Realizing you have a drinking problem and deciding to quit are the first two steps of recovery, and for some people, they are the hardest. So, if that’s where you are in your journey right now, know you’re not alone and that you can claim your life back from a destructive addiction.

Once you’ve decided to quit drinking, you must commit to staying sober, despite any temptations or triggers you might come across. This is much more practical when you have support from therapy, a church group, friends who don’t drink, and/or any other kind of system that motivates you and helps you to stay accountable.

It’s also essential that you add meaningful and enjoyable things to your life that don’t involve drinking, and that you move your life forward so that you can thrive. This article will provide some tips on how to get on with your life while recovering from alcohol abuse.

Get Car Insurance

One of the first things to get in order will be your car insurance (if you don’t have any), as you won’t be able to legally drive without it. If your policy lapsed due to having your license suspended, try going to your former insurance company for coverage. If they won’t work with you, you will need to look around at other companies. Sometimes, a lapse in coverage means that it’s too high a risk for standard companies to insure you. However, there are companies that specialize in insuring higher-risk drivers, though you can expect higher premiums.

Surround Yourself with Support

One of the most important aspects of staying sober is hanging around people who help you in your mission. While therapy, treatment, and church can prove invaluable, so can spending time with non-drinking friends. This is because it helps to break social connections with alcohol and normalize sobriety, and friends can keep you accountable on your journey. Plus, boredom can easily lead to relapse, and doing things with people will help prevent that from happening.

Improve Your Diet

What you eat obviously has a lot to do with your physical health, which plays a major role in your mental and emotional health. Start being conscious of your diet — maximizing fruits, vegetables, lean proteins, and healthy fats, while limiting sugar, sodium and saturated fats. You should also make mood-boosting foods like kale, eggs, spinach, nuts, and wild salmon a part of your diet. If it’s easier for you, just start by replacing one meal a day with a healthier option than you normally would consider, and build from there.

Get Fit

Physical activity is also important. Not only does regular exercise yield long-term health benefits, but it also provides short-term benefits. The endorphins released during exercise creates a sense of reward in the brain, which can instantly boost your mood, reduce stress, and make you feel productive. Also, exercise is known to reduce anxiety and depression symptoms, as well as promote better sleep.

Set New Goals

Finally, in order to move past your addiction, you have to move forward in your life. Think of where you want to be in the future, and start setting goals. This could include goals to start a new career, progress in your current career, or go back to school. It can also include goals for repairing and developing relationships, learning new activities or skills, or any other number of things. Take advantage of your commitment to change by setting and focusing on new goals.

Recovering from alcohol addiction is not easy, but the rewards far outweigh the struggle. Be sure to look into your car insurance, and start hanging around positive, non-drinking friends. Prioritize your physical health to boost your mental and emotional health, and set new goals for your future. Most importantly, have grace on yourself, and try to maintain a positive outlook throughout your journey through addiction recovery.

Source:  Ryan Randolph   Recovery Proud  November 2019

In a pre-clinical study, researchers from Western University in Ontario, Canada, studied the effects of long-term exposure to THC in both adolescent and adult rats.

They found changes in behavior as well as in brain cells in the adolescent rats that were identical to those found in schizophrenia. These changes lasted into early adulthood long after the initial THC exposure.

The young rats were “socially withdrawn and demonstrated increased anxiety, cognitive disorganization, and abnormal levels of dopamine, all of which are features of schizophrenia,” according to the article. The same effects were not seen in the adult rats.

“With the current rise in cannabis use and the increase in THC content, it is critically important to highlight the risk factors associated with exposure to marijuana, particularly during adolescence,” the researchers warn.

Read Medical News Today story here. Read study abstract in the journal Cerebral Cortex here.

Email from Monte Stiles, National Families in Action January 2016

A University of Pittsburgh Medical Center study published in the journal Psychology of Addictive Behaviors last September found that chronic marijuana use during adolescence did not lead to depression, anxiety, psychosis, or asthma by mid-life.

The U.K.’s Independent was one of many newspapers that celebrated the news, scoffing at the National Health Service help page that warns: “Your risk of developing a psychotic illness is higher if you start using cannabis in your teens.”
 
Now, however, the journal has run a correction. It turns out that the researchers misinterpreted their data. They checked it again after criticism of their study and found that there was a two-and-one-half-fold increase in psychotic disorders in midlife after chronic marijuana use that began in adolescence.
 
The director of the Maryland chapter of SAM (Smart Approaches to Marijuana) caught the error and notified the journal which lead to the correction. SAM is calling on all media who reported the original incorrect story to correct their account of it now.
 
Read Independent story here.  Read SAM account of the correction here.

Source: Email from Monte Stiles, National Families in Action, January 2016

Marijuana reporter Joel Warner asks if the media is currently biased in support of marijuana legalization.

He cites a recent incident brought to his attention by Kevin Sabet, founder of SAM (Smart Approaches to Marijuana), who had received a tip that the next-day release of the 2014 National Survey on Drug Use and Health would show that marijuana use in Colorado has reached the highest levels in the nation. Sabet wrote a press release which fell on deaf ears. A Google analysis shows only 17 stories were written about this consequence of legalization in Colorado.

In contrast, a few weeks before, the release of the 2015 Monitoring the Future Survey showed a slight downturn in past-month marijuana use among 8^th, 10^th, and 12^th grade students nationwide. It was hyped by some in the press as a signal that legalization is of no consequence. A total of 156 news stories covered the results of this survey.

Warner notes that there are now “marijuana-business newspapers and marijuana culture magazines, full-time marijuana-industry reporters (this writer included), and even a marijuana-editorial division at the Denver Post called the Cannabist, staffed with a marijuana editor and cannabis strain reviewers,” like Jake Browne, pictured above.
 
He asks if the data supports it, could marijuana journalists “be expected to conclude that legalization has been a failure, if that means they would also be writing the obituaries for their own jobs?”
 
Read Joel Warner’s thoughtful International Business Times article here.

Source: Email from Monte Stiles, National Families in Action January 2016

Two recent studies, one in Great Britain and this one from the University of Southern California, contradict the findings of a rigorous 25-year-long study done with a birth cohort in Dunedin, New Zealand a few years ago. That study found that persistent marijuana use that continued into adulthood resulted in an 8-point drop in IQ. The two new studies find the opposite.

The UCLA study looked at 789 pairs of adolescent twins from two ongoing studies—one in Los Angeles and one in Minnesota—who enrolled between ages 9 and 11. Over 10 years, five IQ tests were administered along with confidential surveys of marijuana use. Marijuana-using twins lost 4 IQ points, but so did their non-using twins, leading researchers to conclude that something other than marijuana was lowering IQ.

The other study compared teens who reported daily marijuana use for six months or longer with teens who used the drug less than 30 times and found no difference in IQ.
 
But critics say both studies are flawed in that they did not measure heavy marijuana use over a long 25-year period like the Dunedin study did.
 
Dr. Madeline Meier, lead researcher of the Dunedin study, writes, “Our 2012 study (Meier et al. PNAS 2012) reported cognitive decline among individuals with a far more serious and far more long-term level of cannabis use. That is, we found cognitive decline in individuals followed up to age 38 who started cannabis use as a teen and who thereafter remained dependent on cannabis for many years as an adult. This new study is different; the two papers report about completely different doses of cannabis, and about participants 2 decades apart in age.  The new study reports cognitive test scores for individuals followed up to only age 17-20, fewer than half of whom had used cannabis more than 30 times, and only a fifth of whom used cannabis daily for > 6 months. This new study and our prior study agree and both report the same finding: no cognitive decline in short-term low-level cannabis users. The message from both studies is that short-term, low-level cannabis use is probably safer than very long-term heavy cannabis use. The big problem remains that for some teens, short-term low-level teenaged cannabis use leads onward to long-term dependence on cannabis when they become adults. That is what is cause for concern.”
 
Read Science story here. Read Dr. Meier’s rebuttal here.

Source: Email from Monte Stiles, National Families in Action January 2016

Subject: Re: Priorities for Reform of UK Drug Policy : Policy-UK Forum : March 2016

Dear Mr Marsh.

Thank you for the invitation. I shall not be attending.

You have included in the Speakers Niam Eastwood & Mike Trace, both people who push drugs legalisation. I have debated publicly with both. Their positions are well known. I do not take either seriously as unbiased commentators on drugs policy. I doubt government does either. I regard both as paid apostles of a particular point of view. A point of view which is not shared by most MPs or members of the public.

In Mike’s case, he was, in his own word “disgraced”, when forced to resign from his then new job at the UN, when he was exposed as being (again in his own words), “a fifth columnist”, for the George Soros financed, “Open Society”, world wide, drug legalisation campaign, (of all possible drugs) . Release has been similarly supported by Soros and was named in Mr Trace’s covert plan on this subject, when it was exposed several years ago..

Given those two speakers, your conference seems to me, to be just another platform for the legalisation lobby, not a genuine, open and serious debate, which can improve policy making or add significant value.

That legalisation lobby has lost the debate in the UK, the starting point was the exposing of Mike Trace. Further debate involving these two very discredited speakers (discredited by association), is in my view pointless. The drug legalisation debate in the UK, is over. The Pschoactive Substances Bill, approaching 3rd reading, also overtakes some of your agenda.

Thank you for the invitation.

David Raynes
NDPA

Source: Email from David Raynes January 2016

Almost all cannabis sold on British streets can cause psychosis after weaker forms were driven from the market.

The most potent “skunk” accounts for 94 per cent of all cannabis seized by police, up from half in 2005, according to the first study for almost a decade.

Dealers are thought to be pushing higher-strength products to get recreational users hooked, with the milder hashish form barely available, researchers say.

Teenager cannabis smokers have been told that skunk is more dangerous and that they must watch out for paranoia and other symptoms of psychosis.

Skunk, also known as sinsemilla, is made from unpollinated cannabis and contains higher levels of THC, a psychoactive compound, than herbal marijuana or resin, also known as hashish.

A Home Office study of police seizures in 2005 found that 51 per cent were skunk and 43 per cent resin. Three years later skunk seemed to be becoming stronger and more common, but the study has not been repeated since 2008.

Now researchers at King’s College London have analysed almost 1,000 samples seized by police in London, Merseyside, Derbyshire, Kent and Sussex. Resin accounted for just 6 per cent of samples, falling to 3 per cent in London, and even that had become stronger since 2008, according to results published in Drug Testing and Analysis.

