugs on families and other relationships would argue forcefully one person’s drug use hurts more than just that person. The issue may be debatable in the case of any single individual, but collectively there can be no doubt: the drug problem is a problem for all of us.

In the twelve years I have worked in drug prevention, I have learned a lot about how drug use develops, and how it can be prevented. I have discovered that there is tremendous energy and potential in drug prevention, but progress has sometimes been slow, for good reason. The reason is that the general public, and in some cases even prevention professionals, hold some core assumptions about the drug problem that are actually incorrect. As a result, much of the effort put into prevention strays slightly, but significantly, from what is needed.

This essay is an attempt to identify, describe, and correct those faulty assumptions. This is not a “how to” book on prevention. I have written such a book (Best Practices in ATOD Prevention, 1997), with much help. But having the right tools are not enough to become a builder. To be successful with “how to,” you have to start with, “what’s that?” This essay is about understanding the drug problem: what causes it and what is needed to stop it. The application of this knowledge is up to each reader. I hope you find some valuable insights here, or perhaps find support for some of your own observations.

I am convinced that if we stop going down dead-end streets, we can really get places in prevention. Thanks for letting me share the results of my explorations in drug prevention.

Fallacy #1: The primary target of drug prevention should be hard-core drug abuse.

This fallacy has three main parts: (a.) which drugs are the problem, (b.) which drug users are the problem, and (c.) the relation of addiction to drug abuse.

a. “Shouldn’t crack, speed, and heroin be our number one concern?”

No. Ounce for ounce these drugs are certainly among the most potent, but they are (or should be) of secondary concern to drug prevention because of the developmental nature of drug abuse, the limitations of prevention, and the greater amount of societal problems associated with other drugs.

Development of Drug Abuse

It is exceedingly rare for an adult who has never used any drug to use drugs like cocaine or heroin. Nearly as rare is a youth or adult who uses one of these drugs without a history of use of at least one, and often all three, “gateway” drugs: alcohol, tobacco, and marijuana.

Don’t misunderstand the gateway drug phenomenon: obviously not all people who use alcohol, tobacco, or marijuana progress to other drug use. But, the odds of other drug use depend on gateway use because those who don’t use gateway drugs are so extremely unlikely to use other drugs.

The gateway phenomenon includes two other notable features in addition to the issue of whether or not gateway drugs are used. One is that the younger a person is when they begin gateway use, the greater their likelihood of drug problems (with gateway and other drugs) later in life. The other is that people who use two or three gateway drugs are more likely to progress to other drugs than people who use one (use of all three is most significant).

So alcohol, tobacco, and marijuana are truly “gateways” to other drug use. Although most of the people who go through the gate don’t do on to other drug use, nearly everyone who goes on to other drugs passes first through the threshold of gateway use. This alone doesn’t conclude the case for where to direct drug prevention, but sets the stage for two other two facts.

Limitations of Prevention

Prevention is just one of the major strands of anti-drug efforts. The other two are treatment and legal restrictions (regarding use, possession, and sale of drugs). To a great extent the target population for prevention and the target for treatment are opposite. By the time people go through gateway use and begin using other drugs, they have become (due to some combination of self-selection and the results of earlier gateway use) fairly habituated to drugs. In many cases they are already addicted. The habit formed from regular drug use is hard to break. When addiction is also present, the strong forces involved are not only psychological but also bio-chemical. We like to think our minds are in control, but addiction can rule behavior at a level so deep and powerful that rational thought pales in comparison.

As a result, prevention efforts that may be appropriate for youth who are non-users or experimenters with drugs are simply not effective with more committed users, and certainly not with addicts. Addiction calls for drug treatment: prevention is inadequate for those trying to back away from heavy drug use.

On the other hand, treatment is not appropriate for first-time experimenters. The treatment process is not designed for that population, and the cost of providing such intensive services is neither justified for the individual drug experimenter nor remotely available for the whole population of experimenters. For them and for those who are yet to experiment, prevention is the key.

Of those who use gateway drugs, some require treatment (or cessation aid, in the case of tobacco), but most do not. Of those who use other drugs, a large proportion requires treatment, and few would benefit from prevention. This strengthens the case for targeting gateway drugs in prevention, and leads to the third point.

Societal Cost of Gateway Drug Problems

Recall that ounce per ounce, gateway drugs are not as destructive as crack, crank, and heroin. But the scope of any one drug’s impact on society depends on the amount of use (including number of users and degree of use by each) as well as the drug’s dangers. Unlike crack and heroin, gateway drugs are used by a large portion of the population. And, though gateway drugs seem less dangerous than so called “hard” drugs, research and bitter experience have shown that the gateway drugs are dangerous enough:

• Tobacco kills four times as many Americans as does alcohol, and alcohol kills three times as many as all illegal drugs combined.
• Alcohol seems to be the leading cause of teen deaths, based on the high percent of instances in which alcohol is a major factor in car crashes, suicides, homicides, drownings, and other unintended injuries.
• Marijuana combines the cancer potential of tobacco with the cognitive impairment of alcohol, except that impaired thought lasts longer after each marijuana use than after each alcohol use.

As a result, the benefit to society of cutting gateway drug use in half would be much greater than cutting other drug use in half. Combine this point with the point about prevention’s limits and the point about the development of drug abuse, and you get a strong case for making gateway drug use (particularly by youth) the prime target of prevention.

b. Shouldn’t prevention always target “high risk” youth?

No. Although it may be appropriate to devote extra preventive effort to some groups of youth, conceiving ATOD prevention in only those terms is problematic for reasons that include the breadth of risk, the importance of environmental risk, and the need for different approaches according to the nature of different risk conditions.

Breadth of Risk

While some characteristics act as “risk factors” for youth ATOD use, the absence of those risk factors doesn’t guarantee a drug-free youth. To some extent, everyone is at risk. The older a persons gets without using, the lower the risk that they will use. Furthermore, while the primary aim of ATOD prevention is to prevent use, an important secondary function is to help prepare all youth for addressing the drug problem in society: as family members, co-workers, or citizens. We are currently a society at risk.

This is not to say that community risk conditions shouldn’t be considered, nor that “selective” ATOD prevention efforts can’t be done for groups of medium risk youth or families. I use the term “medium risk” to refer to youth who haven’t begun ATOD use, but whose family or personal characteristics include some risk factors (e.g., poverty, low academic achievement, parental drug use or addiction, etc.) for youth ATOD use. But these efforts are a supplement to prevention efforts for all youth, rather than a replacement.

Environmental Risk

Preoccupation with risk profiles of individual youths, or even groups of youths, diverts attention away from the strongest influences of whether most youth will try drugs or avoid drugs. The combination of youths’ peer social environment, family environment, school environment, media environment, and their community’s adult social environment account for the vast majority of variation in youth drug behavior. A “low risk” youth who enters a “high risk” environment (e.g., a “no-use” youth who moves to a school where drinking is the norm) is no longer low risk.

Prevention planners who only look at what’s “inside” youth can miss the environmental factors (including media influences) that shape youths’ attitudes. If not directly addressed, these environmental factors can misdirect youths’ attitudes and behaviors as fast or faster than youth-focused programs can positively affect them.

Different Risks – Different Approaches

The risk factor that is most important to the largest number of youth in regard to initiation of gateway drug use is their perception of peer attitudes about drugs, as will be discussed in regard to “Fallacy #3.” However, for a smaller number of youth other factors play a major role. For example, children raised in households with parental violence, neglect, or addiction are more likely than average to develop their own problems with alcohol or other drugs. The number of children in this kind of situation, though much larger than it should be, is small compared to the overall number of children and families.

For a child in a household with parental violence (domestic violence and/or child abuse), what happens to that violence may be the most important “risk factor” for their future mental health, including their relation to drugs. Their greatest need may have little to do with drug prevention, and everything to do with appropriate resolution of the violence.

For a youth failing school, the greatest need may be assistance with whatever is interfering with school achievement.

In each case, the most effective form of drug prevention may be to resolve the problem(s) that increase risk for drug use, rather than to directly address the issue of drugs. On the other hand, a youth who has started to experiment with drugs may need intervention services, sometimes called “indicated prevention”, but actually more closely akin to some forms of substance abuse treatment counseling. In all these instances, the kinds of programs that constitute “universal” drug prevention programs may be less relevant. So, these kinds of “high risk” youth need more focused and intensive assistance than is available through what I am calling drug prevention, i.e. programs designed to impact the gateway drug attitudes and behaviors of large groups of youth. They may be helped somewhat by such programs, and so should not be excluded, but to limit participation in prevention programs only to such “high risk” youths is probably not appropriate, particularly given the risk of a norm of gateway drug use arising among program participants if all are “high risk.”

c. Isn’t addiction prevention the main goal of substance abuse prevention?

No. Addiction is one major outcome of drug use, but the impairment of rational thought, the plethora of anti-social and injurious behaviors caused or heightened by that impairment, and the direct toxic effects of drugs are all substantial societal problems worthy of prevention. Addiction increases these other problems, but a person need not be addicted in order to seriously injure of kill themselves or others while impaired, typically due to negligence (as in DUI crashes) rather than violent intent.

Further, since the number of alcohol or other drug users at any given point in time far exceeds the number of addicts (including alcoholics), the societal damage done by non-addicted persons can cumulatively exceed the damage done by addicts. Even though individual addicted persons are more problematic to society than individual non-addicted AOD (alcohol and other drug) users, the much larger number of non-addicted users makes them a major part of societal AOD problems.

Efforts to make the public more aware of realities of addiction should continue, but preventing addiction is one main goal of drug prevention: not the main goal.

Fallacy # 2: Alcohol and other drug problems are mainly a result of other problems, and drug prevention can best be accomplished by addressing those other problems.

Drug abuse has multiple causative factors: this has become an oft stated truism. Unfortunately, people tend to notice and magnify the causative strand that is most evident in their personal or professional experience. Their observations are strengthened by studies which demonstrate the connection between each of a variety of “risk factors” and drug abuse, but which fail to consider the larger context of the societal drug problem, including which of the many risk factors play the most important roles within the largest numbers of people. Rather than starting with convergence on the most prevalent and powerful risks, people therefore tend to diverge into various less central issues:

• Persons who focus on poverty see poverty as the main root of drug problems.
• Persons concerned with stimulating positive youth development see their work as the best form of drug prevention.
• Persons familiar with dysfunctional family systems see family dysfunction as the main root of drug problems.

Attention to this whole range of negative factors may be appropriate, but mistaking any one of these for the “main” cause of drug problems is not. One person or subgroup may be profoundly influenced by one of these factors, but the prevalence of each factor in the population is far less than the prevalence of drug problems.

Family Dysfunction: Major dysfunction (such as family violence) greatly heightens the chance of youth drug problems, but the majority of youth AOD users (and hence, most of the future AOD abusers) do not come from dysfunctional families. Dysfunctional family life is a potent risk factor but not a prevalent one, in comparison to the scope of youth AOD problems.

Poverty: Poverty makes drug problems more likely, but only slightly more likely: a large number of well-to-do people are among those who children use and abuse alcohol and other drugs.

Positive Youth Development: Policies that empower youth development are a good idea, but aren’t sufficient to prevent youth drug use. The notion that positive youth development can substitute for specific attention to drug prevention is similar to the 1970’s notion that good self-esteem is the key to drug prevention. Unfortunately, ignoring drug prevention in favor of self-esteem tends to produce drug users with high self-esteem. Self-esteem doesn’t protect from the destructive effects of drugs. Youth development programs can be an important aid for youths who lack key developmental assets, but will only impact drug use if:

1. anti-drug norms are already present in the lives of those youth, or
2. the youth development program includes building anti-drug norms as part of its mission.

Two kinds of problems arise from the mis-attribution of heightened importance of these factors as causes of substance abuse:

1. More global causes of ATOD problems, such as youths’ and parents’ attitudes about drug use, may be glossed over in the design of prevention strategies. In other words, potentially efficacious approaches to prevention may be ignored in favor of less broadly effective approaches.
2. Parents may believe that avoiding family dysfunction is sufficient to prevent youth drug problems.

The worst instances of this fallacy in action have parents or other adults allowing and enabling youth alcohol or other drug use under the misguided notion that only troubled individuals abuse substances. Statements like, “It’s no big deal,” or “They’re just going through a phase,” or “It’s part of growing up” tend to be evidence of this. While it’s true that troubled youth are more likely to develop a drug problem, also true is that alcohol or other drug use can cause a person to become troubled – especially if addiction is involved.

Youth alcohol and other drug use is a bad idea no matter how positive an individual’s circumstances. Youth with substantial personal or family problems are more likely to experience significant problems with drugs, but the initial absence of personal disturbance is no insurance policy against addiction or other ATOD problems. And, although family problems constitute a risk factor for youth ATOD use, family wellness is not a sufficient protective factor to counter other negative influences on youth ATOD decisions. Parents who don’t have general problems with family management can take steps (particularly in regard to monitoring youth activities) to decrease their children’s likelihood of ATOD use, but just being a “good” parent isn’t a cure-all. Drug prevention needs to go beyond the foundation of healthy families and positive youth development, to build attitudes and behaviors that especially counter ATOD influences in society.

Fallacy #3: The main essence of successful drug prevention is communication about the dangers of drugs.

This very common misperception probably sidetracks more prevention efforts than any other single error. Actually the essence of success in preventing youth use of gateway drugs is making drug use unpopular: destroying the myth that peers approve of drug use. This can be supplemented by fact-based approaches and parent programs, but the most basic reason youth as a whole start gateway drug use is because they believe their peers approve of it. No matter how dangerous they are told drug use may be, if they think many others are doing it they will tend to do the same, unless they consistently see very negative effects on those believed to be using.

There are two reasons I see for the continuing strength of Fallacy #3 in spite of evidence to the contrary. The first is our nature as human beings. We like to think we are logical, sensible beings. To some extent we are, but most of us, and especially children and youth, base our actions first on what we observe from those around us, and only secondly on what we believe.

Remember that we are talking about society as a whole here: there are certainly some people who are less prone to be influenced by others (psychology calls them “field independent” as opposed to field dependent), and all of us vary in our susceptibility. But as a whole, we’re just not as logical as we like to think. To be human is to be influenced by our observations of others.

The second reason for the fallacy is a more complex one having to do with the nature of scientific studies of youth alcohol and other drug use. Common scientific method in the social sciences involves looking for things that go together in large populations. The question is what “factors” tend to go with, and particularly to predict, youth ATOD use. A basic premise is that correlation does not necessarily equate to causation, especially in cross-sectional one-time studies. However, when a factor such as “perception of harm” is closely matched with drug use over a period of years, as has been the case in the national “Monitoring the Future” study, observers are hard pressed to ignore the likely conclusion that changing perception of harm is the key to prevention.

The problem is, how does one change perception of harm? The common assumption is that you do this by communicating drug dangers. Often overlooked is that there is an equally strong association with perceived peer approval or disapproval for use of drugs: what youth believe their peers think of drugs. I think that, contrary to common assumptions, the perception of peer attitude drives youths’ own attitudes about drugs (both perceived harmfulness and intent to use). Perception of harm then ends up being a strong indicator of whether a youth will use a drug, especially because it is probably also affected by other risk factors. But the route to turning around perception of harm usually has to go through perceptions of peer approval/ disapproval. When we present logical facts about drug dangers to youth, if they think most of their peers approve of drug use, and indeed use drugs, then the warnings seem ungrounded and are easily ignored.

I base this point on a variety of research, but some of the most striking and easiest to communicate is research about what works in prevention. Of all the things that have been tried in prevention curricula for young teens, the most powerful is simply to correct their typically exaggerated assumptions about how many peers use drugs. When they are shown that far fewer than thought peers use, their attitudes change to a degree not seen with mere truth about drugs.

This is not to say that education about drug dangers is not important for youth: it is! These facts back up the facts about peer attitudes, and may be especially important for some youth who are able to base their behavior on rational truth about drug dangers. Even if this weren’t the case, it would simply not be right to let youth grow up in this society without exposing them to the truth about drugs. But to assume that exposure is the key element of prevention is to severely limit the effectiveness of one’s prevention efforts.

One of the important implications of this is that the images presented by mass media, especially in regard to images of youth attitudes and behaviors, should be a vital concern of prevention. We all like to think that we are too sophisticated to be influenced by the images of television and other media, but it’s just not so. We are influenced. That’s why advertising works. While any one youth may be more influenced by their parents than by the media, youth as a whole are dramatically influenced (as has been demonstrated by studies showing that youth smoke those cigarette brands that are most heavily advertised to youth). Media plays the role of a “super-peer,” playing directly into the heart of youth decisions by telling them what is cool and what isn’t. Prevention cannot afford to ignore this. Luckily, the same principles currently used by alcohol and tobacco advertisers to snare youth users can also be used in prevention. But, first we have to get past this fallacy that drug facts are the key.

Fallacy # 4: Making and enforcing laws against the use of drugs, and against underage use of alcohol and tobacco, is contrary to prevention and treatment of drug use.

This premise has been advanced by legalization groups, claiming all would be well if we did away with laws against drug use and relied solely on prevention and treatment. But the truth is that prevention, treatment, and legal barriers to use all depend on each other for effectiveness. The kind of “prevention” touted by legalization groups is not prevention of use but facilitation of “safe” use, called “harm reduction.” The role of prevention in this scenario is to teach people how to use drugs safely. The problem with this is that the laws against each particular drug are enacted because its use is inherently unsafe. An analogy would be explosives manufacturers lobbying to take the funds used to enforce laws against possessing bombs and instead just teaching youth how to use them “safely,” and of course not until they were 18 or 21. Would the public stand for that? Would even the most avid libertarians be crazy enough to support it? Legalizers suggest that drugs hurt only the user, but impacts of our society’s drug problem go far beyond the circle of users, as was discussed earlier.

Even if, after legalization, the current drug-free message of prevention were maintained, a country that tolerates drug use would be giving a strange message that would undercut any such “no-use” message. “Drugs are dangerous and hurt society, but you can go ahead and do them if you want.” Use would soon rise, not so much from drug-free adults starting use but from every new generation of teens becoming more and more enmeshed in drug use, in spite of any legal age restrictions. This is what has happened when legalization has been tried. Similarly, the number of people entering treatment, cooperating with treatment, and avoiding relapse would be far less without the force of law to compel users to quit.

High quality drug prevention and treatment are currently vital to our society, but their success would be lessened, not increased, if legal sanctions against use were eliminated. The specific workings of the legal and criminal justice system in regard to drug use can always be examined for improvement, but most groups who currently call for drug law “reform” are using the term as a euphemism for legalization.

Fallacy # 5: Marijuana is not dangerous.

We tend to think of drugs as poisons to the body, and measure the potency of a drug by how fast and how completely it can interfere with physical health. We are less quick to recognize that the most crucial characteristics of drugs are their “psychoactive” effect: their alteration of thought, feelings, and behavior. Measured by physical effects only, marijuana is not as dangerous as many other drugs (though it has the potential to kill as many people as tobacco does, if it were as popular as tobacco). But, examined for its behavioral effect, marijuana is quite potent. The subtlety with which it alters behavior, typically over a period of weeks or months, makes it all the more effective as a behavioral change agent. The data that has begun to emerge as younger teens and pre-teens smoke more potent marijuana shows a devastating effect on the social functioning of many users. Some users may have been self-centered when they began use, but marijuana heightens that characteristic, killing the empathy and capacity for altruism that embody the best qualities of society. What is left is a person addicted to marijuana and concerned about marijuana, but not so much about relationships, achievement, or even obeying the law. People sometimes discount the effects of marijuana because many users do not seem to be greatly impaired, but the luck of some in warding off clear impairment is a poor balance to the studies and accumulated life experiences of those who have been severely changed by marijuana use.

Fallacy # 6: Anti-drug laws and anti-drug law enforcement is driven by national bureaucracy and the zealousness of federal officials.

People who travel in a sub-culture of drug tolerance tend to perceive the government’s anti-drug actions as being out of touch with the populace, but polls show that a large majority of the American (and other) public opposes drug legalization. The greatest passion in favor of enforcing drug laws comes not from any government but from families that have seen the worst that drugs do. The proper balance between society’s interest in stopping drugs and the freedom of individuals becomes clear when one has witnessed a family or community ravaged by drug use and addiction. The social value of drugs is far below zero. Any loosening of restrictions on drug use has tended to lead to a cycle of increased use, increased damage to society, and a resulting determination to toughen enforcement of laws against drug use. Ultimately, the source of calls for strict enforcement of laws against drugs come not from any one group but from the power of drugs to damage people, and damage society.

Alan Markwood is the Prevention Projects Coordinator at Chestnut Health Systems, Inc. in Bloomington, Illinois. Responsibilities include:

• Participating in prevention research, development, and training projects as a contractor to the Illinois Department of Human Services.
• Directing prevention coalitions in three counties, funded by the federal Center for Substance Abuse Prevention and the Illinois Department of Human Services under grants he wrote.

Mr. Markwood is the principal author of the Best Practices in ATOD Prevention Handbook (1997), and has managed a series of statewide studies on youth substance use in Illinois. He served as InTouch Area 14 Prevention Coordinator at Chestnut Health Systems from 1987 until promoted to his current position in 1995. Prior to his work in prevention, he worked as a School Psychologist for seven years in Illinois and Massachusetts. He has a Master of Arts degree in Psychology from Alfred University and a Certificate of Advanced Graduate Study in Education from Boston University.

Source: www.drugwatch.org Sept.1999

Law enforcement officials in Florida say use of the synthetic drug known as “flakka” is surging there, ABC News reports.

The drug, also called gravel, is available for $5 a vial or less, the article notes. Officials say people are ordering small quantities of flakka through the mail. Its main ingredient is a chemical compound called alpha-PVP.

According to the National Institute on Drug Abuse (NIDA), alpha-PVP is chemically similar to other drugs known as “bath salts,” and takes the form of a white or pink crystal that can be eaten, snorted, injected, or vaporized in an e-cigarette or similar device.

Vaporizing, which sends the drug very quickly into the bloodstream, may make it particularly easy to overdose, NIDA notes. Alpha-PVP can cause a condition called “excited delirium” that involves extreme stimulation, paranoia, and hallucinations that can lead to violent aggression and self-injury. “The drug has been linked to deaths by suicide as well as heart attack. It can also dangerously raise body temperature and lead to kidney damage or kidney failure,” NIDA explains on its website.

The laboratory of the Broward Sheriff’s Office in Fort Lauderdale reports 275 flakka submissions already in the first three months of 2015, compared with fewer than 200 in all of last year.

Flakka makers are continually changing the chemical makeup of the drug, and often mix it with other substances such as crack cocaine or heroin, according to Don Maines, a drug treatment counselor with the Broward Sheriff’s Office. In as little as three days of use, a person’s behavior can undergo striking changes, he said.

“It actually starts to rewire the brain chemistry. They have no control over their thoughts. They can’t control their actions,” Maines said. “It seems to be universal that they think someone is chasing them. It’s just a dangerous, dangerous drug.”

Source: drugfree.org 5^th May 2015

The impact that so-called medical marijuana and later the legalisation of marijuana in Colorado, USA has had serious consequences, a few are show in snippets below.  The items shown are taken from the Rocky Mountain High Intensity Drug Trafficking Area Report.  The complete report can be found at:

http://www.rmhidta.org/default.aspx/MenuItemID/687/MenuGroup/RMHIDTAHome.htm.

The Legalization of Marijuana in Colorado: The Impact Vol. 3 Preview 2015 

Medical Marijuana Registry Identification Cards 

December 31, 2009 – 41,039

December 31, 2010 – 116,198

December 31, 2011 – 82,089

December 31, 2012 – 108,526

December 31, 2013 – 110,979

December 31, 2014 – 115,467

Colorado: 

505 medical marijuana centers (“dispensaries”)1

322 recreational marijuana stores1

405 Starbucks coffee shops2

227 McDonalds restaurants3

Denver: 

198 licensed medical marijuana centers (“dispensaries”)1

117 pharmacies (as of February 12, 2015

• In one year, from 2013 to 2014 when retail marijuana businesses began operating, there was a 167 percent increase in explosions involving THC extraction labs.

Findings 

There has been an upward trend of marijuana-related emergency room visits and hospitalizations since medical marijuana was commercialized in 2009.

There has also been a significant increase in both categories in the first six months of 2014 when retail marijuana businesses began operating

It is important to note that, for purposes of the debate on legalizing marijuana in Colorado, there are three distinct timeframes to consider. Those are:

The early medical marijuana era (2000 – 2008), the medical marijuana commercialization era (2009 – current) and the recreational marijuana era (2013 – current).

2000 – 2008: In November 2000, Colorado voters passed Amendment 20 which permitted a qualifying patient and/or caregiver of a patient to possess up to 2 ounces of marijuana and grow 6 marijuana plants for medical purposes. During that time there were between 1,000 and 4,800 medical marijuana cardholders and no known dispensaries operating in the state.

2009 – Current: Beginning in 2009 due to a number of events, marijuana became de facto legalized through the commercialization of the medical marijuana industry. By the end of 2012, there were over 100,000 medical marijuana cardholders and 500 licensed dispensaries operating in Colorado. There were also licensed cultivation operations and edible manufacturers.

2013 – Current: In November 2012, Colorado voters passed Constitutional Amendment 64 which legalized marijuana for recreational purposes for anyone over the age of 21. The amendment also allowed for licensed marijuana retail stores, cultivation operations and edible manufacturers.

Findings 

Youth (ages 12 to 17 years) Past Month Marijuana Use,

2013 o National average for youth was 7.15 percent

o Colorado average for youth was 11.16 percent

Colorado was ranked 3rd in the nation for current marijuana use among youth (56.08 percent higher than the national average)

In 2006, Colorado ranked 14th in the nation for current marijuana use among youth

In just one year when Colorado legalized marijuana (2013), past month marijuana use among those ages 12 to 17 years increased 6.6 percent.

THE methadone programme has failed drug addicts in Clydebank, a leading addictions worker said this week.

Donnie McGilveray is the manager of Alternatives, a West Dunbartonshire charity that helps reform drug addicts, many of them methadone users.

He told the Post the methadone programme used to treat heroin addicts has gone unregulated — and described the green liquid as a “monster” that keeps people hooked for good.

His comments come after shock statistics were released last week showing that Clydebank pharmacies claimed £153,000 for methadone prescriptions in 2014.

Donnie told the Post: “I think methadone is helpful for a small cohort of people, the five to ten per cent of people who are chaotic, suicidal or maybe sex workers being used and abused by people. There is a small group of people who need to be made safe.

“But that’s not what is happening. We’ve got this monster, a jolly green giant, that many, many addicts are stuck on. And again, it’s not just them who are stuck in this it’s the doctors and nurses who have an obligation to keep them safe.”

National data obtained by BBC Scotland showed pharmacists were paid £17.8 million for handling nearly half a million prescriptions of methadone in 2014. In Clydebank, £153,000 was paid to eight pharmacies to deliver 3,165 prescriptions of the heroin substitute. In Dalmuir Lloyds, £31,671 was claimed for prescribing and supervising methadone to addicts in 2014. But topping the chart was Lloyds Pharmacy on 375 Kilbowie Road which received £38,207 in payments. Pharmacists are paid around £2.32 for dispensing every dose of methadone and about £1.33 for supervising addicts while they take it. Chemists pay the wholesale cost of buying methadone from the government money they claim.

