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May 17, 2024
Rumpel Senior Legal Research Fellow
Paul is a Senior Legal Research Fellow in the Meese Center for Legal and Judicial Studies at The Heritage Foundation.


Novel Psychoactive Substances multiply the difficulties involved in protecting ourselves and our families, friends, and neighbors from falling victim to illicit drug use. Ingenious chemists have used the Internet to research the chemical structure of existing psychoactive substances and use their skills to escape a strict reading of the controlled substances schedules. The result is to make extraordinarily difficult our long-standing strategy of relying primarily on an aggressive, supply-side, law enforcement–focused approach to reducing the availability of dangerous drugs. We can—and should—pursue each worthwhile option to combat this even though we know that we cannot immunize society against the pernicious effects of all NPSs, change hearts bent on evil, or save everyone who succumbs to drug abuse.


Novel Psychoactive Substances (NPSs) multiply the difficulties involved in protecting our-selves and our families, friends, and neighbors from illicit drug use.

NPSs like fentanyl and their illegitimate offspring like the nitazenes have brought an end to the era of drug experimentation.

We can—and should—pursue every worthwhile option to combat this scourge even though we know that we cannot save everyone who succumbs to drug abuse.




Christian Haserot has tried to get clean a handful of times.

But during his most recent attempt, the once aspiring cyber security researcher encountered an insurmountable obstacle.

Everywhere he turned in Portland, he saw people smoking fentanyl.

Even when hunkered down in his sheltered housing bedroom, the fumes would waft up to his window.

“The temptation of having people outside my building, standing in a group smoking in plain sight.. it was too hard for me”, he says, dejected. “I relapsed.”

Three-years-ago Oregon became the first US state in history to decriminalise hard drugs after 58 per cent of voters backed the lenient legislation.

Measure 110 was meant to transform the “war on drugs”, with addicts given treatment and support instead of incarceration.

Tax income from cannabis sales were meant to fund drug treatment programmes.

But with few users seeking help and others flocking to the state in light of its relaxed laws, the state’s biggest city has transformed into a “zombie apocalypse” of drug addicts getting high in broad daylight.

Within 30 seconds of setting off on a patrol of the downtown area with Portland police Sergeant Jerry Cioeta, we see someone keeled over on the cold pavement, their arms wrapped around a red pole.

“This person is really high on fentanyl. That’s why they’re licking a telephone pole”, he says.

Pointing to a group of five men in hats, he adds: “These guys were dealing, that’s why they’re running away from me.”

Around them is a smattering of tents, a shopping trolley and a number of sleeping bags strewn in front of what used to be a hotel.

A significant number of local businesses are boarded up, with those that remain hiring private security to keep watch.

Before Measure 110 came into effect, Portland was “just like any other normal place”, said Mr Haserot, 29.

Dressed in a burgundy puffer jacket and clutching a woolen Oregon hat to protect from the cold, he adds: “Maybe there were some alcoholics out and about, but you didn’t see people holding foils in public and hitting stuff on foil.

“You didn’t see meth pipes out on the street. That was not around. And now it’s, you know, it’s everywhere.”

He says he also meets a “lot of people who moved here because of the drug laws”.

Under Measure 110, anyone caught with small amounts of hard drugs like fentanyl, heroin or meth is given a $100 ticket.

But, if they call a 24-hour hotline to complete an addiction screening within 45 days, the fine disappears. There is no penalty for failing to pay.

“We’ve written over 700 tickets since May, and to the best of our knowledge not a single one has called up and gone to treatment”, Sgt Cieota says. “Two out of two people don’t want help.”

Sgt Cioeta has been an officer in Portland for more than 26 years. When he started out he would respond to alcoholics or domestic violence, now more than 90 per cent of his job is taken up by open air fentanyl use and dealing.

Sgt Cioeta and a team of four other officers are tasked with tackling drug use on the streets, what he describes as a game of “whack-a-mole”.

Around another corner, a drug user is sitting between two carefully manicured city flower pots. He is desperately trying to scrape fentanyl residue out of a metal tin.

Behind him, around a metre a way, a man high on the synthetic opioid has passed out – the only thing keeping him upright is the pressure of his forehead leaning against a red, brick wall.

“Can you smell that?” Sgt Cioeta says. “It kind of smells like weed, but it isn’t, that’s fentanyl.”

Sgt Cioeta said things have become so bad because of a “perfect storm”: the pandemic, Measure 110 and the prevalence of fentanyl.

“It’s a drug like we have never seen on this planet. It’s highly addictive, that withdrawal is sudden, and is super cheap”, he says.

Areas of the city have been “decimated” by fentanyl use, where they’ve transformed “from vibrant to zombie land”.

“One time we had four fatal overdoses in three minutes within five feet of each other.”

Accidental drug overdose death rates in the state doubled from 472 in 2020 to 955 in 2022.

While residents had been in favour of Measure 110 initially, in a survey of 1,000 locals by Emerson College earlier this year [2023], 56 per cent said they wanted it repealed.

But for some, the drug laws are not relaxed enough.

User Quentin Sweet, who has just received a ticket for smoking fentanyl at a tram stop, said he thinks the only place people shouldn’t be able to smoke the drug is a nursery.

“Drugs are not bad for someone, but instead are enjoyable, and even so far as to say a healthy experience that is good for someone”, he says.

Mr Sweet, 23, who has painted his fingernails, and the skin around them, red, says he has no intention of paying the fine or calling the number on the back of the ticket.

“I’ve completely dismissed it as unimportant,” he says.

Keith Humphreys, professor of psychiatry and behavioral sciences who has studied the impact of Measure 110, says decriminalisation has been a “complete failure”.

“They’ve let drugs run the state”, he says.

Mr Humphreys said before the introduction of Measure 110, Oregon’s drug laws were already some of the most lenient in the country.

The complete overhaul “represented a misunderstanding of the nature of being addicted to fentanyl,” he says.

“Because drugs feel good in the short term, even though in the long term they’re wrecking your life, people are much more ambivalent about seeking treatment.

“You can’t throw away all those sticks and just hand out carrots. If you want people to access addiction treatment, there has to be some press from the other side. Otherwise they’ll just continue using drugs until they die.”


By Emily Green (The Lund Report)
Jan. 16, 2024 2 p.m.

As science teacher Zach Lazar looks out across his classroom at South Eugene High School, he sees more kids struggling than he did before the pandemic. In the past two years, Lazar said, three of his students have died from drug use.

“It makes me sad to see how easy it is for students to go down the wrong path,” Lazar said. “I feel like it’s gotten worse, substantially, since we came back from online learning.”

Lazar’s experience aligns with alarming trends: The rate of substance use disorder among Oregon youth ranks third in the country, and in the past six years, 348 Oregonians aged 15 to 24 died from accidental drug overdose. That’s enough to fill more than 15 high school classrooms.

In no other state have overdoses among teens aged 15 to 19 grown faster over the same time period, according to not-yet-finalized federal data. Now, a six-month investigation by The Lund Report in collaboration with the University of Oregon’s Catalyst Journalism Project and Oregon Public Broadcasting shows that a key institution — the state’s K-12 public school system — has failed to adapt to the new reality facing Oregon’s kids.

Oregon law requires administrators of every public school district in Oregon to have a robust substance use prevention strategy based on research. And studies suggest that well-crafted prevention programs can save tax dollars and young lives.

For this project, reporters asked the state’s 197 public school districts what they are doing to prevent substance use among their students. Districts teaching nearly 9 out of 10 of Oregon’s public school students responded.

The results show that most Oregon kids — living in a world with increasingly dangerous drugs and unparalleled external pressures — aren’t getting evidence-backed substance use prevention. That’s judging by the reviews of well-respected expert clearinghouses consulted with for this project. They examine prevention programs and curricula to determine whether they have strong scientific backing.

Among the findings:

  • 60% of Oregon’s school districts don’t use prevention curricula or programs at any grade level that meet even the lowest bar for evidence, including Portland Public Schools, according to the nation’s top prevention and curricula clearinghouses.
  • District responses showed 20% of districts rely on little more than a chapter in a health textbook to get the job of addiction prevention done.
  • Though prevention experts emphasize starting substance use prevention early, only 44 of the 119 districts surveyed use programming endorsed by an expert clearinghouse’s evidence review at the elementary school level.
  • Only one of the responding districts offers an evidence-based program that involves parents — which experts call a powerful component of effective prevention.
  • Oregon’s school districts receive little support and guidance from the state to select substance use prevention programs backed by evidence.
  • Other states follow the science, helping schools adopt evidence-backed programs.

publicly accessible data portal details the results of the statewide inquiry reporters conducted, linking each responding Oregon school district’s prevention program with ratings and evidence reviews.

The data comes with caveats. Among them: Reviews of individual curricula may be incomplete or not done in a timely manner, and prevention science has limitations.

But local experts say this project’s findings show that the state’s leaders could — and should — be doing more to improve the trajectory of young Oregonians.

“These are dire findings and extremely important,” Mark Van Ryzin, a research professor who studies prevention at the University of Oregon’s College of Education, told The Lund Report.

Anthony Biglan, a senior scientist at the Oregon Research Institute said that if acted upon, the findings “could make an enormous difference.”

Gov. Tina Kotek vowed to take action. “These findings are alarming,” she said through a spokesperson. “I pledge to bring key agency leaders together to review these findings and develop a specific action plan to address these gaps. Prevention is part of the solution to Oregon’s addiction crisis.”

The good news? Some schools and educators are showing that evidence-backed prevention in Oregon is possible.

Across the state, 8% of districts have put in place curricula and programs that, according to expert clearinghouses, have the potential to reduce risk factors for addiction, across both their primary and secondary schools.

Still, Oregon’s youth live in a world where drugs are easily accessible through social media and can cost less than a dollar a dose. They are also growing up in the only state to decriminalize possession of hard drugs. The long-term effects of that change on teenage perceptions of drug-use harms and social norms is yet to be seen, as was underscored in interviews with students.

“We are at war in prevention, with big pharma, big tobacco, big alcohol, now big marijuana and drug cartels out of Mexico,” said Rodney Wambeam, a prevention scientist out of the University of Wyoming who’s conducted prevention work in about 40 of the 50 states. “And they are better funded.”

How Linn County brings an evidence-based program into classrooms

“Do you guys know what it means to be assertive?” Standing tall and dressed in black, Shannon Snair commanded attention in a classroom full of 11- and 12-year olds.

It was just past noon at Scio Middle School in rural Willamette Valley, and the sixth graders who had noisily settled into seats moments ago were now listening intently to Snair’s words.

“It’s when you act in a really strong, confident way, letting people know what you need, and why you need something,” Snair said. “And I will tell you, being assertive is not always easy.”

Snair, a county behavioral health worker, spoke with confidence and exuded charisma as she led a lively conversation about situations in which kids may need to stand up for themselves.

Fewer than 1,000 people live in Scio, a farming community, and Snair was visiting its school to teach the final course of the year in LifeSkills Training. It’s one of the most studied and highly regarded substance use prevention curricula available.

Clearinghouse certified studies have shown that LifeSkills can lead to reductions in the use of alcohol, tobacco and cannabis years later among students who’ve completed the program.

Spread over three years, it consists of 30 one-hour sessions that weave together demonstrations, practice and student feedback.

Snair, a mother of two, likes that LifeSkills goes beyond teaching how drugs and alcohol will affect kids’ bodies.

“It also teaches kids general life skills,” she said. “We talk about decision making, we talk about self-esteem, we talk about good communication and social skills. We talk about stress, positive ways to cope with stress.”

Scio School District is in the minority. In Oregon, 3% of public school districts use curricula considered by expert clearinghouses to have valid evidence that they specifically reduce substance use.

As part of a larger prevention strategy, Linn County officials chose LifeSkills Training for schools 25 years ago because it was “the most studied program out there,” said Danette Killinger, who coordinates prevention for the county. Sending health workers into classrooms to teach it saves money and ensures the curriculum is being taught as it was designed, she added.

State’s fentanyl awareness curricula effort limited, experts say

Substance use prevention programs with well-documented effectiveness in middle and high schools, like LifeSkills Training, combine lessons in social and emotional skills with drug and alcohol education.

Elementary school programs with strong evidence, such as the Positive Action program used in Vernonia, focus mainly on self-regulation and social-emotional skills.

There’s a big difference between these programs and the goals of a law passed last year, Senate Bill 238, which took cues from Beaverton School District’s recently developed “Fake and Fatal” curriculum.

The law requires the state to develop classroom units that teach the dangers of synthetic opioids and counterfeit, fentanyl-laced pills, as well as Good Samaritan laws, which protect people from being charged with drug possession if they call first responders to aid in an overdose. While it will give students potentially life-saving information, experts say the law falls well short of what’s needed to help them to avoid or delay substance use altogether.

Biglan, who sits on the state’s Alcohol and Drug Policy Commission’s prevention subcommittee, said the initiative is a good idea given the “urgency,” but testing its specific design will be key.

“It is unlikely that any curriculum that focuses on ‘knowledge’ of drugs will have much impact,” said Van Ryzin, who also works as a research scientist at the Oregon Research Institute. In reference to the failed, fear-based attempts at drug prevention, such as the “This is your Brain on Drugs” ad campaign of the 1980s and ‘90s, he added, “This approach has never been successful, all the way back to those fried egg commercials.”

Teens say schools should step it up

Teenagers at West Linn High School described feeling unprepared when they were confronted with widespread vaping, drinking and cannabis smoking as first-year high school students.

“I’ve lived in West Linn since the first grade, and I don’t recall learning anything about prevention,” said Jonathan Garcia, 17.

“I remember it was like a slap to the face really, when I went to high school and, like, saw everything,” said Claire Peate, 16.

The bottom line is simple, said South Eugene High School sophomore Chazz Keith: “Kids aren’t as dumb as everybody thinks.”

Like other teenagers interviewed, Keith and several of his classmates at South Eugene said they know that they aren’t getting enough quality, up-to-date, straightforward information about drugs and addiction in their classrooms. Schools should do more to educate kids about why people turn to drugs in the first place rather than focusing on scare tactics, they say.

Prevention “just needs to be like, the root of the problem,” said sophomore Bella Kottwitz. “And I feel like in middle school, a lot of it is just teaching like from a textbook.”

And, the teens said, adults don’t get it. Everything has changed, including the substances themselves.

Cannabis has evolved, bred to higher potency and with potential side effects their parents never dreamed of. The meth is different, too, and synthetic drugs bring a whole new array of dangers. Tobacco? It now comes packaged in an array of bright colors and sweet flavors — and vaping is easier for kids to conceal than the tell-tale smell of cigarette smoke.

“The drugs that they grew up with was, like, cigarettes and pot and alcohol,” said Aiden Sauer, 15. “There are a lot worse drugs out right now.”

“And they’re legal,” said Garcia.

“Yeah, and they’re legal now,” Sauer said. “And everyone is just going on about how bad they are. And they are bad, but they’re not giving us any tips or, like, a lifeline to reach out to.”

What classroom prevention looks like

In one survey response, West-Linn-Wilsonville School District officials indicated they employ a prevention strategy delivered through health class, guest speakers, student-led awareness campaigns and supplemental lessons developed by teachers.

But in an interview, Autumn Schmidlin, 15, said she was underwhelmed in a West Linn High School health class where each student had to pick a drug to research and then present to the class.

“A lot of people were joking about it, and they didn’t take it seriously,” she said. “Including me, too, I never really took it fully seriously.” Tasked with presenting on a hallucinogen, she recalled her approach as “I’ll make a colorful presentation, because that’s what you see.”

The Eugene 4J School District’s prevention strategy for middle schoolers consists of health class “plus supplemental lessons,” according to its survey response. The district, however, was out of state compliance for substance use education for several years.

South Eugene High School students told The Lund Report they remembered the lessons as repetitive.

“Every year, you got taught about the same drugs,” said Keith, a sophomore. “It was the same information over and over again, in my experience.”

It’s not surprising health curricula leave impressions like these.

“The point of that health book is to generally teach health,” said Pamela Buckley, a prevention scientist at the University of Colorado Boulder. “It’s not to prevent substance use.”

Additional school district survey results for this project painted a picture of inconsistency and missed opportunities resulting from little state guidance and support:

  • Numerous districts, such as Gresham-Barlow, McMinnville and Oregon City, pointed to their health education curriculum as their primary or sole component of substance use prevention.
  • Some districts appeared to lump all their “prevention” efforts in the same bucket. Asked about their strategies to reduce substance use, 17 districts listed a suicide prevention program, while others pointed to sex-education programs.
  • Of the 119 districts who provided survey results, only 24 noted using programs certified by clearinghouses as evidence-backed at the middle school level — and just 12 districts use these evidence-backed programs in high school.
  • Asked to include whether they made certified alcohol and drug counselors available as part of their prevention strategy, 12% indicated that they did.

In addition, 23 districts noted they hold assemblies as part of their substance use strategies, many others noted classroom presentations from local police, government workers or local behavioral health providers. In some cases, isolated events are a district’s only supplement to health class.

But one-time events don’t work — especially if that’s all a school is doing, explained Rick Collins, a prevention specialist at the U.S. Alcohol Policy Alliance, during an online forum on what works in prevention this past May. Collins said that if these approaches are in use, they need to be layered in with “what we know to be some effective prevention strategies.”

Three districts, including Portland Public Schools, use a curriculum developed by the New York-based pro-decriminalization advocacy group, Drug Policy Alliance, which funded the Measure 110 campaign. The curriculum teaches the effects of drugs on the body, as well as advice for safer drug use, such as “start low and go slow” when trying a new drug for the first time. No clearinghouse consulted for this project has yet reviewed it. The Alliance has funded a study to measure the program’s success in promoting “harm reduction knowledge and behaviors,” including changes in students’ level of “drug policy advocacy” after being taught with the curriculum.

“There’s no consistency,” said Pam Pearce, a prominent prevention educator and co-founder of Oregon’s first high school for teens in recovery from addiction. Having herself researched what Oregon schools teach for prevention she said, “The truth is, when you look at what they teach and when they teach, it’s a free for all.”

Not captured in the district survey are individual classrooms where teachers use evidence-backed practices — like Lazar, the Eugene teacher, who uses cooperative learning to teach students. It’s a group learning model that a clearinghouse recently endorsed after a large-scale study — conducted in Oregon — suggested it can lower rates of alcohol use, as well as risk factors that contribute to substance use.

Experts say a 2021 law requiring social-emotional learning be taught in all districts, House Bill 2166, could serve as an excellent foundation for reducing the risk factors that lead to substance use. These programs are aimed at helping kids learn how to manage emotions, feel empathy and make good decisions. Experts say it’s also among the best approaches to early-learning substance use prevention.

But staff members at Forest Grove School District, which embedded a social-emotional learning program in its elementary schools eight years ago, said it takes teacher buy-in and hundreds of thousands of dollars annually to pay for the ongoing coaching and training needed to do it right.

Because of a lack of additional funding and scientific guidelines, experts say the new law’s rollout looks to be flawed from the start.

“The intention is admirable, but the implementation is miles short of where it has to be, and because there is no measurement or accountability, nobody will ever understand just how ineffective it is,” said Mark Van Ryzin, a research scientist with the Oregon Research Institute. He said because districts are free to select programs that aren’t evidence-backed, “millions” could be wasted.

Biglan agreed, adding, “we are doubtful that schools have the capacity and resources to translate the (state) guidance into effective practice.”

All told, this investigation showed that districts around Oregon, lacking funding, support and guidance from the state, are, for the most part, employing untested combinations of programs with scant evidence to back them or, at worst, doing little more than try to meet the minimum standard for health education. And when it comes to implementing meaningful prevention programs that experts say can work, Oregon’s districts fall far short.

Biglan, the senior scientist at Oregon Research Institute, said the gap between “what we know” about prevention in Oregon “and what we’re doing” is vast.

Annaliese Dolph, a former aide to Gov. Kotek, now directs the state Alcohol and Drug Policy Commission. Under Oregon law, the commission works with the Oregon Department of Education to set its youth substance use prevention standards. Told of the project’s findings in an interview, she called the findings “important” but attributed them to Oregon’s tradition as a “local control” state.

“The fact is that districts have a lot of control about what happens in the class,” she said. She likened the situation to past controversy over districts teaching discredited reading curricula and said that given the dismal state of prevention across Oregon, state leaders’ task now is to determine the “next best step.”

State Rep. Lisa Reynolds, a pediatrician and Democrat who represents northeastern Washington County, was more optimistic about the state’s short-term ability to improve the situation in classrooms. She has been pushing for a conversation about youth prevention and treatment in the upcoming legislative session.

Told of the project’s findings, Reynolds said that she thinks things could be improved, despite lack of funding and the longstanding tradition of local influence over school programming.

“It feels like something that doesn’t have to be some huge complicated thing,” she said. “We don’t need to be reinventing wheels … If there’s evidence about what type of curriculum works, then we should do what we can to have schools adopt the programming.”

