Addiction

by WRD News Team – March 12, 2025

The global fight against addiction has taken an important step forward with the launch of the Hyannis Consensus Blueprint, an initiative that offers a comprehensive, balanced drug policy supported by leading experts and organisations. Speaking at the UN Commission on Narcotic Drugs, Dr. Kevin Sabet, President and CEO of SAM (Smart Approaches to Marijuana), highlighted the Hyannis Consensus Blueprint as a “blueprint for effective drug policy” introduced by international experts and organisations. He emphasised its focus on prevention, treatment, recovery, criminal justice, global cooperation, and supply reduction. Dr. Sabet also warned against the push to normalise drug use, describing the catastrophic human toll of addiction and urging nations to invest in the pillars outlined in the blueprint. His remarks underscored the need for a balanced, evidence-based approach to tackling drug-related challenges worldwide.

What is the Hyannis Consensus Blueprint?

The Hyannis Consensus Blueprint is a groundbreaking framework designed to guide international efforts in addressing the devastating impact of addiction. Key pillars shape this balanced drug policy, including prevention, intervention, treatment, recovery, supply reduction, and enhanced global collaboration. With addiction now at catastrophic levels in many regions, the blueprint represents a vital roadmap for sustainable change.

The principles outlined in the blueprint prioritise strategies that discourage drug use while addressing underlying systemic challenges. It promotes innovating criminal justice systems, encourages adopting evidence-based treatment options, and advocates uniting globally to combat addictive substances.

The Cost of Ignoring Addiction

Failing to address addiction comes with an enormous human and economic cost. The transcript from the Hyannis Consensus launch highlights a pressing need to move beyond toxic cycles of permissive drug policies and normalisation. Legalisation of drugs, as seen in North America, has reportedly led to devastating effects, particularly among young people, and prioritised corporate profits over public health.

The Hyannis Consensus Blueprint stands as a counterpoint to this trend. It promotes a world where communities can thrive without the shadow of addiction, empowering individuals to recover fully and lead drug-free lives.

Prevention and Recovery as Pillars of Change

At its core, the Hyannis Consensus Blueprint revolves around prevention and recovery. Prevention aims to stop drug use before it starts, while recovery offers individuals a path to rebuild their lives. This proactive approach aims to not only reduce harm but also transform lives for the better.

The blueprint urges balancing efforts across criminal justice and public health systems. Effective drug courts alongside harm-reduction interventions serve as vital tools in discouraging drug use and fostering recovery. Nations serious about tackling addiction must consider these solutions to safeguard future generations.

Governments Urged to Prioritise Resilient Societies

Governments worldwide are now being urged to realign their national drug policies with the principles of the Hyannis Consensus Blueprint. Countries are encouraged to reaffirm their commitment to international drug conventions, reject legalisation experiments that prioritise private interests, and expand programmes rooted in criminal justice reform and effective public health measures.

The launch of this blueprint serves as a rallying cry for nations determined to prioritise human dignity and community wellbeing. By adopting the Hyannis Consensus Blueprint, countries can pave the way for healthier, more resilient societies.

Why the Hyannis Consensus Matters

Addiction is more than an individual struggle; it’s a societal challenge that affects families, economies, and futures. The Hyannis Consensus Blueprint is a bold step towards reversing the tide of permissive drug policies and ineffective strategies. For countries looking to protect their citizens, this balanced drug policy provides the tools and vision necessary for meaningful change.

Organisations like the Dalgarno Institute and WFAD are at the forefront of this global effort, highlighting the importance of this significant, timely initiative. Communities deserve policies that prioritise recovery, not exploitation, and the Hyannis Consensus Blueprint is uniquely positioned to achieve this goal.

Learn more here.

Source: https://wrdnews.org/the-hyannis-consensus-blueprint-a-landmark-in-balanced-drug-policy/

Filed under: Addiction,Culture,Drug use-various effects,Latest News,Prevention and Intervention,Treatment and Addiction,USA :

AddictionPolicyForum.png

Mar 5 – Updated: Mar 12
 
A randomized clinical trial published in JAMA Network Open found that incorporating online group mindfulness sessions into buprenorphine treatment for opioid use disorder (OUD) significantly reduced opioid cravings compared to treatment as usual.
The study, led by Dr. Zev Schuman-Olivier and colleagues from Cambridge Health Alliance and Harvard Medical School, examined the effectiveness of a 24-week virtual mindfulness-based program compared to a standard recovery support group using evidence-based practices. The trial included 196 participants across 16 U.S. states.

The mindfulness-based program showed similar levels of opioid use and anxiety reduction compared to standard best-practice groups but significantly outperformed in reducing self-reported opioid craving (67 percent vs. 44 percent, P<0.001). Study results indicate that mindfulness is a potent treatment option that can help reduce opioid craving during buprenorphine treatment.

“These findings are compelling evidence that trauma-informed mindfulness groups can be offered as an option for people during medication treatment for opioid use disorder,” said Dr. Zev Schuman-Olivier, MD, principal investigator of the study, founding director of the Center for Mindfulness and Compassion, and director of addiction research at Cambridge Health Alliance. “Mindfulness should be strongly considered for patients experiencing residual cravings after starting buprenorphine.”
As one participant reported, “This program helped me learn new techniques that I didn’t even know existed before I began. I still meditate all the time and don’t even need to have any sound on. I just lay down and push away all of my stress. It was well worth every minute I spent there.”

OUD remains a major public health crisis in the U.S., with over 100,000 opioid overdose deaths each year. Medications for opioid use disorder (MOUD), such as buprenorphine, are evidence-based treatments for opioid use disorder (OUD). Opioid craving is a risk factor for relapse for patients receiving MOUD. Experts highlight that further research is needed to explore how mindfulness can be integrated into existing OUD treatment frameworks to improve long-term recovery outcomes.

Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2829421
Filed under: Addiction,Culture,Latest News,Mental Health,Opioids,Prevention and Intervention,USA :
by Brian Mann, NPR March 15, 2025

This story originally appeared on NPR’s “All Things Considered.” 

Pennsylvania is seeing roughly 2,000 fewer drug deaths a year. Nationwide, the number of annual deaths from drug overdoses has dropped by more than 30,000 people a year.

On a blustery winter morning, Keli McLoyd set off on foot across Kensington. This area of Philadelphia is one of the most drug-scarred neighborhoods in the U.S. In the first block, she knelt next to a man curled on the sidewalk in the throes of fentanyl, xylazine or some other powerful street drug.

“Sir, are you alright? You OK?” asked McLoyd, who leads Philadelphia’s city-run overdose response unit. The man stirred and took a breath. “OK, I can see he’s moving, he’s good.”

In Kensington, good means still alive. By the standards of the deadly U.S. fentanyl crisis, that’s a victory.

It’s also part of a larger, hopeful trend. Pennsylvania alone is seeing roughly 2,000 fewer drug deaths a year.

Nationwide, the number of annual deaths from drug overdoses has dropped by more than 30,000 people a year.

That’s according to the latest provisional data from the Centers for Disease Control and Prevention, comparing drug deaths in a 12-month period at the peak in June 2023 to the latest available records from October 2024.

Officials with the CDC describe the improvement as “unprecedented,” but public health experts say the rapidly growing number of people in the U.S. surviving addiction to fentanyl and other drugs still face severe and complicated health problems.

“He’s not dead, but he’s not OK,” McLoyd said, as she bent over another man, huddled against a building unresponsive.

Many people in Kensington remain severely addicted to a growing array of toxic street drugs. Physicians, harm reduction workers and city officials say skin wounds, bacterial infections and cardiovascular disease linked to drug use are common.

“It’s absolutely heartbreaking to see people live in these conditions,” she said.

Indeed, some researchers and government officials believe the fentanyl overdose crisis has now entered a new phase, where deaths will continue declining while large numbers of people face what amounts to severe chronic illness, often compounded by homelessness, poverty, criminal records and stigma.

“Initially it’s been kind of this panic mode of preventing deaths,” said Nabarun Dasgupta, who studies addiction data and policy at the University of North Carolina-Chapel Hill. His team was one of the first to detect the national drop in fatal overdoses.

His latest study found drug deaths have now declined in all 50 states and the trend appears to be long-term and sustainable. “Now that we have found some effective ways to keep people alive, it’s really important to reach out to them and try to help them improve their whole lives,” Dasgupta said.

Source: https://whyy.org/articles/fentanyl-deaths-help-for-survivors/

Filed under: Addiction,Drug use-various effects,Fentanyl,HIV/Injecting-Drug-Users,Latest News,Synthetics,Treatment and Addiction,USA :

by Mia Holloman, Directorate of Prevention, Resilience and Readiness – March 11, 2025

A strong Army starts with healthy Soldiers and communities. When Soldiers are at their best, they’re ready for any mission. The Army Substance Abuse Program is committed to preventing substance misuse before it becomes a problem, giving leaders the tools to recognize risks and take action early.

Prevention starts with awareness and the right support. ASAP provides education and resources to help Soldiers, leaders and units work together to address alcohol and drug misuse. Commanders play a vital role in creating positive, substance-free environments and encouraging activities that strengthen resilience and teamwork. By taking a proactive approach, Soldiers stay focused, engaged and mission-ready.

“Take advantage of services that the Army offers before there is an incident,” said Georgina Gould, Army Substance Abuse Program Specialist, Ready and Resilient Integration and Training division.

“If there are indicators that problematic substance misuse is getting in the way at work or at home, schedule an appointment to meet with a provider at your assigned embedded behavioral health clinic, where you can be assessed for voluntary care without command involvement.”

The Substance Use Disorder Clinical Care Program, a vital resource for Soldiers and their Families impacted by substance misuse, complements ASAP’s prevention initiatives.

SUDCC is the Army’s model for delivering substance use treatment in a manner that is integrated, aligned with unit needs and conveniently co-located. Substance use disorder treatment is part of a comprehensive plan aimed at achieving rapid recovery and restoring individuals to full readiness.

“SUDCC’s mission of providing treatment and returning Soldiers to the fight is congruent with the ASAP mission of strengthening the overall fitness and effectiveness of the Army workforce, (conserving) manpower and enhancing Soldier combat readiness,” Gould said.

SUDCC provides care tailored to the unique needs of the Total Army, ranging from initial assessment and counseling to outpatient and inpatient treatment options. Gould said the SUDCC program has a low recidivism rate, meaning individuals are less likely to return to the program.

“There is a low number of Soldiers returning for further treatment after services are completed, which means they are successful in returning to the mission and their Families with enhanced coping skills and wellness,” Gould said.

Together, ASAP and SUDCC demonstrate the important role of the Army community in prevention, awareness and recovery. Substance misuse is not just a personal issue; it can impact entire teams, communities and missions. ASAP and SUDCC bring together partners from different sectors and engage stakeholders to build a strong, united effort against substance misuse.

Source: https://www.army.mil/article/283651/strengthening_the_army_community_through_substance_misuse_prevention_treatment_options

Filed under: Addiction,Culture,Drug use-various effects,Education,Latest News,Prevention and Intervention,USA :

Photo: UNODC
Member states voting at the 68th session of the CND.

Vienna (Austria), 14 March 2025 — The sixty-eighth session of the Commission on Narcotic Drugs (CND) concluded today after five days of intensive discussions on global drug policy, international cooperation and the implementation of international drug policy commitments. The strong engagement and high level of participation from governments and stakeholders in Vienna, 2,000 of whom gathered to exchange views and shape collective responses to evolving drug-related challenges, demonstrates the Commission’s relevance as the global platform for addressing the complexities of the world drug problem in an evidence-based, forward-looking manner.

In her closing remarks, United Nations Office on Drugs and Crime (UNODC) Executive Director Ghada Waly emphasized the importance of strengthening the CND. “In times of division and uncertainty, we need effective multilateral institutions more than ever,” she said. “And the level of engagement at this session has once again confirmed the enduring relevance of this Commission as the global forum for drug policy.”

She urged Member States to redouble their efforts, commitment and cooperation, recognizing that the evolution of the world drug problem demands a renewed and determined response. “UNODC will remain committed to working for a healthier and safer world, guided by the decisions of Member States,” she concluded.

Six New Substances under Control

In fulfilling its normative functions under the international drug control conventions, the Commission acted on recommendations from the World Health Organization (WHO), deciding to place six substances under international control. These include four synthetic opioids –  N-pyrrolidino protonitazene, N-pyrrolidino metonitazene, etonitazepipne, and N-desethyl isotonitazene – which have been linked to fatal overdoses. The Commission also placed hexahydrocannabinol (HHC), a semi-synthetic cannabinoid with effects similar to THC that has been found in a variety of consumer products, under Schedule II of the 1971 Convention. Additionally, carisoprodol, a centrally acting skeletal muscle relaxant, widely misused in combination with opioids and benzodiazepines, was placed under Schedule IV of the 1971 Convention due to its potential for dependence and health risks. These scheduling decisions reflect the Commission’s ongoing efforts to respond to emerging drug threats and protect public health.

Six resolutions adopted

The Commission on Narcotic Drugs (CND) also adopted six resolutions, reinforcing global efforts to address drug-related challenges through evidence-based policies and strengthened international cooperation.

To protect children and adolescents, the Commission encouraged the implementation of scientific, evidence-based drug prevention programs, emphasizing the need for early interventions and cross-sectoral collaboration to build resilience against non-medical drug use.

Recognizing the growing impact of stimulant use disorders, another resolution promoted research into effective, evidence-based treatment options, calling on Member States to invest in innovative pharmacological and psychosocial interventions to improve care for those affected.

The importance of alternative development was reaffirmed with a resolution aimed at modernizing strategies that help communities transition away from illicit crop cultivation, ensuring long-term economic opportunities while addressing broader issues like poverty and environmental sustainability.

In response to the rising threat of synthetic drugs, the Commission adopted a resolution to protect law enforcement and first responders dismantling illicit synthetic drug labs and advocating for stronger safety protocols, enhanced training and international cooperation to reduce risks.

To strengthen the implementation of international drug control conventions and policy commitments, the Commission decided to establish an expert panel tasked with developing a set of recommendations to strengthen the global drug control system.

Additionally, recognizing the environmental damage caused by illicit drug-related activities, the Commission adopted another resolution calling on Member States to integrate environmental protection into drug policies and address the negative impacts on the environment resulting from the illicit drug-related activities.

These resolutions reflect the Commission’s commitment to providing concrete, coordinated responses and ensuring that drug control policies remain effective, adaptive and aligned with contemporary challenges.

Source: https://www.unodc.org/unodc/frontpage/2025/March/cnd-68-concludes_-six-new-substances-controlled-six-resolutions-adopted.html

Filed under: Addiction,Alcohol,Cannabis/Marijuana,Culture,Drug use-various effects,Economic,Education,Latest News,Marijuana and Medicine,Mental Health,Opioids,Others (International News),Prescription Drugs,Prevention and Intervention,Synthetics,Treatment and Addiction,Youth :

    Delegation of the European Union to the International Organisations in Vienna

Statement by Press and information team of the Delegation to UN and OSCE in Vienna:
Distinguished Chair, Excellencies, Ladies and Gentlemen,

It is an honour to be here and to speak on behalf of the European Union and its Member States. Albania, Andorra, Bosnia and Herzegovina, Georgia, Iceland, Montenegro, North Macedonia, Republic of Moldova, San Marino and Ukraine align themselves with this statement.

Mr Chair,

We remain committed to strengthening the global cooperation to address drug-related challenges in accordance with an evidence-based, integrated, balanced and comprehensive approach. We acknowledge the important role of UNODC in monitoring the world drug situation, developing strategies on international drug control and recommending measures to address drug-related challenges.

As we meet today, conflicts and violence are unfolding in numerous parts of the world. The EU and its Member States call for the full respect for the UN Charter andinternational law, including international humanitarian law, whether in relation to Russia’s war of aggression against Ukraine, or the ongoing conflicts in the Middle East, Sudan, Ethiopia, DRC and elsewhere.

Drug trafficking controlled by organised crime groupsthreatens public health, our security, our economies and prosperous development worldwide, and even our democratic institutions and the rule of law. This is an important security challenge that Europe is currently facing. As demonstrated by the European Drug Report 2024, as a consequence of the high availability of drugs, large-volume trafficking and competition between criminal groups in Europe, some countries are experiencing an increase in violence and other forms of criminality linked to the operation of the drug market.

To address this concern, last November the EU hosted the European Conference on Drug-related Violenceas part of the implementation of the EU Roadmap to combat drug trafficking and organised crime. At the conference, the EU Drugs Agency called for action on drug-related violence, to encourage and support efforts to enhance safety and security across all sectors of society with measures to anticipate, alert, respond and learn from the growing complexities of drug-related violence. This initiative reflects our collective determination to address the increasing violence linked to drug trafficking.

In line with the pledge of the Global Coalition to address Synthetic Drug Threats that the EUcommitted to in September 2024, we are currently closely monitoring the risks of a potential increase in the supply and demand for synthetic opioids in Europe. This possible shift could represent unique challenges for public health systems and law enforcement.

Among such challenges is the growing number of illegal laboratories that produce synthetic drugs. Considering the threat they pose, Poland – on behalf of the EU – has tabled a resolution that draws attention to the protection of all those that are at the forefront of dismantling drug laboratories. Our aim is to set the ground for global standards in ensuring the safety of law enforcement officers, and we count on your support for this important resolution.

The EU and its Member States also call for greater consideration of development-oriented drug policies and alternative development measures, as well as the environmental damage linked to the direct and indirect impact of illicit drug crop cultivation, drug production and manufacture and drug policy responses. Conscious of the realities that shape our world, a resolution addressing the environmental impact of drugs has been tabled by France on behalf of the EU. This is atopic that needs more engagement from all of us, and we hope that you will back this resolution as well.

The EU and its Member States continue to emphasise that States are obliged to protect, promote and fulfilhuman rights, including when they develop and implement drug policies. All human beings are born free and equal in dignity and rights, and the EU and its Member States recall that the death penalty should be abolished globally. We condemn the use of capital punishment at all times and under all circumstances, including for drug-related offences. Additional measures should be taken for people in vulnerable and marginalised situations and to reduce stigma and discrimination. We underline that substance use disorders are a health issue requiring compassionateand evidence-based interventions. Stigmatisation and criminalisation of individuals with substance use disorders should be replaced with a health-centredapproach to reduce risks and harm.

Addressing drug-related harm also remains an important pillar of EU drug policy and the EU Drugs Strategy. The EU and its Member States are implementing a human rights-based approach with a range of measures in compliance with the three international drug conventions. The aim is to reduce drug supply and to take prevention, treatment, care and recovery measures, to reduce risk and harm to society and to the individual. We also ensure a meaningful involvement of scientific experts, civil society and affected communities. We urge the international community to further embrace pragmatic measures aimed at reducing the health and social harms, both for the individual and for society, associated with drug use. From needle and syringe exchange programmes to opioid agonist therapies, such evidence-based initiatives are essential for safeguarding public health and dignity. Prevention, treatment, care and recovery measures, risk and harm reduction must be expanded, adequately resourced, and firmly rooted in respect for human rights, as also set out in last year’s CND resolution 67/4 [on preventing and responding to drug overdose through prevention, treatment, care and recovery measures, as well as other public health interventions, to address the harms associated with illicit drug use as part of a balanced, comprehensive, scientific evidence-based approach].

In the context of current global drug-related challenges, it is important to stress that effective solutions can only be achieved through a balanced and whole-of-society approach as well as by engaging all relevant stakeholders, including health-care personnel, who provide critical support to those affected by substance use disorders; law enforcement officers, who risk their lives in targeting organised crime groups involved in drug production and trafficking; academia, which contributes with evidence-based research and innovative solutions; civil society organisations, which play an important role in prevention, and in risk and harm reduction initiatives. International cooperation is also indispensable to tackle the global drugs phenomenon and we count on the close involvement ofall relevant United Nations entities, including human rights bodies, to foster coordinated international action and inter-agency cooperation.

As set out in the high-level declaration by the CND on the 2024 mid-term review, we stress the urgent need for further ambitious, effective, improved and decisive actions as well as for more proactive, scientific evidence-based, comprehensive, balanced approaches to address drug-related challenges.

For that, we emphasise the critical importance of thorough data collection, monitoring, and scientific research. The European Union Drugs Agency is therefore key in developing Europe’s capacity to react to both current and future drug-related challenges, and we have made a concrete pledge in this regard at last year’s High-level segment of the CND.

Mr. Chair, to conclude,

Continuous drug-related challenges require our united front and cooperation to address them in the most effective and sustainable manner, and we count on global efforts to do so together. The EU and its Member States reaffirm their own commitment to fostering a comprehensive, inclusive, and balanced approach to addressing the world drug situation. We call on all Member States and stakeholders to join us in prioritising health, dignity, and human rights in all aspects of drug policy.

Thank you.

SOURCE: https://www.eeas.europa.eu/delegations/vienna-international-organisations/eu-statement-general-debate-68th-session-commission-narcotic-drugs-10-march-2025_en

Filed under: Addiction,Brain and Behaviour,Culture,Education,Health,Latest News,Mental Health,Others (International News),Prevention and Intervention,Treatment and Addiction,Youth :

by Professor Onohuean Hope; Department of Pharmacology and Toxicology, Kampala International University, Uganda, and Professor Frasia Oosthuizen who holds a BPharm, MSc (Pharmacology) and PhD (Pharmacology) qualifications, all obtained from PU for CHE (now North-West University). Published: March 7, 2025 in the journal PLOS One (stylized PLOS ONE, and formerly PLoS ONE) is a peer-reviewed open access mega journal published by the Public Library of Science (PLOS) since 2006.

Published: March 7, 2025

ABSTRACT

Introduction
There is an ongoing global upsurge of opioid misuse, fatal overdose and other related
disorders, significantly affecting the African continent, due to resource-limited settings and
poor epidemiological surveillance systems. This scoping review maps scientific evidence
on epidemiological data on unlawful opioid use to identify knowledge gaps and policy
shortcomings.

Method
The databases (PubMed, Scopus, Web of Sciences) and references were searched
guided by Population, Concept, and Context (PCC) and PRISMA-ScR. The extracted
characteristics examined were author/year, African country, epidemiological distribution,
age group (year), gender, study design and setting, common opioid/s abused, sources of
drugs, reasons for misuse, summary outcomes and future engagement.

Results
A population of 55132 participated in the included studies of 68 articles, with the
largest sample size of 17260 (31.31%) in a study done in South Africa, 11281(20.46%)
in a study from Egypt and 4068 (7.38%) in a study from Ethiopia. The gender of the
participants was indicated in 65(95.59%) papers. The mean and median age reported
in 57(83.82%) papers were 15.9-38, and 22-31years. The majority of study-designs
were cross-sectional, 44(64.71%), and the most used opioids were heroin, 14articles
(20.59%), tramadol, 8articles (11.76%), and tramadol & heroin, 6 articles (8.82%)
articles. Study-settings included urban community 15(22.06%), hospital 15(22.06%),
university students 11(16.18%), and secondary school learners 6(8.82%). The highest
epidemiological distributions were recorded in the South African study, 19615(35.60%),
Egyptian study, 14627(26.54%), and Nigerian study 5895(10.70%). Nine (13.24%)
papers reported major opioid sources as black market, friends, and drug dealers. To
relieve stress, physical pain and premature ejaculation, improve mood and sleep-related
PLOS ONE | https://doi.org/10.1371/journal.pone.0317036 March 7, 2025 2 / 24
PLOS ONE The burden of unlawful use of opioid and associated epidemiological characteristics in Africa
problems and help to continue work, were the major reasons for taking these drugs as
reported in twenty articles (29.41%).

Conclusion
The findings of this scoping review show significant knowledge gaps on opioid usage in
the African continent. The epidemiological distribution of unlawful use of opioids among
young adults, drivers, and manual labourers in both genders is evident in the findings.
The reason for use necessity scrutinises the role of social interaction, friends and family
influence on illicit opiate use. Therefore, there is a need for regular epidemiological
surveillance and investigations into multilevel, value-based, comprehensive, and strategic
long-term intervention plans to curb the opioid problem in the region.

To access the full document, please click on the link below:

                   https://doi.org/10.1371/journal.pone.0317036

Filed under: Addiction,Drug use-various effects,Latest News,Opioids,Others (International News) :

After achieving six months of sobriety, Horning has become a vocal advocate for comprehensive substance use prevention and education programs aimed at helping students in Warren County lead substance-free lives.

His initiative, developed in collaboration with Dr. Patricia Hawley-Mead and district officials, seeks to implement substance use prevention and education services across the school district. The goal of the initiative is to provide students, teachers, and parents with the education, community resources, and intervention strategies needed to prevent substance use and promote healthier lifestyle choices.

“If you were to tell me eight months ago I would be standing in front of you talking about substance abuse prevention and putting Narcan in AED boxes, I would have said you were crazy,” Horning shared with the audience during a recent school board meeting.

Horning’s passion for substance use prevention stems from his own difficult experience with addiction. He has openly shared his struggles with substance use, depression, and unhealthy coping mechanisms that led him down a painful path.

“My addiction was full of loss, hardships, and failures,” Horning explained. “Nothing seemed to work, nothing was helping me, and most importantly, I wasn’t helping myself. I’ve been in and out of psychiatrists’ offices, tried different medications, and felt completely lost. The only way I found recovery was by chance, but it shouldn’t be that way. We need a system in place to give students a way out before it’s too late.”

Looking back on his darkest moments, Horning admitted he never imagined he would be advocating for change in front of a crowd.

“I was not a great person at that moment in time,” he said, becoming emotional. “I made a lot of mistakes. My family, who is sitting behind me today, can tell you that. People inside and outside of school districts saw me at my worst. The disease of addiction is a lifelong battle that I will face until the day I die. But that does not mean it has to end in tragedy. That is why I am standing here today – to fight for others like me.”

Horning recognizes that many students turn to substances for a variety of reasons–whether out of boredom, depression, anxiety, or as a way to cope with personal struggles. His initiative is designed not only to educate students on the dangers of substance use but also to provide them with the tools and support systems they need to make better, healthier choices.

“This initiative will not only help students stay alive in case of an overdose, but it will help them find a way out of addiction and into a new life,” he emphasized. “Even if this helps just one person, it will all be worth it.”

INITIATIVE’S INSPIRATION

The inspiration behind Horning’s initiative came after a district-wide program held on September 18, 2024. During the event, public speaker Stephen Hill presented the First Choice & A Second Chance program to high school students. The program aimed to break the stigma surrounding substance use disorder, raise awareness about the ongoing drug epidemic, and encourage students to make healthier decisions.

Following the event, Horning was motivated to take action. He reached out to district administrators, safety officers, the school nurse department head, and a Family Services of Warren County drug and alcohol counselor to begin crafting a proposal for a comprehensive Substance Use Prevention and Education Service in the district.

The proposal calls for the establishment of educational programs that would teach students about the risks associated with substance use, provide early intervention services, and offer mental health support. Additionally, Horning’s plan includes provisions for Narcan to be available in school AED boxes, ensuring that life-saving measures are ready in case of an overdose emergency.

Hawley-Mead, who has worked closely with Horning on the initiative, stressed the importance of early intervention and prevention.

“The increasing prevalence of substance use among young people is a growing concern,” Mead said. “It poses a significant risk to their academic success, emotional well-being, and future prospects. Early prevention and education efforts have been shown to reduce substance use, improve student decision-making, and help create a more supportive and empathetic learning environment.”

Mead believes that by fostering a collaborative effort among educators, parents, and community partners, the district can proactively address the issue of substance use and equip students with the knowledge and support they need to thrive.

“This initiative will provide students, teachers, and parents with education, resources, and intervention strategies to support healthy choices and foster a positive, drug-free environment,” Mead said.

Horning concluded his speech with an emotional reflection on his own personal journey and the importance of offering help to others who may be struggling.

“What drove me to do this was really a lot of depression and unhealthy coping skills,” he shared. “I was not in the right mindset when I first used. I was not okay. If somebody had sat me down and told me, ‘We can help you,’ it could have saved me years of pain. That’s why we need this now. We need to offer students the opportunity to get help before it’s too late.”

Horning is determined to ensure that no student has to face the same struggles he did. His initiative is not only aimed at providing support for those already struggling with substance use but also preventing others from ever going down that difficult path.

“The only way I found recovery was by chance,” he admitted. “That’s the best way I can put it. Recovery is important, but when you are in an active addiction, it feels impossible to get through to someone. That’s why, eight months ago, I would have called you crazy if you told me I’d be standing here today. But now, I’m here. I have made myself a better person, and I want to give back for what I have found.”

Horning and district officials are now seeking approval from the school board and the community to bring this initiative to life in Warren County schools. Their goal is to integrate substance use prevention education into the curriculum, provide resources for students and families, and ensure that Narcan is available in AED boxes to help prevent potential overdose deaths.

“We don’t have to live in tragedy like other schools have,” Horning said. “We need to teach students how to use Narcan, how to stay alive, and most importantly, how to find a way out of addiction. Recovery is possible, and I want to show others that they don’t have to suffer alone.”

HORNING’S PROPOSAL

Horning’s written proposal outlines five key goals for the pilot initiative: Enhance school safety by increasing access to Narcan for emergency overdose response. Educate the school community about substance use prevention, intervention, and response strategies. Establish a student club focused on substance use awareness, prevention, and peer education to increase awareness and reduce stigma surrounding substance use disorder. Actively engage stakeholders, including students, staff, families, and community partners, to establish an anonymous and supportive program where students can learn about and advocate for substance use prevention. Create a district-sponsored club dedicated to promoting substance use prevention and education.

Hawley-Mead emphasized that while Narcan is already available in nurse’s offices during school hours, having it in AED boxes would ensure it’s accessible during after-school activities and weekend events.

“This proposal aims to make Narcan more widely available and accessible to first responders during emergencies, regardless of the time of day,” she said. “We want to ensure that this life-saving measure is available whenever and wherever it’s needed.”

Horning also reached out to Family Services of Warren County, which has expressed strong support for the initiative.

“They are very, very responsive towards this program,” Horning said. “I’ve spoken with counselors, including Nicole Neukum, executive director, and they’re all willing to give us whatever we need to make this a success.”

School board member Mary Passinger asked Horning if he felt comfortable sharing the personal story behind his addiction.

“It was really a lot of depression and unhealthy coping skills,” Horning responded. “I was not in the right mindset when I first used. If someone had told me, ‘We can help you,’ it could have saved me from years of pain.”

Board member John Wortman commended Horning for his bravery in speaking out and bringing this important issue to the district’s attention.

“There is nothing more important than standing up for what you believe in,” Wortman said. “The proposals outlined here will help make a significant, positive impact on students in Warren County. And that’s something we can all support.”

Superintendent Gary Weber also voiced his strong support for the initiative.

“We are 100% behind this initiative,” he said. “It’s clear that Jessie and Dr. Mead have worked hard to bring together stakeholders and develop a plan that will have a lasting and positive impact. We want to make sure this program is sustainable, and we’re committed to supporting it every step of the way.”

The district is currently reviewing Horning’s proposal, and community members are encouraged to get involved in supporting this critical initiative. For updates and information on how to help, individuals can reach out to district officials or Family Services of Warren County.

With this initiative, Horning hopes to not only save lives but also inspire others to break free from addiction and reclaim their futures.

“Recovery is possible,” he said. “And I want to show others that they don’t have to suffer alone.”

Source: https://www.timesobserver.com/news/local-news/2025/03/student-leads-charge-for-substance-use-prevention/

Filed under: Addiction,Alcohol,Cannabis/Marijuana,Culture,Education,Latest News,Mental Health,Opioids,Prescription Drugs,Prevention and Intervention,Treatment and Addiction,USA,Youth :

New Drug Prevention Guide issued to all schools to raise awareness about drug abuse

Abdulla Rasheed (Abu Dhabi Editor)  Last updated: 
The Ministry of Interior has warned adolescents and young individuals of both genders against the dangers of consuming certain medications, including sedatives, that can lead to addiction and even death due to excessive, non-prescribed use.Supplied

Abu Dhabi: The Ministry of Interior (MoI), in collaboration with the Drug Control Council and the National Drug Prevention Programme, has issued a Drug Prevention Guide, which has been distributed to all schools across the country.

Through the guide, the ministry has warned adolescents and young individuals of both genders against the dangers of consuming certain medications, including sedatives, that can lead to addiction and even death due to excessive, non-prescribed use.

What are sedatives?

Sedatives are medications designed to calm the patient and induce sleep by altering nerve signals in the central nervous system. They are commonly used to treat anxiety, stress, seizures, panic attacks, and sleep disorders.

Sedatives must be used with extreme caution. Misuse or mixing them with substances like alcohol can result in severe health complications, potentially life-threatening. Overuse can inhibit critical nerve signals to the heart, lungs, and other organs, leading to dangerous side effects.

Parents should be aware of the following indicators of sedative addiction:

• Unusual or aggressive behaviour.

• Lack of focus and attention.

• Health issues such as memory loss, movement difficulties, and low blood pressure.

Myths debunked

The guide also cautions against widespread misconceptions among students, such as the belief that these medications can treat depression, relieve physical fatigue, boost energy levels, or enhance memory. The ministry has clarified that such beliefs are entirely false and misleading. It said individuals who consume these drugs without a medical prescription risk falling into the trap of addiction, which can ultimately lead to fatal consequences.

The Ministry of Education has ensured its distribution to schools to assist parents in early detection of substance abuse, protect their children, and educate them on their role in safeguarding their kids from these harmful substances. It also raises legal awareness and provides details on how to access treatment and rehabilitation services within the country.

Additionally, the guide highlights seven key protective factors that can help prevent children from substance abuse. It warns against synthetic drugs disguised as dried leaves, which have devastating effects, as well as the misuse of prescription medications, which can lead to addiction and severe health complications, including death.

Risks of drug abuse

The first chapter of the “Parents’ Guide to Drug Prevention” provides information on the various substances that children might be exposed to and details their health consequences. These include:

• Physical effects: Heart and blood pressure disorders, digestive system complications, severe weight loss, liver infections, immune system deficiencies, epilepsy, and sudden death.

• Psychological effects: Sleep disorders, delusions, hallucinations, schizophrenia, anxiety, depression, social withdrawal, emotional instability, and suicidal tendencies.

• Economic effects: Reduced individual productivity and financial burdens associated with drug use and treatment.

The guide also covers different types of drugs, including inhalants, such as lighter gases, paint fumes, and glue, which are easily accessible but cause severe health risks, including brain and liver damage, limb numbness, headaches, nausea, hallucinations, kidney failure, respiratory failure, and allergic reactions around the nose and mouth.

Recognising signs of drug use

The guide outlines key indicators that can help identify drug abuse, such as:

• Excessive talking and hyperactivity without a clear reason.

• Unusual jaw movements (circular or counter-directional).

• High blood pressure, paranoia, and aggressive behavior.

The guide also warns against addiction to certain prescription medications like:

Painkillers, which can cause respiratory depression, brain damage, and even death.

Depressants, which may result in blurred vision, nausea, difficulty concentrating, and fatal consequences if combined with alcohol.

Stimulants, which can lead to high body temperature, paranoia, and other harmful effects when misused.

Parents can detect prevent drug addiction among children in the following ways:

     2. Open dialogue: Engaging in calm discussions with children about concerns without making accusations.

     3. Empathy and understanding: Being prepared for emotional reactions, such as anger or threats of leaving home, and responding with reassurance and support.

     4. Being firm but loving: Setting clear household rules while expressing care and concern.

     5. Persistence: If discussions become overwhelming, parents should take a break and resume later.

     6. Seeking professional guidance: If a child refuses to talk or get help, parents should consult treatment centers for advice.

     7.Consulting specialists: Parents should seek expert assistance to organise their thoughts and receive proper guidance.

 

Source: https://gulfnews.com/uae/government/uae-ministry-warns-students-against-consuming-sedatives-1.500050438

Filed under: Addiction,Drug use-various effects,Education,Latest News,Others (International News),Prevention and Intervention,Youth :

Consumption of alcoholic beverages could make people more likely to experiment with other drugs

Melissa Rudy
by Melissa Rudy Fox News  – Published 
Longevity doctor reacts to alcohol cancer advisory: ‘It’s about time’

Following the U.S. surgeon general’s new advisory warning of alcohol’s link to multiple cancers, Dr. Brett Osborn, a Florida neurosurgeon and longevity doctor, speaks with Fox News Digital about alcohol’s toxic effects on the brain and body.