Around 60 per cent of the cash they are paid is made up of their handling fee for the drug and their charges for dishing it out to addicts. In 2013, pharmacies claimed back more than £17.9 million from the Scottish Government for handling 470,256 prescriptions of methadone — 22,980 prescriptions more than in 2014.

Donnie also told the Post he believes West Dunbartonshire, which has a long history of drug problems, is making progress tackling addiction. He said: “At the end of the day, the statistics don’t tell you how many people are on methadone or any details of the prescription, but what we can tell is the drug companies are making a killing from it.”

Figures released by the NHS in 2012 revealed that methadone-implicated deaths increased dramatically in cases where the individual had been prescribed the drug for more than a year.

The addictions worker told the Post he believes methadone should be reserved for the chaotic drug users and other substitutes such as Buprenorphine, Subutex and Dihydrocodiene should be implemented. He continued: “Methadone is not just a medical or pharmaceutical matter but a human rights issue. “The dilemma is that if you reduce someone’s methadone they become unstable and could relapse. Some of the people we work with at Alternatives have relapsed, it’s a regular situation.

“If you start to reduce this person they could relapse and relapse significantly, and they might think they can go back onto heroin and inevitably could end up overdosing.”

He added: “That’s my position and I don’t envy the medical side of it in trying to square this problem.”

Top researcher Dr Neil McKeganey, from the Centre for Drug Misuse Research, said the methadone programme “is literally a black hole into which people are disappearing”.

The statistics of methadone prescriptions can be viewed online at:    www.marcellison.com/bbc/methadone

Alternatives is an organisation funded by West Dunbartonshire Council that helps bring recovering addicts back into society. The project has been around since January 1995, firstly covering Dumbarton and the Vale of Leven, latterly broadening out to Clydebank.

Source: http://www.archive.clydebankpost.co.uk/ 7th April 2015

• There is high risk of overdose with flakka, which can lead to violent behavior, hyperthermia and superhuman strength
• The chemical in flakka is similar to a key ingredient in “bath salts,” which were banned in 2012
• Flakka and “bath salts” could be more dangerous than stimulants such as cocaine

(CNN)It goes by the name flakka. In some parts of the country, it is also called “gravel” because of its white crystal chunks that have been compared to aquarium gravel.

The man-made drug causes a high similar to cocaine. But like “bath salts,” a group of related synthetic drugs that were banned in 2012, flakka has the potential to be much more dangerous than cocaine.

“It’s so difficult to control the exact dose [of flakka],” said Jim Hall, a drug abuse epidemiologist at Nova Southeastern University in Fort Lauderdale, Florida. “Just a little bit of difference in how much is consumed can be the difference between getting high and dying. It’s that critical.”

A small overdose of the drug, which can be smoked, injected, snorted or injected, can lead to a range of extreme symptoms: “excited delirium,” as experts call it, marked by violent behavior; spikes in body temperature (105 degrees and higher, Hall said); paranoia. Probably what has brought flakka the most attention is that it gives users what feels like the strength and fury of the Incredible Hulk.

Flakka stories are starting to pile up. A man in South Florida who broke down the hurricane-proof doors of a police department admitted to being on flakka. A girl in Melbourne, Florida, ran through the street screaming that she was Satan while on a flakka trip. Authorities in the state are warning people about the dangers of the drug.

Florida seems to be particularly hard hit by flakka overdoses.

Hall said that there are about three or four hospitalizations a day in Broward County in South Florida, and more on weekends. It is unclear why the Sunshine State is a hotbed for flakka abuse; “it’s a major question in our community,” Hall said.

Cases have also been reported in Alabama, Mississippi and New Jersey.

Flakka, which gets its name from Spanish slang for a beautiful woman (“la flaca”), contains a chemical that is a close cousin to MDPV, a key ingredient in “bath salts.” These chemicals bind and thwart molecules on the surface of neurons that normally keep the levels of mood-regulating neurotransmitters, dopamine and serotonin, in check. The result is to “flood the brain” with these chemicals, Hall said. Cocaine and methamphetamine have similar modes of action in the brain, but the chemicals in flakka have longer-lasting effects, Hall said.

Although a typical flakka high can last one to several hours, it is possible that the neurological effects can be permanent. Not only does the drug sit on neurons, it could also destroy them, Hall said. And because flakka, like bath salts, hang around in the brain for longer than cocaine, the extent of the destruction could be greater.

Another serious, potentially lingering side effect of flakka is the effect on kidneys. The drug can cause muscles to break down, as a result of hyperthermia, taking a toll on kidneys. Experts worry that some survivors of flakka overdoses may be on dialysis for the rest of their life.

Like most synthetic drugs, the bulk of flakka seems to come from China and is either sold over the Internet or through gas stations or other dealers. A dose can go for $3 to $5, which makes it a cheap alternative to cocaine. Dealers often target young and poor people and also try to enlist homeless people to buy and sell, Hall said. These are “people who are already disadvantaged in terms of chronic disease and access to health care,” he added.

It is unclear at this point whether flakka is more dangerous than the “bath salts” that came before it. But it does have one advantage over its predecessor: it has not been banned — yet.

“Flakka largely emerged as a replacement to MDVP [in ‘bath salts’],” said Lucas Watterson, a postdoctoral researcher at Temple University School of Medicine Center for Substance Abuse Research.

Although the Drug Enforcement Administration has placed a temporary ban on flakka, drug makers can work around this ban, such as by sticking a “not for human consumption” label on the drug, Watterson said. It will probably take several years to get the data necessary to put a federal ban on flakka, he added. And a ban can be effective, at least in discouraging potential users.

“The problem is when one of these drugs is banned or illegal, the drug manufacturer responds by producing a number of different alternatives,” Watterson said. “It’s sort of a flavor of the month.”

Source:  http://edition.cnn.com/2015/05/26

Mark Hinkel, a Lexington, Kentucky lawyer, left, was struck by a black pickup truck and killed while participating in a cycling race last Saturday. The driver of the truck told police he had drunk six beers and smoked marijuana before the crash. When hit, Mr. Hinkel was thrown from his bike onto the windshield of the truck and landed in its bed, bleeding but alive.   Apparently unaware that Mr. Hinkel  lay mortally wounded in his truck, the driver continued driving for three more miles before being stopped by police. Mr. Hinkel was taken to the hospital where he was pronounced dead. The driver was arrested and charged with murder, driving under the influence, wanton endangerment, leaving the scene of an accident, and fleeing and evading.   While this death involved marijuana in combination with alcohol, CBS4 investigative reporter Brian Maass in Denver, Colorado has tracked down several deaths caused by marijuana alone.

Daniel Juarez, right, was a high-school student who died in 2012 after stabbing himself 20 times. He had almost 11 times more THC in his blood than the average found in male marijuana users. Mr. Maass obtained Mr. Juarez’s autopsy report never before made public, which revealed Mr. Juarez had 38.2 nanograms of THC in his blood at the time of his death. The level in Colorado that denotes intoxication is 5 nanograms.

Two marijuana deaths received a fair amount of publicity because they occurred shortly after Colorado implemented legalization in 2014.

Levy Thamba Pongi, left, was a 19-year-old Wyoming college student visiting Denver. Friends said he began acting crazy after eating six times the recommended amount—one-sixth—of a marijuana-infused cookie. He started upending furniture, tipping over lamps, then rushed out to the hotel balcony and jumped to his death. The coroner listed marijuana intoxication as a significant factor in his death. A toxicology report showed he had 7.2 nanograms of THC in his blood.

Kristine Kirk of Denver, right, called 911 to report that her husband was acting erratically after eating marijuana edibles. While on the phone with police, her husband shot and killed her in front of their three children. Mr. Kirk is charged with her murder and has pled not guilty. His lawyer may argue Mr. Kirk was not responsible for his actions due to “involuntary” intoxication, according to news reports.

Brant Clark, left, a 17-year-old Boulder, Colorado high-school student, committed suicide eight years ago. His mother is convinced his death is due to marijuana. She says her son consumed a large amount of marijuana at a party and then suffered a major psychotic break that required emergency care at two hospitals over the next three days. Three weeks later, he took his own life, leaving behind a note that said, “Sorry for what I have done. I wasn’t thinking the night I smoked myself out.”

Tron Doshe, right, returned from a Colorado Rockies game in 2012 but apparently lost his keys. He attempted to climb the outside of his apartment building to reach his balcony but fell to his death, which was ruled an accident. Mr. Maass obtained his autopsy report, which revealed that Mr. Doshe’s THC level was 27.3 nanograms, more than five times Colorado’s legal limit. No other drugs were found in his system.

Luke Goodman, above, a college student who accompanied his family on a skiing vacation to Colorado’s Keystone Resort, bought marijuana edibles in the form of candies. He ate two and nothing happened, so he ate some more. In all, he consumed more than five times the recommended amount. Soon after, he became agitated and incoherent. When family members left the condo, he refused to go with them. Soon after they left, he shot himself and died. His mother said, “It was 100% because of the drugs.” His cousin agreed that ingesting so much marijuana triggered the suicide, saying, “He was the happiest guy in the world. He had everything going for him.”   Read the report of Mr. Hinkel’s death here.

Read Brian Maass’s report here.

Summary

The 2012/13 New Zealand Health Survey (NZHS) provides valuable information about cannabis use by adults aged 15 years and over. It builds upon and adds value to the findings of the 2007/08 New Zealand Alcohol and Drug Use Survey report on cannabis.

This report presents information on cannabis use in New Zealand, including patterns of use, drug-driving, harms from use (productivity and learning, and mental health), legal problems, and cutting down and seeking help. Information on the medicinal use of cannabis is also presented.

Patterns of cannabis use

Eleven percent of adults aged 15 years and over reported using cannabis in the last 12 months (defined here as cannabis users). Cannabis was used by 15% of men and 8.0% of women. Māori adults and adults living in the most deprived areas were more likely to report using cannabis in the last 12 months. Thirty-four percent of cannabis users reported using cannabis at least weekly in the last 12 months. Male cannabis users were more likely to report using cannabis at least weekly in the last 12 months.

Cannabis and driving

Thirty-six percent of cannabis users who drove in the past year reported driving under the influence of cannabis in the last 12 months. Men were more likely to have done so.

Cannabis-related learning and productivity harms

Six percent of cannabis users reported harmful effects on work, studies or employment opportunities, 4.9% reported difficulty learning, and 1.7% reported absence from work or school in the last 12 months due to cannabis use.

Cannabis and mental health harms

Eight percent of cannabis users reported a time in the last 12 months that cannabis use had a harmful effect on their mental health. Younger cannabis users (aged 25–34 years) were most affected, with reported harm to mental health decreasing markedly by age 55+ years.

Cannabis and legal problems

Two percent (2.1%) of cannabis users reported experiencing legal problems because of their use in the last 12 months.

Cutting down and help to reduce cannabis use

Most cannabis users (87%) did not report any concerns from others about their use. Seven percent of cannabis users reported that others had expressed concern about their drug use or had suggested cutting down drug use within the last 12 months. Of cannabis users, 1.2% had received help to reduce their level of drug use in the last 12 months. Few cannabis users who wanted help did not get it (3.6%).

Cannabis use for medicinal purposes

Forty-two percent of cannabis users reported medicinal use (ie, to treat pain or another medical condition) in the last 12 months. Rates were similar for men and women. Older cannabis users (aged 55+ years) reported higher rates of medicinal use.

An  infographic (PDF, 174 KB)  provides a short overview of these findings.

The methodology report for the 2012/13 New Zealand Health Survey is also available on this website.

If you have any queries please email hdi@moh.govt.nz

Downloads

• Cannabis Use 2012/13: New Zealand Health Survey (docx, 405 KB)
• Cannabis Use 2012/13: New Zealand Health Survey (pdf, 705 KB)
• Infographic (pdf, 174 KB)

Source:  Ministry of Health. 2015. Cannabis Use 2012/13: New Zealand Health Survey. Wellington: Ministry of Health. Published online:  28 May 2015

http://www.health.govt.nz/publication/cannabis-use-2012-13-new-zealand-health-survey

Two years ago, the Georgia Legislature tried but failed to legalize artisanal cannabidiol (CBD) oils for children suffering from epilepsy. Artisanal CBD oils are products marijuana growers are making in states that have legalized marijuana for medical use. No grower in these states has submitted its CBD product to FDA for approval as a safe or effective medicine.

In contrast, two pharmaceutical companies, GW Pharmaceuticals of Great Britain and Insys Therapeutics of the US, are developing pharmaceutical-grade CBD oils. GW’s version, Epidiolex, is in FDA Phase III clinical trials and Insys Therapeutics is about to undergo FDA testing. The Insys drug is 100% synthesized CBD, meaning it is an exact chemical duplicate of cannabidiol found in the marijuana plant but is made of pure chemicals to eliminate impurities and contaminants. Epidiolex is an extract of marijuana that has been purified to remove impurities and contaminants and is 98% CBD with trace amounts of THC and other cannabinoids. Both drugs must be tested in animals to ensure safety before companies can apply to FDA for permission to test their drugs in humans.

Artisanal CBD oils offer no such protections to patients. Random tests have shown that many contain THC, which can cause seizures, contaminants, and in some cases little to no CBD.

When the Georgia bill failed last year, Governor Nathan Deal formed a partnership with GW to conduct clinical trials of Epidiolex in Georgia as well as a statewide FDA expanded access program for children not able to enroll in the clinical trials. Both programs are up and running.

Despite this, the legislature came back with a bill this year to legalize artisanal CBD oils not only for childhood epilepsy but also for seven other diseases. Moreover, this bill permits possession of up to 20 ounces of CBD oil containing up to 5% THC. The bill passed and the governor signed it in April. It provides immunity from prosecution to those who possess CBD and calls for a special commission to recommend how best to grow marijuana, process it into CBD oils, and distribute it to patients.

Like the researchers whose work is published in JAMA today, specialists who treat epilepsy also are beginning to speak out. The NBC-TV affiliate in Atlanta interviewed several this week. Dr. Yong Park, who is helping run the clinical trials in Georgia, says doctors don’t know what the drug interactions are or what the side effects might be because they don’t have the evidence yet. Nor do they know how many pesticides artisanal CBD oils may contain nor what the long-term effects of daily exposure on the brain might be.

Under the new state law, when doctors sign a letter approving patients for the state registry that allows them to possess CBD oils, says Atlanta pediatrician Cynthia Wetmore, M.D., Ph.D., “they are required to keep track of the patients. But how do we know what dose to recommend? The oil patients have access to is not standardized. Each batch can be different. There’s a lot of variability in each batch. What side effects is it causing, if any? We have to report to the state on each patient, quarterly. It will be hard to know if it’s helping or hurting.”

Perhaps the most haunting concerns come from Dr. Amy Brooks-Kayal, a Colorado pediatric neurologist and president of the American Epilepsy Society. The Atlanta NBC-TV affiliate published her letter to a Pennsylvania representative who held hearings a few months ago on a similar bill in his state. In part, she writes:

The families and children coming to Colorado are receiving unregulated, highly variable artisanal preparations of cannabis oil prescribed, in most cases, by physicians with no training in pediatrics, neurology, or epilepsy. As a result, the epilepsy specialists in Colorado have been at the bedside of children having severe dystonic reactions and other movement disorders, developmental regression, intractable vomiting, and worsening seizures that can be so severe they have to put the child into a coma to get the seizures to stop. Because these products are unregulated, it is impossible to know if these dangerous adverse reactions are due to the CBD or because of contaminants found in these artisanal preparations. The Colorado team has also seen families who have gone into significant debt, paying hundreds of dollars a month for oils that do not appear to work for the vast majority. For all these reasons not a single pediatric neurologist in Colorado recommends the use of artisanal cannabis preparations. Possibly of most concern is that some families are now opting out of proven treatments, such as surgery or the ketogenic diet, or newer antiseizure medications because they have put all their hope in CBD oils.

All three epilepsy specialists want parents to know that giving artisanal CBD oils to children exposes them to risks that cannot be defined. They urge parents instead to enroll their children in clinical trials or expanded access programs that are testing pharmaceutical-grade CBD where doctors can monitor the children closely.

Read Atlanta story and full text of Dr. Brooks-Kayal’s letter here

Source:

http://us2.campaign-archive2.com/?u=2138d91b74dd79cbf58e302bf&id=71df2f126e&e=7ee41d6c49

SUSAN SCHENK AND DAVID HARPER

REUTERS

Ecstasy deserves to remain an illegal drug, as there is substantial evidence of it causing harm.

A dangerous case is being made in New Zealand for the legalisation of MDMA, the primary active ingredient of the street drug, Ecstasy.

Ecstasy rose in popularity among the rave party scene in the early 1980s. Use has since spread to more mainstream groups. New Zealanders are some of the heaviest users of ecstasy worldwide, with an estimated 13 per cent of Kiwi respondents to the Global Drug Survey having used ecstasy in the past year.  Supporters of the move to legalise claim the drug is safe, and recent comments made by Wellington Hospital emergency department specialist, Dr Paul Quigley, would seem to support this position.  Quigley has reported few emergency admissions related to ecstasy use, and from this he has incorrectly assumed this means that MDMA use poses minimal harm.

Emergency room admissions are a flawed benchmark for determining the safety of a drug, such as MDMA, as the major harm associated with MDMA is the death of brain cells, and associated behaviour changes.   These effects are generally not life-threatening and would therefore not lead users to seek emergency care.

This does not, however, indicate that MDMA is safe.

Rather, considerable published evidence has demonstrated that memory loss and attention issues are common in MDMA users and there is compelling evidence for the loss of the brain chemical, serotonin, which leads to further problems associated with sleep patterns and emotional wellbeing.

These effects can seriously impact the individual’s ability to lead a productive life, and it is common for users to experience negative emotional after-effects of ecstasy. Importantly, there are no quick fixes for the many detrimental effects of ecstasy and these effects may persist for years.

It has also been suggested that MDMA dependence is not a likely consequence of use, providing proponents of legalisation another indication that MDMA use poses minimal harm.   This too is unsupported in the scientific literature.

* John Key unconvinced by emergency doctor’s call to legalise MDMA

* Don’t freak out over changing drug laws

For most drugs of abuse, including cocaine and methamphetamine (P), about 10-15 per cent of users become dependent on the drug. The same is true of ecstasy users.

Studies have suggested that a subset of ecstasy users progress to misuse and consume the drug frequently and in high dosages.  In New Zealand, the Illicit Drug Monitoring System provides a snapshot of heavy drug users over time.

According to this authoritative survey, ecstasy use among heavy drug users is substantial, and 15 per cent use ecstasy weekly.  An online survey in Britain suggests MDMA users were more likely to report dependence symptoms than users of cocaine.

Another assumption is that by regulating the supply of MDMA, both producers and users will engage in safe drug production and use.  While it is true that most users don’t know what else they are actually taking when taking an ecstasy pill – it is frequently mixed with any range of other substances, some harmful, some not – that doesn’t mean that pure MDMA is actually safe.

Perhaps ‘safer’, but not ‘safe’.

New Zealand has toyed with legalisation of psychoactive substances for many years. First there were the BZP-TFMPP “legal highs” that were subsequently banned as they were shown to be dangerous after all.  The same was true of synthetic cannabis products that have also recently been banned because they were shown to pose more than an acceptable risk of harm.

Despite what has recently been suggested in the media, there is substantial evidence of harm and risk arising from the use of MDMA.  We have been studying the effects of MDMA on brain and behaviour for about 10 years, and the negative effects of ecstasy have been well-documented by us and many other researchers.

Knowing what we know about ecstasy use, and the well-documented negative consequences of its use, the potential for misuse and the persistent and prolific adverse consequences of MDMA use, it is clear that unrestricted use of MDMA poses a great risk of harm, and that it would be irresponsible to provide MDMA for legal sale in New Zealand.

Professor Susan Schenk is from Victoria University’s school of psychology, and Professor David Harper is the dean of science.

Source:  stuff.co.nz  29th June 2015

Freisthler B¹, Gruenewald PJ², Wolf JP².

Abstract

The current study extends previous research by examining whether and how current marijuana use and the physical availability of marijuana are related to child physical abuse, supervisory neglect, or physical neglect by parents while controlling for child, caregiver, and family characteristics in a general population survey in California.

Individual level data on marijuana use and abusive and neglectful parenting were collected during a telephone survey of 3,023 respondents living in 50 mid-size cities in California.

Medical marijuana dispensaries and delivery services data were obtained via six websites and official city lists. Data were analyzed using negative binomial and linear mixed effects multilevel models with individuals nested within cities.

Current marijuana use was positively related to frequency of child physical abuse and negatively related to physical neglect.

There was no relationship between supervisory neglect and marijuana use. Density of medical marijuana dispensaries and delivery services was positively related to frequency of physical abuse.

As marijuana use becomes more prevalent, those who work with families, including child welfare workers must screen for how marijuana use may affect a parent’s ability to provide for care for their children, particularly related to physical abuse.

Copyright © 2015 Elsevier Ltd. All rights reserved.

Source:  Child Abuse Negl. 2015 Jul 18. pii: S0145-2134(15)00237-9. doi: 10.1016/j.chiabu.2015.07.008.  [Epub ahead of print]

Rancho Mirage. It is so unbelievably hot here it’s well, it’s unbelievable. That’s how hot it is. 106 degrees with no breeze at all.

I am not at all sure why we are even here, but the son of a close relative is visiting and he had expressed an interest in playing golf. We have a super course here at the Club at Morningside and we might have played a few holes but it’s far too hot now. It is heat stroke, sunstroke weather. Cruel.

As I drove our guest to dinner, on my disk of Civil War songs, what should we hear but the stirring strains of “Dixie.” Our guest, age 27, a family man who had gone to college in the deep, rural south, and who now lives in the deep, semi-rural south, had no idea of what the song was or what it represented. None at all.

This young man, extremely eloquent with language, is high all day long. Literally there is no waking moment when he is not high. He smokes powerful pot all day long and late into the night. He used to have a great high school athletic career and intellectual ambitions. Then, in 11th grade, he discovered marijuana and all of his drive, all of his motivation, all of his discipline disappeared.

Marijuana ate this young man’s soul. It was very much like that movie, Invasion of the Body Snatchers, where space aliens invade the bodies of humans. I have never known any chronic user of the chronic whose ambitions and good sense have not been either demolished or very substantially lessened by the use of the weed. It is eating up the soul of the nation altogether.

The most bitter enemies of the United States could not have imagined a more wicked attack on a society based on individual initiative than the mass use of marijuana. To think we have a President in favor of its legalization, a Mayor of Gotham who is a huge proponent of the poison, a rap culture that celebrates this vile poison, is heart breaking.

At dinner, our guest had to excuse himself from the table repeatedly. Each time, he came back smelling like reefer. He was far too stupefied to make conversation. The other people at the table began to talk about a nearby retirement community called “Sun City.” Meals available. Nurses available. Shuffleboard. Many channels of cable TV.

“That sounds perfect for me,” said our young guest. “I could just spend all day getting high.”

We stared at him. “You’re twenty-seven,” I said to this former high school football star.

“I know,” he answered. “Hospice sounds even better. Just a slow morphine drip until I die, with everyone bringing me food and a remote control in my hand for The Simpsons. High on morphine all of the time. Can you believe how great that would be? Like for forty years.”

If ISIS could have its fondest wishes granted, it could ask for no more ruinous fate for America than a drug addicted last, formerly best hope for mankind.

Late that night I spoke to a super-smart friend who has a Ph.D. in psychology from UC. “There used to be studies about how marijuana use destroys motivation,” he said. “They aren’t allowed to do them any longer. It isn’t PC to even question what marijuana use does to young people. Cannot even be questioned.”

By the way, how did our young guest — who stayed at a hotel — get his super-strong ganja? One 20-minute visit with a “pot doctor” he had never seen before out here in the desert. Then a five-minute visit to a “dispensary.”

“All I had to do,” said the guest, “was tell him I had trouble sleeping.”

So much for pot as a salvation in terminal cancer. Pot is the cancer.
Read more at http://spectator.org/articles/62926/marijuana-cancer

This is an excellent report.  It shows how seemingly accurate information is being disseminated by pro-marijuana groups heavily funded by George Soros.  Every claim is disputed by scientific evidence from responsible contributors.

University of Florida Drug Policy Institute Joins Senior Researchers at Harvard, Boston Children’s Hospital, University of Texas, and Others in Responding to Latest Claims by the International Centre for Science in Drug Policy

A team of researchers from the UF Drug Policy Institute, Harvard University, and other institutions authored a lengthy response to a recent monograph written by the George Soros-funded ICSDP claiming that cannabis health claims have been overblown.

The team, led by former American Society of Addiction Medicine President Stu Gitlow, and other researchers with leadership ties to groups like the American Academy of Pediatrics, Boston Children’s Hospital, the University of Texas, the University of Pennsylvania, and other institutions found that the ICSDP report is an example of deceptive and biased research and that it contains abundant factual errors and logical flaws.

The report’s introduction reads: “The ICSDP conveniently cites evidence that supports its own predetermined narrative, concluding that only the pro-marijuana lobby has any substantive evidence in its favor-and ignores evidence to the contrary. Its main strategy is to attribute overblown “straw man” arguments to established marijuana researchers, misstating their positions and then claiming to “rebut” these positions with research.

“This response/critique reveals the lack of objectivity present in the report and, point-by-point, shows how the interests of the nascent Big Marijuana industry, private equity firms, and lobbyists lining up to capitalize on a new marijuana industry, are served.”

About the UF Drug Policy Institute

The UF Drug Policy Institute (DPI) serves the state of Florida, the Nation, and the global community in delivering evidence-based, policy-relevant, information to policymakers, practitioners, scholars, and the community to make educated decisions about issues of policy significance in the field of substance use, abuse, and addiction.

Read about our Distinguished Fellows Here

There are at least two sides to every debate, but in the case of marijuana legalization, only proponents’ side is being heard. That changes with the publication this month of Marijuana Debunked.

One of the favorite claims of marijuana-legalization proponents (and biased journalists, see next story) is that marijuana cures cancer. Like most other claims for the drug’s ability to cure or relieve some 250 different diseases, this one originates from 1) a lack of understanding about how science works and 2) plain, old-fashioned greed.

Ed Gogek, MD, is an addiction psychiatrist who has treated more than 10,000 addicts over his 30-year practice. Like all doctors, he has been trained to evaluate evidence that leads to FDA drug approval as well as insufficient evidence that fails to support such medical claims.

In Marijuana Debunked, Dr. Gogek exposes medical marijuana for what it is: the camel’s nose under the recreational marijuana tent. The four states and the District of Columbia that have legalized recreational pot got there by first legalizing medical pot. And medical pot provided the opening for a commercial industry to develop that already rivals the tobacco and alcohol industries in targeting children and the addicted as lifetime consumers.

Dr. Gogek analyzes the substantial research that shows how marijuana hurts people, especially children. He calls out the media for biased reporting about the drug and the entertainment industry for promoting it’s use. He asks us to rethink marijauna policy to find a “third way” between prohibition and legalization and describes what that might look like.

In short, Dr. Gogek has made a powerful, passionate case against legalization and its inevitable consequences. He shows that we have a choice: we can base marijuana policy on science and find an alternative to current policy or we can succumb to the siren call of free-market profits and increased tax revenues (that won’t cover costs) and legalize a third addictive drug. Everyone concerned about health, justice, and the ability of our citizens to thrive should read his book.