She said the weaknesses in classroom prevention exposed in this project’s findings “has to be part of the focus” for the Oregon Legislature in its long session slated for 2025, if not sooner.

“It continues to frustrate me as a pediatrician that we as a state, as a society, as a health care system, we’re doing that whole thing of catching the people after they fall off the cliff,” she said. “Wouldn’t it be much better if we put a fence at the top of the cliff? And part of that is education.”



States like Washington and Pennsylvania work with scientists to help schools put in place science-backed prevention programs

JANUARY 16, 2024

This article is part of an investigative series showing that as Oregon kids face a world with increasingly dangerous drugs and unparalleled external pressures, the state’s education establishment has failed to adapt.

They’re participating in what’s known as “cooperative learning.” It’s a teaching method in which students spend time working together in randomly selected groups. As they teach each other, it promotes interaction among kids who otherwise wouldn’t socialize, combating peer rejection. . In a trial across 15 middle schools, cooperative learning lowered rates of alcohol use and other risk factors that contribute to substance use, such as emotional problems, bullying, deviant peer affiliation and more.

Following that Oregon-based study, cooperative learning was recently listed among approaches to reducing substance use problems that experts say have good scientific evidence to back them.

Oregon’s position is “ironic,” said Anthony Biglan, a senior scientist at Oregon Research Institute who studies youth prevention. Oregon is “one of the strongest states” in terms of research on school-based prevention, he said, but isn’t putting what it knows into practice. Cooperative learning, for example, is used by some individual teachers, but has yet to be adopted across any district.

Other states do more when it comes to connecting classroom substance use prevention with science.

recent investigation found that in Oregon, most school districts teach substance use prevention curricula and programs that have not been found to meet even the minimum standard of efficacy set by some of the nation’s top prevention and curricula clearinghouses. That’s despite a state law requiring districts to have an up-to-date, comprehensive, science-backed program. And the state does little to help them.

Biglan and other prevention experts point to Washington, Colorado and Pennsylvania, where the state governments have formed partnerships with prevention scientists at local universities to roll out evidence-backed prevention strategies across the state.

Now, a new set of recommendations from Oregon’s Alcohol and Drug Policy Commission is urging state lawmakers to launch a similar effort as they head into the 2024 legislative short session next month.

Other states put science at the center of prevention

In Washington and Pennsylvania, state officials work with prevention scientists at local universities to ensure state programs support evidence-based prevention strategies at the community level. In both states, schools and communities can get state grants to pay for prevention if they select from a predetermined list of evidence-backed programs to adopt.

In Pennsylvania, much of the state’s prevention work flows through the Pennsylvania Commission on Crime and Delinquency, which works closely with the Evidence-based Prevention and Intervention Support center, or EPIS, at Pennsylvania State University. There, principal investigator Janet Welsh and her colleagues have helped implement evidence-based programs in communities and schools that studies indicate led to reductions in delinquency rates and fatal opioid overdoses.

The state has also championed several programs aimed at reducing youth substance use, Welsh said. That includes funding community coalitions, and rolling out a well-regarded national community-based model called PROSPER, which was developed at Pennsylvania State University. It brings together prevention coordinators and universities to deliver two evidence-backed interventions in schools: LifeSkills Training and Strengthening Families. It’s had positive results.

In Pennsylvania, when communities or schools use state grants to implement programs, they are required to apply evidence-supported approaches as they were designed and track their outcomes, Welsh told The Lund Report.

“There are people off in silos doing their own things in Pennsylvania, just like there are anywhere else,” Welsh said. “But we try really hard to have these coordinated systems to the degree that we can.”

In Washington, the health authority’s behavioral health division oversees and coordinates prevention efforts in the state, working with a committee of researchers, policymakers and community-based advocates to incorporate science in a statewide approach. Every three months, the group convenes to discuss pressing issues, potential approaches and the latest research, said the subcommittee’s chair, Brittany Cooper. Cooper is a principal investigator at Washington State University’s Improving Prevention through Action (IMPACT) research lab.

Cooper and her colleagues at the lab regularly look at evidence to review prevention programs and strategies before recommending them to the state. The state also looks to the Washington Institute for Public Policy for guidance on the cost-benefit of different research-backed programs. Strong programs are added to the state’s list of approved prevention strategies that communities pick from when doing state-funded prevention work.

Both states’ approaches place a major focus on community coalitions that bring together schools, law enforcement, public health officials and local groups.

Washington has more than 100 such coalitions, and Pennsylvania has trained more than 125 on the model, known as “Communities that Care.” In Oregon, health authority officials were not able to supply The Lund Report with a complete list of community coalitions.

In both Washington and Pennsylvania, the departments of education are an integral part of prevention coordination, unlike in Oregon.

State could spread promising approaches

On the December morning that The Lund Report visited the South Eugene High School classroom, Zach Lazar’s students were learning about Oregon’s geological history. They were separated into small groups, with each group learning about a different phase of the state’s formation. The kids had to work together to make a group presentation in Google Slides. Next, Lazar walked around the room handing out playing cards, and the sophomores regrouped according to the suit of the card they were handed. Now each student had to teach their new group what they had learned.

For Lazar, it’s a way to ensure kids are paying attention. “It allows everybody to be active and present in the space — and that’s huge,” he said. “You can’t hide when you’re going to be expected to teach someone else in a few minutes. You’ve got to get your stuff done.”

Cooperative learning also encourages students to interact with students they might not normally talk to. The idea is this breaks down biases and prejudices among students that serve as barriers to social connection, and helps socially isolated students establish positive relationships with their peers.

Mark Van Ryzin, a research professor at the University of Oregon, led a study of cooperative learning involving 1,890 middle school students in Oregon that documented the program’s positive benefits. The study found cooperative learning-involved students experienced lower rates of alcohol use, emotional problems, deviant peer affiliation and bullying, as well as higher rates of prosocial behavior, emotional empathy and close relationships with peers. The clearinghouse Blueprints for Health Youth Development, which rigorously evaluates the research behind prevention programs, certified Van Ryzin’s study for its scientific strength and listed cooperative learning on its registry of recommended “promising” interventions.

Van Ryzin said the types of benefits achieved through cooperative learning are key in substance use prevention. “The best approach is to attack the social-contextual issues that lead to experimentation with drugs, but very few programs do this successfully,” he said.

After class, a couple of Lazar’s students told The Lund Report that they had indeed made friends with people they may not have otherwise talked to when learning this way in science class. They also said that Lazar was the only teacher they’d ever had who uses this style of teaching.

Creating groups and moving kids around can take extra time that teachers don’t have. But Van Ryzin thinks an app he’s developed could be used more widely to help more teachers around the state. It creates random student groupings as it moves a class through a pre-loaded curriculum.

He said one opportunity he sees is with high schools’ recent effort to adopt curricula to help ninth graders build skills to succeed in high school.

“Schools have told me, they just pull things off the internet, nobody has any idea if any of this works,” Van Ryzin said.

In contrast, software loaded with this curriculum and backed by a central state program could embed these lessons in classrooms while also spreading the benefits of cooperative learning.

 “We could potentially kill two birds with one stone,” he said. “So we’re building peer relations, building social skills, building belonging, keeping students on track, keeping them in school — why couldn’t we solve all these problems at once?”

Where Oregon stands

The state’s Alcohol and Drug Policy Commission, which is charged with improving Oregon’s state and local addiction treatment, prevention and recovery systems, sent its legislative recommendations to Gov. Tina Kotek and state Senate and House majority and minority leaders on Dec. 11. At the top of its list was a request to fund “a statewide hub for Substance Use Prevention.”

Biglan, who has studied youth prevention for more than three decades, sits on the commission’s prevention subcommittee. He said he hopes there is a “significant representation of prevention scientists” if the hub is approved. He said state agencies including the education department should also be involved, along with Oregon’s regional coordinated care organizations that oversee care delivered to low-income members of the Oregon Health Plan.

“I’m concerned that there’s not enough involvement of the Department of Education,” he said, adding that the department seems to lack the authority and programmatic support “to influence the schools to do things.”

At the University of Oregon’s Prevention Science Institute, research scientist Emily Tanner-Smith said prevention scientists would “be excited” to partner with the state. “UO researchers have deep expertise in school- and community-based prevention programming and thus would be well-poised to engage in such activities,” she said.

In Oregon, “we don’t have comprehensive prevention” anywhere, said Annaliese Dolph, a former aide to Gov. Tina Kotek who took over as director of the state Alcohol and Drug Policy Commission last year. Connecting research and practices will be a “key role” for the commission she said, adding that if lawmakers set up the recommended statewide hub, prevention scientists would “absolutely” play an integral role.

This article was created as part of the series, “Unsupported: Addiction prevention in Oregon classrooms” a reporting project by The Lund Report, University of Oregon’s Catalyst Journalism Project and Oregon Public Broadcasting, with support from the Fund for Investigative Journalism.



This is the Executive Summary of the DEA’s 2024 National Drug Threat Assessment 

Fentanyl is the deadliest drug threat the United States has ever faced, killing nearly 38,000 Americans in the first six months of 2023 alone. Fentanyl and other synthetic drugs, like methamphetamine, are responsible for nearly all of the fatal drug overdoses and poisonings in our country. In pill form, fentanyl is made to resemble a genuine prescription drug tablet, with potentially fatal outcomes for users who take a pill from someone other than a doctor or pharmacist. Users of other illegal drugs risk taking already dangerous drugs like cocaine, heroin, or methamphetamine laced or replaced with powder fentanyl. Synthetic drugs have transformed not only the drug landscape in the United States, with deadly consequences to public health and safety; synthetic drugs have also transformed the criminal landscape in the United States, as the drug cartels who make these drugs reap huge profits from their sale.
Mexican cartels profit by producing synthetic drugs, such as fentanyl (a synthetic opioid) and methamphetamine (a synthetic stimulant), that are not subject to the same production challenges as traditional plant-based drugs like cocaine and heroin – such as weather, crop cycles, or government eradication efforts. Synthetic drugs pose an increasing threat to U.S. communities because they can be made anywhere, at any time, given the required chemicals and equipment and basic know-how. Health officials, regulators, and law enforcement are constantly challenged to quickly identify and act against the fentanyl threat, and the threat of new synthetic drugs appearing on the market. The deadly reach of the Mexican Sinaloa and Jalisco cartels into U.S. communities is extended by the wholesale-level traffickers and street dealers bringing the cartels’ drugs to market, sometimes creating their own deadly drug mixtures, and exploiting social media and messaging applications to advertise and sell to customers.
The Sinaloa Cartel and the Cartel Jalisco Nueva Generación (also known as CJNG or the Jalisco Cartel) are the main criminal organizations in Mexico, and the most dangerous. They control clandestine drug production sites and transportation routes inside Mexico and smuggling corridors into the United States and maintain large network “hubs” in U.S. cities along the Southwest Border and other key locations across the United States. The Sinaloa and Jalisco cartels are called “transnational criminal organizations” because they are not just drug manufacturers and traffickers; they are organized crime groups, involved in arms trafficking, money laundering, migrant smuggling, sex trafficking, bribery, extortion, and a host of other crimes – and have a global reach extending into strategic transportation zones and profitable drug markets in Europe, Africa, Asia, and Oceania.

Source: May 2024

This is The Drug Report’s Friday Fact report – The rate of violent behavior in daily marijuana users aged 18-34 was nearly twice the violent behavior rate of non-users

The study “Associations of cannabis use, use frequency, and cannabis use disorder with violent behavior among young adults in the United States” was recently published by Nora D. Volkow and the team at NIDA. The study found that the rate of violent behavior in daily marijuana users aged 18-34 was nearly twice the violent behavior rate of non-users.

The study consisted of 113,434 participants, aged 18 to 34, and relied on data from the 2015-2019 National Surveys on Drug Use and Health (NSDUH).

The datasets provided information on the rates of daily marijuana use, whether the participants had Cannabis Use Disorder, and violent behavior. The study found:

The violence behavior rates for both males and females who were daily marijuana users and had Cannabis Use Disorder were close to doubling that of males and females who were non-marijuana users.

Source: Email from Smart Approaches to Marijuana (SAM) May 2024

Bertha Madras, a leading expert on weed, outlines the science linking it to psychiatric disorders, permanent brain damage, and other serious harms.

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

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

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

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

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

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

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

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

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

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

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

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

There’s mounting evidence that cannabis can cause schizophrenia. A large-scale study last year that examined health histories of some 6.9 million Danes between 1972 and 2021 estimated that up to 30% of young men’s schizophrenia diagnoses could have been prevented had they not become dependent on pot. Marijuana is  worse in this regard than many drugs usually perceived as more dangerous.

“Users of other potent recreational drugs develop chronic psychosis at much lower rates,” Ms. Madras says. When healthy volunteers in research experiments are given THC—as has been done in 15 studies—they develop transient symptoms of psychosis. “And if you treat them with an antipsychotic drug such as haloperidol, those symptoms will go away.”

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

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

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

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

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

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

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

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

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

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

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

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

Ms. Madras worries that “it sets a precedent for the future.” She points to the movement in states to legalize psychedelic substances, for whose medicinal benefits there also isn’t strong scientific evidence. Meantime, she says it makes no sense that politicians continuously urge more spending on addiction treatment and harm reduction while weakening laws that prevent people from becoming addicted in the first place.
Her rejoinder to critics who say the war on drugs was a failure? “This is not a war on drugs. It’s a defense of the human brain at every possible age from in utero to old age.”

Ms. Finley is a member of the Journal’s editorial board.

Source: May 2024


U.S. News & World Report

By Ernie Mundell HealthDay Reporter

 American teenagers cite stress as the leading reason they might get drunk or high, a new report reveals.

That only underscores the need for better adolescent mental health care, according to the research team behind the study.

Better “access to treatment and support for mental health concerns and stress could reduce some of the reported motivations for substance use,” concluded investigators from the U.S. Centers for Disease Control and Prevention.

In the study, a team led by CDC researcher Sarah Connolly looked at 2014-2020 data on over 9,500 people ages 13 to 18, all of who were being treated for a substance use disorder.

Teens were using a myriad of substances, including alcohol, marijuana, prescription painkillers (often opioids), prescription stimulants (for example, Ritalin), or prescription sedatives (such as Valium or Xanax).

The teens were also asked why they thought they were using or abusing substances.  Easing stress in their lives was the leading factor cited.

“The most commonly reported motivation for substance use was “to feel mellow, calm, or relaxed” (73%), with other stress-related motivations among the top reasons, including “to stop worrying about a problem or to forget bad memories” (44%) and “to help with depression or anxiety” (40%),” Connolly’s team reported.

Stress relief wasn’t the only motivator, of course: Half of the teens reported using substances “to have fun or experiment.” This reason for using substances was more often cited for alcohol or nonprescription drug use than it was for the use of marijuana or other drugs.

Substance abuse with the aim of easing stress was most often cited for marijuana (76% of teens), prescription pain meds (61%) and sedatives/tranquilizers (55%), the study found.

Half of the teens surveyed said they often used drugs or alcohol alone, but 81% said they also used them with friends, a boyfriend or girlfriend (24%), or “anyone who has drugs” (23%).

According to the researchers, prior data has long shown that “anxiety and experiencing traumatic life events have been associated with substance use in adolescents.”

But with burgeoning rates of substance abuse and related overdoses, the consequences of turning to substances to ease stress can be tragic.

“Harm reduction education specifically tailored to adolescents has the potential to discourage using substances while alone and teach how to recognize and respond to an overdose in others,” the team said.

Such interventions might “prevent overdoses that occur when adolescents use drugs with friends from becoming fatal,” they added.

If you or a loved one is stressed by a mental health crisis, confidential 24/7 help is on hand at the 988 Suicide & Crisis Lifeline.

The findings were published in the Feb. 9 issue of the CDC journal Morbidity and Mortality Weekly Report.

More information

There’s tips to identifying stress in your teen at the American Psychological Association.

SOURCE: Morbidity and Mortality Weekly Report, Feb. 9, 2024

Copyright © 2024 HealthDay. All rights reserved.

Tags: parentingdrug abuseanxietystressalcohol


By      Feb. 16, 2024, at 7:53 a.m.

U.S. News & World Report

Smoking Now Fuels More Drug Overdoses than Injecting Does

By Robin Foster HealthDay Reporter

Despite stereotypical images of addicts injecting heroin and then dying, new government research finds that smoking drugs such as fentanyl is now the leading cause of fatal overdoses.

In the new research, published Thursday in Morbidity and Mortality Weekly Report, scientists from the U.S. Centers for Disease Control and Prevention found the percentage of overdose deaths between January 2020 and December 2022 linked to smoking increased 73.7% — going from from 13.3% to 23.1% — while the percentage of overdose deaths linked to injection decreased 29.1% — going from from 22.7% to 16.1%.

These changes were most pronounced when fentanyl was the drug of choice: In those cases, the percentage with evidence of injection decreased 41.6%, while the percentage with evidence of smoking increased 78.9%.

CDC officials explained in their report that they decided to tackle the topic after seeing reports from California suggesting that smoking fentanyl was becoming the preferred way to use the deadly drug.

Fentanyl accounts for nearly 70% of overdose deaths in the United States, they noted.

Some early research has suggested that smoking fentanyl is somewhat less deadly than injecting it, and any reduction in injection-related overdose deaths is a positive, report author Lauren Tanz, a CDC senior scientist who studies overdoes, told the Associated Press.

However, “both injection and smoking carry a substantial overdose risk,” and it’s not clear if a shift toward smoking fentanyl will lower the number of U.S. overdose deaths, Tanz said.

Fentanyl is a powerful drug that, in powder form, is cut into heroin or other drugs. In recent years, it’s been fueling the U.S. overdose epidemic. Drug overdose deaths climbed slightly in 2022 after two big leaps during the pandemic, and provisional data for the first nine months of 2023 suggests it inched up again last year, the AP reported.

For years, fentanyl has been injected, but drug users often smoke it now. Users put the powder on tin foil or in a glass pipe, heated from below, and inhale the vapor, Alex Kral, a RTI International researcher who studies drug users in San Francisco, told the AP.

Smoked fentanyl is not as concentrated as fentanyl in a syringe, but some users see upsides to smoking, Kral explained, including the fact that people who inject drugs often deal with pus-filled abscesses on their skin and risk infections with hepatitis and other diseases.

“One person showed me his arms and said, ‘Hey, look at my arm! It looks beautiful! I can now wear T-shirts and I can get a job because I don’t have these track marks,’” Kral said.

In the new report, investigators were able to cull data from the District of Columbia and 27 states for the years 2020 to 2022. From there, they tallied how drugs were taken in about 71,000 of the more than 311,000 total U.S. overdose deaths over those three years.

By late 2022, 23% of the deaths occurred after smoking, 16% after injections, 16% after snorting and 14.5% after swallowing, the researchers reported.

Tanz said she feels the data is nationally representative because it came from states in every region of the country, and all showed increases in smoking and decreases in injecting. Smoking was the most common route in the West and Midwest, and roughly tied with injecting in the Northeast and South, the report found.

Kral noted the study has some limitations.

It can be difficult to determine the exact cause of an overdose death, especially if no witness was present, he said, and injections might be more reported more often because it is easy to spot needle marks on the body. To detect smoking as a cause of death, “they likely would need to find a pipe or foil on the scene and decide whether to write that down,” he said.

Kral added that many people who smoke fentanyl use a straw, and it’s possible investigators saw a straw and assumed it was snorted.

More information

The National Institute on Drug Abuse has more on drug overdose deaths.

SOURCE: Morbidity and Mortality Weekly Report, Feb. 16, 2024; Associated Press

Copyright © 2024 HealthDay. All rights reserved.


Filed under: Latest News,Prevalence,USA :


Browse state-level percentage estimates based on the 2021-2022 National Surveys on Drug Use and Health (NSDUH). The 37 tables include estimates for 35 measures of substance use and mental health, by age group, along with 95% confidence intervals. The percentages are based on small area estimation (SAE) methods, in which state-level NSDUH data are combined with other data from smaller geographies. The combined data are used to create modeled state estimates of the civilian, noninstitutionalized population ages 12 and older, or adults 18 and older for mental health measures. Each table covers a single measure by state, region, and age group.