A vast majority of American adults say they have consumed alcohol at some point — yet experts warn that alcoholic beverages could be a “gateway drug” to more harmful substances.

More than 84% of adults in the U.S. report having drunk alcohol in their lifetime, according to the 2023 National Survey on Drug Use and Health (NSDUH).

That same survey found that among underage Americans (12 to 17 years of age), more than 21% had consumed alcohol.

What is a ‘gateway drug’?

Dr. Kenneth Spielvogel, senior medical officer at Carrara Treatment in California, defined a “gateway drug” as a substance that exposes someone to other drugs.

Man drinking alcohol

More than 84% of adults in the U.S. report having drunk alcohol in their lifetime, according to the 2023 National Survey on Drug Use and Health. (iStock)

Marijuana is often pegged as a “classic gateway drug,” he told Fox News Digital, as it can lead to cocaine, heroin and other “harder drugs” that present a greater threat to loss of life via impaired driving and other volatile behaviors.

“Alcohol maintains a firm grip on a large portion of the adult population.”

“Any substance that impairs judgment is potentially a gateway drug, in my opinion — however, alcohol is the king of this,” Spielvogel said. “It maintains a firm grip on a large portion of the adult population.”

“I personally have seen the ravages of this — hungover victims turn to meth, cocaine and other drugs for the ‘pick me up’ they feel they need.”

Why alcohol can be a ‘gateway’

For many young people, alcohol is the first substance they try, according to Chris Tuell, a clinical psychotherapist and a chemical and behavioral addiction specialist at the Lindner Center in Mason, Ohio. This makes them more likely to experiment with other drugs later.

“Most people can use alcohol and it does not become problematic — but for some, it is destroying their lives,” he said in an interview with Fox News Digital.

Smoking marijuana

Marijuana is often pegged as a “classic gateway drug,” but one expert said that “alcohol is the king” when it comes to impairing judgment. (iStock)

Consumption of alcohol impairs judgment and decision-making, which can lead to riskier behaviors, including trying other substances, Tuell noted.

“Studies indicate that alcohol alters brain chemistry in ways that increase susceptibility to drug addiction,” the expert cautioned.

Jeremy Klemanski, addiction specialist and CEO of Gateway Foundation in Chicago, echoes his belief that alcohol is a gateway drug.

“We often hear reports from patients that they only use or started using while drinking, or that they were first exposed to alcohol and then tried other drugs for greater physical symptoms and feelings,” he told Fox News Digital.

friends with drinks

Research from the National Institute of Drug Abuse suggests that early exposure to alcohol can “prime the brain” for heightened responses to other drugs. (iStock)

“It is also important to note that once a person has used one mind-altering substance, their general thinking skills are impaired on some level,” he went on. “Other things they might not normally do become easier to justify or accept as an idea to act on.”

There is also a neurological element that comes into play, according to Dr. David Campbell, clinical director and program director at Recover Together Bend in Oregon.

“Alcohol affects neurotransmitter systems that are involved in the reward pathways that are similarly targeted by other drugs,” he told Fox News Digital.

Research from the National Institute of Drug Abuse suggests that early exposure to alcohol can “prime the brain” for heightened responses to other drugs, perhaps increasing the risks of the “gateway effect,” Campbell added.

Other factors at play

Experts emphasized that correlation does not equal causation.

“Just because people who use harder drugs often drink alcohol first does not necessarily mean alcohol caused their drug use,” Tuell noted.

Refusing beer

“There are few drugs where the sudden stoppage of their use can be deadly — alcohol is one of these,” an addiction specialist warned. (iStock)

Campbell agreed, noting that many “contextual factors and psychosocial stressors” should be considered within the broader context of someone’s life.

“Social environment, stressors, ease and proximity to access, social influences, mental health conditions, childhood trauma, genetics and other biological factors may all play a role,” he told Fox News Digital.

When and how to stop

Spielvogel shared some warning signs that someone may be dependent on alcohol and more susceptible to trying other harmful substances.

“One sign is if they have ever tried to cut down on their drinking and failed,” he said. “Also, they may be annoyed when asked about their alcohol consumption.”

People with alcohol dependency may also feel guilty when they drink, or they might consume alcoholic beverages in the morning, he added.

“It is very important that if someone has a use disorder, they seek professional help for their detox and recovery.”

Stopping “cold turkey” may not be the healthiest route, Spielvogel cautioned.

“There are few drugs where the sudden stoppage of their use can be deadly — alcohol is one of these,” he said.

“I cannot stress this enough; it is very important that if someone has a use disorder, they seek professional help for their detox and recovery, whether it’s a private treatment facility or going to a medical professional.”

“Do not do this on your own.”

Melissa Rudy is senior health editor and a member of the lifestyle team at Fox News Digital. Story tips can be sent to melissa.rudy@fox.com.

 

Source: https://www.foxnews.com/health/drinking-alcohol-can-lead-other-substance-use-addiction-experts-warn

Filed under: Addiction,Alcohol,Latest News,Prevention and Intervention,USA :

University of Southern California – Mar 3 2025

A new USC-led study provides the first nationwide picture of who knows about, carries, and uses naloxone to reverse deadly opioid overdoses.

Mireille Jacobson, professor of gerontology at the USC Leonard Davis School of Gerontology and a senior fellow at the USC Schaeffer Center for Health Policy & Economics, said the study was conducted to address the lack of comprehensive data on access to the lifesaving medication and eventually to support work on how it affects the number of deaths attributed to opioid overdoses in the U.S.

There have been many analyses of how new policies, including naloxone becoming available through pharmacy dispensation, correlate with reductions in opioid deaths, but we don’t know exactly how much of the improvement is directly due to naloxone use versus any of the various other things being done to address this crisis at the same time. We don’t really have any data on who knows what naloxone is for, carries it, and administers in the case of an overdose. We’re trying to fill in a missing link.”

Mireille Jacobson, professor of gerontology, USC Leonard Davis School of Gerontology

Addressing an epidemic

In the study, Jacobson and coauthor David Powell, a senior economist at RAND, note the critical need to tackle the ongoing opioid crisis, which has had profound effects in the U.S, and understand the impacts of measures intended to address the devastating rate of overdose deaths.

Of the more than 100,000 drug overdose deaths that occurred nationwide in 2023, more than 75% of them involved opioids, according to data from the Centers for Disease Control and Prevention. Previous USC Leonard Davis School research has also shown how opioid overdose deaths have contributed to the widening gap in life expectancy between the United States and other high-income countries.

Since 2023, naloxone has been available over the counter, in hopes that wider availability would encourage more people to have the drug at the ready to save the life of someone overdosing. However, the lack of reliable, nationwide data on who was buying, carrying, and using naloxone has hindered research on how to best prevent overdose deaths, Jacobson said.

“With the problem being so widespread, one question is how to most effectively manage this crisis,” she said. “To know where to put our resources, we need to know about the actual ways this medication gets to the people who will use it. Our goal was to fill in the data and allow people to understand the mechanisms.”

Online surveys shed light

In June 2024, Jacobson and Powell conducted an online survey of two groups of participants. The first group was a nationally representative sample of 1515 people over the age of 18 not living in an institutional setting, while the second group contained 512 individuals who reported currently or ever having opioid dependence. Additionally, 50 respondents, or 3.3%, from the national sample also reported opioid dependence, bringing the total number of people reporting their own dependence on opioids to 562.

 

  • 700 (46.2%) reported having heard of naloxone and correctly identified it as a drug to reduce opioid overdoses.
  • 160 people, or 10.6%, said they carried naloxone with them.
  • 128 people (8.4%) said they had administered naloxone to someone else, while 93 respondents (6.1%) said they had been administered naloxone themselves.

Among the 562 individuals reporting current or prior opioid dependence:

  • 500 people (89%) had heard of naloxone and knew its purpose.
  • 340 respondents (60.5%) reported carrying naloxone.
  • 267 (47.5%) reported administering the drug to someone else, and 221 (39.3%) said naloxone had been administered to them.

The survey also showed that a person’s perception of the risk of overdose, either for themselves or for someone they know, correlated with the choice to carry naloxone. Of the survey respondents in the national sample who reported themselves as “very likely to overdose,” 31% carried naloxone, and in the sample of people reporting opioid dependence, nearly 74% of those who said they had a high likelihood of overdosing carried the drug. The likelihood of carrying naloxone followed a similar pattern among those who stated that they knew someone else who was very likely to overdose.

Another notable finding concerned how people obtained the naloxone they carried. Among those who have ever carried naloxone, only 42% of those in the national sample, and just 22.6% of those who reported opioid dependence, said they purchased the medicine themselves. These results highlight the problem with estimating naloxone availability based on pharmacy sales, as it excludes the hospitals, clinics, and other community organizations who give the drug away for free, Jacobson explained.

Next steps

While the data provides some of the first nationwide insights on who has and uses naloxone, this is just a starting point for future research, Jacobson said.

She explained that she’s eager for the results to be examined and validated in other larger, more robust surveys, including in the USC Understanding America Survey. Ideally, future study will uncover the best ways to teach people about naloxone and the most efficient avenues to get the drug to the people who will use it to save lives.

“The hope is that we can look at this more longitudinally and in more detail,” Jacobson said.

Source: https://www.news-medical.net/news/20250303/USC-study-sheds-light-on-nationwide-naloxone-awareness-and-use.aspx
Filed under: Addiction,Latest News,Opioids,Prevalence,USA :
Teen non-medical misuse of medications may be more common than we believed.

by Mark Gold M.D. – Professor of Psychiatry, Yale, Florida and Washington Universities

Updated February 27, 2025 |  Reviewed by Gary Drevitch

Key points

  • Teen nonmedical misuse of medications may be more common than previously reported.
  • Adolescents misuse dextromethorphan (DXM) products for their dissociative/hallucinogenic effects and euphoria.
  • A recent alert highlights increasing adolescent interest in using DXM and promethazine together

According to Sharon Levy, MD,Harvard Medical School’s pediatric addiction expert, nonmedical medication misuse may be much more common than previously reported. One of the older fads is in the news again: getting high from cough and cold medicines containing dextromethorphan (DXM). This drug is sometimes combined with prescribed promethazine with codeine. At very high doses, DXM mimics the effects of illegal drugs like phencyclidine (PCP) and ketamine.

More than 125 over-the-counter (OTC) medicines for cough and colds contain DXM. It’s in Coricidin, Dimetapp DM, Nyquil, Robitussin Cough and Cold, and store brands for cough-and-cold medicines. These products are available in pharmacies, grocery stores, and other retail outlets. A safe dose of products with DXM is about 15-30 milligrams (mg) over 24 hours. It usually takes 10 times that amount to make a teenager high.

Teen DXM Slang

A syrup head is someone using cough syrups with DXM to get high. Dexing is getting high on products with DXM. Orange Crush alludes to some cough medicines with DXM. (The name may stem from the orange-colored syrup—and packaging—Delsym.)

Poor man’s PCP and poor man’s X are also common terms, because these drugs are inexpensive, but can cause effects similar to PCP or ecstasy at high doses. Red devils refer to Coricidin tablets or other cough medicines. Robo usually refers to cough syrup with DXM. It derives from the brand name Robitussin but is common slang for any cough syrup. Robo-tripping alludes to abusing products with DXM and, specifically, to the hallucinogenic trips people can attain at high doses.

Parents who hear teens using these terms should ask questions when the child and parent are alone.

Prevalence and Trends

The Monitoring the Future (MTF) survey, conducted by the National Institute on Drug Abuse (NIDA) and the University of Michigan, provides insights into adolescent substance use. The survey began monitoring OTC cough-and-cold medication abuse every year in 2006. That year, the MTF reported that 4.2% of 8th-graders, 5.3% of 10th-graders, and 6.9% of 12th-graders misused OTC cough-and-cold medications in the previous year. In 2015, 2.6% of 8th-graders, 3.3% of 10th-graders, and 4.0% of 12th-graders reported past-year misuse. The most recent data, in 2024, indicate that the percentage dropped somewhat. However, a recent alert from the National Drug Early Warning System at the University of Florida (NDEWS) suggests a resurgence of interest in DXM and its combination with antihistamines.

DXM+ Combination Dangers

When taken alone, DXM’s dissociative and hallucinogenic effects may include euphoria, altered perception of time, paranoia, disorientation, and hallucinations. Physical symptoms of intoxication are hyperexcitability, problems walking, involuntary eye movements, and irritability. High doses can lead to impaired motor function, numbness, nausea and vomiting, increased heart rate, and elevated blood pressure. Chronic misuse results in dependence and severe psychological or physical health issues.

Combining DXM with other substances, especially alcohol, sleeping pills, antihistamines, or tranquilizers, is highly risky, as is combining DXM with antidepressants affecting serotonin, due to the risk of a possibly life-threatening serotonin syndrome.

Combining DXM With Promethazine

Combining the abuse of the prescribed antihistamine promethazine (Phenergan) with DXM may be increasing. The recent alert from the National Drug Early Warning System suggested that this new combination is an emerging threat.

The NDEWS recently checked for recent reports of saccharine (artificial sugar) being detected in abused drugs. Putting on their detective hats, the NDEWS team discovered that increased saccharine in drugs was caused by users adding cough syrup to promethazine. The signal for this combination was detected in more than double the number noted in early 2024.

Combining DXM and promethazine can amplify central nervous system depression, leading to increased drowsiness, dizziness, and impaired motor function. High doses may cause aggression, severe respiratory depression, hallucinations, delirium, paranoia, and cognitive impairments. Reddit social media reports noted an increased risks of falls and injuries due to severely impaired coordination and balance from the DXM-and-promethazine combination.

Promethazine with codeine is still available by prescription in the U.S., but access is restricted due to its classification as a Schedule V controlled substance at the federal level. Pharmacies and healthcare providers have become more cautious in prescribing promethazine with codeine due to its association with recreational use. Some manufacturers have discontinued production of promethazine with codeine, but generic versions remain on the market under tight regulation.

Purple drank is drug slang for the mixture containing codeine and promethazine mixed with a soft drink such as Sprite or Fanta—and sometimes with candy such as Jolly Ranchers. The drink gets its name from the purple color of some cough syrups. Purple drank has been popularized in certain music and hip-hop cultures, with some artists glorifying its use in their lyrics. However, many rappers who once promoted the drug later warned against its dangers after experiencing serious health consequences themselves or witnessing peers suffer from addiction and overdoses.

Professor Linda Cottler, Ph.D., M.P.H., director of NDEWS. commented: “Healthcare professionals should be aware of the potential for abuse and monitor for signs in patients, especially adolescents and young adults,”  Linda added: “Parents should be aware of these combinations and talk to their children about avoiding “cough” medicines acquired from friends, friend’s siblings, or friends’ parents.”

Summary

While the combination of DXM and promethazine is not commonly reported in drug abuse or emergency-room cases, misuse could lead to significant health risks. Stores have started to keep these cough and cold remedies behind the counter to reduce access and potential for teen abuse. Some makers of OTC medicines with DXM have put warning labels on their packaging about the potential for abuse. Many states have banned sales of meds with DXM to minors. These actions have helped reduce teen DXM abuse. However, recent teen interest in abuse of combined DXM and promethazine is concerning.

Source: https://www.psychologytoday.com/us/blog/addiction-outlook/202502/teenage-abuse-of-cough-medicines-and-promethazine

Filed under: Addiction,Drug use-various effects,Latest News,Medicines,Mental Health,Prescription Drugs,Prevention and Intervention,Treatment and Addiction,USA,Youth :
Opinion – by Hannah E. Meyers, Published Feb. 16, 2025, 6:19 a.m. ET
Hannah E. Meyers is a fellow and the director of policing and public safety at the Manhattan Institute.

In November, Donald Trump made significant electoral gains in New York’s black and Latino neighborhoods, and in the city’s least affluent communities. Now he is poised to take an important step to improve public safety in these voters’ neighborhoods.

Rep. Nicole Malliotakis (R-SI) last week wrote to new Attorney General Pam Bondi, pleading for the administration to shut down the city’s two “safe injection sites.”

These facilities, located in East Harlem and Washington Heights, provide supervision to drug abusers as they consume harmful substances like fentanyl, meth, heroin and cocaine.

Yes, these are illegal drugs under federal law — and the aptly nicknamed federal “crack house statute” prevents individuals from retaining property for their consumption.

Indeed, Trump’s Justice Department successfully shuttered similar sites in the past – In 2019, his first administration sued to stop a Philadelphia injection center from opening, and in 2024 a US District Court judge in Pennsylvania finally agreed that the center was not exempt from federal drug laws.

Now Trump should listen to his NYC minority constituents and close the injection sites that are harming their neighborhoods.

New York’s two centers, both run by non-profit OnPoint, were the first in the nation, opening in 2021 under then-Mayor Bill de Blasio — who never met an injurious policy he wouldn’t support in the name of racial justice.

De Blasio gambled successfully that the Biden administration wouldn’t intervene.

OnPoint claims to have saved over 1,000 lives by preventing overdoses. But as my colleague Charles Fain Lehman has pointed out, the sites do not reduce addiction — so they are likely just delaying fatalities: More than 15% of those administered naloxone are dead within a year.

Indeed, data shows that NYC overdose rates have continued to rise since the centers opened.

That’s no surprise, since a rigorous look at the data from even the most touted injection sites in other countries provide no evidence of their effectiveness

But rigor has never been the calling card for politicians and advocates who happily sacrifice other people’s communities in the name of compassion.

State Sen. Gustavo Rivera (D-Bronx) has had the chutzpah to claim that “public drug use, syringe litter and drug-related crime goes down” around sites. In 2023, Rivera urged Gov. Hochul to expand supervised consumption sites statewide, and sponsored Senate legislation — still in committee — to do so.

In 2023, Mayor Eric Adams also proposed adding three more facilities to NYC — but he might be amenable to updating his views with some pressure from Washington.

And that pressure will come if Trump cares about the lives of local residents.

While major crimes fell 13% in northern Manhattan over the past two years, the predominantly black and Hispanic precinct around the East Harlem drug site has seen an almost 8% rise in major crime.

I’ve toured that location with the Greater Harlem Coalition. Members pointed out the large early-childhood education center directly across the street from the injection site, as parents hurried their tots into school in plain view of ongoing drug deals.

The perimeter of the block is dotted with addicts nodding off. Nearby restaurants have had to invest in private security to defend against the criminality the center attracts to the neighborhood.

What’s been keeping this site open despite four years in which the only evidenced change is neighborhood degradation?

Shameless advocacy by pompous, ideologically motivated and race-obsessed elites . . . whose kids don’t go to preschool in Harlem.

In August, Greater Harlem Coalition co-founder Shawn Hill was interviewed by one such far-left advocate: Ryan McNeil, director of harm reduction research at Yale’s School of Medicine.

McNeil was conducting funded “research” into safe injection sites — but a “hot mic” recording revealed his and his colleagues’ woke bias in favor of supporting safe injection sites (and drug decriminalization, more broadly).

With no sense of irony, McNeil — who is himself Caucasian — scorned Harlemites’ concerns over open drug abuse as nothing but “white discomfort,” and derided Hill for suggesting that the Yale researchers should walk around and speak with actual local residents.

But Trump has every reason to listen to these locals, three-quarters of whom are black or Latino.

And it would behove Adams, who faces a crowded primary race this summer, to reverse his past stance and voice support for a federal closure of the city’s two drug consumption sites.

In East Harlem, Trump won about 860 more votes last year than in 2020. Now these supporters, and their neighbors he has yet to persuade, are depending on his help.

 

Source: https://nypost.com/2025/02/16/opinion/inject-some-common-sense-shut-down-nycs-safe-drug-sites/

Filed under: Addiction,Crime/Violence/Prison,Culture,Drug use-various effects,Education,Health,HIV/Injecting-Drug-Users,Latest News,Needle Exchange,Prevention and Intervention,Treatment and Addiction,USA :
by James Cook, BBC Scotland editor and Anton Ferrie, BBC News contributor                                                               

James McMillan and Lisa McCuish grew up next to each other and now they lie side by side in Pennyfuir Cemetery

James McMillan grew up next door to Lisa McCuish in a neat cul-de-sac on a hillside above Oban Bay. Now they lie side by side in Pennyfuir Cemetery.

The newest headstones on the freshly-dug fringes of the graveyard tell an alarming story of a lost generation in this pretty tourist town on Scotland’s west coast.

Oban is home to just 8,000 people and at least eight recent confirmed or suspected victims of drug misuse were buried here. The youngest was 26, the oldest was 48.

The population of the town is about the same as the total number of overdose deaths recorded in Scotland in the past seven years – by far the worst rate in Europe.

The deaths have led to calls for urgent action to tackle addiction in rural Scotland with relatives citing problems accessing vital services.

Scotland’s Health Secretary Neil Gray has told BBC News that he accepts more needs to be done to tackle drug misuse in rural areas.

For James’ mother, Jayne Donn, the nightmare began before dawn on a freezing night in December 2022 when she was woken by the doorbell.

“At 10 to five in the morning, when it was snowing and my Christmas tree was up, the police came to my door,” she says.

The officers had come, as Jayne had long dreaded they would, to tell her that her 29-year-old son was dead of an overdose.

James was another victim of a crisis that has been raging across Scotland for almost a decade, claiming 1,172 lives in 2023.

“As a little boy he was blonde-haired, blue-eyed, full of mischief,” Jayne tells me in the living room of the family home.

The young James loved “fishing, music and his skateboard,” she says.

“As a man, there’s not so many good memories,” says Jayne.

“He was very mixed up. He was very angry. He was very lost.”

James McMillan, who died in December 2022, with his mother Jayne Donn
Jayne Donn

James’ father left the family home when he was seven.

He struggled at school with dyslexia and mental health challenges and later began to dabble with cannabis.

He started to get into trouble, first with teachers, then with the police.

As he grew into adulthood, James drifted away from Oban and from his family, losing a job as an apprentice bricklayer because of poor attendance and concentration, and disappearing to England.

Jayne says she knew little about what was happening there. In truth, her son’s life was unravelling.

He had been diagnosed with attention deficit hyperactivity disorder, bipolar disorder and drug-induced psychosis.

He was struggling with suicidal tendencies, taking more and harder drugs and increasingly turning to crime.

As a result he was in and out of custody for drug offences, breach of the peace, break-ins and theft, at one point serving a two-year prison sentence.

James died in Glasgow on 16 December 2022 – less than two days after he was released from custody following eight months on remand in Barlinnie prison.

James’ mother says she doesn’t know the details of the last charges he had faced or why he was released – but she believes more could have been done to support her son, as he had overdosed on release from custody on three previous occasions.

A Scottish Prison Service source pointed out that decisions taken at the end of a period of remand are a matter for the courts not the prison.

Jayne describes a web of organisations which dealt with her son: charities, local authorities, the NHS, addiction services, housing providers and more.

But she says: “He was released into a city he didn’t know with no jacket, no money and nobody aware.

“He lasted less than 36 hours.”

Lisa McCuish grew up in Oban.                                                                                                         MKC Photocreations 

Lisa McCuish grew up next to James in a street looking down on Oban Bay, where red and black Caledonian MacBrayne ferries bustle to and from the islands of the Hebrides.

Oban was recently named Scotland’s town of the year by an organisation which promotes smaller communities.

Today, Lisa’s sister Tanya is sitting in Jayne’s living room, tears in her eyes, recalling her sibling as “a larger than life character” with “a heart of gold”.

“Lisa was never into drugs, you know, that wasn’t her,” says Tanya.

Things began to go wrong only after Lisa was prescribed diazepam, which is typically used to treat anxiety, seizures or muscle spasms.

“She ended up buying it off the streets because she felt she needed more,” Tanya remembers.

“She kept on saying that she needed more help, more support.”

Then, she says, her sister started taking heroin.

Lisa had a cardiac arrest on 13 September 2022 and died four days later in hospital in Paisley. She was 42 years old.

She had prescription drugs in her system and also Etizolam, a benzodiazepine-type substance commonly known as street Valium because it is often sold illicitly.

Tanya and Jayne take us to the spot where they both mourn, pointing out other nearby graves where recent drug death victims are buried.

They include James’s best friend, who lies alongside him and Lisa. He was 30 when he died of a drug overdose.

“It’s just awful to think there’s at least 10 around here that we can think of,” says Jayne.

There is no official breakdown of how many lives have been claimed by drugs in small communities such as Oban.

We have been able to confirm that at least eight of the deaths occurred within just a year-and-a-half and were related to drugs, or are still under investigation.

This is the reality of Scotland’s drug deaths crisis in just one small community and both Tanya and Jayne say the Scottish government must do more to save lives.

“I personally believe that a lot of addiction is to do with mental health first,” says Tanya.

“There’s no continuity in support from addiction services or mental health services. There’s no link up.”

Jayne, who is a drugs support worker herself, says she spent years trying to bring James home to Oban where she felt he would have a better chance of recovery and survival.

A particular challenge, she says, was that Argyll and Bute Council offered James housing places in Dunoon and Helensburgh – both about two hours away – making it very difficult for his family to support him.

The local authority said it had offered “appropriate” services to James.

The council added that it had housing services throughout the area, but could not always satisfy “individual and sometimes changing criteria”.

Scotland’s Health Secretary Neil Gray says that both families have his deepest sympathies and he accepts that rural drug services could be improved.

“I think that the two cases that you’ve highlighted tell me that there’s more that can be done,” he said.

“I recognise that not everything is available in all parts of Scotland.”

Mr Gray added: “We support alcohol and drug partnerships across Scotland, whether they’re in rural areas or urban areas.

“I would obviously want us to be continuing to do more to make sure that there is access to facilities and services in rural and island areas.”

 

For Justina Murray, chief executive of the charity Scottish Families Affected by Alcohol and Drugs, the problems do not lie with strategy or funding but with culture and delivery, especially in NHS addiction services.

“People want services that are in their own community, they can access when they need them, they’re going to be met at the door by a friendly face,” she says.

“They’re going to be treated with dignity and respect.

“That’s not necessarily the experience you’re going to have engaging with an NHS or a statutory treatment service.”

According to the latest available figures, released in September 2024, there is capacity for 513 residential rehabilitation beds in Scotland, across 25 facilities.

Only 11 of those beds are available in what are considered by the Scottish government to be very remote rural areas, although the majority of facilities do accept referrals from any part of Scotland.

I ask Jayne and Tanya about the argument that individuals and their families, rather than the state, should take more responsibility for their own choices.

“Nobody sets out in life to be a drug addict,” replies Jayne.

“Nobody chooses it. The mental health issue was what led James to try and escape reality.

“He then no longer had capacity to make his choices. He wasn’t James any more.

“These are vulnerable adults who are unable to protect themselves from danger or harm,” adds Tanya.

“Why is more not being done?”

“Something’s got to change,” agrees Jayne.

“We’re losing far too many young people.”

Source: https://www.bbc.co.uk/news/articles/c20pwd04zy4o

Filed under: Addiction,Culture,Environment,Latest News,UK,Youth :

Dangerous but common misconceptions can prevent crucial early addiction treatment.

Key points:

  • Misconceptions and the ignoring of research-based evidence prevent crucial early treatment of addiction.
  • Drugs of abuse cause health, life, and relationship problems with many long-lasting effects.
  • Teen and young adult drug prevention is necessary and needs funding.

Research published in high-quality peer-reviewed journals reveals key information on the realities of addiction, exposing pervasive myths and misconceptions, as in these examples.

False Belief 1: Drug experimentation is normal for teens and shouldn’t alarm parents.

Drug use and experimentation among teens often is ignored by many—even parents, who then may be unaware that any use places adolescent brains in jeopardy. For today’s teens, life often feels overwhelming, but avoiding alcohol, tobacco, marijuana, and other drugs is their one best choice to promote continued healthy physical and mental development. Preventing or delaying all teenage substance use not only reduces their current risks for depression, psychosis, and school/learning problems, but it also significantly decreases their probability of addiction as adults.

Harvard’s Sharon Levy, MD, MPH, and founding National Institute of Drug Abuse Director Robert DuPont, MD, strongly advocate a zero-tolerance approach to youth substance use. They emphasize that no amount of drug use is safe for young people. They promote the One Choice initiative encouraging adolescents to avoid substance use: alcohol, tobacco, marijuana, and other drugs.

It’s now known that THC in marijuana interferes with the developing brain circuits responsible for regulating behavior, leading to increased risk-taking and poor decision-making. Even infrequent teen use can impede judgment, increasing the probability of risky behaviors and accidents. Adolescents also are more likely than adults to develop cannabis use disorder (CUD) due to their heightened neuroplasticity during this developmental stage. The resulting impairment may lead to academic underperformance and problematic interpersonal relationships.

False Belief 2: Addiction is a personal weakness.

Addiction is not about people being weak-minded. It’s far more complicated. Becoming addicted depends on the drug used, dose, route, frequency, and risk factors like ages of users. Also, the same drug at the same dose affects people differently because of personal differences, as well as the presence/absence of traumatic past life experiences.

Yale’s Joel Gelernter identified genetic variants associated with vulnerability to addictions. However, genetic characteristics themselves interact with environmental factors in developing substance use disorders (SUDs). As Nora Volkow, director of NIDA, has said, “Addiction is a complex disease of a complex brain; ignoring this fact will only hamper our efforts to find effective solutions …”

False Belief 3: People must hit “rock bottom” to recover from addiction.

No, no, and no! Roadside alcohol testing has prevented thousands of deaths and helped many people with alcohol use disorders (AUD) obtain help, sometimes by coercion of courts. About 50 percent of those arrested for DUI have an AUD. Users often deny they have a problem with drugs or alcohol and believe they are truthful. But they are lying to themselves.

Addiction is a chronic, relapsing condition driven by changes in brain circuitry, particularly in areas controlling reward, stress, and decision-making. While some people seek help after suffering dire consequences, others are compelled into treatment by the courts, based on a past offense. Waiting to hit “rock bottom” increases major risks of harming the person’s relationships, job, and health—and strengthens the hold of the drug over the person.

False Belief 4: Addiction treatment never works.

Researchers from the University of British Columbia and Harvard Medical School recently analyzed survey data from nearly 57,000 participants in 21 countries over 19 years, providing clear data. They discovered that the number-one barrier to treatment was addicted people themselves: Most were in denial and did not recognize they needed treatment.

Alcoholics Anonymous is often successful, non-judgmentally providing new members a roadmap, role models, hope, and social connections. Successful people actively involved in AA complain that their friends kept asking them why they “weren’t cured yet” since they went to so many meetings. But going to meetings is what works.

Even among experts, there’s no consensus on what constitutes successful treatment. To some, success is that the person is still alive and hasn’t been rushed to the emergency room because of an overdose in the past 6 months or year. To others, it is taking treatment medications. And to still others, only abstinence and a full resumption of all family and work obligations counted as success.

Another issue is that most people with SUDs have multiple addictions. Even when they overdosed, most took multiple drugs. It’s also true that many people come to treatment also needing treatment for other medical, addiction, and psychiatric problems. Yet only rarely are patients evaluated and treated for all issues.

False Belief 5: Overdoses of drugs don’t cause brain damage.

Drugs of abuse can harm the brain. Overdose survivors may suffer from undetected brain damage and hypoxic brain injury caused by opioid-induced respiratory depression. As a society, we better understand hypoxia as associated with drowning or choking than its much more common occurrence in drug overdoses with loss of consciousness.

Recent studies estimate that at least half of people using opioids have illicitly experienced a non-fatal overdose or witnessed an overdose. People who regularly use drugs are at elevated risk of brain injury due to accidents, fights, and overdoses. A single fentanyl overdose could cause hypoxia, brain injury, and memory and concentration problems.

Overdoses with counterfeit pills, cocaine, methamphetamine, xylazine, or heroin usually also include fentanyl, making neurologically compromising overdoses more common.

Summary

Myths and misconceptions increase stigma and decrease the likelihood that someone with an addictive illness will receive prompt, effective treatment. We need early intervention and treatment during the preaddiction phase. Bottom line: Preventing teen and young adult use is crucial.

Mark Gold M.D.

Mark S. Gold, M.D., is a pioneering researcher, professor, and chairman of psychiatry at Yale, the University of Florida, and Washington University in St Louis. His theories have changed the field, stimulated additional research, and led to new understanding and treatments for opioid use disorders, cocaine use disorders, overeating, smoking, and depression.

Source: https://www.psychologytoday.com/intl/blog/addiction-outlook/202502/5-common-false-beliefs-about-drug-use-users-and-addiction
Filed under: Addiction,Brain and Behaviour,Crime/Violence/Prison,Culture,Economic,HIV/Injecting-Drug-Users,Latest News,Marijuana and Medicine,Parents,Prevalence,Prevention and Intervention,Psychiatric drugs,Social Affairs (Papers),USA,Vaping :

by Dan Krauth WABC logo    Eyewitness News – Friday, February 14, 2025

Dan Krauth has more on the letter sent to the newly confirmed attorney general asking her to shut down safe injection sites in New York City.

NEW YORK (WABC) — There are places people can go take illegal drugs under the watchful eye of supervisors to ensure they don’t die.

They are called Overdose Prevention Centers, or also known as safe injection sites, and there are two of them in New York City — the first of its kind in the nation.

Now, after more than three years of operating, there’s a new effort under a new president to shut down the centers that are run by a non-profit organization.

It’s called OnPoint NYC and they have two locations in Washington Heights and East Harlem.

Drug users can take their drug of choice from heroin to cocaine inside the centers and supervisors intervene, most times with oxygen, if the user starts to overdose. They also provide test strips for drugs to ensure they don’t have fatal doses of fentanyl inside.

Since opening in 2021, the executive director said they’ve intervened in more than 1,700 overdoses. They also provide services like medical help, substance abuse treatment and housing assistance.

Opponents say the centers encourage people to do illegal drugs.

“They’re encouraging people to use by giving them a community center to go to and to use heroin, it’s something that’s encouraging addicts not helping them,” said Congresswoman Nicole Malliotakis.

She sent a letter to the newly confirmed attorney general, asking her to shut down both locations along with any others that have opened across the country.

“They don’t work, these heroin injection centers, in fact they attract crime to the neighborhood but also drug dealing, it just does not make sense and they should be shut down,” Malliotakis said.

In response, the executive director of OnPoint NYC sent Eyewitness News a statement:

“OPCs save lives. At OnPoint NYC, our staff has intervened in over 1,700 overdoses, providing life-saving care to mothers, fathers, and loved ones,” said OnPoint NYC Executive Director Sam Rivera. “Every single one of them deserves compassion and a chance at healing. I’m incredibly proud of our team and continually inspired by the dedication they show every day. They don’t just look at the overdose epidemic and wonder what can be done-they don’t have that luxury. They act, because they have lives to save. This work is not just vital; it’s transformational. Lives are being saved, hope is being restored, and healing is possible.”

 

Source:  https://abc7ny.com/post/president-trump-asked-shut-down-overdose-prevention-centers-have-operated-3-years-nyc/15907033/

Filed under: Addiction,Culture,Latest News,Mental Health,Political Sector,Prevention and Intervention,Treatment and Addiction,USA :

(1)    Use of Alternative Payment Models for Substance Use Disorder Prevention in the United States: Development of a Conceptual Framework

Journal: Substance Abuse Treatment, Prevention, and Policy, 2025, doi: 10.1186/ s13011-025-00635-z

Authors: Elian Rosenfeld, Sarah Potter, Jennifer Caputo, Sushmita Shoma Ghose, Nelia Nadal, Christopher M. Jones, … Michael T. French

Abstract:

Background: Alternative payment models (APMs) are methods through which insurers reimburse health care providers and are widely used to improve the quality and value of health care. While there is a growing movement to utilize APMs for substance use disorder (SUD) treatment services, they have rarely included SUD prevention strategies. Challenges to using APMs for SUD prevention include underdeveloped program outcome measures, inadequate SUD prevention funding, and lack of clarity regarding what prevention strategies might fit within the scope of APMs.

Methods: In November 2023, the Substance Abuse and Mental Health Services Administration (SAMHSA), through a contract with Westat, convened an expert panel to refine a preliminary conceptual framework developed for utilizing APMs for SUD prevention and to identify strategies to encourage their adoption.

Results: The conceptual framework agreed upon by the panel provides expert consensus on how APMs could finance a variety of prevention programs across diverse populations and settings. Additional efforts are needed to accelerate the support for and adoption of APMs for SUD prevention, and the principles of health equity and community engagement should underpin these efforts. Opportunities to increase the use of APMs for SUD prevention include educating key groups, expanding and promoting the SUD prevention workforce, establishing funding for pilot studies, identifying evidence-based core components of SUD prevention, analyzing the cost effectiveness of APMs for SUD prevention, and aligning funding across federal agencies.