“The increase of high-potency cannabis on the streets poses a significant hazard to users’ mental health,” said Marta Di Forti, senior author of the paper. “It’s a big worry. It’s pretty much the only kind of cannabis you can buy out there.”

Her previous work suggests that skunk users are five times more likely to develop psychosis than non-users, while there is no extra risk for hash smokers. Britain is largely self-sufficient in skunk as farms take over from hash grown in Morocco and Dr Di Forti said that the stronger product could be a deliberate policy by gangs.

“If high potency is more likely to induce dependence, that’s an advantage for the drug dealer because he wants people to come back as much as possible, rather than recreational users who only use at the weekend when they’re listening to music or going to a party,” she said.

Skunk has not got stronger since 2005, which she said could be because users could not tolerate higher THC concentrations without side-effects.

About 2.2 million people are estimated to have smoked cannabis in the past year, a million of them aged 16-24.

While there is some evidence that users can partially detect higher strength cannabis and cut back, Ian Hamilton, a lecturer in mental health at the University of York, said: “If the cannabis market is saturated with higher potency cannabis this increases the risk of younger and more naive users developing problems as they are less likely to adjust the amount of cannabis they ingest than more experienced users.”

Source: https://www.thetimes.co.uk/edition/news/mental-illness-risk-as-skunk-drives-out-milder-cannabis-wgd58b56l# February 2018 

Marijuana farming is a big business, and marijuana growers are raking in billions.

In California, the crop ranks between lettuce and grapes; total sales in the state, according the Los Angeles Times, will top $21 billion by 2021. In Colorado, where marijuana is also legal, revenues stood at just over $1 billion last year, adding $2.4 billion to the state’s economy.

Those numbers are for legal farms. Illegal marijuana cultivation is much larger. It is estimated that there may be as many as ten million illegal plants grown annually, yielding over $30 billion worth of product.

Cannabis hyperemesis syndrome (CHS) is nothing new, but nonetheless lacks a diagnosis code. This means that nobody—including the Centers for Disease Control and Prevention, which is meant to track such things—knows the prevalence of the condition. It is, however, relatively rare. Medical sources say that it’s likely, as you’d expect, to become more common as nationwide cannabis use increases.

No one claims that CHS is lethal, but it is uncomfortable—and in an emergency room situation requires such medications as haloperidol, an antipsychotic, to relieve vomiting and pain. Business Insider recently reported the story of 29-year-old Alice Moon, who began using cannabis regularly to treat pain and nausea. She did so without problems for five years, but then began experiencing CHS symptoms monthly, and eventually weekly.

People who use any substance deserve access to relevant health information, without exaggeration in either direction. “Marijuana is somehow making millions violently sick” and “Mysterious Syndrome Related To Marijuana Use Begins To Worry Doctors” are two CHS-related news headlines from the past month alone. But CHS likely doesn’t affect millions, and it is less mysterious than some imply.

So this isn’t a Reefer Madness story, designed to scare people, nor a head-in-the-sand story, designed to appeal to those who see cannabis as a risk-free panacea.

Even pro-cannabis advocates agree that CHS exists. “It’s a diagnosis of exclusion,” Peter Grinspoon, MD, a primary care physician at an inner-city clinic in Boston, told Filter. Grinspoon is also on staff at Massachusetts General Hospital, teaches at Harvard Medical School, and authored the memoir Free Refills: A Doctor Confronts His Addiction (2016). “I’m not sure how you can really differentiate it from cyclic vomiting syndrome (CVS), idiopathic [unknown cause] vomiting, or just something else causing the vomiting—except for a cannabis history.”

 CHS is caused by heavy long-term use of cannabis—i.e., it’s not a result of overdose or acute toxicity.

Experts believe that the action of the cannabinoid THC on our CB1 receptors, which are found all over the body but mainly in the brain, produces the symptoms of CHS—though the amounts of THC required, the duration of use in months or years, and why some people experience CHS and not others, are still unexplained.

One thing everyone seems to agree on: CHS is caused by heavy long-term use of cannabis—i.e., it’s not a result of overdose or acute toxicity. And it has one unusual manifestation: People afflicted like to take many hot baths or showers for relief.

A study published last month, based on emergency room visits in a Colorado hospital, also found that CHS is more likely to be associated with smoked than edible cannabis. Of 2,567 ER visits that were at least partly attributed to cannabis use, 18 percent of patients who inhaled it were said to have CHS, versus 8.4 percent of those who ate it.

Emergency Physicians’ Experiences

 “It’s very dramatic—patients are sometimes writhing on the floor, and they’re vomiting so much. It’s a horrible syndrome,” said Andrew C. Meltzer, MD, associate professor in the Department of Emergency Medicine and Clinical Research Director of GWU School of Medicine and Health Sciences. “It’s very different from any other kind of vomiting thing, and very disruptive to the ED.”

And in the worst cases, “repeated aggressive vomiting can cause tears in the esophagus.”  

 Unlike gastroenteritis, with CHS there is no diarrhea, no fever and more of a hypersensitivity to pain in the abdomen, Meltzer told Filter. There is an “overlap” with cyclical vomiting syndrome (CVS), in that many symptoms are the same. Blood work might be needed to rule out pancreatitis and hepatitis, and some patients get radiology.

Toxicology testing, on the other hand, is not very useful, because so many people use marijuana without showing these symptoms. Rather, it’s important to get a history of the extent and duration of marijuana use from the patient, said Meltzer. “Confusion exists in the medical literature,” he noted. In addition, he believes there is a pervasive failure to recognize chronic cannabis use as a possible cause of vomiting.

“We’re still trying to figure out how to make them feel better,” said Meltzer of CHS patients. “Typical anti-emetics like Phenergan and Zofran don’t work. Instead, we use antipsychotics, like haloperidol.” In fact, if the haloperidol works, Meltzer views that as diagnostic of CHS in some ways. The heat from capsaicin rubbed on the abdomen also provides some relief from pain.

In the patients Meltzer has seen with CHS, all “would qualify as addicted” to cannabis, he said. He doesn’t recommend using morphine for CHS pain because of what he sees as the addiction risk in this population.

Some CHS patients can’t be treated with emergency room management alone. Meltzer said he had to admit one patient for dehydration, fluids replacement, renal insufficiency, and other problems. “But now we’re getting more used to how to manage this with haloperidol and even Ativan. They are sedated, they sleep, and they go home.”

“I don’t care what people do in their free time, but in the medical history I try to include things that are pertinent.”

Ryan Marino, MD, an emergency medicine physician and medical toxicologist at the University of Pittsburgh, sees CHS about two-to-three times a month—but acknowledges it could be more, because sometimes it’s hard to be sure.

“The big issue is [CHS] is under-recognized,” said Marino, agreeing with Meltzer. “So a lot of patients get unnecessary testing.” For someone who comes in with a lot of nausea and vomiting, and is young and otherwise healthy, he says it’s important to ask about their marijuana use.

“I try to be as non-judgemental as possible” in asking those questions, he said. “I don’t care what people do in their free time, but in the medical history I try to include things that are pertinent.”

With emergency patients, the differential diagnosis is crucial and must be done quickly. “When there’s belly pain, you worry about things that need surgery, like appendicitis and the gallbladder,” said Marino. “CVS is kind of similar [to CHS], but people aren’t using cannabis.” So asking about marijuana use history can clearly help.

“The main thing seems to be people who use heavily and regularly: daily use or near-daily use,” said Marino. “With the rise of medical cannabis, more people have access to it, so maybe there are more presentations now than there used to be. But with no ICD [International Classification of Diseases] code, I don’t think you’d be able to say whether you can find prevalence.”

Marino acknowledges that there’s a fine line to tread in questioning patients, especially in situations where they are worried about law enforcement, and some healthcare providers are better than others at getting honest histories. “There are going to be people on the provide side who don’t get the truth out of patients, and there are patients who won’t disclose. This is why the way we treat patients is important.”

Gastroenterologists’ Perspectives

 Whether they’re called in to consult in the emergency department or see a person in their office, gastroenterologists have a big role to play for CHS patients. CHS has been known about since 2004, but a seminal 2011 Current Drug Abuse Reviews article put gastroenterologists on the alert.

A year ago, Healio interviewed gastroenterologist Joseph Habboushe, MD for an article titled “Cannabinoid hyperemesis syndrome: What GIs should know.” Habboushe had surveyed 155 patients in an emergency department who reported smoking marijuana frequently and found that 32.9 percent of them met criteria for CHS. He concluded that the syndrome is vastly underreported.

“I would definitely ask” about marijuana use in the case of an otherwise-healthy, vomiting patient, said Lisa Gangarosa MD, AGAF, FACP, professor of Medicine at the UNC Division of Gastroenterology and Hepatology, speaking for the American Gastroenterological Association. “The diagnosis is largely made on the history.”

There is no clear test. “Basically, if the history fits, and if the patient stops smoking and gets better, that’s what it was.”

Some testing would be done to exclude other problems, such as stomach cancer, a large ulcer or gallstones, Gangarosa told Filter. It’s also important to conduct basic lab testing, such as for pregnancy, and then, if all of that testing comes back negative, to think about endoscopy and ultrasound of the gallbladder.

Gangarosa has only seen CHS in patients who have been “smoking pot,” not in anyone who has been prescribed dronabinol, which is synthetic THC.

There is no clear test for the syndrome. “In some cases you can say your impression is suspected marijuana-induced hyperemesis,” she said. “Basically, if the history fits, and if the patient stops smoking and gets better, that’s what it was.”

Surprisingly, many patients who use cannabis haven’t heard of CHS, said Gangarosa. For others, they don’t want to stop smoking, “and they don’t want to believe that this is the cause of their problems. It’s the same thing with pancreatitis—just because of the health harms, doesn’t mean people want to give up drinking.”

The Hot Bath Phenomenon

Andrew Meltzer, the ED physician, said that some of his patients have taken six-to-eight warm baths a day to relieve symptoms.

This reminds me of a personal experience. A member of my family had acute gastritis at the age of six, with a lot of vomiting, and was hospitalized for a week. All she wanted to do was lie in the hospital bathtub with the water as hot as possible. There was no marijuana involved, but bells went off in my head when I heard about the hot shower “cure.” Could this be a common way of responding to extreme vomiting and pain in general?