The indicators are presented in the following 37 tables:

Drug use and Perceived Risk

  1. Illicit Drug Use in the Past Month
  2. Marijuana Use in the Past Year
  3. Marijuana Use in the Past Month
  4. Perceptions of Great Risk from Smoking Marijuana Once a Month
  5. First Use of Marijuana in the Past Year (among those at risk for initiation)
  6. Illicit Drug Use Other than Marijuana in the Past Month
  7. Cocaine Use in the Past Year
  8. Perceptions of Great Risk from using Cocaine Once a Month
  9. Heroin Use in the Past Year
  10. Perceptions of Great Risk from Trying Heroin Once or Twice
  11. Hallucinogen Use in the Past Year
  12. Methamphetamine Use in the Past Year
  13. Prescription Pain Reliever Misuse in the Past Year
  14. Opioid Misuse in the Past Year


  1. Alcohol Use in the Past Month
  2. Binge Alcohol Use in the Past Month
  3. Perceptions of Great Risk from Having Five or More Drinks of an Alcoholic Beverage Once or Twice a Week
  4. Alcohol Use, Binge Alcohol Use in the Past Month, and Perceptions of Great Risk from Having Five or More Drinks of an Alcoholic Beverage Once or Twice a Week (among people aged 12 to 20)


  1. Tobacco Product Use in the Past Month
  2. Cigarette Use in the Past Month
  3. Perceptions of Great Risk from Smoking One or More Packs of Cigarettes per Day

Substance Use Disorders

  1. Substance Use Disorder in the Past Year
  2. Alcohol Use Disorder in the Past Year
  3. Alcohol Use Disorder in the Past Year (among people aged 12 to 20)
  4. Drug Use Disorder in the Past Year
  5. Pain Reliever Use Disorder in the Past Year
  6. Opioid Use Disorder in the Past Year

Substance Use Treatment

  1. Received Substance Use Treatment in the Past Year
  2. Classified as Needing Substance Use Treatment in the Past Year
  3. Did Not Receive Substance Use Treatment in the Past Year among those Classified as Needing Substance Use Treatment

Mental Illness

  1. Any Mental Illness in the Past Year
  2. Serious Mental Illness in the Past Year
  3. Received Mental Health Treatment in the Past Year
  4. Major Depressive Episode in the Past Year


  1. Had Serious Thoughts of Suicide in the Past Year
  2. Made Any Suicide Plans in the Past Year
  3. Attempted Suicide in the Past Year
Publication Date: February 15, 2024
Collection Date: 2021-2022
Report Type: Data Table


A Research Letter published in the Journal of the American Medical Association (JAMA) raises alarms about administering melatonin gummies to children. Between 2012 and 2021, reports to U.S. poison control centers regarding pediatric melatonin ingestions surged 530% and were linked with 27,795 emergency department and clinic visits, 4,097 hospitalizations, 287 intensive care admissions, and tragically, 2 fatalities. Investigation into melatonin products’ labels revealed widespread inaccuracies relating to the presence of both melatonin and cannabidiol (CBD).


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


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



Understanding motives for cannabis use is important for addiction prevention and intervention

(SACRAMENTO)A study in Psychology of Addictive Behaviors by researchers at UC Davis Health and the University of Washington surveyed teens over a six-month period to better understand their motives for using cannabis.

The researchers found that teens who have more “demand” for cannabis (meaning they are willing to consume more when it is free and spend more overall to obtain it) are likely to use it for enjoyment.

Using cannabis for enjoyment (“to enjoy the effects of it”) was linked to using more of it and experiencing more negative consequences.

Teens who have more demand for cannabis were also likely to use it to cope (“to forget your problems”). Using cannabis to cope was linked to experiencing more negative consequences, as identified by the Marijuana Consequences Checklist. Examples of negative effects include having trouble remembering things, difficulty concentrating and acting foolish or goofy.

Cannabis — also called marijuana, pot or weed — is the most used federally illegal drug in the United States. As of November 2023, 24 states and the District of Columbia have legalized cannabis for medicinal and recreational use. At the federal level, marijuana remains a Schedule One substance under the Controlled Substances Act.

“Understanding why adolescents use marijuana is important for prevention and intervention,” said Nicole Schultz, first author of the study and an assistant professor in the UC Davis Department of Psychiatry and Behavioral Sciences. “We know that earlier onset of cannabis use is associated with the likelihood of developing a cannabis use disorder. It is important we understand what variables contribute to their use so that we can develop effective strategies to intervene early,” Schultz said.

We know that earlier onset of cannabis use is associated with the likelihood of developing a cannabis use disorder. It is important we understand what variables contribute to their use so that we can develop effective strategies to intervene early.”Nicole Schultz, assistant professor, Department of Psychiatry and Behavioral Sciences

Cannabis a public health concern

Cannabis is the most used psychoactive substance among adolescents. In 2022, 30.7% of twelfth graders reported using cannabis in the past year, and 6.3% reported using cannabis daily in the past 30 days.

The increased use is a public health concern, as cannabis can have significant impacts on teen health. A study earlier this year from Columbia University found teens who use cannabis recreationally are two to four times as likely to develop psychiatric disorders, such as depression and suicidality, than teens who do not use cannabis. Teens are also at risk for addiction or cannabis use disorder, where they try but cannot quit using cannabis.

When talking about prevention and intervention with addictive substances, it is essential to know why people use the substances, according to Schultz.

“The reasons often change over time. At the beginning, someone might use a substance for recreational reasons but have different motives later when the substance has become a problem for them,” she said.

For the study, the researchers used mediation analysis to focus on two motives: enjoyment and coping. They examined how these two motives explained the relationship between cannabis demand — a measure of how important or “reinforcing” cannabis is to the user — and cannabis-related outcomes, which included negative consequences and use.

Study participants were between the ages of 15 and 18. Participants completed an initial survey and follow-up surveys at three months and six months. High school students comprised 60.7% of the participants, and four-year college students comprised 24.7%. All lived in the greater metropolitan area of Seattle, where the legalized age for recreational cannabis use is 21 and older.

Of these participants, 87.6% identified as white, 19.1% as Asian or Asian American, 16.9% identified as Hispanic or Latinx, 4.5% as Black or African American, 3.4% as American Indian or Alaska Native and 3.4% identified with another race. Participants could choose more than one selection for race.

The researchers found that greater cannabis demand was significantly associated with using cannabis for enjoyment. Using for enjoyment was also significantly associated with cannabis use for the young study participants.

“This finding makes sense because using for enjoyment is typically related to the initiation of use versus problematic use. And given the age of the participants in this study, they may have short histories of use,” Schultz said.

Being willing to consume more cannabis at no cost, spend more money on cannabis overall, and continue spending at higher costs was positively associated with using cannabis for coping reasons.

Participants who used cannabis for coping and enjoyment both reported experiencing negative consequences from cannabis use. These included feeling increased anxiety, making decisions that were later regretted and getting in trouble with school or an employer.

The researchers noted several limitations of the study, including a lack of diversity, with nearly 88% of the survey participants identifying as white. Another limitation was that the participants’ cannabis usage was self-reported. The study results may also be specific to regions like Seattle, where cannabis has been legalized for adults.

“The current study suggests that encouraging substance-free activities that are fun for adolescents and help adolescents cope with negative feelings may help them use less cannabis and experience fewer negative consequences from use,” said Jason J. Ramirez senior author of the study. Ramirez is an assistant professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington and a faculty member of the Center for the Study of Health and Risk Behaviors.

Additional authors include Tessa Frohe from the University of Washington and Christopher J. Correia from Auburn University.

The Substance Abuse and Mental Health Services Administration has a website and a national hotline, at 1-800-662-4357, for individuals and families facing substance use disorders. Information about cannabis use disorder is available on the Centers for Disease Control webpage.

This research was supported by the National Institute on Drug Abuse (R21DA045092) and the National Institute on Alcohol Abuse and Alcoholism (F32AA028667, T32AA007455, K01AA030053)


Ten years after cannabis was first legalized for casual use in adults, scientists are struggling to provide evidence-based recommendations about the risks to young people.

Krista Lisdahl has been studying cannabis use among adolescents for two decades, and what she sees makes her worried for her teenage son.

“I see the data coming in, I know that he is going to come across it,” she says.

As a clinical neuropsychologist at the University of Wisconsin–Milwaukee, she sees plenty of young people who have come into contact with the drug to varying degrees, from trying it once at a party to using potent preparations of it daily. The encounters have become more frequent as efforts to legalize cannabis for recreational use intensify around the world. In some of her studies, around one-third of adolescents who regularly use cannabis show signs of a cannabis use disorder — that is, they can’t stop using the drug despite negative impacts on their lives. But she wants more conclusive evidence when it comes to talking about the drug and its risks to young people, including her son.

Deciding what to say is difficult, however. Anti-drug messaging campaigns have dwindled, and young people are forced to consider sometimes-conflicting messages on risks in a culture that increasingly paints cannabis and other formerly illicit drugs as harmless or potentially therapeutic. “Teenagers are pretty smart, and they see that adults use cannabis,” Lisdahl says. That makes blanket warnings and prohibitions practically useless.

It’s now a decade since the drug was officially legalized for recreational use by adults aged 18 and older in Uruguay, and aged 21 and older in the states of Colorado and Washington. Many other states and countries have followed, and researchers are desperately trying to get a handle on how usage patterns are changing as a result; how the drug impacts brain development; and how cannabis use correlates with mental-health conditions such as depression, anxiety and schizophrenia.

The data so far don’t tell clear stories: young people don’t seem to be using in greater numbers than before legalization, but there seem to be trends towards more problematic use. Frequent use also coincides with higher rates of mental-health issues and the risk of addiction, but there could be other explanations for these trends. Experimental studies in humans and animals could help, but they are stymied by the fact that cannabis is still illegal in many places. And it is difficult to study the same products and potencies that people can now readily access.

As a result, some researchers worry that society is stumbling, unaware, into a big public-health problem. “I am concerned that this will hit us like tobacco hit us,” says Nora Volkow, director of the National Institute on Drug Abuse in Bethesda, Maryland. Even if the risks of cannabis use are small, “it’s like playing roulette,” she says.

In the hope of getting a better handle on the situation, her agency funded the Adolescent Brain Cognitive Development (ABCD) study. Started in 2015, ABCD recruited more than 10,000 children aged 9 and 10, with the goal of taking annual images of their brains to monitor how different factors affect their development. Participants are now between 16 and 18, and some are starting to come into contact with the drug, says Lisdahl, who co-leads the project. “So we should be able to really measure the impact of starting cannabis,” she says.

Changing patterns of use

Medicinal cannabis has been legal in some parts of the United States since 1996, but Colorado and Washington led the way on legalizing its recreational use when the issue was put to public votes in 2012. Uruguay was the first country to legalize the sale of the drug for recreational use the following year. There were fears that legalization would result in a flood of adolescent users, but so far, this doesn’t seem to be the case, says Angela Bryan, a neuroscientist at the University of Colorado, Boulder. “Paradoxically, the legalization of cannabis has decreased use among adolescents”, at least in her state, she says.

A series of biennial surveys by the Colorado Department of Public Health and Environment found that cannabis use among students aged 14–18 declined from a stable rate of about 21% during 2005–19 to 13% in 2021 (see Nationwide usage patterns seem to show a similar dip, which one study associated with the COVID-19 pandemic1.

But legalization is bound to have varying effects in different areas, says James MacKillop, a clinical psychologist at McMaster University in Hamilton, Canada. There was no initial spike in cannabis use among adolescents when it was legalized in Canada for adults aged 18 and older 5 years ago. But there was a rise in use when illegal cannabis stores that are not licensed by the government began to open, he says.

Now, “There are more cannabis storefronts than there are Tim Hortons,” says MacKillop, referring to a famously ubiquitous Canadian coffee shop. Some negative consequences might also be emerging. A recent study in Ontario found that residents who were within walking distance of a cannabis dispensary were more likely to attend a hospital for treatment of psychosis2 — which is increasingly being linked to high-potency cannabis products.

A hemisphere away, Uruguay saw an initial spike in usage among those age 18 to 21 as legalization rolled out in 2014. But usage quickly went back to pre-legalization levels, according to survey results3. The survey also found no increase in adolescents developing addiction or having more problematic use of cannabis. This could be because of a slew of factors, says Ariadne Rivera-Aguirre, a social epidemiologist at New York University, who led the survey. These include the fact that Uruguay has set limits on the potency of products sold legally, banned advertisements on packaging and only permits the sale of cannabis flower products — no edibles or concentrates.

Rivera-Aguirre measured not just how many adolescents were using cannabis, but also how many were using it at problematic levels, which she says many past surveys haven’t taken into account. The spike in use might have been the result of increased discussion and media attention surrounding legalization, Rivera-Aguirre says. Many others are also interested in understanding when casual use becomes problematic. “That’s where I think the research needs to focus, rather than worrying about the typical 17-year-old who has a joint at a party,” says Bryan.

Whereas use hasn’t exploded in people under 21, there are concerns about the types of product being sold. Increasingly, what is available at dispensaries — at least outside Uruguay — has much higher concentrations of delta-9-tetrahydrocannabinol (THC), the main active ingredient in cannabis. “The cannabis of today is not the cannabis of yesteryear,” says Ryan Sultan, a clinical psychiatrist at Columbia University in New York City. The THC concentration in products obtained by the US Drug Enforcement Administration has increased by more than threefold since 1996 (see, and many dispensaries sell vaping fluids and products for ‘dabbing’, a method of consuming concentrated THC that can deliver large amounts of the drug into a person’s lungs.

Health impacts

High-potency preparations carry much higher risks of inducing psychosis, and some researchers fear that this could have long-term effects. “The thing that the psychiatric community is scared to their bones about is the link between cannabis and schizophrenia,” says Sultan.

A study of more than 40,000 people with schizophrenia in Denmark, where cannabis has been legal since 2018, found that around 15% of cases could be tied to cannabis use disorder, with that figure being even higher in young men4.

But it is unclear whether the association in Denmark is causal or not, says Carsten Hjorthøj, an epidemiologist at the University of Copenhagen who led the work. It could be that those with schizophrenia are seeking out cannabis to self-medicate. There are similar issues in clarifying the connections between cannabis and depression and anxiety, but the associations are there.

In a study of almost 70,000 adolescents in the United States, Sultan found that around 1 in 40 were addicted to cannabis. Another 1 in 10 used cannabis but were not addicted. Even in this group, young people were twice as likely to experience bouts of depression along with other negative outcomes, such as skipping school, having lower grades than non-users and being arrested5.

Some researchers are working on establishing possible mechanisms by which cannabis can affect mental health, and others are finding connections through surveys and health records. Many are hoping that more conclusive results will come from long-term studies such as ABCD.

Studies that just look at connections at a single point in time are limited. “You have to wonder, what is the reason that you find that adolescent cannabis users show higher levels of depression?” asks Madeline Meier, a clinical psychologist at Arizona State University in Tempe. “Is that because the cannabis caused depression in these adolescents, or is it because adolescents with depression selectively seek out cannabis? Or is there some third variable?”

What’s going on in the brain?

Cannabis works by mimicking natural cannabinoid neurotransmitters in the body, which can activate a handful of receptors in the brain. “It’s mimicking that system, but it’s cheating the system,” Lisdahl says, because high-potency THC products are stimulating receptors much more than everyday activities would.

In adolescents, one of the main concerns is THC’s ability to bind easily to one receptor, called CB1. These receptors are found all over the brain, but they are particularly common in areas associated with reward and executive functioning — which includes memory and decision-making. CB1 is more abundant in adolescent brains than in adult ones.

Researchers are trying to see how the prolonged use of cannabis, especially products with high concentrations of THC, can affect mental health or cognitive function. Meier and her colleagues analysed the effect of cannabis use into adulthood for a group of around 1,000 people born between 1972 and 1973. They found that those who used cannabis consistently scored lower, on average, on IQ tests than did those who used cannabis less frequently or not at all. And this effect was most pronounced in people who started using cannabis in adolescence6.

Meier says her work points to infrequent cannabis use in adolescence not leading to significant cognitive decline. But, she says, “it’s enough to urge caution against using.” The bigger issue, to her, is that people who start using during adolescence are at a higher risk of long-term use.

One criticism of her team’s study, Meier says, is that it didn’t account for other factors that affect cognitive function, such as genetics and socio-economic status7.

These criticisms were all considered when designing the ABCD study, Volkow says. By recruiting 10,000 children from various backgrounds, the study is likely to include a sufficiently large and diverse group of frequent cannabis users. Over the course of the study, researchers will be imaging participants’ brains, tracking academic test scores and measuring cognitive function, all while interviewing them about their contact with drugs. Many think that it will be able to paint as accurate a picture of the effects of cannabis as one study can.

And its timing should also help researchers to understand the long-term effect of high-potency THC products, because many of the participants are likely to end up trying these. Efforts to study such products in the United States have been hampered by the fact that cannabis is still illegal at the federal level. Publicly funded research institutions can access only one strain of cannabis, and it is notoriously weaker than the products sold in dispensaries or on the street.

“Certain kinds of research are not being done because it takes so many complicated steps,” says R. Lorraine Collins, a psychologist at the University at Buffalo in New York. “It adds extra costs and extra staffing.” And as for research-grade cannabis, study participants “don’t like it at all”, says psychiatrist Jesse Hinckley, who specializes in adolescent addiction at the University of Colorado Anschutz Medical Campus in Aurora.

Some researchers have created workarounds to study cannabis on the streets. Bryan and others in Colorado have fashioned several vans into mobile laboratories, which they call canna-vans, to allow them to test the blood of cannabis users before and after they take the drug. The researchers have begun to expand their work to adolescents.

Volkow is working to make research on cannabis relevant to the current landscape — one rife with vaping, dabbing, edibles and other products. And Lisdahl is gearing up for the next stage of the ABCD study. Most of her cohort is now aged between 16 and 18 — the point at which she and others are expecting that some will begin using cannabis. When Lisdahl talks to the young people in her study and their parents, she worries that there’s little concrete guidance on cannabis safety — so she has to give advice on a case-by-case basis.

“I would just like to have information for the teens and for the adults to make better decisions for themselves,” Lisdahl says.

She also hopes to nail down how much cannabis is too much, and what contributes to the risk of developing a cannabis use disorder. This might differ from person to person, and could involve genetics and even the structure of the brain. All of this could help her in conversations with her own son. “He has lofty academic goals and I’ve seen that cannabis disrupts things like speed of thinking, complex attention and short-term memory, and it affects grades negatively.” For now, she hopes that pointing this out will make a difference, or at the very least, keep him informed of the risks.


Navigating the Adolescent Overdose Crisis: Insights and Prevention Strategies

An Alarming Rise in Adolescent Drug-Related Mortality

Recent years have seen a worrisome increase in drug-related fatalities among adolescents in the United States. As relayed by Dr. Joseph R. Friedman, this alarming trend necessitates a more aggressive approach to overdose prevention. While the reasons behind this rise are multifaceted, the surge in opioid-related deaths, particularly due to fentanyl poisoning, is a crucial factor to consider.

The Overdose Crisis among U.S. Adolescents

In 2022, an average of 22 adolescents aged 14 to 18 died each week in the U.S. from drug overdoses, according to a study published in The New England Journal of Medicine. This death rate is more than double what it was in 2018, with 75% of these drug overdose fatalities attributed to fentanyl poisoning. This issue became particularly pronounced during the COVID-19 pandemic, with states like Arizona, Colorado, and Washington identified as hotspots for adolescent drug overdose death rates.

Addressing the Crisis: Naloxone in Schools

The Washington State Department of Health (DOH) has taken proactive measures against this crisis by offering naloxone to all public high schools across the state. This initiative aims to combat the surge in opioid-related fatalities among adolescents by providing access to naloxone, a substance capable of reversing the harmful effects of an opioid overdose. The initiative also aligns with a recent directive from the U.S. Department of Education and the White House drug policy office, urging schools to train staff and students on the use of naloxone and keep it on hand.

The Role of Education and Awareness

Equipping adolescents with the knowledge and tools to keep themselves safe from drug overdose is paramount. Parents are encouraged to discuss the dangers of counterfeit pills, which often contain lethal amounts of fentanyl. Additionally, they are advised to keep Naloxone or Narcan, an over-the-counter overdose reversal medication, readily available at home. Efforts have been made on this front through the X Foundation, established in honor of a teenager who died of fentanyl poisoning. The foundation aims to raise awareness and provide education about the epidemic.

The Take-Home Naloxone Program: A Potential Lifesaver

The take-home naloxone program, studied by ScienceDirect, has shown potential in reducing the number of opioid-related fatalities. The program focuses on distributing naloxone to people at risk of overdosing, especially those who frequently use opioids alone. However, the study underlines the need for multifaceted interventions, highlighting that naloxone distribution should go hand-in-hand with overdose prevention education.


The rise in adolescent drug-related mortality is a pressing issue that requires immediate attention. While the distribution of naloxone in schools and overdose prevention education play significant roles in combating this crisis, a comprehensive approach is necessary. This includes proactive measures at home, open discussions about the dangers of drug misuse, and accessibility to life-saving medications. Together, these efforts can help turn the tide against the alarming trend of adolescent drug overdoses.



ORLANDO, Fla.Jan. 24, 2024 /PRNewswire/ — Victoria’s Voice Foundation, a nonprofit providing evidence-based drug education and addiction prevention support for families, marked a major milestone yesterday, surpassing one million children and parents impacted through its education programs – with a school assembly in Nashville on the dangers of vaping and drug use. The event was held at Davidson Academy for 375 students in grades 7-12.