Conclusion: Given that the use of APMs for SUD prevention is a new practice, additional research, education, and resources are needed. The conceptual framework and strategies generated by the expert panel offer a path for future research. SUD health care stakeholders should consider ways that SUD prevention can be effectively and equitably implemented within APMs.

To read the full text of the article, please visit the publisher’s website.

(2)     Quitline-Based Young Adult Vaping Cessation: A Randomized Clinical Trial Examining NRT and mHealth

Journal: American Journal of Preventive Medicine, 2025, doi: 10.1016/j.amepre.2024 .10.019

Authors: Katrina A. Vickerman, Kelly M. Carpenter, Kristina Mullis, Abigail B. Shoben, Julianna Nemeth, Elizabeth Mayers, & Elizabeth G. Klein

Abstract:

Introduction: Broad-reaching, effective e-cigarette cessation interventions are needed.

Study design: This remote, randomized clinical trial tested a mHealth program and nicotine replacement therapy (NRT) for young adult vaping cessation.

Setting/participants: Social media was used from 2021 to 2022 to recruit 508 young adults (aged 18-24 years) in the U.S. who exclusively and regularly (20+ days of last 30) used e-cigarettes and were interested in quitting.

Intervention: All were offered 2 coaching calls and needed to complete the first call for full study enrollment. Participants were randomized to one of 4 groups in the 2×2 design: mailed NRT (8 weeks versus none) and/or mHealth (yes versus no; stand-alone text program including links to videos and online content).

Main outcome measures: Self-reported 7-day point prevalence vaping abstinence at 3 months.

Results: A total of 981 participants were eligible and randomized; 508 (52%) fully enrolled by completing the first call. Enrolled participants were 71% female, 31% non-White, and 78% vaped daily. Overall, 74% completed the 3-month survey. Overall, 83% in the mailed NRT groups and 24% in the no-mailed NRT groups self-reported NRT use. Intent-to-treat 7-day point prevalence abstinence rates (missing assumed vaping) were 41% for calls only, 43% for Calls+mHealth, 48% for Calls+NRT, and 48% for Calls+NRT+mHealth. There were no statistically significant differences for mailed NRT (versus no-mailed NRT; OR=1.3; 95% CI=0.91, 1.84; p=0.14) or mHealth (versus no mHealth; OR=1.04; 95% CI=0.73, 1.47; p=0.84).

Conclusions: This quitline-delivered intervention was successful at helping young adults quit vaping, with almost half abstinent after 3 months. Higher than anticipated quit rates reduced power to identify significant group differences. Mailed NRT and mHealth did not significantly improve quit rates, in the context of an active control of a 2-call coaching program. Future research is needed to examine the independent effects of coaching calls, NRT, and mHealth in a fully-powered randomized control trial.

To read the full text of the article, please visit the publisher’s website.

(3)     The Alcohol Exposome

Journal: Alcohol, 2025, doi: 10.1016/j.alcohol.2024.12.003

Authors: Nousha H. Sabet, & Todd A. Wyatt

Abstract:
Science is now in a new era of exposome research that strives to build a more all-inclusive, panoramic view in the quest for answers; this is especially true in the field of toxicology. Alcohol exposure researchers have been examining the multivariate co-exposures that may either exacerbate or initiate alcohol-related tissue/organ injuries. This manuscript presents selected key variables that represent the Alcohol Exposome. The primary variables that make up the Alcohol Exposome can include comorbidities such as cigarettes, poor diet, occupational hazards, environmental hazards, infectious agents, and aging. In addition to representing multiple factors, the Alcohol Exposome examines the various types of intercellular communications that are carried from one organ system to another and may greatly impact the types of injuries and metabolites caused by alcohol exposure. The intent of defining the Alcohol Exposome is to bring the newly expanded definition of Exposomics, meaning the study of the exposome, to the field of alcohol research and to emphasize the need for examining research results in a non-isolated environment representing a more relevant manner in which all human physiology exists.

To read the full text of the article, please visit the publisher’s website.

(4)     Neural Variability and Cognitive Control in Individuals with Opioid Use Disorder

Journal: JAMA Network Open, 2025, doi: 10.1001/jamanetworkopen.2024.55165

Authors: Jean Ye, Saloni Mehta, Hannah Peterson, Ahmad Ibrahim, Gul Saeed, Sarah Linsky, … Dustin Scheinost

Abstract:

Importance: Opioid use disorder (OUD) impacts millions of people worldwide. Prior studies investigating its underpinning neural mechanisms have not often considered how brain signals evolve over time, so it remains unclear whether brain dynamics are altered in OUD and have subsequent behavioral implications.

Objective: To characterize brain dynamic alterations and their association with cognitive control in individuals with OUD.

Design, setting, and participants: This case-control study collected functional magnetic resonance imaging (fMRI) data from individuals with OUD and healthy control (HC) participants. The study was performed at an academic research center and an outpatient clinic from August 2019 to May 2024.

Exposure: Individuals with OUD were all recently stabilized on medications for OUD (<24 weeks). Main outcomes and measures: Recurring brain states supporting different cognitive processes were first identified in an independent sample with 390 participants. A multivariate computational framework extended these brain states to the current dataset to assess their moment-to-moment engagement within each individual. Resting-state and naturalistic fMRI investigated whether brain dynamic alterations were consistently observed in OUD. Using a drug cue paradigm in participants with OUD, the association between cognitive control and brain dynamics during exposure to opioid-related information was studied. Variations in continuous brain state engagement (ie, state engagement variability [SEV]) were extracted during resting-state, naturalistic, and drug-cue paradigms. Stroop assessed cognitive control.

Results: Overall, 99 HC participants (54 [54.5%] female; mean [SD] age, 31.71 [12.16] years) and 76 individuals with OUD (31 [40.8%] female; mean [SD] age, 39.37 [10.47] years) were included. Compared with HC participants, individuals with OUD demonstrated consistent SEV alterations during resting-state (99 HC participants; 71 individuals with OUD; F4,161 = 6.83; P < .001) and naturalistic (96 HC participants; 76 individuals with OUD; F4,163 = 9.93; P < .001) fMRI. Decreased cognitive control was associated with lower SEV during the rest period of a drug cue paradigm among 70 participants with OUD. For example, lower incongruent accuracy scores were associated with decreased transition SEV (ρ58 = 0.34; P = .008). Conclusions and relevance: In this case-control study of brain dynamics in OUD, individuals with OUD experienced greater difficulty in effectively engaging various brain states to meet changing demands. Decreased cognitive control during the rest period of a drug cue paradigm suggests that these individuals had an impaired ability to disengage from opioid-related information. The current study introduces novel information that may serve as groundwork to strengthen cognitive control and reduce opioid-related preoccupation in OUD.

To read the full text of the article, please visit the publisher’s website.

Source: https://drugfree.org/drug-and-alcohol-news/research-news-roundup-february-13-2025/

Filed under: Addiction,Brain and Behaviour,Culture,Health,Latest News,Marijuana and Medicine,Mental Health,Treatment and Addiction,USA,Vaping,Youth :

by Brian Mann –  NPR’s first national addiction correspondent – published January 29, 2025 at 7:00 AM EST

When Robert F. Kennedy Jr. talks about the journey that led to his growing focus on health and wellness — and ultimately to his confirmation hearings this week for U.S. secretary of health and human services — it begins not with medical training or a background in research, but with his own addiction to heroin and other drugs.

“I became a drug addict when I was 15 years old,” Kennedy said last year during an interview with podcaster Lex Fridman. “I was addicted for 14 years. During that time, when you’re an addict, you’re living against conscience … and you kind of push God to the peripheries of your life.”

Kennedy now credits his faith; 12-step Alcoholics Anonymous-style programs, which also have a spiritual foundation; and the influence of a book by philosopher Carl Jung for helping him beat his own opioid addiction.

If confirmed as head of the Department of Health and Human Services after Senate hearings scheduled for Wednesday and Thursday, Kennedy would hold broad sway over many of the biggest federal programs in the U.S. tackling addiction: the Centers for Disease Control and Prevention, the National Institute on Drug Abuse and the Substance Abuse and Mental Health Services Administration.

While campaigning for the White House last year, Kennedy, now 71 years old, laid out a plan to tackle the United States’ devastating fentanyl and overdose crisis, proposing a sprawling new system of camps or farms where people experiencing addiction would be sent to recover.

“I’m going to bring a new industry to [rural] America, where addicts can help each other recover from their addictions,” Kennedy promised, during a film on addiction released by his presidential campaign. “We’re going to build hundreds of healing farms where American kids can reconnect with America’s soil.”

People without housing in San Francisco in May 2024. A film released by Robert F. Kennedy Jr.’s presidential campaign included a scene that 
appeared to blame methadone — a prescription medication used to treat opioid addiction — for some of the high-risk street-drug use visible
on the streets of San Francisco.

Some addiction activists — especially those loyal to the 12-step faith- and values-based recovery model — have praised Kennedy’s approach and are actively campaigning for his confirmation.

“RFK Jr is in recovery. He wants to expand the therapeutic community model for recovering addicts,” Tom Wolf, a San Francisco-based activist who is in recovery from fentanyl and opioid addiction, wrote on the social media site X. “I support him for HHS secretary.”

 

A focus on 12-step and spirituality, not medication and science-based treatment

 

But Kennedy’s approach to addiction care is controversial, described by many drug policy experts as risky, in part because it focuses on the moral dimension of recovery rather than modern, science-based medication and health care.

“He clearly cares about addicted people,” said Keith Humphreys, a leading national drug policy researcher at Stanford University. “But in terms of the plans he’s articulated, I have real doubts about them.”

According to Humphreys, Kennedy’s plan to build a network of farms or camps doesn’t appear to include facilities that offer proper medical treatments for seriously ill people facing severe addiction.

“That’s a risk to the well-being of patients, and I don’t see any merit in doing that,” Humphreys said.

“I think [Kennedy’s plan] would be an enormous step backward,” said Maia Szalavitz, an author and activist who used heroin and other drugs before entering recovery.

“We have spent the last 15, 20 years trying to move away from treating addiction as a sin rather than a medical disorder,” she said. “We’ve spent many years trying to get people to take up these medications that we know cut your death risk in half, and he seems to want to go backwards on all that.”

The vast majority of researchers, doctors and front-line addiction treatment workers agree that scientific data shows medications like buprenorphine, methadone and naloxone are game changers when it comes to treating the deadliest street drugs, including fentanyl and heroin.

The Biden administration moved aggressively to make medical treatments far more affordable and widely available. Many experts believe those programs are factors in the dramatic national drop in overdose deaths that began in 2023.

Kennedy, who studied law and political science, not health care, before becoming an activist on subjects ranging from pharmaceuticals and vaccines to the American diet, has remained largely silent on the subject of science-based medical treatments for opioid addiction.

His campaign film included a scene that appeared to blame methadone — a prescription medication that has been used to treat opioid addiction since the 1970s — for some of the high-risk street-drug use visible on the streets of San Francisco.

In public statements, Kennedy has also repeated the inaccurate claim that the addiction and overdose crisis isn’t improving. In fact, fatal overdoses have dropped nationally by more than 20% since June 2023, according to the Centers for Disease Control and Prevention, falling below 90,000 deaths in a 12-month period for the first time in half a decade.

“What we have mostly heard from Kennedy is a skepticism broadly of medications and a focus on the 12-step and faith-based therapy,” said Vanda Felbab-Brown, an expert on drug policy at the Brookings Institution, a Washington, D.C., think tank.

“That appeals to a lot of crucial groups that have supported President Trump in the election. But we know what is fundamental for recovery and stabilization of people’s lives and reducing overdose is access to medications,” Felbab-Brown said. “Unfortunately, many of the 12-step programs reject medications.”

She’s worried that under Kennedy’s leadership, the Department of Health and Human Services could shrink or eliminate funding for science-based medical treatment and instead focus on spirituality-based approaches that appear to help a relatively small percentage of people who experience addiction.

Kennedy’s views on other science-based treatments, including vaccines, have sparked widespread opposition among medical researchers and physicians.

 

Kennedy boosts an Italian model for addiction recovery that has faced controversy

 

Another concern about Kennedy’s addiction proposals focuses on his interest in a program for drug treatment created in Italy in the 1970s.

The San Patrignano community is a therapeutic rehabilitation community center in Italy for people with drug addictions. The center, which
was founded by Vincenzo Muccioli in 1978, received renewed media attention after a 2020 Netflix documentary described alleged abuses.
Robert F. Kennedy Jr. now describes the program as a model for recovery care in the United States.

“I’ve seen this beautiful model that they have in Italy called San Patrignano, where there are 2,000 kids who work on a large farm in a healing center, learning various trades … and that’s what we need to build here,” Kennedy said during a town hall-style appearance on the cable channel NewsNation last year.

According to Kennedy’s plan, outlined in interviews and social media posts, Americans experiencing addiction would go to San Patrignano-style camps voluntarily, or they could be pressured or coerced into accepting care, with a threat of incarceration for those who refuse care.

But the San Patrignano program has been controversial and was featured in a 2020 Netflix documentary that included images of people with addiction allegedly being held in shackles or confined in cages. The farm’s current leaders have described the documentary as biased and unfair.

Kennedy, meanwhile, has continued to use the program as a model for the camps he would like to build in the United States.

“I’m going to build these rehab centers all over the country, these healing camps where people can go, where our children can go and find themselves again,” he said.

Szalavitz, the author and activist who is herself in recovery, noted that the Italian program doesn’t include science-based medical care, including opioid treatment medications. She said Kennedy’s fascination with the model reflects a lack of medical and scientific expertise.

“It really is great to include people who have personal experience of something like, say, addiction in policymaking. But you don’t become an addiction expert simply because you’re someone who struggled with addiction,” Szalavitz said. “You have to engage with the research literature. You have to understand more beyond your own narrow anecdote. Otherwise you’re going to wind up doing harm to people.”

Copyright 2025 NPR

Source: https://www.ideastream.org/2025-01-29/rfk-jr-says-hell-fix-the-overdose-crisis-critics-say-his-plan-is-risky

Filed under: Addiction,Culture,Drug use-various effects,Latest News,Political Sector,Prevention and Intervention,Social Affairs,USA,Youth :

by WRD News Team – January 14, 2025 

Forwarded by Shane Varcoe • 05.02.25

 

Breakthroughs in Addiction Science Over 50 Years

January 14, 2025 by WRD News Team

Addiction science has undergone tremendous progress over the past five decades, transforming our understanding of drugs and their impact on the brain and society. Recent advancements offer hope in addressing the escalating challenges of drug use, addiction, and overdose. However, the need for evidence-based prevention and treatment strategies remains crucial in combating this ongoing public health crisis.

Prioritising Drug Prevention

Prevention is one of the most effective ways to combat substance use disorders. Research consistently highlights how drug exposure can interfere with brain development from prenatal stages to young adulthood, setting the stage for lifelong challenges. Children and adolescents are particularly vulnerable, as early drug experimentation sharply increases the risk of addiction later in life.

Adverse childhood experiences—ranging from poverty to trauma—also contribute to substance use risks by disrupting brain development. Preventative measures can mitigate these risks and promote resilience. For example, school-based programmes and community initiatives have demonstrated significant success in reducing drug use among young people. Importantly, these interventions offer long-term benefits, improving mental health and reducing dependency rates across generations.

Scaling up these preventative approaches is vital. By investing in evidence-based prevention at schools, healthcare facilities, and community centres, society can safeguard future generations from the devastating impacts of drugs.

Challenges in Addressing Substance Use Disorders

One of the greatest hurdles today is the lack of access to effective addiction treatment. Millions of people struggle with substance use disorders, yet only a small percentage receive adequate care. This gap highlights the pressing need to expand addiction treatment services and eliminate barriers such as stigma and limited healthcare coverage.

Treatment options, including medication and behavioural therapies, have proven to be effective for many struggling with addiction. For instance, medications that address opioid dependency, combined with comprehensive care, can significantly improve recovery outcomes. However, these treatments remain inaccessible to many, especially in underserved communities.

Expanding treatment availability within prisons, rural areas, and low-income communities could swiftly reduce addiction rates and improve recovery success. Research also shows that offering treatment to individuals in justice systems can lower overdose risks after release and reduce reoffending, creating broader societal benefits.

The Role of Science in Combating Addiction

Scientific advancements are paving the way for more effective solutions to addiction. New innovations, such as brain stimulation therapies, target the neurological circuits disrupted by substance use, offering promising pathways for treatment. Additionally, cutting-edge pharmaceuticals like GLP-1 agonists, already used for managing diabetes, are showing potential in reducing cravings and dependency behaviours associated with addiction.

The use of artificial intelligence (AI) in addiction science is further revolutionising the field. AI tools can help detect overdose patterns, study drug impacts on mental health, and even guide personalised treatment interventions. Large-scale studies, such as those examining adolescent brain development, continue to shed light on how substance use affects young minds, offering invaluable insights for effective prevention.

Towards a Unified, Drug-Free Future

While remarkable progress has been made, the fight against addiction is far from over. Preventing drug use, providing accessible treatment, and investing in research remain paramount. By adopting a proactive, science-backed approach to addiction prevention, we can reduce the devastating effects of substance use disorders and create healthier, drug-free communities.

Addiction science offers the tools needed to address these challenges, but lasting change requires collective effort. Only through unified actions can we overcome this crisis and protect future generations from the harms of addiction.

Start prioritising prevention and treatment today to help build a safer, healthier world.

Source: https://wrdnews.org/breakthroughs-in-addiction-science-over-50-years/

Filed under: Addiction,Australia,Culture,Latest News,Prevention and Intervention,Treatment and Addiction :

 Vern Pierson – January 27, 2025

Vern Pierson is the district attorney of El Dorado County and was a co-sponsor of Proposition 36. He is a past president of the California District Attorneys Association.

A sign warning against selling fentanyl in Placer County hangs over Taylor Road in Loomis on July 24, 2023.
Photo by Miguel Gutierrez Jr., CalMatters

California’s drug crisis has only escalated, with so-called “compassionate solutions” like harm reduction and past policies that decriminalized hard drugs making things worse.  

Many drug addicts in the state have essentially faced two stark choices: homelessness or incarceration. This false dichotomy has normalized substance abuse, endangered public safety and failed to address the root causes of both homelessness and addiction.

In response, California voters last fall overwhelmingly passed Proposition 36, a third option that prioritizes rehabilitation over incarceration and offers a clear path to recovery, helping break the cycle of addiction and homelessness.

Programs like syringe exchanges, for example, have fallen short in addressing addiction itself. While well-intentioned, these programs have led to unintended consequences, including public spaces littered with used needles, increased health risks and the normalization of drug use. While syringe exchanges help reduce disease transmission, they don’t always guarantee that people enroll in treatment programs, and research shows they can even increase mortality rates.

The scale of this problem is stark. In 2021 alone, nearly 11,000 Californians died from drug overdoses, with over two-thirds involving opioids like fentanyl. Each of these lives lost represents a missed opportunity for intervention and recovery. Prop. 36 has given the state a framework to address this crisis by requiring treatment and rehabilitation for people struggling with addiction. This approach has the potential to reduce recidivism, save lives and help people reclaim their futures.

Source: https://calmatters.org/commentary/2025/01/addiction-homelessness-crisis-proposition-36/

Filed under: Addiction,Latest News,Legal Sector,Social Affairs,USA :

An update on the progress of national initiatives to address the opioid crisis.

by Mark S. Gold M.D. – Addiction Outlook

Updated January 31, 2025 | Reviewed by Jessica Schrader

  • Key points:
  • In 2016, drug experts mapped out solutions to the opioid epidemic.
  • Several major initiatives subsequently were proposed and implemented.
  • Many changes have had profound influences, reducing the impact of opioid use and saving lives.

In their 2016 New England Journal of Medicine article on opioids, Nora Volkow, M.D., director of the National Institute on Drug Abuse (NIDA) and A. Thomas McLellan, Ph.D., who served as deputy director of the White House Office of National Drug Control Policy during the Obama administration, reported on what was needed to combat the opioid epidemic.

They focused initially on opioid prescribing for pain. Pain experts resisted restrictions on opioids since they were the treatment of choice and addiction was only 3% to 8% for chronic pain and lower for acute pain. Pain patients develop a physical dependence on opioids, but few become addicts.

Volkow and McLellan were prescient in their statements/predictions nearly a decade ago. They acknowledged the need for opioids for managing chronic pain for some but pointed to overprescriptions in the 1990s and 2000s as a major driver of the opioid crisis. They discussed naloxone (Narcan) saving lives by reversing opioid overdoses. They advocated expanding access to medication-assisted treatment (methadone, buprenorphine) to treat opioid addiction, calling it an evidence-based strategy for reducing illicit drug use and deaths. They noted state prescription drug monitoring programs (PDMPs) could be enhanced to track prescribing patterns and minimize diversion.

Volkow and McLellan called for research to develop effective non-opioid pain treatments and reduce reliance on opioids. They also addressed stigma associated with pain management and addiction treatment, urging the medical community and policymakers to view these issues through an evidence-based lens rather than a cloud of blame/moral failure. Most of all, they called for integrating scientific advances into policy and practice and improving training for providers of pain management and addiction treatment.

Here’s my “report card” on how we’re doing, based on the major recommendations from these experts in 2016.

Balancing Pain Management and Developing New Pain Treatment with Addiction Prevention. Grade: C+

Real progress was made in preventing opioid addiction and overdose deaths. However, many chronic pain patients report inadequate relief now due to stricter prescribing practices, sometimes resulting in untreated/undertreated pain. This is a problem without easy answers. Dr. Volkow has emphasized an urgent need for non-opioid-based medications bypassing the brain’s reward pathways, reducing abuse potential. NIH’s Helping to End Addiction Long-term (HEAL) Initiative researched non-opioid pain medications and therapies. There are promising candidates, such as cebranopadol, suzetrigine (FDA approved 1/30/25), LEVI-04, and others in the pipeline. However, progress remains slow, and chronic pain patients face limited options.

Curbing Overprescription/Misuse. Grade: A-

Opioid prescribing rates nearly halved, from 81.3 prescriptions per 100 people in 2012 to 43.3 in 2023. Medical, pharmacy, and health professional education reversed years of over-prescription. All states have PDMPs to track opioid prescriptions, reducing over-prescription and diversion. Some overcorrections in prescribing (or rather, not prescribing) opioids led to some patients seeking illicit drugs (heroin or fentanyl), contributing to the overdose crisis.

Expanding Opioid Pain Prescription Guidelines. Grade: A-

The CDC says opioid prescriptions in the United States peaked in 2012, with a rate of 81.3 prescriptions per 100 persons. By 2023, this rate nearly halved to 43.3 prescriptions per 100. This major reduction reflects efforts to address the opioid epidemic through updated prescribing guidelines and increased awareness of opioid risks. The CDC Guidelines for Prescribing Opioids for Chronic Pain (2016) recommended limiting opioid prescriptions for chronic pain outside active cancer treatment, palliative care, and end-of-life care, emphasizing using the lowest effective dose of opioids and restricting opioid prescriptions for acute pain to three to seven days. However, some health care providers remain hesitant to prescribe any opioids, ever.

The SUPPORT Act (2018) required electronic prescribing for controlled substances under Medicare and imposed new requirements for education and monitoring. Medicare Part D Opioid Policies (2019) implemented stricter safety edits at the pharmacy level for high-dose opioid prescriptions and introduced limits on opioid-naive pain patients, such as a maximum of seven days for acute pain.

Naloxone and Medication-Assisted Treatment (MAT). Grade: B+

Naloxone (Narcan) is widely available now, and over-the-counter sales were approved, as has the longer-acting antagonist nalmefene. However, fentanyl, the predominant opioid abused today, is very strong and challenging naloxone reversal protocols. Nalmefene may help.

Access to MAT (buprenorphine, methadone) improved. Patients with OUDs can start on buprenorphine without having to see a physician in person. On the downside, existing treatments are old, and the best outcomes are with the oldest OUD treatment, methadone. Methadone should be available for prescription by office and clinic-based physicians. Without detox and residential care options, patients with polysubstance, alcohol, meth, or cocaine use disorders and psychiatric dual disorders have been difficult to treat .

Stigma. Grade: B

NIDA has led national efforts to destigmatize substance use disorders (SUDs), especially OUDs. Expanding federal and state reimbursement for buprenorphine and methadone, and expanding the number of OUD prescribers, have succeeded somewhat. Classification of addiction as a disease, working with ASAM, and supporting destigmatizing language have helped. However, stigma persists, discouraging patients from seeking care.

Chronic pain patients still report feeling judged. AA, NA, and other mutual help groups are ubiquitous and destigmatizing. Yet, social network fellowships have been underutilized. One 2016 national survey revealed three-quarters of primary care physicians were unwilling to have a person with opioid use disorder marry into their family, and two-thirds viewed people with OUD as dangerous. It is not clear this has changed.

Science-Driven Policy. Grade: A-

Federal and state policies increasingly rely on evidence-based recommendations, such as funding research in non-opioid treatments. This is a huge accomplishment.

Developing totally new approaches has lagged, but innovation and invention can be like that sometimes. Broadly and equitably supporting MATs has helped people with OUD access evidence-based treatments. In the absence of a cure, we have made limited progress in developing and implementing effective non-opioid therapies. However, the doctors’ original focus on leveraging science to guide policy, improve treatments, and address root causes of the opioid epidemic was spot on, saving lives.

Policy Initiatives Impacted Opioid Prescribing and Pain Management Shifts. Grade: B-

Balancing effective pain management with risks of opioid use remains challenging. Patients with pain are treated with a combination of alternative strategies and therapies, with mixed outcomes. In states where it is legal, cannabis is increasingly used as an alternative treatment for chronic pain—even though evidence of its efficacy is mixed and cannabis use disorders may emerge. Complementary and alternative treatments like acupuncture, chiropractic care, massage therapy, and yoga are gaining popularity. Alternative therapies can’t provide the same level of relief as opioids. Those with complex or severe pain feel marginalized by policies restricting opioids. Non-pharmacological therapies like physical therapy, acupuncture, or CBT may be expensive, time-intensive, or uncovered by insurance. Many patients report inadequate relief, difficulty accessing specialized therapies, and frustration with the healthcare system.

New Hope in the Lab

Yale researchers identified alternative compounds with therapeutic potential chemicals extracted from the cannabis plant. A recent study showed that certain cannabinoids reduced the activity of a protein central to pain signaling in the peripheral nervous system. The protein, Nav1.8, enables repetitive firing of those neurons, a key process in transmitting pain signals. Blocking Nav1.8, and muting its activity, has shown promise in reducing pain in clinical studies. Cannabigerol in particular has the potential to provide effective pain relief without opioid risks.

Summary

In the opioid death crisis, the first phase was dominated by prescription pain medication abuse. Volkow and McLellan outlined changes necessary to reverse the epidemic. While tremendous progress has been made in this decade, more needs to be done as users first switched from pain medications to heroin, then fentanyl, adding xylazine, and now speedballing or polydrug use. The investment in prevention efforts, such as the DEA’s “One Pill Can Kill”, should be expanded.

Source: https://www.psychologytoday.com/us/blog/addiction-outlook/202501/opioid-crisis-grading-the-progress-of-national-initiatives

Filed under: Addiction,Heroin/Methadone,Latest News,Opioids,USA :
by Lauren Irwin – WNCT Greenville

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

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

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

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

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

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

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

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

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

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

Source:  https://www.msn.com/en-us/health/medical/nearly-1-in-3-americans-have-reported-losing-someone-to-a-drug-overdose-study/ar-BB1nsfVP?

 

Filed under: Addiction,Culture,Drug use-various effects,Latest News,Prevalence,USA :
President, Foundation for Drug Policy Solutions
Trump Selects Robert F. Kennedy Jr. To Head of Health and Human Services

Prevention is key, and we cannot forget that today’s marijuana is highly potent. In 2025 and beyond, federal agencies must prioritize public health and safety and work to undo legalization’s harmful consequences.

The Department of Health and Human Services (HHS) is positioned to implement a wide range of policy initiatives to prevent marijuana use and hold the industry accountable. For example, marijuana legalization has re-elevated the conversation about second-hand smoke. California recently passed a law permitting “cannabis cafes” in which users can openly smoke marijuana. Second-hand marijuana smoke has been found to be more harmful than second-hand tobacco smoke and contains many of the same cancer-causing substances. Our country has legally and culturally rejected indoor cigarette smoking. HHS must stand on science and reject indoor marijuana smoking by publishing strict guidelines prohibiting it, just as it did with indoor cigarette smoking.

Transparency within the “medical” marijuana industry is also desperately needed. As it did with opioids, HHS should create a registry of medical marijuana recommendation practices and make the information available to the public. The database could include information regarding regional breakdowns, a list of overprescribing doctors, and pot-industry kickbacks received by doctors.

Sunlight is the best disinfectant when it comes to quack doctors. In August, a Spotlight PA article uncovered Pennsylvania medical pot doctors who were doling out thousands of medical marijuana cards per year. These are similar to the “pill mills” that fueled the opioid epidemic.

Last year, the Food and Drug Administration (FDA) bucked federal legal precedent around marijuana rescheduling by inventing new, lower standards. Its flawed marijuana rescheduling review was designed to permit marijuana rescheduling. The ramifications of changing this precedent aren’t limited to marijuana; other dangerous drugs (e.g., psychedelics) could be reclassified to a lower schedule based on the new lax standards. HHS should issue internal agency guidance that advises FDA to adhere to the established five-factor test for determining currently accepted medical use. This will ensure that drug scheduling, which has direct implications for the availability of drugs, remains science based.

The Trump-Vance administration must soundly reject moving marijuana from Schedule I to Schedule III for one simple reason: marijuana fails to meet the legal definition of a Schedule III drug. It has not been approved by the FDA for the treatment of any disease or condition. Moving marijuana to Schedule III is a handout to corporations, as it would allow companies to deduct advertising and other expenses from their taxes, fueling the growth of an industry that profits from addiction.

Far from being a legitimate medicine, marijuana is harming the millions of Americans who misuse it. Given that 3 in 10 users develop a marijuana use disorder, better known as addiction to marijuana, the incoming administration needs to focus on helping connect Americans to treatment.

Federal law enforcement also plays a crucial role in curbing marijuana legalization and its effects. In 2013, the Obama administration issued the Cole Memo, a document that cemented the federal government’s non-enforcement policy on marijuana. The first Trump administration rescinded the memo, but more must be done to enforce federal laws already on the books. The Justice Department has the power to prevent distribution to minors, curtail drugged driving, and investigate state-legal dispensaries being used as a cover for illegal drug trafficking—all things the Obama administration promised to do. By beginning with this targeted enforcement strategy, law enforcement can shut down the operations of the industry’s worst actors.

To promote public safety, the Trump-Vance administration should also crack down on illegal marijuana grows, particularly those in remote areas on federal lands. These operations are often controlled by cartels and poison the surrounding natural environment with toxic chemicals.

We also need a new national anti-drug media campaign, updated for the 21st century. This campaign must broadcast messages widely through traditional and social media and talk about the dangers and truth behind the use of drugs. The Office of National Drug Control Policy (ONDCP), the drug policy office within the White House, has a key role to play, too, particularly in drug use prevention. ONDCP helps oversee the Drug-Free Communities Support Program, which is responsible for much of our federally funded drug prevention work. In an era in which drugs are sold and marketed via social media, it’s more important than ever that effective anti-drug prevention messages reach young people. ONDCP also oversees the High Intensity Drug Trafficking Areas program, which forms a crucial partnership between local, state, and federal law enforcement to curtail drug trafficking. Both these programs’ funding should be protected and prioritized.

A good strategy must focus on all drugs, but we can’t ignore the politically inconvenient ones. If President Trump wants to make America healthy again, the conversation must include marijuana, a drug with an addiction rate of up to 30 percent that is being pushed by a profit-driven industry that desperately needs federal accountability.

Dr. Kevin Sabet is the President of Smart Approaches to Marijuana (SAM) and the Foundation for Drug Policy Solutions (FDPS) and a former White House drug policy advisor to Presidents Obama, Bush and Clinton.

SOURCE:  https://www.newsweek.com/making-america-healthy-again-must-start-better-drug-policy-opinion-2014657

Filed under: Addiction,Economic,Education,Health,Latest News,Marijuana and Medicine,Political Sector,Prevalence,Prevention and Intervention,Treatment and Addiction,USA :
Nora’s Blog  January 8, 2025 – By Dr. Nora Volkow
This past year, NIDA commemorated its 50th anniversary, which made me reflect on how far addiction science has come in a half century—from the barest beginnings of an understanding of how drugs work in the brain, and only a few treatment and prevention tools, to a robustly developed science and multiple opportunities to translate that science into clinical practice. Yet the challenges we face around drug use and addiction have never been greater, with annual deaths from overdose that have vastly exceeded anything seen in previous eras and the proliferation of increasingly more potent addictive drugs.

Our 50th year brought hope, as we finally saw evidence of a sustained downturn in drug overdose deaths. From July 2023 to July 2024, the number of fatal overdoses dropped nearly 17 percent, from over 113,000 to 94,000. We still don’t know all the factors contributing to this reversal, so investigating the drivers of this decline will be crucial for sustaining and accelerating the downturn. We also need to recognize that the decline is not homogenous across populations: Black and American Indian/Alaskan Native persons continue to die at increased rates. And 94,000 people dying of overdose in a year is still 94,000 too many.

As we begin a new year, I see four major areas deserving special focus for our efforts: preventing drug use and addiction, preventing overdose, increasing access to effective addiction treatments, and leveraging new technologies to help advance substance use disorder (SUD) treatment and the science of drug use and addiction.

Preventing drug use and addiction

The brain undergoes continuous development from the prenatal period through young adulthood, and substance exposures and myriad other environmental exposures can influence that development. Prenatal drug exposure can lead to learning and behavioral difficulties and raise the risk of later substance use. Adverse childhood experiences, including neglect, abuse, and the impacts of poverty, as well as childhood mental disorders, can negatively impact brain development in ways that make an individual more vulnerable for drug use and addiction. Early drug experimentation in adolescence is also associated with greater risk of developing an SUD.

Early intervention in emerging psychiatric disorders as well as prevention interventions aimed at decreasing risk factors and enhancing protective factors can reduce initiation of drug use and improve a host of mental health outcomes. Research on prevention interventions has shown that mitigating the impact of socioeconomic disadvantage counteracts the effects of poverty on brain development,1 and some studies have even documented evidence of intergenerational benefits, improving outcomes for the children of the children who received the intervention.2 Studies have also shown them to be enormously cost-effective by reducing later costs to healthcare and other services, providing health and economic benefits to communities that put them in place.3

Yet, in the United States, efforts to prevent substance use have been largely fragmented, and the infrastructure and funding required to bring effective programs to scale is lacking. What kinds of policy innovations could we put into place to ensure that everyone who could benefit from evidence-based prevention services has access to them, whether through school, healthcare, justice, or community settings?  NIDA, along with other NIH Institutes, the Centers for Disease Control and Prevention, and the Substance Abuse and Mental Health Services Administration, have charged the National Academy of Sciences, Engineering, and Medicine with creating an actionable blueprint for supporting the implementation of prevention interventions that promote behavioral health. The report is due out early this year and has the potential for tremendous public health impact.4

Preventing overdose

We also need to continue research toward mitigating fatal overdoses. Comprehensive data on overdose reversals do not currently exist, but recipients of SAMHSA State Opioid Response grants alone reported more than 92 thousand overdose reversals with naloxone in the year ending March 31, 2023, and this is likely just a small fraction of the lives saved. We do not yet know the extent to which greater use of naloxone has played a role in the recent declines in overdose fatalities, but this medication, the first intranasal formulation of which was developed by NIDA in partnership with Adapt Pharma, is a real public health success.

NIDA is supporting research to evaluate approaches to naloxone distribution, for instance through mobile vans and peer-run community services that also provide sterile injection equipment to prevent HIV and HCV transmission. We are also supporting research on new approaches to reversing drug overdoses, such as wearable devices that would auto-inject naloxone when an overdose is detected and electrical stimulation of the phrenic nerve to restore breathing, a method already used in resuscitation devices.5 We are also supporting research on compounds that could potentially reverse methamphetamine overdoses, such as monoclonal antibodies and molecules called sequestrants that bind and encapsulate methamphetamine in the body.6

Improving access to addiction treatment

In 2023, only 14.6 percent of people with an SUD received treatment, and only 18 percent of people with an opioid use disorder (OUD) received medication.7 Stigma, along with inadequate coverage of addiction treatment by both public and private insurers, contributes to this gap. To fix this will require partnering with payors to develop and evaluate new models for incentivizing the provision of evidence-based SUD care.