Experts stress that the hot shower treatment is anecdotal, and can’t be used as a sure sign of CHS. “But it’s something I ask people,” said Ryan Marino. “It seems as if most people have figured out” that it works. “It might be that they’re so symptomatic they try anything, and find the one thing that works.”

Like the capsaicin, which provides heat, and heating pads, heat from the hot shower on the belly might relieve the pain, said Marino. However, “I don’t think anyone has a good reason for the link” between CHS and hot showers.

A Researcher’s View

The National Institute on Drug Abuse (NIDA) referred Filter to Kiran Vemuri, PhD, a research assistant professor at Northeastern University in Boston, who has a grant from the agency to find an antidote for synthetic cannabinoid intoxication.

That, of course, is a very different issue from CHS. But as an organic chemist, Vemuri has studied emesis from a CB1 antagonist perspective. He is aware of the paradox with THC: The synthetic version, dronabinol, is approved by the FDA to treat the nausea and vomiting associated with chemotherapy, as well as to increase appetite in wasting associated with AIDS, and for many other conditions.

How would the same substance that treats nausea induce it?

“This only happens in people who have been consuming cannabis for a long time,” Vemuri said. But he noted that most information in the literature is anecdotal and based on case histories. “People try to come up with a number”— how much cannabis, for how long—“but you can never really tell as to what causes the hyperemesis. Is it the dose, is it the strain?”

“If you know the CB1 receptor is implicated … the best treatment option would be an antagonist.” Except there isn’t one.

Vemuri has studied antagonists which induce nausea, with the CB1 receptor the biological target. CB1 receptors are all over the body, but most are in the brain, he said.

If you want to know everything the top researcher in emesis (vomiting) knows about the topic, look up the work of Linda Parker. It’s hard to study in animals, because not all of them even vomit.

There is no antidote for emesis itself, said Vemuri. “But if you know that the CB1 receptor is implicated, and the patient is presenting with an overdose of THC or synthetic cannabinoids, the best treatment option would be an antagonist.” Except there isn’t one.

As for the hot showers, CB1 receptors could indeed be involved, but there is no “concrete connection” to CHS or its treatment, said Vemuri.

And he cautions that “‘overdose’ is a big word when it comes to THC.” The dose, the strain, the route of administration all matter, he said. And because THC can reside in fat, and build up, it makes sense that some of the side effects could be worse in people who have consumed THC over a long period of time. “At the end of the day, anything in excess is not good.”  

No Easy Cure

There was one medication which briefly showed promise for CHS—ribonabant—but it was removed from the market due to psychiatric side effects (suicidal ideation). “The target is so new,” Vemuri said. “But NIDA is definitely interested, and no one ever gave up on the target, and no one ever gave up on cannabis, and no one ever gave up on the antagonists. Recently I was at a conference where I got to know companies that are pursuing both CB1 and CB2.”

While hot showers may provide temporary relief, and anti-emetics and intravenous hydration can help “someone in the throes of repetitive vomiting,” for now, the best way for CHS patients to avoid further symptoms for good is to stop using cannabis, said Lisa Gangarosa, the gastroenterologist.

“That is always the recommendation,” agreed Marino. “It seems to be the only thing that makes it better or makes it go away. But it’s not always the easiest thing. It’s easy for me to say.”

The implications of quitting for people who use cannabis for medical reasons—and the difficulties for people who are addicted—are clear. But for now, the unknown minority of cannabis users unfortunate enough to experience cannabis hyperemesis syndrome have no other reliable recourse.

Source:  https://www.dbrecoveryresources.com/2019/04/what-is-cannabis-hyperemesis-syndrome/ April 2019

Source: http://archive.unu.edu/events/files/2008/Santos_SharedRespnsibility_presentation_200810.pdf 2008

Police forces in the province collected 795 blood samples from motorists suspected of driving while under the influence.

One year after the legalization of recreational use of cannabis in Canada, the black market for the drug — as well as its use behind the wheel — continues to keep Quebec police forces busy.

In 2018, police collected 795 blood samples from motorists suspected of driving while under the influence, and sent them to Quebec’s medical legal centre for processing. That’s 254 more than in the previous year.

The presence of cannabis was detected in 46 per cent of those cases.

The Sûreté du Québec says cannabis is the most commonly detected drug in its traffic stops.

The provincial force said that since legalization, cannabis was detected in the systems of 113 persons pulled over for impaired driving, compared with 73 cases a year earlier — an increase of 54 per cent.

More than 670 officers trained in drug use evaluation have been deployed across the province.

In a statement issued Thursday detailing its operations over the past year, the SQ said it had opened 1,409 investigations into the illegal production, supply and distribution of cannabis, which led to 1,458 warrants being executed and charges filed against 1,403 individuals.

Meanwhile, raids on illegal outdoor cannabis fields were carried out in August and September, and saw 37,000 plants seized.

Over the past year, the SQ seized 71,500 cannabis plants, 161 kilograms of cannabis, 15.8 kilograms of cannabis oil and resin, 23,460 units of edible cannabis and $180,000 in cash.

Source:  https://montrealgazette.com/news/local-news/quebec-pot-arrests-behind-the-wheel-up-54-since-legalization October 2019

VIENNA: The United Nations Commission on Narcotic has unanimously adopted Pakistan’s resolution on strengthening efforts to prevent drug abuse in educational settings.

The resolution was adopted during the commission’s sixty first regular session in Vienna. The resolution drew attention of the Commission towards the common challenges of drug abuse among children and youth in schools colleges and universities.

It underscored the need for enhancing efforts including policy interventions and comprehensive drug prevention programmes to protect children and youth from the scourge of illicit drugs and to make educational institutions free from drug abuse.

The resolution emphasized upon the important role of educational institutions in promoting healthy lifestyles among young people and calls for close coordination among law enforcement agencies, educational centres and health authorities at domestic level.

It reflected political commitment of the global community to promote international cooperation through exchange of experiences and good practices and technical assistance to address drug abuse in educational institutions. Pakistan’s initiative to table this resolution was widely appreciated.

Source: https://www.thenews.com.pk/print/294734-un-adopts-pakistan-s-resolution-for-efforts-to-prevent-drug-abuse  March 2018

Abstract
Marijuana is currently a growing risk to the public in the United States. Following expanding public opinion that marijuana provides little risk to health, state and federal legislatures have begun changing laws that will significantly increase accessibility of marijuana. Greater marijuana accessibility, resulting in more use, will lead to increased health risks in all demographic categories across the country. Violence is a well-publicized, prominent risk from the more potent, current marijuana available.
We present cases that are highly popularized storylines in which marijuana led to unnecessary violence, health risks, and, in many cases, both. Through the analysis of these cases, we will identify the adverse effects of marijuana use and the role it played in the tragic outcomes in these and other instances. In the analysis of these cases, we found marijuana as the single most common, correlative variable in otherwise diverse populations and circumstances surrounding the association of violence and marijuana.

Conclusion
According to research studies, marijuana use causes aggressive behavior, causes or exacerbates psychosis and produce paranoias. These effects have been illustrated through case studies of highly publicized incidents and heightened political profiles.
These cases contain examples of repeated illustrations of aggression, psychosis and paranoia by marijuana users and intoxication.
Ultimately, without the use and intoxication of marijuana, the poor judgment and misperceptions displayed by these individuals would not have been present, reducing the risk for actions that result in senseless deaths.

Import to these assertions, is that the current marijuana is far more potent in THC concentrations, the psychoactive component. Accordingly, and demonstrated in direct studies, more potent marijuana results in a greater risk for paranoid thinking and psychosis.
In turn, paranoid behavior increases the risk for paranoid behaviors and predictably associated with aggressive and violent behaviors. Marijuana use causes violent behavior through increased aggressiveness, paranoia and personality changes (more suspicious, aggressive and anger).
Recent illicit and “medical marijuana” (especially grown by care givers for medical marijuana) is of much high potency and more likely to cause violent behavior. Marijuana use and its adverse effects should be considered in cases of acts of violence as its role is properly assigned to its high association.
Recognize that high potency marijuana is a predictable and preventable cause of tragic violent consequences.

Source: https://www.omicsonline.org/open-access/marijuana-violence-and-law-2155-6105-S11-014.pdf January 2017

Researchers at the University of Exeter and UCL (University College London) have identified a gene which can be used to predict how susceptible a young person is to the mind-altering effects of smoking cannabis. The finding could help identify otherwise healthy users who are most at risk of developing psychosis.

The research, funded by the Medical Research Council and published in Translational Psychiatry, also show that female cannabis smokers are potentially more susceptible to short-term memory loss than males. Previous studies in this field have looked at people who already have psychosis, but this is the first study to look at healthy people and to examine their acute response — or how the drug affects their minds.

Previous research has found a link between the AKT1 gene and people who have gone on to develop psychosis. In the new study, Celia Morgan, Professor of Psychopharmacology at the University of Exeter and Professor Val Curran and her team from UCL found that young people with variation in the ‘AKT1’ gene experienced visual distortions, paranoia and other psychotic-like symptoms more strongly when they were under the influence of cannabis.

Around one per cent of cannabis users develop psychosis. Although low in number, the impact can be devastating and long lasting. It is known that smoking cannabis daily doubles an individual’s risk of developing a psychotic disorder, but it has been difficult to establish who is most vulnerable. Researchers have previously found a high prevalence of one variant of the AKT1 genotype in cannabis users who went on to develop psychosis as a result of their use. This is the first research that shows the link between the same gene and the effects of smoked cannabis in healthy young people.

It is hoped that it will help identify those most at risk of the negative effects of cannabis smoking and may aid the development of genotype targeted medication.

Professor Morgan said: “These findings are the first to demonstrate that people with this AKT1 genotype are far more likely to experience strong effects from smoking cannabis, even if they are otherwise healthy. To find that having this gene variant means that you are more prone to mind-altering affects of cannabis when you don’t have psychosis gives us a clue as to how it increases risk in healthy people. Putting yourself repeatedly in a psychotic or paranoid state might be one reason why these people could go on to develop psychosis when they might not have done otherwise. Although cannabis-induced psychosis is very rare, when it happens it can have a terrible impact on the lives of young people. This research could help pave the way towards the prevention and treatment of cannabis psychosis.”

Professor Curran added: “The current study is the largest ever to be conducted on the acute response to cannabis. Our finding that psychotic-like symptoms when young people are ‘stoned’ are predicted by AKT1 variants is an exciting breakthrough as this acute reaction is thought to be a marker of a person’s risk of developing psychosis from smoking the drug.”