During the assembly, Michael DeLeon – director of youth outreach and school programs for Victoria’s Voice and founder of Steered Straight, a drug prevention program for school systems nationwide – discussed vaping, stressing the escalating incidence of overdose deaths from vapes laced with fentanyl, as well as drug use information, associated risks, and tools for prevention. DeLeon also shared his personal story of addiction, incarceration and recovery, and reinforced with students the importance of making responsible, informed choices.

“We are very proud to achieve this important milestone,” said Victoria’s Voice co-founders Jackie and David Siegel, who were on hand at the Davidson assembly. “This marks a significant step in our ongoing efforts to educate and empower families about drug use and addiction. It is our life’s work to spare other parents the pain and grief we experienced.”

Victoria’s Voice has created a diverse and versatile collection of education and prevention programming to meet the needs of communities and at-risk populations nationwide. The foundation’s live school speaker series encourages students to live drug-free. The series also includes prevention resources and activities to engage students year-round, programming tailored for parents and educators, and complimentary copies of Victoria’s Voice, the powerful, personal diary of the Siegels’ late daughter, Victoria.

The foundation also offers Vital Signs, a free program that prepares parents to recognize the early signs of drug use in their children; a community speaker program; free video programming for life skills and drug prevention; and Victoria’s Voice, which the foundation provides for free to schools and other organizations.

About Victoria’s Voice Foundation
Victoria’s Voice Foundation was established in 2019 by Jackie and David Siegel after losing their 18-year-old daughter to an accidental drug overdose. Victoria’s Voice is dedicated to providing evidence-based drug education and addiction prevention support for families, including access to Naloxone. Since its founding, Victoria’s Voice has positively impacted more than one million parents and children through its education programs. For more information about Victoria’s Voice, please visit


The International Narcotics Control Board (INCB) study recommends responding with the same methods, running counter-narcotics campaigns offering advice that can be trusted on popular online platforms.

“We can see that drug trafficking is not just carried out on the dark web. Legitimate e-commerce platforms are being exploited by criminals too,” said Jallal Toufiq, INCB President.

Criminal gangs take advantage of the chance to reach large global audiences on social media channels by turning them into marketplaces and posting inappropriate, misleading and algorithm-targeted content that is widely accessible to children and adolescents, the board noted.

Poppy cull

The authors of the report observed a significant decline in opium poppy cultivation and heroin production in Afghanistan following the Taliban’s ban on drugs. But, South Asia’s methamphetamine trafficking boomis linked to its manufacture in Afghanistan with outlets in Europe and Oceania.

In Colombia and Peru, there has been a notable increase in illicit coca bush cultivation, rising by 13 per cent and 18 per cent respectively in 2022.

Cocaine seizures also reached a record level in 2021 in West and Central Africa, a major transit region.

And Pacific island States have transitioned from being solely transit sites along drug trafficking routes to becoming destination markets for synthetic drugs.

In North America, the opioid crisis persists, with the number of deaths involving synthetic opioids other than methadone surpassing 70,000 in 2021. In Europe, several countries are pursuing a regulated market for cannabis for non-medical purposes, which, the INCB experts believe, may be inconsistent with drug control.


Real-world dangers online

Other trends linked to drug dealing today include the use of encryption methods in communications and transactions, anonymous browsing on the darknet and payments in hard-to trace cryptocurrencies, which increase challenges for prosecutors.

The INCB report also highlighted how criminals relocate their operations to regions with less stringent law enforcement or lighter sanctions, often choosing countries where extradition can be evaded.

The latest data also emphasizes the heightened risk of deadly overdoses linked to the online availability of fentanyl – many times more potent than heroin – and other synthetic opioids.

Another area of concern is telemedicine and online pharmacies. While such services have the potential to enhance healthcare access and simplify the prescription and delivery of lifesaving medicines, illegal internet outlets that sell drugs without a prescription directly to consumers are a very real health risk.

The global trade in illicit pharmaceuticals is estimated at $4.4 billion.

In many cases, it is impossible for consumers to know whether the drugs or medicines they are buying are counterfeit, banned or illegal.

To combat the online threat, the report’s authors insist that internet platforms should be used to raise awareness about drug misuse and support public health campaigns, especially targeting young people.

Given the global nature of the challenge, countries should cooperate to identify and respond to new threats, said INCB, whose 13 members are elected by the UN’s Economic and Social Council (ECOSOC).


In its 2023 Annual Report, the International Narcotics Control Board:

– finds that online drug trafficking has increased the availability of drugs on the illicit market;

– warns that patient safety is at risk from illicit Internet pharmacies selling drugs without a prescription directly to the consumer;

– highlights the daunting task facing law enforcement authorities to monitor and prosecute online drug activities;

– sees opportunities to use the Internet and social media for drug use prevention campaigns and to improve access to drug treatment services;

– encourages governments to use the full range of INCB tools and programmes to assist in their efforts to counter exploitation of the Internet for drug trafficking; and

– voices concern about the persistent regional disparities in availability and consumption of licit drugs for the treatment of pain.

VIENNA, 5 March (UN Information Service) – The evolving landscape of online drug trafficking is presenting new challenges to drug control, says the International Narcotics Control Board (INCB) in its Annual Report. There are also opportunities to use the Internet for drug use prevention and treatment to safeguard people’s health and welfare, the Board says.

The increased availability of illicit drugs on the Internet, the exploitation by criminal groups of online platforms including social media, and the increased risk of overdose deaths due to the online presence of fentanyl and other synthetic opioids are some of the key challenges for drug control in the Internet era.

“We can see that drug trafficking is not just carried out on the dark web. Legitimate e-commerce platforms are being exploited by criminals too. We encourage governments to work with the private sector and INCB projects to prevent and detect trafficking of drugs and other dangerous substances online,” said Jallal Toufiq, the President of INCB.

Using social media and other online platforms means drug traffickers can advertise their products to large global audiences. Various conventional social media platforms are being used as local marketplaces and inappropriate content is widely accessible to children and adolescents.

Encryption methods, anonymous browsing on the darknet and cryptocurrencies are commonly used to avoid detection, posing difficulties for prosecuting online trafficking offences. Offenders can move their activities to territories with less intensive law enforcement action or lighter sanctions or base themselves in countries where they can evade extradition. The sheer scale of online activity is an added complication. In one case in France, law enforcement authorities collected more than 120 million text messages from 60,000 mobile phones.

Patient safety is at risk from illicit Internet pharmacies which sell drugs without a prescription directly to consumers. It is impossible for consumers to know whether the drugs are counterfeit, unapproved or even illegal. The global trade in illicit pharmaceuticals is estimated to be worth 4.4 billion USD.

Opportunities for drug treatment and prevention

The Board sees opportunities to use online platforms to prevent non-medical use of drugs, raise awareness about the harms of drug use and support public health campaigns. Governments can use social media platforms to conduct drug use prevention campaigns to prevent substance misuse among young people in particular.

“There are opportunities to use social media and the Internet to prevent drug use, raise awareness of its harms and improve access to drug treatment services,” said INCB President Toufiq, “At the same time we are concerned about the increasing use of social media to market drugs including to children and the ways that criminals are exploiting online platforms for illicit activities.”

Telemedicine and Internet pharmacies could improve access to healthcare and help reach patients with drug use disorders and deliver drug treatment services to more people. Online platforms could also be used for sharing information about adverse consequences of drug use and communicating warnings of adulterated drugs which could save lives.

International cooperation essential to tackle this growing trend

The global nature of online platforms makes collaborative efforts vitally important for identifying new threats and developing effective responses.

INCB is encouraging voluntary cooperation between governments and online industries to tackle the misuse of legitimate e-commerce platforms for drug trafficking. Its initiatives such as the GRIDS programme have led to drug seizures and arrests as well as criminal networks being dismantled.

The manufacturing, marketing, movement and monetization industries are particularly vulnerable to being exploited by those trafficking in dangerous substances. The Board says that increased cooperation is needed between governments, international organizations, regulatory authorities and the private sector to meet these evolving challenges.

Persistent disparities in access to medicines for the treatment of pain

In many parts of the world there is not enough affordable morphine available to meet medical needs. These persistent regional disparities in opioid analgesics used for pain treatment are not due to a shortage of opiate raw materials but rather in part due to inaccurate estimates of the actual medical needs of their populations. Levels of consumption of pain relief medicine remain highest in Europe and North America.

There was an acute need for medicines containing internationally controlled substances in 2023 for people caught up in natural disasters and emergencies related to climate change and conflict. INCB urges governments to use simplified control procedures in such situations to ensure unimpeded availability of these medicines.

Notable developments in illicit drug supply

In Afghanistan, illicit opium poppy cultivation and heroin production declined dramatically. INCB says that alternative livelihoods need to be offered to affected farmers who may not have other sources of income.

The opioid crisis continues to have serious consequences in North America with the number of deaths that involved synthetic opioids other than methadone continuing to increase, reaching more than 70,000 in 2021.

Drug trafficking organizations continue to expand their operations in the Amazon Basin into illegal mining, illegal logging and wildlife trafficking.

Record levels of illicit coca bush cultivation were recorded in Colombia and Peru, rising by 13 percent and 18 per cent respectively. Seizures of cocaine reached a record level in 2021 in West and Central Africa, a significant transit region for cocaine.

Several European countries have continued to establish regulated markets for cannabis for non-medical purposes. These programmes do not appear to be consistent with the drug control conventions.

South Asia appears to be increasingly being targeted for the trafficking of methamphetamine illicitly manufactured in Afghanistan to Europe and Oceania.

Pacific island States have transformed from solely transit sites along drug trafficking routes to destination markets for synthetic drugs. This is posing significant challenges to communities and their public health systems.

Precursors report

As part of international efforts to prevent illicit drug manufacturers from replacing certain controlled chemicals with closely related substitutes, the Board is recommending that a total of 16 amphetamine-type stimulant precursors (two series of closely related chemicals) are put under international control.

Two fentanyl precursors have also been assessed and recommended for international control by INCB, following a request made by the United States. The Precursors report also shows a surge in non-controlled fentanyl precursors in North America in 2023.

The Commission on Narcotic Drugs will vote at its session in March on placing all 18 substances under international control, through placement in Table I of the 1988 Convention.

INCB is concerned about the lack of audits and inspections in certain free trade zones which are susceptible to misuse for illicit activities. The Board calls on governments to ensure proper oversight over these zones to prevent them being exploited for precursor trafficking.


INCB is the independent, quasi-judicial body charged with promoting and monitoring Government compliance with the three international drug control conventions: the 1961 Single Convention on Narcotic Drugs, the 1971 Convention on Psychotropic Substances, and the 1988 Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances. Established by the Single Convention on Narcotic Drugs of 1961, the thirteen members of the Board are elected in a personal capacity by the Economic and Social Council for terms of five years. 



The lowered rates of substance use that youth reported after the start of the COVID-19 pandemic remained steady into 2023. However, the rate of fatal drug overdoses among youth, which rose in 2020, remained increased well into 2022.

After the COVID-19 pandemic and its associated school closures began in 2020, youth reported that they were using illicit substances significantly less, according to the 2023 Monitoring the Future survey. Among 12th graders, use of any illicit substances in the previous year fell from 36.8% in 2020 to 32% in 2021. Among 10th graders, the rate fell from 30.4% to 18.7%, while it fell from 15.6% to 10.2% among 8th graders.

Rate of Reported Past-Year Illicit Substance Use Among 8th, 10th, and 12th Graders.

Many schools have returned to in-person learning since the fall of 2021, and yet the percentage of students reporting any illicit substance use in 2023 has held steady at the lowered levels reported during the pandemic, according to the most recent Monitoring the Future survey. In 2023, 31.2% of 12th graders, 19.8% of 10th graders, and 10.9% of 8th graders reported any illicit substance use in the past year.

Monitoring the Future has tracked national substance use among 8th, 10th, and 12th graders at hundreds of schools across the country annually since 1975. It is conducted by the University of Michigan and funded by the National Institute on Drug Abuse (NIDA).

Addressing substance use among youth, especially with regard to prevention, should involve not only reaching out to institutions like schools, but also connecting with families to engage them, said Anish Dube, M.D., M.P.H.

“This is encouraging news,” said Anish Dube, M.D., M.P.H., chair of APA’s Council on Children, Adolescents, and Their Families. “Peers have a huge influence on young people and the types of decisions they make. For better or worse, the pandemic limited the amount of time young people physically spent with their peers, and this may be at least one reason why we saw less risk-taking behavior among youth.”

Youth who responded to the survey most commonly reported drinking alcohol, vaping nicotine, and using cannabis in the past year. Compared with 2022 levels, past-year use of alcohol fell among 12th graders and remained stable for 10th and 8th graders. Nicotine vaping declined among 12th and 10th graders and remained stable among 8th graders. Finally, cannabis use remained stable among students in all three grades.

Unintentional Drug Overdose Death Rates Among U.S. Youth Aged 15-19.

Simultaneously, however, in recent years the rate of fatal overdoses among youth has increased. A 2022 study published in JAMA found that, beginning in 2020 until June 2021, adolescents experienced a greater relative increase in overdose mortality compared with the overall population. An analysis by NIDA published last December found that the upward trends previously reported continued into the summer of 2022. Between the end of 2019 and the beginning of 2020, the rate of unintentional overdose deaths per 100,000 population among youth aged 15 to 19 rose from 0.89 to 1.32. The rate has not declined since that increase. In the summer of 2022, the rate was 1.63.

“In my own clinical experience, one of the biggest challenges has been the widespread availability of fentanyl and its derivatives, their lethality, and the ease with which they can be laced into other substances that young people are trying,” Dube said.

When youth weren’t seeing their friends during the COVID-19 pandemic shutdowns, they did not have the peer interactions that may lead to substance use, said Oscar Bukstein, M.D., M.P.H.

The illicit substances available now are highly addictive and can provide a quick and intense high, said Oscar Bukstein, M.D., M.P.H. That is part of the reason the rate of overdose deaths among adults is so high, and the same is likely true for youth.

“Young people in particular are usually novice drug users,” Bukstein pointed out. Just like younger adolescents are more likely to experience alcohol poisoning, youth who are using other illicit substances may similarly be unaware of the true danger of what they are using, he explained. Bukstein is a member of APA’s Council on Children, Adolescents, and Their Families and a professor of psychiatry at Harvard Medical School.

Bukstein also noted that, because Monitoring the Future surveys youth in schools, those who are not in school due to high-risk behaviors such as truancy or dropping out are less likely to be included. That means the survey may not capture youth who are at the highest risk for substance use. These youth need far more resources than are available to them, such as residential treatment for those who need more than intensive outpatient care, Bukstein said.

Overall, Bukstein is optimistic about Generation Z, he added. “I’ve noticed that there’s a greater sense among the general adolescent population that they want something out of life,” he said. “They know these substances are dangerous, that they are not going to get them where they want to go, and they don’t need them.”


The United States is knee-deep in what some experts call the opioid epidemic’s “fourth wave,” which is not only placing drug users at greater risk but is also complicating efforts to address the nation’s drug problem.

These waves, according to a report from Millennium Health, were the crisis in prescription opioid use, followed by a significant jump in heroin use, then an increase in the use of synthetic opioids like fentanyl.
The latest wave involves using multiple substances at the same time, combining fentanyl mainly with either methamphetamine or cocaine, the report found. “And I’ve yet to see a peak,” said one of the co-authors, Eric Dawson, vice president of clinical affairs at Millennium, a specialty laboratory that provides drug-testing services to monitor use of prescription medications and illicit drugs.
The report, which takes a deep dive into the nation’s drug trends and breaks usage patterns down by region, is based on 4.1 million urine samples collected from January 2013 to December 2023 from people receiving some kind of drug-addiction care.
Its findings offer staggering statistics and insights. Its major finding is how common polysubstance use has become. According to the report, an overwhelming majority of fentanyl-positive urine samples — nearly 93% — contained additional substances. “That is huge,” said Nora Volkow, director of the National Institute on Drug Abuse at the National Institutes of Health.
The most concerning, Volkow and other addiction experts said, is the dramatic increase in the combination of methamphetamine and fentanyl use. Meth, a highly addictive drug often in powder form that poses several serious cardiovascular and psychiatric risks, was found in 60% of fentanyl-positive tests last year. That is an 875% increase since 2015.
“I never, ever would have thought this,” Volkow said.
Among the report’s other key findings:

  • The nationwide spike in methse alongside fentanyl marks a change in drug use patterns.
  • Polydrug use trends complicate overdose treatments. For instance, naloxone, an opioid-overdose reversal medication, is widely available, but there isn’t an FDA-approved medication for stimulant overdose.
  • Both heroin and prescribed-opioid use alongside fentanyl have dipped. Heroin detected in fentanyl-positive tests dropped by 75% since peaking in 2016. Prescription opioids were found at historic low rates in fentanyl-positive tests in 2023, down 89% since 2013.

But Jarratt Pytell, an addiction medicine specialist and assistant professor at the University of Colorado’s School of Medicine, warned these declines shouldn’t be interpreted as a silver lining.
A lower level of heroin use “just says that fentanyl is everywhere,” Pytell said, “and that we have officially been pushed by our drug supply to the most dangerous opioids that we have available right now.”
“Whenever a drug network is destabilizing and the product changes, it puts the people who use the drugs at the greatest risk,” he said. “That same bag or pill that they have been buying for the last several months now is coming from a different place, a different supplier, and is possibly a different potency.”
In the illicit drug industry, suppliers are the controllers. It may not be that people are seeking out methamphetamine and fentanyl but rather that they’re what drug suppliers have found to be the easiest and most lucrative product to sell.
“I think drug cartels are kind of realizing that it’s a lot easier to have a 500-square-foot lab than it is to have 500 acres of whatever it takes to grow cocaine,” Pytell said.
Dawson said the report’s drug use data, unlike that of some other studies, is based on sample analysis with a quick turnaround — a day or two.
Sometimes researchers face a months-long wait to receive death reports from coroners. Under those circumstances, you are often “staring at today but relying on data sources that are a year or more in the past,” said Dawson.
Self-reported surveys of drug users, another method often used to track drug use, also have long lag times and “often miss people who are active for substance use disorders,” said Jonathan Caulkins, a professor at Carnegie Mellon University. Urine tests “are based on a biology standard” and are good at detecting when someone has been using two or more drugs, he said.
But using data from urine samples also comes with limitations. For starters, the tests don’t reveal users’ intent.
“You don’t know whether or not there was one bag of powder that had both fentanyl and meth in it, or whether there were two bags of powder, one with fentanyl in it and one with meth and they took both,” Caulkins said. It can also be unclear, he said, if people intentionally combined the two drugs for an extra high or if they thought they were using only one, not knowing it contained the other.
Volkow said she is interested in learning more about the demographics of polysubstance drug users. “Is this pattern the same for men and women, and is this pattern the same for middle-age or younger people? Because again, having a better understanding of the characteristics allows you to tailor and personalize interventions.”
All the while, the nation’s crisis continues. According to the Centers for Disease Control and Prevention, more than 107,000 people died in the U.S. in 2021 from drug overdoses, most because of fentanyl.
Caulkins said he’s hesitant to view drug use patterns as waves because that would imply people are transitioning from one to the next.
“Are we looking at people whose first substance use disorder was an opioid use disorder, who have now gotten to the point where they’re polydrug users?” he said. Or, are people now starting substance use disorders with methamphetamine and fentanyl, he asked.
One point was clear, Dawson said: “We’re just losing too many lives.”



Illicit fentanyl, the driving force behind the U.S. overdose epidemic, is increasingly being used in conjunction with methamphetamine, a new report shows.

The laboratory Millennium Health said 60% of patients whose urine samples contained fentanyl last year also tested positive for methamphetamine. Cocaine was detected in 22% of the fentanyl-positive samples.

Millennium officials said the report represents the impact of the “fourth wave” of the nation’s overdose epidemic, which began over a decade ago with the misuse of prescription opioids, then came a heroin crisis and more recently an increase in the use of illicit fentanyl. The study found that people battling addiction are increasingly using illicit fentanyl along with other substances, including stimulants such as methamphetamine and cocaine.

The report suggests heroin and prescription opioids are being abused less often than they were a decade ago. Of the urine samples containing fentanyl analyzed in the report, 17% also contained heroin and 7% showed the presence of prescription opioids.

The Millennium report is based on analyses of urine samples collected from more than 4.1 million patients in 50 states from Jan. 1, 2013, to Dec. 15, 2023. The samples were collected in doctors’ offices and clinics that see patients for pain, addiction and behavioral health treatment.

Overall, 93% of fentanyl samples tested positive for at least one other substance, a concerning finding, said Dr. Nora Volkow, director of the National Institute on Drug Abuse.

“I did not expect that number to be so high,” she said.

Overdose deaths climb

Drug overdose deaths in the United States surged past 100,000 in 2021 and increased again in 2022. Provisional data from the Centers for Disease Control and Prevention showed overdose deaths through September 2023 increased about 2% compared with the year before.

Other reports show that stimulants, mostly methamphetamine, are increasingly involved in fentanyl overdoses. In 2021, stimulants were detected in about 1 in 3 fentanyl overdose deaths, compared with just 1 in 100 in 2010.