Increased access to methadone is a particularly high priority in the era of fentanyl and other potent synthetic opioids. Results from a recent study in British Columbia showed that risk of leaving treatment was lower for methadone than for buprenorphine. Risk of dying was similarly low for both groups.8 Currently in the United States, methadone is only available from specialized opioid treatment centers, but studies piloting access through pharmacies have shown promise.

OUD medications also need to be accessible to people with SUD in jails and prisons. Research conducted in justice settings has shown that providing access to all three FDA-approved medications for OUD during incarceration reduced fatal overdose risk after release by nearly 32 percent.9 Access to buprenorphine during incarceration was also associated with a 32 percent reduction in recidivism risk.10 Through NIDA’s  Justice Community Overdose Innovation Network (JCOIN), we continue to promote research into innovative models and strategies for integrating medications for OUD in justice settings.

I am also hopeful that we will soon see increased utilization of contingency management for treating stimulant use disorders. Providing incentives for treatment participation and negative drug tests is the most effective treatment we have for methamphetamine and cocaine addictions, but implementation has been hindered by regulatory ambiguities around caps on the dollar value of those incentives. However, demonstration projects underway in four states (California, Washington, Montana, and Delaware) are implementing contingency management with higher incentives and could further bolster evidence for the effectiveness—including cost effectiveness—of this approach.

Leveraging new treatments and technologies

There are many promising new technologies that could transform the treatment of addiction, including central and peripheral neuromodulation approaches. Transcranial magnetic stimulation (TMS) was already approved by the FDA as an adjunct treatment for smoking cessation and peripheral auricular nerve stimulation was approved for the treatment of acute opioid withdrawal. TMS, transcranial direct current stimulation (tDCS), and peripheral vagal nerve stimulation are under investigation for treating other SUDs. Low-intensity focused ultrasound—a non-invasive method that can reach targets deep in the brain—is also showing promise for the treatment of SUD. NIDA is currently funding clinical trials to determine its safety and preliminary efficacy for treating cocaine use disorder11 and OUD with or without co-occurring pain.12 

Advances in pharmacology have helped identify multiple new targets for treating addiction that are not limited to a specific SUDs like OUD. Instead, these targets aim to modulate brain circuits that are common across addictions; they include among many others D3 receptor partial agonists/antagonists, orexin antagonists and glucagon-like peptide 1 (GLP-1) agonists. The latter are particularly promising, as these types of drugs, including semaglutide and tirzepatide, are already being used for the treatment of diabetes and obesity.

Anecdotally, patients taking GLP-1 agonists report less interest in drinking, smoking, or consuming other drugs. Recent studies based on electronic health records have revealed that people with SUDs taking GLP-1 medications to treat their obesity or diabetes had improved outcomes associated with their addiction, such as reduced incidence and recurrence of alcohol use disorder,13 reduced health consequences of smoking,14 and reduced opioid overdose risk.15 NIDA is currently funding randomized clinical studies to assess the efficacy of GLP-1 agonists for the treatment of opioid and stimulant use disorders and for smoking cessation.

Creation of large data sources and repositories in parallel with advances in computation and analytical modeling including AI are helping in the design of new therapeutics based on the 3D molecular structure of addictive drugs and the receptors they interact with.16 NIDA-funded researchers have published studies showing that AI could be used to provide more timely, comprehensive data on overdose, such as by using social-media to predict overdose deaths.17 It could be used to enable higher-resolution analyses in basic neuroscience research18 and facilitate studies using large data sources like electronic health records.19 AI is also being used to support delivery of behavioral therapies and relapse prevention in virtual chatbots and is being studied in wearable devices. Although there is much work to be done to ensure that AI is deployed safely and ethically, particularly in clinical settings, this technology has considerable potential to enhance and expand access to care.

AI will also be transformative for analyzing big data sets like those being generated by the Adolescent Brain Cognitive DevelopmentSM (ABCD) Study and HEALthy Brain and Child Development Study. These landmark NIH-funded studies are gathering vast quantities of neuroimaging, biometric, psychometric, and other data across the first two decades of life. They will be able to answer important questions about the impacts of drugs and other environmental exposures on the developing brain, inform prevention and treatment interventions, and establish a valuable—and unprecedented—baseline of neurodevelopment that will be a crucial resource in pediatric neurology.

The field of addiction science has progressed at a breathtaking pace. These advances could not have been made without the commitment of an interconnected community of people. Researchers, clinicians, policymakers, community groups, and people living with SUDs and the families that support them all play a role in collaboratively finding solutions to some of the most challenging questions in substance use and addiction research. Together, we turn our eye to 2025 and the challenges and opportunities ahead.

Filed under: Addiction,Culture,Economic,Education,Health,Latest News,Prevalence,Prevention and Intervention,USA :
 

Contemporary issues on drugs

As well as providing an in-depth analysis of key developments and emerging trends in selected drug markets, the Contemporary issues on drugs booklet looks at several other developments of policy relevance. The booklet opens with a look at the 2022 Taliban ban on the cultivation and production of and trafficking in drugs in Afghanistan and its implications both within the country and in transit and destination markets elsewhere. This is followed by a chapter examining the convergence of drug trafficking and other activities and how they affect natural ecosystems and communities in the Golden Triangle in South-East Asia. The chapter also assesses the extent to which drug production and trafficking are linked with other illicit economies that challenge the rule of law and fuel conflict. Another chapter analyses how the dynamics of demand for and supply of synthetic drugs vary when the gender and age of market participants are considered. The booklet continues with an update on regulatory approaches to and the impact of legalization on the non-medical cannabis market in different countries, and a review of the enabling environment that provides broad access to the unsupervised, “quasi-therapeutic” and non-medical use of psychedelic substances. Finally, the booklet offers a multi-dimensional framework on the right to health in the context of drug use; these dimensions include availability, accessibility, acceptability, quality, non-discrimination, non-stigmatization and participation.
 

Key findings and conclusions

The Key findings and conclusions booklet provides an overview of selected findings from the analysis presented in the Drug market patterns and trends module and the thematic Contemporary issues on drugs booklet, while the Special points of interest fascicle offers a framework for the main takeaways and policy implications that can be drawn from those findings.

Sources:

Issues:  https://www.unodc.org/unodc/en/data-and-analysis/wdr2024-contemporary-issues.html

Findings and Conclusions: https://www.unodc.org/unodc/en/data-and-analysis/wdr2024-key-findings-conclusions.html

Filed under: Addiction,Drug use-various effects,Economic,Health,Latest News,Mental Health,Others (International News),Prevalence,Prevention and Intervention :

Public News Service  – Terri Dee, Anchor/Producer  – Monday, January 6, 2025

One popular New Year’s resolution is to quit alcohol consumption.

Although easier said than done, one recovery center said there are modifications to try if previous attempts are not working. A good start is taking a hard look at what has worked and what has not.

Marissa Sauer, a licensed clinical addiction counselor at Avenues Recovery, a Fort Wayne recovery center, pointed out if there was a simple answer, everybody would use it. She added other influences are linked to alcohol and substance abuse.

“There’s genetics. Were my parents and my grandparents struggling with substances? Does someone have maybe adverse childhood experiences that have led to substances being a coping mechanism of some kind?” Sauer explained. “Maybe there are these mental health diagnoses.”

Sauer mentioned people, places, or things which could inhibit or enable someone to abuse drugs or alcohol, making it complicated to simply walk away. Medication, therapy or conversations with people who have beaten their addictions are all effective measures for recovery.

The US Surgeon General’s 2025 Advisory Report indicates alcohol consumption is the third leading preventable cause of cancer after tobacco and obesity and the public is taking notice.

There is a growing momentum of the “sober curious” movement, avoiding happy hours at bars, ordering a low or no-alcohol drinks known as mocktails, or completely abstaining from alcohol for 30 days for “dry January.” Sauer said longtime substance abusers fear change and she wants them to know there is hope.

“Whether you’re 21 or whether you’re 51, that ability to heal is there,” Sauer emphasized. “The best gift that you could give yourself for a healthy 2025 is to give your loved ones the absolute best version of yourself.”

An Indiana State Epidemiological report from 2021-2022 revealed almost 24% of residents aged 12 and older have participated in binge drinking, with the highest rate among young adults aged 18 to 25.

Source: https://www.publicnewsservice.org/2025-01-06/alcohol-and-drug-abuse-prevention/in-substance-recovery-center-supports-sober-existence/a94456-1

Filed under: Addiction,Alcohol,Latest News,Treatment and Addiction,USA :

Gamblers Anonymous meetings are filling up with people hooked on trading and betting. Apps make it as easy as ordering takeout.

Wall Street Journal      by Gunjan Banerji         Dec. 20, 2024

A new type of addict is showing up at Gamblers Anonymous meetings across the country: investors hooked on the market’s riskiest trades.

At Gamblers Anonymous in the Murray Hill neighborhood of Manhattan, one man called options “the crack cocaine” of the stock market. Another said he faced hundreds of thousands of dollars in trading losses after borrowing from a loan shark to double down on stocks.  And one young man brought his mom and girlfriend to celebrate one year since his last bet.

They were among a group of about 60 people, almost all men, who sat in rows of metal folding chairs in a crowded church basement that evening. Some shared their struggle with addiction—not on sports apps or at Las Vegas casinos—but using brokerage apps like Robinhood.

Many of the men, and scores of others around the country, discovered trading and betting during the pandemic boom that began in 2020. Some were drawn in by big wins in meme stocks and other viral stock sensations, leading them into even higher-octane wagers that offer the chance to put up a small amount of cash for a potentially mammoth return—or more often, a crushing loss.

Others bought and sold cryptocurrencies on apps that make trading as easy as ordering takeout on Uber Eats or toiletries on Amazon. In an age where sports betting has become an accepted pastime—accessible by the flick of the thumb on an iPhone app—they found the same rush betting on dogecoin, Tesla or Nvidia as wagering on Patrick Mahomes to carry the Kansas City Chiefs to the Super Bowl.

Doctors and counselors say they are seeing more cases of compulsive gambling in financial markets, or an uncontrollable urge to bet. They expect the problem to worsen. The stock market has climbed 23% this year and bitcoin recently topped $100,000  for the first time, tempting many people to pile into speculative trades. Wall Street keeps introducing newer and riskier ways to play the market through stock options or complex exchange-traded products that use borrowed money and compound the risk for investors.

Some who are desperate to stop trading are turning to self-help groups like Gamblers Anonymous. A GA pamphlet advises members to stay away from bets on stocks, commodities and options as well as raffle tickets and office sports pools. Sometimes members hand over retirement accounts to their spouses.

Modeled after Alcoholics Anonymous, GA dates back to 1957 and now has hundreds of chapters in every U.S. state. Attendees at local GA meetings from Ponca City, Okla., to Allentown, Pa., subscribe to a 12-step program. It begins with accepting that they are powerless over gambling and can include a financial review in a so-called pressure relief group meeting. New attendees are peppered with calls from others and latch onto veteran members who commit to helping them stay on track.

‘Hi, my name is Mitch’

More than 30 people interviewed by The Wall Street Journal, many of whom regularly attend GA meetings, said they’ve struggled with compulsive gambling in financial markets. At times, the trading led to mood swings, sleepless nights and even depression. Their trades—and spiraling losses—became a shameful secret that they kept from their partners or other loved ones.

I asked Gamblers Anonymous for permission to attend some meetings. Attendees introduced me to the groups at the start of the meetings, and I observed the discussions. Members introduced themselves by their first names, according to GA practices.

“Hi, my name is Mitch, and I’m a compulsive gambler,” one said at a GA meeting this month near Ozone Park, N.Y. “Hi Mitch,” the group responded in unison.

The suburban dad of three, slightly balding with a big smile, stood in front of more than a dozen members in a church basement. He is haunted by the rising price of bitcoin—and the riches that could have been his, he said. Up around 40% since Election Day, bitcoin prices are on a wild ride. What would have happened, he wondered out loud, if he had just left his bitcoin in a digital wallet and handed it over to his wife?

Then he reminded himself and the group that he was never able to just buy and hold. “I needed more and more,” Mitch told the group. “I’m a sick, compulsive gambler. That’s why I keep making these meetings. I don’t trust myself.”

One attendee told him to stop eyeing cryptocurrency prices. Another reminded him of the toll trading had taken on his family and asked: “What’s more important, crypto or your kids?”

The entrepreneur, based in Long Island, N.Y., said cryptocurrencies caught his eye when he was in his late 40s and had gone more than 20 years since placing his last bet. He had sworn off gambling after a penchant for bold bets had led him to Gamblers Anonymous meetings in his early 20s. He invested $100 in bitcoin and watched it soar. He poured thousands of dollars into ether and smaller, more speculative coins. Something kept him from sharing with his GA group that he was trading.

When his portfolio rose above $1 million, he thought to himself, “That’s four Lambos.” He flew to Florida to look at potential vacation homes for his family near Walt Disney World.

Within months, he found himself in a familiar cycle. The rush of adrenaline he got when he bought and sold tokens pushed him to trade more frequently—to the point where he was trading hundreds of times a day—and taking bigger risks. He would wake at 4 a.m. to monitor his portfolio.

He parked his car in the lot of a Long Island shopping plaza near his home to trade in isolation. His neck grew tense from hunching over the screen.

When crypto prices started tumbling, snowballing losses left him sullen. “Sometimes I would get a passing thought as I went to bed: I hope I don’t wake up in the morning,” he said. His portfolio had fallen around $1 million from its peak.

Desperate for a way out, he typed “crypto gambling treatment center” into Google. He confessed to his GA mentors that he had been gambling.

A spiking problem

Pennsylvania’s gambling hotline has fielded more calls tied to gambling in stocks and crypto since 2021 than it did in the prior six years combined. At a New York-based treatment center, Safe Foundation, clinical director Jessica Steinmetz estimates about 10% of patients are seeking help for addictions tied to trading. Before 2020, there were no such patients.

Lyndon Aguiar, a clinical director at Williamsville Wellness, a gambling treatment center in Hanover, Va., said counselors sit down with traders and delete dozens of stock, sports and financial news apps from their phones when they walk in the doors for its inpatient treatment program. The center has seen a 25% increase in gambling tied to markets since 2020, compared with the prior four years. Patients might install Gamban, an app that locks individuals out of gambling on their phones. The app started blocking Robinhood and Webull in July 2021.

A Robinhood spokesperson said it includes “robust safeguards to help customers make informed decisions” and that individuals deserve the freedom to become stewards of their own finances. A spokesperson for Webull said the platform offers educational tools to foster responsible investment decisions.

New patients often suffer from withdrawal symptoms including severe anxiety and depression when they first stop trading, he said. Some start fidgeting or repeatedly tapping their fingers against a table, itching to place a trade.

Abdullah Mahmood, administrative coordinator of a gambling program at the Maryhaven addiction treatment center in Columbus, Ohio, said he has seen several clients enter the treatment center’s doors this year for trading addictions. Options are particularly problematic, he said.

Activity in options is on track to smash another record this year.  Trading in contracts expiring the same day, which are the riskiest, has soared to make up more than half of all trades in the market for S&P 500 index options this year, according to figures from SpotGamma. These trades are more electric than traditional stocks, with the potential to rocket higher or plunge to zero within minutes.

Similar to wagering on how many points Mavericks point guard Luka Dončić will score in the first quarter of an NBA game, traders are increasingly using options to speculate how stocks will fare during the trading session, rather than at the closing bell.

This year, “a client came down to my office, suicidal,” Mahmood said. “He had lost $14,000 in just five minutes in options trading on the app Robinhood.”

Doug Royer, 61, has been attending Mahmood’s  group counseling sessions every Monday.

He initially entered the center’s doors for help with his drinking. Then, he saw signs for a gambling program while walking the halls of Maryhaven’s treatment center. Immediately, the six figures he lost trading came to mind.

After selling his house in 2022, he had poured thousands of dollars into investments like the Grayscale Bitcoin Trust, Lockheed Martin and Texas Pacific Land before amping up the risk with options trading. He traded in and out of companies such as Spirit Airlines and Estée Lauder, while borrowing on margin in an attempt to magnify his bets, brokerage statements show.

Eventually, he said he had almost no money left to trade with after losses in options and lotteries. He said he has been working part-time as a massage therapist near Columbus, Ohio.  “It’s very easy to make a lot of money,” Royer said. “It’s also easy to lose everything really fast.”

Addiction counselors say gambling in financial markets often goes undetected and can be tough to track because individuals confuse their actions with investing. Unlike sports betting apps such as FanDuel and DraftKings, most brokerage apps don’t post warnings about gambling or offer hotlines to seek help. The proliferation of financial instruments, along with flashy brokerage apps that make them easy to trade, has also helped some gamblers convince themselves that they weren’t actually placing bets.

The National Council on Problem Gambling started including questions about investing in its annual survey in 2021, after its gambling hotline received an influx of calls during the meme-stock mania. The council’s executive director, Keith Whyte, said NCPG reached out to apps like Robinhood to suggest they adopt consumer protections ingrained in gambling apps. “In some cases, the consumer protections in the gambling industry exceed that in the financial markets,” Whyte said.

Like the anticipation of sex or delicious food, a financial gamble like an options trade can flood your brain with feel-good chemicals, said Brian Knutson, a professor of psychology and neuroscience at Stanford University. The bigger the financial payout or tastier the dish, the stronger the rush. That anticipation can keep a trader going back to place another bet, forming a reinforcing habit, added Knutson, who has studied risk-taking in financial markets for more than two decades.

“It’s not just the release, per se, of the dopamine, but the speed of the release that’s reinforcing,” Knutson said.

Chris Cachia, a 38-year-old power-plant technician in Ontario, Canada, got swept up with trading during the meme-stock mania in 2021. After turning around 7,000 Canadian dollars into roughly 50,000 trading stocks like GameStop and BlackBerry, he found short-dated stock options when he went hunting for fatter profits. He scored some early wins. Before long, the thousands he made evaporated and his account sank into a deep hole. Yet he said he couldn’t walk away—he was consumed by a fear of missing out on the riches that others boasted about online.

One week while his wife was traveling, he holed up in his home office for days trading. He grew desperate for a win and bet more money than he had in his brokerage account. It didn’t work out.

The subsequent loss left him so depressed that he skipped his brother’s bachelor party. “It was causing erratic changes in my behavior as I got deeper and deeper in,” Cachia said. “I was basically a full-out gambling addict.” He said he tried to quit countless times since his trading ramped up during the pandemic, deleting brokerage and social-media apps from his phone, only to quickly download them again. He wasn’t able to pull away until his wife threatened to leave him. “She gave me an ultimatum: You need to stop this, or I’m done,” Cachia said.

__

Source: More Men Are Addicted to the ‘Crack Cocaine’ of the Stock Market – WSJ

www.drugwatch.org
drug-watch-international@googlegroups.com

Filed under: Addiction,Gambling,Latest News,Mental Health,USA :

  Polytechnique insights: A REVIEW BY INSTITUT POLYTECHNIQUE DE PARIS

            Guillaume Airagnes
            Lecturer at Universite  Paris Cite
           Amine Benyamina
            Professor at Paris Saclay Faculty of Medicine
             assisted by Sophie Podevin
            Journaliste Scientifique, Ginkio
Key points:
  • Addictions are widespread among the French population: in 2020, 25.5% of adults smoked every day and 10% drank at least one glass of alcohol a day.
  • Addiction is based on criteria such as craving, continued consumption despite the dangers, or a withdrawal syndrome when the substance is stopped.
  • In France, the most commonly used addictive substances are tobacco (responsible for 75,000 deaths a year), alcohol (41,000 deaths a year) and cannabis.
  • There has been a marked increase in the use of psychostimulant drugs among adults since 2010, and diversion of opiate-based medicines is on the rise.
  • Current research is focusing on studies specifically dedicated to drug users, to better identify effective therapies tailored to their profiles.

As the leading cause of a deregulation in the brain’s reward circuit, addictions are still widespread among the French population. This is largely due to the widespread use of legal psychoactive substances: tobacco and alcohol, which are the two leading causes of premature death in France. In 2020, nearly 25.5% of adults smoked every day (12 million people) and 10% drank at least one glass of alcohol a day (5 million people). So, what is the situation for substance addictions in France for the coming year?

A restricted definition

First of all, to qualify as an addiction, a person must meet at least 2 of the 11 criteria set out in the Diagnostic and Statistical Manual of Mental Disorders (DSM‑5), including: craving, a compelling need to consume the substance or perform the activity; loss of control over the quantity and time devoted to consumption; increased tolerance to the product; a strong desire to reduce doses; continued use despite the damage; or the presence of a withdrawal syndrome when the addictive behaviour is abruptly stopped…

To date, only addictions to substances (tobacco, alcohol, cannabis, cocaine, opium and derivatives) or to video games and gambling are recognised as “addictions”. Social networking, sexual hyperactivity and sugar are not considered as such due to a lack of data and scientific evidence.

Top three

In France, the most widely used addictive substances are still tobacco, alcohol and cannabis. The first two are responsible for 75,000 and 41,000 deaths a year respectively. These are terrifying figures, known but ignored because of habit.

In an article published on 20 October 2024, Doctor Bernard Basset, chairman of the Addictions France association, and psychiatrist and addictologist Amine Benyamina, chairman of the Fédération Française d’Addictologie (FFA), proposed a series of measures combining public health and government debt, such as taxing drinks according to their alcohol content, or introducing a minimum price per drink based on the Scottish model. “In France, we have a real cultural problem with alcohol and very powerful lobbies,” says Amine Benyamina. “All public prevention policies are stifled or censored.” And yet, according to data collected by the Constances epidemiological cohort, which numbered almost 200,000 people in 2018, 19.8% of men and 8% of women in the working population are thought to have a harmful use of alcohol.

While the problem persists, it is changing. Starting with a major positive point made by Guillaume Airagnes, Director of the French Observatory of Drugs and Addictive Tendencies (OFDT) and Doctor of Psychiatry and Addictology: “The general consumption of substances such as tobacco and alcohol has been falling among young people since 2010.” However, there was a downside at the time of Covid, when several addictive activities were on the increase during confinement.

On the other hand, a clear increase in the use of psychostimulant drugs has been observed among adults since 2010, “although the levels of use in the general population remain incomparably lower than those for tobacco, alcohol or cannabis” points out Guillaume Airagnes.

These substances, like ecstasy, have benefited from their image becoming much more commonplace. This is also the case for cocaine, the availability of which has risen steadily over the last ten years, and which used to be the social marker of a wealthy economic category. In 2021, 26.5 tonnes of cocaine were seized, a 67% increase on 2018. “Cocaine benefits from the tenacious stereotype that it does not produce dependence. In reality, while the signs of physical withdrawal are almost non-existent, it is one of the most psychologically tyrannical substances, with extremely powerful cravings,” describes Amine Benyamina, who is also head of the psychiatry and addictology department at the Paul-Brousse hospital in Paris. This increase is set to continue. The 2020 lockdowns demonstrated the adaptability of the drug trade, with home delivery services, marketing, attractive packaging, the use of social networks and instant messaging, and even payments in cryptocurrency.

Misuse of medicines as a new drug

Another less well-known development is the misuse of certain opiate-based drugs, such as codeine or tramadol, which are intended for therapeutic purposes. These are morphine derivatives with a less powerful analgesic effect than morphine. “Paradoxically, this makes them more addictive,” explains Guillaume Airagnes. “As the psychoactive effects are less intense, this leads to greater compulsive consumption.” Misuse of these drugs has been documented for around ten years and remains under close surveillance, although it still only concerns a “very small proportion of users” the director of the OFDT points out.

In his department, Amine Benyamina also sees new types of drug misuse: “More marginal but just as problematic is the use of pregabalin or LYRICA. This is a product designed to treat neuropathic pain or post-traumatic stress syndromes.” This analgesic, which this time is not a morphine derivative, also has a strong addictive potential, encouraging patients to continue taking it beyond the prescription period.

One of the first problems facing carers is the lack of information about drug users themselves. In fact, most of the data on addiction in France comes from surveys carried out on the general population to be more representative. But not for much longer! In April 2024, the first national e‑cohort open only to drug users was launched: ComPaRe Pratiques Addictives. “We already have several thousand subscribers,” says Guillaume Airagnes, who is heading up the study. “The only condition to be eligible is to be a psychoactive substance user at the time of inclusion in the study. Of course, our aim is to follow up participants for at least 5 years, regardless of whether they continue to use substances.”

The responses and the long-term follow-up will enable Guillaume Airagnes and his teams to explore several avenues of research: the question of multiple drug use, which seems to be the rule rather than the exception; the relationship between drug use and economic, demographic or professional situation; the study of the very strong stigmatisation phenomenon among these users, etc. These data will also enable us to better target effective therapies that are adapted to each profile.

In its Guide pratique de psychothérapies les plus utilisées en addictologie of May 2022, the Fédération Française d’Addictologie lists and ranks the different therapies according to their clinical relevance. The behavioural and cognitive therapy (BCT) approach remains the most popular, with a method that can be adapted to addictions with and without substances and solid results confirmed by scientific studies.

But other avenues of treatment are being explored, such as the surprising use of LSD derivatives. “The initial results are surprising and encouraging,” says Professor Amine Benyamina with satisfaction. “Of course, it’s important to remember that these studies are very closely supervised” warns the professor, who is working with his team on the effect of psilocybin on alcohol addiction. “They should not be reproduced at home!”

Filed under: Addiction,Europe,Latest News,Medicines :

COMMENT BY NATIONAL DRUG PREVENTION ALLIANCE ON THE ARTICLE BY DREXEL – 15 DECEMBER 2024:

 NDPA has significant reservations about his article. Drexel (a ‘private university’ in Philadelphia) are asserting that all drug use is stigmatised ,and that such stigmatisation as they observe should be negated. But other specialists in the field counter by giving comments on stigma/human behaviour etc, as follows:

  • There is no doubt that language which stigmatises a situation or a person is something to be avoided, and there should be an un-stigmatised opening for people to access healthful interventions, but
  • Drug use and addiction is a ‘chicken and egg’ situation, and
  • Writers like this one start half way through the situation, when a person has made a decision to stop being a ‘drug-free’ person; they are already moving down a path which can lead to consequences which were not what they wanted when deciding to use, so
  • They are already a user, and what one might call the ‘pre-addictive’ stage is ignored. Addicted users are portrayed as no less or more than victims, seduced by profiteering suppliers, which
  • Circumvents the initial chapter in the story i.e. the stage in which a person decides to use a substance which
  • In retrospect ca be seen as a bad decision, which should be the target of productive prevention. This is
  • ‘pre the event’ – the heart of the word ‘prevention’ which in its Latin-base (‘praevenire’) means ‘to come before’ – not to come ‘during’!

Take the following paragraph in this paper:

“Awareness of stigma as an impediment to treatment has grown in the last two decades. In the wake of America’s opioid epidemic — when strategic, deceitful marketing, promotion and overprescription of addictive painkillers resulted in millions of individuals unwittingly becoming addicted — the general public began to recognize addiction as a disease to be treated, rather than a moral failure to be punished — as it was often portrayed during the “War on Drugs” in the 1970s and ‘80s”.

Whilst we can harmonise with the authors of this paper in seeking to remove ‘stigma as an impediment to treatment’, we part company with them when they classify all addicts as ‘unwitting victims of deceitful marketing and promotion’. The simple fact is that they made a bad decision, for whatever reason … in some cases suckered, yes, or in other cases not looking down that road and its consequences on themselves and others around them (‘short termism’) – this was not a ‘moral  wrong’, it was what it was.

Prevention should therefore assist people to make healthful decisions – the kind of decision which countless former users make for themselves, thereby moving themselves off the ‘pre-addictive’ road onto a healthful one.

This paper does not include this wider picture, and is the less for that.

<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<NDPA>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

DREXEL PRIVATE UNIVERSITY TEXT:

December 11, 2024

Researchers from Drexel’s College of Computing & Informatics have created large language model program that can help people avoid using language online that creates stigma around substance use disorder.

Drug addiction has been one of America’s growing public health concerns for decades. Despite the development of effective treatments and support resources, few people who are suffering from a substance use disorder seek help. Reluctance to seek help has been attributed to the stigma often attached to the condition. So, in an effort to address this problem, researchers at Drexel University are raising awareness of the stigmatizing language present in online forums and they have created an artificial intelligence tool to help educate users and offer alternative language.

Presented at the recent Conference on Empirical Methods in Natural Language Processing (EMNLP), the tool uses large language models (LLMs), such as GPT-4 and Llama to identify stigmatizing language and suggest alternative wording — the way spelling and grammar checking programs flag typos.

“Stigmatized language is so engrained that people often don’t even know they’re doing it,” said Shadi Rezapour, PhD, an assistant professor in the College of Computing & Informatics who leads Drexel’s Social NLP Lab, and the research that developed the tool. “Words that attack the person, rather than the disease of addiction, only serve to further isolate individuals who are suffering — making it difficult for them to come to grips with the affliction and seek the help they need. Addressing stigmatizing language in online communities is a key first step to educating the public and reducing its use.”

According to the Substance Abuse and Mental Health Services Administration, only 7% of people living with substance use disorder receive any form of treatment, despite tens of billions of dollars being allocated to support treatment and recovery programs. Studies show that people who felt they needed treatment did not seek it for fear of being stigmatized.

“Framing addiction as a weakness or failure is neither accurate nor helpful as our society attempts to address this public health crisis,” Rezapour said. “People who have fallen victim in America suffer both from their addiction, as well as a social stigma that has formed around it. As a result, few people seek help, despite significant resources being committed to addiction recovery in recent decades.”

Awareness of stigma as an impediment to treatment has grown in the last two decades. In the wake of America’s opioid epidemic — when strategic, deceitful marketing, promotion and overprescription of addictive painkillers resulted in millions of individuals unwittingly becoming addicted — the general public began to recognize addiction as a disease to be treated, rather than a moral failure to be punished — as it was often portrayed during the “War on Drugs” in the 1970s and ‘80s.

But according to a study by the Centers for Disease Control and Prevention, while stigmatizing language in traditional media has decreased over time, its use on social media platforms has increased. The Drexel researchers suggest that encountering such language in an online forum can be particularly harmful because people often turn to these communities to seek comfort and support.

“Despite the potential for support, the digital space can mirror and magnify the very societal stigmas it has the power to dismantle, affecting individuals’ mental health and recovery process adversely,” Rezapour said. “Our objective was to develop a framework that could help to preserve these supportive spaces.”

By harnessing the power of LLMs — the machine learning systems that power chatbots, spelling and grammar checkers, and word suggestion tools— the researchers developed a framework that could potentially help digital forum users become more aware of how their word choices might affect fellow community members suffering from substance use disorder.

To do it, they first set out to understand the forms that stigmatizing language takes on digital forums. The team used manually annotated posts to evaluate an LLM’s ability to detect and revise problematic language patterns in online discussions about substance abuse.

Once it has able to classify language to a high degree of accuracy, they employed it on more than 1.2 million posts from four popular Reddit forums. The model identified more than 3,000 posts with some form of stigmatizing language toward people with substance use disorder.

Using this dataset as a guide, the team prepared its GPT-4 LLM to become an agent of change. Incorporating non-stigmatizing language guidance from the National Institute on Drug Abuse, the researchers prompt-engineered the model to offer a non-stigmatizing alternative whenever it encountered stigmatizing language in a post. Suggestions focused on using sympathetic narratives, removing blame and highlighting structural barriers to treatment.

The programs ultimately produced more than 1,600 de-stigmatized phrases, each paired as an alternative to a type of stigmatizing language.

 

destigmatized text

 

Using a combination of human reviewers and natural language processing programs, the team evaluated the model on the overall quality of the responses, extended de-stigmatization, and fidelity to the original post.

“Fidelity to the original post is very important,” said Layla Bouzoubaa, a doctoral student in the College of Computing & Informatics who was a lead author of the research. “The last thing we want to do is remove agency from any user or censor their authentic voice. What we envision for this pipeline is that if it were integrated onto a social media platform, for example, it will merely offer an alternate way to phrase their text if their text contains stigmatizing language towards people who use drugs. The user can choose to accept this or not. Kind of like a Grammarly for bad language.”

Bouzoubaa also noted the importance of providing clear, transparent explanations of why the suggestions were offered and strong privacy protections of user data when it comes to widespread adoption of the program.

To promote transparency in the process, as well as helping to educate users, the team took the step of incorporating an explanation layer in the model so that when it identified an instance of stigmatizing language it would automatically provide a detailed explanation for its classification, based on the four elements of stigma identified in the initial analysis of Reddit posts.

“We believe this automated feedback may feel less judgmental or confrontational than direct human feedback, potentially making users more receptive to the suggested changes,” Bouzoubaa said.

This effort is the most recent addition to the group’s foundational work examining how people share personal stories online about experiences with drugs and the communities that have formed around these conversations on Reddit.

“To our knowledge, there has not been any research on addressing or countering the language people use (computationally) that can make people in a vulnerable population feel stigmatized against,” Bouzoubaa said. “I think this is the biggest advantage of LLM technology and the benefit of our work. The idea behind this work is not overly complex; however, we are using LLMs as a tool to reach lengths that we could never achieve before on a problem that is also very challenging and that is where the novelty and strength of our work lies.”

In addition to making public the programs, the dataset of posts with stigmatizing language, as well as the de-stigmatized alternatives, the researchers plan to continue their work by studying how stigma is perceived and felt in the lived experiences of people with substance use disorders.

 

 

In addition to Rezapour and Bouzoubaa, Elham Aghakhani contributed to this research.

Read the full paper here: https://aclanthology.org/2024.emnlp-main.516/

This is an RTE component

Contact: Britt Faulstick – 
215.895.2617britt.faulstick@drexel.edu
Source: https://drexel.edu/news/archive/2024/December/LLM-substance-use-disorder-stigmatizing-language
Filed under: Addiction,Cannabis/Marijuana,Culture,Education,Health,Latest News,Prevention and Intervention,Social Affairs,USA,Youth :

Few patients know about evidence-based treatment—or have or seek access to it

Fact Sheet 

Projects:Substance Use Prevention and Treatment
Overview

Alcohol is the leading driver of substance use-related fatalities in America: Each year, frequent or excessive drinking causes approximately 178,000 deaths.1 Excessive alcohol use is common in the United States among people who drink: In 2022, of the 137 million Americans who reported drinking in the last 30 days, 45% reported binge drinking (five or more drinks in a sitting for men; four for women).2 Such excessive drinking is associated with health problems such as injuries, alcohol poisoning, cardiovascular conditions, mental health problems, and certain cancers.3

In 2020, many people increased their drinking because of COVID-19-related stressors, including social isolation, which led to a 26% increase in alcohol-related deaths during the first year of the pandemic.4

Figure 1

Alcohol‑Related Deaths Have Increased Since 2016

Growth is driven by increases in both acute and chronic causes of death

Notes: Chronic causes of death include illness related to excessive alcohol use such as cancer, heart disease, and stroke, and diseases of the liver, gallbladder, and pancreas. Acute causes include alcohol-related poisonings, car crashes, and suicide.