The study involved 442 young cannabis users who were tested while under the influence of the drug, and while sober. The researchers measured the extent of the symptoms of intoxication and effect on memory loss and compared it to results seven days later when the young people were drug free. They found that those who with this variation in the AKT1 geneotpye were more likely to experience a psychotic response.

As part of the study, researchers gained permission from the Home Office to analyse the cannabis samples for their make-up and strength. Samples were dropped off at a police station and analysed by the forensic science service.

The research also found that females were more vulnerable than males to impairment in short term memory after smoking cannabis.

“Animal studies have found that males have more of the receptors that cannabis works on in parts of the brain important in short term memory, such as the prefrontal cortex. We need further research in this area, but our findings indicate that men could be less sensitive to the memory impairing effects of cannabis than females,” added Professor Morgan.

Source: https://www.sciencedaily.com/releases/2016/02/160216111357.htm February 2016

Marijuana legalization is on the ballot in 2016 in California, Arizona, Nevada, and elsewhere
The marijuana movement received a big jolt last November. No, it wasn’t another celebrity endorsement or cable news special glorifying the drug. Rather, in the midst of what we’ve been told was an inevitable march to victory, marijuana lost. And it lost big.

Many of us interested in this off-year Ohio race were expecting to be up all night. But at 8:32 p.m. Nov. 3, the Associated Press recorded one of the biggest losses ever for pot, as voters rejected legalization there by more than 2-1. (Full disclosure: The organization I head up, SAM, played a role in the campaign and defeat through our affiliate partners.)

Sure, the question was asked in a year no one usually votes, taking place in a sensible Midwestern state not known for its indulgences. Most of us thought it would lose, despite the victory “polls” constantly trumpeted out by the legalizers , but none of us thought it would lose this big.

What does that tell us for the 2016 races, when five states — California, Arizona, Nevada, Massachusetts, and Maine — are likely to have ballot questions on full legalization? A lot. Here’s what we’ve learned:

The Ohio initiative would have legalized a constitutionally mandated oligopoly for a few dozen investors to make millions on marijuana. The “No” campaign quickly pivoted from “marijuana is bad” to “marijuana monopolies with people making tons of cash are bad” — and it worked. The Ohio election was the first that tested the “Big Marijuana” message out. Groups like SAM have been saying it now for years, and videos showing the parallels are out there on social media, but it had not been tested out in a real campaign.

Money isn’t everything.

The pro side in Ohio spent more than $12 million to convince Buckeye voters that legalizing a pot monopoly was a good thing, and they still lost bad. While it’s true that money is required to get political messages out, especially when spent in a smart(er) way via targeted social media campaigns, Ohio proved that money isn’t everything.

The “no” side, while gathering an impressive group of organizations to oppose the measure, didn’t even pass the $1-million spending mark. But the message of opposing Big Pot stuck, and the amount of free media gained was remarkable. Every article mentioned the investor scheme.

Marijuana legalization isn’t inevitable.
The five states up for grabs in 2016 are critical, and voters will decide pot’s fate in an important presidential election year. But, all five states have different critical issues.

A state known for sin and vice — Nevada — might seem the perfect one to try legalizing pot. Except for one man: Sheldon Adelson. The billionaire is dead-set against legalization, and he put his money where his mouth is in 2014 when he helped narrowly defeat a pot initiative in Florida. This time around, legalizers are gunning for his home state, but there’s talk of a well-respected state legislator and a handful of other bipartisan officials coming out against Nevada’s initiative. Stay tuned.

In Arizona, a legalization push has barely gotten off the ground, but is already finding opposition. And in Massachusetts, Democrat Attorney General Maura Healey and Republican Gov. Charlie Baker both oppose the initiative. In Maine, legalizers are trying to sanction pot smoking “social clubs,” though a recent conference highlighted dissension among traditional allies.

If we have learned anything from the brief time marijuana has been legal in Colorado, it is this: We have now entered the age of ‘corporate cannabis’ — slick advertising, child-friendly product placement.

In all of these states, laws are being written largely by lobbyists who have one goal — to make money. And one does not get rich in the drug business from casual users. They must rely on heavy users.

If we have learned anything from the brief time marijuana has been legal in Colorado it is this: We have now entered the age of ‘corporate cannabis’ — slick advertising, child-friendly product placement and companies that spend more on PR and lawyers than they do creating safe products.

The sky may not fall if legalization passes in these states, but voters should ask themselves something before getting into the ballot box. Are your relationships enhanced when your friends or family are smoking marijuana? Does marijuana make for safer roads? Better workplaces? Smarter students?

Despite strong evidence to the contrary, we are being told pot will fund our schools, get rid of drug cartels and cure cancer, all at once. And worst of all, we’re being sold this false dichotomy — that our only choices for drug policy are legalize or lock ‘em up. Promote Pot Tarts or fund private prisons. Give a kid a criminal record for holding a joint or allow another addictive industry to take over meetings in state capitals.

But that is false. No one I know wants to see a young kid marred forever because he happened to get caught with a joint in his pocket. But the alternative to that is not simply to ignore an unhealthy, unproductive behavior and promote its use. With the increasing research linking mental illness and marijuana, we at least should press the pause button before going any further.

We can’t build a great, compassionate society by promoting addiction for profit.

BY KEVIN SABET

Source: https://www.lifezette.com/2015/12/legalized-pot-no-its-not-inevitable/
December 2015

The Centers for Disease Control and Prevention’s Vital Signs addresses a single, important public health topic each month. This month’s edition presents their latest findings on youth exposure to e-cigarette advertising. They also highlight strategies to prevent youth exposure to e-cigarette advertising and youth e-cigarette use.

The use of e-cigarettes among U.S. youth has increased considerably since 2011. Exposure to advertisements depicting e-cigarettes might contribute to increased e-cigarette use among youth. CDC analyzed nationally representative data to estimate the prevalence of e-cigarette advertisements among middle school and high school students in the U.S. Four sources of exposure were assessed: retail stores, Internet, TV and movies, and newspapers and magazines.

Key points in the Vital Signs report include:

• Approximately 18.3 million U.S. middle school and high school students were exposed to at least one source of e-cigarette advertising in 2014.
   
• Approximately half of all middle school and high school students (an estimated 14.4 million students) were exposed to e-cigarette advertisements in retail stores.
   
• Approximately one third of middle school and high school students were exposed to e-cigarette advertisements on the Internet (10.5 million), on TV or at the movies (9.6 million), or while reading newspapers or magazines (8.0 million).

Source: https://www.cadca.org/resources/e-cigarette-advertising-found-be-pervasive-youth-cdc-says 2016

• Polly Ross, 32, suffered with Hyperemesis Gravidarum during second pregnancy
• Mother smoked cannabis and magic mushrooms to ease pain, an inquest heard
• ‘Talented and clever’ translator took her life in 2015 after battling with psychosis

A mother-to-be who took cannabis after developing the same morning sickness condition as the Duchess of Cambridge killed herself after developing a drug-induced psychosis, an inquest heard.  

Talented translator Polly Ross, 32, suffered Hyperemesis Gravidarum (HG), the condition which saw Kate Middleton rushed to hospital in August while visiting the queen in Aberdeen.

Hull Coroner’s Court in East Yorkshire was told today how a desperate Mrs Ross took cannabis and magic mushrooms in a bid to tackle the severe bouts of sickness.

However in July 2015, just a year after the birth of her second daughter, she died after stepping out in front of a train.  

A coroner heard Mrs Ross had developed ‘drug induced psychosis’ after taking cannabis to stop symptoms of HG.

Mrs Ross told her GP, Dr Daniella Malesknasr, she had taken cannabis during her pregnancy after visiting the doctors suffering from post natal depression.

Dr Malesknasr told the hearing: ‘She had told me when she was pregnant with her second child that she was taking cannabis and magic mushrooms to help combat HG during her pregnancy – but she was no longer taking it.’

Professor Paul Marks, the senior coroner, questioned: ‘And does taking cannabis actual benefit those suffering from HG?.’

The doctor replied: ‘I can’t possibly comment on that.’

Dr Malesknasr said ‘alarm bells were ringing’ after Polly had told her she wanted to commit suicide on February 13, 2015.

The inquest heard the GP had called in at her home to find her in a psychotic episode and Mrs Ross was sectioned the following month.

By March 18, Dr Malesknasr said Mrs Ross was diagnosed with drug induced psychosis following the amounts of magic mushrooms and cannabis she had been taking.

The GP said she was then given Respiradon to help battle the psychosis.

Mrs Ross tried to take her life three times with self harm and taking an overdose twice in a three month period.

However, the court heard she was remarkably allowed to discharge herself voluntarily following the last attempt to take her own life.

Professor Marks said: ‘So after taking an overdose of paracetamol tablets, Polly was allowed to just leave voluntarily?’

Dr Malesknasr said: ‘I can’t comment on that because it is a hospital matter.’

However, in May 2015 a psychiatrist in the community said that psychosis was no longer a problem and she should come off the anti-psychosis drug Respiradon.

The translator was given help by a crisis team to give her a ‘higher and intense level of support’, but Mrs Ross had refused them entry to her house in Driffield, East Yorkshire.

Mrs Ross died on July 12, 2015, by stepping in front of a train in Hull, East Yorkshire, and ‘death was instant’, Hull Royal Infirmary Consultant Histopathologist Dr Ian Richmond told the hearing.

She had told mental health workers at the women-only care centre at Westlands voluntary care unit in Hull, East Yorkshire, that she was going to the shop.

A statement from Mrs Ross’s aunt Emma May, who cared for her during her final months, read: ‘With the right guidance, medication and support, Mrs Ross could have made a full recovery.

‘There should be systems in place to protect that life especially because there are so many suicides attempts of post natal women.

‘I cannot understand why she was allowed to leave the hospital unit before she died.

‘Polly clearly said many times that she would kill herself, many months before she did.

‘I feel that she posed a significant risk to herself, did not have sufficient capacity to make decision and more should have been done to protect and care for her.’

Mrs Ross, who ran her own ‘very good’ translation business in Paris, was described as ‘an extremely intelligent lady and very driven in her own ambition’, by Mrs May.

She was also described as ‘frighteningly clever’.

She met her English husband Samuel Ross in 2011 in the French capital and the pair quickly married and had two daughters born in June 2012 and June 2014 respectively.

Mrs Ross suffered HG during pregnancy with both children and had post natal depression following the birth of both children.