The finding of methamphetamine in so many samples is especially concerning, said Eric Dawson, vice president of clinical affairs Millennium Health.

“Methamphetamine is more potent, more pure and probably cheaper than it’s ever been at any time in this country,” Dawson said. “The methamphetamine product that is flooding all of our communities is as dangerous as it’s ever been.”

Methamphetamine has no rescue drugs, treatments

As methamphetamine use appears to play a larger role in the addiction crisis, the medical community does not have the same tools to counter its misuse.

Naloxone and similar overdose reversal medications counteract opioid overdoses by blocking opioid receptors in the brain to quickly reverse the effects of an overdose. Narcan, a nasal spray version of naloxone, can be purchased and is kept in stock by public health departments, schools, police and fire departments and federal agencies nationwide. Chain retailers such as CVS, Walgreens, Rite Aid and Walmart began selling Narcan over the counter without a prescription.

But there is no medication approved by the Food and Drug Administration for overdoses involving stimulants such as methamphetamine.

Opioid substitute medications such as methadone and buprenorphine are used to reduce cravings and ease withdrawal symptoms from opioids. There are no equivalent medications, however, for people who are dependent on methamphetamine or other stimulants, Dawson said.

That deficit is glaring, Dawson said: “We need effective treatments for stimulant-use disorder.”

Meth samples more common in the West

The Millennium report also found that drug use differed by region, and methamphetamine samples were detected more frequently in the western U.S.

Methamphetamine was detected in more than 70% of fentanyl-positive urine samples in the Pacific and Mountain West states. Meth showed up least often in fentanyl-positive samples in the mid- and south-Atlantic states, the report said.

Cocaine appeared to be more prevalent in the eastern U.S. More than 54% of fentanyl-positive samples in New England also had cocaine. By comparison, fewer than 1 in 10 of the samples showed cocaine in the mountain region of the West, the report said.

Other findings from the report:

∎ The presence of cocaine samples in fentanyl-positive specimens surged 318% from 2013 to 2023.

∎ The presence of heroin in fentanyl-positive specimens dropped by 75% after a peak in 2016.

∎ The presence of prescription opioids in fentanyl-positive specimens dropped to an all-time low in 2023, which researchers cite as evidence that the U.S. addiction crisis has shifted from pain medications.

Nationwide, the addiction epidemic has evolved to a phase in which people are often using multiple substances, not just fentanyl, Volkow said. This polysubstance abuse complicates matters for public health authorities seeking to slow the nation’s overdose deaths.

Volkow said reports such as Millennium Health’s are important because they give researchers a snapshot of the nation’s evolving drug use and provide more timely data than death investigations from overdoses can offer.



Why Do People Relapse? Understanding and Overcoming Relapse in Substance Abuse Recovery: Embarking on the journey of addiction recovery is a tough, but worthwhile goal. However, it is not uncommon for you to face setbacks in the form of relapse during your recovery journey.

In this blog post, we will explore the reasons why people relapse in drug addiction, explore the various stages of relapse, and discuss effective strategies for preventing relapse. Understanding these aspects is crucial for you, your family members, and addiction treatment programs to help you best achieve recovery.

Why Relapse Occurs During Drug Abuse Recovery

The biggest stumbling block people face on the path of recovery is when they slip up. Knowing why relapse happens is critical for those working on getting clean and those helping them out. Let’s dive into the four big causes of going back to drugs during recovery – how mental health problems, ineffective ways of dealing with stress or emotions, intense withdrawal symptoms, and not setting solid limits work together to trip people up.

Mental Health Issues Combined With Substance Addiction

Mental health challenges often coexist with substance abuse. Attending a dual diagnosis treatment program, which addresses both mental health issues and substance use disorder, can significantly increase the effectiveness of your recovery efforts.

Your dual diagnosis treatment team understands how substance use disorders are a chronic disease and will work to give you the tools you need to successfully tackle recovery and lay the groundwork for a sober life.

Poor Coping Skills

Many individuals turn to drugs or alcohol as a coping strategy to deal with negative emotions, stress, conflict in relationships, and peer pressure. As the Marlatt and Gordon model establishes, the seeds of relapse are planted in a high-risk scenario and nurtured by unhealthy coping skills.

If you are facing elevated stress levels, coupled with poor coping skills, you are at a much greater risk for addiction relapse. Negative emotions like anger, depression, anxiety, and boredom can also increase your risk for returning to drug and alcohol use for comfort.

Simply put, without effective coping skills, relapse rates drastically increase.

Uncomfortable Withdrawal Symptoms During Detox

The physical discomfort experienced during withdrawal can be overwhelming, leading your to turn to substance use to alleviate these symptoms. All will to stay sober can easily vanish in the face of intense cravings and physical pain, even if you are fully aware of the consequences.

The vulnerability during the withdrawal phase, coupled with the desire to avoid physical and mental distress, underscores the importance of comprehensive support and coping strategies to navigate this critical stage of the recovery journey successfully.

Lack of Healthy Boundaries

A strong contributor to relapse is your social environment- the people you surround yourself with. Having friends or family members who engage in drug abuse and significantly challenge your recovery and your resolve to stay sober. Even just being around them can trigger intense cravings, heightening your risk of relapse.

Establishing and maintaining well-defined boundaries is crucial for preventing relapse. Without clear boundaries, individuals may find themselves in situations that trigger drug use.

The Stages of A Relapse

A relapse can happen in many ways. What is commonly seen as a “traditional” relapse happens when you consciously decide to consume alcohol or use drugs. This might involve choosing to smoke marijuana to reduce stress after a substantial period of sobriety or having a glass of wine with friends, believing you can handle it without spiraling into excessive use.

On the flip side, a “freelapse” is the informal term for an accidental relapse, which occurs when you unintentionally use drugs or alcohol.

This could occur if you mistakenly consume alcohol, thinking it is a non-alcoholic drink at a party.

At times, the path toward a relapse unfolds without you even realizing it, manifesting in actions taken weeks or months before using drugs or alcohol. Specific thoughts, emotions, and events can act as triggers, sparking cravings and urges for drug use. If not effectively addressed, these triggers can significantly elevate the risk of relapse, which is why it is extremely important to proactively manage these risk factors in the recovery process.

Emotional Relapse Stage

The onset of the emotional relapse stage before actually picking up a drug or sipping a drink. In this phase, you may find yourself struggling to manage your negative emotions in a healthy manner. Rather than addressing your feelings openly, there might be a tendency to bottle them up, withdraw from social interactions, deny the existence of problems, and overlook self-care.

Although the thought of drug and alcohol use may not be at the forefront of your mind during this stage, the avoidance of confronting emotional pain and challenging situations sets the stage for potential relapse in the future. Recognizing and addressing these early signs becomes crucial in preventing future relapse and fostering a healthier recovery journey.

Mental Relapse Stage

In the mental relapse phase, you may struggle with conflicting emotions surrounding sobriety. Within this stage, there is an internal struggle: one side strives to remain sober, while the other wrestles with cravings, harboring secret thoughts about a potential relapse.

Mental relapse goes beyond mere internal conflict; it includes romanticizing past drug use, downplaying the negative feelings and consequences, and actively seeking opportunities for using drugs or alcohol. This intricate mental struggle highlights the delicate balance you have to maintain between your substance addiction and your will to recover.

Physical Relapse Stage

The physical relapse stage is where the actual addiction relapse occurs. What starts out as an initial slip, perhaps with just a few sips of a drink or or hit of a drug, can quickly escalate into a full-blown relapse, characterized by a complete loss of control over your actions and total drug dependence.

The importance of recognizing early warning signs and implementing effective strategies to prevent progression towards physical relapse in the ongoing journey of drug recovery.

What To Do If You Relapse

Whether you have relapsed before or not, knowing what to do if you slip back into the throws of drug abuse is critical for getting back on track and preventing future relapse. No relapse is insurmountable and there’s always an opportunity for recovery.
If you have experienced a relapse, quickly follow these proactive steps to minimize the negative effects of drug use and prevent further substance use.

1. Ask for help. Seeking assistance from family members, friends, and other addicts in the recovery process can significantly help you navigate the challenges of relapse. Create a sober support system and immerse yourself in it. The worst thing you can do in early recovery is suffer in silence.

2. Find support groups near you. Both traditional twelve-step support groups like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), as well as science-based alternatives like SMART Recovery, offer nonjudgmental spaces for you to discuss substance abuse relapses openly. With meetings available on a daily basis, you can quickly find a support group that’s right for you, allowing you to talk about your relapse experiences within 24 hours of it happening.

3. Avoid triggers at all costs. Being around people, places, situations, etc… that are triggering to you, in the aftermath, of a relapse can be detrimental to your recovery, and actually intensify your cravings. By putting distance between yourself and your triggers helps to create an environment ripe for addiction recovery.

4. Establish healthy boundaries. In all stages of substance abuse recovery, but especially shortly after a relapse, it’s vital to set boundaries to protect yourself from threats against your sobriety. A key component to maintaining firm personal boundaries is steering clear of people who are not completely onboard with your choice to be sober. These people will only try to pressure you back into a lifestyle of using drugs or alcohol, so surrounding yourself with your sober support system is the only way to remain sober after a relapse.

5. Prioritize your self-care. Both your mental and physical well-being should be taken care of, especially in the wake of a relapse, and is one of the key components of recovery, and it gives you a way to relieve tension and reduce stress.

6. Self-reflect about why the relapse happened. Rather than seeing a relapse as a setback, you can see it as a learning tool. Dedicate time to reflect on the circumstances leading to the relapse. Explore the events that unfolded before the relapse occurred. Did you try out any other coping mechanisms prior to resorting to substance use? Think about potential alternatives to using or drinking that you could have used.

Asking yourself these questions offers insights into what you can do differently, encouraging a constructive approach to managing challenges that arise along your path to substance use disorder recovery.

7. Come up with a relapse prevention plan. This is a guide designed to be a steadfast companion to help you maintain sobriety. It should be as detailed as possible, and easy to follow when needed.

Acting promptly after a relapse significantly increases your chances of a quick recovery with minimal negative consequences. It is important to remember that recovery is not linear or bound by time constraints. It is never too late to regain control after a relapse.

If early recovery seems too overwhelming, seek drug addiction treatment to help manage the task. Some treatment centers offer an inpatient program with medical detox and behavioral therapies to help you regain your footing and relapse prevention classes to help you assimilate back into your daily life with the help of addiction specialists.

How to Prevent Relapse After Drug Addiction Treatment

Preventing relapse in addiction recovery involves a complex approach that addresses both the physical and psychological aspects of your substance use.

To start off, recognizing the specific situations or emotions that may lead to relapse and developing effective coping strategies, whether through therapy, mindfulness, or healthy activities, is paramount in navigating through moments of weakness. Building and maintaining a strong support system, made up of supportive friends, family, and possibly support groups, provides a crucial safety net.

Additionally, the creation of a personalized relapse prevention plan, including detailed strategies for recognizing and managing triggers, is vital to staying sober. Regular self-reflection and adjustments to the plan over time ensure its continued effectiveness, empowering you to maintain lifelong sobriety.

Compose a Relapse Prevention Plan

Creating a personalized plan to prevent addiction relapse is a crucial component of substance abuse recovery. This plan should include strategies for recognizing triggers and coping with cravings. It should also outline your specific triggers for drug use, as well as at least 3 positive coping skills that work for you.

Additionally, your relapse prevention plan should list specific people who are in your sober support system, with their phone numbers, who you can call for help when you are feeling the urge to use. You should also compile a list of local addiction support groups that can be there for you in your time of need.

Regularly consulting and revising this plan is instrumental, making sure it stay relevant to your evolving life experiences and fortifying your commitment to a sober life.

Build a Supportive, Nurturing Environment

Building a strong support system and fostering a supportive environment are key factors in maintaining long-term sobriety. Creating a nurturing atmosphere involves not only external factors but also the changes you make within yourself.

Most addicts relapse because they do not change both the people they hang around with, as well as the way they approach situations in life after completing an addiction treatment program and in the early stages of recovery. By attending a local support group meeting, you can meet and befriend people who are going through the same things you are and you can be pillars of strength for each other.

Further, you may find it helpful to make a list of fun activities that do not involve drinking alcohol or using drugs. This list may be helpful when you are experiencing cravings and need to divert your attention.

Maintain a Positive Mindset

Cultivating a positive mindset not only enhances your motivation and resilience during challenging times but also reinforces your belief in yourself and your capacity for personal growth and living a fulfilling, sober life. Your positive outlook serves as a powerful ally in overcoming obstacles, nurturing a sustainable foundation for lasting recovery.

Make Your Self Care a Priority

Prioritizing self-care, including healthy habits and activities, contributes to overall well-being and reduces the risk of relapse. Self-care encompasses a range of activities that bring you pleasure without causing harm, including but not limited to yoga, meditation, exercise, reading, journaling, and eating healthy foods.

Why Do People Relapse During the Recovery Process?

Recovery from drug addiction is a complex journey that requires dedication, resilience, and ongoing support. By understanding the reasons behind relapse, implementing effective treatment programs, and adopting preventative strategies, you can increase your chances of achieving and maintaining long-term sobriety.

Remember, relapse does not signify failure but rather serves as an opportunity for growth and reinforcement of your commitment to recovery.


Washington tribal leaders are looking at an overseas model to combat the rise in opioid use among teens.

It’s called the Icelandic Prevention Model, and it’s helped slash alcohol use among Icelandic 15- and 16-year-olds from 77% to 35% in 20 years.

“There’s no other model in the world that has that kind of turnaround in the community,” said Nick Lewis, councilmember of the Lummi Nation and chairman of the Northwest Portland Area Indian Health Board.

Washington has dubbed its effort the “Washington Tribal Prevention System” and the Health Care Authority, along with five tribes, will partner with Planet Youth, a non-profit bringing the Icelandic Prevention Model to other places.

The model involves re-thinking how to discourage drug use by placing responsibility on the community, rather than the individual. Instead of asking kids to “just say no,” the Icelandic Prevention Model calls on the adults in a child’s life to create an environment without drugs and alcohol, said Margrét Lilja Guðmundsdóttir, chief knowledge officer at Planet Youth.

“The child should never be responsible for the situation in the community,” Guðmundsdóttir said.

The Washington Tribal Prevention System officially kicked off its ten-year pilot program with the ceremonial signing of contracts on Feb. 14. The five tribal governments participating are Jamestown S’Klallam Tribe, Lummi Nation, Tulalip Tribes, Swinomish Indian Tribal Community and Colville Tribes.

In Washington, American Indian and Alaska Native residents have the highest rate of death from opioid overdoses, far outpacing other races and ethnicities, according to state Department of Health data. 

“Our stories might be different,” Lewis said. “But if they can turn things around, we can too.”

The first two years, the Health Care Authority officials said, are just administrative planning, which will cost $2 million to $3 million a year. Gov. Jay Inslee has called for $1 million for the project in his supplemental budget proposal this year, and the rest of the money would come from federal grants.

Whether lawmakers will provide the $1 million Inslee requested or some other amount for the program will become clearer in the days ahead as the Legislature irons out budget legislation.

When the program moves out of the planning phase – scheduled to happen in its third year – costs are expected to go up dramatically. But Aren Sparck, tribal affairs administrator for the Health Care Authority, said he’s optimistic about finding funding from both private and public entities because of how much interest there is in the model.

Sparck also said the program could be adopted by other tribes and communities. “I think this is going to be a test for the entire state,” he said.

What exactly is the Icelandic model?

In Iceland, youth, parents, schools, the government and other community members work in tandem to create an environment that discourages drug use.

For example, the country has free after-school activities funded by the government. Kids are bussed directly to those activities. Youth councils help shape what activities happen, so teens are actually interested. It’s about making drug-use prevention a lifestyle, said Loni Greninger, tribal vice chair at Jamestown.

Last year, Health Care Authority officials and several tribal delegations visited Iceland to see the model for themselves. Sparck said he was skeptical at first — but when he saw the model in person, “jaws were on the floor.” The way Iceland has managed to make its model just a part of daily life, Sparck said, is exactly what he wants to see in Washington.

“I was talking to some of the youth and asking them, ‘What’s it like to be in the world’s most successful prevention model? And they asked us, ‘What’s the Icelandic Prevention Model?’” Sparck said.

Sparck said one of the things he learned about was a large dance party that young people in Iceland helped plan. Students invited one of the well-known DJs in Europe and policed each other, ensuring there were no drugs and alcohol at the event.

“What we saw was empowering the youth to make their decisions together. So they own this, and they’re a part of it and invested in it,” Sparck said.

Putting trust in youth to help create an alcohol and drug-free environment is also a big part of the model, officials said.

“A child wants a healthy environment,” Lewis said. “A child wants to grow up and be healthy. You never hear a child say ‘I want to grow up and be a drug addict.’”

The tribal model

The Icelandic Prevention Model relies on cultural practices within Iceland. Planet Youth works with its partners to translate the model into their own cultures, Guðmundsdóttir said.

While this is the first time Planet Youth has worked with tribal governments, Guðmundsdóttir and tribal leaders said Iceland and Washington’s tribes share a lot of values in common — namely the belief that it takes a community to raise a child.

“You’re literally wrapping your arms around these kids in everything prevention and wellness,” Greninger said about Iceland’s model.

“That’s what we tribes aspire to do,” she said. “But when you are working with separate entities, we all have our own visions and missions and agendas, we’re all busy every single day. It’s hard to line up all of that.”

Planet Youth — and efforts to implement Iceland’s model in other places — are relatively new, and it took Iceland decades to get where it is now. But there’s already research suggesting Iceland’s model is transferable.

“It’s not a quick fix,” Guðmundsdóttir said. “It’s a never-ending story. You will always have new kids, new parents, new kinds of substances.”

“It’s not a one-year project. It’s a long-term way of thinking,” she added.

When Lummi Nation policymakers presented the Iceland Prevention Model to Lewis, he said he recognized it as just another name for what his tribe is already doing, but without the resources they need to implement it at the level Iceland has.

According to Lewis, it’s often difficult to get funding for tribal drug treatment practices because they aren’t always considered evidence-based — and it’s almost impossible to gather enough proof that a tribal practice works because tribal populations are so small.

The Icelandic Prevention Model, to Lewis, proves that what tribes have already been trying to do works when it’s fully resourced. He hopes using Iceland’s model will help raise the funding needed and remove the silos between different efforts in Washington.

“If we’re going to break this cycle, we need to go back to creating healthy environments and get back to the values that bring people together,” Lewis said.


“I never imagined that sports could do this”: UNODC celebrates the power of sports in preventing violence, crime, and drug use among youth on the International Day of Sports


Alice*, a 15-year-old living in a rural area in Nigeria, was struggling. Feeling lonely at home, subjected to punishment for the smallest of reasons, she had tried everything in an effort to cope. Running away from home. Cutting her wrists with a razor in a failed suicide attempt. Drinking alcohol. Taking too many sleeping pills.

Her drug use, once discovered by her father, threatened to further derail her young life, for he would delay paying her school fees, claiming her education had been a wasted investment. Cut off from her friends, Alice’s isolation deepened.

Eventually, Alice returned to school, where she was enrolled in the United Nations Office on Drugs and Crime (UNODC)’s “Line Up Live Up” (LULU) programme. LULU uses sports-based life skills training to empower youth and enhance their resilience to violence, crime, and drug use.

The programme struck a chord with Alice, who reported that the “LULU programme gave me a whole new meaning and understanding of life.” Alice recalled several lessons that stuck out for her during LULU, including one which required the students to run to the opposite side of the hall without being hit by balls flying from all directions. Each time the students were struck, they would have to start all over again.

Alice noted that at first, she was embarrassed each time a ball would hit her. It reminded her of the shame she had felt facing her friends after her father reported her drug use to the school. “I kept having to start all over again,” she said, but “I succeeded at the tail end and it taught me to never give up.”

Youth face many challenges that make them vulnerable to crime, violence, and victimization. Sports can offer vulnerable youth a sense of identity and belonging while also enhancing their physical and mental health and wellbeing. When used in an intentional, well-designed manner, sports can serve as a useful vehicle for cognitive, social, and emotional learning and key life skills. They can challenge harmful stereotypes and normative beliefs linked to violence and crime, including gender-based violence. Finally, sports can create safe spaces for young people and local communities to positively interact, promote tolerance, and contribute to building safe, just, and fair societies.

The UNODC Global Initiative on Youth Crime Prevention through Sport promotes the effective use of sport as a tool for addressing known risk and protective factors to youth violence and crime in order to reduce juvenile delinquency and offending and prevent drug use. It also supports the design and delivery of tailored sport-based interventions to prevent youth victimization and recruitment by organized criminal groups, including from gangs and violent extremist groups.

Alice’s principal attested to the transformation she witnessed among her students. “I thought that the LULU programme would be targeting drugs and academics,” she said. “Little did I know that this knowledge could be transferred to other, deeper personal and social life situations. The program digs for the biggest problems in the student’s lives and helps them solve them in their own ways.