Did the National Cancer Institute “Finally Admit that Marijuana Cures Cancer”?
When a news story begins like this—“For the medical industrial complex, there is nothing as terrifying as a cure, or remedy, for a highly profitable and fatal disease like cancer”—you know you are in for a biased read.

Politicususa.com published a story Sunday that asserts the National Cancer Institute (NCI) is now “advising that cannabinoids are useful in treating cancer and its side effects by smoking, eating it in a baked product, drinking herbal teas, or even spraying it under the tongue.”

Deconstructing this quotation word-for-word reveals it is actually a combination of phrases from different questions in Cannabis and Cannabinoids (PDQ): Questions and Answers about Cannabis on NCI’s website:

advising–not found anywhere in “Cannabis and Cannabinoids.”

that cannabinoids are useful in treating cancer and its side effects—these words are from Question 2, What are cannabinoids, second paragraph: “Cannabinoids may be useful in treating the side effects of cancer and cancer treatment” (emphasis added).

by smoking, eating it in a baked product, drinking herbal teas, or even spraying it under the tongue—these words and phrases are lifted from different parts of Question 5, How is cannabis administered?

“Cannabis may be taken by mouth or may be inhaled. When taken by mouth (in baked products or as an herbal tea), the main psychoactive ingredient in Cannabis (delta-9-THC) is processed by the liver, making an additional psychoactive chemical.  . . . A growing number of clinical trials are studying a medicine made from a whole-plant extract of Cannabis that contains specific amounts of cannabinoids. This medicine is sprayed under the tongue.”

[The medicine is nabiximols, trade-name Sativex, which is 50 percent THC and 50 percent cannabidiol extracted from the marijuana plant and purified.]

In addition to doctoring his quotation, the author presents his claim as information NCI quietly slipped onto its website only two weeks ago. He fails to notice that the mid-July date is an update, not a brand new “admission” of information “previously concealed from the public.”

He also fails to report Questions 9 and 10 which point out that FDA has not approved cannabis or cannabinoids for cancer treatment, not approved cannabis for treating the side effects of chemotherapy, but has approved two drugs which are synthetic THC, Dronabinol and Nabilone, for relieving chemotherapy-related nausea and vomiting in patients who do not respond to standard therapy.

But reporting that would make it hard to conclude, as the author does, that “it is absolutely despicable, and frankly evil, that the medical industry helped keep an incredibly inexpensive and highly-effective cancer-killing drug out of reach.”

Politicususa.com gets an “A” for spin, but an “F” for accuracy. File this story in the trash can where it belongs.

Read Politicususa.com story here. Read National Cancer Institute Cannabis and Cannabinoids Q&A here.

Source: TheMarijuanaReport.org  26^th August 2015

Let us provide a rational answer to a nonsensical question. It is a nonsensical question because blood is never impaired by THC. Never. Alcohol doesn’t impair blood either. These drugs only impair the brain, not the blood.

We can only test for drug content in the brain by means of an autopsy, something most drivers would reasonably object to.

We test blood as a surrogate for what’s in the brain. For alcohol, blood is a very good surrogate. Alcohol is a tiny, water-soluble molecule that rapidly crosses the blood-brain barrier and quickly establishes and maintains an equilibrium concentration between what’s in the blood and what’s in the brain.

Blood is a terrible surrogate for learning the amount of THC in the brain. It’s used because we blindly follow the precedence set by alcohol, perhaps even believing the pot lobby’s mantra that marijuana should be regulated like alcohol. It’s also used because we haven’t proven anything else that’s any better. Oral fluid likely is somewhat better, but that may only be because it can be collected more quickly at the roadside.

Blood is a terrible surrogate because unlike alcohol, THC is a very large fat-soluble molecule. This results in three major differences in behavior compared to alcohol:

1. THC crosses the blood-brain barrier much more slowly than alcohol. This is why studies show that the blood level of THC can be dropping at the same time that the feeling of being high is increasing.
2. THC migrates very rapidly from the blood to the body’s fat stores. This is why the THC level in blood drops by 90% within the first hour after smoking, even though the metabolic half-life of THC is estimated to be about four days.
3. Because of the high fat content in the brain, THC remains in the brain long after it can no longer be detected in the blood. This is why pot users consistently have higher levels of THC in their brains than in their blood, according to autopsy results.

Perhaps this explains why researchers agree that marijuana impairs driving, but none claim there is a good correlation between blood levels of THC and impairment.

The fact is that there is no level of THC above which, everyone is impaired, and below which, no one is impaired.

The same is true of alcohol. In spite of common belief, the .08 BAC limit wasn’t determined by science. It can’t be, due to the reality of biological variability. The .08 BAC limit was determined by politicians, using scientific input as well as societal input. That explains why the alcohol per se limit varies from .02 to .08 gm/dl in various developed countries of the world, and those countries based their decision all on the same science! It’s other societal inputs such as risk tolerance and desire for freedom that come into play to make that decision.

None of this proves it’s safe to drive after smoking pot. It’s not. It simply explains why a defined per se limit of THC in blood that proves someone is impaired can never be supported by science.

This also may explain why the preferred means to deal with drug impaired driving is not to establish per se limits, but rather to establish a zero tolerance policy for mind altering drugs in a driver that has been shown to be impaired.

Source:  http://www.duidvictimvoices.org/   April 2015

New drunken-driving laws in British Columbia have led to a dramatic decrease (roughly 50%). Officials ramped up penalties on drivers who tested at a lower blood alcohol level (.05, as opposed to the current .08 legal standard) and authorized police to immediately impound cars.

TRANSCRIPT

WILLIAM BRANGHAM: Six years ago, a terrible family tragedy occurred here in rural British Columbia.  But over time, it became much more than that. This tragedy set in motion dramatic changes to the laws governing drinking and driving — changes that supporters say have already saved dozens of lives. That tragedy involved a four year old girl. Her name was Alexa Middelaer

LAUREL MIDDELAER: Well, it was a beautiful May long weekend and my daughter, Alexa, loved this one particular horse and she really wanted to show her grandparents that horse.  I remember saying good bye to her, and then very shortly after that we heard all kinds of sirens. And at that moment I just– I just knew.  I said, “It– it’s Alexa.  Something happened to Alexa.”

WILLIAM BRANGHAM: A 56 year-old woman doing nearly twice the speed limit, lost control of her car and smashed into the exact spot where Alexa stood feeding the horse on the side of the road.  The woman – – who was later convicted and sent to prison — admitted to police she’d had three glasses of wine before getting into her car.

LAUREL MIDDELAER: When we knew, roadside, that our daughter was dead, I remember my husband just — in the ambulance — we both held each other and he said, “This will not break us.  This will define us.  There will be some good in this.”

WILLIAM BRANGHAM: After the accident, Alexa’s parents – Michael and Laurel – launched a campaign to try and change the culture around drinking and driving … and to deter people from doing it….  Their events became a regular feature on local news

LAUREL MIDDELAER (from local news) We will honor our daughter and we will make the necessary changes that, number one…

WILLIAM BRANGHAM: But they soon realized it would take more than that – they realized they’d have to change the drunk driving laws, which, like in the U.S., sets the legal blood alcohol limit at .08 percent.  After lobbying the government for nearly a year — alongside groups like Mothers Against Drunk Driving – their efforts paid off.   In 2010, the Provincial Government not only stiffened penalties against driving at.08, but more importantly, it targeted drivers who fall below that level — to .05 — drivers who are not legally drunk.  The rationale?  Even a few drinks – as few as two for a woman, and three for a man — can impair your driving ability

The big change was that if you were now caught driving with a .05 blood alcohol level, the police were authorized – on the spot — to fine you, suspend your drivers license, and immediately impound your car for at least three days.  They’d get you out of the vehicle, and a tow truck would haul it away. 

In late 2010, police began enforcing the new laws, and police impound lots across British Columbia began filling up. The changes sparked an uproar.  Civil libertarians argued it gave the police too much power – and restaurant owners like  Mark Roberts said the new laws damaged the economy… he says his business dropped between 10 and 20 percent.

MARK ROBERTS: When the change of drinking-driving laws came out, we knew that was going to have a strong impact on our business.

WILLIAM BRANGHAM: What did you think?  That customers would suddenly be afraid and that they wouldn’t come to your door?

MARK ROBERTS: We thought that there was a lot of unknowns about what that meant.  How many drinks could people have?  There was very little information about how that was going to be enforced, how it was going to impact what people could drink. We were creating non-alcoholic drinks to make up for the lost sales.  It was a lot of fear, a lot of unknowns, and some real changes in people’s behavior.

WILLIAM BRANGHAM: And the impact was immediate.  During the first year the new law was in effect, the number of drunk driving deaths in British Columbia plunged. Critics argued that first year was just a fluke.  But the second year?  The number declined again.  A 55% reduction in deaths in just two years.

The message, it seemed, had started getting through to drivers

TIM STOCKWELL: So it was quite well-publicized.  And for deterrence to work it’s as much about knowing and expecting there being a consequence than it actually be likely.  People’s perception that they were likely to be caught was probably way higher than it actually was.

WILLIAM BRANGHAM: And that’s key?

TIM STOCKWELL: That is key.  It’s very important….

WILLIAM BRANGHAM: Tim Stockwell is an expert on alcohol policy at the University of Victoria. He told us he can’t think of a single reform that’s had this big an impact, this quickly.  He and his colleagues recently published a peer-reviewed study of the effectiveness of the new laws.

TIM STOCKWELL: These laws epitomize a perfect deterrence theory in action.  And it is very important to understand that you don’t need draconian, severe penalties. They have to be severe enough.  It’s more important that they are certain, and that they are swift.  So on the spot, losing your car for three days, a week, that’s severe enough.

WILLIAM BRANGHAM: The new laws have faced some setbacks: the police had problems with some of their breathalyzers, the government had to ammend the laws when courts ruled that drivers deserved a better appeals process.  And last fall a judge ruled in favor of a driver who appealed his 2012 driving suspension.  Critics say that ruling that could force a rewriting of the laws.  For now, the heart of the new laws though remain intact.

WILLIAM BRANGHAM: What about the argument that there have been so many lives saved by these new rules that yes, it may have taken a hit out of your business, but that to save a bunch of people’s lives that that’s an OK price to pay?

MARK ROBERTS:  Yeah.  Well, it’s hard to argue that.  I’m certainly not going to sit here and say well, we should allow people to drink whatever, and whatever the consequences are, that’s the way it is going to be.  I certainly wouldn’t advocate that.

WILLIAM BRANGHAM: Why do you think this has been so effective?

LAUREL MIDDELAER: I think because the consequence is firm.  I think that people respond when there’s a harsher consequence.  And I think, too, because it’s aligned to a larger goal.  Just like secondhand smoke, we have no tolerance for that anymore, just like when seatbelts came in, there was that fundamental shift.  My goal has always been that there will be a fundamental shift that it’s not OK to drink and drive.  Drinking is fine.  Absolutely — drink whatever you like and enjoy and partake, but just don’t mix it with driving.

Source:   http://www.pbs.org/newshour  Jan.2014

Looking inside the dome of the National Advanced Driving Simulator -1. Photo by University of Iowa National Advanced Driving Simulator

Virtual reality is shedding light on the dangers of driving stoned.

Currently in the U.S., police officers have limited resources to assess just how high a person is when driving under the influence of marijuana. Also unclear is the degree to which driving both drunk and stoned – the most common combination of substances seen among DUI cases — impairs one’s ability to pilot a vehicle.

Marilyn Huestis, a scientist at the National Institute on Drug Abuse, used the National Advanced Driving Simulator to tackle these issues one virtual road trip at a time.

The simulator consists of a car surrounded by a dome. Inside the dome is a 360-degree screen displaying the outside virtual world. The dome can tilt and move, mimicking the sensation of accelerating and braking.

This study was the first to record people’s saliva, blood and breath samples before, during and after driving under the influence. In the U.S., the only way to identify the amount of tetrahydrocannabinol (THC), the psychoactive ingredient in marijuana, in a driver’s body is through blood samples. These samples are typically taken 90 minutes to four hours after being pulled over. However, other countries use saliva samples, which provide more rapid results.

The team began by asking occasional marijuana and alcohol users to participate in a 45-minute driving simulation. Each participant drove the simulator multiple times under various states of inebriation: sober, after inhaling THC, after drinking alcohol, and under the influence of both THC and alcohol. The route changed each session, but always included interstate driving and city driving at nighttime.

Among the researcher’s findings: THC impairs the ability to stay within traffic lanes.

“A concentration of 13.1 nanograms per milliliter THC was an equivalent impairment to that of the illegal limit for alcohol at 0.08 percent at the time of driving,” said Huestis, lead author of the study, which was published in the journal Drug and Alcohol Dependence.

To put that in perspective, THC levels peak around 100 to 200 nanograms per milliliter within minutes of inhalation, but drop drastically into the single digits within a couple hours. Because of this plummet, the THC concentration measured while driving is much higher than what you would find in blood drawn hours after being suspected of driving under the influence.

This study found that the effects of driving both high and drunk were additive, meaning that if you smoke a joint and drink a beer, you are more impaired than if you had only smoked.

A view from inside the dome of the National Advanced Driving Simulator – 2. Photo by University of Iowa National Advanced Driving Simulator

Researchers also studied the effectiveness of roadside exams at detecting THC. In the U.S., if an officer suspects someone is driving while high, they are required by law to take the driver to a hospital to secure a blood sample. However, in Belgium, officers take an oral swab during the arrest that gets tested at the scene and later in a lab. Meanwhile In Germany, if someone tests positive for THC during a roadside saliva test, they have to submit a blood sample to confirm.

The team found that two saliva tests for THC — Dräger DrugTest® 5000and Alere DDS2 — were as accurate as blood testing. The saliva tests remained accurate when participants were under the influence of both THC and alcohol.

A view from the outside of the National Advanced Driving Simulator – 3. The virtual screen and car sit inside the dome. Photo credit: University of Iowa National Advanced Driving Simulator

They also found that alcohol increases the body’s ability to absorb THC, meaning that you get more stoned if you smoke while drinking versus if you smoke while sober.

“When alcohol was present with cannabis, you had a significantly higher of peak THC,” Huestis said.

Cannabis also slows the rate at which alcohol is metabolized, dulling concentration. If you smoke before you drink, you’ll have to wait longer to sober up.

Source:  http://www.pbs.org/newshour   June 27^th 2015

A woman who was admitted to rehab three times because of her severe drug addiction has turned her life around by becoming an addiction therapist helping others going through what she did.

Vicky, from Hale, Manchester, reveals that her drug addiction started at a young age; she was smoking weed when she was 11 and took acid and mushrooms by the age of 16.

The 49-year-old, who attended Altrincham Grammar School, comes from a wealthy background and was expected to go into medicine or dentistry.

However, her parents split when she was young and she hasn’t seen her biological father since she was seven years old. The breakdown of the family unit, she explains, led her to feel as though there was a deficit in her life.

As a result, she began to use food, substances and sex to fill the void to help her feel better about herself.

Vicky explains that she’s had obsessive behaviours towards food – often bingeing on a whole box of crisps at once – since a young age.

At the age of 11 she moved to Canada for six months to live with relatives where she started smoking cannabis. By 16 she was aware her drinking habits weren’t ‘normal’. Vicky felt she had no cut off point and regularly had memory loss. She also started taking what she considered to be recreational drugs: cannabis, acid and mushrooms.

When she was 17, she was introduced to amphetamine. Looking back, Vicky says she considers that her recreational drug use was about helping her to feel better about herself.

After college, Vicky flitted between working for her mother’s business and restaurants jobs in Hale, during which time the Cheshire-set friendships and free-flowing champagne encouraged her drinking and drug taking habits.

She admits that she was living for the moment, seeking fun and excitement but her lifestyle choices were slowly ruining the opportunities she had been given. When she was 20, Vicky returned to Canada and dated a cocaine dealer – a time that she describes as her ‘Nirvana’ with cocaine on tap.

When her visa expired, she moved back to the UK and began dating someone who had a similar background of drug misuse. She started using heroin and crack for two years and whilst she was able to hold down a job, she admits she started to function less and less.

She started to steal to pay for drugs, received a drink driving conviction at aged 22 and received multiple cautions for drug possession and related incidents. Vicky believes she was merely given a slap on the wrist due to her background.

Aged 23, Vicky felt very isolated and ended up living back at home at which point her parents became aware there was a problem. They called a psychiatrist for help and Vicky was admitted to rehab for eight weeks in 1988, she returned on two more occasions.

Following Vicky’s third admittance to rehab, the alcohol and drug induced death of a close friend and former boyfriend on her 25th birthday hit Vicky very hard. She reached her lowest point and attempted suicide more than once. However, she began to turn her life around.

She had to sign a contract to agree to secondary care treatment at a female-only facility where she was taught to take personal responsibility for her own happiness.

Vicky, who now lives with the father of her two youngest children that she met in recovery 18 years ago, studied for a Diploma in Counselling at the University of the West of England and a Masters at Bristol University; she has been qualified as a counsellor for 18 years.

She met her partner and father of her two youngest children in recovery 18 years ago. Vicky is dedicated to helping others affected by addiction, and has a particular passion for helping and working with families and the ‘forgotten others’. Helping others through her own business, Victoria Abadi Therapies, has helped Vicky’s own recovery.

She said: ‘I had always thought I was fascinated by substances and drugs, but over the years I’ve come to realise that what really interests me is addiction itself. I knew from as young as 21 that I wanted to be an addiction therapist. A lot has changed since my days in detox and rehab, we know so much more about addiction but there’s still more to learn.

‘My main advice to anyone affected by addiction, whether it’s yourself or someone you care about, is to talk. It might seem obvious but it’s not always easy to reach that stage.

‘Once you reach the point of realisation that addiction is a medical issue not simply a moral choice the path to recovery will come easier. Likewise, for families shedding the shame and stigma by talking about your experience will open up the possibility of helping your loved one through it.

‘There are some great impartial services, such as Port of Call, who can help with pointing you in the right direction and getting you or a loved the help they need. ‘The best thing that comes out recovery is the ability to have close meaningful relationships.’

For help and advice on addiction recovery visit Port of Call, Victoria Abadi Therapies or call 0800 0029010.

Source: http://www.dailymail.co.uk

From time-to-time proponents of marijuana legalization throw out some fuzzy statistics claiming no one has ever died from marijuana.

Case-in-point, earlier this month a group in Arkansas advocating major changes in our state’s marijuana laws tweeted the following:

“No one has ever died from cannabis.” Let’s investigate this claim.

Unpacking the Statistics on Alcohol and Marijuana

In the tweet above, Arkansans for Compassionate Care is apparently citing a statistic from the Center for Disease Controlon the number of deaths from alcohol every year (88,000, on average). If we read how the CDC arrived at that figure, we see it was by calculating the number of alcohol-related accidents and health problems.

In other words, it isn’t simply that 88,000 people die from blood alcohol poisoning (which some might describe as an “alcohol overdose”) each year. Alcohol is contributing to the deaths of about 88,000 people each year in the form of heart and liver problems, car crashes, and so on.

These are what the CDC calls “alcohol attributable deaths” (you can see a full list of them here). They are deaths caused by something that was a direct effect of alcohol use.

So let’s take a look at marijuana-attributable deaths. Has marijuana really never killed anyone, as so many of its proponents claim?

Kevin Sabet with Smart Approaches to Marijuana did an interview with The Daily Signal last year in which he took the claim to task, saying,

“Saying marijuana…has never killed anyone is like saying tobacco has never killed anyone. Nobody dies from a tobacco overdose. You can’t smoke yourself to death. And yet nobody would dispute that tobacco causes death. … You die from lung cancer–you don’t die from smoking. You die from what smoking did to your lungs, which is a direct effect from smoking. And so in that same way marijuana does kill people in the form of mental illnesses and suicide, in the form of car crashes. … You can’t say marijuana doesn’t kill.”

Marijuana-Attributable Deaths

A little research reveals news articles, police reports, and academic studies on a number of marijuana-attributable deaths:

1. December, 2014: The National Institute on Drug Abuse updated its marijuana research paper, saying, “Marijuana is the illicit drug most frequently found in the blood of drivers who have been involved in accidents, including fatal ones,” and citing research that marijuana is increasingly detected in fatal vehicle accidents.

2. December, 2014: Oklahoma authorities reported a man with marijuana both in his system and on his person drove into oncoming traffic, crashing into another vehicle and killing its driver.

3. May, 2014: A study published by the University of Colorado School of Medicine found that, “the proportion of marijuana-positive drivers involved in fatal motor vehicle crashes in Colorado has increased dramatically since the commercialization of medical marijuana in the middle of 2009.”

4. April, 2014: A 47-year-old Denver man allegedly shot his wife while she spoke with a 911 dispatcher over the phone. According to various reports, the wife called 911 after her husband consumed candy laced with marijuana and began hallucinating and frightening the couple’s children. Some sources indicate the man may have taken prescription drugs with the marijuana. CBS News reports that 12 minutes into the call with 911, the wife “told dispatchers her husband was getting a gun from a safe before a gunshot sounded and the line went quiet.” The marijuana candy had, apparently, been purchased a licensed shop in the Denver area.

5. April, 2014: Researchers writing in the Journal of the American Heart Association investigated marijuana’s effects on cardiovascular health. They reviewed 1,979 incidents from 2006 to 2011, and found, “there were 22 cardiac complications (20 acute coronary syndromes), 10 peripheral complications (lower limb or juvenile arteriopathies and Buerger‐like diseases), and 3 cerebral complications (acute cerebral angiopathy, transient cortical blindness, and spasm of cerebral artery). In 9 cases, the event led to patient death.” (Emphasis added).

6. March, 2014: A 19-year-old college student jumped to his death after eating a marijuana-laced cookie purchased at a licensed marijuana store in Colorado. Reports indicate the man began shaking, screaming, and throwing objects in his hotel room after eating the marijuana “edible.” He ultimately jumped over the fourth-floor railing, into the lobby of the hotel at which he was staying. According to CBS News, the autopsy report listed marijuana as a “significant contributing factor” to his death.

7. February, 2014: researchers from Germany determined the deaths of two apparently-healthy, young men were in fact the result of marijuana. According to their article published in the journal Forensic Science International. Researchers concluded, “After exclusion of other causes of death, we assume that the young men died from cardiovascular complications evoked by smoking cannabis.”

8. November, 2013: Seattle news outlets reported an elderly Washington resident was killed after a neighbor’s apartment exploded as a result of a hash oil operation. Hash oil is a highly-potent extract produced from marijuana using flammable chemicals such as butane.

9. June, 2013: A 35-year-old Oregon man died as a result of an explosion and fire caused by a hash oil operation he and a friend were conducting in a garage.

10. October, 2011: The Office of National Drug Control Policy released a report analyzing traffic accidents from 2005 – 2009. The report noted, “Among fatally injured males who tested positive for drugs, 28 percent tested positive for cannabinoids compared with 17 percent of females,” and that, “Cannabinoids were reported in 43 percent of fatally injured drivers under age 24 who tested positive for drugs.”

11. 2004: A study in the official journal of the American Academy of Pediatrics examined case studies of three otherwise-healthy adolescent boys who were admitted to hospitals due to stroke following heavy marijuana use; two of the boys ultimately died, and the study concluded marijuana may cause stroke and death.

These are just a few reports on deaths linked to marijuana. According to well-publicized FOIA responses, from 1997 to 2005 the FDA recorded 279 marijuana-related deaths–long before Colorado voters decided to legalize the drug.

We have brought up many of these statistics before in our discussions on marijuana. Each time we did, marijuana supporters tried to evade by arguing that marijuana hasn’t caused as many deaths as other drugs. However, there is a world of difference between claiming marijuana has never killed a single person and claiming marijuana has not killed as many people as other substances.

Emergencies Caused by Marijuana

Besides death, marijuana has caused or contributed to many well-documented emergencies. Some of these emergencies easily could have resulted in death or serious injury.

Here are just a few examples of emergency situations caused by marijuana:

1. March, 2015: Four high school students were hospitalized after eating brownies laced with marijuana hash oil. One student was actually found unresponsive in a school bathroom after eating a marijuana-laced brownie.

2. February, 2015: A 20-month-old Canadian toddler overdosed after eating a marijuana-laced cookie authorities say his father baked. The child survived, but suffered seizures and had to be admitted to a hospital.

3. February, 2015: News outlets report guests at Colorado hotels often leave unused food and beverages as tips for housekeeping staff. However, with the legalization of marijuana–and marijuana-infused foods–in Colorado, some guests are leaving marijuana edibles behind. One Breckenridge hotel employee reported accidentally overdosing when she ate a candy she did not realize was laced with marijuana.

4. February, 2015: An explosion occurred at an Arizona apartment complex. Witnesses indicated one of the people involved in the explosion was attempting to extract hash oil from marijuana using butane.

5. January, 2015: News outlets in Oregon reported a woman overdosed after she ate three gummy candies laced with marijuana.

6. December, 2014: A high school teacher in Maryland was hospitalized after a student gave her a brownie containing marijuana.

7. December, 2014: Two middle school students in Oklahomawere rushed to the hospital after one of them reportedly passed out following marijuana-use at school.

8. November, 2014: A Connecticut teen was taken to the hospitalfrom school after she started having difficulty breathing following ingestion of a marijuana-laced gummy bear.

9. June, 2014: According to The Aspen Times, a seven-year-old girl was taken to the hospital after eating marijuana-laced candy her mother brought home from work at an area hotel. The candy was left by a hotel guest–presumably as a tip.

10. March, 2014: A Colorado man attempting to extract hash oil from his marijuana was taken to the hospital after the butane used to extract the oil ignited.

11. December, 2013: A two-year-old in Colorado overdosed and was hospitalized after eating a cookie laced with marijuana. News outlet indicate the girl found the cookie in the yard of an apartment complex.

Recurring Themes: Kids and Accidental Overdoses

A recurring theme in many of these news stories is that children and teens are becoming severely ill after ingesting marijuana-laced food (often referred to as “edibles”).

In July of 2013, researchers writing in JAMA Pediatrics determined accidental ingestion of marijuana by young children is on the rise and carries serious risks.

The greatest dangers appear to be toddlers and young children who accidentally find cookies or candy laced with marijuana and teens acquiring marijuana edibles at school without realizing how potent the drug-infused food is.

In both scenarios, children accidentally overdose on marijuana and must be taken to the ER. In some cases, as noted above, the children even pass out or become unresponsive.

A child who loses consciousness from marijuana overdose could easily fall and strike their head or suffer another serious injury. A teen who ingests a marijuana edible–without realizing its potency–before climbing behind the wheel of a car to drive away from school could easily be involved in a serious traffic accident.

Side-Effects May Including Exploding Apartments

A few of the cases we have cited include explosions caused by marijuana hash oil operations.

Many marijuana users produce their own hash oil at home by extracting the oil from marijuana using flammable chemicals like butane. In many cases, the room fills up with butane and is ignited by a stray spark, causing a serious explosion.

The people most at-risk are apartment dwellers. A person who lives in an apartment complex may have their home destroyed because a neighbor’s hash oil operation exploded. In Washington, at least one person was actually killed as a result of a hash oil operation that exploded in a neighbor’s apartment.