Source: Marissa B. Esser et al., “Deaths From Excessive Alcohol Use—United States, 2016-2021,” Morbidity and Mortality Weekly Report 73, no. 8154-61, https://www.cdc.gov/mmwr/volumes/73/wr/mm7308a1.htm#T1_down

© 2024 The Pew Charitable Trusts

Nationwide, nearly 30 million people are estimated to have alcohol use disorder (AUD); it is the most common substance use disorder. AUD is a treatable, chronic health condition characterized by a person’s inability to reduce or quit drinking despite negative social, professional, or health effects.5 While no single cause is responsible for developing AUD, a mix of biological, psychological, and environmental factors can increase an individual’s risk, including a family history of the disorder.6

There are well-established guidelines for AUD screening and treatment, including questions that can be asked by a person’s health care team, medications approved by the U.S. Food and Drug Administration (FDA), behavioral therapies, and recovery supports, but these approaches often are not put into practice.7 When policies encourage the adoption of screening and evidence-based medicines for AUD, particularly in primary care, the burden of alcohol-related health problems can be reduced across the country.8

The Spectrum of Unhealthy Alcohol Use

For adults of legal drinking age, U.S. dietary guidelines recommend that they choose not to drink or drink in moderation, defined as two drinks or fewer in a day for men, and one drink or fewer in a day for women.9 One drink is defined as 0.6 ounces of pure alcohol—the amount in a 12-ounce beer containing 5% alcohol, a 5-ounce glass of wine containing 12% alcohol, or 1.5 ounces of 80-proof liquor.10

Consumption patterns exceeding these recommended levels are considered:

  • Heavy drinking, defined by the number of drinks consumed per week: 15 or more for men, and eight or more for women.11
  • Binge drinking, defined by the number of drinks consumed in a single sitting: five or more for men, and four or more for women.12

Alcohol use disorder is defined by The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as having symptoms of two or more diagnostic criteria within a 12-month period.13 The diagnostic criteria assess behaviors such as trying to stop drinking but being unable to, alcohol cravings, and the extent to which drinking interferes with an individual’s life.14 AUD can be mild (meeting two or three criteria), moderate (meeting four or five criteria), or severe (six or more criteria).15

Identifying and preventing AUD

Primary care providers are well positioned to recognize the signs of unsafe drinking in their patients. The U.S. Preventive Services Task Force recommends that these providers screen adults 18 years and older for alcohol misuse.16 One commonly used evidence-based approach, SBIRT—or screening, brief intervention, and referral to treatment—is a series of steps that help providers identify and address a patient’s problematic substance use.17

Using a screening questionnaire, a provider can determine whether a patient is at risk and, if so, can deliver periodic brief behavioral interventions in an office setting. Such interventions have been shown to reduce heavy alcohol use among adolescents, adults, and older adults.18 When a patient meets the criteria for AUD, providers can offer medication, connect them to specialty treatment, refer them to recovery supports such as Alcoholics Anonymous or other mutual-help groups, or all of the above, depending on a patient’s needs and preferences.19 When these interventions are used in primary care settings, they can reduce heavy alcohol use.20

While screening for AUD is common, few providers follow up when a patient reports problematic alcohol use. From 2015 to 2019, 70% of people with AUD were asked about their alcohol use in health care settings, but just 12% of them received information or advice about reducing their alcohol use.21 Only 5% were referred to treatment.22

Emergency departments (EDs) are another important setting for identifying AUD, and to maintain accreditation they are required to screen at least 80% of all patients for alcohol use.23 Alcohol is the most common cause of substance-related ED visits, meaning many people in these settings are engaged in excessive or risky alcohol consumption and could be linked to care.24

The use of SBIRT in the ED can also reduce alcohol use, especially for people without severe alcohol problems.25 Providers who use SBIRT can help patients reduce future ED visits and also some negative consequences associated with alcohol use, such as injuries.26

Commonly cited barriers to using SBIRT in these health care settings include competing priorities and insufficient treatment capacity in the community when patients need referrals. Conversely, SBIRT use increases with strong leadership and provider buy-in, collaboration across departments and treatment settings, and sufficient privacy to discuss substance use with patients.27

Jails and prisons should also screen for AUD, as well as other SUDs, to assess clinical needs and connect individuals with care. However, screening practices may not be evidence based. A review of the intake forms used to screen individuals in a sample of jails in 2018-19 found that some did not ask about SUD at all, and of those that did, they did not use validated tools accepted for use in health care and SUD treatment settings.28

Withdrawal management

Up to half of all people with AUD experience some withdrawal symptoms when attempting to stop drinking.29 For many, common symptoms such as anxiety, sweating, and insomnia are mild.30 For a small percentage, however, withdrawal can be fatal if not managed appropriately.31 These individuals can experience seizures or a condition called alcohol withdrawal delirium (also referred to as delirium tremens), which causes patients to be confused and experience heart problems and other symptoms; if untreated, it can be fatal.32 People with moderate withdrawal symptoms can also require medical management to address symptoms such as tremors in addition to anxiety, sweating, and insomnia.33

To determine whether a patient with AUD is at risk of severe withdrawal or would benefit from help managing symptoms, the American Society of Addiction Medicine recommends that providers evaluate patients with positive AUD screens for their level of withdrawal risk.34 Based on this evaluation, providers can offer or connect patients to the appropriate level of withdrawal management.35

At a minimum, high-quality withdrawal management includes clinical monitoring and medications to address symptoms.36 Providers may also offer behavioral therapies.37 Depending on the severity of a patient’s symptoms and the presence of co-occurring conditions such as severe cardiovascular or liver disease that require a higher level of care, withdrawal management can be provided on either an inpatient or an outpatient basis.38

According to the U.S. Department of Justice’s Bureau of Justice Assistance and the National Institute of Corrections, jails should also use evidence-based standards of care to address alcohol withdrawal. These standards include screening and assessing individuals who are at risk for withdrawal and, if the jail cannot provide appropriate care, transferring them to an ED or hospital.39

Withdrawal management on its own is not effective in treating AUD, and without additional services after discharge, most people will return to alcohol use.40 Because of this, providers should also connect people with follow-up care, such as residential or outpatient treatment, after withdrawal management to improve outcomes. Continued care helps patients sustain abstinence, reduces their risk of arrests and homelessness, and improves employment outcomes.41

Patients face multiple barriers to this follow-up care, however. For example, withdrawal management providers from the Veterans Health Administration cited long wait times for follow-up care, inadequate housing, and lack of integration between withdrawal management and outpatient services as reasons patients couldn’t access services.42 Patients have also cited barriers such as failure of the withdrawal management provider to arrange continued care, lengths of stay that were too short to allow for recovery to begin, insufficient residential treatment capacity for continued care, and inadequate housing.43

Promising practices for improving care continuity include: providing peer recovery coaches—people with lived expertise of substance use disorder who can help patients navigate treatment and recovery; psychosocial services that increase the motivation to continue treatment; initiating medication treatment before discharge; reminder phone calls; and “warm handoffs,” in which patients are physically accompanied from withdrawal management to the next level of care.44

Treating AUD

In 2023, 29 million people in the U.S. met the criteria for AUD, but less than 1 in 10 received any form of treatment.45 Formal treatment may not be necessary for people with milder AUD and strong support systems.46 But people who do seek out care can face a range of barriers, including stigma, lack of knowledge about what treatment looks like and where to get it, cost, lack of access, long wait times, and care that doesn’t meet their cultural needs.47

For those who need it, AUD treatment can include a combination of behavioral, pharmacological, and social supports designed to help patients reach their recovery goals, which can range from abstaining from alcohol to reducing consumption.48

While for many the goal of treatment is to stop using alcohol entirely, supporting non-abstinence treatment goals is also important, because reduced alcohol consumption is associated with important health benefits such as lower blood pressure, improved liver functioning, and better mental health.49

Services for treating AUD—including medication and behavioral therapy—can be offered across the continuum of care, from primary care to intensive inpatient treatment, depending on a patient’s individual needs.50

Medications

Medications for AUD help patients reduce or cease alcohol consumption based on their individual treatment goals and can help improve health outcomes.51 Medications can be particularly helpful for people experiencing cravings or a return to drinking, or people for whom behavioral therapy alone has not been successful.52 But medications are not often used: Of the 30 million people with AUD in 2022, approximately 2% (or 634,000 people) were treated with medication.53

The FDA has approved three medications to treat AUD:

  • Naltrexone reduces cravings in people with AUD.54 This medication is also approved to treat opioid use disorder, and because it blocks the effects of opioids and can cause opioid withdrawal, patients who use these substances must be abstinent from opioids for one to two weeks prior to starting this treatment for AUD.55 It can be taken daily or as needed in a pill or as a monthly injection.56 Oral naltrexone is effective at reducing the percentage of days spent drinking, the percentage of days spent drinking heavily, and a return to any drinking.57 Injectable naltrexone can reduce the number of days spent drinking and the number of heavy drinking days.58 Additionally, naltrexone can reduce the incidence of alcohol-associated liver disease—an often-fatal complication of heavy alcohol use—and slow the disease’s progression in people who already have it.59
  • Acamprosate is taken as a pill.60 It reduces alcohol craving and helps people with AUD abstain from drinking.61 It reduces the likelihood of a return to any drinking and number of drinking days.62
  • Disulfiram deters alcohol use by inducing nausea and vomiting and other negative symptoms if a person drinks while using it.63 It is also taken as a pill.64 There is insufficient data to determine whether a treatment is more effective than a placebo at preventing relapses in alcohol consumption or other related issues.65 However, for some individuals, knowing they will get sick from consuming alcohol while taking disulfiram can increase motivation to abstain.66 As medication adherence is a challenge for patients, supervised administration of disulfiram by another person—for example, a spouse—can improve outcomes in patients who are compliant.67

Additionally, some medications used “off-label” (meaning they were approved for treating other conditions) have also effectively addressed AUD. A systematic review found that topiramate, a medication approved for treating epilepsy and migraines, had the strongest evidence among off-label drugs for reducing both any drinking and heavy drinking days.68 Like naltrexone, it can reduce the incidence of alcohol-related liver disease.69

Despite the benefits that medications provide, they remain an underutilized tool for a variety of reasons—such as lack of knowledge among patients and providers, stigma against the use of medication, and failure of pharmacies to stock the drugs.70

Behavioral therapies

Behavioral therapies can also help individuals manage AUD, and they support medication adherence:

  • Motivational enhancement therapy focuses on steering people through the stages of change71 by reinforcing their motivation to modify personal drinking behaviors.72
  • Cognitive behavioral therapy addresses people’s feelings about themselves and their relationships with others and helps to identify and change negative thought patterns and behaviors related to drinking, including recognizing internal and external triggers. It focuses on developing and practicing coping strategies to manage these triggers and prevent continued alcohol use.73
  • Contingency management uses positive reinforcement to motivate abstinence or other healthy behavioral changes.74 It can help people who drink heavily to reduce their alcohol use.75

All of these approaches can help address AUD, and no one treatment has proved more effective than another in treating this complicated condition.76 Combining behavioral therapies with other approaches such as medication and recovery supports, as described below, can improve their efficacy.77

Recovery supports

Peer support specialists and mutual-help groups can also help people achieve their personal recovery goals:

  • Peer support specialists are individuals with lived expertise in recovery from a substance use disorder who provide a variety of nonclinical services, including emotional support and referrals to community resources.78 The inclusion of peer support specialists in AUD treatment programs has been found to significantly reduce alcohol use and increase attendance in outpatient care.79
  • Mutual-help groups, such as Alcoholics Anonymous (AA) and Self-Management and Recovery Training (SMART), support individuals dealing with a shared problem. People may seek out these groups more than behavioral or medication treatment for AUD because they can join on their own time and at no cost, and they may better cater to people’s needs related to varying gender identities, ages, or races.80 Observational research shows that voluntary attendance at peer-led AA groups can be as effective as behavioral treatments in reducing drinking.81

People with AUD can use recovery supports on their own, in combination with behavioral treatment or medication, or as a method to maintain recovery when leaving residential treatment or withdrawal management.82

While the U.S. records more than 178,000 alcohol-related deaths each year, some populations have a higher risk of alcohol-related deaths, and others face greater barriers to treatment.83

American Indian and Alaska Native communities

Despite seeking treatment at higher rates than other racial/ethnic groups, American Indian and Alaska Native people have the highest rate of alcohol-related deaths.84

Figure 2

American Indian and Alaska Native Individuals Have Persistently Higher Alcohol‑Related Death Rates Compared With Other Racial and Ethnic Groups

Alcohol‑related deaths per 100,000 people

© 2024 The Pew Charitable Trusts View image

Risk factors that impact these communities and can contribute to these deaths include historical and ongoing trauma from colonization, the challenges of navigating both native and mainstream American cultural contexts, poverty resulting from forced relocation, and higher rates of mental health conditions than in the general population.85 Substances, including alcohol, are sometimes used to cope with these challenges.86

However, American Indian/Alaska Native communities also have rich protective factors such as their cultures, languages, traditions, and connections to elders, which can help reduce negative outcomes associated with alcohol use, especially when treatment services incorporate and build on these strengths.87

For example, interviews with American Indian/Alaska Native patients with AUD in the Pacific Northwest revealed that many participants preferred Native-led treatment environments that incorporated traditional healing practices and recommended the expansion of such services.88

To improve alcohol-related outcomes for American Indians and Alaska Natives, policymakers and health care providers must develop a greater understanding of the barriers and strengths of these diverse communities and support the development of culturally and linguistically appropriate services. The federal Department of Health and Human Services Office of Minority Health defines such an approach as “services that are respectful of and responsive to the health beliefs, practices, and needs of diverse patients.”89

People living in rural areas

Rural communities are another group disproportionately affected by AUD. People living in rural areas have higher alcohol-related mortality rates than urban residents but are often less likely to receive care.90 They face treatment challenges including limited options for care; concerns about privacy while navigating treatment in small, close knit communities; and transportation barriers.91

Figure 3

Alcohol‑Related Deaths Have Increased Faster in Rural Areas

2012‑22 change in alcohol‑induced death rate per 100,000 by urban and rural areas

Telemedicine can help mitigate these barriers to care.92 Cognitive behavioral therapy and medications for AUD can be delivered effectively in virtual settings.93 People with AUD can also benefit from virtual mutual-help meetings, though some find greater value in face-to-face gatherings.94

Despite the value of virtual care delivery, people living in rural areas also often have limited access to broadband internet, which can make these interventions challenging to use.95 Because of this, better access to in-person care is also needed.

Next steps

To improve screening and treatment for patients with AUD, policymakers, payers, and providers should consider strategies to:

  • Conduct universal screenings for unhealthy alcohol use and appropriately follow up when those screenings indicate a problem. Less than 20% of people with AUD proactively seek care, so health care providers shouldn’t wait for patients to ask them for help.96
  • Connect people with continued care after withdrawal management so that they can begin their recovery. People leaving withdrawal management settings should have a treatment plan that meets their needs—whether that’s behavioral treatment, recovery supports, medication, or a combination of these approaches.
  • Further the use of medications for AUD. With just 2% of people with AUD receiving medication, significant opportunities exist to increase utilization and improve outcomes.97
  • Address disparities through culturally competent treatment and increased access in rural areas. The populations most impacted by AUD should have access to care that meets their needs and preferences.

AUD is a common and treatable health condition that often goes unrecognized or unaddressed. Policymakers can improve the health of their communities by supporting providers in increasing the use of evidence-based treatment approaches.98

If you are concerned about your alcohol consumption, you can use the Check Your Drinking tool created by the Centers for Disease Control and Prevention to assess your drinking levels and make a plan to reduce your use.

Source: https://www.pewtrusts.org/en/research-and-analysis/fact-sheets/2024/12/americas-most-common-drug-problem-unhealthy-alcohol-use

Filed under: Addiction,Alcohol,Drug use-various effects,Drugs and Accidents,Latest News,Prevention and Intervention,Treatment and Addiction,USA :

Sima Patra • Sayantan Patra • Reetoja Das • Soumya Suvra Patra

Published: December 31, 2024

DOI: 10.7759/cureus.76659

Cite this article as: Patra S, Patra S, Das R, et al. (December 31, 2024) Rising Trend of Substance Abuse Among Older Adults: A Review Focusing on Screening and Management. Cureus 16(12): e76659. doi:10.7759/cureus.76659

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Abstract

There is undoubtedly an alarmingly rising trend of substance use among older adults. This has necessitated a paradigm shift in healthcare and propelled strategies aimed at effective prevention and screening. Age-related physiological changes, such as diminished metabolism and increased substance sensitivity, make older adults particularly vulnerable to adverse effects of substances. This not only has adverse psychological consequences but also physical consequences like complicating chronic illnesses and harmful interactions with medications, which lead to increased hospitalization.

Standard screening tools can identify substance use disorders (SUDs) in older adults. Tools like the Cut-down, Annoyed, Guilty, and Eye-opener (CAGE) questionnaire and Michigan Alcohol Screening Test-Geriatric (MAST-G) are tailored to detect alcoholism, while the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) and Alcohol Use Disorders Identification Test (AUDIT) assess abuse of illicit and prescription drugs. Since older adults are more socially integrated, screening should be done using non-stigmatizing and non-judgmental language.

Prevention strategies include educational programs, safe prescribing practices, and prescription drug monitoring. Detection of substance abuse should be followed by brief interventions and specialized referrals. In conclusion, heightened awareness, improved screening, and preventive measures can mitigate substance abuse risks in this demographic. Prioritizing future research on non-addictive pain medications and the long-term effects of substances like marijuana seems justified.

 

Source: https://www.cureus.com/articles/322781-rising-trend-of-substance-abuse-among-older-adults-a-review-focusing-on-screening-and-management?score_article=true#!/

Filed under: Addiction,Drug use-various effects,Education,Effects of Drugs,Latest News,Mental Health,Prevention and Intervention,Social Affairs,Treatment and Addiction,USA :
By Sherry Larson, People’s Defender –

“An ounce of prevention is worth a pound of cure.” Cliché – sure – truthful – absolutely! And when it comes to youth and alcohol, vaping and drug use, it is crucial to begin prevention efforts from an early age.

The Adams County Medical Foundation, under the direction of Sherry Stout, recognized a gap in youth prevention services and applied for a grant that focused on prevention. In 2015, a collective of professionals and retired professionals established a Data Prevention Committee to obtain information regarding youth drug, alcohol, vaping and tobacco usage. The Committee partnered with local schools and the Adams County Health Department to obtain data through surveys, resulting in a detailed database of information, including information on vaping, tobacco, and underage drinking.

The Committee recognized a need for more comprehensive funding to develop prevention strategies. Beginning in 2015, the Committee worked towards growing and qualifying for The Drug-Free Communities (DFC) grant, which supported their plans for future endeavors. “The Drug-Free Communities Support Program was created in 1997 by the Drug-Free Communities Act. Administered by the White House Office of National Drug Control Policy (ONDCP) and managed through a partnership between ONDCP and CDC, the DFC program provides grants to community coalitions to reduce local youth substance use.” (cdc.gov)

In October 2023, the Committee voted to form the Adams County Youth Prevention Coalition to meet the requirements to apply for DFC funds. The Coalition needed to be active for six months before applying for funding. The Coalition was mandated to have representatives from 12 community sectors who were not a part of the Medical Foundation. Those sectors are: Youth, Parents, Businesses Media, School, Youth-serving organizations, Law enforcement, Religious/fraternal organizations, Civic and volunteer organizations, Healthcare professionals, State, local, and Tribal governments and other organizations involved in reducing illicit substance use.

Three individuals will partner with the sectors to facilitate the grant: Tami Graham, Program Director; Billy Joe McCann, leader of the Youth Coalition; and Danielle Poe, the community’s only credentialed prevention professional, to represent education and school data collection through OHYES surveys.

In January 2024, The Adams County Youth Prevention Coalition hired Thrive Consulting to assist with the grant process. The grant application took extensive time and data to complete, resulting in an over 100-page document due and submitted in April 2024. Among demonstrating membership from the twelve sectors, the application required proof of consistent meetings and minutes showing that these representatives were actively working on strategizing prevention. Poe said, “A level of community readiness is expected.” Stout clarified that the funding is a community grant and should be led by the community and not isolated by a committee. Stout explained, “This is the first time Adams County qualified to receive the grant. It is a once-in-a-lifetime opportunity where significant funds are available to address prevention issues.”

The Coalition was notified in September 2024 that Adams County would receive the Drug-Free Communities Grant. Graham explained that the grant, which went into effect in October 2024, would reimburse $125,000 a year for 5 years of prevention work. Expecting a successful five years of prevention efforts, the Coalition would be eligible to reapply for a second term.

Poe and Graham discussed plans for the first year of executing the grant. Poe stated that the primary focus will be education, the Coalition’s learning responsibilities, and strategic planning for years two through five.

Carrying on with the Prevention Committee’s concentrations, the Coalition will examine data-proven prevention strategies, media campaigns, and differences between good and bad prevention techniques. In August 2025, the Coalition will submit a yearly progress report to the Drug-Free Communities Grant.

Stout said, “I would encourage widespread involvement of anyone who cares about our youth and their future.” The public is welcome to attend and share comments or concerns at Coalition meetings on the first Monday of every month. The sessions take place at noon in the FRS community room.

Source: https://www.peoplesdefender.com/2024/12/12/drug-free-communities-start-with-youth/

Filed under: Addiction,Drug use-various effects,Latest News,Prevention and Intervention,USA,Youth :

y Dr. Nora Volkow

Such experiences contribute to a feeling that research is a one-way transaction benefiting scientists but giving little back to the community. Lack of meaningful community engagement also compromises the quality of the science by not incorporating the valuable ideas and insights of people who use drugs.

NIDA is committed to improving community engagement in all parts of the research process. For that reason, we have asked the National Advisory Council on Drug Abuse (NACDA)—the body of experts that advises on NIDA’s scientific research priorities—to convene a working group to recommend ways to enhance the meaningful engagement of people who have experience with drug use in the research our Institute funds. The workgroup will inform the creation of resources that outline NIDA’s expectations regarding community engagement and help both applicants and community partners navigate this critical work.

NIDA has long encouraged community-engaged research, and it is required element in various NIDA research funding opportunities, including those supported through our Racial Equity Initiative. The evolving opioid overdose crisis has underscored the importance of ensuring that people’s lived experience of substance use is centered in the science we support. For example, one of the pillars of the NIH Helping to End Addiction Long-term (HEAL) Initiative is that research must be relevant and responsive to the individuals, families, and communities it aims to help. One way HEAL studies are doing this is by drawing on the input of community advisory boards to ensure that the research is best tailored to the needs of the people most impacted by it.

The NIDA-funded Harm Reduction Research Network is a nationwide set of projects to enhance the impact of harm-reduction efforts, and its community advisory boards have already helped shape some of the studies. One project involves the development of a survey instrument to capture experiences of people who use drugs, and advisory board members helped tailor the wording of the instrument so that it reflected language more likely to be used by people who use drugs. Another study aimed at reducing overdose and increasing engagement in harm reduction and treatment services had originally been limited to people who use methamphetamine. Based on the input of advisors with more up-to-date knowledge of drug-use in their community, the study was broadened to include people who use cocaine, as that was identified as an emerging stimulant in their area.

The Integrative Management of Chronic Pain and OUD for Whole Recovery (IMPOWR) project is addressing the needs of people with substance use disorders and pain via a network of multidisciplinary team science collaborations. Its community advisory boards weigh in on funding decisions for pilot studies, and some of these studies have included a community partner as a co-investigator. Based on community input about the important role of PTSD and discrimination in healthcare settings in pain and opioid misuse and addiction, IMPOWR researchers added PTSD and stigma/discrimination items to their common data elements (the standardized questions that facilitate data-sharing across studies).

The Native Collective Research Effort to Enhance Wellness (NCREW) Initiative is partnering with Tribal organizations to support community-driven research projects that address opioid misuse and pain in Native communities. By providing needed training, technical assistance, and tools, the NCREW project is building capacity within Native communities to conduct locally prioritized research that incorporates indigenous knowledge and lived experience, with the aim of building effective, sustainable, and strengths-based interventions.

As outlined in NIDA’s Strategic Plan, NIDA is committed to partnering with people with lived and living experience in the development of new treatments for substance use disorder. Consistent with that goal, NIDA is funding four Patient Engagement Resource Centers (PERCs) to test various models of patient engagement that can inform research on SUD treatment services. Each PERC will recruit members of a particular patient population to understand what prevents them from finding or receiving evidence-based treatment services. This information will be used to pilot test patient-informed solutions to these challenges that can ultimately serve as models for the development of interventions in other settings.

There are many other ways that partnering with people with living experience of substance use could benefit both science and the community. Surveillance is one example. The drug market is rapidly changing, and people who actively use drugs and live this reality are best poised to provide information on the drug supply and its effects. And through their engagement in surveillance efforts, participants could gain information on new adulterants and contaminants that could help inform their own decisions.

In these, as with other research efforts, people who use drugs need to be treated with respect, and their confidentiality must be protected. They must also be compensated fairly for their time, their input, and their commuting and childcare costs.

Including people with experience of substance use and addiction in the scientific workforce—and making sure they feel safe and recognized as valuable members of the research team—must also become a priority for our science. As some of my colleagues at NIDA’s Intramural Research Program argued two years ago in the Journal of Addiction Medicine, people with lived and living experience of substance use disorders have unique perspectives that are invaluable in making sure that the right research questions are asked.

These are just some of the possible topics that may be discussed in the new NACDA workgroup. For that group, we are seeking individuals who identify as having experience with substance use or a substance use disorder or as a family or caregiver of someone who does. Participants will meet virtually three or four times during 2025 and potentially early 2026 and will be compensated for their time during the meetings. If you are interested in participating, further information is available on the Council Workgroups page. We are accepting application statements through January 10, 2025.

Associated links:

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Source: Forwarding Agency:

Herschel Baker, International Liaison Director & Queensland Director

Drug Free Australia

Web: https://drugfree.org.au/

mailto:drugfreeaust@drugfree.org.au

mailto:drugfree@org.au

Filed under: Addiction,Drug use-various effects,Education,Prevention and Intervention,Treatment and Addiction,USA :

Workplaces have a unique opportunity to make subtle yet meaningful adjustments to better support employees who may be in recovery or experiencing challenges. When businesses make small changes in their events, management style, and overall culture, they create an environment that respects and uplifts employees facing SUDs. Here are three impactful ways to make the workplace more welcoming:

# 1: Host Inclusive Gatherings with Non-Alcoholic Options

Work events can inadvertently center around alcohol, creating uncomfortable situations for employees who don’t drink and/or are in recovery. Making a few simple shifts can help ensure everyone feels included:
• Avoid holding meetings in bars or pubs. Instead, choose locations that aren’t centered on alcohol, such as coffee shops, casual restaurants, or outdoor spaces.
• Offer a variety of non-alcoholic drinks that are as enjoyable as alcoholic options. These could include mocktails, sparkling water with unique flavors, or other festive drinks. This small touch shows thoughtful consideration and signals that the event is meant for everyone.
• Consider alcohol-free events. Not every event needs to feature alcohol to be fun. Think of team-building activities like escape rooms, game nights, or cooking classes, which naturally focus on engagement without the need for alcohol.

#2: Encourage Supervisors to be Allies

Supervisors play a critical role in creating a compassionate, supportive workplace. By actively supporting employees rather than judging them, supervisors can contribute significantly to a culture of empathy and openness. Here’s how they can help:
• Listen without judgment. If an employee opens up about their challenges, supervisors should approach the conversation with empathy, focusing on support rather than consequences, while of course maintaining safety.
• Respect privacy and confidentiality. Supervisors should reassure employees that their personal issues will remain private and will only be discussed on a need-to-know basis, which helps foster trust.
• Share personal experiences if appropriate. For supervisors in recovery, sharing their stories can inspire others, showing that it’s possible to face challenges and succeed. Authentic, relatable leadership can be incredibly powerful for employees who may feel isolated.

#3: Encourage Coworkers to Support Each Other

Sometimes, coworkers are the first to notice changes in behavior or attendance. They can be crucial sources of support, helping to create a culture that’s proactive and understanding:
• Encourage open, honest communication. Rather than approaching a struggling coworker with judgment, a simple “I’m here if you need anything” can make a huge difference.
• Assist with resources. Coworkers can help each other navigate employment policies, find helpful information, or locate support groups if needed. Being informed and sharing resources can be invaluable.
• Respect boundaries and avoid gossip. Gossip or speculation only adds stigma to those facing SUDs. A culture of respect encourages coworkers to redirect conversations if someone starts gossiping or making assumptions about another’s struggles. For more on the importance of language on stigma, check out the National Institute of Drug Abuse’s resource, Words Matter as well as Drug Free America Foundation’s resource on Stigma here.

These small adjustments—hosting inclusive events, training supervisors as allies, and encouraging a supportive culture among coworkers—can help a business become a welcoming, stigma-free environment for employees with SUDs working towards recovery. By focusing on inclusivity, empathy, and respect, workplaces can create meaningful, positive changes that support both individual well-being and the company’s overall success.

Sources:

Drug Free America Foundation, Inc. “Stigma.” https://www.dfaf.org/wp-content/uploads/2024/09/Stigma-2024.pdf

O’Connor, P., PhD. (2023, November 23). Human resource departments can help or hinder employees with SUDs. Psychology Today. https://www.psychologytoday.com/us/blog/philosophy-stirred-not-shaken/202311/substance-use-disorders-and-the-work-place

Words matter: preferred language for talking about addiction | National Institute on Drug Abuse. (2023, November 15). National Institute on Drug Abuse. https://nida.nih.gov/research-topics/addiction-science/words-matter-preferred-language-talking-about-addiction

 

Filed under: Addiction,Alcohol,Prevention and Intervention,USA,Workplace :
One in 3 adults who responded to a new nationwide survey said they had suffered “secondhand harm” from another person’s drinking, and more than 1 in 10 said a loved one’s drug use had harmed them. PHI’s William Kerr shares insights on how secondhand harms from alcohol and drug use can affect families, relationships and communities.

“Think of it as collateral damage: Millions of Americans say they have been harmed by a loved one’s drug or alcohol use.

One in 3 adults who responded to a new nationwide survey said they had suffered “secondhand harm” from another person’s drinking. And more than 1 in 10 said they had been harmed by a loved one’s drug use.

That’s close to 160 million victims — 113 million hurt by loved one’s drinking and 46 million by their drug use, according to the survey published recently in the Journal of Studies on Alcohol and Drugs.

There are more harms than people think… They affect families, relationships and communities.William Kerr
Scientific Director, Center Director & Study Co-Author, Alcohol Research Group’s National Alcohol Research Center, Public Health Institute

He said it makes sense that risky drinking and drug use have far-reaching consequences, but researchers only began looking at the secondhand harms of alcohol in recent years. Less has been known about the damage done by a loved one’s drug use.

The new study is based on a survey of 7,800 U.S. adults. They were questioned between September 2019 and April 2020, before the pandemic became a factor in Americans’ substance use.

People were asked if they had been harmed in any of several ways due to someone else’s substance use.

In all, 34% of respondents said they had suffered secondhand harm from someone else’s alcohol use. The harms ranged from marriage and family problems to financial fallout, assault and injury in a drunken-driving accident.

Meanwhile, 14% of respondents said they’d suffered similar consequences from a loved one’s drug abuse.

The two groups overlapped, too — 30% of respondents reporting secondhand harm from alcohol also said they were affected by someone’s drug use.

Kerr said in a journal news release that the differences probably owe to the fact that drinking and alcohol use disorders are more common than drug use and disorders. But, he added, researchers want to learn more and are launching a new survey with more questions about the harms related to individual drugs.”

Source: https://www.phi.org/press/us-news-phi-study-shows-nearly-160-million-americans-harmed-by-anothers-drinking-drug-use/

Filed under: Addiction,Alcohol,Drug use-various effects,USA :

     Too many families know the pain of losing a loved one to a drunk or drug-impaired driving accident.  Each year, more than 10,000 Americans lose their lives in these preventable tragedies.  During National Impaired Driving Prevention Month, we remind everyone that they can save lives by driving only when sober, calling for a ride, planning ahead, and making sure friends and loved ones do the same.

In 2022, over 13,000 people were killed in drunk-driving accidents.  Still, millions of people drive under the influence each year, not only putting themselves in harm’s way but also endangering passengers, pedestrians, and first responders. Even just one drink or one pill can ruin lives.

My Administration is committed to preventing accidents and impaired driving.  The National Highway Traffic Safety Administration has raised awareness about its risks and consequences through media campaigns, including “If You Feel Different, You Drive Different”; “Drive Sober or Get Pulled Over”; and “Buzzed Driving is Drunk Driving.”  Furthermore, since the beginning of my Administration, we have dedicated over $100 billion to disrupt the flow of illicit drugs and expand access to the prevention and treatment of substance use disorder.

Reducing fatalities and injuries in impaired driving accidents also means improving the safety of our Nation’s vehicles.  That is why my Bipartisan Infrastructure Law invests in technologies that can detect and prevent impaired driving and requiring new passenger cars to include collision warnings and automatic braking to prevent accidents.  The Department of Transportation also released a National Roadway Safety Strategy to eliminate traffic deaths and make crashes less destructive.

This holiday season, let us recommit to doing right by our neighbors, friends, and families by driving sober.  For those planning on drinking, arrange a sober ride home beforehand — ride-sharing apps are a convenient way to get home safely.  If you have had alcohol or used substances, do not get behind the wheel — one accident can cost someone their life.  If you are responsible for driving yourself or others, stay sober, buckle up, put the phone away, and drive the speed limit.  And if you witness a friend, loved one, colleague, or anyone putting themselves or others in danger, lend a hand to keep them safe. You could save a life.

NOW, THEREFORE, I, JOSEPH R. BIDEN JR., President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States, do hereby proclaim December 2024 as National Impaired Driving Prevention Month.  I urge all Americans to make responsible decisions and take appropriate measures to prevent impaired driving.

IN WITNESS WHEREOF, I have hereunto set my hand this twenty-ninth day of November, in the year of our Lord two thousand twenty-four, and of the Independence of the United States of America the two hundred and forty-ninth.

JOSEPH R. BIDEN JR.

 

Source: https://www.whitehouse.gov/briefing-room/presidential-actions/2024/11/29/a-proclamation-on-national-impaired-driving-prevention-month-2024/

 

Filed under: Addiction,Alcohol,Drug use-various effects,Drugs and Accidents,Prevention and Intervention,USA :

These TC experts emphasize the critical need for a more proactive approach to substance use education

More than 40,000 youth used nicotine pouches last year alone, a staggering increase from 2021. The relatively new and less detectable product’s increasing prevalence among youth underscores an urgent need for informed discussion and intervention regarding adolescent substance use more broadly. Data shows that 59 percent of people 12 or older used tobacco, vaped nicotine, alcohol or illicit drugs in 2023, despite proof that substance use during these formative years poses a severe threat to cognitive function. “Early drug use can impair neurocognitive development and increase youth vulnerability to later use of illicit substances, and even academic failure,” shares John Allegrante, the Charles Irwin Lambert Professor of Health Behavior and Education at Teachers College, who examines the topic in his latest research with an international group of Nordic investigators.“With each generation, the messaging and campaigns around these dangerous products change to target those most vulnerable: our youth. We [educators] need to work with parents to provide more support resources and surveillance during such critical years.”We spoke with Allegrante and other TC experts about the risks and ways educators, parents and communities can address these challenges together.

 

A Call to Action: Reimagining Awareness, Prevention, and Intervention 

While interventions like the “Just Say No” campaign and the D.A.R.E. programs of the ’80s and ’90s have proven to be unsuccessful, the desire for more effective and youth-informed approaches to preventing  substance use among youth in the U.S. continues to grow.

Influencer marketing and social media promotions for e-cigarettes have increased the risk of youth vaping. Studies show that social media platforms often glamorize e-cigarettes with trendy flavors like cotton candy, attracting young users. TC’s Ayorkor Gaba, Assistant Professor of Counseling & Clinical Psychology, notes that there is a rise in innovative approaches, like media literacy education, to help youth critically analyze media and reject harmful messages.

She explains that social media can also share science-based health messages, enhancing prevention and treatment of substance use.  For example, influencers frequently share their lived experience with overdose,  the harmful effects of vaping, and recovery. Though “impactful,” the overall quality, accuracy and reliability of this content posted can be poor. “The lack of evidence-based content on social media reinforces the need for expert involvement (e.g., public health, psychology, etc.) in disseminating evidence-based content on social media,” notes Gaba. “Due to the significant influence of social media on youth, experts and researchers should integrate youth perspectives in developing social media-based intervention and prevention that can reach millions of youth. “

The CDC notes that a high majority of adolescent substance use (81 percent) occurs during socialization with friends. “As teens, we’re all looking to fit in,” adds TC doctoral student Treasure Tannock. “Between ages 15-25, we seek to cling to anything that gives us a better understanding of self-identity. If we can use that same mindset better to reach young people about the dangers of use through a more holistic, relatable lens, we might be able to make progress.”

To start, Tannock recommends getting youth involved in creative outlets that pique their interest, a concept she implemented during her clinical work at Rikers Island. “We asked individuals: Who are you now? Who do you want to be? What obstacles do you face with substance use? And how can you receive support?” explained Tannock, a Clinical Psychology student. “We then collaborated with music and art therapists to help express their stories. Over time, many became open to support and envisioned a new path forward.”