Truly, I never imagined that sports could do this.”



The majority of adults with substance use disorders start during their adolescent years. That’s why experts say prevention efforts in schools are paramount, but many schools struggle with implementation.

According to a survey by the Education Week Research Center in 2022, 67% of school health workers say that dealing with students who are vaping and using alcohol, marijuana, or opioids is “a challenge” or “a major challenge.”

The moment to address a gap in school prevention could not be more prime for action, experts say, as more young people between the ages of 10 and 19 have died of overdoses across the U.S. The driving factor behind those deaths is fentanyl, a potent synthetic opioid.

“In the era of fentanyl, with experimentation, plenty of kids die because they just don’t know that that’s a risk,” said Chelsea Shover, an epidemiologist who studies substance use at the University of California, Los Angeles.

Even a tiny amount of fentanyl can kill. In 2021, the synthetic opioid was identified in more than three-quarters of adolescent overdose deaths.

Some experts pointed out that children may purchase pain medication or prescription stimulant pills on social media, which –– unbeknown to them –– can be counterfeit and laced with fentanyl.

The U.S. Drug Enforcement Administration has seized a record 86 million fentanyl pills in 2023, which already exceeds last year’s total of 58 million pills.

Shover said, with this rapidly changing landscape, schools are slow to adapt.

“Your [school’s] alcohol and tobacco curriculum can probably stay pretty much the same. But your curriculum around opioids and overdose and street drugs needs to be updated to what’s actually happening,” she said.

Prevention sometimes takes a backseat

Schools often have more robust processes in place to react when a student is known to use substances – prevention often takes a back seat.

The goal of these prevention efforts, experts say, should not be to tell kids to say no to drugs. Ideally, they would provide young people with facts about the health, social, and legal concerns that come with substance use and hone social skills and competencies that help kids cope with stressors.

Research suggests that social influences are central and powerful factors in both promoting and discouraging substance use among adolescents, and that many of them turn to substances to cope with anxiety or stress and some do it when they’re bored.

“When you’re talking about substance use prevention, what you’re really talking about is helping children develop the skills and competencies to withstand the pressures and to be able to prevent them from starting to use substances in the first place, or at least, knowing where to turn and those kinds of skills get built up very early,” said Ellen Quigley, vice president at the Richard M. Fairbanks Foundation. The foundation provides funding to 159 Indianapolis Schools through its Prevention Matters initiative.

Students who are not engaged in school or fail to develop or maintain relationships and those who fail academically are more likely to engage in substance use, one study found. Some of the crucial skills to teach as part of prevention efforts include conflict resolution, how to make friends, and how to deal with bullying, Quigley said.

Then, comes the messenger.

Experts say kids may be reluctant to ask for help from people who can get them in trouble like teachers and police officers. A report from the National Council for Mental Wellbeing found that only 17% of teenagers said they trust teachers or other educators. The report suggests that students have more trust in doctors, nurses and nonprofit workers.

“Drug education, it’s partly to tell students about what’s going on, and what tools are there, what risks there are, but it’s also to open a conversation for students who are struggling either themselves with substance use, or their friends are,” Shover at UCLA said.

Limited resources stand in the way

There has been substantial progress in developing and studying prevention programs for adolescent drug use, but challenges to effective implementation persist.

“While there was a lot of attention to treatment, which makes a lot of sense, there weren’t a lot of resources available for prevention,” said Quigley

Integrating prevention programs requires time and money, which some schools say they don’t usually have –– especially in lower-income communities where resources overall are limited.

One place where this is evident is Logansport School Corporation, the largest school district in Cass County, Ind. It’s a rural part of the state that is around an hour and a half north of Indianapolis, with a below-average income level. Major employers in the county are mostly manufacturing plants and meat processing facilities. Compared to most other rural communities in Indiana, the county has a large immigrant population.

Over the past few years, it has seen a steady increase in opioid use.

The school district has leaned in on peer mentorship as an approach for prevention and support to those who use substances, said Logansport School District Superintendent Michele Starkey.

“We know that those positive relationships are key to the success of students. And so that’s something that we have identified as being a huge need,” she added.

Experts say peer mentorship is a promising approach.

But the school district has had to halt other programs due to lack of funding, said Jennifer Miller, the principal of the Junior High.

“There used to be a program throughout the county that would specifically address substance abuse, vaping with the junior high level kids. And so, that doesn’t exist anymore. But there is such a need for it,” Miller said.

Tens of millions of dollars are coming to states across the country. It’s part of a major settlement with opioid manufacturers and distributors for their role in the opioid epidemic. There’s also federal and state funding available.

Logansport school district and 4C Health, a federally qualified healthcare center, got a million dollars in federal funding a few months ago.

Lisa Willis-Gidley, the Chief Revenue Officer at 4C Health, said they depend on such grants because prevention programs are not covered by insurance. Still, she says implementing effective programs can be a challenge.

“Schools don’t have a ton of time,” she said. “They’ve got to focus on their goals and their academics. And so, you have to look at can we give them these pieces of valuable material in a manner that’s not going to be totally disruptive to their academic goals and performance?”

Experts say federal and state legislation can help set standards for substance use education and ensure enough funding for schools that need it.



Appointing Jeff Sessions as US Attorney General infused new life into those of us who know that marijuana is destroying our nation from within. But were we premature in believing that Donald Trump would put an end to what Barack Obama and George Soros inflicted on this nation in the last eight years? After eight months, we still don’t have federal drug policy flowing from the President.

The pattern of past presidents is familiar. Bill Clinton moved the Office of National Drug Control Policy (ONDCP) to a backwater, and reduced its size by about 75 per cent. In 1996, with help from Hillary Clinton and investor George Soros, Clinton allowed California to violate federal laws and become the first victim of the ‘medical marijuana’ hoax. Soros, Peter Lewis and John Sperling, all out-of-state billionaires, financed that campaign with close to $7million (£5.3million).

Obama downgraded the position of Drug Czar from cabinet level to reporting to the Vice President. He then allowed, or directed, Attorney General Eric Holder to ignore the inherent responsibility of the Executive Branch to enforce federal law. Drug strategy in ONDCP was changed to focus on ‘harm reduction’, the subversive ploy of Soros to focus on treatment and rehabilitation, at the expense of primary prevention. The President espoused the claim that ‘marijuana is no worse than alcohol’, leaving most people with a flawed impression. Federal agencies such as the Substance Abuse and Mental Health Services Administration (SAMHSA) spent their fortunes on anything other than marijuana. Congress passed the Rohrabacher/Farr Bill which withheld federal dollars from the Drug Enforcement Administration (DEA) so they couldn’t even enforce the law. The result? Twenty-nine states now have some form of legalised pot. Marijuana users had increased from about 15million to 22.3million Americans at the last count.

Now comes President Trump. During the campaign he indicated he felt legalising marijuana should be a state’s right. He is wrong, but could be forgiven if he took the time to learn why. He was building a hotel empire while many of us have been fighting the drug problem for 40 years. The truth about marijuana has been so misrepresented and suppressed for the last 20 years that he, like most people, doesn’t know what to believe. He has the best scientific information in the world available to him, but the question is: who is giving him advice? Anyone? Or drug legalisers such as Rohrabacher, Peter Theil, Trump confidant Roger Stone? Or even George Soros?

The truth is, marijuana was a dangerous drug 50 years ago, when the potency was only 0.5 per cent to 2 per cent. Today’s highly potent pot, with an advertised range of 25 per cent (+/-) of the active ingredient THC, and up to 98 per cent as wax or oils used in edibles, dabbing and vaping, has the potential to destroy the country by ruining our collective health and intellectual capacity.

Experts such as Dr Stuart Reece from Australia or Dr Bertha Madras of Harvard will attest that marijuana use by either parent can cause congenital abnormalities in a foetus. What’s worse, these abnormalities can affect the next four generations.

Psychotic breaks, mental illness and addiction caused by marijuana have led to a substantial increase in crime, homelessness, erosion of the quality of our inner cities, academic failure, traffic fatalities and public health costs. The combined economic impact in the US is well over $1trillion per annum.

Only the federal government has the resources to combat billionaire-backed legalisation campaigns and the illicit drug trade; the enforcement of federal laws is the only thing that will save California and the nation. Hopefully the President will step up and get us back on track without further delay.

Roger Morgan

RogerMorgan is the Chairman of the Take Back America Campaign

Source: October 2017

The National Institute on Drug Abuse (NIDA) is pleased to publish in its Research Monograph series the proceedings of the 48th Annual Scientific Meeting of the Committee on Problems of Drug Dependence, Inc. (CPDD). This meeting was held at Tahoe City, Nevada, in June 1986.

The scientific community working in the drug abuse area was saddened by the untimely death of one of its very productive and active leaders: Joseph Cochin, M.D., Ph.D. Joe was a talented scientist who was greatly admired by his students and colleagues. For the past five years, Joe had served as the Executive Secretary of the CPDD. This monograph includes papers from a symposium on “Mechanisms of Opioid Tolerance and Dependence,” dedicated to his memory. These papers were presented by many of his friends and colleagues, who took the opportunity to express their high esteem for Joe.
The CPDD is an independent organization of internationally recognized experts in a variety of disciplines related to drug addiction. NIDA and the CPDD share many interests and concerns in developing knowledge that will reduce the destructive effects of abused drugs on the individual and society. The CPDD is unique in bringing together annually at a single scientific meeting an outstanding group of basic and clinical investigators working in the field of drug dependence. This year, as usual, the monograph presents an excellent collection of papers. It also contains progress reports of the abuse liability testing program funded by NIDA and carried out in conjunction with the CPDD. 

This program continues to represent an example of a highly successful government/private sector cooperative effort. I am sure that members of the scientific community and other interested readers will find this volume to be a valuable “state-of-the art” summary of the latest research into the biological, behavioral, and chemical bases of drug abuse.

Charles R. Schuster, Ph.D.
National Institute on Drug Abuse

For the full contents, please go to: 

Source: This version September 2023


We tested whether cannabinoids (CBs) potentiate alcohol-induced birth defects in mice and zebrafish, and explored the underlying pathogenic mechanisms on Sonic Hedgehog (Shh) signaling. The CBs, Δ9-THC, cannabidiol, HU-210, and CP 55,940 caused alcohol-like effects on craniofacial and brain development, phenocopying Shh mutations. Combined exposure to even low doses of alcohol with THC, HU-210, or CP 55,940 caused a greater incidence of birth defects, particularly of the eyes, than did either treatment alone. Consistent with the hypothesis that these defects are caused by deficient Shh, we found that CBs reduced Shh signaling by inhibiting Smoothened (Smo), while Shh mRNA or a CB1 receptor antagonist attenuated CB-induced birth defects. Proximity ligation experiments identified novel CB1-Smo heteromers, suggesting allosteric CB1-Smo interactions. In addition to raising concerns about the safety of cannabinoid and alcohol exposure during early embryonic development, this study establishes a novel link between two distinct signaling pathways and has widespread implications for development, as well as diseases such as addiction and cancer.

Source: November 2019

Cannabis is harmful to the lungs, but in a different way to tobacco, causing significant respiratory symptoms such as bronchitis with evidence to suggest it can result in destructive lung disease – sometimes referred to as ‘bong lung’ – in heavy cannabis users.

These are the key findings from a review of research on the effects of smoking cannabis on the lungs undertaken by respiratory specialists, Professor Bob Hancox, from the University of Otago’s Department of Preventive and Social Medicine and Dr Kathryn Gracie, from Waikato Hospital’s Respiratory Department.

Cannabis is the second-most commonly smoked substance after tobacco and the most widely-used illicit drug world-wide. Although cannabis remains illegal in most countries, many countries – like New Zealand – are considering decriminalising or legalising its use.

Professor Hancox explains that much of the debate about legalising cannabis appears to revolve around the social and mental health effects. Both he and Dr Gracie believe policies around the liberalisation of cannabis should consider the wider health effects of smoking cannabis.

“The potential for adverse effects on respiratory health from smoking cannabis has had much less attention than the social and mental health effects,” Professor Hancox says.

“We believe policies around the liberalisation of cannabis should consider the potential impacts on the lungs.

“Whether liberalising availability will lead to further increases in cannabis use remains to be seen, but it is likely that patterns of cannabis use will change, with resulting health consequences.”

Because cannabis has been an illegal and unregulated substance and the fact most cannabis users also smoke tobacco, making the effects difficult to separate, Dr Gracie explains that it has been difficult to carry out research on cannabis and its direct impact on the lungs.

“Perhaps, most importantly, the individuals who are extremely heavy users of cannabis may not be well represented in the existing epidemiological research. Most case reports of cannabis-related destructive lung disease document very heavy cannabis consumption.

“Despite these limitations there is sufficient evidence that cannabis causes respiratory symptoms and has the potential to damage both the airways and the lungs.”

“Cannabis may also increase the risk of lung cancer, but there is not enough evidence to be sure of this yet,” Dr Gracie says.

Professor Hancox says there is still a lot to learn about cannabis, but there is sufficient evidence to show that smoking cannabis is not harmless to the lungs.

A combination of smoking both cannabis and tobacco is likely to result in poorer health outcomes.

“Many people smoke both cannabis and tobacco and are likely to get the worst of both substances.”

Source: May 2020

Abstract and Figures

In 2017 Iceland received word-wide attention for having dramatically reversed the course of teenage substance use. From 1998 to 2018, the percentage of 15-16-year-old Icelandic youth who were drunk in the past 30 days declined from 42% to 5%; daily cigarette smoking dropped from 23% to 3%; and having used cannabis one or more times fell from 17% to 5%. The core elements of the model are: 1) long-term commitment by local communities; 2) emphasis on environmental rather than individual change; 3) perception of adolescents as social attributes. This presentation describes how the Iceland prevention model is built upon collaboration between policy makers, researchers, parent organizations, and youth practitioners. These groups have created a system whereby youth receive the necessary guidance and support to live fun and productive lives without reliance on psychoactive substances. The Model is being replicated in 35 municipalities within 17 countries around the globe. The Icelandic Model: Evidence Based Primary Prevention – 20 Years of Successful Primary Prevention Work was featured for the past two years at the Special Session of the United Nations General Assembly on the World Drug Problem.

Source: February 2019


Introduction:  In response to recent news of a huge increase in drug overdose deaths and arrests for drug trafficking among Fairfax County youths, Fox News TV5 reporter Sherri Ly interviewed U.S. Drug Czar John Walters for his expert views on the cause and potential cure for these horrific family tragedies.  Following is a transcript of that half-hour interview with minor editing for clarity and emphasis added.  The full original interview is available through the 11/26/08 Fox5 News broadcast video available at link:

WALTERS:  Well, as this case shows, while we’ve had overall drug use go down, we still have too many young people losing their lives to drugs, either through overdoses, or addiction getting their lives off track.  So there’s a danger.  We’ve made progress, and we have tools in place that can help us make more progress, but we have to use them

Q 1:  You meet with some of these parents whose children have overdosed.  What do they tell you, and what do you tell them?

WALTERS:  It’s the hardest part of my job; meeting with parents who’ve lost a child.  Obviously they would give anything to go back, and have a chance to pull that child back from the dangerous path they were on.  There are no words that can ease their grief.  That’s something you just pray that God can give them comfort.  But the most striking thing they say to me though is they want other parents to know, to actAnd I think this is a common thing that these terrible lessons should teach us.

Many times, unfortunately, parents see signs: a change in friends, sometimes they find drugs; sometimes they see their child must be intoxicated in some way or the other.  Because it’s so frightening, because sometimes they’re ashamed – they hope it’s a phase, they hope it goes away – they try to take some half measures.  Sometimes they confront their child, and their child tells them – as believably as they ever can – that it’s the first time.  I think what we need help with is to tell people; one, it’s never the first time.  The probability is low that parents would actually recognize these signs – even when it gets visible enough to them – because children that get involved in drugs do everything they can to hide it.  It’s never the first time.  It’s never the second time.  Parents need to act, and they need to act quickly.  And the sorrow of these grieving parents is, if anything, most frequently focused on telling other parents, “Don’t wait: do anything to get your child back from the drugs.”

Secondly, I think it’s important to remember that one of the forces that are at play here is that it’s their friends.  It’s not some dark, off-putting stranger – it’s boyfriends, girlfriends.  I think that was probably a factor in this case.  And it’s also the power and addictive properties of the drug.  So your love is now being tested, and the things you’ve given your child to live by are being pulled away from them on the basis of young love and some of the most addictive substances on earth.  That’s why you have to act more strongly.  You can’t count on the old forces to bring them back to safety and health.

Q 2:  When we talk about heroin – which is what we saw in this Fairfax County drug ring, alleged drug ring – what are the risks, as far as heroin’s concerned?  I understand it can be more lethal, because a lot of people don’t know what they’re dealing with?

WALTERS:  Well it’s also more lethal because one, the drug obviously can produce cardiac and respiratory arrest.  It’s a toxic substance that is very dangerous.  It’s also the case that narcotics, like heroin – even painkillers like OxyContin, hydrocodone, which have also been a problem – are something that the human body gets used to.  So what you can frequently get on the street is a purity that is really blended for people who are addicted and have been long time addicted.  So a person who is a new user or a naïve user can more easily be overdosed, because the quantities are made for people whose bodies have adjusted to higher purities, and are seeking that effect that only the higher purity will give them in this circumstance.  So it’s particularly dangerous for new users.  But we also have to remember, it almost never starts with heroin.  Heroin is the culmination here.  I think some of the – and I’ve only seen press stories on this — some of these young people may have gotten involved as early as middle school.

We have tools so that we don’t have to lose another young woman like this– or young men.  We now have the ability to use Random Student Drug Testing (RSDT) because the Supreme Court has, in the last five years, made a decision that says it can’t be used to punish.  It’s used confidentially with parents.  We have thousands of schools now doing it since the president announced the federal government’s willingness to fund these programs in 2004.  And many schools are doing it on their own.  Random testing can do for our children what it’s done in the military, what it’s done in the transportation safety industry– significantly reduce drug use.

First, it is a powerful reason not to start.  “I get tested, I don’t have to start.”  We have to remember, it’s for prevention and not a “gotcha!”  But it’s a powerful reason for kids to say, even when a boyfriend or girlfriend says come and do this with me, “I can’t do it, I get tested.  I still like you, I still want to be your friend; I still want you to like me, but I just can’t do this,” which is very, very powerful and important.  And second, if drug use is detected the child can be referred to treatment if needed.

Q 3:  Is the peer pressure just that much that without having an excuse, that kids are using drugs and getting hooked?

WALTERS:  Well one of the other unpleasant parts of my job is I visit a lot of young people in treatment; teenagers, sometimes as young as 14, 15, but also 16, 17, 18.  It is not uncommon for me to hear from them, “I came from a good family.  My parents and my school made clear what the dangers were of drugs.  I was stupid.  I was with my boyfriend (or girlfriend) and somebody said hey, let’s go do this.  And I started, and before I knew it, I was more susceptible.

We have to also understand the science, which has told us that adolescents continue to have brain development up through age 20-25.  And their brains are more susceptible to changes that we can now image from these drugs.  So it’s not like they’re mini-adults.  They’re not mini-adults.  They’re the particularly fragile and susceptible age group, because they don’t have either the experience or the mental development of adults.  That’s why they get into trouble, that’s why it happens so fast to them, that’s why it’s so hard for them to see the ramifications.

So what does RSDT do?  It finds kids early–­ if prevention fails.  And it allows us to intervene, and it doesn’t make the parent alone in the process.  Sometimes parents don’t confront kids because kids blackmail them and say “I’m going to do it anyway, I’m going to run away from home.”  The testing brings the community together and says we’re not going to lose another child.  We’re going to do the testing in high school – if necessary, in middle school.  We’re going to wrap our community arms around that family, and get those children help.  We’re going to keep them in school, not wait for them to drop out.  And we’re certainly not going to allow this to progress until they die.

Q 4:  And in a sense, if you catch somebody early, since you’re saying the way teenagers seem to get into drug use is a friend introduces it to a friend, and then next thing you know, you have a whole circle of friends doing it.  Are you essentially drying that up at the beginning, before it gets out of hand?

WALTERS:  That is the very critical point.  It’s not only helping every child that gets tested be safer, it means that the number of young people in the peer group, in the school, in the community that can transfer this dangerous behavior to their friends shrinks.  This is communicated like a disease, except it’s not a germ or a bacillus.  It’s one child who’s doing this giving it behaviorally to their friends, and using their friendship as the poison carrier here.  It’s like they’re the apple and the poison is inside the apple.  And they trade on their friendship to get them to use.  They trade on the fact that people want acceptance, especially at the age of adolescence.  So what you do is you break that down, and you make those relationships less prone to have the poison of drugs or even underage drinking linked to them.  And of course we also lose a lot of kids because of impaired driving.