The legality of hash oil extraction is questionable under state laws in Washington, Colorado, and elsewhere. Colorado’s Attorney General released an opined in December that home production of marijuana hash oil is illegal. However, many people disagree. Regardless of its legality, it is clearly dangerous to the marijuana users and their family members and neighbors.

Conclusion: Marijuana Has Caused Far More Than 0 Deaths

Given the amount of evidence–both scientific and anecdotal–there simply does not seem to be any way around it: Marijuana is responsible for many deaths.

Moreover, marijuana has caused numerous medical emergencies that could have been fatal under different circumstances.

We continue to say it over and over again: Marijuana may be many things, but “harmless” simply

Source: www.familycouncil.org March 19, 2015 By Jerry Cox

Another death in Colorado has been listed as having “marijuana intoxication” as a factor, according to a CBS4 investigation, and several other families are now saying they believed the deaths of their loved ones can be traced to recreational marijuana use.

Daniel Juarez, an 18-year-old from Brighton, died Sept. 26, 2012 after stabbing himself 20 times. In an autopsy report that had never been made public before, but was obtained by CBS4, his THC level — the active ingredient in marijuana — was measured at 38.2 nanograms. In Colorado, anything over 5 nanograms is considered impaired for driving.

Juarez was nearly eight times the legal limit. “If he had not smoked marijuana that night he would still be here,” said his sister, Erika Juarez. “He was extremely high. There’s no other reason he would do it,” said his older sister.

According to police reports and interviews obtained by CBS4, Juarez and a friend were smoking marijuana that night when Juarez told his friend “he didn’t want anymore because he was too high.” Juarez, who was a standout soccer player for Brighton High School, then told his friend “I just had an epiphany.”

(RELATED STORIES: Marijuana Legalization Story Archive)

Police and witnesses then say Juarez literally ran wild, stripping off most of his clothing and running into his nearby apartment. There, he got a knife and stabbed himself 20 times, one of the stab wounds piercing his heart. Juarez’s autopsy report lists his manner of death as suicide with “marijuana intoxication” as a “significant condition.”

A police report in the death notes that the THC in the teenager’s blood was “almost 11 times more than the average amount found in a male using marijuana.”

Police and medical personnel suspected the marijuana Juarez smoked might have been laced with methamphetamine or another substance that could have triggered the irrational behavior. The autopsy shows that tests were done for amphetamines, synthetic stimulants and synthetic cannabinoid drugs, but all those tests were negative.

“I lost my brother to it,” said Erika Juarez. “It’s not harmless, it can kill people and most people don’t see that.”

Up until now, just three other deaths in Colorado were seen as having links to marijuana. Levy Thamba Pongi, a 19-year-old college student jumped from a Denver balcony to his death in 2014 after eating marijuana edibles. Marijuana intoxication was listed as a factor in his death.

Richard Kirk of Denver is accused of killing his wife, Kristine. Before her death, she called police and said her husband seemed to be hallucinating after ingesting marijuana edibles and prescription medications.

And college student Luke Goodman killed himself in Keystone in March shortly after ingesting marijuana edibles. His mother told CBS4 she believes the marijuana caused her son to kill himself. An autopsy report showed Goodman’s THC level at 3.1 nanograms, below the impaired driving limit.

The Juarez case adds another to the list of death cases with links to marijuana.

CBS4 found another Colorado death with strong ties to recreational marijuana. On May 18, 2012, Tron Dohse was returning to his Thornton apartment after attending a Rockies game. When he arrived home he had apparently lost his keys so he attempted to climb the outside of the apartment building to get to his balcony and gain access to his apartment.

He fell to his death, which was ruled an accident.

According to his autopsy report obtained by CBS4, Dohse’s THC level was 27.3 nanograms, more than five times the Colorado limit for impaired driving.

An autopsy on the 26-year-old restaurant worker showed no other drugs or alcohol in his system. His older sister, Tori Castagna, told CBS4 she now believes marijuana impairment led her brother to make poor decisions the night of his death.

“I couldn’t believe how high the (THC) level was,” said Castagna. “I think it had a very strong impact on what he did that night. I think his judgment was completely skewed. I really believe that was the main contributor.”

According to a Thornton police report, the first officer to arrive wrote that he smelled “a strong odor of an unknown alcoholic beverage coming from his person/breath.” And a witness told police that prior to the late night fall, Dohse “was intoxicated.” But by the time Dohse’s blood was drawn, no alcohol was present, only an elevated level of THC.

“I do believe he was very impaired from that high level,” said Castagna. “We’re seeing more things like this that are showing how serious it can be.”

Dr. Chris Colwell, Chief of Emergency Medicine at Denver Health Medical Center, said since the legalization of recreational marijuana in Colorado, he has seen more and more cases like these of people who have ingested marijuana making poor decisions, decisions they would not otherwise make.  ‘In some cases they will ingest marijuana and behave in a way we would describe as psychotic,” he said.

Colwell said several times each week people enter the Denver Health emergency department after ingesting marijuana and acting suicidal.  “We’ll see several of those every week … that we have to restrain to insure they aren’t a danger to themselves or other people,” Colwell said.  Colwell said after ingesting marijuana he has seen people jumping off balconies, driving at high speeds and driving erratically.

“They’re making decisions they would not have made when not under the influence of marijuana,” he said.  Colwell said recalled one particular case from last Halloween when a man ingested marijuana edibles, dressed up as Superman, and then jumped off a balcony, “Almost as if he could fly as the costume would imply.” Colwell said the man suffered seven fractures but survived.  “It was a very dangerous situation.”He said later he didn’t know why he did what he did. Colwell said his ER is seeing more and more of the same issues from marijuana that it has historically seen from alcohol.

Marijuana activists call these kinds of stories scare tactics and say the problems associated with marijuana ingestion are infinitesimal when compared to alcohol and prescription drugs.

Mason Tvert, a pro-marijuana activist, said he wasn’t buying stories of suicides following pot ingestion.  “There is no evidence that using marijuana makes you want to kill yourself,” said Tvert. “There is no science, no research that says by using marijuana you are going to become suicidal. There is evidence that people who tend to be suicidal may be more likely to use marijuana.”  Tvert went on to say that the number of adverse incidents following the ingestion of marijuana are infinitesimal when compared to alcohol.  “The fact that we are talking about the handful of incidents over the past several years suggests that this is not an exceptionally large problem, but it is something that needs to be talked about,” he said.  Tvert said these deaths are “absolutely” being blown out of proportion by the media, especially when compared to deaths connected to alcohol.

In Boulder, eight years after her son’s death, Ann Clark believes her son’s own words show that marijuana led him to kill himself.

Her son Brant was a 17-year-old high school student who attended a party, and according to his mother, smoked a large amount of marijuana. She said that session caused a “major psychotic break. The changes in my son were so intense that in the next three days he required emergency care at two hospitals.”

Hospital documents examined by CBS4 from December 2007 say Brant told doctors, “Marijuana really messed me up.” Brant “reported feelings of paranoia after marijuana that he couldn’t shake.”  Three weeks later, Brant Clark took his own life leaving behind two notes, one for his mother and a second addressed to God.   “Sorry for what I have done I wasn’t thinking the night I smoked myself out’, the note said.

“I believe my son would be alive today if he had never used marijuana,” said Ann Clark.

In a 2014 article in the New England Journal of Medicine, doctors from the National Institutes of Health published an article entitled, “Adverse Health Effects of Marijuana Use” and wrote, “Both immediate exposure and long-term exposure to marijuana impair driving ability; marijuana is the illicit drug most frequently reported in connection with impaired driving and accidents, including fatal accidents. There is a relationship between the blood THC concentration and performance in controlled driving-simulation studies.”

The authors go on to write, “Recent marijuana smoking and blood THC levels of 2 to 5 ng per milliliter are associated with substantial driving impairment.”

The doctors who wrote the article concluded, “During intoxication, marijuana can interfere with cognitive function and motor function and these effects can have detrimental consequences.”

CBS4 Investigator Brian Maass has been with the station more than 30 years uncovering waste, fraud and corruption. Follow him on Twitter@Briancbs4

Source:  http://denver.cbslocal.com/2015/05/18/marijuana-intoxication-blamed-in-more-deaths-injuries/

Posh Spectator and Sunday Times journalist James Delingpole has got his Y-fronts in a twist over outing the PM as former closet stoner. His former mates in the PM’s inner circle don’t approve and have been letting him have it. I can imagine why he’s felt such an urgent need to justify breaking this public school ‘omerta’. He hadn’t anticipated the fall out, he says, in a mea culpa in the Sunday Times. He hadn’t anticipated the impact his revelation to Cameron biographer Isabel Oakeshott would have because he thought that ‘puffing on a reefer’ at Oxford  was no big deal. It was barmy that it was ever a criminal act, he argues in self defence. And he still thinks so.

So since the law’s an ass, what was wrong with putting up two fingers to it? Nor does he see any reason to change his mind about dope now, thirty years later:

“Marijuana is being decriminalised across the world. Quite soon we’ll find the idea that (it) was ever a criminal act about as barmy and illiberal as the notion, that, not so long ago, a man could be imprisoned for sleeping with another man.”

So ‘me lud’, he effectively argued in mitigation, under the impression that we all (not least Dave and his inner sanctum) share liberal views about dope smoking, his and the future PM’s casual disregard for the law (then) was OK.

And besides what was the worst that could have happened as a result of his revelation in today’s modern and progressive world? Dave looking a hypocrite if he ever votes against the decriminalisation of cannabis or Barack Obama cracking a few retro Cheech and Chong jokes next time he meets our PM for a hamburger/baseball love in?

Ho, ho – all very amusing and just about how flippant Mr Delingpole perceives drug use. He really didn’t need to tell us of the state of arrested adolescence he says he is in.

The irony of this self observation is that arrested development is indeed one of the effects of cannabis on the brain. It affects normal maturity (as any drug counsellor will tell you) and specifically the brain development of adolescents. It affects attention, memory and executive functions in the brain. Its use risks worse effects  – from psychotic episodes to full blown schizophrenia for those with a genetic vulnerability. Its victims often do not know until it too late.

Delingpole, although a journalist, seems blissfully unaware of these research findings. It is also hard to believe he is unaware of cases where this apparently ‘innocent’ activity has destroyed the lives of children from affluent families similar to those he and his former friend Dave hail from.

It is hard too to believe as a journalist he’s remained oblivious to the crisis of NHS mental health and psychiatric units, which are bursting at the seams with young male psychotic cannabis addicts –  many incurable.

Maybe it’s a matter of I’m all right Jack. Maybe, he has no children of his own to worry about. Maybe, he’s naive enough to think by some magic of making cannabis freely available these cases would not exist. I have no idea.

As a journalist he should, at the very least, acknowledge that cannabis is a dangerous and for young people, in particular, a very undesirable and addictive drug.

His self-serving attempt to claim the moral high ground (he is not a slave to anyone you’ll be pleased to hear; he does not ingratiate himself with the powerful and he deplores those who do and have compromised themselves to benefit from the Cameron regime) is no substitute for responsible  journalism.

Before he so blithely downplays this drug again and so casually assumes its eventual legalisation is a world wide done deal, I suggest he first acquaint himself with a few more facts and then attend this debate where Dr Kevin Sabet, author of Reefer Sanity: Seven Great Myths About Marijuana, President of Smart Approaches to Marihuana (SAM) and a former advisor on drug policy to President Obama will be speaking.

Source: By Kathy Gyngell www.conservativewoman.co.uk  Sept.2015

A new call to action has been released from scientists around the world, reflecting “a growing consensus among experts that frequent cannabis use can increase the risk of psychosis in vulnerable people and lead to a range of other medical and social problems,” according to the The Guardian.

Researchers now believe the evidence for harm is strong enough to issue clear warnings, said the article.  For example, Sir Robin Murray, professor of psychiatric research at King’s College London, stated:

“It’s not sensible to wait for absolute proof that cannabis is a component cause of psychosis. There’s already ample evidence to warrant public education around the risks of heavy use of cannabis, particularly the high-potency varieties. For many reasons, we should have public warnings.”

Estimates suggest that deterring heavy use of cannabis could prevent 8 to 24% of psychosis cases handled by treatment centers, depending on the area. In London alone, where the most common form of cannabis is high-potency marijuana (or “skunk” as it is sometimes called in the United Kingdom), avoiding heavy use could avert many hundreds of cases of psychosis every year.

“It is important to educate the public about this now,” said Nora Volkow, director of the US National Institute on Drug Abuse (NIDA). “Kids who start using drugs in their teen years may never know their full potential. This is also true in relation to the risk for psychosis. The risk is significantly higher for people who begin using marijuana during adolescence. And unfortunately at this point, most people don’t know their genetic risk for psychosis or addiction.”

Ian Hamilton, a mental health lecturer at the University of York, said more detailed monitoring of cannabis use is crucial to ensure that information given out is credible and useful. Most research on cannabis, particularly the major studies that have informed policy, is based on older low-potency cannabis resin, he points out. “In effect, we have a mass population experiment going on where people are exposed to higher potency forms of cannabis, but we don’t fully understand what the short- or long-term risks are,” he said.

Prof Wayne Hall, director of the Centre for Youth Substance Abuse Research at the University of Queensland, said that while most people can use cannabis without putting themselves at risk of psychosis, there is still a need for public education:

“We want public health messages because, for those who develop the illness, it can be devastating. It can transform people’s lives for the worse. People are not going to develop psychosis from having a couple of joints at a party. It’s getting involved in daily use that seems to be the riskiest pattern of behavior: we’re talking about people who smoke every day and throughout the day.”

“When you’re faced with a situation where you cannot determine causality, my personal opinion is why not take the safer route rather than the riskier one, and then figure out ways to minimize harm?” said Amir Englund, a cannabis researcher at King’s College London.

A UK government spokesperson also said its position on cannabis was clear.

“We must prevent drug use in our communities and help people who are dependent to recover, while ensuring our drugs laws are enforced. There is clear scientific and medical evidence that cannabis is a harmful drug which can damage people’s mental and physical health, and harms communities.”

These comments underline the need for a global drug policy that prevents drug use, instead of promoting it. Global drug policy should continue to evolve to match the new scientific evidence available, and that includes taking into account the heavy price that increases in drug use entail, particularly in less-developed countries.

Source:    www.preventdontpromote.org   16^th April  2016

Prevent. Don’t Promote. (http://preventdontpromote.org/) is a global campaign that more than 300 organizations across the world are launching at UNGASS 2016 to support the UN drug conventions.  This consortium of organizations advocates fora global drug policy based on public health and safety through the prevention of drug use and drug problems.

Aligned with the principles of Drug Policy Futures, we believe that drug policies should:

• Prevent initiation of drug use.
• Respect human rights (for users and non-users alike) as well as the principle of proportionality.
• Strike a balance of efforts to reduce the use of drugs and the supply of drugs.
• Protect children from drug use.
• Ensure access to medical help, treatment and recovery services.
• Provide access to controlled drugs for legitimate scientific and medical purposes.

Ensure that medical and judicial responses are coordinated with the goal of reducing drug use and drug-related consequences.

By Mark H. Moore; Mark H. Moore is professor of criminal justice at Harvard’s Kennedy School of Government.

CAMBRIDGE, Mass.— History has valuable lessons to teach policy makers but it reveals its lessons only grudgingly.

Close analyses of the facts and their relevance is required lest policy makers fall victim to the persuasive power of false analogies and are misled into imprudent judgments. Just such a danger is posed by those who casually invoke the ”lessons of Prohibition” to argue for the legalization of drugs.

What everyone ”knows” about Prohibition is that it was a failure. It did not eliminate drinking; it did create a black market. That in turn spawned criminal syndicates and random violence. Corruption and widespread disrespect for law were incubated and, most tellingly, Prohibition was repealed only 14 years after it was enshrined in the Constitution.

The lesson drawn by commentators is that it is fruitless to allow moralists to use criminal law to control intoxicating substances. Many now say it is equally unwise to rely on the law to solve the nation’s drug problem.

But the conventional view of Prohibition is not supported by the facts.

First, the regime created in 1919 by the 18th Amendment and the Volstead Act, which charged the Treasury Department with enforcement of the new restrictions, was far from all-embracing. The amendment prohibited the commercial manufacture and distribution of alcoholic beverages; it did not prohibit use, nor production for one’s own consumption. Moreover, the provisions did not take effect until a year after passage -plenty of time for people to stockpile supplies.

Second, alcohol consumption declined dramatically during Prohibition. Cirrhosis death rates for men were 29.5 per 100,000 in 1911 and 10.7 in 1929. Admissions to state mental hospitals for alcoholic psychosis declined from 10.1 per 100,000 in 1919 to 4.7 in 1928.

Arrests for public drunkenness and disorderly conduct declined 50 percent between 1916 and 1922. For the population as a whole, the best estimates are that consumption of alcohol declined by 30 percent to 50 percent.

Third, violent crime did not increase dramatically during Prohibition. Homicide rates rose dramatically from 1900 to 1910 but remained roughly constant during Prohibition’s 14 year rule. Organized crime may have become more visible and lurid during Prohibition, but it existed before and after.

Fourth, following the repeal of Prohibition, alcohol consumption increased. Today, alcohol is estimated to be the cause of more than 23,000 motor vehicle deaths and is implicated in more than half of the nation’s 20,000 homicides. In contrast, drugs have not yet been persuasively linked to highway fatalities and are believed to account for 10 percent to 20 percent of homicides.

Prohibition did not end alcohol use. What is remarkable, however, is that a relatively narrow political movement, relying on a relatively weak set of statutes, succeeded in reducing, by one-third, the consumption of a drug that had wide historical and popular sanction.

This is not to say that society was wrong to repeal Prohibition. A democratic society may decide that recreational drinking is worth the price in traffic fatalities and other consequences. But the common claim that laws backed by morally motivated political movements cannot reduce drug use is wrong.

Not only are the facts of Prohibition misunderstood, but the lessons are misapplied to the current situation.

The U.S. is in the early to middle stages of a potentially widespread cocaine epidemic.    (in 2001)   If the line is held now, we can prevent new users and increasing casualties. So this is exactly not the time to be considering a liberalization of our laws on cocaine. We need a firm stand by society against cocaine use to extend and reinforce the messages that are being learned through painful personal experience and testimony.

The real lesson of Prohibition is that the society can, indeed, make a dent in the consumption of drugs through laws. There is a price to be paid for such restrictions, of course. But for drugs such as heroin and cocaine, which are dangerous but currently largely unpopular, that price is small relative to the benefits.

Source:  http://nyti.ms/U1QHdN  Published October 16 1989

1.     Prohibited the commercial manufacture, and distribution of alcoholic beverages

It DID NOT prohibit use, or production for one’s own consumption

2.     Alcohol consumption declined dramatically during prohibition.

Cirrhosis death rates for men were 29.5 per 100,000 in 1911 and 10.7 inn 1929

Mental hospital admission for alcoholic psychosis declined from 10.1 per 100,000 in 1919 to 4.7 in 1928.

Arrests for public drunkenness and disorderly conducted declined 50% between 1916 and 1922

Consumption of alcohol declined by 30 to 50%

3.     Violent crimes DID NOT increase dramatically during prohibition.  Homicide rates rose dramatically from 1900 to 1910 but remained roughly constant during prohibition’s 14-year rule.  Organized crime did become more visible during prohibition but it existed before and after.

4.     Following the repeal of prohibition, alcohol consumption increased.  Today alcohol is estimated to be the cause of 50% of traffic deaths and is implicated in more than half of the nation’s homicides.

Source:  J.McDougal 2001  –  re-printed Drug Watch International e-mails.

Easy-to-use technology provides alternative to injectable form of lifesaving medication.

The National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, is pleased to announce that intranasal naloxone –a nasal spray formulation of the medication designed to rapidly reverse opioid overdose – has been approved by the U.S. Food and Drug Administration (FDA). The new technology has an easy-to-use, needle-free design, providing family members, caregivers and first responders with an alternative to injectable naloxone for use during a suspected opioid overdose.

The new technology will be marketed by Adapt Pharma Limited, a partner of Lightlake Therapeutics Inc. NIDA and Lightlake, a biopharmaceutical company developing novel treatments for addiction, entered into a partnership in 2013 to apply new technology towards developing a lifesaving intervention for opioid overdose. The product will be marketed under the brand name NARCAN® Nasal Spray.

In 2013, more than 16,000 people died from a prescription opioid overdose, or approximately 44 people per day. In addition, another 8,000 died from heroin-related overdoses, a rate that has nearly quadrupled between 2002 and 2013. This FDA-approved intranasal delivery system could reduce the thousands of opioid-related deaths each year, and give patients a second chance to enter into long term addiction treatment. Family members can ask their health providers or pharmacists how to obtain the nasal spray, which is expected to be commercially available by early next year.

Source:    https://www.drugabuse.gov/news-events/news-releases/2015/11/18

Piscataway, NJ – Although there have been calls to lower the legal drinking age from 21, a new study raises the possibility that it could have the unintended effect of boosting the high school dropout rate.

The report, published in the September issue of the Journal of Studies on Alcohol and Drugs, looked back at high school dropout rates in the 1970s to mid-80s — a time when many U.S. states lowered the age at which young people could legally buy alcohol.

Researchers found that when the minimum drinking age was lowered to 18, high school dropout rates rose by 4 to 13 percent, depending on the data source. Black and Hispanic students — who were already more vulnerable to dropping out — appeared more affected than white students.

The findings do not prove that the 18 drinking age was to blame, according to lead researcher Andrew Plunk, Ph.D., an assistant professor of paediatrics at Eastern Virginia Medical School, in Norfolk. However, he said, state drinking-age policies would likely be unrelated to the personal factors that put kids at risk of drinking problems or dropping out.

Plus, Plunk explained, states made those policy changes based on national trends at the time — mainly, the belief that with the voting age lowered to 18, the legal drinking age should drop, too. So it’s unlikely that other events happening within states would explain the connection to high school dropout rates.

And why would the legal drinking age matter when it comes to high school dropout rates?

“The minimum legal drinking age changes how easy it is for a young person to get alcohol,” Plunk said. “In places where it was lowered to 18, it’s likely that more high school students were able to get alcohol from their friends.”

And for certain vulnerable kids, that access might lower their chances of finishing high school. Policies that allowed 18-year-olds to buy alcohol showed a particular impact on minority students, as well as young people whose parents had drinking problems. In that latter group, the dropout rate rose by 40 percent.

In the mid-1980s, federal legislation returned the legal drinking age to 21 nationwide.

However, there is an ongoing debate about lowering it again — largely as a way to combat clandestine binge drinking on college campuses. The argument is that college students who can legally buy alcohol at bars and restaurants will drink more responsibly.

But Plunk said that debate is missing something: What might the effects be in high schools?

“I think this study gives us some idea of what could happen if we lower the legal drinking age,” Plunk said. “It suggests to me that we’d see this same dropout phenomenon again.”

###

Plunk, A. D., Agrawal, A., Tate, W. F., Cavazos-Rehg, P., Bierut, L. J., & Grucza, R. A. (September 2015). Did the 18 drinking age promote high school dropout? Implications for current policy.  76(5), 680-689.

The Journal of Studies on Alcohol and Drugs is published by the Center of Alcohol Studies at Rutgers, The State University of New Jersey. It is the oldest substance-related journal published in the United States

Source: Journal of Studies on Alcohol and Drugs,  28th  September 2015

According to the National Institute on Drug Abuse, “Besides the risk of spontaneous abortion, heroin abuse during pregnancy (together with related factors like poor nutrition and inadequate prenatal care) is also associated with low birth weight, an important risk factor for later delays in development. Additionally, if the mother is regularly abusing the drug, the infant may be born physically dependent on heroin and could suffer from neonatal abstinence syndrome (NAS), a drug withdrawal syndrome in infants that requires hospitalization. According to a recent study, treating opioid-addicted pregnant mothers with buprenorphine (a medication for opioid dependence) can reduce NAS symptoms in babies and shorten their hospital stays.”

Source:   http://www.wmdt.com/news    Sept 18th 2015

A new study has caused quite a stir among would-be marijuana cognoscenti because it contradicts major research about the impact of marijuana on physical and mental health. The Marijuana Report asked neuroscientist, Bertha K. Madras of Harvard Medical School, to look briefly at the study. Dr. Madras served as Deputy Director for Demand Reduction at ONDCP.

Bertha K. Madras, PhD

A recent manuscript by Bechtold et al,¹ describes a longitudinal assessment of a population of marijuana users which, after data collection, were divided into four user groups: (1) nonusers to low use (48%, n=186); (2) limited to adolescent use (10%, n=38); (3) late initiators and increasing (20%, n=76); and (4) early onset with chronic use (22%, n=86). Marijuana use was monitored from adolescence (age 15) into young adulthood (age 26). Ten years later, and ten years after the last determination of marijuana use, study authors asked the subjects, now at an average age of 35.8 years, to report their health status. Each of the four groups self-reported no differences in physical or mental health problems in their mid-thirties. The authors concluded that regardless of how much and how long marijuana was used, and regardless of race, the physical and mental health problems of these four groups were similar. That is, high marijuana use for prolonged periods was not associated with any physical or mental health problems. They also claimed that this is a definitive study because it was longitudinal and superior to other published reports on long-term health consequences of marijuana.

A critical evaluation of the validity of the findings and sweeping conclusions is essential, lest they are interpreted inappropriately. A perusal of the study and the authors’ stated caveats in the manuscript reveal significant weaknesses, with the use of an unrepresentative, possible archaic population, inadequate sample size, inadequate methodologies to assess mental health and physical problems, (self-reports, evaluation of psychiatric status without considering the “spectrum” nature of psychiatric conditions, and absence of addiction evaluation). The findings conflict with other well designed longitudinal studies that assess long-term consequences of marijuana use with early age of initiation of marijuana.

This type of study would not approach or fulfill rigorous criteria for longitudinal research, as exemplified by the 2014 NIDA funding opportunity with similar goals (see “An example of a well-designed study,” last section). The conclusions conceivably are compromised by the following perceived shortcomings of the study.

Population Concerns

1. The sample size, 386 people, was too small to detect a marijuana effect on psychotic disorders or on other health conditions. NIDA recommends a sample size of 10,000 to detect differences (see final paragraphs). About 50% of the subjects – age 14 – were selected on the basis of their high scores on anti-social behaviors 1 (conduct problems) and the remainder from adolescents without high anti-social behavior scores, but it is not clear whether the drop-out rate from the study was equally represented by both categories. Did more people with early onset anti-social behaviors drop out and does this skew the conclusions? Was there under-sampling of a population at highest risk? There is strong and accumulating evidence that marijuana use is associated with psychosis, with earlier age of onset of schizophrenia, and with worsening of psychotic/schizophrenic symptoms. These association studies were gleaned from thousands of people, not from fewer than 400 subjects, especially when only 100 people are in the high risk group. The small sample size would also make it difficult to detect other serious marijuana-associated medical problems. Reporting of cardiovascular complications related to marijuana and the extreme seriousness of these events (death rate of 25.6%) is increasing, but this occurs in a small number of users (one estimate is 1.8%).

Marijuana is a possible risk factor for cardiovascular disease in young adults,⁶ with a temporal association between marijuana use and heart attacks, sudden cardiac death, and for stroke, transient ischemic attack, and marijuana-induced arteritis.⁷ Pulmonary symptoms attributable to marijuana use, even with less intense use, include chronic bronchitis, daily cough, and phlegm production (four quality studies document these findings). No power analysis indicates adequacy of sample size.