 

How Parents, Schools and Communities Can Help

Although there is much work to be done, parents, communities and educators can start by laying the groundwork for more proactive dialogue and means of support. 

Allegrante explains that during the pandemic, increased supervision at home led to a decrease in adolescent substance use, an observation from his post-pandemic research. “As young people return to school and socialize more, we’re seeing a resurgence in use,” he explains. “Many prevention efforts start too late; by the time we address it, habits are ingrained. We must start these conversations in middle or even elementary school.”

With so much at stake, schools are tasked with a greater responsibility to address the crisis. A recent survey by the American Addiction Centers revealed that schools are the primary setting where youth receive informative substance use education. However, out of the 500 students surveyed, only 75 percent had a substance-use-focused curriculum in their health class. 

“School is still a prime captive audience location for prevention, but it requires an interdisciplinary approach, resources and a theory-driven, evidence-based curriculum across the board,” Allegrante adds. “We need to work with communities, public health agencies and even local government officials to bridge the gap.”

Yet, prevention must extend beyond the classroom. It’s imperative for parents to stay informed about their children’s habits, as research shows that parental involvement is key to mitigating peer pressure and promoting informed decision-making. “Parenting practices (e.g., monitoring, communication) have been linked to youth substance use, yet there are few accessible supports to help the busy parent develop skills in this area. Gaba recommends an app by the Substance Abuse Mental Health Services Administration called “Talk. They Hear You.,” specifically designed to help parents and caregivers turn everyday situations into opportunities to discuss alcohol and drugs with their children. “It gives them the skills, confidence, and knowledge to start and maintain these conversations as their kids grow.”

Gaba also highlights the need to address disparities,  urging, “It’s a matter of life and death.” Between 2018 and 2022, drug overdose deaths among youth more than doubled, particularly impacting Latinx and Black communities. “Many still mistakenly believe opioids do not affect these groups, leading to decreased awareness and access to vital resources like Naloxone (Narcan), which can reverse overdoses,” she notes. “Additionally, substance use is notably higher among lesbian, gay, and bisexual (LGB) youth compared to their non-LGB peers.” To address these challenges, Gaba advocates for culturally tailored interventions that actively involve marginalized youth in the design process and target the social determinants of health that contribute to their elevated risks.

“Community support is also vital,” notes Tannock. “Having safe, accessible community spaces like libraries or after-school programs can make a significant difference. It’s a team effort.” She urges parents to inquire about local prevention resources. 

Although substance use among youth is an ongoing challenge, the National Institute on Drug Abuse (NIH) reports that adolescent substance use continues to fall below pre-pandemic levels, an encouraging statistic.

“If we look at how drastically cigarette smoking has declined as a consequence of culture change, especially in advanced economies of the world, it’s a testament to just how far we’ve come,” concludes Allegrante. “But it took a concerted effort over many years, and we can certainly chart a similar path forward with this next generation.”  — Jacqueline Teschon

Source: https://www.tc.columbia.edu/articles/2024/november/why-we-need-to-modernize-substance-use-education/

Filed under: Addiction,Education,Parents,Prevention and Intervention,USA,Youth :

The martial language used by the government when presenting its plan to combat drug trafficking cannot mask the wide blind spots in its announcements, particularly in terms of health and social issues.

Published in Le Monde on November 9, 2024, at 12:46 pm (Paris), updated on November 9, 2024, at 2:14 pm 2 min read Lire en français

Gang warfare in a growing number of towns, repeated shootings punctuated by the deaths of ever-younger teenagers, drug traffickers with increased financial power and influence operating even from their prison cells… There can be little doubt that France, like other European countries, is grappling with the scourge of drugs on an unprecedented level. Criminal groups thrive on an illicit market estimated at over €3.5 billion, posing an ever-growing threat to the lives of entire neighborhoods, to public health and even to democracy.

Asymmetrical and unequal, the battle between drug traffickers prepared to do anything and a democracy based on the rule of law requires institutions and procedures to be strengthened and adapted. The announcements made in Marseille on Friday, November 8, by Interior Minister Bruno Retailleau and Justice Minister Didier Migaud are a step in this direction: The creation of a “national prosecutor” to combat organized crime, which would be subject to special criminal courts composed solely of magistrates to avoid pressure on juries. The system will also be improved for criminals who accept to collaborate with the justice system. Both of these procedures are among the logical proposals inspired by a Senate bill resulting from an inquiry commission report published in May, as well as by the former justice minister Eric Dupond-Moretti’s work.

There are, however, some grey areas surrounding this legislative measure, which is scheduled for parliamentary review in 2025, notably as regards the precise scope of the new prosecutor and the expansion of the current anti-drug office. As for the immediate measures announced on Friday, they remain imprecise, both in terms of the reinforcement of the Paris prosecutor’s office, to which a “coordination unit” would be attached, and the resources devoted to scrambling the telephone conversations of prisoners at the “top end” of the criminal spectrum, who would be assigned to specialized prison quarters.

Concrete action needed

But the martial language used by the two ministers to demonstrate their willingness to “join forces” over and above their political differences, cannot mask the blind spots in their announcements. Significantly, the health minister was not consulted. Information on addiction, risk reduction for drug users and providing care for people addicted to drugs are a few examples of these blind spots.

Cracking down on trafficking and putting pressure on the supply of illicit substances are essential, but they cannot be effective unless they are accompanied by strong action on demand and without a debate, informed by other countries, on the benefits and risks of partial decriminalization. At a time when consumption is becoming commonplace in many circles, from the most disadvantaged to the most privileged, public authorities should also strive to build and disseminate a counter-narrative to that of social ascent through trafficking.

A real “national cause,” the battle against drug trafficking requires France to build the conditions, if not for a consensus, at least for a political majority. This requires not only the addition of a strong preventive component but also that the government distances itself from the interior minister’s constant conflation of drugs and immigration.

Source: https://www.lemonde.fr/en/opinion/article/2024/11/09/france-s-drug-problem-both-repression-are-prevention-are-needed_6732224_23.html
Filed under: Addiction,Alcohol,Drug use-various effects,Education,Education Sector,Europe,Legal Sector,Prevention and Intervention,Social Affairs :

The drug and alcohol awareness event was held at Faizen-E-Madina Mosque on Gladstone Street

Shariqua Ahmed – BBC News, Peterborough

A drug and alcohol awareness event has taken place at a mosque to encourage Muslims and families struggling with addiction to seek help.

Dozens of people, including children, attended the workshop organised by Dr Azhar Chaudhry at Peterborough’s biggest Mosque, Faizan-E-Madina.

Dr Chaudhry said the issue of drug and alcohol dependency within the city’s Muslim community was “a huge problem”, but engaging with them had been a challenge due to cultural stigma.

Raja Alyas from Peterborough-based Aspire charity, which works with harder-to-reach communities, called it “a step in the right direction”.

Dr Azhar Chaudhry has been organising awareness workshops for the community as a volunteer over the years

‘Still work to be done’

Dr Chaudhry, who works at Thistlemoor Medical Centre, said the involvement of the mosque committee, who attended and helped organise it, was “encouraging”.

He said there was still work to be done on engaging with Mosques who can support initiatives like Aspire, but appreciated their efforts to work together.

He moved to the UK in 2001 from Pakistan and is part of the British Islamic Medical Association (BIMA).

He runs other workshops on CPR, diabetes and cancer screening to raise awareness within the community as a volunteer.

“I love what I do. I am passionate about saving lives”, he said.

“You will be shocked to see how prevalent the drug and alcohol issues are in the Muslim community. I see it as a GP who works in a diverse part of the city.

“But it is difficult to engage with them, they don’t want to seek help.

“It is a sensitive issue for the community. There is a lot of stigma, so it needs to be addressed cautiously but attitudes are improving, hopefully.”

Aspire said the mosque committee has offered to help organise more regular drug and alcohol awareness events

Aspire works with Peterborough City Council, GPs and the Probation Service.

It also operates a clinic regularly at Thistlemoor Medical Centre to give people facing stigma a “discreet option” to seek help.

Mr Alyas said: “The workshop was well attended and was very interactive and great to see young people asking questions about how they can safeguard themselves.

“The young generation is being empowered with knowledge on making their decisions,” he said.

“It was good to see the attendees acknowledging that there is an issue. Previously, when we tired to set up a workshop like this it was not as well received.

“But the mosque saying they look forward to more events including for women is a step in the right direction.”

The event was organised by Dr Azhar Chaudhry and the Aspire charity and was supported by Faizan-E-Madina Mosque

Follow Peterborough news on BBC Sounds, Facebook, Instagram and X.

Source: https://www.bbc.co.uk/news/articles/crr92nyl7k4o

Filed under: Addiction,Alcohol,Drug use-various effects,UK :
Attorney General Russell Coleman proposed a statewide, youth-focused addiction prevention initiative before the Kentucky Opioid Abatement Advisory Commission Tuesday.

The Commission unanimously approved the two-year, $3.6 million proposal, which is centered around a research-backed youth education campaign.

This campaign, called “Better Without It,” will feature data-driven outreach to engage with young Kentuckians where they are, including on social media, streaming platforms, college campuses and through partnerships with influencers. The campaign will showcase positive, Kentucky-focused messages designed specifically to encourage young people to fulfill their potential.

The Commission and Attorney General’s Office will partner with prevention experts and creative marketing professionals to build the educational campaign that is compelling to young Kentuckians.

“Our kids are growing up with no margin of error. As little as one pill can – and is – killing our neighbors. Today, the Opioid Commission joined with our Office to build a prevention program that will give young people the encouragement that they are better without it,” said Attorney General Coleman “We will reach Kentucky’s young people where they are with a message that resonates. I’m grateful to the Commission for their strong support for this program that can truly save lives.”

In addition to the education campaign, the prevention program will also promote existing school-based programs and amplify the work of the Commission to support youth-focused prevention efforts.

To date, the Commission has distributed more than $55 million to combat the drug crisis, directly helping Kentuckians overcome addiction and promote long-term recovery.

Source: https://nkytribune.com/2024/09/attorney-general-coleman-announces-statewide-youth-drug-prevention-campaign/

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

RED RIBBON WEEK is Celebrated Annually October 23-31.

Red Ribbon Week highlights the importance of living a drug-free life. It presents an opportunity for parents, educators, and communities to reinforce the drug-free messages they share with their children throughout the year. During Red Ribbon Week, youth and adults around the nation pledge to increase their knowledge by learning more about the destructive effects of drug abuse, including prescription drug misuse, and renew their commitment to live a healthy, drug-free lifestyle.

Source: https://www.dea.gov/redribbon?
Filed under: Addiction,Drug use-various effects on foetus, babies, children and youth,Education,Parents,Prevention and Intervention,USA :

The Pennsylvania State University  Oct 12 2024

Students who feel a sense of belonging at their university are more likely to binge drink than those who do not feel the same connection, according to a new study by researchers at Penn State, the University of California, Santa Cruz and University of Oregon.

In the study, published in the Journal of Studies on Alcohol and Drugs, scientists -; including researchers in the Penn State College of Health and Human Development -; found that college students with “good” mental health who felt connected to their university were more likely to binge drink than those who did not feel as connected to their university.

Stephane Lanza, professor of biobehavioral health and Edna P. Bennett Faculty Fellow in Prevention Research, studied the topic with Danny Rahal and Kristin Perry when both were postdoctoral trainees in the Penn State Prevention and Methodology Training Program. The researchers examined the ways that both positive and negative aspects of mental health can contribute to the risk of binge drinking, cannabis use and nicotine use.

“In 2021, students at many universities were returning to campus after the COVID-19 shutdown -; and some students were attending in-person college classes for the first time,” said Rahal, lead author of this research and assistant professor of psychology at University of California Santa Cruz.

Data from that time indicated that many students felt disconnected from their school. Universities wanted to foster a sense of connectedness among their students for many good reasons, but we wanted to know if there was something positive -; specifically a sense of belonging -; that is related to substance use. Our study showed that feeling connected to one’s university is associated with higher rates of substance use.”

Danny Rahal, The Pennsylvania State University

The researchers examined data from 4,018 university students collected during the 2022-23 school year. Participants answered questions about substance use, their sense of belonging at their school and their mental health -; specifically about anxiety, depressive symptoms, perceived stress, flourishing in life and confidence in their academic success.

A statistical modeling technique called latent profile analysis allowed the researchers to simultaneously account for all these measures by combining them to identify five profiles of student mental health. In this study, a student was considered to have good mental health if they had lower levels of stress, depressive symptoms and anxiety, as well as higher flourishing and academic confidence than their peers.

 

The researchers said this does not mean that connectedness is bad for students to experience; rather, the results are nuanced.

“We want to cultivate connectedness among students,” said Perry, assistant professor of family and human services at University of Oregon. “Connectedness gets them involved. It can be a really powerful protective factor against negative mental health outcomes and can help keep students in school. But connectedness at school can go hand in hand with binge drinking if there is a culture of drinking at the school.”

Though the researchers said they expected these results about drinking, they were surprised to learn that students with poor mental health who felt connected to their university were more likely to use non-vaped tobacco products than students with poor mental health who did not feel connected to their university. The results around cannabis were less conclusive, but the researchers said the trend was clear.

“Generally, students who felt connected to their university were more likely to use substances than disconnected students with the same level of mental health,” Rahal said.

While a sense of belonging was related to substance use, it could also be part of the solution, according to the researchers.

“Cultivating belonging for all students is an important way that universities can embrace diversity and help all students thrive,” Lanza said.

Though drinking is common on university campuses, many students believe that it is far more common than it is, the researchers explained. In this dataset, slightly fewer than one-third of students reported binge drinking in the last month. Despite the fact that two-thirds of students had not engaged in binge drinking, the researchers also found that students believed a typical student consumed three to five drinks multiple times each week. The researchers said this disconnect between perception and reality points to an opportunity to change the culture -; by creating ample opportunities for all students to socially engage and participate in alcohol-free environments -; so that alcohol feels less central to student life.

Minoritized college students, in particular, often face messages that make them feel unwelcome based on their race, gender, socioeconomic status or other factors, according to the researchers.

“We cannot expect students to stay enrolled unless they are engaged with the campus community,” Lanza continued. “If universities lose students from a specific group, the campus becomes less diverse, and the entire university community becomes less rich. Additionally, when members of those groups leave school, they miss educational opportunities and the earning potential that comes with a college degree. By providing all students with diverse opportunities to build a real sense of belonging at their universities, we can improve campus life while putting people on the path to a healthier life.”

The National Institute on Drug Abuse and Penn State funded this research.

Source: https://www.news-medical.net/news/20241012/New-research-explores-how-campus-belonging-impacts-binge-drinking-and-substance-use.aspxThe Pennsylvania State University
Filed under: Addiction,Alcohol,Education,Health,Mental Health,USA,Youth :

Source: The Sunday Mail

Filed under: Addiction,Australia,Environment,Prevalence :

By Ian Webster  Oct 28, 2024

Ian W Webster AO is Emeritus Professor of Public Health and Community Medicine of the University of New South Wales. He has worked as a physician in public and regional hospitals in Australia and UK and in NGOs dealing with homelessness, alcohol and drug problems and mental illness.

Please review Ian Webster’s paper which clearly shows that we need to learn from our success in the past that Prevention is the best way forward.

The second New South Wales Drug Summit will be held in regional centres for two days in October and the final two days will be in Sydney on the 4th and 5th December to be co-chaired by Carmel Tebbutt and John Brogden – a balance of politics.

Do summits achieve worthwhile outcomes?

The first Drug Summit in 1985 was national. It worked. It established the enduring principle of harm minimisation. It brought police, health, and education together, canvassed all drugs – including alcohol and tobacco, and it started funding for practicable and policy-based research.

It worked because Prime Minister Hawke needed it to, for family reasons. It worked because the Health Minister, Neal Blewett, needed it to work as he had carriage of its outcomes and the national response to burgeoning HIV/AIDS epidemic.

The 1999 NSW Drug Summit was in response to the rising prevalence of heroin use and opiate deaths. It worked because there was a political will to succeed. It included measures to deal with blood borne infections of HIV, hepatitis B and C; it expanded the state’s opioid treatment programs; expanded needle-syringe programs; introduced the antidote naloxone; and three seminal firsts – the first medically supervised injecting centre, drug courts, and court referral into treatment.

It worked because the Premier Bob Carr wanted it to. Which meant that the summit’s recommendations were managed through the Cabinet Office, supported by a ministerial expert advisory group. The ‘piper called the tune’ for all the state government departments; and they were made to work together.

The Alcohol Summit of 2003 was not as effective. Politicians were too close to the alcohol problem and implementation was handed to the Department of Health which meant other departments washed their hands of involvement. Police, on the other hand, carried the day with counterattacks on alcohol violence and behaviours at liquor outlets.

Contemporary drug problems

Now other substances must be dealt with – amphetamine type stimulants, especially crystalline methamphetamine, cocaine, hallucinogens, MDMA, pharmaceutical stimulants, the potent drug fentanyl, the even more potent nitrazenes, ketamine and unsanctioned use of psychiatric/neurological drugs. Cocaine is flooding the drug markets.

Heroin and alcohol remain as major problems. The Pennington Institute estimated there were 2,356 overdose deaths in 2022, 80% of which were unintended. And alcohol, not only damages the drinker, and the bystander, but creates extensive social harms in the lives of others.

NSW Ice Inquiry

Four and half years ago Commissioner, Dan Howard, reported on his Inquiry into the Drug Ice; he had started the Inquiry six years previously. His recommendations provide a scaffold for the upcoming Summit. The earlier NSW Drug Summit (1999) was followed by a strong impetus to implement its recommendations, but the Government dropped the ball 20 years ago. The last formal drug and alcohol plan was 10 years before the Ice Inquiry.

Fundamental to drug law reform is the decriminalisation of personal use and possession of drugs. This recommendation stands above all others in Dan Howard’s Report.

The thrust of the Inquiry’s recommendations centre on harm minimisation:

  • drug problems are health problems,
  • government departments across the board have responsibilities,
  • treatment, diversion, workforce initiatives, education and prevention programs must be adequately resourced,
  • accessible and timely data are needed,
  • Aboriginal communities, and other vulnerable communities, those in contact with the criminal justice system, all disproportionally affected by alcohol and other drugs, must be high priority population groups.

The NSW Liberal Government pushed back against decriminalising low-level personal drug use, against medically supervised injecting centres, against pill testing, cessation of drug detection dogs at music festivals, and needle and syringe programmes in prisons. Later it gave in-principle support to 86 of the recommendations.

Will the Summit achieve?

The hopes of the drug and alcohol sector are for easy access to naloxone (antidote to opiates), supervised drug-taking services, accessible sites for drug-checking, early surveillance on trends, better access to now available effective treatments, for the treatment of prisoners to equal that for all citizens, and a more equitable distribution of treatment and rehabilitation services across the state, and to ‘at-risk’ population groups.

Success will depend on the practicality of the recommendations and the preparedness of government to act on them in good faith.

It is trite to say, but this depends on political will. The will was strong in the earlier national Drug Summit (1985) and NSW Drug Summit (1999). But so far, Government responses to the Ice Inquiry have been late and weak-willed which does not bode well for the delivery of needed reforms.

There is now a Labor Government, also tardy in its response. It remains to be seen whether NSW Labor has the stomach to overturn past prejudicial stances on drug use and addiction, and whether it will put sufficient funds to this under-funded and stigmatised social and health problem.

What will not be achieved

The Summit and its outcome cannot attack the real drivers of drug problems – the incessant search by humankind for mind altering substances, the mysteries of addiction, and the abysmal treatment of people in unremitting pain.

The root causes of drug problems are socially determined. Action at this level will require an unimaginable upheaval of society and government. In western countries drug overdoses (including alcohol overdoses), suicide, and alcoholic liver disease, are regarded as ‘diseases of despair’. The desperation and despair which pervades vulnerable, and not so vulnerable, population groups, is the underground of drug use problems here and in other countries. Commissioner Howard said, we [society] are given “tacit permission to turn a blind eye on the factors driving the most problematic drug use: trauma, childhood abuse, domestic violence, unemployment, homelessness, dispossession, entrenched social disadvantage, mental illness, loneliness, despair and many other marginalising circumstances that attend the human condition.”

Somehow a better balance must be struck for law enforcement between the war on traffickers and the human rights of users. It is for the rest of us to treat drug using people as our fellow citizens.

Kind Regards

Herschel Baker

 

Source: Drug Free Australia

Filed under: Addiction,Alcohol,Australia,Cannabis/Marijuana,Cocaine,Drug use-various effects,Effects of Drugs,Health,Mental Health,Prevalence,Prevention and Intervention,Social Affairs :

By Brittany Vargas  /  September 30, 2024

The American Academy of Pediatrics (AAP) published its first clinical practical guidelines on opioid prescriptions for children with acute pain, outlining 12 evidence-based recommendations for safely and appropriately treating pain in young patients.

The guidelines have been published alongside a technical report in Pediatrics and presented at the group’s 2024 annual meeting.

While not the only set of guidelines of its kind, ”is the first set that is really for anyone who takes care of children, not just surgeons, anesthesiologists, and pain specialists,” said Rita Agarwal, MD, a pediatric anesthesiologist at Stanford University in Stanford, California, who helped write the recommendations.

The opioid guidelines were created to give clinicians a clearer, more objective framework for safe treatment of acute pain in the outpatient setting while mitigating the risk of addiction, overdose, or other harmful effects.

”Most of what we’ve been doing thus far as practitioners has been anecdotal, from experience, or from word of mouth,” said Adaora Gabriellene Madubuko, MBBS, MD, assistant professor of pediatrics at Rutgers New Jersey Medical School in Newark.

The AAP advises clinicians to start with the lowest possible dose based on age and weight, to use an immediate-release formula, and provide no more than a 5-day supply, unless trauma or surgery calls for longer-term pain management.

Clinicians should not use opioids as their only strategy for reducing pain in this population. Combining the drugs with other medications can enable prescription of lower doses of opioids and could decrease the side effects of other medications, according to the report. These might include acetaminophen and nonsteroidal anti-inflammatory drugs. Other strategies can include ice or heat, transcutaneous electrical nerve stimulation, age-appropriate relaxation or distraction strategies, and music therapy.

The report also recommends prescribing naloxone alongside each prescription and training caregivers to identify a potential overdose in their child. Clinicians should also provide tips to caregivers about safe storage and disposal of opioids.

The AAP also suggests restricting the use of codeine or tramadol among children under age 12; teens aged 12-18 with obesity, obstructive sleep apnea, or severe lung disease; and patients under age 18 with postsurgical pain after tonsillectomy or adenoidectomy.

Other recommendations include:

  • Use caution in prescribing opioids for children or teens who already are taking sedating medications, such as benzodiazepines.
  • When treating acute, worsening pain in patients with preexisting chronic pain, clinicians should prescribe opioids when indicated and partner with any other opioid-prescribing clinicians involved in the patient’s care and with specialists in chronic pain and other opioid stewardship programs.
  • Do not prescribe codeine or tramadol to patients who are breastfeeding.

Each recommendation included a strength of evidence when available. When randomized controlled trials, diagnostic studies, or observational studies were not available, the AAP based recommendations on case reports or expert opinion.

”A lot of the guidelines are really common sense,” but methodically researched and well-defined recommendations were needed to reduce risks and guide clinicians who may be wary of prescribing the drugs in the wake of the opioid crisis, Agarwal said.

When awareness of the opioid epidemic first started, ”there was very little attention being paid to children,” Agarwal said. ”The thought was, ‘This doesn’t happen to our kids, this isn’t in my backyard.”’

Over time, evidence emerged that children and teens could misuse, abuse, and become addicted to opioids just like adults, said Agarwal. In response, rates of opiate prescriptions for kids dropped off.

”We’ve heard of the horror stories of high school kids sharing and distributing opioids to their friends,” Madubuko said. She has prescribed the drugs ”with great caution. I could count on my hands how many patients I’ve prescribed opioids to over the last couple of years.”

But a decline in opioid prescribing has led to some children lacking adequate pain management and lowering their quality of life, according to the AAP practice guidelines. Underprescribing can particularly impact non-White patients and those in certain ethnic or socioeconomic groups, studies show.

The guidelines bring much-needed objectivity to the prescription process, potentially reducing some of these disparities, Agarwal said.

”By creating a standard that says, these are the things you should look for, these are the things you should treat, we leave less room for saying ‘I think this person is faking,’ or ‘I don’t think they’re having as much pain as they say they are.”’ Agarwal said. ”The guidelines emphasize the fact that if a patient says they’re having a lot of pain, you should believe them first.”

Madubuko is on AAP’s Patient and Family-Centered Care and Neonatal Care Task Forces but was not involved in the creation of the guidelines. 

Brittany Vargas is a medicine, mental health, and wellness journalist.

Source: Medscape Medical News

Filed under: Addiction,Drug use-various effects on foetus, babies, children and youth,USA :
Marsha F. Lopez, Ph.D., M.H.S. marsha.lopez@nih.gov, 
MeLisa R. Creamer, Ph.D., M.P.H., and 
Erin M. Parker, Ph.D.Authors Info & Affiliations
In the 50 years since its establishment, the National Institute on Drug Abuse has made significant investment and strides toward improving individual and public health. Epidemiology serves as the foundation for understanding the how many, why, how, where, and who of drug use and its consequences, and effective epidemiology research and training are geared toward actionable findings that can inform real-world responses. Epidemiologic findings enhance clinicians’ ability to provide ongoing care by incorporating information about the patterns and outcomes of drug use that their patients may experience. The goal of this article is to provide a context for epidemiology of substance use as a foundation for prevention, with examples of how epidemiology can provide targets for prevention, and to set the stage for addressing the importance of prevention in clinical settings.
Source: https://psychiatryonline.org/doi/10.1176/appi.focus.20240018 
Filed under: Addiction,Brain and Behaviour,Mental Health,Treatment and Addiction,USA :
Tulsa World
Aug 25, 2024

The Cherokee Nation’s approach to substance abuse recovery is harm reduction, which has drawn criticism from some who work in addiction recovery.

“Harm reduction is a pretty controversial topic. A lot of people feel it can be enabling drug users. It can feel counterproductive and counter intuitive,” said Jennifer Steward, director of the University of Tulsa’s Behavioral Health Clinic.

In a Tulsa World interview, Steward said the controversial aspect comes from the fact that harm reduction does not encourage abstinence from drug use, which makes it different from traditional substance abuse rehabilitation programs. Harm reduction instead focuses on keeping active drug users alive, with considerations for their health and safety.

The Cherokee Nation harm reduction program utilizes a mobile unit that brings supplies to drug-users on the streets: clean needles, cotton swabs and Narcan, which can reduce cravings and combat a potentially fatal overdose.

Steward said many harm reduction programs also provide a safe, clean environment to partake in drug use, free of disease such as HIV or hepatitis C, with staff ready to assist in case of overdose.

Cherokee Nation prevention specialist Coleman Cox said that his tribe recognized the potential for addiction among the Cherokee people after being exposed to the opioid epidemic is “far reaching and the latest in a long line of injustices brought upon indigenous peoples.”

According to the Centers for Disease Control, in 2021 the highest rate of drug overdose deaths was in American Indian and Alaskan Native individuals. Data from the Substance Abuse and Mental Health Services Administration indicates 5.1% of Natives have misused opioids, which can include prescribed pain-relief medications, hydrocodone, oxycodone, fentanyl and heroin.

“We bent the opioid industry to a settlement for the harm it inflicted, and we are making the opioid industry help pay for every single penny of this facility,” said Cherokee Nation Chief Chuck Hoskin Jr. in reference to their treatment facility they broke ground for Thursday morning.

The Cherokee Nation received a Substance Abuse and Mental Health Services Administration grant last year for harm-reduction services. They now operate a storefront at 214 N. Bliss Ave. in Tahlequah. It is open not only to tribal members but also to the public, and all participants can remain anonymous.

The new facility that the tribe broke ground on this week is a $25 million dollar addiction treatment center just outside of Tahlequah.

The Cherokee Nation’s Public Health and Wellness Fund Act of 2021 dedicated $100 million in settlement funds from opioid and e-cigarette lawsuits for a variety of public health programs.

Cox said harm reduction meets people where they are at in their addiction. This means that if the user does not want to seek rehabilitative services, they do not have to. Rehabilitation services may be recommended, but they are not a requirement.

“Harm reduction is more than Narcan and clean needles. It’s treating others how they want to be treated — with dignity, respect and value, without conditions,” said Cox.

Evan White, a member of the Absentee Shawnee tribe, is the director of Native American research at Laureate Institute for Brain Research in Tulsa. He has worked with various tribal behavioral health programs through his research.

“Harm reduction is a model that has a strong evidence base for good outcomes,” he said, “especially in substance use disorders.”

White believes harm reduction could be attractive to Native communities as it values a person’s autonomy.

“I see a consistent value of a person as an individual within Native communities. Healing is an important part of the process in these cultural spaces, even though there is a lot of stigma around substance abuse in our broader society,” he said.

For Native individuals with substance abuse issues, White said participating in cultural activities may enhance self-control and mindfulness.

The Cherokee Nation’s program provides opportunities for Native people in recovery to partake in cultural activities.

“We planted a Three Sisters Garden: corn, beans and gourds,” said Cox. “Corn provides the bean a pathway for growth. Beans give back by imparting nitrogen to the soil. Gourd provides protection and covers the ground. Three different things working in harmony. Body, mind and spirit.”

Members of the program get to adopt a plant, name it and tend to it. Cox said the vegetables are not for eating, however.

“They are meant to harvest seeds for the future bounty, beyond what we can see now. Just like when our members come to us for whatever kind of help, we plant a seed that one day they will harvest a healthier life,” he said.

Cox said the harm reduction staff launched a new chapter of “wellbriety movement” that they call “recovery rez.” It’s a cultural approach to the traditional 12-step recovery plan.

“At Recovery Rez they begin with prayer and fellowship meal, then smudge and hold a talking circle guided by the passing of an eagle feather from speaker to speaker. They close out the evening with a drum circle and singing. All are welcome, and citizens don’t need to be in recovery to benefit from the cultural protective factors,” said Cox.

Steward said it can be difficult to view harm reduction as a substance abuse program because harm reduction focuses on the long-term.

“The goal is to help someone be ready to engage in rehabilitation later on, but in order to do that, they have to be alive,” she said.

According to Cherokee Nation spokeswoman Julie Hubbard, the tribe’s harm reduction program has had 3,099 encounters for service, and it has 1,049 members currently. The number of people who still inject drugs within the program is 743. The amount of lives saved at the program from Narcan distribution is 44.

Source: https://tulsaworld.com/news/local/indigenous/cherokee-nation-takes-long-term-approach-to-substance-abuse-recovery-via-harm-reduction/article_290c6be4-60a1-11ef-ab14-934bc604a21b.html
Filed under: Addiction,Drug use-various effects,Harm Reduction including HIV (Papers),Needle Exchange,Treatment and Addiction,USA :

By Caroline Spikes

Published: Sep. 1, 2024

Aug. 31 is known as International Awareness Day the department wanted to spread awareness about the crisis of drug overdoses.

During this event, people gathered at the city hall and lit candles to remember lost lives or loved ones.

The South Carolina Department of Alcohol and other Drug Abuse Services states the number of overdoses has been increasing for the past 10 years.

Organizations and community members came together to learn more about how to spot an overdose and the importance of Narcan nasal sprays.

Thomas Young, a Charleston County support specialist, said his overdose was a wake-up call to get the help he needed.

“I was basically dead on arrival and it took six Narcan to get me awake,” Young said.

There have been between 100-120 incidents regarding overdoses with 20 of those fatal within the first six months of this year according to the North Charleston Police Department.

In 2022 alone, there were 437 opioid-related deaths in the Lowcountry and over 1,800 throughout the whole state, according to the South Carolina Department of Health and Environmental Control.

Opioid prevention coordinator Shelbey Joffrion said she thinks substance abuse disorder is important for people to know and how it touches to have someone by them during difficult times.

“I just think it’s important that everyone knows the substance abuse disorder touches everyone,” Joffrion said. “I have not met anyone who says they have not had their friend or family in their circle. It touches all of us.”

Young explains he never thought it be sober ever again and how it takes a team to overcome a drug addiction.

“I never I never thought I’d be sober, ever,” Young said. “It’s basically a miracle that I’m sober because I was a glorified drug user for many years. Nobody can really get clean by themselves, no matter how much they try. We kind of need everybody in this together.”

Click this link for more information regarding the South Carolina Department of Alcohol and other Drug Abuse Services.

Copyright 2024 WCSC. All rights reserved.

Source: https://www.live5news.com/2024/09/01/north-charleston-hosts-first-overdose-awareness-day-event/

Filed under: Addiction,Drug use-various effects,Education,Prevention and Intervention,USA :

By Luke Niforatos

Recognizing Overdose Awareness Day on Aug. 31, the Denver City Council passed a proclamation that called for numerous radical, unproven drug policies. The most notable of these was “safe supply,” a misnomer that provides free, pharmaceutical, addictive opioids to those with an opioid addiction. If it sounds like a bad idea, that is because it is.

Even worse, absent from the discussion is a promotion of evidence-based treatment and prevention services that prioritize recovery.

Denver’s proclamation encourages “prioritizing harm reduction initiatives such as naloxone, fentanyl testing strips, syringe services programs, overdose prevention sites, and a safe supply.” By lumping in these interventions together, radical extreme drug policy and harm reduction advocates are hoping we don’t notice some of these unproven policies that are nothing more than slippery slopes to full drug legalization.

Case in point: British Columbia, Canada, has already focused its attention almost exclusively on all of these harm reduction initiatives while reducing focus on prevention, treatment, and recovery.

The result? Overdose deaths have continued to rise in that province and it leads North America in its rate of overdose mortality. Focusing on harm reduction alone has not delivered on its promise as a solution to the drug crisis.

The most troubling of these proposals is “safe supply.” Anything but what its name suggests, “safe supply” provides opioids to people who use drugs on the premise that a medical-grade drug supply is better than one that may be mixed with other substances in the illicit market. It’s like giving away free booze to alcoholics in the hopes that they drink less.

In essence, Denver’s City Council members are echoing the calls of radical activists in proposing to give people in active addiction their drugs directly — and for free.

A recent study in JAMA Internal Medicine reviewed British Columbia’s so-called “safe supply” program. The researchers found that just as many people died from overdoses as before the policy took effect. Additionally, the “safe supply” drugs are often sold on the black market so those users can obtain what they really want — usually fentanyl. Even extreme harm reduction supporters in British Columbia have recognized its shortcomings. But instead of backtracking, they are doubling down on this unproven approach.

Dr. Bonnie Henry, the provincial health officer in British Columbia, recently called for the province to “enable access to non-prescribed alternatives to unregulated drugs.” In effect, they know the medical model of safe supply, also known as “prescribed alternatives,” has not worked, so they want to increase access to legalized drugs in retail stores, clubs, and community centers. They’d place life-threatening drugs in neighborhoods across the province.

Denver’s City Council could be headed down this path.

Instead, we should wake up — and favor an evidence-based approach that is comprehensive: both supply reduction, which includes enforcing the law on open-air drug markets and dealers, and demand reduction, which includes prevention, treatment, and recovery services. Of course, harm reduction interventions like naloxone have a role to play, but they cannot be the only leg of the stool.

Prioritizing a comprehensive approach will send a clear message that in Denver we actually want to achieve something in honor of the many victims of overdose.

Many readers may be shocked to learn that the proclamation in Denver overlooked many of these common-sense interventions.

The word “treatment” was referenced only once. The concept of “drug use prevention,” such as empirically proven programs discouraging use among minors and non-users, was completely absent. And the word “recovery” was not referenced at all.

Many recognize the tragedy of the drug crisis, which took the lives of more than 100,000 Americans in 2022. To overcome this crisis, policymakers must support a comprehensive approach that favors a wide range of responses, including demand reduction, supply reduction, and harm reduction. Denver’s City Council has chosen to proclaim the extreme proposals of activists over real solutions.

Let’s hope they reverse course soon.

Yes, we should meet people where they are in their addiction. But we cannot leave them there.

Luke Niforatos is the executive vice president of the Foundation for Drug Policy Solutions and an international drug policy expert.

Source: https://gazette.com/opinion/safe-supply-only-will-deepen-denver-s-drug-crisis/article_65ce5e4c-6705-11ef-997f-6f63e2ef75a3.html
Filed under: Addiction,Drug use-various effects,Prevalence,Prevention and Intervention,USA :
(Spectrum News/Vania Patino)

By Vania Patino Los Angeles

Sep. 02, 2024

LOS ANGELES — Facing peer pressure can be hard, but teens at the Boys and Girls Club in Monterey Park are learning to say no to drugs and alcohol together.