Q 5:  And how does the drug testing program work, then, in schools– the schools that do have it.  Is it completely confidential?  Are you going to call the police the minute you find a student who’s tested positive for heroin or marijuana or any other illicit drug?

WALTERS:  That’s what is great about having a Supreme Court decision.  It is settled – random testing programs cannot be used to punish, to call law enforcement; they have to be confidential.  So we have a uniform law across the land.  And what the schools that are doing RSDT are seeing is that it’s an enormous benefit to schools for a relatively small cost.  Depending on where you are in the country, the screening test is $10-40.  It’s less than what you’re going to pay for music downloads in one month for most teenage kids in most parents’ lives.  And it protects them from some of the worst things that can happen to them during adolescence.  Not only dying behind the wheel, but overdose death and addiction.

 Schools that have done RSDT have faced some controversy; so you have to sit down and talk to people; parents, the media, young people.  You have to engage the community resources.  You’re going to find some kids and families that do have treatment needs.  But with RSDT you bring the needed treatment to the kids.

I tell, a lot of times, community leaders – mayors and superintendents, school board members – that if you want to send less kids into the criminal justice system and the juvenile justice system, drug test — whether you’re in a suburban area or in an urban area.

What does the testing do?  It takes away what we know is an accelerant to self-destructive behavior: crime, fighting in school, bringing a weapon, joining a gang.  We have all kinds of irrefutable evidence now – multiple studies showing drugs and drinking at a young age accelerate those things, make them worse, make them more violent, as well as increasing their risks of overdose deaths and driving under the influence.  So drug testing makes all those things get better.  And it’s a small investment to make everything else we do work better.

Again, drug testing is not a substitute for drug education or good parenting or paying attention to healthy options for your kid.  It just makes all those things work better.

Q 6:  And I know you’ve heard this argument before, but isn’t that big brother?  Aren’t there parents out there who say to you, “I’m the parent: why are you going to test my child for drugs in school; that’s my job?” 

WALTERS:  I think that is the critical misunderstanding that we are slowly beginning to change by the science that tells us substance abuse is a disease.  It’s a disease that gets started by using the drug, and then it becomes a thing that rewires our brain and makes us dependent.  So instead of thinking of this as something that is a moral failing, we have to understand that this is a disease that we can use the kind of tools for public health – screening and interventions – to help reduce it.

Look, let me give you the counter example.  It’s really not big brother.  It’s more like tuberculosis.  Schools in our area require children to be tested for tuberculosis before they come to school.  Why do they do that?  Because we know one, they will get sicker if they have tuberculosis and it’s not treated.  And we can treat them, and we want to treat them.  And two, they will spread that disease to other children because of the nature of the contact they will have with them and spreading the infectious agent.  The same thing happens with substance abuse.  Young people get sicker if they continue to use.  And they spread this to their peers.  They’re not secretive among their peers about it; they encourage them to use them with them.  Again, it’s not spread by a bacillus, but it’s spread by behavior.

If we take seriously the fact that this is a disease and stop thinking of it as something big brother does because it’s a moral decision that somebody else is making, we can save more lives.  And I think the science is slowly telling us that we need to be able to treat this in our families, for adults and young people.  We have public health tools that we’ve used for other diseases that are very powerful here, like screening – and that’s really what the random testing is.  We’re trying to get more screening in the health care system.  So when you get a check up, when you bring your child to a pediatrician, we screen for substance abuse and underage drinking.  Because we know we can treat this, and we know that we can make the whole problem smaller when we do. 

Q 7:  You have said there were about 4,000 schools across the country now that are doing this random drug testing.  What can we see in the numbers since the Supreme Court ruling in 2002, as far as drug use in those schools, and drug use in the general population?

WALTERS:  Well, what a number of those schools have had is of course a look at the harm from student drug and alcohol use.  Some of them have put screening into place, random testing, because they’ve had a terrible accident; an overdose death; death behind the wheel.  What’s great is when school districts do this, or individual schools do this, without having to have a tragedy that triggers it.  But if you have a tragedy, I like to tell people, you don’t have to have another one.  The horrible thing about a tragic event is that most people realize those are not the only kids that are at risk.

There are more kids at risk, obviously, in our communities in the Washington, DC area where this young woman died.  We know there’s obviously more children who are at risk of using in middle school and high school.  The fact is those children don’t have to die.  We cannot bring this young lady back.  Everybody knows that.  But we can make sure others don’t follow her.  And the way we can do that is to find, through screening, who’s really using.  And then let’s get them to stop – let’s work with their families, and let’s make sure we don’t start another generation of death.  So what you see in these areas is an opportunity to really change the dynamic for the better.

Q 8:  Now, although nationally drug use among our youth is going down – what does it say to you – when I look at the numbers specific to Virginia, the most recent that I could find tells me that 3% of 12th graders, over their lifetime, have used a drug like heroin?  What does it say to you?  To me, that sounds like a lot.

WALTERS:  Yeah, and it’s absolutely true.  I think the problem here is that when you tell people we are taking efforts that are making progress nationwide, they jump to the conclusion that that means that we don’t have a problem anymore.  We need to continue to make this disease smaller.  It afflicts our young people.  It obviously also afflicts adults, but this is a problem that starts during adolescence — and pre-adolescence in some cases — in the United States.  We can make this smaller.  We not only have the tools of better prevention but also better awareness and more recognition of addiction as a disease.  We need to make that still broader.  We need to use random testing.  If we want to continue to make this smaller, and make it smaller in a permanent way, random testing is the most powerful tool we can use in schools.

We want screening in the health care system.  We have more of that going on through both insurance company reimbursement and public reimbursement through Medicare and Medicaid for those who come into the public pay system.  That needs to grow.  It needs to grow into Virginia, it’s already being looked at in DC; it needs to grow into Maryland and the other states that don’t have it.  We are pushing that, and it’s relatively new, but it’s consistent with what we’re seeing – the science and the power of screening across the board.

We need to continue to look at this problem in terms of also continuing to push on supply.  We’re working to reduce the poisons coming into our communities, which is not the opposite of demand; that we have to choose one or the other.  They work together.  Keeping kids away from drugs and keeping drugs away from kids work together.  And where we see that working more effectively, we’ll save more lives.  So again, we’ve seen that a balanced approached works, real efforts work, but we need to follow through.  And the fact that you still have too many kids at risk is an urgent need.  Today, you have kids that could be, again, victims that you have to unfortunately tell about on tonight’s news, that we can save.  It’s not a matter we don’t know how to do this.  It’s a matter of we need to take what we know and make it reality as rapidly as possible.

Q 9:  Where are these drugs coming from?  Where’s the heroin that these kids allegedly got coming from?

WALTERS:  We do testing about the drugs to figure out sources for drugs like heroin.  Principally, the heroin in the United States today has come from two sources.  Less of it’s coming out of Colombia.  Colombia used to be a source of supply on the East Coast, but the Colombian government, as a part of our engagement with them on drugs, has radically reduced the cultivation of poppy and the output of heroin.  There still is some, but it’s dramatically down from what it was even about five years ago.  Most of the rest of the heroin in the United States comes from Mexico.  And the Mexican government, of course, is engaged in a historic effort to attack the cartels.  You see this in the violence the cartels have had as a reaction.  So we have promising signs.  There are dangerous and difficult tasks ahead, but we can follow through on that as well.

Most of the heroin in the world comes from Afghanistan; 90% of it.  And we are working there, of course, as a part of our effort against the Taliban and the forces of terror and Al Qaeda, to shrink that.  The good news is that last year we had a 20% decline in cultivation and a 30% decline in output there.  Most of that does not come here, fortunately.  But it has been funding the terrorists.  It’s been drained out of most of the north and the east of the country.  It’s focused on the area where we have the greatest violence today, in the southwest.  We’re working now – you see Secretary Gates talking to the NATO allies about bringing the counter-insurgency effort together with the counter-narcotics effort to attack both of these cancers in Afghanistan.  We have a chance to change heroin availability in the world in a durable way by being successful in Afghanistan.  We’ve started that path in a positive way.  Again, it’s a matter of following through as rapidly as possible.

Q 10:  Greg Lannes, the father of the girl in Fairfax County who died, told me that one of his main efforts, as you imagined, was to let people know that those drugs, they’re coming from where it is produced, outside our country; that they’re getting all the way down to the street level and into our neighborhoods– something that people don’t realize.  So when you hear that they busted a ring of essentially teenagers who have been dealing, using and buying heroin, what does that say to you as the man in charge of combating drugs in our country?

WALTERS:  Well again, we have tools that can make this smaller.  But we have to use those tools.  And we have multiple participants here.  Yes we need to educate.  And we need to make sure that parents know they need to talk to their children, even when their children look healthy and have come from a great home.  Drugs – we’ve learned, I think, over the last 25 years or more, drugs affect everybody; rich or poor, middle class, lower class or upper class.  Every family’s been touched by this, in my experience, by alcohol or drugs.  They know that reality– we don’t need to teach them that.

What we need to teach them is the tools that we have that they can help accelerate use of.  Again, I think – there is no question in my mind that had this young woman been in a school, middle school or high school that had random testing – since that’s where this apparently started, based on the information I’ve seen in the press – she would not be dead today.  So again, we can’t go back and bring her to life.  But we can put into place the kind of screening that makes the good will and obvious love that she got from her parents, the obvious good intentions that I can’t help but believe were a part of what happened in the school, the opportunities that the community has to have a lot of resources that she didn’t get when she needed them.  And now she’s dead.  Again, we can stop this: we just have to make sure we implement that knowledge in the reality of more of our kids as fast as possible.

Q 11:  Should anyone be surprised by this case?  And that such a hardcore drug like heroin is being used by young people?

WALTERS:  We should never stop being surprised when a young person dies.  They shouldn’t die.  They shouldn’t die at that young age, and we should always demand of ourselves, even while we know that’s sometimes going to happen today, that every death is a death too many.  I think that it is very important not to say we’re going to accept a certain level.  Never accept this.  Never!  That’s my attitude, and I know that’s the president’s  attitude as well here.  Never accept that heroin’s going to get into the lives of our teenagers.  Never accept that our children are going to be able to use and not be protected.  It’s our job to protect themThey have a role, also, obviously in helping to protect themselves.  But we need to give them the tools that will help protect them.

When I talk to children and young adults in high school or college, they know what’s going on among their peers.  And in some ways, when you get them alone and they feel they can talk candidly, they tell us they don’t understand why we, as adults who say this is serious, don’t act.  They know that we see children who are intoxicated; they know that we must see signs of this, because as kid’s lives get more out of control, they show signs of it.  They want to know why we don’t act.

We can use the tools of screening, and we can use the occasion of a horrible event like this to bring the community together and say it’s time for us to use the shock and the sorrow for something positive in the future.  I haven’t met a parent of a child who’s been lost who doesn’t say I just want to use this now for something positive.  And that’s understandable, and I think we ought to honor that wish.

Q 12:  Well, I guess I’m not asking should we accept that this is in our schools, but is it naïve for people not to understand or realize that these hardcore drugs are in our schools, and in our communities, and in our neighborhoods. 

WALTERS:  Yeah.  Where it is naïve, I think, is to not recognize the extent and access that young people have to drugs and alcohol.  I think we sometimes think that because they come from a home where this isn’t a part of their lives now, that it’s not ever going to be part of their lives.  Look, your viewers should go on the computer.  Type marijuana into the Google search engine and see how many sites encourage them to use marijuana, how to get marijuana, how to grow marijuana, the great fun of marijuana.  Go on YouTube and type in marijuana, and see how many videos come up using marijuana, joking around about marijuana.  And then when you start showing one, of course the system is designed to show you similar things.  Type in heroin.  See what kind of sites come up, and see what kind of videos come up on these sites.  Young people spend more time on these sites than they do, frequently, watching television.  Remember, there is somebody telling your children things about drugs.  And if it’s not you, the chances are they’re telling them things that are false and dangerous.  So there is a kind of naiveté about what the young peoples’ world, as it presents itself to them, tells them about these substances.  It minimizes the danger, it suggests that it’s something that you can do to be more independent, not be a kid anymore. 

We, from my generation — because I’m a baby boomer — unfortunately have had an association of growing up in America with the rebellion that’s been associated with drug use.  That’s been very dangerous, and we’ve lost a lot of lives.  We have to remember that it’s alive and well, and has become part of the technological sources of information that young people have.  I also see young people in treatment centers who got in a chat room and somebody offered them drugs or offered them to come and buy them alcohol and flattered them, and got them involved in incredibly self-destructive behavior.  The computer brings every predator and every dangerous influence into your own child’s home – into their bedroom in some cases, if that’s where that computer exists.  You wouldn’t let your kids go out and play in the park with drug dealers.  If you have a computer and it’s not supervised, those drug dealers are in that computer.  Remember that.  And they’re only a couple of keystrokes away from your child.

Q 13:  And you talk about the YouTube and the computers and all those things.  What about just the overall societal image?  Because we have this whole image with heroin, of heroin chic.  How much does that contribute to the drug use, and how difficult does it make your job, when a drug is being made out to be cool in society by famous people?

WALTERS:  There are still some elements of that.  It was more prominent a number of years ago.  I would say you see less of that now glamorized in the entertainment industry, or among people who are celebrities in and out of entertainment.  You see more cases of real harm.  But it’s still out there.  The one place that I think is replacing that, just to get people ahead of the game here, is prescription pharmaceuticals.  Those have been marketed to kids on the internet as a safe high.  They falsely suggest that you can overcome the danger of an overdose because you can predict precisely the dosage of OxyContin, hydrocodone, Vicodin.  And there are sites that suggest what combination of drugs to use.  We’ve seen prescription drug use as the one counter example of a category of drug use going up among teens.  We’re trying to work on that as well, but that’s something that’s in your own home, because many people get these substances for legitimate medical care.  Young people are going to the medicine cabinet of family or friends, taking a few pills out and using those.  And those are as powerful as heroin, they’re synthetic opioids, and they have been a source of overdose deaths. 

So let’s not forget – while this Fairfax example reminds us of the issues of heroin chic and of the heroin that’s in our communities, the new large problem today is a similar dangerous substance in pill form in our own medicine cabinets.  Barrier to access is zero.  They don’t have to find a drug dealer; they just go find the medicine cabinet.  They don’t have to pay a dime for it because they just take it and they share that with their friends.  We need to remember, that’s another dimension here.  Keep these substances out of reach – under our control when we have them in our home.  Throw them away when we’re done with them.  Make sure we talk to kids about pills.  Because people, again, are telling them that’s the place to go to avoid overdose death, is to take a pill.

Q 14:  When you see a lot of these celebrities checking in and out of rehab, does it sort of glamorize it for kids?  And teach them hey, you can use, you can check into rehab, you can come back, you can – you know.  Is there a mixed message there?

WALTERS:  There is.  Some young people interpret it the way you describe; of it’s something you do and you can get away with it by going into rehab.  We do a lot of research on young people’s attitudes for purposes of helping shape prevention programs in the media, as well as in schools and for parents.  We do a lot with providing material to parents.  I would say that compared to where we’ve been in the last 15 or 20 years, there’s less glamorization today.

I think we should also remember the positive, because we reinforce that.  A lot of young people – obviously not all or we wouldn’t have this death – believe that taking drugs makes you a loser.  They’ve seen that a lot of those celebrities are showing their careers going down the toilet because they can’t get away from the pills and the drugs and the alcohol.  And I think they see that even among some of their peers.  That’s a good thing.  We should reinforce that as parents: teaching our kids that drug and alcohol use may be falsely presented to you as something you do that would make you popular, make you seem like you should have more status in society generally.  But actually, look at a lot of these people; they’ve had enormous opportunities, enormous gifts, and they can’t stop themselves from throwing them away.  And they may not stop themselves from throwing away their lives. 

I think you could use these events as a teachable moment.  It can go two ways.  Help your child understand what the truth is here.  And I tell young people – and I think parents have to start this more directly – this is the way this is going to come to you:  Somebody you really, really want to like you; somebody you really, really like; someone you may even love — or think you love — they’re going to say come and do this with me.  If you can’t find any other reason to not do this with them, say, “Before we do this, let’s go to a treatment center.  Let’s go talk to people who stood where we stood and said it’s not going to happen to me.”  If everybody, when they got the chance to start, thought of an addict or somebody who was dead, they wouldn’t start.  The fact is that does not enter their mind. 

Many people in treatment centers understand that part of the task of recovery is helping other people avoid this.  So they’re willing to talk about it.  In fact, that’s part of their path of staying clean and sober, which not many kids are going to be able to do on their own.  But it makes them think that what presents itself as something overwhelmingly attractive has behind it a horrible dimension, for their friends as well as for themselves.  And more and more, I think kids understand this.

We can use the science of this as a disease, and the experience of many families.  Remember, uncle Joe didn’t used to be like this.  Especially Thanksgiving, when we have families getting together and all of a sudden mom’s going to get loaded and become ugly in the corner.  We also have to remember we have an obligation to reach out to those people, and to get them help.  We can treat them.  Nobody gets sober, in my experience, by themselves.  They have to take responsibility.  But you have to overcome the pushback, and addiction and alcoholism have, as a part of the disease, denial.  When you tell somebody they have a problem, they get angry with you.  They don’t say hey thanks, I want your help.  They don’t hit bottom and become nice.  That’s a myth.  They need to be grabbed and encouraged and pushed.  Almost everybody in treatment is coerced – by a family member, by an employer, sometimes by the criminal justice system.

So remember that, when you find your child using and they want to lie to you up down and sideways saying, “It’s the first time I’ve ever done it.”  No, no, no, no, no, that’s the drugs talking.  That shows you, if anything, you have a bigger problem than you realized and you need to reach out, get some professional help.  But don’t wait!

Source:    National Institute of Citizen Anti-drug Policy (NICAP)

DeForest Rathbone, Chairman, Great Falls, Virginia, 703-759-2215,


3,4-Methylenedioxymethamphetamine (MDMA, Ecstasy) tablets are widely used recreationally, and not only vary in appearance, but also in MDMA content. Recently, the prevalence of high-content tablets is of concern to public health authorities. To compare UK data with other countries, we evaluated MDMA content of 412 tablets collected from the UK, 2001-2018, and investigated within-batch content variability for a sub-set of these samples. In addition, we investigated dissolution profiles of tablets using pharmaceutical industry-standard dissolution experiments on 247 tablets. All analyses were carried out using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Our data supported other studies, in that recent samples (2016-2018) tend to have higher MDMA content compared to earlier years. In 2018, the median MDMA content exceeded 100 mg free-base for the first time. Dramatic within-batch content variability (up to 136 mg difference) was also demonstrated. Statistical evaluation of dissolution profiles at 15-minutes allowed tablets to be categorized as fast-, intermediate-, or slow-releasing, but no tablet characteristics correlated with dissolution classification. Hence, there would be no way of users knowing a priori whether a tablet is more likely to be fast or slow-releasing. Further, within-batch variation in dissolution rate was observed. Rapid assessment of MDMA content alone provides important data for harm reduction, but does not account for variability in (a) the remainder of tablets in a batch, or (b) MDMA dissolution profiles. Clinical manifestations of MDMA toxicity, especially for high-content, slow-releasing tablets, may be delayed or prolonged, and there is a significant risk of users re-dosing if absorption is delayed.

Source: August 2019

The United States is knee-deep in what some experts call the opioid epidemic’s “fourth wave,” which is not only placing drug users at greater risk but is also complicating efforts to address the nation’s drug problem.

These waves, according to a report from Millennium Health, began with the crisis in prescription opioid use, followed by a significant jump in heroin use, then an increase in the use of synthetic opioids like fentanyl.

The latest wave involves using multiple substances at the same time, combining fentanyl mainly with either methamphetamine or cocaine, the report found.

“And I’ve yet to see a peak,” said one of the co-authors, Eric Dawson, vice president of clinical affairs at Millennium Health, a specialty laboratory that provides drug testing services to monitor use of prescription medications and illicit drugs.

The report, which takes a deep dive into the nation’s drug trends and breaks usage patterns down by region, is based on 4.1 million urine samples collected from January 2013 to December 2023 from people receiving some kind of drug addiction care.

Its findings offer staggering statistics and insights. Its major finding: How common polysubstance use has become. According to the report, an overwhelming majority of fentanyl-positive urine samples — nearly 93% — contained additional substances.

“And that is huge,” said Nora Volkow, director of the National Institute on Drug Abuse at the National Institutes of Health.

The most concerning, she and other addiction experts said, is the dramatic increase in the combination of meth and fentanyl use. Methamphetamine, a highly addictive drug often in powder form that poses several serious cardiovascular and psychiatric risks, was found in 60% of fentanyl-positive tests last year. That is an 875% increase since 2015.

“I never, ever would have thought this,” Volkow said.