Think about this: The prevalence of schizophrenia is 1 in 100. If you sample only 86 subjects of the riskiest group, “early onset chronic users” category, it is unlikely that you can detect a significant increase in prevalence of psychosis or schizophrenia. Another example: a recent study found the incidence of serious cardiac effects of marijuana in 1.8% of heavy users. Was the sample of early onset chronic users (86 people) large enough to detect serous cardiac effects, especially from self-reports?

2. The study does not have a drug-naïve population for comparative measures of outcomes. The authors report that the amount of marijuana used during adolescence and early adulthood had no effect on the occurrence of a range of health problems.

Think about this: The study has no group that controls for a general, representative population, a non-drug using population. Some other studies have shown different outcomes among youth or young adults who choose not to use, those who use occasionally, or heavy users. What populations are these groups compared to? Are the group sizes large enough to detect differences?

3. The populations and use patterns investigated in this study are anachronistic and conceivably irrelevant for 2015. Subjects were initially screened in 1987-1988, with a majority of users recruited that did not fall into the heavy use range (daily or near daily use), a use pattern increasingly observed at the present time. The majority of subjects used marijuana during the 1990’s when the psychoactive THC content of marijuana was relatively low, compared with current concentrations.

Think about this: The most serious health outcomes associated with marijuana use, including addiction, occur in heavy users (daily or near daily use) using for long periods of time. Currently, marijuana access has risen rapidly as its legal status changes, its perception of harm has plummeted among youth, along with a rising perception that as a medicine it is safe and can be used daily. Daily use of high potency 2 marijuana among adolescents and young adults is near or at its highest level in nearly three decades. The populations of this study may be irrelevant to current trends, especially since 2009, as marijuana potency is at its highest level ever, availability is greater because of reduced federal and state oversight, as daily use increases, and perception of harm declines. These factors conceivably influence self-reporting of effects and their magnitude. Are the outcomes of this study relevant to current use patterns and marijuana potency?

4. The population is not representative of the general population: (a) the prevalence of concussions (27.7%) is inordinately high. (b) Death by gunfire is inordinately high. No explanations are offered for the abnormally high prevalence of concussions or death by gunfire, and whether this population has a higher than average prevalence of cognitive impairment. Was there a relationship between concussions and marijuana use or self-reporting of adverse health problems?

Think about this: The overall rate of traumatic brain injury (concussions) presenting in emergency departments in the United States (recent CDC statistics) is 19 per 100,000 persons; for males in this age group, it is about 470 per 100,000 persons (or 4.7 for each 1,000 persons). A concussion rate of 27% of this population (270 per 1000 persons) is about 60 times higher than the general population within this age range. Some rigorous research criteria exclude subjects with traumatic brain injury because of the potential for cognitive impairment. The high numbers of concussions and deaths due to gunfire are anomalous if compared to statistics within the general population. Is this sample representative?

5. Self-reported medical health problems by these subjects differ from population statistics, on the basis of occurrence by race. According to CDC statistics in 2010, the prevalence of diseases in the general population among African American (AA) adults compared to white (W) adults is different than reported in this study. The CDC ratios (AA:W) for the general population are: Diabetes, CDC = 1.6:1; this study = 4:0. Chronic kidney disease, CDC = 1.14:1, this study = 0:0.6. Sexually transmitted diseases, CDC = 4:1; this study = 0.5:1.1.

Think about this: The health problems self-reported by the African-Americans and white subjects may or may not be accurate, but they differ from the CDC prevalence data for the general population. Differences highlight the need for recruiting sufficiently large numbers of subjects to be representative of the population as a whole. Do differences reflect the unusual populations of this study, which may not generalize to the entire population?

Methodological Concerns: Outcome measures

6. The purpose of the study was to determine whether different patterns of marijuana use among youth affected mental and physical health. All findings are based on an inadequate method for measuring outcomes – self reports, because of potential bias, recall errors, and reliance on self-knowledge of medical conditions. The authors did not investigate medical records, did not confirm marijuana and other drug use with biometric tests, did not interrogate contacts, and did not inquire about sequence of use of other drugs.

Think about this: More than 75% of people harbouring a substance use disorder (SUD), based on objective DSM-IV criteria (Diagnostic and Statistical Manual-IV), do not think they have a SUD and do not seek treatment.² To rely solely on self-reporting of mental or physical health problems with a questionnaire, raises doubts about the overall study design and conclusions. Other examples: Fifty percent of men who died of heart disease had no obvious symptoms. A diagnosis of diabetes or high blood pressure is made by biometric testing, not by self-reports. Without confirmation from medical records or physician-initiated tests, is it possible to know high blood pressure or diabetes with certainty?

7. Following from #6 above, there is no evidence that subjects reported health outcomes based on their medical records. Authors did not question whether study participants had visited a physician during the past year, past five years or ten years since the last contact. Confirmation of medical conditions by a medical record would strengthen the conclusions. The core outcomes of this study are mental and physical health. Knowing whether the mental and physical health of subjects in this study had been objectively diagnosed by a physician or specialist (psychiatrist, addiction medicine) is critical. The unknown medical record, combined with an assumption that subjects’ self-reports were accurate, diminish the convictions of the authors’ conclusions.

Think about this: Many health problems are not apparent to individuals until they are referred to, or measured by a professional; addiction, high blood pressure, diabetes, cancer, and cognitive impairment. Were all subjects reporting results from a recent annual check-up? Unless this information and results are provided, can one assume that self-reports are accurate?

8. Following from #6, #7 above, mental health diagnoses were based on questionnaires, not on biometric testing or long-term assessment (mental health diagnosis requires more than a single session and long-term evaluation). The diagnosis of psychosis, mood disorders, and anxiety disorders, does not rely solely on a person’s response to a single oral or written questionnaire or impressions of their own health. Definitive diagnosis for a serious mental health problem such as schizophrenia, requires systematic questioning, and over a significant period of time to determine whether symptoms persist and are not temporary aberrations. Moreover, mental health problems including substance use disorders (addiction), occur along a continuum of mild to severe. It is possible that the focus on a diagnosis of a psychotic disorder in the current study limited their ability to detect subtle effects of marijuana use on brain function, thought processes, or early psychotic symptoms. Scores were not generated that reflect this continuum. Authors arbitrarily selected a cut-off point to rate the presence or absence of a diagnosis.

Think about this: It is simple to detect one’s own asthma or headache but, for many mental health problems, self-diagnosis may be inaccurate. Can one know if they are developing subtle signs of a mental problem or cognitive impairment unless measured objectively? Can one know if an early stage of cancer is present unless discovered by imaging, by biopsy, or gene expression profiling? Can one know if 4 asymptomatic heart disease is present without ECG testing? Is self-diagnosis of an early stage of mental illness reliable?

Methodological concerns: Marijuana use

9. The investigators divided marijuana users over time into four groups, using model fit statistics. The chart showing marijuana use over time for these four groups provides no error bars indicating whether these groups are significantly different at each age during the study.

Think about this: One would assume the groups were different, based on the four-group solution that was selected on the basis of model fit statistics, substantive interpretation, face validity of classes, parsimony, and consistency of findings with prior research. But, it would be helpful if error bars representing range of use at each age were included to assure the reader that the group divisions based on subjective criteria (interpretation, face validity of classes, parsimony, and consistency of findings with prior research) are transparently clear at each age.

Some data of the marijuana use component are missing: 46% of the subjects had voids in data. Almost half of the subjects did not report marijuana use at various times during the 10 years of survey. This partial set of data is problematic, even though authors claim missing data were from people similar to those who yielded full data sets, and it is possible to interpolate missing data. Reasons for these data gaps should be provided.

Think about this: If a segment of data is not available, does it invalidate or skew the chart showing trends of the four groups? Uncertain.

10. Marijuana use was not questioned at the end of the study (age 36 years). Strong longitudinal studies have shown that early onset and heavy use of marijuana is associated with or is a causative agent in long-term adverse effects on educational achievement, employment, welfare dependency, use of other illicit drugs, psychotic symptoms, I.Q. reduction, and others.^3-5 This study provides marijuana use rates until age 26, measures life outcomes at age 36 but doesn’t ask subjects whether they used marijuana from age 26-36 and at age 36. Most users apparently were not consuming daily or nearly daily and three of the four groups had largely stopped using by the age of 26. Why was marijuana use not measured at the end of the study?

Think about this: It is critical to know whether the people using marijuana from age 15-26 years, were still using at age 36, at the time the health outcomes were questioned. If you are studying whether marijuana has interfered with the mental and physical health of subjects at the present time, is it not logical to interrogate whether they are currently using, or if they stopped and when they stopped? If they stopped 10 years before the study, then long-term consequences may be less likely.

11. Marijuana potency was far lower (1980’s to 1990’s) during the period of marijuana consumption of this population. This conceivably affects outcomes and consequences.^5.

12 Quantity, frequency, and potency of marijuana use is a critical measure. Frequency and potency were not questioned. The main outcome measure was the number of times marijuana was used during the year. The patterns of use, number of times used each day, and potency, were not interrogated during each annual survey.

Methodological concerns: Outcomes not measured

13. Marijuana addiction (cannabis use disorder or CUD), among the most significant of the adverse effects of marijuana, was not interrogated. The prevalence of CUD is related to age of onset, quantity and frequency of use and is closely linked to other life outcomes.

Think about this: Addiction is among the most prominent effects of chronic marijuana use, and yet the study did not ask about addiction.

14. Life outcomes were not measured (employment, educational achievement) at the

end of the study. Other strong longitudinal studies have interrogated life outcomes and concluded that marijuana has adverse long-term effects on employment and educational achievement, and other social consequences, as a function of age of onset and quantity used.^3-5

Think about this: Longitudinal studies indicate that heavy continuous marijuana use leads to lower socioeconomic status and achievement (e.g. college education, employment) than infrequent or no use. When an individual is using marijuana very frequently for a number of years, are they more or less likely to maintain a job, complete high school or college, or be on welfare?

15. Cognitive testing was not measured. Cognitive impairment is one of the hallmarks of acute and possibly long-term marijuana use. It is also associated with other adverse life outcomes.

Think about this: If you were designing a study to learn whether an intoxicant that is known to interfere with learning, memory, and executive function, would you omit evaluating learning and memory from the study?

16. A number of health problems questioned (e.g. cancer, high blood pressure, heart attacks, strokes) arise later than the average age of the subjects (mid- 30’s). The health questionnaire was filled out by marijuana users in their mid-30’s, an age at which most significant health problems are not yet manifest.

17. Acute effects of marijuana were not asked: intoxication, accidents, emergency department mentions, unplanned pregnancies, and HIV-AIDS. For example, a recent European study collected Emergency Department data from 14 European centers for six months to determine acute toxicity of marijuana. Of the sample, 356 (16.2 %) involved marijuana alone or together with other drugs/alcohol and 1.6 % with marijuana alone. Of the 35 non-fatal lone marijuana presentations, the most commonly reported features were agitation/aggression (22.9 %), psychosis (20.0 %), anxiety (20.0 %), and vomiting (17.1 %). There was one fatality due to prolonged cardiac arrest, with no other drugs detected.⁶

Think about this: Acute marijuana toxicity can lead to emergencies requiring medical attention. Does omission of this from the questionnaire achieve a comprehensive view of medical consequences of marijuana?

Citations and Comparison with other Studies

18. Authors omit mention of important recent longitudinal studies that show different outcomes than their own study. Other carefully controlled and longitudinal studies have shown that early age of onset of marijuana use is associated with a number of mental and physical consequences, including addiction, cognitive deficits, mental health problems, educational and employment outcomes, and others. Citations 3 and 4 are not mentioned, others are dismissed with a list of weaknesses, even though the current study is fraught with significant weaknesses.

19. The authors attempt to support their conclusions by dismissing well designed reports by others. In the introduction, they do not discuss severe limitations of their own study: (e.g. daily use of high potency marijuana is currently at its highest level in 30 years of surveys, in contrast with their subjects; weaknesses of self-reported medical and psychiatric conditions, and others as stated above). Instead, the introduction curiously offers a critique, entitled Limitations in Prior Research. In it they conclude that “prior research has produced mixed findings regarding the associations between chronic marijuana use and indicators of physical and mental health, …and that individuals who begin using marijuana frequently during early adolescence and those who use at high frequencies throughout adolescence and young adulthood tend to develop more health problems (i.e., psychotic symptoms, respiratory problems) than infrequent/nonusers, in contradistinction to their own findings.

Think about this: In their critique:

(1) The authors claim this study is among a “handful of studies that have been able to prospectively delineate subgroups of individuals with varying developmental patterns of marijuana use from adolescence into young adulthood.” The strength of the present study was to document marijuana use, but not in depth and not confirmed by biometric testing, annually for the decade of life encompassing adolescence and early adulthood. Yet, other research has interrogated key variables, age of onset, frequency and quantity of marijuana use (confirmed with biometric testing), some in prospective, longitudinal studies, others in cross-sectional studies. The medical record at the study’s inception is of limited value because it is neither comprehensive nor independently verified. The initial assessment of 15-year-old boys was inadequate and was not followed by a longitudinal assessment, except for marijuana use. The 10 year hiatus in data collection is a weakness. Self-reports of mental and physical health are inappropriate.

(2) They claim that “few longitudinal studies have examined whether young men who exhibit early and chronic developmental patterns of marijuana use are more likely to exhibit both physical and mental health problems in their mid-30s.” Unfortunately, this study does not answer this question because of the quality of the outcome measures, no marijuana use patterns recorded for 10 years, and the only medical and 7 mental health outcomes are reported by mothers of the subjects around age 15 and by the subjects themselves at ~ age 36.

(3) They claim that “Many studies have failed to control for important confounding factors, such as health problems that predated the onset of regular marijuana use and co-occurring use of tobacco, alcohol, and hard drug.” Yet, the documented and age appropriate deficits associated with marijuana use, in-depth psychiatric status, cognitive impairment, declining academic performance, school drop-out rates, accidents, and others were not interrogated in this survey.

Limited references

1. Bechtold, J., Simpson, T., White, H. R., & Pardini, D. Chronic Adolescent Marijuana Use as a Risk Factor for Physical and Mental Health Problems in Young Adult Men Online First Publication, August 3, 2015. http://dx.doi.org/10.1037/adb0000103 Psychology of Addictive Behaviors.

2. Substance Abuse and Mental Health Services Administration, Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-48, HHS Publication No. (SMA) 14-4863. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.

3. Fergusson DM, Boden JM, Horwood LJ. Psychosocial sequelae of cannabis use and implications for policy: findings from the Christchurch Health and Development Study. Soc Psychiatry Psychiatr Epidemiol. 2015 May 26. [Epub ahead of print]

4. Fergusson DM, Boden JM. Cannabis use and later life outcomes. Addiction. 2008 Jun;103(6):969-76; discussion 977-8.

5. Meier MH, Caspi A, Ambler A, Harrington H, Houts R, Keefe RS, McDonald K, Ward A, Poulton R, Moffitt TE. Persistent cannabis users show neuropsychological decline from childhood to midlife. Proc Natl Acad Sci U S A. 2012 Oct 2;109(40):E2657-64.

6. Dines AM, Wood DM, Galicia M, Yates CM, Heyerdahl F, Hovda KE, Giraudon I, Sedefov R; Euro-DEN Research Group, Dargan PI. Presentations to the Emergency Department Following Cannabis use-a Multi-Centre Case Series from Ten European Countries. J Med Toxicol. 2015 Feb 5. [Epub ahead of print]

7. Jouanjus E, Lapeyre-Mestre M, Micallef J; French Association of the Regional Abuse and Dependence Monitoring Centres (CEIP-A) Working Group on Cannabis Complications*. Cannabis use: signal of increasing risk of serious cardiovascular disorders. J Am Heart Assoc. 2014 Apr 23;3(2):e000638. doi:10.1161/JAHA.113.000638.

8. Thomas G, Kloner RA, Rezkalla S. Adverse cardiovascular, cerebrovascular, and peripheral vascular effects of marijuana inhalation: what cardiologists need to know. Am J Cardiol. 2014 Jan 1;113(1):187-90.

An example of a well-designed longitudinal study

NIDA Funding Opportunity http://grants.nih.gov/grants/guide/rfa-files/RFA-DA-15-015.html

Research Design and sample should describe the following:

• A longitudinal single-cohort design to prospectively examine the neurodevelopmental and behavioral effects of substance use from early adolescence through the period of risk for substance use and substance use disorders.

• Participants, approximately ages 9-10 at baseline, who are largely naïve to substance use at the time of study enrollment; the focus on a largely asymptomatic population at baseline provides the opportunity to define brain and behavioral risk factors and trajectories before the onset of substance use;

• A design with a sample size that is sufficiently large to achieve the study goals; preliminary estimates indicate a sample size of approximately 10,000 participants (combined across sites) at the end of the 5-year funding cycle would be needed, though a smaller sample can be proposed if justified by feasibility and statistical-power analyses;

• A sampling strategy designed to establish a community-based sample that is broadly representative of and generalizable to the U.S. general population as a whole, including males and females, as well as major racial, ethnic, and sociodemographic subgroups of the population; it is recognized that the level of precision achieved for various subgroups may vary, and that probability-based sampling and oversampling of certain demographic subgroups or geographical regions may be required;

• A sampling design that considers oversampling of population subgroups at greater risk for uptake of substance use during adolescence (e.g., positive family history of substance use disorders, externalizing psychopathology, disinhibitory traits, prenatal exposure to substances);

• A research approach that considers incorporating genetically informative designs (e.g., family based) or subjects (e.g., twins, siblings);

• A sampling design to produce geographical variation of macro-level factors associated with substance use (e.g., state-level policies concerning the permissiveness of marijuana, alcohol, and tobacco use; regional variation in prevalence of marijuana, alcohol, and tobacco use; rural, urban and suburban populations);

• State-of-the-art data-collection procedures (e.g., computer-administered/assisted interviews), practices (e.g., cultural matching) and quality-control processes (e.g., random verification, logic-checking);

• Standardized measures that, where possible, are compatible with data-harmonization efforts (e.g., PhenX Toolkit) and ongoing studies of substance use and neurodevelopment;

• Comprehensive multi-informant (e.g., respondent, parent/guardian, sibling, etc. as appropriate) assessment of substance use to permit estimates of prevalence, incidence, and change in use patterns (e.g., quantity, frequency) by specific substances (e.g., nicotine, alcohol, marijuana), products and product types (cigarettes, e-cigarettes, snuff, beer, liquor, joints, blunts), and modes of administration (e.g., inhalation, oral, drinking, nasal); measures of change should be sensitive enough to detect dynamic patterns among adolescents as they enter and pass through the period of risk for substance use;

Behavioral Measures and Biospecimens should describe the following:

• Comprehensive and multi-level assessment of predictors, mediators, moderators, and outcomes associated with substance use (e.g., demographics, pubertal status, personality traits, parental monitoring, peer group deviance, family structure, parent-child relationships, prosocial behaviors, romantic relationships, stressful events, availability of substances, state and local policies related to marijuana, alcohol, and tobacco use, educational attainment, learning 9 disability designation or receipt of services, crime, unemployment, experience and/or witnessing of trauma or violence);

• Assessment of concurrent and historical participation in interventions that may prevent or mitigate substance use and its consequences (e.g., pre- and post-natal prevention programs; Head Start; receipt of counseling, psychotherapy and other behavioral health interventions or services; family or classroom-based prevention interventions);

• Comprehensive measurement of confounders and other risk factors (e.g., prenatal exposure, abuse or trauma, drug availability, exposure to environmental risk factors, sport injuries especially to the head, etc.);

• Rigorous quantitative and categorical assessment of symptomatology and psychiatric disorders, including severity;

• Family history assessment of substance use disorders and other psychopathology;

• Age-appropriate assessment of HIV-risk knowledge and behaviors;

• Neuropsychological battery of tests that is developmentally sensitive and that allows for the assessment of major neurobehavioral dimensions associated with substance use (e.g., attention, information processing, learning and memory, cognitive control, motivation, emotional regulation, disinhibition, risk taking);

• Screening for drug intoxication prior to behavioral, cognitive, or functional imaging sessions and neuropsychological assessment, with delineated thresholds for inclusion/exclusion;

• Clear and justified inclusion/exclusion criteria to identify individuals unable to complete the assessment protocol for various reasons (e.g., use of certain prescribed medications, language/reading impairments, brain injury, severe mental illness, etc.);

• Detailed plans and procedures to collect, process, analyze, and store biospecimens (e.g., urine, blood, saliva, hair) indicative of substance exposure; • Additional biospecimens should be collected for subsequent research on genetic/epigenetic factors influencing or affected by substance use, with accompanying plans for analyses.

The Rocky Mountain High Intensity Drug Trafficking Area released its third annual report this week. The organization has been tracking the impact of marijuana legalization in Colorado since the state first legalized the drug for medical use in 2000, passed legislation to allow dispensaries beginning in 2009–which spawned a commercial marijuana industry–and legalized pot for recreational use in 2012. The 2015 report shows that by 2013, Colorado marijuana use was nearly double the national usage rate. The state ranked 3rd in the nation for youth use in 2013, up from 14th in 2006; 2nd in the nation for young adult use in 2013, up from 8th in 2006; and 5th in the nation for adults, up from 8th in 2006.

Drug-related school expulsions, most of which are marijuana-related, far exceed school expulsions for alcohol use. Note the sudden jump in drug expulsions that began in 2009 when Colorado allowed a commercial marijuana industry to emerge. Total school suspensions and expulsions rose from 3,736 by the end of the 2008-2009 school year to 5,249 by the end of the 2013-2014 school year.

Marijuana-related traffic fatalities in Colorado also began rising with the introduction and growth of the commercial marijuana industry in 2009. While total State wide fatalities decreased between 2006 and 2014, marijuana-related fatalities increased over that time.

Colorado marijuana-related emergency room visits increased to 18,255 in in 2014.

Marijuana-related hospitalizations have nearly quintupled since Colorado first legalized marijuana for medical use. Again, note the surge starting in 2009 when growers, processors, and dispensaries were first authorized, and a commercial industry began developing extensive marijuana products such as edibles, vape pens, and butane hash oils (BHO) to attract new customers. BHO has elevated THC levels to the highest seen in the nation; some contain 75 percent to 100 percent THC.

Although there is no data to document whether the increase in homelessness in Denver and other Colorado cities is marijuana-related, those who provide services to the homeless report that many say they relocated to Colorado because of marijuana’s legality.

In Colorado, marijuana is not available in about three-fourths of the state. Of a total 321 local jurisdictions, 228 (71 percent) ban all forms of marijuana businesses; 67 (21 percent) allow both medical and recreational marijuana businesses; and 26 (8 percent) allow only medical or recreational marijuana businesses.

Read report here.

This wonderful book tells much of the story about cannabis that we are not allowed to hear.

I strongly commend it to you all. It does the neuroscience very well, and reviews much of the brain and neuroscience nicely and in a sensible and balanced way, and also indicates how the crazy side skews their presentation of evidence to aid and abet their grossly dishonest agenda. It actually gives a list of 21 social harms directly related to drug addiction – and then says that there are several dozen more which have not been mentioned!!!!

It is written by a senior practising psychiatrist majoring in addiction medicine, who was also a cannabis addict from 17-19 years of age. So he has known both sides of the fence.

Source: Book reviewed by Stuart Reece sreece@bigpond.net.au  Sept 2015

https://books.google.co.uk/

On the heels of the Federal Drug Administration’s (FDA) second public workshop to explore the public health considerations associated with e-cigarettes, nonprofit research organization RTI International released a new research paper “Exhaled Electronic Cigarette Emissions: What’s Your Secondhand Exposure?,” which explores the composition of e-cigarette vapor and the potential health impacts of secondhand exposure.

“As proliferation of e-cigarettes surges, understanding the health effects of e-cigarette use and exposure to vapors is essential,” said Jonathan Thornburg, Ph.D., author of the study published by RTI Press, and director of Exposure and Aerosol Technology at RTI. “We need to be aggressively investing in and conducting research that answers lingering questions about the potential health impacts of secondhand exposure to e-cigarettes, while taking the necessary action to protect public health now.”

The study finds e-cigarette emissions contain enough nicotine, and numerous other chemicals to cause concern. A non-user may be exposed to secondhand aerosol particles similar in size to tobacco smoke and diesel engine smoke. Meanwhile, e-cigarettes are a rapidly growing business with annual sales doubling yearly to $1 billion in 2013, and a current lack of regulation that has allowed for a surge in marketing.

Because e-cigarette products are not yet regulated, the chemicals and devices involved vary widely, as may the potential health impacts. Many factors — including the specific device used — influence the chemical makeup and toxicity of e-cigarette emissions. The full scope of health impacts of e-cigarette smoke, as well as secondhand exposure’s impacts on children, is still unknown.

“Secondhand exposure to e-cigarettes is just one aspect of the research that must be considered as we make decisions about appropriate use of these products,” said Annice Kim, Ph.D., senior social scientist at RTI. “It is critical that we explore the role of e-cigarette marketing — especially to children and youth — so that we can better understand motivators for use and put public health safeguards in place.”

RTI hosted a press briefing today to answer questions about public health concerns associated with secondhand exposure to e-cigarette emissions and product marketing.

The briefing featured RTI experts Thornburg and Kim as well as Stanton Glantz, Ph.D., professor of medicine, University of California, San Francisco (UCSF) and director, UCSF Center for Tobacco Control Research and Education.  E-cigarettes are nicotine-delivering consumer products designed to closely mimic the experience of smoking conventional cigarettes. The courts have already determined e-cigarettes to be tobacco products, and the FDA has proposed following the same classification.

According to the Centers for Disease Control and Prevention, secondhand smoke from traditional cigarettes has killed 2.5 million adults who were non-smokers, in the past 50 years. Secondhand smoke from traditional cigarettes is associated with the top four causes of death in America.

To read the study “Exhaled Electronic Cigarette Emissions: What’s Your Secondhand Exposure?,” which is the 100th publication of RTI Press, and to access more research about e-cigarettes, visit http://www.rti.org/e-cigarettes and follow RTI on Twitter @RTI_Intl.

Source: RTI Press, March 2015  http://www.newswise.com/articles/view/631070/?sc=dwtn   12th March 2015

Hospitals across the country have been reporting hundreds of cases of seriously ill people coming to the emergency room after using synthetic marijuana. In New York City, more than 120 cases were reported in a single week, according to NPR.

Many cases have also been seen in Alabama and Mississippi. Several people have died, the article notes.

Synthetic marijuana is often sold under the name “K2” or “Spice.” According to the American Association of Poison Control Centers, these drugs can be extremely dangerous. Health effects can include severe agitation and anxiety; fast, racing heartbeat and high blood pressure; nausea and vomiting; muscle spasms, seizures, and tremors; intense hallucinations and psychotic episodes; and suicidal and other harmful thoughts and/or actions.

“We have to chemically restrain and physically restrain them because they become violent and very strong. It takes four to five personnel to restrain them on a gurney,” Dr. Robert Glatter, an emergency physician at Lenox Hill Hospital in New York City, told NPR. One patient last week ended up in the ICU. “He was combative and required sedation in the ER,” Dr. Glatter said.