The inquest, expected to last three days, continues.

WHAT IS HG?

Source: https://www.dailymail.co.uk/news/article-5063227/Pregnant-mum-killed-developing-drug-habit.html November 2017

Abstract

University of Alberta led guideline warns health risks may outweigh benefits, provides guidance on when (and when not to) prescribe.

A new medical guideline published today suggests Canada’s family physicians should take a sober second thought before prescribing medical cannabis to most patients.

Published in Canadian Family Physician, “Simplified Guideline for Prescribing Medical Cannabinoids in Primary Care” states there is limited evidence to support the reputed benefits of medical marijuana for many conditions, and what benefits do exist may be balanced out or even outweighed by the harms.

“While enthusiasm for medical marijuana is very strong among some people, good-quality research has not caught up,” said Mike Allan, director of evidence-based medicine at the University of Alberta and project lead for the guideline.

The guideline was created after an in-depth review of clinical trials involving medical cannabis and will be distributed to roughly 30,000 clinicians across Canada. It was overseen by a committee of 10 individuals, supported by 10 other contributors, and peer reviewed by 40 others, each a mixture of doctors, pharmacists, nurse practitioners, nurses and patients. The review examined cannabinoids for the treatment of pain, spasticity, nausea and vomiting, as well as their side-effects and harms.

Researchers found that in most cases the number of randomized studies involving medical cannabis is extremely limited or entirely absent. The size and duration of the studies that do exist are also very narrow in scope.

“In general we’re talking about one study, and often very poorly done,” said Allan. “For example, there are no studies for the treatment of depression. For anxiety, there is one study of 24 patients with social anxiety in which half received a single dose of cannabis derivative and scored their anxiety doing a simulated presentation. This is hardly adequate to determine if lifelong treatment of conditions like general anxiety disorders is reasonable.”

According to the guideline, there is acceptable research for the use of medical cannabinoids to treat a handful of very specific medical conditions. They include chronic neuropathic (nerve) pain, palliative cancer pain, spasticity associated with multiple sclerosis or spinal cord injury, and nausea and vomiting from chemotherapy. Even in those specific cases, the benefits were found to be generally minor.

For nerve pain, 30 per cent of patients given a placebo saw a moderate improvement in their pain while 39 per cent experienced the same effect while on medical cannabinoids. In patients with muscle spasticity, 25 per cent of those taking a placebo saw a moderate improvement compared to 35 per cent on medical cannabis. The use of medical cannabis was best supported in its use for chemotherapy patients experiencing nausea and vomiting. Just under half of patients using cannabinoids for their symptoms had an absence of nausea and vomiting compared to 13 per cent on placebo.

“Medical cannabinoids should normally only be considered in the small handful of conditions with adequate evidence and only after a patient has tried of number of standard therapies,” said Allan. “Given the inconsistent nature of medical marijuana dosing and possible risks of smoking, we also recommend that pharmaceutical cannabinoids be tried first before smoked medical marijuana.”

While the researchers found evidence supporting the use of medical cannabinoids to be limited, side-effects were both common and consistent. About 11 per cent of patients were not able to tolerate medical cannabinoids, versus three per cent of those taking placebo. Common effects included sedation (50 per cent versus 30 per cent), dizziness (32 per cent versus 11 per cent) and confusion (nine per cent versus two per cent).

“This guideline may be unsatisfactory for some, particularly those with polarized views regarding medical cannabinoids,” said Allan.

He added that those who oppose the use of cannabinoids for medical therapy may be disappointed that the guideline considers medical cannabinoids in specific cases. Others, who feel cannabinoids are highly effective and don’t pose any risk, may be frustrated that the guideline doesn’t advocate their use sooner or for a broader range of conditions.

“Better research is definitely needed — randomized control trials that follow a large number of patients for longer periods of time. If we had that, it could change how we approach this issue and help guide our recommendations.”

Source: https://www.sciencedaily.com/releases/2018/02/180215153923.htm February 2018

The Centers for Disease Control (CDC) recently issued a warning about vaping following a multistate outbreak of severe lung problems linked to the use of electronic cigarettes. According to the CDC, there are, as of September 6, 450 reported cases of possible vaping-linked lung problems across 33 states and 1 territory, resulting in 6 deaths. Officials have not identified a specific e-cigarette product as a cause of the illnesses, meaning that various devices on the market could be contributing to this alarming pattern. Patients admitted for lung problems report difficulty breathing, fatigue, fever, nausea, and vomiting. Somehow, to proponents and purveyors of e-cigarettes, the very idea that vaping could be dangerous seems to have come as a surprise. 

The CDC updated its warning to suggest that e-cigarette and vaping device users refrain from using the products at all during the course of its investigation. It has also warned against buying counterfeit or street vaping products, including those with THC or other cannabinoids, and against modifying e-cigarette products. Moreover, the CDC urges youth, pregnant women, and adults who do not currently use tobacco products to refrain from using e-cigarette products, and encourages individuals who smoke and want to quit to use FDA-approved medications instead of e-cigarettes. Some health officials and experts believe that street vaping products with illicit or tainted substances may be behind the outbreak of lung problems, but no one can be certain at this point. Some patients have reported using vaping cartridges with THC or cannabinoids, but others have reported using different vaping cartridges without such substances. Most contain ingredients not generally tested for chronic inhalation in humans, and, to make matters worse, they can become contaminated in ways detrimental to respiratory and heart health. It is unlikely that any substance you inhale has been tested for safety for weeks, months, or over the long haul. But inhalation from vaping has effects on the lungs that are dramatic, can be easily seen on imaging, and do not seem easy to reverse.

Tobacco smoking in the English colonies of North America started early and peaked in the U.S. in the 1960s and 1970s, credible evidence proving its causal links to cancer, emphysema, and bronchitis emerging only over a century after its explosive growth and wild popularity. Why would boosters and defenders of today’s e-cigarettes, looking back at this history, believe that research would come to indicate the product’s benefits for the lungs, or for the respiratory health of those they may expose to vaping?

While experts and officials will continue to study this outbreak and may identify particular illicit substances as the culprit, the headlines have naturally raised questions for individuals who vape about long term consequences. What we know about cigarette smoking is bad enough, but there are few surprises. Here, we’re in uncharted territory. Yes, the FDA and other agencies will look at the broader health and safety of e-cigarette products and devices, but in the meantime, users will need to be evaluated and hope that their own lungs are not compromised in ways that only become clearly understood after they stop, or years down the line. While receiving considerably less media coverage, journalists recently found that the FDA began investigating vaping-associated seizures after some users of JUUL, the top-selling vaping product in the U.S., submitted claims of seizures to the administration’s safety portal.

It is important to note that Research You Can Use previously observed that there is not yet enough evidence to conclude whether e-cigarettes are suitable for smoking cessation. Some researchers now suggest that vaping nicotine may not be safer than smoking tobacco cigarettes. More recently, the FDA has agreed that JUUL’s claims of comparative safety are unproven. Other new studies have looked at the relative health of ingredients in some e-cigarette products, and the effects of vaping on the vascular system. The truth is that it’s risky and scientifically invalid to start from the premise that drugs are safe until proven dangerous. It reminds me of cocaine being touted as safe, or non-addicting, or even as “the champagne of drugs” until the aftermath of widespread use in the 1970s and 80s demonstrated that it was highly addictive and led to heart problems, brain damage, and other diseases.

What did these studies find?

One study, led by Yale’s Julie Zimmerman, found that chemical interactions in some of JUUL’s inhaled liquid nicotine mixtures yield unanticipated new chemicals that can cause breathing problems. In this study, researchers created a machine to trap JUUL aerosol and investigate its chemical composition. They found that the alcohols hosting flavors and nicotine in JUUL’s e-liquid react with vanillin, a flavor prohibited in tobacco cigarettes, to produce acetals. The effects of inhaling acetal chemicals are unknown, but the study notes that they can cause inflammation and lung irritation. The study found acetals in JUUL’s ‘Crème Brulée’ flavor. One researcher told Yale in an interview that the team was surprised to find such high vanillin chemical levels, pointing out that the detected levels reached those established for health limits on vanillin in bakeries and flavoring businesses.

This study also found menthol in 4 of the 8 JUUL flavors it tested. Menthol, the researchers note, can expand nicotine intake. This could be concerning in part because JUUL pods already have high nicotine content relative to other nicotine products—individuals absorb from one JUUL pod as much nicotine as an entire pack of cigarettes. The researchers also observe that the findings are notable because users of the product often believe that the ingredients and chemical makeup of e-liquids are stable, without realizing that the included chemicals can combine, alter each other, or produce potentially harmful new compounds. The study calls for vaping regulations that tackle the creation of new and possibly toxic chemical elements in e-liquids, exposure to flavorings, and menthol levels.

Another new study, this time from the University of Pennsylvania, examined the effects of vaping on the vascular system and found that e-cigarette use, even without nicotine, can damage blood flow. Researchers studied 31 nonsmokers between the ages of 18 and 35, with no prior history of cardiovascular problems, hypertension, asthma, respiratory tract infections, or cancer. Participants in the study inhaled from e-cigarette devices 16 times each, at three seconds per inhalation. The researchers then used MRIs to measure the participants’ blood vessel health, having evaluated it before and after the vaping exercises. In the participants’ post-vaping leg veins, oxygen levels fell 20 percent, and their peak blood flow velocity fell 17 percent. Their femoral arteries also dilated 34 percent less. The researchers call for additional research on the topic to corroborate their findings in larger groups, and their results focus only on the ECO e-cigarette device, but they nonetheless point to serious concerns about chronic use of vaping products, which may not give time for users’ blood vessel health to normalize or reset.

Why is this important?

Individuals who use vaping products can assume, on the basis consumer-focused “evidence,” that because e-cigarette makers claim that their products are a healthier alternative to tobacco products, they must be “healthy” overall. Some evidence does support the idea that vaping is preferable to smoking tobacco, which is why the United Kingdom’s government asserts that vaping is 95 percent less harmful than e-cigarette use and encourages e-cigarette users to switch to vaping. The dispute over this assertion may come down to the exact meaning of “less harmful,” but those with vaping-related lung disease would certainly argue that vaping is not safer than smoking tobacco. It’s also true that news reports on vaping can often overstate claims in the other direction, alleging or implying that e-cigarettes alone are responsible for severe lung distress. On this point, it may be useful to consider a similar research problem: attempting to determine whether smoking cannabis causes lung cancer when most cannabis smokers also smoke other drugs, and when many also smoke tobacco. By the time health officials and experts reach a definitive conclusion, it may be too late for those vaping. While exaggerations or misleading reports exist, they should not be used to support denial of mounting evidence, or instill confidence in vapers when new research shows obvious reasons to worry—and to worry about health more seriously than the “long-term effects are unknown” talking point.