 

What You Need To Know

    • The Boys and Girls Club in Monterey Park offers a drug and alcohol prevention program for youth called Brent’s Club
    • Participants are drug tested at random every week and rewarded through activities, trips and scholarships for saying no to drugs
    • Earlier this year, a group of students traveled to Washington D.C to participate at the Boys & Girls Clubs of America’s Summit for America’s Youth
    • The students were able to speak with elected officials about the need for continued funding toward drug prevention resources

 

Victoria Perez is one of the high school students who chooses to spend her afternoons at the Brent’s Club chapter offered at the Boys and Girls Club.

“I thought maybe it would just be lessons of drug and alcohol awareness, but it just it’s so much bigger than that,” Perez said.

Perez and the other participants soon realized they were not just gaining knowledge about the dangers of drugs, but were also being rewarded for actively taking those lessons into their daily decision making.

The program takes their commitment to staying drug free serious, and it’s why every week participants are drug tested at random.

So far, director of the Brent’s Club, Angel Silva, says they have not had any test results come back positive.

The deal is that those who remain drug free are rewarded through field trips, activities and also become eligible for a full four-year scholarship or partial renewable scholarships.

“Like our Maui trip that we do every summer, where we go, and we do a service project on the island of Maui,” Silva said.

The approach was designed by the Brent Shapiro Foundation, which was created by Brent’s parents after losing their son to addiction. The hope was to prevent this from happening to any other families and help reduce the risks of falling into substance abuse among youth.

This year, some participants created the TLC or Think, Lead, Create Change mental health project to advocate for continued funding toward drug use prevention, treatment and recovery resources.

Perez was one of the participants and, along with her team, was able to attend the Boys & Girls Clubs of America’s Summit for America’s Youth in Washington, D.C.

This was the first time flying for many of the participants and the first time at D.C. for all the students.

It’s experiences like those that Silva says these students would otherwise not have access to without the program.

Perez says it took a lot of preparing and researching to create the project, but was all worth it when they were able to present it to elected officials and share why this cause means so much to them.

“It was such an amazing opportunity, especially for advocating for not just alcohol and drug abuse, but for mental health and how those things merge together,” Perez said.

The advocacy and awareness the students are helping create comes as a time when fentanyl continues to be the most common cause of accidental drug overdose deaths in Los Angeles County.

“We were learning and teaching at the same time very much, because we thought we knew everything about fentanyl, but it decided to change the whole game,” Silva said.

Although, it can be tough to keep up, he says the ever-changing substance landscape makes their efforts that much more important.

Something Perez’s mother, Monica Vargas, agrees with and why she says the program has given her a peace of mind although the idea was jarring at first.

“It was a little shocking because where I come from, I’m a first generation, so we tend to come sometimes from very close or conservative families. So we think out of sight, out of mind. We don’t talk about it,” Vargas said.

However, she knew it was important for parents to communicate with their children, and this program was the perfect way to do it.

“If those additional incentives help, especially with so much pressure out there for these teens, by all means, I’m all for it. I’m 100% for it,” Vargas said.

Along with the incentives, Silva says the students have also become each other’s support system, which itself is a way to reduce the risk of substance abuse among youth.

“That’s the great part. You know, it’s not just within the clubhouse, they all go to the same school, and they hold each other accountable,” Silva said.

Source: https://spectrumnews1.com/ca/southern-california/health/2024/09/02/teens–drug-and-alcohol-prevention-

Filed under: Addiction,Alcohol,Drug use-various effects,Education,Fentanyl,Prevention and Intervention,USA,Youth :

By  Charlotte Caldwell

September 6, 2024

LIMA — The Lima Police Department recently posted on its Facebook page about an increase in overdoses in Lima over the past few weeks.

With September being National Recovery Month, where organizations try to increase public awareness about mental health and addiction recovery, local organizations and law enforcement agencies shared their experiences with addiction and overdoses and the help that is available.

The problem

Lima Fire Chief Andy Heffner said his department responded to 85 overdoses so far this year. He said the overdose numbers have risen and fallen throughout the year, with about one-week breaks in between. He believed the numbers were based on the drugs available in the area.

Project Auglaize County Addiction Response Team Project Coordinator/Peer Support Specialist Brittany Boneta spoke on the reason for the overdose spikes.

“When it comes to overdoses, one is too many,” Boneta said. “I think the number of overdoses comes in waves. There could be a really bad batch of heroin or fentanyl that gets distributed throughout the county that could lead to a spike in overdoses.”

Heffner cited the Drug Enforcement Administration’s website, which said seven out of every 10 pills seized by the DEA contain a lethal dose of fentanyl. The website also said 2 milligrams of fentanyl can be enough to kill someone.

“It only takes one time when Narcan is not available that you could lose your life. If you get clean, you will never have to worry about an overdose, and neither will the people that love you,” Heffner said.

Bath Township Fire Chief Joe Kitchen said his department used Narcan 21 times on patients from August 2023 to August 2024. The department also distributes Narcan to families just in case an overdose occurs.

“Although we have only left behind a few kits so far, I think it gives the family of a known addict some peace of mind that they could assist them in the event of an OD prior to EMS arrival,” Kitchen said.

Another problem is a tranquilizer called Xylazine is being mixed with fentanyl, which does not respond to the usual methods of reversal.

“There are always new drugs/drug combinations being introduced on the streets that make it difficult for those in the treatment world to keep up with and know how to effectively treat,” said Jamie Declercq, the vice president of clinical operations for Lighthouse Behavioral Health Solutions. “Right now, we are seeing an increase in substances (such as Xylazine) across the county which does not respond to Narcan, so that is likely one reason for the increase in overdose deaths.”

Their stories

Boneta was addicted to opiates and crack cocaine over a seven-year period, and her addiction journey started when she was prescribed Percocet by a cardiologist for a heart condition when she was 18.

“There wasn’t a drug I wouldn’t use,” Boneta said. “I was an honor roll student in high school with more trauma than almost anyone I know, and when I went off to college I wasn’t educated on the true dangers of drugs, the thirst to fit in, and all of my trauma stuffed down.”

When her doctor stopped prescribing Percocet, she bought them from drug dealers, not knowing they were laced with heroin.

“When the drug supply of the fake Percocet ran out, I was just buying actual heroin. The heroin was starting to have fentanyl added to it, and before long that was all I was consuming,” Boneta said.

Boneta was eventually sent to prison for drugs, and during that time her 6-year-old son was involved in a house fire and suffered serious injuries.

“I was transported from the prison, in my orange jumpsuit and shackles on my wrists and ankles, to say my goodbyes to my son. I think seeing him lying there in a coma covered in bandages was something so soul-shaking that I knew this was my rock bottom,” Boneta said.

“My son had countless surgeries and was getting better and stronger as the months went by, so I decided I was going to completely reset my life and work my butt off just as hard,” Boneta continued. “I completed as many recovery groups and classes as possible and started learning coping skills and tools to use when I was released from prison. I knew that I wanted to help other people like me and show them that people can understand what they are going through and not have judgment towards them.”

Diane Urban, of Delphos, the founder/president of the Association of People Against Lethal Drugs, started APALD because her youngest son died from a fentanyl overdose. Her older son is also a former addict, and her niece is in active addiction.

“He was clean for the last nine months of his life, he came to live with me, and he relapsed due to an ingrown wisdom tooth that was coming in, his face was swelling up, and because he had Medicaid, we couldn’t find him any help anywhere except for a place in Van Wert, and it was a two-week out appointment. Unfortunately, unbeknownst to me, he relapsed, and I found him dead in his bedroom from a fentanyl overdose,” Urban said.

Challenges to get help

Transportation, not enough of a variety of local recovery options available and financial barriers were all cited as issues addicts face when they decide to get help.

“For peers that are needing inpatient treatment or sober living, we have to send them to other counties for help,” Boneta said. “There is definitely a need for more substance abuse treatment in our county.”

Declercq said Allen County also has a need for inpatient or residential treatment, and people who need that care have to go to one of the major cities nearby.

Urban dealt with having to go outside the area when her son got help.

“Seven years ago when I had to get help for my son, we had to go to Columbus. There was no help to get in right away because (Coleman Health Services) was so backed up,” Urban said. “There can never be enough resources because what happens is all these resource centers and rehabilitation centers, they keep you for a period of time then they release you, and a lot of people when they get released like that, they don’t have adequate support for more of a long-term stay, more of them tend to relapse.”

Urban said her son got treatment for free with Medicaid, but in her experience, organizations prioritize people who have insurance.

Auglaize County Sheriff Mike Vorhees also mentioned a challenge with people not having a way to get to treatment.

“We don’t provide transportation yet, but that’s something that we’re working on,” Vorhees said in regard to the services Project ACART provides. “It depends on who it is. If it’s an elderly person, we can work with the Council on Aging; if it’s a veteran we go through Veterans Services.”

Financially, Declercq said Lighthouse Behavioral Health Solutions’ case managers help people apply for Medicaid, or the local mental health board has options for those who don’t qualify for Medicaid.

“One of the most frustrating barriers for seeking treatment is those with commercial insurance or Medicare, as those companies only pay for very limited services,” Declercq said. “Commercial plans typically pay for a short detox stay and limited individual/group counseling sessions, but do not pay for the intensive level of treatment that a program like Lighthouse offers.”

“Thirty days of treatment and/or 10 individual counseling sessions are not enough to truly treat a person who has been in active addiction for years,” Declercq continued. “Oftentimes even one year of intense treatment only touches the surface of the issues that someone in addiction needs to address.”

Available help

Project ACART has only been around about a year, and Boneta is working part-time and is the only employee. She has reached out to 19 people so far, and only two have denied treatment. She put together a resource guide in 2023 including mental health and substance abuse centers; residential detox treatment centers; 24/7 support services; substance use support groups; where to find Narcan; food pantries, hot meals and clothing; housing assistance and shelters; and low income and subsidized housing.

Boneta received help from peer support specialists through Coleman Health Services during her addiction. Now, as a peer support specialist, she uses a combination of her own experiences and formal training. She equated her role to being like a cheerleader. She is available to clients day and night to connect them to agencies to get help or just talk about their struggles.

“I meet people where they’re at and treat every situation differently. Some of the things I do are assessing needs and struggles, setting goals, advocating for my peers, giving resources, facilitating engagement with my peers and their families or service providers, and encouraging and uplifting them,” Boneta said.

Project ACART’s services are also free because of an Ohio grant.

“Many people in active addiction do not have housing, food, clothing, money or insurance, but they should still have the opportunity to get the help they need,” Boneta said.

Declercq said Lighthouse Behavioral Health Solutions also recently opened a peer support center in Lima for clients to have a place to go for sober activities.

“Downtime/boredom is often a trigger for people who are early in recovery, so this gives them a place to fill that time in a positive way,” Declercq said. “Our peer supporters offer a unique support system to our clients because they are people with past lived experience in addiction who are able to show them that life beyond addiction is achievable and fulfilling.”

Coleman’s seemed to be the go-to choice for law enforcement referrals, and Urban also directs people to the organization.

“My oldest son was a success story, he went to Coleman’s, got treatment, got on the MAT (medication-assisted treatment) program, Suboxone, and he’s thriving today. Owns his own house, owns his own business, married, doing absolutely wonderful. He’s like eight years clean,” Urban said.

Ohio Department of Commerce Division of Securities Recovery Within Reach program also provides a list of recovery resources and offers ways to pay for treatment.

 

Source: https://www.limaohio.com/top-stories/2024/09/06/local-organizations-share-addiction-experiences-challenges-resources/

Filed under: Addiction,Crime/Violence/Prison,Drug use-various effects,Fentanyl,Prevalence,Treatment and Addiction,USA :

Posted By: Staff September 9, 2024

By Marcel Gemme

September is National Suicide Prevention Month. During this month, prevention organizations, survivors, mental health advocates, and community members unite to promote suicide prevention and awareness.

One important aspect of suicide prevention is recognizing the connection between substance use and suicide. Drug addiction prevention campaigns are always working hand-in-hand with suicide prevention campaigns in local communities.

Drug and alcohol addiction, such as alcohol and opioid use disorders, for example, significantly increases the risk of suicidal ideation, attempts, and death. These are generally the two most implicated substances in suicide risk.

The risk of suicidal thoughts and behavior is elevated with acute alcohol intoxication and chronic alcohol use or dependence. The same applies to opioid use, as it can increase the risk of suicide and unintentional overdose caused by opioids alone or polysubstance use.

According to the American Foundation for Suicide Prevention, suicide is the 9th leading cause of death in Arizona. It is the second leading cause of death among those aged 10 to 34 in the state. Unfortunately, 91% of communities in Arizona did not have enough mental health providers to serve residents in 2023. It’s estimated that almost four times as many people died by suicide in Arizona than in alcohol-related motor vehicle accidents.

Fortunately, prevention campaigns work and increase awareness surrounding substance use and suicide. Anyone can take action today by knowing simple things, such as dialing 988 for the Suicide and Crisis Lifeline, a 24-7 free and confidential support for people in distress.

Locally, there is an Arizona Statewide Crisis Hotline, where anyone can phone 1-844-534-HOPE(4673) or text 4HOPE(44673).

We must all work to change the conversation from suicide to suicide prevention. There are actions that anyone can take to help and give hope to those who are struggling. Consider some of the following pointers.

Ask, do not beat around the bush, but ask that person how they are doing and if they are thinking about suicide. Acknowledging and talking about suicide reduces suicidal ideation. Be there for that person, and they will feel less depressed, less suicidal, and less overwhelmed.

Keep them safe and help them stay connected. When lethal means are made less available or less deadly, the frequency and risks of suicide decline. Moreover, the hopelessness subsides when you help that person create a support network of resources and individuals.

Most importantly, maintain contact, follow up, and see them in person as frequently as possible. This is a critical part of suicide prevention, along with always learning more about prevention and awareness.

However, this process is not bulletproof, and we must recognize there are countless instances of individuals taking their lives and giving no indication or red flag they were suicidal. But if we can keep changing the conversation, breaking down the walls of stigma, and making the resources accessible, more people may ask for help before it is too late.

Marcel Gemme is the founder of SUPE and has been helping people struggling with substance use for over 20 years. His work focuses on a threefold approach: education, prevention, and rehabilitation.

Source: https://gilavalleycentral.net/suicide-prevention-is-an-important-part-of-drug-education/

Filed under: Addiction,Alcohol,Drug use-various effects,Mental Health,USA :

Methods: We recruited 58 MA-dependent young adult females from a compulsory isolation drug rehabilitation center in Sichuan Province and randomly divided them into an MBRP group (n = 29) and a control group (n = 29) according to their degree of psychological craving. The MBRP group received 2 hours of MBRP training twice a week for 4 weeks, alongside routine treatment at the drug rehabilitation center. Meanwhile, the control group solely received routine treatment at the drug rehabilitation center without any additional interventions. The assessment was conducted before and immediately after the intervention, with the Compulsive Drug Use Scale (OCDUS) used to assess craving and the Five-Factor Mindfulness Scale (FFMQ) used to assess trait mindfulness. Also, a “mental feedback monitoring balance” instrument was used to assess concentration and relaxation during some training sessions. This randomized trial was conducted to evaluate the effectiveness of decreasing psychological craving and increasing trait mindfulness.

Results: At baseline, there were no significant differences in total or dimension scores for FFMQ or OCDUS between the two groups (all P > 0.05). After the intervention, the repeated measures ANOVA showed a significant time main effect on changes in observing, non-judging, and non-reacting scores (all P < 0.05), and a significant interaction effect between time and group on both FFMQ total score and OCDUS score (P < 0.01 or P < 0.05). Mental feedback monitoring indicated significant improvement in concentration and relaxation after breath meditation exercises (P < 0.05 or P < 0.001). Additionally, the MBRP group showed improved relaxation during the body scan exercise (P < 0.01).

Conclusion: MBRP training can improve the trait mindfulness of MA addicts and reduce psychological cravings effectively.

The full article can be accessed via the source link below:

Source: https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2024.1339517/full

Filed under: Addiction,Mental Health,Methamphetamine/GHB/Hallucinogens/Oxycodone,Others (International News),Prevention and Intervention,Treatment and Addiction :

Past-year use of cannabis and hallucinogens stayed at historically high levels in 2023 among adults aged 19 to 30 and 35 to 50, according to the latest findings from the Monitoring the Future survey. In contrast, past-year use of cigarettes remained at historically low levels in both adult groups. Past-month and daily alcohol use continued a decade-long decline among those 19 to 30 years old, with binge drinking reaching all-time lows. However, among 35- to 50-year-olds, the prevalence of binge drinking in 2023 increased from five and 10 years ago. The Monitoring the Future study is conducted by scientists at the University of Michigan’s Institute for Social Research, Ann Arbor, and is funded by the National Institutes of Health.

 

Source: https://monitoringthefuture.org/

Filed under: Addiction,Alcohol,Cannabis/Marijuana,USA :

October 1, 2024

By Nora Volkow, MD, Director, and Rita Valentino, Ph.D., Director, Division of Neuroscience and Behavior, NIDA

This blog was originally posted on the The BRAIN Blog.

The BRAIN Initiative is marking a milestone—10 years of advancing neuroscience and neurotechnology research by funding innovative projects. As part of a rotating series of blog posts, the directors of the BRAIN Initiative-partnering Institutes and Centers share their voice and perspectives on the impact BRAIN has made on their respective missions—and vice versa.

This year marks the 50th anniversary of the National Institute on Drug Abuse (NIDA). The research NIDA has funded and conducted over five decades has greatly advanced the biomedical understanding of addiction as a treatable condition involving brain systems governing reward, emotion, stress, and self-control. NIDA research has helped pave the way for effective prevention, treatment, and harm reduction approaches, and opened up new pathways to recovery.

NIDA has been a key player in the BRAIN Initiative, as our Institute continues to apply these new tools and emerging knowledge to inform research about the science of drug use and addiction. As the United States continues to face a devastating overdose epidemic fueled in recent years by an influx of illicit fentanyl, NIDA’s scientific efforts are ever more important. Central to those efforts is our significant investment in basic neuroscience research. Since its launch a decade ago, the BRAIN Initiative has greatly aided and accelerated that research. Tools developed through the BRAIN Initiative are catalyzing scientists’ ability to precisely monitor and manipulate brain activity at multiple scales, giving us an ever more fine-grained understanding of the brain mechanisms underpinning drugs’ effects and suggesting potential avenues for mitigating, preventing, or reversing those effects to heal the brain.

The BRAIN initiative has transformed neuroscience research at many levels. It has created a culture of team science that has led to development and dissemination of new tools that have been used to characterize gene expression with cellular resolution across multiple species, tools that allow visualizing and manipulating neural circuits, as well as new approaches to data science and computational modeling. Our staff who work on BRAIN Initiative program teams get a unique exposure to these approaches and technologies that will critically shape our Institute’s research in future years.

Advances made possible through the BRAIN Initiative will transform translational research by improving the validity and innovation of the models we use to probe mechanisms underlying substance use and use disorders—enriching our research community’s capacity to innovate. NIDA participation in the BRAIN Initiative provides opportunities to accelerate the application of these advances among the researchers who focus on these questions. And it enables NIDA to promote areas of focus where our Institute has been at the forefront, including investigation of non-neuronal cells (glia) and developmental studies that dovetail with the Adolescent Brain Cognitive Development (ABCD) study.

How has NIDA participated in the NIH BRAIN Initiative?

Several of NIDA’s scientific staff are members of BRAIN Initiative program teams, and our Institute leads or co-leads some key BRAIN projects. NIDA co-leads the team that is managing the Data Science and Informatics project, which is creating the informatics infrastructure needed for storing, sharing, and interpreting the vast quantities of data gathered by the BRAIN Initiative. NIDA also co-leads the Tools and Technologies for Brain Cells and Circuits research program, which is creating brain cell atlases of the neuronal and glial cells in the brain. This fundamental knowledge will be used to build viral vectors to monitor and manipulate brain function at the cellular level.

We are also a major supporter of the Brain Behavior Quantification and Synchronization Program (BBQS). This uniquely transdisciplinary program, which was just launched in 2022, is supporting the development and validation of novel tools and methods for quantifying complex behaviors and simultaneously recording brain activity. This program promises to transform behavioral and cognitive neuroscience by supporting research that will generate high-resolution tools for analyzing behavior and new computational and theoretical approaches for understanding behavior as a complex system. NIDA leads the BBQS emphasis area on organismal behavior.

Although it was just launched two years ago, the BRAIN BBQS concept has influenced multiple NIDA initiatives, including Translating Socioenvironmental Influences on Neurocognitive Development and Addiction Risk (TransSINDA), Mechanistic Studies on Social Behavior in Substance Use Disorder (in both humans and animal models), and the NIDA Animal Genomics Consortium. These initiatives support research that identifies cause-and-effect relationships between socioenvironmental factors and brain function that guide behavior.

Toward advancing the emergence of common marmosets as a promising animal model in neuroscience, NIDA has also played a leadership role in BRAIN’s transgenic marmoset initiative. This set of projects is aimed at developing novel tools and techniques for marmoset genome editing and male germline editing to facilitate research on genetic underpinnings of brain health and disease, as well as assisted reproduction techniques to increase the efficiency of these procedures.

What major BRAIN-funded scientific advancements or conversations has NIDA been a part of?

As one of the Institutes co-leading the BRAIN Initiative’s Tools and Technologies for Brain Cells and Circuits research program, NIDA has been closely involved in shaping and supporting the inventory and molecular mapping of cell classes across the whole mouse brain, and there are ongoing plans to accomplish the same in human and nonhuman primate brains.

A component of this program is the Cell Census Network, and among the brain regions of central interest in this project are the basal ganglia. The basal ganglia comprise the reward pathway and other circuits that play a major role in substance use disorders. Scientific staff at NIDA and several NIDA-funded grantees are participating in the effort to create a systematic map of this region to enhance our knowledge of its cellular and molecular architecture. This research could potentially lead to tools that could selectively target the basal ganglia’s cellular constituents, which would be a game changer for NIDA science.

Through BRAIN Initiative programs like BBQS mentioned above, NIDA has been co-leading discussions about advancing cause and effect relationships in human neuroscience research. We now have large neurocognitive datasets that can be mined and analyzed using large-scale network approaches, such as those generated by the Human Connectome Project and the ongoing ABCD study. These databases have enabled novel insights about fundamental brain function and neurocognitive dysfunction. For instance, ABCD is deepening our understanding of how environmental exposures affect neurocognition including revealing factors like economic disadvantage and social discrimination that can be targeted in prevention efforts. But while these datasets are excellent for identifying associations between network structure/function and behavior, they generally cannot help us establish causal relationships, leaving a gap in our ability to translate findings to clinical application.

Data derived from new methods and approaches like systematic circuit perturbation in combination with neural recordings in a behavioral context hold potential to fill this gap and significantly advance our understanding of these important cause and effect relationships in human neuroscience.

How has the BRAIN Initiative advanced or shaped NIDA’s mission?

Many tools developed through the BRAIN Initiative are helping NIDA scientists understand how drugs affect the brain, from cellular to circuit levels. For example, NIDA’s BRAIN-inspired research programs are already producing exciting findings. One of them is NIDA Single Cell Opioid Response in the Context of HIV, or SCORCH, which is applying single-cell sequencing-based approaches to inventory the cellular targets of drugs and the changes in those targets that drugs induce. A NIDA-funded team has recently identified a group of neurons in the dorsal peduncular nucleus, a brain region central to emotional regulation, reward, and motivation, that act as a master regulator of opioid reward.

Another NIDA initiative inspired by BRAIN is the Neural Ensembles and Used Substances (NExUS) Collaboratory, which seeks to integrate molecular information from cell taxonomies with measurement of neuronal population dynamics in behaving animals. NExUS aims to decipher how activity within the mosaic of brain cells “encode” particular properties of misused substances, such as the analgesic versus addictive properties of opioids. A NIDA-funded team has also recently used a mouse model to identify a brain circuit that mediates placebo pain relief.

In its 10 years, the BRAIN initiative has provided tools to visualize, monitor, and manipulate brain activity from molecular to network levels and has led to an exponential growth in understanding of how the brain functions. NIDA has been a key player in this effort, and our Institute continues to apply these new tools and emerging knowledge to inform research on urgent questions under its mission to advance the science of drug use and addiction.

Source: https://nida.nih.gov/about-nida/noras-blog/2024/10/brain-10-view-national-institute-drug-abuse

Filed under: Addiction,Brain and Behaviour,USA :
: CAPT Christopher Jones, Pharm.D., Dr.P.H., M.P.H., Director, Center for Substance Abuse Prevention

In October, SAMHSA celebrates Substance Use Prevention Month — an opportunity for the prevention field and prevention partners to highlight the importance and impact of prevention. And given the substance use and overdose challenges facing our country, prevention has never been more important. This month, each of us can inspire action by sharing how prevention is improving lives in communities across our nation.

As part of the Biden-Harris Administration and the U.S. Department of Health and Human Services’ Overdose Prevention Strategy, along with SAMHSA’s Strategic Plan, our prevention efforts aim to prevent substance use in the first place, prevent the progression of substance use to a substance use disorder, and prevent and reduce harms associated with use. Our grantees across the country are doing just that every day. Here are just a few quick stories of our grantees in action.

Pueblo of Zuni – Zuni Tribal Prevention Project
Zuni, New Mexico
(Strategic Prevention Framework-Partnerships for Success grant awardee, FY 2020)

In 2021, Pueblo of Zuni (Zuni Tribal Prevention Project) developed a Family Wellness Kit program to strengthen family communication during the COVID-19 pandemic. Family bonding, parent-child communication, and cultural identity (PDF | 818 KB) are protective factors against substance use and other youth risk behaviors.

The kits included culturally relevant family cohesion activities, and a new type of kit was distributed monthly (over 18 months) with:

  • Four activities (one for siblings; one for grandparents; one for the entire family; and one for siblings, grandparents, or family).
  • One activity guide with instructions.
  • Activity supplies.
  • One debrief guide with discussion prompts.
  • One parent/caregiver skill development guide on active listening, validation, effective communication, family engagement, positive discipline, and setting boundaries.

Staff follow-up every three months to check-in with the families: 72 activities had been developed, and 85 percent of 102 registered families completed the program. Families appreciated the integration of Zuni culture in the kits and enjoyed completing the activities together. They also reported spending more quality time together, growing closer, and communicating more.

A participant described the benefit as, “…being together as a family and just having more conversations; we even show more affection, like giving hugs and saying, ‘I love you.’” Families also said that they continued using the activities and created more family routines such as family nights and putting away cell phones during family times like dinner.

Connecticut Department of Mental Health and Addiction Services, Prevention and Health Promotion Division – Know Ur Vape
(Substance Use Prevention, Treatment, and Recovery Services Block Grant recipient)

In 2022, the Connecticut Department of Mental Health and Addiction Services (DMHAS) Prevention and Health Promotion Division partnered with Connecticut Clearinghouse and Connecticut’s Tobacco Enforcement division to develop a vaping prevention campaign.

Launched in 2023, Know Ur Vape leverages the power of social media influencers and the social media trend of “unboxing” videos to reach youth and young adults. The campaign seeks to prevent vaping initiation among teens and young adults and encourage quitting among those who vape.

Each video starts out in a familiar way, then features a surprising plot twist, and concludes with a health message and a resource. Each influencer receives one of three themed boxes: sports, beauty, or mystery. As they open the box and interact with the contents, their reactions indicate excitement, confusion, concern, and then displeasure. The videos demonstrate the negative effects of vaping, including its addictive and disruptive nature, impairment to athletic performance, and harmful effects on skin and physical appearance.

Influencers include University of Connecticut athletes. As part of the campaign, television personality Nia Moore sat down with Megan Albanese of Southington STEPS coalition on Instagram Live to discuss her negative experiences with vaping.

In the campaign’s first three months, the videos were viewed 177,656 times on social media, with 18,905 likes and 776 comments. On TikTok, the videos received 113,904 views and on Instagram, one post received 24,600 views. The campaign was featured on the Drug Enforcement Administration’s Just Think Twice website and the CADCA website.

West Virginia Departments of Health and Human Services – Overdose Prevention and Response
(First Responders – Comprehensive Addiction and Recovery Act grant awardee, FY 2022)

The Police and Peers Initiative in the Fayette, Kanawha, Monongalia, Nicholas, and Preston counties of West Virginia places Peer Recovery Support Specialists (PRSS) with law enforcement to enhance care for people in crisis. The initiative established partnerships with local Quick Response Teams, Law Enforcement Assisted Diversion teams, and others in the community.

PRSS provide opioid reversal, case management, and motivational interviewing services; linkage to addiction treatment, social services, support programs; and customized action plans based on the individual’s self-identified needs. This enhances quality of care and services and reduces the burden on law enforcement officers (who can then focus on public safety).

Since 2022, the program has linked 120 people to treatment and 110 to psychosocial support services (housing, clothing, basic needs, employment, etc.) as well as distributed 262 naloxone kits and 780 fentanyl test strips.

Early in the initiative, a Fayette County Sheriff’s Deputy contacted a PRSS about an overdose incident. The PRSS met with the individual, who chose to enroll in an outpatient Medication for Opioid Use Disorder program. This person has now sustained over eight months of recovery, gained employment, reinstated their driver’s license, and bought a vehicle.

During an Oak Hill Police Department callout, a PRSS de-escalated a disturbance. The peer connected three people to treatment — all of whom completed treatment — and one person was reunited with their children while maintaining recovery.

With the Kingwood Police Department (starting in April 2024), PRSS activities include collaborating with the municipal court, training the fire department on naloxone administration, participating in ride-alongs, attending coalition meetings, and developing a street outreach plan.

Prairie Band Potawatomi Nation – Walking in 2 Worlds
Mayetta, Kansas
(Tribal Behavioral Health grant awardee)

Prairie Band Potawatomi Nation hosted a two-day workshop to help human services professionals support the Native Two-Spirit, lesbian, gay, bisexual, transgender, queer (2SLGBTQ) population. The “Walking in 2 Worlds” event educated professionals and community members about the struggles and complexities of 2SLGBTQ adults and youth across Indian Country.

Issues for these individuals include isolation; homelessness; job insecurity; racism; stigma; and increased risks of substance use, substance use disorders, overdose, violence, suicide, and human trafficking victimization. Many cases of violence and human trafficking go unreported, due to multiple (and intersecting) barriers faced by this population, and a lack of supportive services tailored to address their unique needs.

The workshop benefitted from speakers who shared personal stories, documentary films, and technical assistance from SAMHSA’s Native Connections training and technical assistance.

Resources to Tell Your Prevention Story

Prevention has never been more important. As a nation, we continue to face significant substance use and mental health challenges, especially among youth and young adults. Prevention works and helps us get ahead of these challenges so that youth, families, and communities can thrive.

Prevention Month is a key opportunity to elevate the national conversation and showcase prevention’s positive effects on communities across the country. Here are ideas and resources for you to tell your prevention story.

To Tell Your Story During Prevention Month:

  • Download the Substance Use Prevention Month toolkit — which includes social media messages, graphics, email signature graphic, virtual meeting background, and resources.
  • Share your #MyPreventionStory on social media.

To Get Involved Year-round:

To Put Prevention Science into Practice:

In determining which grantees to highlight for this blog, SAMHSA’s Center for Substance Abuse Prevention staff (including government project officers) looked across CSAP’s prevention portfolio to identify grantees that represent the scope of our prevention portfolio and would reflect: diversity in population served or population of focus (e.g., age, ethnicity, sexual orientation, social context of family or individual), geographic diversity of the programs (e.g., rural, urban, and regions), outcome of focus (e.g., upstream prevention or preventing a downstream outcome such as overdose), and diversity in prevention strategies implemented (e.g. social media and public messaging, naloxone distribution and training, individual programs, family programs).

Source: https://www.samhsa.gov/blog/substance-use-prevention-month-telling-prevention-story

Filed under: Addiction,Drug use-various effects,Prevention and Intervention,USA :
Dr. Robert DuPont (NIDA, USA) shifted the paradigm from demonization to treatment of users.

Key points

  • In the 1970s, people addicted to opioids were demonized, considered hopeless. Some still believe this.
  • Setting high standards and following addicted patients for five years helps doctors know what treatments work.
  • Prevention is key to success in substance abuse, and it’s important to encourage non-use among teens.
In the United States, people addicted to opioids were once demonized as hopelessly bad, and treatment was virtually nonexistent. No one may have done more to change both matters than psychiatrist Robert DuPont, M.D, who, in 1969, during an unexplained surge in crime in the nation’s capital, was working with prisoners in the District of Columbia Department of Corrections. DuPont decided to test incoming inmates for drugs and was shocked to learn that nearly half (45%) were addicted to heroin. Desperate for heroin, they turned to crime for money.

At the behest of the district’s mayor, DuPont developed a D.C.-based clinic, the Narcotics Treatment Administration. It treated more than 15,000 heroin addicts over the next three years, and the D.C. crime rate plummeted by 50%, in a direct correlation.

Helping Medical Professionals Do Better

Robert L. “Bob” DuPont, born in 1936, graduated from Emory University and Harvard Medical School and completed his psychiatric training at the National Institutes of Health. He became the first director of the newly-created National Institute on Drug Abuse (NIDA), where he created a first-of-its-kind comprehensive training program for doctors, nurses, and counselors working in addiction treatment programs. Drug overdose deaths began declining, from from 6,413 to 2,492 by 1980.

In 1978, DuPont left government service to create the Institute for Behavior and Health (IBH), a think tank focusing on drug policy. Dupont has published more than 400 journal articles and 15 books, most recently Chemical Slavery: Understanding Addictions and Stopping the Drug Epidemic (2018).

The IBH conducted the first national study of doctors dependent on drugs and alcohol, their treatment, and five-year outcomes. “Physicians are given a comprehensive assessment by a team of professionals and get treatment for comorbidities, but the focus is on their addictions. They typically attend a month or more of residential treatment and, as outpatients, are monitored for five years with random drug and alcohol testing. If they miss a scheduled test or test positive for any drug, including alcohol, they are taken out of their practice again, assessed, and sent back to treatment.”

DuPont points out that many doctors who entered the program were initially resentful because they didn’t think there was anything wrong with them—typical of individuals with substance use disorder from all walks of life. Yet, most physicians greatly value their medical license, and the overwhelming majority cooperated because participation and success meant they could continue to practice medicine.

His study of nearly 1,000 drug-addicted physicians closely monitored for five years showed what is possible for the rest of the population. Seventy-eight percent never tested positive for drugs or alcohol, an excellent record. In addition, of those who did have a positive or missed drug test, nearly two-thirds never had a second positive test.

A follow-up study of physicians who successfully completed treatment and monitoring contracts five or more years ago showed that more than 95% were still in recovery. Physicians rated the treatment they had received as important to their recovery but said the most valued part of their care was involvement in the 12 steps.

Lessons Learned About Substance Abuse

DuPont says many people don’t realize that it’s rarely just one drug abused by most problematic substance users. And that is particularly true of individuals who die from drug overdoses, in whom two or more drugs are often identified post-mortem.

He also notes that many drugs used today are not in their natural forms but instead are ultra-potent synthetics, like fentanyl. In 2022, about 111,000 people died, and in 2023, about 108,300 people died of drug overdose. .

Early diagnosis and treatment is key

The earlier patients are diagnosed and treated, the better their chances of achieving and sustaining recovery, says DuPont. Many people can stop using substances for some period. However, the real problem is not drug withdrawal, as many people believe, but, instead, the repeated relapses. Yet he has known many individuals with seemingly hopeless drug or alcohol issues who emerged sober and productive. He largely credits organizations like Alcoholics Anonymous and Narcotics Anonymous.

Prevention is best

Whenever possible, prevention of drug use is best, particularly among young people. Not only is adolescence a time when most addictions begin, it’s also a time when the brain is uniquely vulnerable..

DuPont now focuses on youth substance-use prevention: no alcohol, nicotine, marijuana/THC, or other drugs by those under age 21. He notes that the percentage of 12th graders who report never using in their lifetime has increased from around 26% in 2018 to 32% in 2023. The trend is also evident in younger students. DuPont emphasizes, “This trend is key to reversing decades of pain, suffering, and addictions.“

At age 88, Robert DuPont, M.D., advocates for treatment research, long-term treatment with outcome reporting, mental health treatment parity (as important as physical health), and prevention. Recovery, he insists, is possible.