There is likely something unusual about the K2 that is causing the recent rash of ER visits, Dr. Glatter notes. Makers of synthetic drugs frequently change their molecular structure, to evade laws that outlaw the drugs. The changing structure also makes the drugs more difficult to detect on drug tests. These changes make the effects of the drugs more unpredictable.

“Chemists are getting more and more creative in designing these structures,” said Marilyn Huestis of the National Institute on Drug Abuse. She added, “What’s in it today isn’t going to be what’s in it tomorrow.”

Source:  www.drugfree.org 28th April 2015

There’s a new drug in town.

It’s called Shatter and it looks like dark-amber toffee. It’s THC, the chemical that causes the high in marijuana, extracted from the plant and has highly addictive qualities, said Stratford police Insp. Sam Theocharis.

It’s been around for a while but it’s new to Stratford, Theocharis said.  Police have started to see the drug a bit more frequently and wanted to get the message out to the public.

“When you look at it, it just looks like goo but it’s a new form of marijuana drug,” he said.

Shatter is clear, smooth and solid. It can consist of more than 80% THC, according to the High Times website.

Police seized some Tuesday along with methamphetamine, cocaine, marijuana and prescription drugs after an investigation by the Street Crime Unit.  Two men in their 40s were arrested and face several charges including possession for the purpose of trafficking. The drugs seized are valued at more than $1,500. Cell phones, scales and baggies were also seized, police said.

Shatter sells for about $100 a gram on the streets. It’s dangerous and often leads to overdose, police said.  Whether it will overshadow crystal meth and oxycodone in popularity has yet to be seen.

“I can’t predict but anything that gives you a better high is going to be sought after,” Theocharis said.

Source: http://www.stratfordbeaconherald.com/

“Even at normal doses, taking psychiatric drugs can produce suicidal thinking, violent behavior,  aggressiveness, extreme anger,  hostility, irritability, loss of ability to control impulses, rage reactions, hallucinations, mania, acute psychotic episodes, akathisia, and bizarre, grandiose, highly elaborated destructive plans, including mass murder.

“Withdrawal from psychiatric drugs can cause agitation, severe depression, hallucinations, aggressiveness, hypomania, akathisia, fear, terror, panic, fear of insanity, failing self-confidence, restlessness, irritability, aggression, an urge to destroy and, in the worst cases, an urge to kill.” -  From “Drug Studies Connecting Psychotropic Drugs with Acts of Violence” – unpublished.

My previous article on Global Research discussed the frustration of large numbers of aware observers around the world that were certain that Andreas Lubitz, the suicidal mass murderer of 149 passengers and crewmembers of the of the Lufthansa airliner crash, was under the intoxicating influence of brain-disabling, brain-altering, psychotropic medicines that had been prescribed for him by his German psychiatrists and/or neurologists who were known to have been prescribing for him.

These inquiring folks wanted and needed to know precisely what drugs he had been taking or withdrawing from so that the event could become a teachable moment that would help explain what had really happened and then possibly prevent other “irrational” acts from happening in the future. For the first week after the crash, the “authorities” were closed mouthed about the specifics, but most folks were willing to wait a bit to find out the truth.

However, another week has gone by, and there has still been no revelations from the “authorities” as to the exact medications, exact doses, exact combinations of drugs, who were the prescribing clinics and physicians and what was the rationale for the drugs having been  prescribed. Inquiring minds want to know and they deserve to be informed.

There are probably plenty of reasons why the information is not being revealed. There are big toes that could be stepped on, especially the giant pharmaceutical industries. There are medico-legal implications for the physicians and clinics that did the prescribing and there are serious implications for the airline corporations because their industry is at high risk of losing consumer confidence in their products if the truth isn’t adequately covered up. And the loss of consumer confidence is a great concern for both the pharmaceutical industry and its indoctrinated medical providers.

It looks like heavily drugged German society is dealing with the situation the same way the heavily drugged United States has dealt with psychiatric drug-induced suicidality and drug-induced mass murders (such as have been known to be in a cause and effect relationship in the American epidemic of school shootings – see www.ssristories.net).

The Traffickers of Illicit Drugs That Cause Dangerous and Irrational Behaviors Such as Murders and Suicides are Punished. Why not Legal Drug Traffickers as Well?

But there is a myth out there that illegal brain-altering drugs are dangerous but prescribed brain-altering drugs are safe. But anyone who knows the molecular structure and understands the molecular biology of these drugs and has seen the horrific adverse effects of usage or withdrawal of legal psychotropic drugs knows that the myth is false, and that there is a double standard being applied, thanks to the cunning advertising campaigns from Big Pharma.

But there is an epidemic of legal drug-related deaths in America, so I submit a few questions that people – as well as journalists and lawyers who are representing drug-injured plaintiffs – need to have answered, if only for educational and preventive practice purposes:

1) What cocktail of 9 different VA-prescribed psych drugs was “American Sniper” Chris Kyle’s Marine Corps killer taking after he was discharged from his psychiatric hospital the week before the infamous murder?

2) What were the psych drugs that Robin Williams got from Hazelden just before he hung himself?

3) What were the myriad of psych drugs, tranquilizers, opioids, etc that caused the overdose deaths of Philip Seymour Hoffman, Michael Jackson, Whitney Houston, Heath Ledger, Anna Nicole Smith, etc, etc, etc (not to mention Jimi Hendrix, Bruce Lee, Elvis Presley and Marilyn Monroe) – and who were the “pushers” of those drugs?

4) What was the cocktail of psychiatric and neurologic brain-altering drugs that Andreas Lubitz was taking before he intentionally crashed the passenger jet in the French Alps – and who were the prescribers?

5) What are the correctly prescribed drugs that annually kill over 100,000 hospitalized Americans per year and are estimated to kill twice that number of out-patients?

(See http://www.collective-evolution.com/2013/05/07/death-by-prescription-drugs-is-a-growing-problem/)

Because the giant pharmaceutical companies want these serious matters hushed up until the news cycle blows over (so that they can get on with business as usual), and because many prescribing physicians seem to be innocently unaware that any combination of two or more brain-altering psychiatric drugs have never been tested for safety (either short or long-term), even in the rat labs, future celebrities and millions of other patient-victims will continue dying – or just be sickened from a deadly but highly preventable reality.

But what about “patient confidentiality”, a common excuse for withholding specific information about patients (even if crimes such as mass murder are involved)? It turns out that what is actually being protected by that assertion are the drug providers and manufacturers. Common sense demands that such information should not be withheld in a criminal situation.

America’s corporate controlled media makes a lot of money from its relationships with its wealthy and influential corporate sponsors, contributors, advertisers, political action committees and politicians, but, tragically, the media has been clearly abandoning its historically-important investigative journalistic responsibilities (that are guaranteed and protected by the Constitution). It is obvious that the media has allied itself with the corporate “authorities” that withhold, any way they can, the important information that forensic psychiatrists (and everybody else) needs to know.

We should be calling out and condemning the authorities that are withholding the information about the reported “plethora of drugs” that is known to have been prescribed for Lubitz by his treating “neurologists and psychiatrists”, drugs that were found in his apartment on the day of the crash and identified by those same authorities who have not revealed the information to the people who need to know. Two weeks into the story and there still has been no further information given, or as far as I can ascertain, or asked for by journalists.

So, since the facts are being withheld by the authorities, I submit some useful lists of common adverse effects of commonly prescribed crazy-making psych drugs that Lubitz may have been taking. Also included are a number of withdrawal symptoms that are routinely  and conveniently mis-diagnosed as symptoms of a mental illness of unknown cause.

And at the end of the column are some excerpts from the FAA on psych drug use for American pilots. I do not know how different are the rules in Germany, but certainly both nations have to rely on voluntary information from the pilots.

1) Common Adverse Symptoms of Antidepressant Drug Use

Agitation, akathisia (severe restlessness, often resulting in suicidality), anxiety, bizarre dreams, confusion, delusions, emotional numbing, hallucinations, headache, heart attacks  hostility, hypomania (abnormal excitement), impotence, indifference (an “I don’t give a damn attitude”), insomnia, loss of appetite, mania, memory lapses, nausea, panic attacks, paranoia, psychotic episodes, restlessness, seizures, sexual dysfunction, suicidal thoughts or behaviors, violent behavior, weight loss, withdrawal symptoms (including deeper depression)

2) Common Adverse Psychological Symptoms of Antidepressant Drug Withdrawal

Depressed mood, low energy, crying uncontrollably, anxiety, insomnia, irritability, agitation, impulsivity, hallucinations or suicidal and violent urges. The physical symptoms of antidepressant withdrawal include disabling dizziness, imbalance, nausea, vomiting, flu-like aches and pains, sweating, headaches, tremors, burning sensations or electric shock-like zaps in the brain

3) Common Symptoms of Minor Tranquilizer Drug Withdrawal

Abdominal pains and cramps, agoraphobia , anxiety, blurred vision, changes in perception (faces distorting and inanimate objects moving), depression, dizziness, extreme lethargy, fears, feelings of unreality, heavy limbs, heart palpitations, hypersensitivity to light, insomnia, irritability, lack of concentration, lack of co-ordination, loss of balance, loss of memory, nightmares, panic attacks, rapid mood changes, restlessness, severe headaches, shaking, sweating, tightness in the chest, tight-headedness

4) Common (Usually Late Onset) Adverse Psychological Symptoms From Anti-Psychotic Drug Use

Blurred vision, breast enlargement/breast milk flow,  constipation, decreased sweating, dizziness, low blood pressure, imbalance and falls, drowsiness, dry mouth, headache, hyperprolactinemia (pituitary gland dysfunction), increased skin-sensitivity to sunlight, lightheadedness, menstrual irregularity (or absence of menstruation), sexual difficulty, (decline in libido, anorgasmia, genital pain).

The lethal adverse effects of antipsychotic drugs include Catatonic decline, Neuroleptic Malignant Syndrome (NMS, a condition marked by muscle stiffness or rigidity, dark urine, fast heartbeat or irregular pulse, increased sweating, high fever, and high or low blood pressure); Torsades de Pointes (a condition that affects the heart rhythm and can lead to sudden cardiac arrest”; Sudden death

5) Late and Persistent Adverse Effects of Antipsychotic Drug Use  (Some of these symptoms may even start when tapering down or discontinuing the drug!)

Aggression, akathisia (inner restlessness, often intolerable and leading to suicidality), brain atrophy (shrinkage), caffeine or other psychostimulant addiction, cataracts, creativity decline, depression, diabetes, difficulty urinating, difficulty talking, difficulty swallowing, fatigue and tiredness, hypercholesterolemia, hypothyroidism, intellectual decline (loss of IQ points), obesity, pituitary tumors, premature death, smoking – often heavy – (nicotine addiction), tardive dyskinesia (involuntary, disfiguring movement disorder), tongue edge “snaking” (early sign of movement disorder), jerky movements of head, face, mouth or neck, muscle spasms of face, neck or back, twisting the neck muscles, restlessness – physical and mental (resulting in sleep difficulty), restless legs syndrome, drooling, seizure threshold lowered, skin rashes (itching, discoloration), sore throat, staring, stiffness of arms or legs, swelling of feet, trembling of hands, uncontrollable chewing movements, uncontrollable lip movements, puckering of the mouth, uncontrollable movements of arms and legs, unusual twisting movements of body, weight gain, liver toxicity

6) Common Symptoms of Antipsychotic Drug Withdrawal

Nausea and vomiting, diarrhea, rhinorrhea (runny nose), heavy sweating, muscle pains, odd sensations such as burning, tingling, numbness,  anxiety, hypersexuality, agitation, mania, insomnia, tremor, voice-hearing

FAA Medical Certification Requirements for Psychotropic Medications

https://www.leftseat.com/psychotropic.htm

Pilots can only take one of four antidepressant drugs – Celexa (Citalopram), Lexapro (Escitalopram), Prozac (Fluoxetine) and Zoloft (Sertraline).

Most psychiatric drugs are not approved under any circumstances.

These include but are not limited to:

• Abilify (Aripiprazole)
• Effexor (Venlafaxine)
• Elavil (Amitriptyline)
• Luvox (Fluvoxamine Maleate)
• Monoamine Oxidase Inhibitors
• Paxil (Paroxetine)
• Remeron (Mirtazapine)
• Serzone (Nefazodone)
• Sinequan (Doxepin)
• Tofranil (Imipramine)
• Trazodone
• Tricyclic Antidepressants
• Wellbutrin (Bupropion)

To assure favorable FAA consideration, the treating physician should establish that you do not need psychotropic medication. The medication should be discontinued and the condition and circumstances should be evaluated after you have been off medication for at least 60 and in most cases 90 days.

Should your physician believe you are an ideal candidate, you may be considered by the FAA on a case by case basis only. Applicants may be considered after extensive testing and evidence of successful use for one year without adverse effects. Medications used for psychiatric conditions are rarely approved by the FAA. The FAA has approved less than fifty (50) airmen under the FAA’s SSRI protocol.

After discontinuing the medication, a detailed psychiatric evaluation should be obtained. Resolved issues and stability off the medication are usually the primary factors for approval.

Dr Kohls is a retired physician who practiced holistic mental health care for the last decade of his family practice career. He writes a weekly column on various topics for the Reader Weekly, an alternative newsweekly published in Duluth, Minnesota, USA. Many of Dr Kohls’ weekly columns are archived at http://duluthreader.com/articles/categories/200_Duty_to_Warn.

Source:  http://www.globalresearch.ca/the-connections-between-psychotropic-drugs-and-irrational-acts-of-violence/5441484  April 08, 2015

Lynne Featherstone accepts advisory council’s recommendation of 12-month ban on substances including most widely used alternative to cocaine

Mephedrone, also known as 4-MMC and used as an alternative to cocaine, has already been banned in the UK. Photograph: Rex

Five legal highs, including an alternative to cocaine that is one of the most common in Britain, are to be banned from midnight on Thursday, ministers have announced.

The drug minister, Lynne Featherstone, said she had accepted a recommendation from the government’s official drug advisers that the five legal highs should face a temporary ban of 12 months while a full assessment of the harm they posed was undertaken.

The Advisory Council on the Misuse of Drugs has said one of the five legal highs, ethylphenidate, which users inject and is widely marketed as a “research chemical” or as a component in branded products such as Gogaine, Nopaine, Burst and Banshee Dust, has been available over the internet in Britain for four years. They said it was one of the most commonly encountered new psychoactive substances (NPSs), as legal highs are officially known, in Britain and has emerged as an alternative to cocaine.

The ACMD recommended the ban on ethylphenidate based on evidence that it had caused serious problems, particularly in Edinburgh and Taunton, Somerset. Four related compounds are to banned at the same time to prevent users switching.

Ethylphenidate is typically sold at £15 a gram for powder, £20 a gram in crystal form and £1 for a 50mg tablet. Professor Les Iversen, the chair of ACMD, said injecting users were putting themselves at risk of blood-borne disease and infections.

Police Scotland said Burst, as it is marketed in Edinburgh, was responsible for the majority of legal-high casualties seeking emergency hospital treatment in the city last summer.

Avon and Somerset police said an epidemic of injecting legal highs in public places in Taunton last summer had led to more than 200 needles being recovered in one clean-up day. In December, the high street “head shop” selling the products was closed down.

The banned substances are closely related to methylphenidate, a licensed stimulant marketed under the brand name of Ritalin that is regularly prescribed to children for the treatment of attention deficit hyperactivity disorder.

The temporary ban means anyone caught making, supplying or importing the drugs will face up to 14 years in prison and an unlimited fine. Possession is not illegal but police and border officials are allowed to search or detain anyone they suspect of having the drugs and seize, keep or dispose of the banned substance.

Drug law reform campaigners said such bans were simply trapping authorities in an “endless game of whack-a-mole” as they tried to play catch-up with drugs chemists. They said that while the government had responded to the frenzy over legal highs, drug misuse deaths overall had risen sharply.

The decision to ban methylphenidate-related substances while continuing to use the parent chemical as a medicine might raise questions over the safety of a drug often prescribed to children.

Ethylphenidate-based products are a growing issue and their use is associated with bizarre and violent behaviour

Advisory Council on the Misuse of Drugs

“The methylphenidate-related materials being marketed as NPS have psychoactive effects so similar to the parent compound that they can be expected to present similar risks to users,” Iversen said in the letter.

Although it has been marketed as a party drug, the ACMD’s advice warns that some ethylphenidate users appear to have developed chronic problems, continually redosing the drug intravenously in binges.

The ACMD report says that in Edinburgh “there has recently been a report of an outbreak of Staphylococcus aureus and Streptococcus pyogenes infections in this area associated with NPS injecting, which is believed to involve ethylphenidate.”

It added: “Ethylphenidate-based products are a growing issue in Edinburgh and their use is associated with bizarre and violent behaviour.”

Drugs reform campaigners said the government’s use of temporary bans on new substances had authorities constantly playing catch up with drugs chemists. The only answer was wholesale reform of drug policy, they said. Danny Kushlick, head of external affairs for Transform, said: “These substances have been brought out because of the success in enforcing the ban on ecstasy and cocaine in particular. Really we have to recognise that this is a self-inflicted trade.

Legal high drug deaths soar in UK

“If we were to have a regulated trade in drugs these ones would not exist. You would not have ‘fake cocaine’ if you could get real cocaine. The whole NPS market is a product of prohibition.

“This is a never-ending game of whack-a-mole because even using the analogues legislation there are new analogues; they can churn these out by the hundreds. This is the opposite of control and regulation. It’s fuelling anarchy in the market and we need to look at regulating frameworks for more benign drugs.”

Niamh Eastwood, director of Release, said new bans on substances only served to push drug use further underground and spur the development of new chemicals with unknown risks to users.

She said: “Speaking more broadly, the government appears to have made NPS something of a cause célèbre in its fight against drugs, apparently in response to the media frenzy over what many unhelpfully term ‘legal highs’. While NPS are indeed a part of the modern debate on drugs, they form a comparatively small part of the market.

“At a time when the associated harms are increasing for other substances – drug misuse deaths rose 21% in 2013, 32% when focusing solely on heroin/morphine deaths – there is a real risk that the government is turning its attention away from addressing the failures of its drug policy holistically in order to pander to poorly-founded fears over this new phenomenon.”

Ethylphenidate is already banned in Denmark, Austria, Germany, Hungary, Portugal, Sweden, Jersey and Turkey. It is also classified under analogue scheduling in the US and Australia.

The other substances recommended for the temporary ban by the ACMD included 3,4-dichloromethylphenidate, methylnaphthidate, isopropylphenidate and propylphenidate. It wasn’t clear how widespread their use was.

Methylphenidate, the drug from which ethylphenidate and its related compounds is derived, is currently controlled as a class B drug in Britain but also licensed as a medicine for conditions including ADHD and narcolepsy. It has also been widely used recreationally, and as a study aid. Research has found it can offer modest improvements in working memory and episodic memory.

Source:   http://www.theguardian.com/science/2015/apr/09/

The most obvious characteristic of marijuana-legalisation campaigners – apart from billionaire interests on the scale of Big Tobacco – is that their lobbying and promises are based on theories not facts.

Legalisers regularly use the words “science” and “evidence base” but rarely cite research references. Never has this chasm between theory and fact been so powerfully and conspicuously exposed as in the March analysis by local media in Clearing the Haze of events a year after marijuana was legalised for recreational use in Colorado.

Here in the UK, a decade-long follow up by researchers into Britain’s disastrous 2004 ‘Lambeth experiment’ of depenalisation proved that it led to more crime and hospitalisations not less. The Colorado aftermath of legalisation is on a vaster scale.

CLAIM:“We view our top priority as creating an environment where negative impacts on children from marijuana legalisation are avoided completely,” Colorado’s governor promised.

FACT:There are growing concerns over exposure, potency and availability of marijuana to children. Even before legalisation, Governor John Hickenlooper predicted the need for “a project to analyse the correlation between marijuana use during pregnancy and birth defects” (FYI, here’sa listand one on perils tochildren). Colorado hospitals have admitted more children for marijuana harms. A June 2014 survey of 100 Colorado school officers found that 89 per cent witnessed a rise in marijuana-related incidents since legalisation.

CLAIM:Legalisation will fund prevention, education.

FACT:Colorado budgeted only about $34,000 for its Office of Behavioral Health’s prevention work in the 2014-2105 fiscal year; nothingwas received. Its Department of Public Health and EnvironmentGood to Knowcampaign, crafted with marijuana business owners, tells children how to use pot. “It’s like inviting a tobacco company to help us learn how to use tobacco and develop our next anti-smoking campaign.”

CLAIM:Regulation works.

FACT:How regulation would work was described only in soundbites before voting. Hickenlooper later admitted it was “reckless” and “a bad idea”. This February, Colorado Attorney General Cynthia Coffman declared it “not worth it”. Ben Cort at the University of Colorado Hospital disclosed that “Colorado has been met by an industry that fights tooth and nail any restrictions that limit profitability. Like Big Tobacco, the marijuana industry derives profits from addiction and its survival depends on turning a percentage of kids into lifelong customers.”

CLAIM:Legalisation of marijuana will unclog prisons.

FACT:There aren’t enough offenders in prison for simple possession of pot to unclog the system if they were freed: only 103. In 2011, the federal government convicted only 48 marijuana offenders with under 5,000 grams of marijuana: almost 12,000 joints.

CLAIM:Legalisation will produce new revenue for the general fund.

FACT:Tax revenues failed to meet projections – taxpayers could even get two refunds. The Governor’s Office of Marijuana Coordination director said the first priority for tax revenue is to cover regulatory costs. Moreover, Colorado isn’t equipped to gather cost-benefit analysis to quantify costs linked with cannabis abuse. This is alongside lawsuits against the state, manufacturing hazards, pressured resources for the homeless, concerns over children’s welfare and more: “Voters didn’t understand how difficult, resource-intensive and costly the enforcement of even just marijuana driving laws would be”.

CLAIM:Legalisation of marijuana will hobble drug cartels.

FACT:Cheaper marijuana prices mean cartels turn to ‘harder’ drugs including ‘black tar’ heroin and methamphetamine, as well as cybercrime and continued people-trafficking.

CLAIM:By regulating sales of marijuana, Colorado will make money otherwise locked into the black market.

FACT:Black-market sales are booming so much that they are blamed for cannabis tax revenues falling short of claims. “Don’t buy the argument that regulating sales will eliminate the black market, reduce associated criminal activity and free up law enforcement agencies’ resources,” Coffman urged in February. Worse is that “Colorado is the black market for the rest of the US”: neighbouring Denver suffered an almost 1,000 per cent spike in marijuana seizures.

CLAIM:Legalisation and regulation will see people using lower strengths of drugs.

FACT:Colorado permits one ounce of tetrahydrocannabinol (THC), the active ingredient giving a euphoric high. Many people envision an ounce of dried marijuana plant, about 40 standard cigarettes. But one ounce of concentrated THC equals over 2,800 average-size brownies or candy; an ounce of hash oil is roughly 560 standard ‘vaping’ hits.

CLAIM:Medical marijuana works, only legalisation allows research.

FACT:Treating marijuana – sold in dispensaries without FDA approval and shown to be more carcinogenic than tobacco when combusted – as if exempt from the approval process others drugs must undergo for public safety, is seen as derailing legitimate research on specific parts of the marijuana plant for new clinically-proven medicines without addiction risks. As the prevention charity, Cannabis Skunk Sense, puts it: “it’s like getting penicillin by eating mouldy bread”. Non-legalisation has not stopped 70+ scientific studies on cannabinoids elsewhere, and the National Institutes of Health awarded over $14million for such research.

CLAIM:Marijuana is safer than alcohol.

FACT:“Not when it comes to driving – and officers are seeing people using both substances, which is worse,” revealed one police chief.In the first six months of 2014, 77 per centDUIDs (driving under influence of drugs) involved marijuana. Accident risk doubles with any measurable amount of THC in the bloodstream, rising when alcohol is added.

The tragic fact above all else is that these downsides were predicted by authoritative individuals and organisations – and ignored. The good of many people was sacrificed for the greed of a few: be it for money, power or a drugged delusion. Deirdre Boyd

Source: www.conservativewoman.co.uk 1^st April 2015

A new political party is planning to field as many as 100 candidates at the general election to force the issue of cannabis legalisation centre stage.

Cista – Cannabis is Safer than Alcohol – is inspired by legalisation of the drug in some US states. The party’s election candidates will include Paul Birch, who co-founded Bebo before it was sold to AOL for $850m (£548m) in 2008 and says he is investing up to £100,000 in the venture.

Other candidates around the UK are soon to be named; this week the party said Shane O’Donnell, a former Conservative party activist, would stand against Labour’s Keir Starmer and the Green party leader, Natalie Bennett, in the London constituency of Holborn and St Pancras.

According to YouGov polling commissioned by Cista and provided to the Guardian, 44% of voters support the legalisation of cannabis against 42% who don’t (with 14% undecided).

The two mainstream parties with the most to lose from some voters being tempted to opt for Cista in marginal constituencies are the Greens, which supports decriminalisation, and the Liberal Democrats, which has been looking at the decriminalisation of all drugs for personal use and allowing cannabis to be sold on the open market.

However, Birch’s party has made a policy decision not to run in Brighton, where the sole Green MP Caroline Lucas is defending her seat, and in constituencies with incumbent Lib Dem MPs. The decision was taken after Lib Dem MP Julian Huppert, one of parliament’s most visible advocates of the decriminalisation of drugs, raised the issue of a candidate from Cista standing against him.

Birch said that in the main the other parties were keen not to talk about the issue of legalisation because they were embarrassed by it. “In the absence of this party forming I doubt that it would be an election issue. The Greens are the most explicit but even they don’t make it a prominent issue,” he added.

“With what has been happening in US states though, it now feels like it’s within touching distance. It’s like this is the final push and the time is right.”

Birch suggested that parallels with the road to legalisation in US states were forming on the basis of another of his party’s YouGov poll findings, which was that 18% of people believed that cannabis was safer than alcohol, while more than half thought that they were the same in safety terms.

He said: “In Colorado [one of the first US states to legalise the recreational use and sale of marijuana] the basis of their campaign was to juxtapose cannabis and alcohol. They knew that once they moved people to understand that it was safer then people would be happy to legalise it.”

Principally, Birch has faith that the public will come around to the idea in greater numbers as a result of becoming ever more informed. Of a recent experiment where the Channel 4 News anchor Jon Snow took large amounts of skunk-type cannabis, resulting in him feeling “as if his soul had been wrenched from his body”, Birch said that this was akin to forcing a teetotaller to down a bottle of illegally distilled moonshine. In a regulated industry, he argued, the risk to consumers could be considerably reduced.

Cista’s candidates will campaign for a royal commission to review the UK’s drug laws relating to cannabis – a relatively modest initial aim calibrated to maximise its appeal. They will also push the economic argument for legalisation, which the party argues could net the exchequer as much as £900m if cannabis were legalised and properly controlled.

The party, which is keen to establish itself as a professional outfit in contrast to previous electoral attempts at highlighting the decriminalisation cause, is signing up members and candidates using online forms. It is eager to push back against stereotypes and, in particular, encourage women to become involved.

Five candidates, including Birch, are signed up to stand for election on 7 May, while he and his team will this week begin travelling around the UK in search of other candidates who they expect will include academics, existing campaigners, students and people who work or have experience of working in the criminal justice system.