The CDC’s overall position on vaping in recent years, subject to change,  is that e-cigarettes “have the potential” to help adult smokers quit if they are not pregnant and can entirely substitute vaping for smoking tobacco products. Again, the CDC is now suggesting that individuals avoid vaping while investigations into the associated outbreak continue. It also says that scientists still have much to learn about e-cigarettes and warns that they are not safe for youth. The CDC, FDA, NIDA, and other authorities have recognized youth vaping as a growing epidemic, and have begun taking measures to confront it. Federal officials are now reportedly creating a plan to ban flavored e-cigarette products, which have a particular appeal to youth. Given the recent outbreak of severe lung problems and continued youth interest in e-cigarettes, additional action on this front will likely be required. Another recent study, for example, found 25 distinct “vape tricks” in 59 sample videos on YouTube with a median count of over 32,000 views. “Vape tricks” are stylized and playfully affected techniques for vaping, such as exhaling clouds in unique shapes, that attract the young. 48 percent of the videos were linked to industry posting accounts. This study recommended restrictions on e-cigarette social media marketing to help curb youth vaping, which sounds like a promising avenue for public health. Officials may also find it beneficial to take account of new studies about vaping’s effects on lung and blood vessel health as they deal with the increasingly apparent reality that e-cigarette use is not merely problematic in associated outbreaks, but in legal use, too.

Source: https://www.addictionpolicy.org/blog/tag/research-you-can-use/vaping-and-lungs September 2019

The United States is confronting a public health crisis of rising adult drug addiction, most visibly documented by an unprecedented number of opioid overdose deaths. Most of these overdose deaths are not from the use of a single substance – opioids – but rather are underreported polysubstance deaths. This is happening in the context of a swelling national interest in legalizing marijuana use for recreational and/or medical use. As these two epic drug policy developments roil the nation, there is an opportunity to embrace a powerful initiative. Ninety percent of all adult substance use disorders trace back to origins in adolescence.^a New prevention efforts are needed that inform young people, the age group most at-risk for the onset of substance use problems, of the dangerous minefield of substance use that could have a profound negative impact on their future plans and dreams.

MOVING BEYOND A SUBSTANCE-SPECIFIC APPROACH TO YOUTH PREVENTION

The adolescent brain is uniquely vulnerable to developing substance use disorders because it is actively and rapidly developing until about age 25. This biological fact means that the earlier substance use is initiated the more likely an individual is to develop addiction. Preventing or delaying all adolescent substance use reduces the risk of developing later addiction.

Nationally representative data from the National Survey on Drug Use and Health shows that alcohol, tobacco and marijuana are by far the most widely used drugs among teens. This is no surprise because of the legal status of these entry level, or gateway, drugs for adults^b and because of their wide availability. Importantly, among American teens age 12 to 17, the use of any one of these three substances is highly correlated with the use of the other two and with the use of other illegal drugs. Similarly for youth, not using any one substance is highly correlated with not using the other two or other illegal drugs.

For example, as shown in Figure 1, teen marijuana users compared to their non-marijuana using peers, are 8.9 times more likely to report smoking cigarettes, 5.6, 7.9 and 15.8 times more likely to report using alcohol, binge drink, and drink heavily, respectively, and 9.9 times more likely to report using other illicit drugs, including opioids. There are similar data for youth who use any alcohol or any cigarettes showing that youth who do not use those drugs are unlikely to use the other two drugs. Together, these data show how closely linked is the use by youth of all three of these commonly used drugs.

^aAmong Americans age 12 and older who meet criteria for substance use disorders specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). ^bMarijuana remains illegal under federal law but is legal in some states for recreational use the legal age is 21, and in some states for medical use, the legal age is 18. Nationally the legal age for tobacco products is 18 and for alcohol it is 21.

Figure 1. Past Month Use of Other Drugs, if Marijuana is Used, Ages 12-17

These findings show that prevention messaging targeting youth must address all of these three substances specifically. Most current prevention efforts are specific to individual substances or kinds and amounts of use of individual drugs (e.g., cigarette smoking, binge drinking, drunk driving, etc.), all of which have value, but miss a vital broader prevention message. What is needed, based on these new data showing the linkage of all drug use by youth, is a comprehensive drug prevention message: One Choice: no use of any alcohol, nicotine, marijuana or other drugs for youth under age 21 for reasons of health. This no use prevention message provides clarity for young people, parents, physicians, educators, communities and for policymakers. It is not intended to replace public health prevention messages on specific substances, but enhances them with a clear focus on youth.

Some claim adolescent use of alcohol, cigarettes and marijuana is inevitable, a goal of no use of any drug as unrealistic and that the appropriate goal of youth prevention is to prevent the progression of experimentation to later heavy use or problem-generating use. These opinions are misleading and reflect a poor understanding of neurodevelopment that underpins drug use. Teens are driven to seek new and exciting behaviors which can include substance use if the culture makes them available and promotes them. This need not be the case. New data in Figure 2 (below) show over the last four decades, the percentage of American high school seniors who do not use any alcohol, cigarettes, marijuana or other drugs has increased steadily. In 2014, 52% of high school seniors had not used any alcohol, cigarettes, marijuana or other drugs in the past month and 26% had not used any alcohol, cigarettes, marijuana or other drugs in their lifetimes. Clearly making the choice of no use of any substances is indeed possible – and growing.

Key lessons for the future of youth prevention can be learned from the past. Substance use peaked among high school seniors in 1978 when 72% used alcohol, 37% used cigarettes, and 37% used marijuana in the past month. These figures have since dropped significantly (see Figure 3 below). In 2016, 33% of high school seniors used alcohol, 10% used cigarettes and 22% used marijuana in the past month. This impressive public health achievement is largely unrecognized.

Although the use of all substances has declined over the last four decades, their use has not fallen uniformly. The prevalence of alcohol use, illicit drug use and marijuana use took similar trajectories, declining from 1978 to 1992. During this time a grassroots effort known as the Parents’ Movement changed the nation’s thinking about youth marijuana use with the result that youth drug use declined a remarkable 63%. Rates of adolescent alcohol use have continued to decline dramatically as have rates of adolescent cigarette use. Campaigns and corresponding policies focused on reducing alcohol use by teens seem to have made an impact on adolescent drinking behavior. The impressive decline in youth tobacco use has largely been influenced by the Tobacco Master Settlement Agreement which provided funding to anti-smoking advocacy groups and the highly-respected Truth media campaign. The good news from these long-term trends is that alcohol and tobacco use by adolescents now are at historic lows.

It is regrettable but understandable that youth marijuana use, as well as use of the other drugs, has risen since 1991 and now has plateaued. The divergence of marijuana trends from those for alcohol and cigarettes began around the time of the collapse of the Parents’ Movement and the birth of a massive, increasingly well-funded marijuana industry promoting marijuana use. Shifting national attitudes to favor legalizing marijuana sale and use for adults both for medical and for recreational use now are at their highest level and contribute to the use by adolescents. Although overall the national rate of marijuana use for Americans age 12 and older has declined since the late seventies, a greater segment of marijuana users are heavy users (see Figure 4). Notably, from 1992 to 2014, the number of daily or near-daily marijuana uses increased 772%. This trend is particularly ominous considering the breathtaking increase in the potency of today’s marijuana compared to the product consumed in earlier decades. These two factors – higher potency products and more daily use – plus the greater social tolerance of marijuana use make the current marijuana scene far more threatening than was the case four decades ago.

Figure 4. Millions of Americans Reporting Marijuana Use, by Number of Days of Use Reported in the Past Month

Through the Parents’ Movement, the nation united in its opposition to adolescent marijuana use, driving down the use of all youth drug use. Now is the time for a new movement backed by all concerned citizens to call for One Choice: no use of any alcohol, nicotine, marijuana or other drugs for youth under age 21 for reasons of health. This campaign would not be a second iteration of the earlier “Just Say No” campaign. This new no-use message focuses on all of the big three drugs together, not singly and only in certain circumstances such as driving.

We are at a bitterly contentious time in US drug policy, with front page headlines and back page articles about the impact of the rising death rate from opioids, the human impact of these deaths and the addiction itself. At the same time there are frequent heated debates about legalizing adult marijuana and other drug use. Opposing youth substance use as a separate issue is supported by new scientific evidence about the vulnerability of the adolescent brain and is noncontroversial. Even the Drug Policy Alliance, a leading pro-marijuana legalization organization, states “the safest path for teens is to avoid drugs, including alcohol, cigarettes, and prescription drugs outside of a doctor’s recommendations.”

This rare commonality of opinion in an otherwise perfect storm of disagreement provides an opportunity to protect adolescent health and thereby reduce future adult addiction. Young people who do not use substances in their teens are much less likely to use them or other drugs in later decades. The nation is searching for policies to reduce the burden of addiction on our nation’s families, communities and health systems, as well as how to save lives from opioid and other drug overdoses. Now is precisely the time to unite in developing strong, clear public health prevention efforts based on the steady, sound message of no use of any alcohol, nicotine, marijuana or other drugs for youth under age 21 for reasons of health.

Robert L. DuPont, MD, President, Institute for Behavior and Health, Inc.

Source: https://www.ibhinc.org/blog/reducing-adult-addiction-youth-prevention  February 2018

Ontario’s proposal to allow people to consume marijuana in hotel rooms opens the door to a boom in cannabis tourism, says lawyer Matt Maurer.

Maurer heads the cannabis law group at Minden Gross in Toronto, and says he knows businesspeople who are interested in opening cannabis-friendly hotels and resorts.

Maurer says he was surprised by the province’s proposal to loosen up the ban on consuming cannabis anywhere other than private homes. The government has also asked for public comments on whether to allow cannabis lounges.

Maurer said he assumed the provincial government would eventually consider exemptions to the cannabis act passed in December, which bans consumption in public places.

 “I was surprised that it happened so quickly.”

Maurer calls consumption in hotels “step No. 1” in the development of a cannabis tourism industry.