Among the report’s other key findings:

  • The nationwide spike in methamphetamine use alongside fentanyl marks a change in drug use patterns.
  • Polydrug use trends complicate overdose treatments. For instance, though naloxone, an opioid-overdose reversal medication, is widely available, there isn’t an FDA-approved medication for stimulant overdose.
  • Both heroin and prescribed opioid use alongside fentanyl have dipped. Heroin detected in fentanyl-positive tests dropped by 75% since peaking in 2016. Prescription opioids were found at historic low rates in fentanyl-positive tests in 2023, down 89% since 2013.

But Jarratt Pytell, an addiction medicine specialist and assistant professor at the University of Colorado’s School of Medicine, warned these declines shouldn’t be interpreted as a silver lining.

A lower level of heroin use “just says that fentanyl is everywhere,” Pytell said, “and that we have officially been pushed by our drug supply to the most dangerous opioids that we have available right now.”

“Whenever a drug network is destabilizing and the product changes, it puts the people who use the drugs at the greatest risk,” he said. “That same bag or pill that they have been buying for the last several months now is coming from a different place, a different supplier, and is possibly a different potency.”

In the illicit drug industry, suppliers are the controllers. It may not be that people are seeking out methamphetamine and fentanyl but rather that they’re what drug suppliers have found to be the easiest and most lucrative product to sell.

“I think drug cartels are kind of realizing that it’s a lot easier to have a 500-square-foot lab than it is to have 500 acres of whatever it takes to grow cocaine,” Pytell said.

Dawson said the report’s drug use data, unlike that of some other studies, is based on sample analysis with a quick turnaround — a day or two.

Sometimes researchers face a months-long wait to receive death reports from coroners. Under those circumstances, you are often “staring at today but relying on data sources that are a year or more in the past,” said Dawson.

Self-reported surveys of drug users, another method often used to track drug use, also have long lag times and “often miss people who are active for substance use disorders,” said Jonathan Caulkins, a professor at Carnegie Mellon University’s Heinz College. Urine tests “are based on a biology standard” and are good at detecting when someone has been using two or more drugs, he said.

But using data from urine samples also comes with limitations.

For starters, the tests don’t reveal users’ intent.

“You don’t know whether or not there was one bag of powder that had both fentanyl and meth in it, or whether there were two bags of powder, one with fentanyl in it and one with meth and they took both,” Caulkins said. It can also be unclear, he said, if people intentionally combined the two drugs for an extra high or if they thought they were using only one, not knowing it contained the other.

Volkow said she is interested in learning more about the demographics of polysubstance drug users: “Is this pattern the same for men and women, and is this pattern the same for middle-age or younger people? Because again, having a better understanding of the characteristics allows you to tailor and personalize interventions.”

All the while, the nation’s crisis continues. According to the Centers for Disease Control and Prevention, more than 107,000 people died in the U.S. in 2021 from drug overdoses, most because of fentanyl.

Caulkins said he’s hesitant to view drug use patterns as waves because that would imply people are transitioning from one to the next.

“Are we looking at people whose first substance use disorder was an opioid use disorder, who have now gotten to the point where they’re polydrug users?” he said. Or, are people now starting substance use disorders with methamphetamine and fentanyl, he asked.

One point was clear, Dawson said: “We’re just losing too many lives.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.


We’re building on the momentum of SAMHSA’s 20th Prevention Day and looking ahead to National Prevention Week (May 12-18).

About 4,300 prevention professionals, researchers, and advocates from across the country attended SAMHSA’s 20th Prevention Day held outside of Washington, D.C., on January 29, 2024. This was the largest Prevention Day gathering to date, offering 83 sessions with about 200 speakers ― leading with science, advancing the prevention of substance use and misuse, and enhancing lives. The prevention field’s synergy and positive energy were palpable.

The opening plenary featured:

Then, to tell the story of prevention, I started with data. The data show us a few things.

  • First, the SUD prevention field should be proud of our successes. Youth substance use has declined significantly over the past 20 years, as indicated by the National Institute on Drug Abuse’s Monitoring the Future survey and the Centers for Disease Control and Prevention’s Youth Risk Behavior Survey. SAMHSA’s National Survey on Drug Use and Health also shows that the vast majority of adolescents are not using substances.
  • At the same time, there are significant challenges that call us to action, including rising alcohol-attributable deaths and drug overdose deaths, the changing epidemiology of populations at elevated risk (with a particular focus on disparities and inequities), the increasingly dynamic landscape of substance use (and an increasingly toxic illicit drug supply), and the link between mental health issues and substance use.

We need to:

  • Use the data to inform our messaging. This includes the use of data on non-use of substances, as part of a social norms approach (which emphasizes the impact of peer communities on substance use).
  • Look at how we’re engaging with diverse communities ― ensuring they are at the table ― and approaching this work through an equity lens.
  • Practice prevention across the lifespan, not just among youth.
  • Partner with those addressing mental health, who can be champions for substance use prevention. (It is worth noting that many of those with substance use also have co-occurring mental health conditions).
  • Involve more youth in prevention programming* ― such as problem-solving, communications skills, and broader prevention programs that address healthy relationships, connectedness, and safety.

I also took the opportunity to share the Center for Substance Abuse Prevention’s (CSAP’s) new vision, mission, strategic priorities, guiding principles, and a comprehensive path forward. CSAP’s key imperatives are:

  • Lift up the prevention conversation and tell the prevention story including prevention’s positive impact on communities across our country.
  • Support a holistic approach to prevention addressing the full spectrum of risk and protective factors (at the individual, family, school, community, and society levels).
  • Increase the number of communities exposed to proven prevention strategies.
  • Identify and develop innovative strategies to build and translate science-based and practice-based evidence.
  • Build new and strengthen existing partnerships and collaborations.
  • Create opportunities for multi-directional input from grantees, partners, and the field to inform our work.
  • Provide outstanding customer service to grantees and the field.

Ultimately, we aim to prevent use in the first place, prevent the progression of use, and reduce harm. And we have the prevention playbook to do so.

We then transitioned to a panel with former CSAP directors (Dona Dmitrovic, Johnnetta Davis-Joyce, Frances M. Harding, and Beverly Watts Davis). During a Q&A, they reflected on their prevention journeys and shared pearls of wisdom:

  • Prevention is foundational ― you can build everything else (mental health promotion, violence prevention, etc.) on it.
  • There are so many heroes in the prevention field, who fill our hearts with joy.
  • We’ve come so far, with the use of prevention science and young people going into prevention will drive the field forward.
  • Preventionists know how to connect the dots and are strong.
  • Prevention, harm reduction, treatment, recovery, and mental health promotion are now working together.
  • Prevention needs you. Look around your community; for example, go into the vape shops when kids get out of school.
  • Start now with prevention, no matter what your age, or where you are in life.
  • One day can change your life. One moment can change someone else’s life.

Later, Dr. Delphin-Rittmon hosted an “Ask the Assistant Secretary” meeting with youth, at which she shared resources for youth preventionists and answered a range of questions.

Throughout the day at the Prevention Action Center (CSAP’s interactive learning hub), attendees took part in activities and learned about SAMHSA’s campaigns.

In the closing plenary, Tom Coderre, Principal Deputy Assistant Secretary of SAMHSA, emphasized that SAMHSA’s doors are open and made one request to the audience: go back to your communities and share the value of prevention with potential new partners. Thanks to you, prevention is working.

The next day, for the SAMHSA Power Session at CADCA’s National Leadership Forum, Mr. Coderre joined the directors of SAMHSA’s centers for prevention, treatment, and mental health services, showcasing our collaborative work in advancing the nation’s behavioral health.

Reflecting on our 20th Prevention Day, I walked away with a strong feeling of hope and community, energized by the voices of thousands of people who share the common goal of helping individuals, families, and communities to thrive. That is the work of prevention.

We look forward to your participation in National Prevention Week (May 12-18, 2024), and to seeing you at the next SAMHSA Prevention Day on February 3, 2025.



Vienna (Austria), 22 March 2024 — The 67th session of the Commission on Narcotic Drugs (CND) concluded today, after a two-day high-level segment focusing on the Midterm Review of the 2019 Ministerial Declaration and five days of discussions focused on the implementation of international drug control treaties and drug policy commitments.

In his closing remarks, H.E. Philbert Johnson of Ghana, Chair of the CND at its 67th session, thanked all delegations for contributing to the biggest gathering of the Commission ever, with 140 Member States of the United Nations represented as well as representatives of 18 intergovernmental organizations, 141 non-governmental organizations, and nine UN entities. More than 2500 participants attended in total.

Ghada Waly, Executive Director of the United Nations Office on Drugs and Crime (UNODC), in her closing remarks acknowledged that a fundamental truth had emerged from this year’s high-level segment – that even in times of division and fractures, common ground can be found, as embodied in the High-Level Declaration adopted at the opening session.

The Executive Director made the following pledge on behalf of UNODC as part of the Chair’s Pledge4Action initiative: “UNODC pledges to support a paradigm shift towards much stronger frameworks for prevention in Member States, whether to prevent drug use and harmful behaviours, to prevent illicit economies from exploiting and expanding, or to prevent violence associated with the illicit drug trade, with a focus on children and adolescents, as well as those who are in settings of vulnerability.”

She continued: “We will strive to provide and improve low-cost and accessible tools that build prevention skills, identify and share best practices for prevention in different contexts, and encourage and support far greater investment in prevention nationally and globally, to build the resilience of individuals and communities.”

During the regular segment of the 67th session, Member States exchanged views on, inter alia, a) the implementation of the international drug control treaties and drug policy commitments; b) the inter-agency cooperation and coordination of efforts in addressing and countering the world drug problem; c) the recommendations of the subsidiary bodies of the Commission; and d) the Commission’s contributions to the review and implementation of the 2030 Agenda for Sustainable Development.

The Commission decided to place one benzodiazepine, one synthetic opioid, two stimulants, one dissociative-type substance, sixteen precursors of amphetamine-type stimulants and two fentanyl precursors under international control. The scheduling of the two series of amphetamine-type stimulant precursors is part of – for the first time – the taking of a pre-emptive measure to address the proliferation of closely related designer precursors with no known legitimate use.

During the 67th  session of the CND, four resolutions were also adopted, covering topics including: alternative development; rehabilitation and recovery management programmes; improving access to and availability of controlled substances for medical purposes; and preventing and responding to drug overdose.

2024 Midterm Review

In accordance with the 2019 Ministerial Declaration, Commission conducted a midterm review of progress made in the implementation of all international drug policy commitments during the two-day High-Level Segment, consisting of a General Debate and two multi-stakeholder round-table discussions on the topics “Taking stock: work undertaken since 2019” and “The way forward: the road to 2029”. The final review is planned for 2029.

As part of the General Debate, 66 countries pledged concrete actions towards addressing and countering the world drug problem as part of the Chair’s Pledge4Action initiative.


The CND is the policymaking body of the United Nations with prime responsibility for drug control and other drug-related matters. The Commission is the forum for Member States to exchange knowledge and good practices in addressing and countering the world drug problem.



Nearly 108,000 Americans died of drug overdoses in 2022, according to final federal figures released Thursday by the Centers for Disease Control and Prevention.Over the last two decades, the number of U.S. overdose deaths has risen almost every year and continued to break annual records — making it the worst overdose epidemic in American history.

The official number for 2022 was 107,941, the CDC said, which is about 1% higher than the nearly 107,000 overdose deaths in 2021.

Between 2021 and 2022, data shows the fatal overdose rate for synthetic opioids other than methadone — which the CDC defines as fentanyl, fentanyl analogs and tramadol — increased 4.1%. Rates for cocaine and psychostimulants with abuse potential — which includes drugs such as methamphetamineamphetamine and methylphenidate — also increased.

There were also some declines seen in certain drugs, with lower rates reported for heroin, natural and semisynthetic opioids, and methadone.

The overdose death rate for females declined for the first time in five years, according to the report. But the male overdose death rate continued to inch up, the report said, accounting for about 70% of U.S. overdose deaths.

There were also shifts among age groups from 2021 to 2022, with a decreased rate of drug overdose deaths among those aged 15 to 24, and 25 to 34.

Rates increased, however, among adults aged 35 and older, with the highest rates for adults aged 35 to 44.

While adults aged 65 and older had the lowest rates in both 2021 and 2022, they also experienced the largest percent increase at 10.0% (from 12.0 per 100,000 in 2021 to 13.2 per 100,000 in 2022).

The overall drug overdose death rate rose from 2021 to 2022, but the increase was so small it was not considered statistically significant.

Earlier provisional data estimated more than 109,000 overdose deaths in 2022, but provisional data includes all overdose deaths, while the final numbers are limited to U.S. residents.

The CDC has not yet reported overdose numbers for 2023, although provisional data through the first 10 months of the year suggest overdose deaths continued to be stable last year.

In an effort to prevent drug overdoses and deaths in young people, the American Medical Association has called for school staff to “put naloxone in schools so it can save lives.” The association also issued a statement in conjunction with other organizations encouraging states, schools and local communities to allow students to carry naloxone in schools of all grade levels.

State and federal legislators have introduced legislation to require schools carry naloxone, and the Biden administration encouraged schools at the end of last year to keep the medication on-hand and teach staff how to use it.



In This Article

The United States faces a complex and evolving crisis when it comes to substance use disorders (SUDs). These disorders affect people across demographics. It destroys lives and strains families, communities, and healthcare systems.

Understanding the shocking scale of this problem, along with its risk factors, is crucial for creating prevention and treatment programs that save lives.

  • Nearly 50 million Americans experienced a substance use disorder in the past year.
  • Despite the widespread need, only a tiny fraction (9.1%) of those with co-occurring mental health issues and SUDs receive treatment for both conditions.
  • Over 70% of individuals with alcohol abuse or dependence never receive treatment.
  • Suicidal thoughts are alarmingly common, affecting over 13 million US adults and 3.4 million adolescents in the past year.
  • Addiction doesn’t discriminate: heroin use has increased across all income levels in recent years.

This article draws on the most recent and reliable data sources available. By focusing on up-to-the-minute information, we gain the clearest possible picture of the challenges and the best ways to address them.

Prevalence of Substance Use Disorders by Drug Type

Substance use disorders (SUDs) affect a significant portion of the US population. In 2022, the numbers reveal the varying prevalence of different substance-related disorders:

Overall Substance Use Disorders

  • An estimated 48.7 million Americans aged 12 or older had a substance use disorder (SUD) in the past year.

Alcohol Use Disorder (AUD)

  • Alcohol use disorders were the most common, affecting 29.5 million people.

Drug Use Disorder (DUD)

  • 27.2 million people had a drug use disorder.
  • Of those with DUD, 8.0 million also had an alcohol use disorder, highlighting the overlap between the two.

Illicit Drug Use

  • Around 70.3 million people aged 12 or older used illicit drugs in the past year.
  • Marijuana was the most common illicit drug, used by 61.9 million people (22.0% of those aged 12+).

Mental Health & Substance Use

  • Mental health issues are closely linked to SUDs. Nearly 1 in 4 adults (59.3 million) experienced any mental illness (AMI) in the past year.
  • Among adolescents (12-17), 19.5% (4.8 million) experienced a major depressive episode (MDE) in the past year.

Suicidal Thoughts & Behaviors

Suicidal thoughts are concerningly common, especially linked to mental health struggles:

  • 1 in 20 US adults (13.2 million) had serious suicidal thoughts in the past year.
  • Over 1 in 8 adolescents (13.4% or 3.4 million) had serious suicidal thoughts in the past year.

These statistics show the widespread impact of substance use disorders. It’s crucial to address both substance use and mental health needs, as they often go hand-in-hand.

Age and Gender Differences in Addiction Rates

Substance use and addiction rates vary significantly based on both age and gender.  Here’s a breakdown of the key trends:

Gender Differences

Males vs. Females

Generally, men are more likely to use illicit drugs and have higher rates of alcohol use/dependence. However:

  • Women are equally likely to develop substance use disorders (SUDs).
  • Women may be more prone to cravings and relapse, impacting their recovery process.

Specific Substances

  • Marijuana: Use is lower among females, but they may experience different effects.
  • Alcohol: Men have historically had higher AUD rates, but this gap is narrowing.
  • Prescription Drugs: Women are more likely to overdose or seek emergency care due to prescription drug misuse.
  • Stimulants: Abuse rates are similar, but women may start using earlier and experience stronger cravings.

Age Differences

  • Adolescents: Alcohol use rates are surprisingly similar for boys and girls aged 12-17.
  • Young Adults: Females aged 12-20 may have slightly higher rates of alcohol misuse than males.
  • Older Adults: Women 65+ have significantly higher rates of prescription painkiller addiction than their male peers.

Treatment & Recovery Considerations

  • Gender-Specific Care: Treatment programs tailored to the unique needs of men or women can be more effective.
  • Telescoping Effect: Women often progress from substance use to dependence more quickly than men, impacting treatment approaches.

Socioeconomic Factors and Addiction Risk

Socioeconomic status plays a significant role in addiction risk. Here’s how factors like income, education, and social circumstances contribute:

Income & Addiction

  • Smoking is much more common among low-income individuals than those with high incomes.
  • Contrary to stereotypes, higher income levels are linked to increased alcohol and drug use among teens and young adults.

Education & Parental Influence

  • Low parental education levels correlate with an increased risk of heroin use in children.
  • Students who skip school (truancy) are far more likely to experiment with or become addicted to heroin.

Socioeconomic Disparities

  • People in the lowest income brackets are more likely to report problems associated with substance abuse.
  • Lower socioeconomic status dramatically increases the risk of alcohol-related death and opioid addiction.

Unexpected Trends

  • Heroin use has increased across all income groups in the US.
  • Upper-middle-class youth face a surprisingly high risk of drug and alcohol addiction.

Poverty, Marginalization, & Substance Use

  • Poverty and social disadvantage create a cycle where substance use becomes both a cause and a consequence of hardship.

Addiction doesn’t discriminate based on socioeconomic status.  Effective prevention and treatment must address the unique challenges faced by people from all backgrounds.

Co-occurring Mental Health Disorders and Addiction

People can struggle with both substance use disorders (SUDs) and mental health conditions, known as co-occurring disorders or dual diagnoses. Here’s a look at how prevalent this is:

Prevalence of Co-occurring Disorders

  • 7.7 million US adults experience co-occurring mental health and substance use disorders.
  • Of adults with SUDs, 37.9% also have a mental illness. Among adults with a mental illness, 18.2% have a co-occurring SUD.
  • Over 60% of teens in substance use treatment programs also meet the criteria for a mental health disorder.

Treatment & Barriers

  • Only 9.1% of people with co-occurring disorders receive treatment for both conditions.
  • Common reasons for not seeking help include cost (cited by 52.2% of those needing mental health care) and not being ready to stop using substances (38.4%).

Specific Conditions

  • SUDs frequently co-occur with anxiety disorders like generalized anxiety, panic disorder, and PTSD.
  • Depression, bipolar disorder, and other mood disorders are also highly prevalent alongside substance use disorders.

Additional Statistics

  • Co-occurring serious mental illness (SMI) and SUDs in young adults (18-25) rose from 1.7% in 2015 to 2.8% in 2019.
  • Of those with heroin use disorder, over 66% are nicotine-dependent, and significant percentages struggle with alcohol or cocaine addiction.
  • People with co-occurring disorders are much more likely to be arrested, highlighting the complex challenges they face.

Global Perspective

  • Studies across cultures show high rates (50-80%) of psychiatric conditions among people with drug use disorders.

The significant overlap between mental health and addiction underscores the need for treatment that addresses both conditions simultaneously.

Treatment Rates and Barriers to Accessing Care

Despite the importance of treatment, many individuals with mental health and substance use disorders never receive the help they need. Here’s a look at the numbers:

Treatment Rates

  • Co-occurring Disorders: Only 9.1% of the 7.7 million adults with co-occurring disorders receive treatment for both conditions.
  • Substance Use Disorders (SUDs): Treatment gaps are wide, with the vast majority (78.1%) of individuals with alcohol abuse/dependence going untreated.
  • Mental Health Disorders: Over half of people with conditions like depression, anxiety disorders, and bipolar disorder do not receive treatment.

Barriers to Accessing Care

There are various barriers to accessing proper care for SUD treatment. Closing the treatment gap requires addressing these obstacles:

  • Cost & Insurance: High costs and inadequate insurance coverage prevent many from seeking care (37% for mental health, 31% for SUD treatment).
  • Provider Shortages: Lack of mental health professionals, especially in rural areas, limits access.
  • Stigma: Fear of judgment or confidentiality concerns deter individuals from seeking help.
  • Lack of Awareness: People may not know what resources exist or how to recognize signs of needing help.
  • Systemic Issues: Long waitlists, fragmented care systems, and socioeconomic factors like poverty create additional barriers.


Substance use disorders (SUDs) are a widespread problem in the US. It affects nearly 50 million people. This crisis cuts across all demographics and has devastating consequences for individuals, families, and communities.

Alarmingly, despite the need, treatment rates remain low. Only a tiny fraction receive help, especially for co-occurring mental health issues.

We must strive for improved access to treatment programs that address both substance use and mental health needs. Considering the unique challenges different populations face will lead to more effective solutions.



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