Source:  http://www.theguardian.com/society/2015/feb/25

The family of a Tulsa man who shot himself Saturday night in Keystone is blaming his suicide on his ingestion of edible marijuana candies.

“It was completely a reaction to the drugs,” Kim Goodman said about her son Luke’s Saturday night suicide.

Luke Goodman’s death is now the third death in Colorado linked to marijuana edibles.

The 23-year-old college graduate was in the midst of a two-week ski and snowboard vacation with family members. Saturday afternoon he and his cousin, Caleb Fowler, took a bus from Keystone to Silverthorne where Fowler says they bought $78 worth of edibles and marijuana.

“He was excited to do them,” Fowler told CBS4.

When the young men got back to Keystone, Fowler said they began ingesting the edible pot. He said his cousin favored some peach tart candies, each piece of candy containing 10 mg of the active ingredient in marijuana, the recommended dose for an adult consuming an edible.

But when Goodman consumed several and experienced no immediate effects he kept gobbling them up. “Luke popped two simultaneously” after the first two didn’t seem to do anything, said Fowler.

Then he said Goodman took a fifth candy, five times the recommended dose. His mother says her son likely didn’t see the warning on the back of the container which says, “The intoxicating effects of this product may be delayed by two or more hours … the standardized serving size for this product includes no more than 10 mg.”

Several hours later Fowler said his cousin became “jittery” then incoherent and talking nonsensically. “He would make eye contact with us but didn’t see us, didn’t recognize our presence almost. He had never got close to this point, I had never seen him like this,” Fowler said.

Fowler says Goodman became “pretty weird and relatively incoherent. It was almost like something else was speaking through him.” When family members left the condo Goodman refused to join them. After they left he got a handgun that he typically traveled with for protection, and turned it on himself.

Summit County Coroner Regan Wood says the preliminary cause of death is a self-inflicted gunshot wound. As for the impact of the marijuana edibles, she said, “That’s what we’ve heard consistently.” She said the impact the edibles had on Goodman will be more clear when toxicology results come back in a few weeks. “It’s still under investigation,” said Wood.

While definitive answers may be weeks away, Kim Goodman, Luke Goodman’s mother, told CBS4 she knows why her son took his own life. “It was 100 percent the drugs,” she said. “It was completely because of the drugs — he had consumed so much of it.” She said her son was well adapted, well-adjusted and had no signs of depression or suicidal thoughts. “It was completely out of character for Luke … there was no depression or anything that would leave us being concerned, nothing like that.”

Caleb Fowler echoed the feeling saying he fully believed the ingestion of so much marijuana laced candy triggered the suicide. “He was the happiest guy in the world. He had everything going for him.”

A year ago a Wyoming college student jumped to his death from a Denver hotel balcony after eating a marijuana cookie. Witnesses said Levy Thamba Pongi was rambling incoherently after eating the cookie. The Denver coroner ruled “marijuana intoxication” was a significant factor in Pongi’s death.

Richard Kirk of Denver faces first-degree murder charges stemming from the fatal shooting of his wife in Denver last year. Before her death his wife called 911 and said her husband had eaten marijuana candy and taken prescription medication and was hallucinating.

Kristine Kirk and Richard Kirk (credit CBS)

Luke Goodman’s family is now planning a memorial service for Friday in Tulsa. His mother says she remembers her last interaction with her son.

“We both said ‘I love you’ and I said ‘Have a great week.’ ”

Kim Goodman told CBS4 she believes marijuana edibles should be removed from store shelves.

“I would love to see edibles taken off the market … I think edibles are so much more dangerous.”

Source: CBS4 26^th March 2015

Source: https://learnaboutsam.org/

This article shows how drug use in an area can impact more than the individual and their families and friends.  The local economy and small businesses are having to cope with lower productivity due to ‘functioning’ drug dependents in the workforce.    NDPA

New Hampshire drug czar: Addiction dragging state’s economy down

Providing more treatment and recovery options for drug addicts is as much about the addicts as it is about helping spur the state’s economy, said the state’s new drug czar.

“For me, it’s all about the money,” said John G. “Jack” Wozmak, senior director for substance misuse and behavioral health.  Wozmak was appointed in January by Gov. Maggie Hassan. The position is funded by a grant from the New Hampshire Charitable Foundation. Wozmak spent nearly a decade as the administrator of the Beech Hill substance abuse treatment facility in Dublin, and since 1998 had been the Cheshire County administrator.

“With a broad range of experience dealing with substance misuse through his roles in the public sector and in private substance abuse treatment, Jack will help strengthen our efforts to improve the health and safety of Granite Staters, and I thank him for his commitment to serving the people of New Hampshire, as well the New Hampshire Charitable Foundation for making his position possible,” Hassan said in a statement.

Wozmak’s task: Get a host of agencies and organizations to work together to reduce the state’s drug abuse, particularly heroin addiction.  Wozmak takes the post at a time when heroin overdoses and deaths are at an all-time high in New Hampshire. The Centers for Disease Control reports that New Hampshire is among 28 states that saw big increases in heroin deaths.

But Wozmak said drug addiction is more than the headline-generating heroin overdoses and drug-related burglaries and robberies that dominate the news.
“Yes, the number of heroin deaths is doubling (from the previous year). But that’s just the tip of the iceberg” of the state’s drug epidemic, he said.

Functioning addicts

The underlying problem – and what the drug czar said will help him get more money for treatment and prevention efforts from state legislators – is the thousands of drug abusers who do not necessarily overdose but drive up costs for employers, he said.
“You don’t hear about the day-to-day drug exposure that companies have because it’s all below the surface, like an iceberg,” he said.

Employers see everything from diminished production to having to overstaff or pay overtime to cover for employees addicted to drugs who miss work, he said. This hurts profit and, in turn, decreases the state’s revenue from business profits taxes. He said estimates from the state’s hospitality sector indicate that as many as 20 percent of that field’s employees may have drug addiction issues.

“I want to increase jobs and this is getting in the way,” he said. “It’s just interfering with productivity. It’s interfering with the economy.”  Wozmak said the drug problem as been exacerbated by a myriad of issues, including budget cuts for treatment programs, along with insurance companies cutting or capping policy coverage for substance abuse treatment.

In the 1980s, he said, the state had more than 600 beds at six private centers providing treatment for substance abuse. After all the cuts by insurance companies, the state now has 62 beds available, he said.

Further, the state ranks second-to-last – after Texas – in providing treatment for drug addiction and has the lowest rate in the country – 6 percent – of people who get treatment for their addictions.  “We have decimated the system of treatment and recovery, and we have to rebuild it,” he said. “Imagine the outrage if diabetes were treated this way.”

More money

Hassan has proposed more than tripling the state’s spending for the Commission on Alcohol and Drug Abuse Prevention, Treatment and Recovery in her proposed two-year budget, from a total of nearly $2.9 million in the 2014-15 budget, to nearly $9.6 million in 2016-17.

The way to convince legislators that the funding is necessary is by appealing to their desire for job growth in a state that has had anemic population growth, Wozmak said.  To get population and job growth, he said, the state has to make its work force healthier and the best way to do that is to reduce drug addiction.

“If you ran on a platform of job growth, you have to deal with this issue,” he said. “If (job growth is) not going to be from people moving here, then you have to improve the work force that’s here.  “If you’re not looking to take care of this problem, then you’re falling down on your promise,” he said. “If you want to create jobs, you have to make the work force more viable.”

Wozmak said the problem can be solved. He said his role includes getting the affected parties – including law enforcement, public resources, private or nonprofit organizations, charities and treatment facilities – working together. He said a provision of the Affordable Care Act that requires insurers to cover substance abuse again should help spur private investment in treatment and recovery facilities.

“There is no easy answer, but I believe there are many opportunities to make the change now on a variety of levels and a myriad of fronts,” he said. “I think we’re going to have a lot of success.”  He said getting help from the state’s medical professionals will also be key, as most heroin addicts, he said, start with addictions to prescription painkillers. He said medical professionals are “not the sole source” of the issue, but could be involved in changing the way pain is managed to help prevent addictions.

“None of them wanted to become addicts,” he said.

– See more at: http://www.unionleader.com/article/    8^th March 2015

The largest recent US national survey of drink and drug problems shows that outside the addiction treatment clinic, remission is the norm and recovery common. After 14 years half the people at some time dependent on alcohol were in remission, a milestone reached for cannabis after six years, and for cocaine after just five.

SUMMARY Among the US general adult population, and for each of nicotine, alcohol, cannabis and cocaine (including crack), this study sought to estimate the time from onset of dependence to remission, the cumulative probability of remission in different racial/ethnic groups, and to identify factors related to the probability of remission.

It drew its data from the National Epidemiological Survey of Alcohol and Related Conditions (NESARC) conducted in 2000–2001, which focused on drinking disorders but also asked about other forms of drug use and psychological problems. The aim was to interview a representative sample of civilian, non-institutionalised adults aged 18 and over living in households and group residences such as college halls, boarding houses and non-transient hotels. About 8 in 10 of the sample responded to the survey yielding 43,093 respondents. The featured report investigated the subgroups who had some time in their lives been dependent on nicotine (of which there were 6937), alcohol (4781), cannabis (530) or cocaine (408).

Dependence was defined as meeting the dependence criteria of the applicable version of the American Psychiatric Association’s DSM manual, DSM-IV. ‘Lifetime’ dependence was diagnosed if the respondent reported having experienced at least three specific signs of this syndrome within the same 12-month period at some point in their life. The age this first happened for any particular substance was the onset year, while the remission year was based on the age when the respondent’s answers indicatedthey had last stopped meeting dependence criteria for the drug, and had continued to do so for at least a year until interviewed for the survey – essentially, the most recent (at least so far) lastinglysuccessful remission. It was on this basis that the study calculated remission rates for individual substances and related them to the time between the onset of dependence and remission.

Main findings

Proportion of dependent users in remission

Within a year of first becoming dependent, 3% each of smokers and drinkers were in remission and remained so until they were surveyed. For cannabis the figure was nearly 5% and for cocaine, nearly 9%. After ten years the proportions in remission had risen to 18% for nicotine, 37% for alcohol, 66% for cannabis and 76% for cocaine  chart. It could be estimated that by the end of their lives 84% of formerly dependent smokers would be in remission, 91% for alcohol, 97% for cannabis and 99% for cocaine. About 26 years after first becoming dependent, half the people at some time dependent on nicotine were in remission, a milestone reached for alcohol after 14 years, for cannabis six years, and for cocaine five years.

Once other factors had been taken in to account, for each of the substances, men who had been dependent at some time were significantly less likely than women to be in remission, especially in respect of the two illegal drugs, cannabis and cocaine; for every 10 women only about six men were in remission from dependence on these drugs. Black Americans once dependent on nicotine or cocaine were less likely to be in remission than white Americans – for cocaine, half as likely. After four years, about 50% of whites had sustained remission from dependence on cocaine; African Americans took nine years to reach the same milestone.

About 80% of people at some time dependent on nicotine or alcohol and almost all those once dependent on cannabis or cocaine had also at some time met diagnostic criteria for another psychiatric disorder, including conduct (antisocial behaviour in early life) and personality disorders. Once other factors had been taken in to account, people who had met criteria for conduct disorder were much more likely than others to have overcome their dependence on cannabis. In contrast, a diagnosis of a personality disorder was associated with a lower probability of remission from cannabis (and also alcohol) dependence. Having once experienced mood and anxiety disorders was unrelated to remission from dependence on any of the four substances.

The authors’ conclusions

The general picture is that the vast majority of people in the USA once dependent on nicotine, alcohol, cannabis or cocaine stop being dependent at some point in their lives, and this happens after fewer years for cannabis or cocaine than for nicotine or alcohol. Black Americans stay dependent longer on nicotine and cocaine than white Americans, and probabilities of remission are associated with social and psychological characteristics and dependence on other substances. However, the fact that that many people once dependent were no longer at the time of the survey should be interpreted with caution given the irregular course of addictions punctuated by remissions and relapses; their remission may have been temporary. Possible explanations for these findings are considered below.

More than two thirds of remissions from cannabis and cocaine dependence occurred within the first decade after onset of dependence, but only a fifth for nicotine and a third for alcohol. These differences may be explained in part by how quickly adverse physical, psychological and social consequences become apparent. For instance, the risk of early cardiovascular problems is much higher among individuals dependent on cocaine than among those dependent on nicotine or alcohol. Behavioural disturbances resulting from cannabis or cocaine dependence and their illegal status impose stronger social pressures to remit. The pervasive availability of alcohol and nicotine also means pervasive environmental prompts to using the drugs. Particularly for nicotine, perceived immediate benefits including anxiety and stress reduction, improved cognitive performance, and weight control, may initially outweigh perceived potential harms from long-term use.

Consistent with previous studies, black Americans once dependent on cocaine were less likely to remit than their white counterparts. Psychosocial factors that commonly affect black populations, including discrimination and lower levels of social capital, have been recognised as barriers to remission and triggers to use or relapse; genetic factors may also contribute.

Men were less likely than women to remit from dependence, perhaps because substance use is more damaging (physically, mentally and socially) for women, heightening motivation to stop using. Feelings of guilt and concerns about substance use during pregnancy and child-rearing may also play a particular part in prompting remission among women.

Individuals who met criteria for a personality disorder were less likely to remit from alcohol or cannabis dependence. This may be because characteristics of these disorders such as being impulsive, intolerant to stress, anxious, and craving new experiences, also predispose to substance use, and these characteristics tend to persist.

Among the limitations of the study were that it omitted institutionalised individuals including prisoners. People whose substance use led to their early death would also have been missed, as may some with severe but non-fatal consequences. These omissions may have caused an overestimation of the probability of remission across the entire population. The study also had no information on the number and duration of remission episodes over an individual’s lifetime; it could only relate other factors to the latest of these remissions.

 COMMENTARY The good news from this analysis is that, in the US context, rather than continued dependence, remission is the norm. Most people overcome or grow out of their dependence on the drugs analysed by the study – for cocaine and cannabis, after just five or six years, and for alcohol, after 14, and over their lives people continue to remit until nearly all are no longer dependent. But at least in respect of drinking, there are a set of multiply problematic drinkers who despite treatment, take many more years to stop being dependent. The findings on black versus white Americans suggest that remission rates depend on socioeconomic factors; sampled at another period in the USA’s economic cycles or in respect of drugs used predominantly by more or less advantaged sections of the population, remission rates too might differ, and look more or less like the chronic disease model.

The data presented in the featured article did not show whether the user ‘in remission’ had simply become dependent on another drug. Within the set of illegal drugs and medicines, this seemed uncommon, because the total remission rate was so high. But it seems more than possible that some who matured out of illegal drug use instead took up heavy drinking, in social and legal terms, a dependence easier to live with as an adult.

Remission rates looking forward

An acknowledged weakness of the featured report is that it asked respondents to recall changes which may have happened many years ago. However, the survey was repeated about three years later when 87% of the people who still qualified for the survey were re-interviewed. The follow-up offered an opportunity to see how many dependent at the time of the first survey had recovered three years later. These analyses seem only to have been done for drinking, for which they confirm that most people cease to be dependent though most too continue to experience drink-related problems and to sometimes drink heavily, and remain vulnerable to relapse. This average impression results from the pooling of dramatically different trajectories, from older multiply problematic alcoholics who usually do not remit despite treatment, to youngsters who generally quickly remit without formal help. Details below.

Among the re-interviewed sample were 1172 of the 1484 people who had been dependent on alcohol in the year before the first interview three years before. Nearly two thirds were longer dependent in the year before the follow-up interview. So complete was their recovery that a fifth of those previously dependent had in the past year experienced no indications of abuse or dependence; of these, three quarters were still drinking. About 11% not only had no symptoms, but were exclusively drinking within low-risk guidelines, evenly split between those drinking moderately and those not drinking at all.

But this broad-brush picture hid substantial variation in the fates of different types of dependent drinkers. At one extreme were the most severely affected drinkers with multiple psychological problems and on average about nine years of dependence behind them, two thirds of whom were still dependent at the second interview. At the other were young adults and older drinkers with few complicating psychological disorders and few years of dependent drinking. For most of these the dip in to dependence was a phase which (at least for time being) was over by the the second interview, when just under 30% were still dependent.

At least for the three years between the surveys, remission was very stable. Among the re-interviewed sample were 1772 of the 2109 who three years before had been in “full remission” from past dependence on alcohol, meaning that even though they may sometimes have drunk above low-risk guidelines, for the past 12 months they had reported no symptoms of alcohol abuse or dependence. Of these just 5% had slipped back to being dependent in the year before the second interview, though a third who had been drinking above low-risk guidelines had re-experienced some symptoms of alcohol abuse or dependence. Most stable in their recovery were the abstainers, of whom just 1 in 50 experienced such symptoms. The much greater stability of recovery in abstainers and low-risk drinkers was confirmed when other factors had been taken in to account, but was not apparent among the younger adults in the sample.

Treatment’s impact

Few dependent drug users recover through treatment and fewer still dependent on alcohol – in theNESARC survey on which the featured analysis was based, of those no longer dependent on alcohol,just 24% had at any time been in any kind of treatment for their drinking problems. Over two thirds of those who achieved more complete forms of recovery also did so without treatment.

While this shows that in the USA, treatment is generally not needed to recover from substance dependence, treatment may still make recovery more likely. In respect of dependence on alcohol, one analysis of data from the NESARC survey was consistent with formal treatment promoting recovery characterised by abstinence or low-risk drinking and no symptoms of abuse or dependence, but another and perhaps more reliable analysis found no such association.

Both however found that when treatment had been accompanied by attendance at 12-step mutual aid groups, recovery was more likely – especially abstinent recovery. These analyses could not however disentangle the possible effects of the motivation and conditions which drive someone to seek help, from the effect of actually receiving that help. Complicating the picture is the fact in this survey, the most severely affected and multiply comorbid drinkers with many years of dependence behind them were far more likely to seek treatment than less severely affected types of dependent drinkers. Despite seeking help, they were by a large margin the ones most likely to still be dependent when the survey was repeated three years later.

What about heroin and other opiates?

A notable omission from the illicit drugs included in the featured report was heroin and other opiates. Fortunately these were the subject of the greatest number of relevant studies in another review of follow-up studies of remission from dependence on amphetamine, cannabis, cocaine or opiate-type drugs. It included only studies of general populations or people who entered treatment in the normal way rather than enrolling in treatment trials.

Across the ten studies relevant to opiate-type drugs, every year on average between 22% and 9% of people were either abstinent or no longer dependent; the higher figure is the average of the proportions remitted among people who could be followed up, while the lower estimate includes cases who could not be followed and assumes they are still dependent. Generally the subjects were patients in treatment. Based mainly on patients in treatment, corresponding figures for cocaine were between 14% and 5%. The single study (from the USA) of a general population sample of cocaine-dependent people found that 39% had remitted four years after initially surveyed. For cannabis, the estimate was 17% per annum based on general population surveys and assuming people not followed up were still dependent.

In accordance with the featured article, such figures imply that within 10 years most dependent users of these drugs will no longer be dependent and may have entirely ceased use.

Racial differences reflect socioeconomic status

An analysis of data from the NESARC survey showed that taking alcohol and other drugs together, the longer dependence careers of black versus white Americans was associated with their having less social and socioeconomic resources, signified by fewer being married and fewer having completed their schooling. Once these were taken in to account, racial differences were no longer significant. The implication is that it is not race as such which makes the difference, but the position black people tend to occupy in US society. Given the same disadvantages, white Americans has dependence careers just as extended as black Americans.

Diagnostic system affects remission rate

Much in this analysis depends on the definitions used in the survey. Specifically, the probability of remission equates to the probability that someone will for at least the past 12 months have dropped below experiencing three or more dependence symptoms together in respect of the same drug. From the same survey, it is known for alcohol that many will still be consuming heavily, experiencing symptoms of dependence such as withdrawal and compulsive use, and suffering poor physical and mental health (1 2). They may be remitted from their dependence, but not according to most understandings, ‘recovered’.

Had the line been drawn elsewhere, the chances of remission might have been substantially lower – for example, as commonly in NESARC reports on drinking (1 2 3 4), if remission had been defined as non-problem moderate use or abstinence.

The latest version of the DSM manual (DSM-5) softens this binary system by diagnosing a substance use disorder when at least two symptoms are present in the same 12 months, and rating this as moderate if there were two or three, severe if four or more. ‘Abuse’ and ‘dependence’ are now subsumed within this continuum. The change seems likely to bring many more less severely affected people under the same substance use disorder umbrella as the three-symptom population investigated by the featured analysis. Their remission rates too may differ.

It is also theoretically possible that ‘remission’ may partly reflect the lack of noticeable change or struggle as with the years dependence becomes more deeply embedded and dominant in one’s life, and the change processes probed by some diagnostic questions cease to be live issues – not a sign of recovery, but of the lack such a prospect and the narrowing of life to substance use. For example, having plateaued in their use levels, long-term dependent users may no longer (or not for the past 12 months) have found themselves needing to take more of the drug to feel the desired effects, or taking more than they intended. Perhaps too in the past they had tried unsuccessfully to stop using, or had at least persistently wanted to, but now no longer tried or even wanted to. Ensuring a steady supply of drink or drugs they made no attempt to interrupt would minimise experience of withdrawal. They may also have no important interests and activities left to sacrifice to their dependence – all among the symptoms used to diagnose dependence.

Some findings from NESARC are consistent with this possibility. In the three years between the first interview and the re-interview, the alcohol dependence symptoms which fell away most often and most consistently across different types of drinkers were “taking alcohol often in larger amounts or over a longer period than was intended”, “a persistent desire or unsuccessful efforts to cut down or control use”, and withdrawal.

Similarly, young adult dependent drinkers tend not to endorse the dependence symptom relating to inability to stop drinking or cut back, presumably because they have yet to try.

Related analyses

This data from the featured report has been reanalysed to show that for each of these drugs, the probability that someone would have ceased being dependent remained the same no matter how long ago they had first become dependent. For the author this falsified theories which assume that the longer it lasts, the deeper dependence becomes embedded in neural circuits or lifestyles.

The survey on which the featured article was based and other US national surveys were among those included in a synthesisof hundreds of studies of remission and recovery from substance use problems. This too concluded that “Recovery is not an aberration achieved by a small and morally enlightened minority of addicted people. If there is a natural developmental momentum within the course of [these] problems, it is toward remission and recovery”.

Last revised 24 October 2013. First uploaded 19 October 2013

Source:  Probability and predictors of remission from life-time nicotine, alcohol, cannabis or cocaine dependence: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

Lopez-Quintero C., Hasin D.S., Pérez de los Cobos J. et al.
Addiction: 2011, 106(3), p. 657–669.

To go or not to go? That is the question when invited to take part in supposedly objective drugs conferences and television investigations, behind which  looms the constant presence of one Sir Richard Branson. Two seemingly flattering invitations to drugs policy events came my way this month.

The first was to be invited to a Home Affairs Select Committee event at the University of Cambridge’s Homerton College on March 12th.  At first sight, it felt a welcome recognition of my longstanding work in the field of drug addiction, and of my new recovery solutions service (DB Recovery Resources). Moreover, it seemed like an opportunity to guide and inform public opinion – even as far as the United Nations. But I was torn for days on whether to accept or not. Finally, I regretfully declined.

Why? The Home Affairs Select Committee’s invitation was entitled “The International Conference on Drugs Policy” and its findings at the end of the day were to be fed into the influential UNGASS, the United Nations General Assembly’s Special Session on world drug problems in 2016. Tempting. But a closer look raised concerns. What exactly was a Parliamentary select committee doing hosting a drugs policy conference? Why had they chosen deputy prime minister Nick Clegg who, at the time of my invitation, was scheduled to chair it? He is a recognised proponent of drugs legalisation, going so far as to include it in his election pledge.

So I was aware of the agenda and bias of the conference before I was invited.  The list of speakers spoke for itself. Every single speaker bar one  – Sarah Graham, an addiction therapist – turned out to be  a high-profile legalisation campaigner, several from organisations funded by the convicted insider trader and fomenter  George Soros. Only after I had publicised the biased agenda on my daily newsletter did HASC kindly invited me to attend. They also at the same time added a second ‘non-legalisation’ speaker to their invite list: Professor Neil McKeganey. But I could see it was still skewed. We would be the minority underdog against high-profile and well-funded legalisation campaigners, like Dr Julian Huppert MP, Baroness Molly Meacher, Roberto Dondisch from Mexico, Danny Kushlick of Transform, Professor David Nutt, who famously said taking ecstasy was less risky than horse riding, former policeman and cannabis activist Tom Lloyd, and last but not least Mike Trace, who was forced to resign his UN role when the Daily Mail revealed him to be the driving force behind an effort to disband the world’s anti-drug laws by stealth.

What chance would I have to support my colleagues? Would this be like National Treatment Agency meetings I had attended too many times in the past (before it was abolished)  where vested-interest findings and recommendations were written before the meeting and then presented as an impartial consensus of all those present – and absent?

Would it be like the self-styled United Kingdom Drug Policy Commission meetings (before it closed) which exploited the names of attendees as supporting its predetermined ‘consensus agreement’, when in reality there was a dearth of support? Was I confident that any anti-legalisation points would be included in the final report to UNGASS? That I sadly declined the invitation gives you the answer.

No. The worry is now that UNGASS may believe this Home Affairs Select Committee report, that UK taxpayers are unwittingly funding, to be impartial.  Better to blog, I thought, and hopefully open their eyes to the truth.

The second ‘flattering’  invitation was to appear on Channel 4’s Cannabis Live programme on 3 March. Although warned in advance about its inherent bias – it was funded by both C4 and Soros-supported organisations, and known legalisation proponents were booked as its speakers – I decided to accept in the hope I would be able to capture some airtime for anti-legalisation views.

(Declaration: my view is informed by the basic laws of supply and demand: increased availability leads to increased consumption. In addition there is, to my very real knowledge, so much disinformation about pot in the public domain that few people can make an informed choice). It was the right decision; although it was questionable whether there was a need for a programme experimenting ‘live’ with substances that are already known to have significant and very negative side effects. It was also worrying that Professor Nutt was  an “independent” scientific expert on it, given his obsession with cannabis legalisation and his well known insistence that it is less harmful than alcohol.

A plus turned out to be Jon Snow’s and Andrew Marr’s very negative experiences when skunk was tested on them. Perhaps that’s why presenter Snow carefully inched my neighbour off his seat to interview me, allowing time for me to make some pivotal points.  These were particularly in response to Branson’s call for regulation [legalisation] of cannabis as a solution to the world’s drug problems. I pointed out  that tobacco is regulated yet kills  more people than any other drug in the world;   that alcohol, benzos and methadone are all regulated but follow tobacco in killing more people each than illicit drugs.

I also pointed out that the first paper linking cannabis and psychosis was published 170 years ago –  in 1845  – so this is not new. All my points were transmitted unedited. A number of ‘silent’ audience members in Narcotics Anonymous introduced themselves and thanked me as we were leaving the studio.  It reminded  me of  US drug czar Michael Botticelli’s recent comment: “I do wish the recovery community was much more involved in anti-legalisation efforts”.