“You could come to Ontario, go to the government-owned retail store, pick up your cannabis, head out to the hotel room, consume it there and head out to where ever you are going that evening, to a show or an event.”

The provincial regulations unveiled last month propose that cannabis could be consumed by residents and their guests at rooms in hotels, motels and inns, as long as the drug is not smoked or vaped. Smoking and vaping marijuana would be allowed in designated smoking rooms.

The regulations have been posted for public comment. The government plans to put them into effect when recreational marijuana is legalized across the country, expected in July.

Ontario has also opened the door to cannabis consumption lounges, asking for public comments on the idea. There’s no time frame for the lounges, but rules won’t be in place be by July. The province says the comments it receives will “inform future policy development and consultations.”

Abi Roach, who runs a cannabis vaping lounge in Toronto called Hotbox Cafe, says she’s interested in opening more if they become legal. She dreams of the day when lounges will be allowed to sell single servings of cannabis, just like drinks are served in a bar or restaurant. 

At the Hotbox (slogan: “serving potheads since … ahh I forget”), guests pay a $5 entry fee and bring their own pot.

If Ontario allows lounges, they probably won’t feature smoking inside because of concerns over the health dangers of second-hand smoke to both customers and employees, said Roach. “I don’t like to be in a big smoky room, either.”

At the Hotbox, only vaping is allowed inside. Pot smokers puff at an outdoor patio.

Roach also sees a demand for pot-friendly hotels. She’s helping design a cannabis-themed room at a hotel to be built in downtown Toronto. Each room in the hotel is owned by a private investor and offers a themed experience. If cannabis consumption is made legal in hotel rooms, they’ll go ahead with that project.

However, Roach said she doubts if Canada will see a big influx of cannabis tourists from the U.S. because we’ll be competing with a growing number of American states that are legalizing pot, some of which have taken a more creative, freewheeling approach. Ontario plans to sell cannabis from behind the counter at a restricted number of government-run stores. That won’t appeal to people who want convenience and innovative products from craft producers, said Roach.

“Canada really has to be careful in terms of blocking innovation in this industry.”

Roach said she recently drove from Vancouver to Washington State, where she stopped at a gas station and bought a joint. “To me as a tourist, it was like, ‘Wow, this is great!’ ”

In the lvillage of Embrun 40 kilometres southeast of Ottawa, Frank Medewar says he plans to open a lounge if they are made legal. He already runs InfoCannabis, a service that advises people about medical marijuana, and Seed 2 Weed, a store that sells growing equipment.

Medewar says his lounge will be modern and upscale, similar to an old-fashioned cigar lounge.

At the headquarters of the world’s largest medical marijuana company, Canopy Growth Corp. in Smiths Falls, spokesman Jordan Sinclair said the company would love to make the huge grow-op a tourist destination.

Canopy is in a former Hershey chocolate factory that was famous for tours taken by thousands of schoolchildren and tourists.

Canopy plans to have the plant open for public tours this summer, said Sinclair.

The company would also like to run a retail store on site, so the experience would be similar to a winery tour. However, the province has nixed that idea.

At Ottawa Tourism, spokesperson Jantine Van Kregten said the legalization of cannabis is on the radar. However, she hasn’t heard of any specific plans for hotels or other tourist ventures. “I think everybody is kind of taking a wait-and-see approach. I haven’t heard a lot of talk, a lot of scuttlebutt, in the industry of what their plans are. I think a lot of questions are unanswered about exactly how the legislation will roll out.”

Source: https://ottawacitizen.com/news/local-news/ontario-proposal-to-allow-cannabis-consumption-in-hotel-rooms-could-jump-start-pot-tourism February 2018

Study drawing on data from the Netherlands is the first to show how admissions to treatment centres rise and fall in line with cannabis strength

Many countries have seen far stronger cannabis come on to the market in the past few decades

Researchers have found fresh evidence to suggest that more potent strains of cannabis are at least partly to blame for the number of people seeking help from drug treatment programmes.

Scientists at King’s College London drew on data from the Netherlands to show that admissions to specialist treatment centres rose when coffee shops sold increasingly more potent cannabis, but fell again when the cannabis weakened.

The work is the first to investigate how admissions to drug treatment programmes rise and fall in line with the strength of cannabis available to users. It found that changes in demand for treatment typically lagged five to seven years behind changes to cannabis strength.

“This is the first study to provide evidence for an association between changes in potency and health-related outcomes,” said Tom Freeman, an addiction scientist at King’s.

The demand for specialist treatment among cannabis users has risen steadily in recent years, with more people now citing the drug on admission than any other illicit substance. In Europe, the number of first-time referrals for cannabis rose 53% from 2006 to 2014.

Cannabis plants produce more than 100 active compounds called cannabinoids but THC, or delta-9 tetrahydrocannabinol, is largely responsible for the drug-related high. A second compound called CBD, or cannabidiol, appears to reduce some of the mental health risks linked to heavy cannabis use by counterbalancing the effects of THC.

In work funded by the Society for the Study of Addiction, Freeman and others studied data gathered by the Trimbos Institute, a non-profit mental health and addiction organisation in the Netherlands. Each year, the institute conducts anonymous tests on cannabis for sale at a random selection of coffee shops in the country.

Writing in the journal, Psychological Medicine, the researchers show that THC levels in cannabis soared from an average of 8.6% to 20.4% from 2000 to 2004, then slowly fell to 15.3% by 2015. When the researchers looked at the impact on drug treatment programmes, they found that first-time cannabis admissions nearly quadrupled from seven to 26 per 100,000 inhabitants from 2000 to 2010, and then dropped to less than 20 per 100,000 inhabitants in 2015. It means that for every 1% increase in THC, about 60 more people entered treatment.

“We see a rapid increase in THC between 2000 and 2004 followed by a slower decline, and then you see a very similar profile in drug treatment admissions,” Freeman said. The rise in cannabis potency was one of a number of factors driving admissions to specialist drug services.

Val Curran, professor of psychopharmacology at UCL, said: “This adds to a growing number of scientific studies which suggest rising THC potency of cannabis is associated with greater incidence of mental health problems including addiction and possibly psychosis.”

But she added that stronger cannabis was not solely responsible for increasing demand for drug treatment. “Other factors include the marked decrease in levels of cannabidiol (CBD) in cannabis. There is evidence that CBD can protect against some mental health harms of THC,” she said.

Ian Hamilton, a mental health lecturer at the University of York, agreed that other factors beyond the potency of the drug were important. “It is possible that seeking help for problems with cannabis has become more acceptable by users and treatment providers. Over the same period that cannabis referrals to treatment have been increasing, referrals for problems with opiates such as heroin have been in decline. So although cannabis has traditionally been viewed as relatively benign by treatment workers they may now be more inclined to offer support,” he said.

Source: https://www.theguardian.com/science/2018/jan/31/stronger-cannabis-linked-to-rise-in-demand-for-drug-treatment-programmes January 2018

After Lynley Graham’s custody photo was posted to a police force’s Facebook page, horrified users were quick to discuss the harmful effects of hard drugs

Deep lines etched across a woman’s face and cheeks sunken to the bone – this one shocking image illustrates the effects of substance abuse.

Lynley Graham’s custody picture has been released by Humberside Police after she was jailed for 18 months for drug offences.
Graham was found in possession of class A drugs, including heroin and cocaine, and was subsequently charged with possessing a class A drug with intent to supply, Grimsby Live reports.

After the photo was posted to Humberside Police’s Facebook page on Wednesday, users were quick to discuss the 53-year-old’s weathered appearance.

Before and after pictures show a striking physical transformation.

One said: “I’m 64, I look young compared to her. Is she a lesson, perhaps, in what substance abuse can do to your skin?”

Another added: “Let’s hope some young people look at her and see what a life of drugs does apart from ruining entire families.”

Drug addiction and misuse contributed to more than 2,500 UK deaths in 2017.

Inhalants can cause damage to the kidneys, liver and bone marrow, and persistent drug consumption can result in abscesses, tooth decay – known as ‘meth mouth’ in the United States.

Other symptoms include premature ageing of the skin, often adding decades to someone’s appearance.

Rehabs.com, a US-based charity, has also published startling images of drug users to demonstrate the long-term toll narcotics have on one’s appearance.

Drugs can damage almost every system in the body; bloodshot eyes, dilated pupils, puffy faces and discoloured skin are all noticeable signs.

Some users suffer a rapid physical deterioration – with facial appearances sometimes ruined in just a matter of years.

Self-inflicted wounds, common among consumers of methamphetamine, can be caused by users picking at their skin to relieve the sensation of irritation – sometimes described as like crawling insects.

And a skeletal appearance can be the result of appetite-suppression.

Cocaine can commonly lead to chronic skin ulcers, pus-filled skin and the development of Buerger’s disease – an inflammation in small and medium-sized blood vessels.

Heroin has been known to dry the skin, leaving addicts with itchy and aged skin.

In May, Sir Angus Deaton, a world-leading economist, warned that drug abuse and alcoholism claim more lives of those in middle-age than heart disease.

‘Economic isolation’ is cited as one of the biggest contributors.

In 2017, a poll of 1,600 adults found that almost nine in ten said that seeing the physical effects of hard drugs made them less likely to take them.

The publication of such images is a common tactic among anti-addiction campaigners.

Scotland is experiencing its own drug crisis, with a 27 per cent rise in drug-related deaths, according to official statistics.

It puts Scotland’s drug mortality rate three times higher than the UK as a whole, and higher than any other country in the European Union.

The NHS offer services for drug and alcohol recovery, as do outside agencies, such as Addaction

Source: https://www.mirror.co.uk/news/uk-news/shocking-image-illustrates-how-drugs-18790997 July 2019

As more cases turn up, doctors are concerned about the extent to which memory loss may be undetected.

Just over five years ago, a man suffering from amnesia following a suspected drug overdose appeared at Lahey Hospital and Medical Center in Burlington, Massachusetts, a Boston suburb. He was 22, and had injected what he believed to be heroin. When he woke up the next morning, he was extremely confused, repeatedly asking the same questions and telling the same stories. Doctors at Lahey quickly diagnosed the man with anterograde amnesia—the inability to form new memories.

His brain scan revealed why. “I thought it was an extremely strange scan—it was almost hard to believe,” says Jed Barash, a neurologist working at Lahey at the time. In the scan, the twin, seahorse-shaped structures of the man’s hippocampi were lit up against the dark background of the rest of the brain—a clear sign of severe injury to just that one region.

“It was strange because that was all there was,” Barash says.

Memory researchers have known since the late 1950s that the hippocampi are responsible for turning short-term memories into lasting ones, so the amnesia was not surprising. Just how the damage occurred, however, remained a mystery. Lack of oxygen to the brain that would have occurred during the overdose could not be the only explanation. The number of survivors in the state that year could easily have numbered in the thousands, so why was there only one patient with this seemingly unique brain damage?

Along with his colleagues, Barash—now the medical director at the Soldiers’ Home health-care facility in Chelsea, Massachusetts—figured that the opioids must have played a role, and that hunch became only more acute as three more patients—each fitting the same pattern—appeared at Lahey over the next three years. All had the same unique destruction of the hippocampi, all had amnesia, and all were suspected to have overdosed. By that point, the doctors at Lahey faced two fundamental questions: What was causing the strange new syndrome? And precisely how rare was it?

Both questions remain unanswered, but a case report published Tuesday in the Annals of Internal Medicine adds to a growing body of evidence suggesting that the problem is far from isolated, and that a potent opioid variation could be involved. A total of 14 patients have now been identified in Massachusetts, one of whom was first admitted to a hospital in his home state of New Hampshire. The new case study reveals two more patients—one from Virginia, and one from Maryland. Both turned up at a medical facility in West Virginia.

Although many of the patients had taken a variety of drugs, all but one either have a history of opioid use or tested positive for opioids. The most recent case, a 30-year-old man examined last year in West Virginia, is the first patient proven to have taken fentanyl, an extremely potent and dangerous opioid that is rarely tested for in toxicology screens.

There are many barriers to determining the true scope of the problem, from lack of proper testing to the fact that many patients never come to attention in the first place. And amid a larger opioid crisis that some experts say could claim as many as 500,000 lives over the next decade, pinning down the cause of a dozen or so amnesia cases can seem trifling. “It’s sort of like the Titanic going down and you’re worried about some details,” says Alfred DeMaria, the state epidemiologist for Massachusetts.

At the same time, DeMaria suggests that, at the very least, these patients may offer a different route for understanding a disorder, as was the case with a small cluster of patients in the early 1980s who developed Parkinson’s disease after taking contaminated drugs—a misfortune that turned out to be limited to a few people, but which nonetheless gave Parkinson’s researchers a new tool for studying the disease. More worryingly, he also points to several examples of medical investigations that began with a small number of mysterious cases and turned out to have significant public health-implications, such as the appearance of West Nile Virus, or the AIDS epidemic.

Bertha Madras, a psychobiologist at McLean Hospital in Belmont, Massachusetts, and a member of President Donald Trump’s Commission on Combating Drug Addiction and the Opioid Crisis, agreed that getting to the bottom of these amnesia cases is crucial—particularly given that many cases may be going undetected since the type of cognitive testing needed to diagnose amnesia may not be routinely done in overdose survivors. She also suspects that with overdose-antidote drugs like naloxone becoming more widely available, it is possible that more patients, rather than turning up dead, will show up at hospitals.

And with more survivors, Madras said in an email message, “there conceivably will be more cases of brain damage, especially in the very oxygen-sensitive hippocampus, the ‘epicenter’ of initial learning and memory.”

* * *

After encountering more patients following that first one in 2012, Barash contacted the Massachusetts Department of Public Health in 2015, which put out a request to emergency-room physicians, neurologists, and radiologists statewide for information that might identify additional cases. By the end of 2016, a total of 14 people who matched the pattern had been identified. Then, in May of 2017, the DPH made what they called “an unusual amnestic syndrome” with “acute, bilateral hippocampal” damage a reportable disease syndrome—a status that requires any doctor who sees such a case to forward patients’ medical records for review.

As of today, however, DeMaria believes there is no such mechanism in place in other states, and that’s one of the barriers to getting a handle on the prevalence of the amnestic syndrome. Marc Haut, the neuropsychologist who examined the man from Virginia in 2015, and one of the authors on the new Annals paper, had no way of knowing about the investigation in Massachusetts and initially chalked up the damage to cocaine use. At the time, he saw no reason to consider opioids, in part because of the information the patient shared with him. “Patient reports about substance use [are] not always accurate for a couple of reasons, one being the patients themselves,” he says. “And the other being that patients often don’t know what they’re buying and using.”

So it was not until he received an email from Barash that Haut, the chair of the behavioral medicine and psychiatry department at West Virginia University, reconsidered whether opioids could have played a role. To date, only eight of the 16 patients reported in the cluster had cocaine in their system, making opioids a more consistent link than any other drug. Barash, who is also an author on the Annals paper, wonders if fentanyl—considered to be 50 times more potent than heroin—is a key component, in part because the timing and location of the appearance of these amnestic cases parallels the rise of fentanyl overdoses in two of the hardest hit regions in the country. Teasing this out is complicated with the ever-changing landscape of drugs that people are taking, often in combination. “Cocaine overdose deaths are escalating,” said Madras, “along with evidence of combined use of fentanyl, heroin, and cocaine in some deaths.”

And despite the fact that fentanyl abuse has become so common, routine toxicology screens don’t test for the presence of the drug. It was only because Haut had been tipped off that he requested the advanced toxicology screen for the 2017 patient, which found evidence that he had taken fentanyl in addition to cocaine. His MRI scan also revealed the signature hippocampal damage: “bright, big, and intense,” according to Haut.

Source: https://www.theatlantic.com/health/archive/2018/01/fentanyl-overdose-amnesia/551846/ January 2018

President Donald Trump took a few minutes in his State of the Union address to acknowledge what he called the “terrible crisis of opioid and drug addiction – never been has it been like it is now”.

The American President told Congress that “we have to do something about it”, stating that 174 drug-addiction caused  deaths a day meant that “we must get much tougher on drug dealers and pushers”.

This should come as no surprise. The crisis, which claimed well over 100,000 lives between 2015 and 2016, is now so widespread and catastrophic it was declared a public health emergency by President Trump in October.

The rate of American deaths caused by overdoses of heroin-like synthetic opioids has doubled since 2015, in a tragic symptom of the opioid epidemic ravaging the United States.

The US’s Centre for Disease Control and Prevention has published figures showing that the rate of deaths due to synthetic opioids excluding methadone, such as fentanyl and tramadol, jumped from 3.1 per 100,000 in 2015 to 6.2 per 100,000 in 2016.

The total number of deaths due to opioid overdoses also climbed from 52,400 to 63,600, a 21 per cent increase – marking a steady rise since 1999.

Synthetic opioids are the biggest killers

The dramatic rise in the use of synthetic opioids owes more to practicality than demand, Dr David Herzberg, a University of Buffalo expert in the history of drug addiction, told The Telegraph.

“Fentanyl [the most widely used synthetic opioid] is much easier to smuggle than heroin because you need less of it,” he said.

Since synthetic opioids are made in labs rather than from plants, like traditional heroin, they can be made anywhere in the world, and vary dramatically in strength.

Fentanyl is around 50 times stronger than heroin – and some new strains are up to 10,000 times stronger.

This huge variation in potency is what makes makes synthetic opioids so deadly, since users are often completely unaware of the strength of the substance they are injecting, said Dr Jon Zibbell, a Senior Public Health Scientist at RTI International, a nonprofit that funds opioid research.

“I know a kid who buys carfentanil [a newer strand of fentanyl] online and that’s all he injects; he argues it’s totally safe but people mixing it with other stuff don’t really know what they’re doing.

“It’s not the drugs themselves that are killing people but the inability of people to adapt to the uneven potency in the illicit market,” he said.

The rise in fentanyl dates back to 2013, when drug traffickers in Mexico started adding it to heroin to stretch their product further to meet growing demand.

Now fentanyl has also grown in popularity with small drug dealers within the US who buy it online from China, which Dr Zibbell said has led to a bloated supply of fentanyl with no standardization of strength.

Rise of drug overdose death most pronounced among men

Fentanyl is not the only heroin-like drug experiencing a boom in users in the US; the country’s mushrooming opioid crisis is well documented, with the overall rate of opioid drug overdoses increasing every year since 1999.

This owes much, Dr Herzberg said, to a history of over-prescription of painkillers dating back more than three decades to the Reagan administration, when tight controls on opioid sales were relaxed: “Opioid markets were opened up to the full range of strategies drug companies use to sell their products. So a large volume of these drugs were pumped into the market without adequate warnings about the risks.”

While data shows a higher rate of overdoses in men, recent research has found the serious health impacts for women are just as severe.

A recent paper by Dr Zibbell published in the American Journal of Public Health demonstrated that those regions of the US particularly ravaged by the opioid epidemic have also seen an outbreak of new cases of the degenerative blood disease hepatitis C.

While the rate of death by opioid overdose is lower for women, the rate of new hepatitis C cases developing is much higher. This is particularly concerning as researchers have also documented a large increase in babies born to infected mothers, along with a rise in neonatal abstinence syndrome (babies born physically dependent on opioids).

The trouble in poor, white states may be spreading

Rust belt states such as Ohio, Pennsylvania and West Virginia – with an astonishing rate of 52 drug overdose deaths per 100,000 – have shouldered the brunt of the opioid crisis.

This is partly due to the poverty of these states, but race is also a huge factor – areas with large white populations are disproportionately impacted since the epidemic is rooted in prescription drug abuse, said Dr Herzberg.

“Studies prove that physicians are less likely to prescribe opioids to African Americans or other racial minorities – even when they need them – because of the stereotypes associating them with drug abuse,” he said.

There are signs, however, that the problem has spread to other communities. The mostly non-white District of Columbia, for example, had a rate of death by drug overdose of 38.8 per 100,000 – almost most twice the national average of 19.8.

Dr Zibbell’s research also found high rates of drug treatment and new hepatitis C cases among hispanics. “That was a big deal because the epidemic has been described as mostly affecting the white population,” he said.

Experts say the spread of the opioid crisis beyond the mostly white rust belt states is particularly worrying as it highlights the nationwide extent of the crisis.

“The Trump administration is not putting action or money behind its pronouncements on the problem. If the present trajectory continues it will claim many more young lives,” he said.

President Trump remained defiant in his speech, however.

“The struggle will be long and it will be difficult,” he acknowledge, before adding “we will succeed”.

Source: https://www.telegraph.co.uk/news/2018/01/31/deadly-fentanyl-behind-dramatic-doubling-synthetic-opioid-death/ January 2018