However the trouble with Cannabis Live – posing as science when it was exhibitionist entertainment, as one distinguished former Professor of pharmacology commented to me afterwards  – is that it provided a launchpad for the differences between “beneficent” hash and “nightmarish” skunk to be exploited by the legalisation lobbyists. Their hidden agenda. It was worrying that the programme ignored the harms from hash (as opposed to skunk):  yet these include the risk of psychosis, behavioural changes, lack of motivation, lowering of IQ, lung cancer, mouth cancer, motor crashes, lowering of fertility (a mixed blessing) – and the fact that pregnant women using hash can give birth to addicted babies with a range of mental-health problems and medical problems, including leukaemia.

At a press conference the next day, billionaire legalisation campaigner Branson was still calling for regulation (legalisation of cannabis) as a solution despite all the downsides he’d witnessed at Cannabis Live. Of course he did not mention that tobacco is regulated and it kills more people than any other drug in the world, for the simple reason that it is the most widely used drug in the world.

In his cloud cuckoo land, the 80 per cent of cannabis users who use skunk would downgrade to the milder version if they were both legal. I don’t think so. It’s against human nature. Finally, it was left to David Nutt to round up the programme – with his extraordinary recommendation that skunk should remain low in the index of drug harms, in cannabis’s current place, while hash should plummet to the lowest ranking. Maybe he was too close to the skunk factory set up beside his artificial brain in the studio. Had anyone in the audience changed their mind about being pro- or anti-legalisation, asked Snow at the end of the programme? Not one hand went up. I leave you to decide whether this infotainment fulfilled Channel 4’s mission to “keep public service values to the fore”.

Source:   www.the Conservative Woman.co.uk    7^th March 2015

Though many young people seem to perceive marijuana as harmless, its use may pose serious risk for adverse behaviors and health consequences.

An extensive research review published June 5 in the New England Journal of Medicineconcluded that marijuana use is linked to multiple adverse effects—particularly in youth.

“Despite some contentious discussions regarding the addictiveness of marijuana, the evidence clearly indicates that long-term marijuana use can lead to addiction,” said lead author Nora Volkow, M.D., director of the National Institute on Drug Abuse (NIDA), and three of NIDA’s top officials.

Stanimir G.Stoev/Shutterstock

According to the 2012 National Survey on Drug Use and Health, marijuana is the most commonly used “illicit” drug in the United States, with an estimated 12 percent of people aged 12 or older reporting its use in the prior year. The 2013 Monitoring the Future Survey—supported by NIDA—found that 6.5 percent of 12th graders report daily or near-daily marijuana use, with 60 percent perceiving regular use of marijuana not to be harmful (Psychiatric News, February 6). Volkow and colleagues suggested that as more states move toward policies that legalize cannabis for medical or recreational purposes, rates for marijuana use among teenagers and young adults will increase, as will the negative health consequences associated with its use.

“The regular use of marijuana during adolescence is of particular concern, since use by this age group is associated with an increased likelihood of deleterious consequences,” Volkow and colleagues cautioned.

The review, “Adverse Health Effects of Marijuana Use,” provided science-based reasoning to explain the onset of marijuana addiction and gave an overview of the adverse health consequences associated with marijuana use from data of 77 studies and literature reviews.

From animal studies, the authors concluded that exposure to tetrahydrocannabinol (THC)—the primary psychoactive chemical in cannabis—in early life can recalibrate the dopaminergic system, the reward system of the brain, to become more sensitive to stimulation with drugs. The authors speculated that the findings may help to explain the increased vulnerability to abuse of marijuana and other substances in later life, which have been reported by adults who initiated cannabis use during adolescence.

The review also highlighted studies showing an association between marijuana use and impaired regions of the human brain, including the precuneas, a key node that is involved in alertness and self-conscious awareness, and the hippocampus, which is important in learning and memory. Other adverse consequences of cannabis use included impaired driving, lowered IQ scores into adulthood, and a potential risk to exacerbate psychotic symptoms in those with mental disorders. The review suggested that risks for adverse effects increase when the drug is used along with alcohol.

“Some physicians continue to prescribe marijuana for medicinal purposes despite limited evidence of a benefit,” noted Volkow and colleagues. “Because older studies are based on the effects of marijuana containing lower levels of THC, stronger adverse health effects may occur with the use of today’s more-potent marijuana.”

The authors emphasized that more research must be done on the potential health consequences of second hand marijuana smoke, the long-term impact of prenatal cannabis exposure, and the effects of marijuana legalization policies on public health.

“It is important to alert the public that using marijuana in the teen years brings health, social, and academic risk,” said Volkow. “Physicians in particular can play a role in conveying to families that early marijuana use can interfere with crucial social and developmental milestones and can impair cognitive development.”

Source: http://psychnews.psychiatryonline.org/ June 26, 2014

On Nov. 4, Alaskans will consider Ballot Measure 2, an initiative to legalize the sale and use of marijuana for recreational purposes. And those who support that commercial trade are investing heavily in hoping you will vote “yes.” Make no mistake about it, marijuana — like tobacco and alcohol — is big business.

Like alcohol and tobacco, the costs of marijuana to public health, public safety, our youth and lost productivity, are similarly high. It’s not surprising that Outside investors would regard Alaska as fertile territory for unconditional legalization.

In 1975, our Supreme Court found a right for Alaskans to consume small amounts of marijuana in their homes in the privacy provisions of the Alaska Constitution. And in 1998, Alaskans voted to legalize marijuana for medical purposes with 58 percent support. But Ballot Measure 2 is not about “medical marijuana,” nor is it necessary in order to protect adult Alaskans who consume marijuana in their homes from police intrusion. The measure is less about freedom than it is about profit at the expense of public health. That’s why I plan to vote “no” on Ballot Measure 2.

I came to this decision after careful consideration of the medical evidence. My guide through the scientific literature was Dr. Nora Volkow, the director of the National Institute on Drug Abuse (NIDA). Earlier this year, Dr. Volkow published a peer-reviewed paper about the health effects of marijuana in the New England Journal of Medicine, one of the nation’s most eminent medical publications. Volkow directs a component of our National Institutes of Health which is, of course, neutral on state level policy initiatives. Fortunately for all of us, NIH does not prohibit its scientists from entering the discussion by objectively sharing the science with policymakers and the public.

Here’s what Volkow has to say about the state of the evidence: “The popular notion seems to be that marijuana is a harmless pleasure, access to which should not be regulated or considered illegal.”

However popular notions are not always correct. One of the detrimental effects is addiction. “The evidence clearly indicates that long term marijuana usage can lead to addiction,” Volkow states. “About 16 (percent) of those who begin marijuana usage as teenagers will become addicted. And there seems to be a strong association between repeated use and addiction. About a quarter to a half of those who use marijuana everyday are addicted. …Marijuana use by adolescents is particularly troublesome.”

Those who begin using marijuana as teenagers, when the brain is still developing, are two to four times more likely to demonstrate dependence symptoms within two years of first use than those who first use marijuana as adults. And since marijuana use “impairs critical cognitive functions … for days after use many students could be functioning at a cognitive level that is below their natural capability for considerable period of times,” according to Volkow.

These effects could be even longer lasting. Adults who smoked marijuana during adolescence have fewer fibers in specific brain regions that are important to things like alertness, self-consciousness, learning and memory.

NIDA-funded research provides some support for long standing fears that use of marijuana may be a gateway to use of other drugs with even greater known adverse health effects. Truthfully, the same may be said of alcohol and tobacco. Whether the mechanism is chemical, cultural or some combination of the two, is less well known. No evidence is cited to suggest that marijuana use keeps young people away from other drugs.

The prevalence of impaired driving in Alaska is well known and deeply troublesome. On this, Volkow observes that “both immediate and long term exposure to marijuana impair driving ability; marijuana is the illicit drug most frequently reported in connection with impaired driving and accidents, including fatal accidents.” Moreover, the mixing of marijuana and alcohol can further exacerbate the dangers to public safety.

Perhaps the most startling revelation of Volkow’s research is that all marijuana is not alike. The potency of marijuana is determined by its Tetrahydrocannabinol, or THC, content. Analysis of seized marijuana for sale on the street demonstrates that THC concentrations have been rising from about 3 percent in 1980 to about 12 percent today. Volkow suggests that this may be the reason for increased emergency room visits associated with marijuana and a higher level of fatal crashes. Also, the initiative specifically defines marijuana to include concentrates, which can contain 80-90 percent THC. Marijuana edibles would also be legalized and commercialized under the initiative. In Colorado, child-attractive edibles like lollipops, flavored drinks and gummy bears, with multiple doses of THC, are being sold.

Marijuana is a drug and with all drugs there are risks and benefits. Research suggests that use of marijuana or some of its component chemicals can be beneficial for the alleviation of a variety of medical conditions. But patients with these conditions benefit from discussions with their healthcare providers about the risks and benefits.

The state should examine the most appropriate access for this class of users. That said, the evidence that marijuana is harmful for non-medical use is growing. That should give Alaskans pause as we enter the voting booth.

I believe strongly in working for the health, safety, educational achievement, productivity and community welfare of Alaskans. That is why I am voting “no” on Ballot Measure 2.

• Lisa Murkowski is a Republican U.S. Senator representing Alaska.

Source: www.juneauempire.com/opinion/2014-10-22

The polarized legalization debate leads to exaggerated claims and denials about pot’s potential harms. The truth lies in between.

Pretty much everyone who has spent time smoking marijuana knows at least one diehard stoner. The guy whose eyes are always red, the girl who doesn’t use the term “wake and bake” ironically, the person who just can’t seem to ever get it together. These heavy smokers might work at a low-level job or they may be unemployed—but everyone who knows them well knows that they are capable of much more, if only they had any ambition.

Is this really addiction? I believe that it is (and I don’t think that’s an argument against legalization). In fact, the reasons why marijuana is addictive elucidate the true nature of addiction itself.  Addiction is a relationship between a person and a substance or activity; addictiveness is not a simple matter of a drug “hijacking the brain.” In fact, with all potentially addictive experiences, only a minority of those who try them get hooked—and people can even become addicted to apparently “nonaddictive” things, like carrots. Addiction depends on learning, context and psychology, not just neurotransmitters.

With two states having already legalized recreational marijuana use and several more considering doing so, understanding the nature of addiction is more important than ever. Partisans on both sides of the debate have made extreme claims here; some legalizers saying there’s no such thing as marijuana addiction, while some prohibitionists claim “cannabis as addictive as heroin.”

Our concepts of addiction, however, come primarily from cultural experience with alcohol, heroin and, later, cocaine. No one has ever argued that opioids like heroin don’t have the potential to cause addiction because the withdrawal symptoms—vomiting, shaking, pallor, sweating and diarrhea—are objectively measurable. Opioids cause physical dependence that is evident when they become unavailable. The same is true for alcohol, where withdrawal is even more severe and can sometimes even be deadly.

So early researchers focused on these measurable symptoms related to alcoholism and opioid addictions in defining addiction: Using a drug could lead to becoming tolerant to it, tolerance could lead to dose escalation, which could in turn lead to physical dependence, and then the addiction could be driven by the need to avoid the painful symptoms of withdrawal. It was simple and physical.

In this view, however, cocaine and marijuana were not “really” addictive. While people can experience withdrawal symptoms like irritability, depression, craving and sleep problems when quitting these drugs, these are much more subjective and therefore can be dismissed as “psychological” rather than physical. You might really want coke or pot, but you didn’t need it like a real junkie, the thinking went.

And since most of us like to believe that we have much more control over our minds than we do over physical symptoms, “psychological” addiction is seen as far less serious than the “physical” type. It’s the remnants of this kind of thinking that mainly underlie the idea that marijuana addiction doesn’t exist. Unfortunately, that view of addiction is stuck in the 1970s.

In the 1980s—ironically, not long after Scientific American caused a big controversy by arguing that snorted cocaine is no more addictive than eating potato chips—entrepreneurs began marketing a ready-made smokeable form of the drug. The birth of crack shattered the idea that “physical” dependence is more serious than psychological dependence because people with cocaine addictions don’t vomit or have diarrhea when they quit; while they may appear desperate, it’s not in the physically obvious way of heroin or alcohol withdrawal. And so, if you are going to argue that marijuana is not addictive because you don’t get sick when you quit, you also have to argue the same for crack.

In the 1970s view, cocaine and marijuana were not “really” addictive: You might really want coke or pot, but you didn’t need it like a real junkie, the thinking went.

Good luck with that one, I say. Clearly, crack-addicted people are every bit as compulsive as those with heroin problems—and their criminal involvement if they can’t afford the drug is at least equally likely, though not as common as has been claimed. Crack dealt a deathblow to the “psychological” vs. “physical” distinction—and if it hadn’t, neuroscience was creeping up to show that the psychological and the physical aren’t exactly distinct anyway.

In the ‘70s and ‘80s, researchers also began recognizing that simply detoxing heroin addicts—getting them through the two-week period of intense physical withdrawal symptoms—is not effective treatment. If heroin addiction was driven primarily by the need to avoid withdrawal, addicted people should be out of the woods after they complete cold turkey. But as those of us who have been through it know, that is far from the hardest part.

While kicking heroin isn’t fun, staying off it in the long run is the problem—those “mere” psychological cravings are what drive addiction. Physical dependence isn’t the main problem; it isn’t even necessary. Indeed, we now know that you can actually have physical dependence without any addiction at all: There are some blood pressure medications, for example, that can have deadly withdrawal symptoms if not tapered properly, but people on these meds don’t crave them even though they are quite dependent. Similarly, antidepressants like Paxil have physical withdrawal symptoms, but because they don’t produce a high, you don’t see people robbing drug stores to get them.

So what is addiction, then, if tolerance, withdrawal and physical dependence aren’t essential to it? All of these facts point to one definition that can sum up the problem: Addiction is compulsive use of a substance or engagement in a behavior despite negative consequences. (Put more in neuroscience, addiction is a learned distortion in the brain’s motivational systems that make us persist in pursuing things linked to evolutionary fitness like food and sex.) Anything that causes pleasure via these systems—and that’s basically anything that is possible to enjoy—can be addictive to some person at some time. And that includes marijuana (and, for that matter potato chips).

This doesn’t mean that marijuana addiction is necessarily as severe as cocaine, heroin or alcohol addiction—in fact, it typically isn’t. If given the choice, most families would vociferously prefer having a member addicted to marijuana rather than to cocaine, heroin or alcohol. The negative consequences associated with marijuana addiction tend to be subtler: lost promotions, for example, rather than lostjobs; worse relationships, not no relationships. And of course, no risk of overdose death.

Marijuana addiction may quietly make your life worse without ever getting bad enough to seem worth addressing; it may not destroy your life but it may make you miss opportunities.

But this is also what can make it insidious. Marijuana addiction may quietly make your life worse without ever getting bad enough to seem worth addressing; it may not destroy your life but it may make you miss opportunities. With any pattern of regular drug use, it’s important to continually track whether the risks outweigh the benefits, keeping in mind that addiction itself may distort this calculation. This is especially true with marijuana.

However, as with all other drugs, only a minority of marijuana users ever struggle with addiction. Research suggests that about 10% get hooked—and on average, marijuana addiction lasts six years. Even more than other addictions, marijuana addiction seems to be driven by self-medication of mental health problems—90% of people with marijuana addiction also have another addiction or mental illness, typically alcoholism or antisocial personality disorder.

This suggests that exposing more of the population to marijuana won’t necessarily increase the addicted population. First, people with antisocial personality disorder, by definition, tend not to be law abiding, so most have probably already tried it. Second, the percent of people with other pre-existing mental illness will not change because marijuana becomes legal—in fact, in the UK, when they reversed their prior liberalization of marijuana law because of fears related to increased schizophrenia, psychosis rates actually went up. (The link probably wasn’t causal, but it does suggest that legal crackdowns on cannabis don’t prevent related psychosis).

If some people with alcohol, cocaine or heroin addiction switch to marijuana instead, overall harm would be reduced. As I and others have been reporting at least since 2001, using marijuana as an “exit” drug is a real phenomenon, both in cocaine and opioid addiction.

When we consider the risks of various substances, we tend to do so in isolation—but that’s not how choices are made in the real world. Most people would rather their partners have no addictions—but again, some are clearly worse than others. Marijuana craving is rarely as severe as crack craving, as is obvious.

Still, like anything that can be pleasurable, marijuana can be addictive. This doesn’t mean all addictions are the same or that it is as addictive as the currently legal drugs alcohol and tobacco—the data shows it is less so.

Pretending it can’t do any harm at all, however—or that there aren’t people who are addicted to it—does no one any good. If we want better drug policy, as with other types of recovery, we need to avoid denial.

Maia Szalavitz is one of the nation’s leading neuroscience and addiction journalists, and a columnist at Substance.com. She has contributed to Time, the New York Times, Scientific American Mind, the Washington Post and many other publications. She has also published five books, including Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids (Riverhead, 2006), and is currently finishing her sixth, Unbroken Brain, which examines why seeing addiction as a developmental or learning disorder can help us better understand, prevent and treat it. Her last column for Substance.com was about why the oft-documented fact that most people age, or grow, out of substance misuse is not common knowledge.

Source: www.substance.com 15^th October 2014

The drugs sent 28,000 people nationwide to the emergency room in 2011.

Attorneys general are fighting the illegal sale of synthetic marijuana with their pens.

A letter signed by 43 attorneys general — including Roy Cooper from North Carolina — was sent to nine major oil companies last Tuesday, urging them to eliminate synthetic marijuana from their gas stations’ convenience stores and retail locations.

Use of the drugs is a national problem — sending 28,000 people to the emergency room in 2011.

“Given the significant danger synthetic drugs present to users, especially our young people, we are extremely troubled that these drugs have been readily available in well-known retail locations,” the attorneys’ letter said.

Synthetic marijuana is often marketed under names like “K2” and “Spice” and is not tested for safety, according to the American Association of Poison Control Centers, which received 3,679 calls due to exposure to the drug in 2014.

Kelly Alanis-Hirsch, a researcher who studies substance abuse disorders at UNC, said the synthetic drug is not comparable to the organic drug, and the lack of regulation poses a serious threat to users’ health.

“It is created by spraying various chemicals on herbs or other leafy material,” Alanis-Hirsch said. “The chemicals mimic the effect of THC that appears naturally in organic marijuana, but the synthetic marijuana compounds vary by manufacturer.”

Federal and state laws prohibit the manufacture, sale and consumption of synthetic marijuana. Synthetic marijuana was made illegal in the state in 2011 when the N.C. General Assembly classified it as a controlled substance.

In 2012, President Barack Obama signed the Synthetic Drug Abuse Prevention Act, which categorized 26 synthetic cannabinoids as Schedule 1 drugs under the Controlled Substances Act — outlawing the drugs at the federal level.

But Alanis-Hirsch said that drug companies have evaded the federal law by manufacturing substances similar, but not identical, to those prohibited by the federal government.

“Recipes are changed in response to governmental efforts to make the product illegal; thus, it’s marketed as a ‘legal high,’” she said.

Mary-Nel Saarloos, a medical doctor in Asheville, said she often treats patients who have overdosed, but the constantly changing chemical components make it difficult to diagnose. Blood and urine tests often can’t detect these components of the drug, she said.

The National Association of Attorneys General called for major oil companies to revoke franchises of gas stations that violate the federal controlled substances laws.

“Young people should not die or be seriously injured from using products bought at gas stations or convenience stores,” the letter says.

Source: www.dailytarheel.com17^th February 2015

Can marijuana use put offspring at heightened risk for opiate addiction, even if the use stops before the offspring are conceived? Recent animal research by NIDA-supported scientists suggests that the answer may be yes.

Dr. Yasmin L. Hurd and colleagues at the Icahn School of Medicine at Mount Sinai in New York City showed that rats whose parents had been exposed as adolescents to the main psychoactive ingredient in marijuana sought heroin more vigorously than the offspring of unexposed animals. Although more research is needed to confirm and explain the findings, they are consistent with other studies suggesting that a parent’s history of drug use, even preconception, may affect a child’s brain function and behavior.

Lasting Imprint

Scientists have known for a while that drugs of abuse produce some of their effects epigenetically—that is, by increasing or decreasing the rates at which the body’s genetic machinery produces certain proteins. Researchers recently reported that some epigenetic changes produced by cocaine appear to be inherited and affect the behavior of subsequent generations. In that experiment, rats whose parents had been exposed to cocaine responded differently when introduced to the drug than did rats whose parents had not been exposed.

Dr. Hurd and colleagues hypothesized that rats whose parents were exposed as adolescents to the main psychoactive ingredient in marijuana (delta-9 tetrahydrocannabinol, or THC) would inherit epigenetic changes that would alter their responses to heroin. To test the hypothesis, the researchers injected adolescent male and female rats with THC for 3 weeks on an intermittent schedule (1.5 milligram per kilogram of body weight every 3 days) that corresponds to the amounts consumed by a typical recreational marijuana user. They waited 2 to 4 weeks for the drug to wash out of the rats’ bodies, then paired and mated them.

Figure 1. Offspring of THC-Exposed Parents Work Harder To Get Heroin  When only a single press of a lever was required to obtain a dose of heroin, the offspring of THC-exposed and unexposed rats self-administered similar amounts of the drug. However, when the researchers raised the work requirement to 5 lever presses for a single dose, the rats whose parents had been exposed to THC pressed almost 3 times as often as the offspring of unexposed rats.

When the offspring of these matings reached adulthood, the researchers presented them with a lever that, when pressed, delivered heroin (30 micrograms per kilogram of body weight). At first, the animals self-administered the drug at roughly the same rates as a group of control animals whose parents had not been exposed to THC. However, when the researchers made the animals work harder for the drug—requiring them to press the active lever at least 5 times to receive a dose—those whose parents had been exposed to the drug pressed on average nearly 3 times as often as the control rats (see Figure 1).

When the researchers removed the animals’ access to heroin, the THC-exposed rats’ offspring exhibited more pronounced withdrawal symptoms, such as increased locomotion and repetitive behaviors. Also during withdrawal, the two groups of rats differed in their readiness to approach a novel stimulus in their environment.

Figure 2. Offspring of THC-Exposed Rats Show Long-Term Depression of Synaptic Activity in the Striatum Medium spiny neurons in the dorsal striatum of rats whose parents had been exposed to THC responded less to electrophysiological stimulation than the neurons in rats whose parents had not been exposed to THC.

Using electrophysiology, the researchers also demonstrated that the offspring of the THC-exposed rats had altered neuronal functioning (see Figure 2). The specific alteration that they observed—enhanced long-term synaptic depression of medium spiny neurons in the dorsal striatum—has been associated with addiction in previous studies. The neurons are less responsive to stimulation, which inhibits an individual’s ability to adjust to experience and results in habitual and compulsive behaviors rather than adaptive ones.

To identify the epigenetic factors that might underlie the differences they had observed in the offspring of the THC-exposed animals, the researchers assayed concentrations of messenger RNA (mRNA) for key proteins in the brain. The formation of mRNA is the first step in the process of protein production, and mRNA levels indicate how much protein is being produced at a given time. The researchers’ analysis showed that, during adolescence, the THC-exposed animals’ offspring had higher levels of mRNA for glutamate receptors and for the cannabinoid 1 receptor in the ventral striatum. During adulthood, the offspring of the THC-exposed rats had less mRNA for N-methyl-D-aspartate (NMDA)-type glutamate receptors in the dorsal striatum (see Figure 3). Reduced production of glutamate receptors could underlie the reduced responsiveness to stimulation researchers observed in that brain region.

Figure 3. Offspring of THC-Exposed Parents Show Decreased Expression of Genes for Key Receptor Genes in the Brain Expression of genes for the glutamate-responsive receptors NMDA (Grin1 and Grin2A) and α-amino-3-hydroxy-5-methyl-4-isoxazole propionate (AMPA) (Gria1) and for the endocannabinoid receptor CB1 (CNR1) was lower in the dorsal striatum of adult rats whose parents had been exposed to THC. These changes in gene expression suggest an epigenetic effect of THC on glutamate and endocannabinoid signalling in the brain.

Is It Real?

The Mount Sinai researchers took pains to rule out potential nonepigenetic explanations for the differences they observed between their groups of rats. One concern was that the THC-exposed rats’ pups might themselves be exposed to the drug during gestation, resulting in altered brain development. To preclude this possibility, the researchers postponed mating their THC-exposed animals until sensitive gas chromatography and mass spectrometry confirmed that no drug remained in the animals’ blood or brain tissue. Another concern was that the THC-exposed animals might parent differently than the unexposed animals, potentially altering their offspring’s responses to heroin. To prevent this, the researchers removed the THC-exposed animals’ pups from their parents immediately after birth and had unexposed dams raise both groups of offspring in mixed litters.

Despite these careful controls, Dr. Hurd and colleagues say that they cannot completely rule out nonepigenetic explanations for the alterations they observed in their THC-exposed rats’ offspring until they see what happens in the next two generations of their germ line. The researchers are proceeding with this work.

“The idea of cross-generational transmission of complex traits such as drug responses without alterations to the genome is contentious,” says Dr. John Satterlee, Project Officer at NIDA’sGenetics and Molecular Neurobiology Research Branch. “Is it real? And if it’s real, how is it transmitted?” he asks.

Dr. Satterlee agrees with Dr. Hurd that studies on future generations are needed to definitively rule out the possibility that nonepigenetic factors led to the observed effects in the offspring. Previous exposure to THC theoretically could affect the womb or placental formation, he says, or lead to changes in the parents’ microbiome—the assemblage of microorganisms in the gut controlling a variety of conditions and behaviors—that were then transmitted to their offspring.

“If the effect is real, it’s important,” Dr. Satterlee says. “If studies show that marijuana use also shows cross-generational effects in people, those results would add to the known dangers of the drug and amplify the importance of prevention efforts, especially those aimed at youth,” he adds.

This study was supported by NIH grants DA030359 and DA033660.

Source: Neuropsychopharmacology. 39(6):1315-1323, 2014. Abstract

Szutorisz, H.; DiNieri, J.A.; Sweet, E. et al. Parental THC exposure leads to compulsive heroin-seeking and altered striatal synaptic plasticity in the subsequent generation.

Feb. 24, 2015 8:30am

Jennifer Kerns is a branded contributor to The Blaze and other publications where she writes about the 2nd Amendment, religious liberty, the future of the GOP, limited government battles and other political hot topics. She served as Spokeswoman for the historic Colorado recalls, as Spokeswoman for the California Republican Party, twice as an Appointee of Governor Arnold Schwarzenegger, and as Spokeswoman for Prop. 8 which went all the way to the U.S. Supreme Court.

During her career as a GOP strategist, she has been described as one of “the most relevant Press Secretaries in the West” — winning every major newspaper endorsement for her candidates. Proud of her ability to win over tough liberal reporters and coalitions, she made her mark by being the first known Press Secretary in history (Republican or Democrat) to win 52 unanimous endorsements from such liberal publications as the Los Angeles Times, San Francisco Chronicle and the Spanish-language La Opinion – arguably among the toughest Press Corps, in the most populous State in the nation.

What a long, strange trip it’s been for pot legalization in Colorado. First, the law came under fire last year for not protecting youth as scores of children were taken to emergency rooms after ingesting their parents’ pot edibles.

Just a few days ago, nine former heads of the Drug Enforcement Administration — both Republican and Democrat — signed onto an amicus brief urging the U.S. Supreme Court to overturn Colorado’s legalization of marijuana citing numerous public safety concerns.