About the Author

Mark S. Gold, M.D., is a pioneering researcher, professor, and chairman of psychiatry at Yale, the University of Florida, and Washington University in St Louis. His theories have changed the field, stimulated additional research, and led to new understanding and treatments for opioid use disorders, cocaine use disorders, overeating, smoking, and depression.

Source: https://www.psychologytoday.com/gb/blog/addiction-outlook/202408/a-front-row-change-agent-of-the-drug-epidemic
Filed under: Addiction,Prevention and Intervention,Treatment and Addiction,USA :
Bethesda, Maryland  / Monday, August 19, 2024

The National Institutes of Health (NIH) has launched a programme that will support Native American communities to lead public health research to address overdose, substance use, and pain, including related factors such as mental health and wellness. Despite the inherent strengths in Tribal communities, and driven in part by social determinants of health, Native American communities face unique health disparities related to the opioid crisis. For instance, in recent years, overdose death rates have been highest among American Indian and Alaska Native people. Research prioritized by Native communities is essential for enhancing effective, culturally grounded public health interventions and promoting positive health outcomes.

“Elevating the knowledge, expertise, and inherent strengths of Native people in research is crucial for creating sustainable solutions that can effectively promote public health and health equity,” said Nora D. Volkow, M.D., director of NIH’s National Institute on Drug Abuse (NIDA). “As we look for ways to best respond to the overdose crisis across the country, it is crucial to recognize that Native American communities have the best perspective for developing prevention and therapeutic interventions consistent with their traditions and needs. This programme will facilitate research that is led by Native American communities, for Native American communities.”

Totaling approximately $268 million over seven years, pending the availability of funds, the Native Collective Research Effort to Enhance Wellness (N CREW) Programme will support research projects that are led directly by Tribes and organizations that serve Native American communities, and was established in direct response to priorities identified by Tribes and Native American communities.

Many Tribal Nations have developed and continue to develop innovative approaches and systems of care for community members with substance use and pain disorders. During NIH Tribal Consultations in 2018 and 2022, Tribal leaders categorized the opioid overdose crisis as one of their highest priority issues and called for research and support to respond. They shared that Native communities must lead the science and highlighted the need for research capacity building, useful real-time data, and approaches that rely on Indigenous Knowledge and community strengths to meet the needs of Native people.

The N CREW Programme focuses on: Supporting research prioritized by Native communities, including research elevating and integrating Indigenous Knowledge and culture; Enhancing capacity for research led by Tribes and Native American Serving Organizations by developing and providing novel, accessible, and culturally grounded technical assistance and training, resources, and tools; Improving access to, and quality of, data on substance use, pain, and related factors to maximize the potential for use of these data in local decision-making.

“Native American communities have been treating pain in their communities for centuries, and this programme will uplift that knowledge to support research that is built around cultural strengths and priorities,” said Walter Koroshetz, M.D., director of NIH’s National Institute of Neurological Disorders and Stroke (NINDS). “These projects will further our collective understanding of key programmes and initiatives that can effectively improve chronic pain management for Native American and other communities.”

The first phase of the programme will support projects to plan, develop, and pilot community-driven research and/or data improvement projects to address substance use and pain. In this phase, NIH will also support the development of a Native Research Resource Network to provide comprehensive training, resources, and real-time support to N CREW participants.

The second phase of the program, anticipated to begin in fall 2026, will build on the work conducted in the initial phase of the program to further capacity building efforts and implement community-driven research and/or data improvements projects. Additional activities that support the overarching goals of the N CREW Programme may also be identified as the program develops.

The N CREW Programme is led by the NIH’s NIDA, NINDS, and National Center for Advancing Translational Sciences (NCATS), with participation from numerous other NIH Institutes, Centers, and Offices. The N CREW Program is funded through the NIH Helping to End Addiction Long-term Initiative (or NIH HEAL Initiative), which is jointly managed by NIDA and NINDS. For the purposes of the N CREW Programme, Native Americans include American Indians, Alaska Natives, and Native Hawaiians. Projects will be awarded on a rolling basis and publicly listed.

This new programme is part of work to advance the Biden/Harris Administration’s Unity Agenda and the HHS Overdose Prevention Strategy.

Source: https://www.pharmabiz.com/NewsDetails.aspx?aid=171961&sid=2
Filed under: Addiction,Drug use-various effects,Mental Health,Prevention and Intervention,USA :
Posted on 02/08/2024

Herschel Baker of Drug Free Australia has shared research references showing links between marijuana use and violence across the globe.

 

  1. A Review of Cases of Marijuana and Violence

The main scope of this paper was to inform the general public about the relationships between marijuana and violence in the general population and in individuals with mental illnesses, as recent findings do link marijuana with cases where psychosis was present. This article is a case review and not a research study; therefore, the chief limitations regard inferences that can be made from a case study. However, the findings suggest a further need for research on marijuana and violence. The authors of this paper did not intend to take sides regarding the legalization of marijuana. The focus was public health in regards to marijuana [2,11,14,18,36]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7084484/

  1. The Relationship Between Marijuana Use and Intimate Partner Violence in a Nationally Representative, Longitudinal Sample   These findings have a number of implications for intimate partner violence prevention. First, given that any marijuana use appears to increase the risk for intimate partner violence, violence-prevention strategies should include early and continued marijuana prevention efforts in existing intimate partner violence treatment and prevention programming. Second, knowledge regarding the link between marijuana use and intimate partner violence could be used to inform domestic violence treatment providers of issues related to intimate partner violence recidivism. If early and continual marijuana treatment is emphasized as an important component of domestic violence treatment, then repeat occurrences of intimate partner violence among marijuana users may be reduced. Third, recognizing that there is a shared overlap between intimate partner violence perpetration and victimization and that marijuana use is a strong predictor for experiencing both outcomes, programs and policies that incorporate the complex relationship between marijuana and intimate partner violence could be developed to offer a more comprehensive treatment regimen. These holistic approaches are likely to be more beneficial than the current programs that are often “client specific” (e.g., they only serve drug users, or victims, or perpetrators; Karmen, 2007). Fourth, the finding that males are at increased risk for intimate partner vioence indicates that males should be included in intimate partner violence prevention programming, which has traditionally been reserved for women. Culturally specific programming may also be relevant, as different risk fac[1]tors may be present for Blacks compared with other groups, which may increase their risk for intimate partner violence. Future research is necessary to delineate these cultural-specific risk factors. Finally, the findings from this study may shed light on the potential harms of legislation legalizing marijuana use, as increased access to marijuana may increase use and, therefore, increase the harm associated with marijuana use (e.g., domestic violence, chronic diseases, and unintentional injuries). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3782298/.

3, Association Between the Use of Cannabis and Physical Violence in Youths: A Meta-Analytical Investigation  https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2020.19101008These results demonstrate a moderate association between cannabis use and physical violence, which remained significant regardless of study design and adjustment for confounding factors (i.e., socioeconomic factors, other substance use). Cannabis use in this population is a risk factor for violence. A large study just published by a team from Montreal University in Canada has found that people who regularly smoke cannabis are almost three times more likely to commit a violent offence as those who abstain from the drug. The paper entitled “Association Between the Use of Cannabis and Physical Violence in Youths: A Meta-Analytical Investigation” and published in the American Psychiatric Association’s (APA) American Journal of Psychiatry did a meta-analysis of 30 studies which covered 296,815 people up to the age of 30. The study found that over time, prolonged cannabis use profoundly alters the brain, making the user less able to control their temper, and that addicts may also suffer from withdrawal symptoms, making them irritable and prone to lashing out. Psychiatrist Professor Sir Robin Murray, a world-leading expert on the neurological impact of the drug, was quoted in the media saying that the link between cannabis use and violence was a ‘neglected area’. The researchers say that while ‘the [scientific] literature has shown that cannabis use may lead to violent behaviours and aggression; however, this association has been inconsistent’ – with some studies showing a relationship and others not – their meta-analysis found users were more than twice as likely (2.15 times) to have committed a violent offence as non-users. Among ‘persistent heavy users’, the risk of violence was 2.81 times higher.

  1. Think Ya Know? Is Marijuana a Risk Factor for Violence? https://saynopetodope.org.nz/family-violence-child-abuse/
  1.  Association Between the Use of Cannabis and Physical Violence in Youths: A Meta-Analytical Investigationhttps://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2020.19101008These results demonstrate a moderate association between cannabis use and physical violence, which remained significant regardless of study design and adjustment for confounding factors (i.e., socioeconomic factors, other substance use). Cannabis use in this population is a risk factor for violence.
  2. Association of Cannabis Use With Self-harm and Mortality Risk Among Youths With Mood Disordershttps://jamanetwork.com/journals/jamapediatrics/article-abstract/2775255?utm_campaign=articlePDF&utm_medium=articlePDFlink&utm_source=articlePDF&utm_content=jamapediatrics.2020.5494 Cannabis use disorder is a common comorbidity and risk marker for self-harm, all-cause mortality, and death by unintentional overdose and homicide among youths with mood disorders. These findings should be considered as states contemplate legalizing medical and recreational marijuana, both of which are associated with increased CUD.
  3. Cannabis and Cannabinoids in Mood and Anxiety Disorders: Impact on Illness Onset and Course, and Assessment of Therapeutic Potentialhttps://pubmed.ncbi.nlm.nih.gov/31577377/ Forty-seven studies were included: 32 reported on illness onset, nine on illness course, and six on cannabinoid therapeutics. Cohort studies varied significantly in design and quality. The literature suggests that cannabis use is linked to the onset and poorer clinical course in bipolar disorder and PTSD, but this finding is not as clear in depression and anxiety disorders (ADs). There have been few high-quality studies of cannabinoid pharmaceuticals in clinical settings.
  4. Association of Cannabis Use in Adolescence and Risk of Depression, Anxiety, and Suicidality in Young Adulthood A Systematic Review and Meta-analysis https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2723657?utm_campaign=articlePDF&utm_medium=articlePDFlink&utm_source=articlePDF&utm_content=jamapsychiatry.2018.4500 Although individual-level risk remains moderate to low and results from this study should be confirmed in future adequately powered prospective studies, the high prevalence of adolescents consuming cannabis generates a large number of young people who could develop depression and suicidality attributable to cannabis. This is an important public health problem and concern, which should be properly addressed by health care policy.
  5. Young-adult compared to adolescent onset of regular cannabis use: A 20-year prospective cohort study of later consequenceshttps://pubmed.ncbi.nlm.nih.gov/33497516/ Initiation of regular cannabis use after high school strongly predicted smoking and illicit drug use in the mid-30s. This group also accounted for a higher proportion of illicit drug use and smoking in the cohort. Sensitivity analyses suggested that this association was at least partially causal. Given the legalisation of cannabis use in an increasing number of jurisdictions, we should increasingly expect harms from cannabis use to lie in those commencing use in young adulthood.

10  Association between Alcohol, Cannabis and Other Illicit Substance Abuse and Risk of Developing Schizophrenia: A Nationwide Population Based Register Study https://www.cambridge.org/core/journals/psychological-medicine/article/abs/association-between-alcohol-cannabis-and-other-illicit-substance-abuse-and-risk-of-developing-schizophrenia-a-nationwide-population-based-register-study/8914A1F1A0CBFBF17982720CBE2C2451 In conclusion, the consumption of substances is an extensive problem throughout the world and a current debate on legalizing cannabis in many countries has made uncovering the risk of abusing substances an important area of investigation (21,36). We found robust associations between a wide variety of substance abuse and an increased risk of developing schizophrenia. We are not aware of any other study focusing on the effect of such a wide variety of substance abuse and the interaction between the abuses as our study.

  1. Association of High-Potency Cannabis Use With Mental Health and Substance Use in Adolescence https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2765973 In conclusion, the consumption of substances is an extensive problem throughout the world and a current debate on legalizing cannabis in many countries has made uncovering the risk of abusing substances an important area of investigation (21,36). We found robust associations between a wide variety of substance abuse and an increased risk of developing schizophrenia. We are not aware of any other study focusing on the effect of such a wide variety of substance abuse and the interaction between the abuses as our study.
  1. Cannabis use and violence in patients with severe mental illnesses: A metanalytical investigation https://pubmed.ncbi.nlm.nih.gov/30780061/

With the upcoming policy changes on cannabis internationally such as the 2018 Canadian legalization of cannabis, it is of high importance to better investigate its potential harmful effects on violence mostly in more vulnerable psychiatric populations to devise effective interventions. Cannabis use should be considered in violence risk prevention and management.

  1. Professor Dame Carol Black Inquiry Violence Stories Violent deaths/injuries caused by cannabis users

https://www.cannabisskunksense.co.uk/uploads/site-files/Professor_Dame_Carol_Black_Inquiry_Cannabis_Violent_stories.pdfMales 53 Females 5 Methods: Stabbings: 19 Shootings: 21 Killing by hand: 4 (eg. Throttling, Beating, Battering, Jaw breaking) Axe: 1 Drowning: 1 Beheading: 2 Chased/run down by vehicle: 2 Bombings: 4 Victims: Relatives: 17 Strangers: 25 Friends: 6 Obama: 1 Mass killings 11 Possible Links with terrorists 6

  1. Attacker Smoked Cannabis: suicide and psychopathic violence in the UK and Ireland“Those whose minds are steeped in cannabis are capable of quite extraordinary criminality.” https://attackersmokedcannabis.com/
  1. Easton Woodhead suffering from marijuana-smoking psychosis in the lead-up to killing of homeless man Wayne Perry

https://www.theage.com.au/national/victoria/easton-woodhead-suffering-from-marijuanasmoking-psychosis-in-the-leadup-to-killing-of-homeless-man-wayne-perry-20150302-13shuy.html

  1. At Least Eleven Pot-Related Homicides Since Legalization, DA    George Brauchler    Sayshttps://www.westword.com/news/marijuana-related-homicides-in-colorado-since-legalization-9345285
  2. Marijuana Is More Dangerous Than You Think https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6461328/

Some population-level data does exist, though. Research from Finland and Denmark, two countries that track mental illness more accurately, shows a significant increase in psychosis since 2000, following an increase in cannabis use. And last September, a large survey found a rise in serious mental illness in the U.S. too. In 2017, 7.5% of young adults met the criteria for serious mental illness, double the rate in 2008.

A 2012 paper in the Journal of Interpersonal Violence, examining a federal survey of more than 9,000 adolescents, found that marijuana use was associated with a doubling of domestic violence in the U.S. A 2017 paper in the journal Social Psychiatry and Psychiatric Epidemiology, examining drivers of violence among 6,000 British and Chinese men, found that drug use was linked to a fivefold increase in violence, and the drug used was nearly always cannabis.

Source: https://www.dbrecoveryresources.com/2024/08/marijuana-and-violence-2/

Filed under: Addiction,Australia,Cannabis/Marijuana,Crime/Violence/Prison,Youth :

Tuesday, July 30, 2024

Today, the U.S. Department of Health and Human Services’ (HHS) Substance Abuse and Mental Health Services Administration (SAMHSA) released the results of the 2023 National Survey on Drug Use and Health (NSDUH), which shows how people living in United States reported their experience with mental health conditions, substance use and pursuit of treatment. The 2023 NSDUH report includes selected estimates by race, ethnicity and age group. The report is accompanied by two infographics offering visually packaged highlight data as well as visual data by race and ethnicity.

“Each year, data from the annual NSDUH provides an opportunity to identify and address unmet healthcare needs across America. We’re pleased to see that more people received mental health treatment in 2023 than the previous year,” said Miriam E. Delphin-Rittmon, Ph.D., HHS Assistant Secretary for Mental Health and Substance Use and the leader of SAMHSA. “Also, to build upon increasing accessibility to data, this year’s release features two infographic reports: one focusing on race and ethnicity and one highlighting selected overall data.”

The 2023 NSDUH Report includes the following selected key findings.

Mental Health:

  • Among adults aged 18 or older in 2023, 22.8% (or 58.7 million people) had any mental illness (AMI) in the past year.
  • 4.5 million youth (ages 12 to 17) had a major depressive episode in the past year, of which nearly 1 in 5 also had a substance use disorder.
  • Among adults aged 18 or older in 2023, 5.0% (or 12.8 million people) had serious thoughts of suicide, 1.4% (or 3.7 million people) made a suicide plan, and 0.6% (or 1.5 million people) attempted suicide in the past year.
  • Multiracial adults aged 18 or older were more likely than adults in most other racial or ethnic groups to have AMI, serious mental illness (SMI), and serious thoughts of suicide.
  • Estimates of suicidal thoughts and behaviors among adults in 2023 were comparable to 2022 and 2021.

Substance Use:

  • In 2023, 3.1% of people (8.9 million) misused opioids in the past year, which is similar to 2022 and 2021 (3.2% and 8.9 million, 3.4% and 9.4 million respectively).
  • Among the 134.7 million people aged 12 or older who currently used alcohol in 2023, 61.4 million people (or 45.6%) had engaged in binge drinking in the past month.
  • Marijuana was the most commonly used illicit drug, with 21.8% of people aged 12 or older (or 61.8 million people) using it in the past year.
  • American Indian or Alaska Native and Multiracial people were more likely than most other racial or ethnic groups to have used substances or to have had an SUD in the past year.
  • In 2023, 9.4% of people aged 12 or older vaped nicotine in the past month, up from 8.3% in 2022.
    • In the past year, more people initiated vaping (5.9 million people) compared to any other substance.
    • Nicotine vaping estimates from 2021 are not comparable with estimates from 2022 and 2023.

Services and Recovery:

  • 31.9% of adolescents aged 12 to 17 (or 8.3 million people) received mental health treatment in the past year, an increase of more than 500,000 from 2022.
  • 23.0% of adults aged 18 or older (or 59.2 million people) received mental health treatment in the past year, an increase of 3.4 million from 2022.
  • Among people aged 12 or older in 2023 who were classified as needing substance use treatment in the past year, about 1 in 4 (23.6% or 12.8 million people) received substance use treatment in the past year. People were classified as needing substance use treatment in the past year if they had a substance use disorder (SUD) or received substance use treatment in the past year.
  • 30.5 million adults aged 18 or older (or 12.0%) perceived that they ever had a substance use problem. Among these adults, 73.1% (or 22.2 million people) considered themselves to be in recovery or to have recovered.
  • 64.4 million adults aged 18 or older (or 25.3%) perceived that they ever had a mental health issue. Among these adults, 66.6% (or 42.7 million people) considered themselves to be in recovery or to have recovered.
  • There were no racial ethnic differences among adults aged 18 or older in 2023 who perceived that they ever had a substance use problem or problem with their mental health who considered themselves to be in recovery or to have recovered from their drug or alcohol use problem or mental health issue.

About the National Survey on Drug Use and Health

Conducted by the federal government since 1971, the NSDUH is a primary source of statistical information on self-reported substance use and mental health of the U.S. civilian, noninstitutionalized population 12 or older. For the 2023 NSDUH national tables and some reports, statistical testing was conducted between estimates from different years (e.g., past month alcohol use in 2023 vs. the estimate in 2022). Where testing involved 3 years of comparable data for 2021 to 2023, pairwise testing was conducted between estimates in these years (i.e., 2021 vs. 2022, 2021 vs. 2023, and 2022 vs. 2023). Statistical tests for overall trends from the baseline year to the current year will not be conducted until four comparable NSDUH data points are available. The NSDUH measures include:

  • Use of illegal drugs, prescription drugs, alcohol, and tobacco,
  • Substance use disorder and substance use treatment,
  • Major depressive episodes, suicidal thoughts and behaviors, and other symptoms of mental illness, mental health care, and
  • Recovery from substance use and mental health disorders.

Addressing the nation’s mental health crisis and drug overdose epidemic is a top priority of the Biden-Harris Administration and are core pillars of the Administration’s Unity Agenda. The President’s Unity Agenda is operationalized through the HHS Overdose Prevention Strategy, the HHS Roadmap for Behavioral Health Integration, and the National Strategy for Suicide Prevention.

If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat at 988lifeline.org. To learn how to get support for mental health, drug or alcohol issues, visit FindSupport.gov. If ready to locate a treatment facility or provider, go directly to FindTreatment.gov or call 800-662-HELP (4357).

 

The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services (HHS) that leads public health efforts to advance the behavioral health of the nation. SAMHSA’s mission is to lead public health and service delivery efforts that promote mental health, prevent substance misuse, and provide treatments and supports to foster recovery while ensuring equitable access and better outcomes.

Last Updated:
Source: https://www.samhsa.gov/newsroom/press-announcements/20240730/samhsa-releases-annual-national-survey-drug-use-and-health
Filed under: Addiction,Alcohol,Cannabis/Marijuana,Cocaine,Heroin/Methadone,Mental Health,Treatment and Addiction,USA :

07/08/2024

Founded in 2015 by Christina von Sperling Afridi and her husband, Ambassador Tariq Khan Afridi, in the wake of their son’s death, the Karim Khan Afridi Welfare Foundation’s (KKAWF) mission is to raise awareness of the tragic consequences of drug addiction among Pakistani youth – The KKAWF is a member of the Dianova network – Image: young female student in Karachi (Pakistan), Photo by Muneer ahmed ok on Unsplash

In a significant move towards strengthening drug prevention initiatives in Pakistan, the First Meeting of the National Narcotics Control Committee (NNCC) witnessed notable mentions of the Karim Khan Afridi Welfare Foundation (KKAWF). Constituted under the National Anti-Narcotics Policy 2019 by the Ministry of Narcotics Control, the NNCC aims to consolidate and coordinate nationwide efforts against narcotics. The KKAWF’s impactful work in drug prevention and awareness among the youth has been prominently recognized, reflecting the foundation’s growing influence and contribution to this critical issue.A particularly commendable mention was made in a letter from the Ministry of Federal Education and Professional Training, highlighting the inclusion of KKAWF’s ‘Hum Sath Hain’ prevention program. This innovative initiative has already made substantial strides in combating drug abuse at the grassroots level. Over 300 teachers from public schools have been trained under this program, equipping them with the necessary skills and knowledge to educate and guide their students about the dangers of drug abuse. These trained educators are now actively implementing the ‘Hum Sath Hain’ program in their respective schools, directly impacting thousands of students and fostering a drug-free culture among the youth.

The Ministry’s letter, which was attached to the Minutes of the First Meeting of the NNCC, further highlighted the certification of three Master Trainers from the Federal Directorate of Education (FDE) by KKAWF. This certification is a testament to the foundation’s commitment to quality and sustainable training programs.

By empowering Master Trainers, KKAWF ensures that the knowledge and skills necessary for effective drug prevention are passed on, thereby creating a ripple effect that amplifies the program’s reach and impact.

The Foundation’s efforts were not only acknowledged through official documentation but also received commendation from key figures at the meeting. The Director General of Excise, Taxation and Narcotics Control Punjab, who was among the participants, praised KKAWF’s relentless efforts in drug prevention. This recognition from a high-ranking official underscores the importance and effectiveness of KKAWF’s initiatives.

KKAWF has consistently been at the forefront of drug prevention and awareness in Pakistan, focusing on educating young people about the dangers of drug use. The foundation’s programs are designed to address the root causes of drug abuse, providing youth with the tools and support they need to make informed choices. By collaborating with schools and educational institutions, KKAWF ensures that its messages reach young people in a structured and impactful manner.

The mention of KKAWF at the NNCC meeting signifies a broader acceptance and endorsement of its programs at the national level. Such recognition not only validates the foundation’s hard work but also provides it with a platform to expand its reach and influence. It opens doors for more collaborations with government bodies, educational institutions, and other stakeholders, thereby enhancing the collective efforts against drug abuse in the country.

In conclusion, the First Meeting of the National Narcotics Control Committee marked a significant milestone for the Karim Khan Afridi Welfare Foundation. The inclusion of their ‘Hum Sath Hain’ program in the official records, along with commendations from high-ranking officials, highlights the foundation’s vital role in drug prevention. As KKAWF continues to expand its initiatives and impact, it sets a commendable example for other organizations working towards a drug-free Pakistan.

Source: https://www.dianova.org/news/unite-for-a-drug-free-pakistan/

Filed under: Addiction,Others (International News),Prevalence,Prevention and Intervention :
12 Aug 2024

Substance abuse disorders are on the rise among young people. The American Addiction Center reports one in seven young adults are affected. Crisis coach Scott Silverman and youth drug prevention educator Rocky Herron joined the CBS 8 Morning Show with details.

Source: https://www.youtube.com/watch?v=K6BYoWOnAG8

Filed under: Addiction,Drug use-various effects on foetus, babies, children and youth,Prevention and Intervention,USA,Youth :

Effort aims to elevate Indigenous knowledge and culture in research, to respond to the overdose crisis and address related health disparities

The National Institutes of Health (NIH) has launched a program that will support Native American communities to lead public health research to address overdose, substance use, and pain, including related factors such as mental health and wellness. Despite the inherent strengths in Tribal communities, and driven in part by social determinants of health, Native American communities face unique health disparities related to the opioid crisis. For instance, in recent years, overdose death rates have been highest among American Indian and Alaska Native people. Research prioritized by Native communities is essential for enhancing effective, culturally grounded public health interventions and promoting positive health outcomes.

“Elevating the knowledge, expertise, and inherent strengths of Native people in research is crucial for creating sustainable solutions that can effectively promote public health and health equity,” said Nora D. Volkow, M.D., director of NIH’s National Institute on Drug Abuse (NIDA). “As we look for ways to best respond to the overdose crisis across the country, it is crucial to recognize that Native American communities have the best perspective for developing prevention and therapeutic interventions consistent with their traditions and needs. This program will facilitate research that is led by Native American communities, for Native American communities.”

Totaling approximately $268 million over seven years, pending the availability of funds, the Native Collective Research Effort to Enhance Wellness (N CREW) Program will support research projects that are led directly by Tribes and organizations that serve Native American communities, and was established in direct response to priorities identified by Tribes and Native American communities.

Many Tribal Nations have developed and continue to develop innovative approaches and systems of care for community members with substance use and pain disorders. During NIH Tribal Consultations in 2018 and 2022, Tribal leaders categorized the opioid overdose crisis as one of their highest priority issues and called for research and support to respond. They shared that Native communities must lead the science and highlighted the need for research capacity building, useful real-time data, and approaches that rely on Indigenous Knowledge and community strengths to meet the needs of Native people.

The N CREW Program focuses on:

  1. Supporting research prioritized by Native communities, including research elevating and integrating Indigenous Knowledge and culture
  2. Enhancing capacity for research led by Tribes and Native American Serving Organizations by developing and providing novel, accessible, and culturally grounded technical assistance and training, resources, and tools
  3. Improving access to, and quality of, data on substance use, pain, and related factors to maximize the potential for use of these data in local decision-making.

“Native American communities have been treating pain in their communities for centuries, and this program will uplift that knowledge to support research that is built around cultural strengths and priorities,” said Walter Koroshetz, M.D., director of NIH’s National Institute of Neurological Disorders and Stroke (NINDS). “These projects will further our collective understanding of key programs and initiatives that can effectively improve chronic pain management for Native American and other communities.”

The first phase of the program will support projects to plan, develop, and pilot community-driven research and/or data improvement projects to address substance use and pain. In this phase, NIH will also support the development of a Native Research Resource Network to provide comprehensive training, resources, and real-time support to N CREW participants.

The second phase of the program, anticipated to begin in fall 2026, will build on the work conducted in the initial phase of the program to further capacity building efforts and implement community-driven research and/or data improvements projects. Additional activities that support the overarching goals of the N CREW Program may also be identified as the program develops.

The N CREW Program is led by the NIH’s NIDA, NINDS, and National Center for Advancing Translational Sciences (NCATS), with participation from numerous other NIH Institutes, Centers, and Offices. The N CREW Program is funded through the NIH Helping to End Addiction Long-term Initiative (or NIH HEAL Initiative), which is jointly managed by NIDA and NINDS. For the purposes of the N CREW Program, Native Americans include American Indians, Alaska Natives, and Native Hawaiians. Projects will be awarded on a rolling basis and publicly listed.

This new program is part of work to advance the President’s Unity Agenda and the HHS Overdose Prevention Strategy.

Source:  https://nida.nih.gov/news-events/news-releases/2024/08/nih-launches-program-to-advance-research-led-by-native-american-communities-on-substance-use-and-pain

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

Dr. David R. Holtgrave, Ph.D., Joins the Department of Health as Senior Policy Advisor to the Commissioner to Enhance the Department’s Mission to End the Opioid Epidemic

ALBANY, N.Y. (August 15, 2024) – The New York State Department of Health is pleased to welcome nation-leading public health, prevention and substance use policy expert Dr. David R. Holtgrave, Ph.D., to the executive leadership team as Senior Policy Advisor to the Commissioner. Dr. Holtgrave joins the State Health Department with more than 35 years of public health experience, including serving in the White House Office of National Drug Control Policy from 2022-2024.

“Dr. Holtgrave is a national leader in drug prevention programs and a public health expert who comes to the State Health Department to help our fight against the overdose epidemic,” State Health Commissioner Dr. James McDonald said. “I’m thrilled to welcome Dr. Holtgrave to the executive leadership team, as we continue to rebuild the Department and hire experienced, compassionate public health experts.”

Dr. Holtgrave joins the Department with decades of experience addressing urgent public health issues, demonstrated by his development of an evidence-based national response plan to confront the emerging challenge of fentanyl combined with xylazine in the illegal drug supply, his rapid research to inform COVID-19 clinical decision making and his transitional work in addressing HIV-related health inequities in the U.S.

At the Department of Health, Dr. Holtgrave is charged with a range of activities all with the common theme of translating data into the best possible public health programs and policies for the residents of New York. In particular, he will focus on facilitating the substance use work in the Department to ensure that it is as coordinated, evidence-based and impactful as possible.

“I am honored and humbled by Commissioner McDonald’s invitation to join in the impactful work being done at the Department of Health,” Senior Policy Advisor to the Commissioner Dr. David Holtgrave said. “As the Department is committed to improving the health and well-being of all New Yorkers and building health equity across the State, I am delighted to be able to serve on this incredible team.”

Prior to his service in the White House Office of National Drug Control Policy, Dr. Holtgrave served as the Dean of the University at Albany School of Public Health and worked in close partnership with the New York State Department of Health.

From 2005 to 2018, he was the Chair of the Department of Health, Behavior, and Society at the Johns Hopkins Bloomberg School of Public Health, and served as a member and then Vice-Chair of the Presidential Advisory Council on HIV/AIDS (PACHA). His experience includes service as the Director of the Division of HIV/AIDS Prevention – Intervention Research & Support at the U.S. Federal Centers for Disease Control and Prevention (CDC); and as Professor and then Vice-Chair of the Department of Behavioral Sciences and Health Education at the Emory University Rollins School of Public Health.

A first-generation college student, Dr. Holtgrave earned his Ph.D. in 1988 from the University of Illinois at Urbana/Champaign in Quantitative Psychology and immediately thereafter held a post-doctoral research fellowship in the Interdisciplinary Programs in Health at the Harvard T.H. Chan School of Public Health.

Source: https://www.health.ny.gov/press/releases/2024/2024-08-15_executive_leadership.htm

Filed under: Addiction,Prevention and Intervention,USA :
  • Written by Aisha Ashley Aine & TIMOTHY NSUBUGA

Back in 2016 when radio personality Ann Ssebunya started the Drugs Hapana Initiative (DHA), the aim was to create awareness and prevention of drugs and substance abuse in her community.

Over the years, DHA has grown to cover the nation. Last weekend, it went a notch higher to create the National Prefects Conference, a forum where Ssebunya and other experts mentored young people to realize their full potential and empower them to act as change agents, write ASHLEY AINE and TIMOTHY NSUBUGA.

More than 200 prefects from various schools from the north, east, south, west, and central teamed up at Nile hall Hotel Africana for the National Prefects Conference.

A team of mental health specialists from Butabika hospital led by the executive director Dr David Basangwa, Dr Kenneth Ayesiga and Dr Eric Kwebiiha, among others, together with a well-prepared group of facilitators, took to the floor to explain the situation of global and national drug use among the youth and the causes and effects of drug abuse on mental health amongst the youth of this nation.

The use of alcohol and drugs during adolescence and early adulthood has become a serious public health problem in Uganda. The World Health Organisation global status report 2024 stated that Uganda has one of the highest alcohol and substance abuse rates in the world.

In another study done on drug and substance abuse in the schools of Kampala and Wakiso, it was found that 60% to 71% of the students used illicit drugs, with alcohol and cannabis taking the biggest percentages. These facts were presented by the head girl of Nabisunsa Girls School in her articulate speech, backed by research she carried out with a team of nine from her prefectorial body.

The global situation on drug use today, according to the World Drug Report research, shows a higher increase in the abuse of drugs by young people in this generation than has ever been recorded in history. Thirty-five million people have suffered and are suffering from drug use disorders, and the majority of people under rehabilitation in Africa are under 35 years of age.

As per the drug abuse state in Uganda, with evidence from hospitals, schools, community surveys and police, it has been found that the country is now a consumer Uganda with alcohol use as high as 12.21pp and a heavy use of hard drugs, that is, hallucinogens like marijuana, mushrooms, phencyclidine/angel dust (smoked or snorted), ketamine, lysergic acid diethylamide (LSD), also known as CIA truth serum, aviation fuel, codeine (cough syrups), cocaine, khat (mairungi), herion, kuber and ice, among many others.

Dr Basangwa, in his well-detailed PowerPoint presentation, showed what the drugs looked like and their names. He stated that although there might be some who think he is enabling and triggering curiosity for people to use drugs, he noted that while handling cases of drug abusers, they had all regretted not knowing the effects of what they were taking and wished they had known.

So, his purpose today was to inform the youth of the various drugs and the effects they can have on a person, and to raise awareness among the youth.

“We cannot fight what we do not know, as drugs come in many forms,” he said.

The head teacher of Kitintale Progressive School revealed in an interview that he once found one of his students with a watch that emits flavoured tobacco smoke, or, in simple terms, a vape watch. Another speaker told of how a vape fell from the belongings of a girl walking with her mother at school, and the poor woman picked it up, not knowing what it was.

He continued by giving an example of the alcohol and drug unit in Butabika, which is mostly filled with young people—people who have dropped out of school, while those still studying are also brought by their parents for rehabilitation. The theme of the conference called for the discussion of psychoactive drugs and their abuse.

These are the types of drugs that usually work on the brain to cause mood changes, but the catch is their addictive effect if abused. Questions arose from the audience to the doctors panel: does it feel good to do drugs? Why does a person get addicted to drugs? and why would anyone opt for drugs? What would encourage someone to try these dangerous substances?

EXPERT TAKE

The panel of mental health doctors took turns answering, explaining first that addiction comes about because drugs have the capacity to change the way the brain functions; it changes the functionality of the brain that makes it need the drug on a daily basis, which is what we call addiction.

There are various inexhaustible factors—environmental, social, and economic—that bring or cause people to try drugs. A perfect example of an environmental factor is the recent global pandemic that brought a high rise in drug abuse in our country. The pandemic saw the use of narcotic drugs as recreational means, and as the youth had too much time on their hands, they turned to drug use.

Others do drugs for experimental purposes or, rather, out of curiosity. The speaker, reminiscing about his days in school, tells of how they had students in school who were known smokers of marijuana, and the whole time, out of curiosity, he had wanted to try it, but when he did, he didn’t like the feeling, and that was the end of it.

But there are some unlucky ones that will try it and like the feeling, and they will go back again to get that feeling. Aggrey Kibenge, the permanent secretary of the ministry of Gender, Labour and Social Development, said the major factors causing the youth to engage in drug use are peer pressure, family history or exposure to drugs, the feel-good feeling, loneliness, depression, the issue of abuse at home that cripples the mental states of children as they grow, the absence of parents during childhood,

As the speakers told of the effects of the drugs on the young leaders, one of the prefects voiced her concerns about who is qualified to advise or counsel drug users— someone who has gone through the same ordeal.

ENTER CHANDIRU

Ssebunya, the organiser, scheduled Jackie Chandiru, someone with firsthand experience in addiction and recovery, to facilitate a 20-minute session with the young leaders. She walked through the conference hall as she told and showed the story and scars from her addiction.
Chandiru had certainly been blessed by God; as she testifies, it was He who pulled her back.

She had had an accident and had a back injury that required surgery. This injury caused her a lot of pain, and it was then that the doctors prescribed her a painkiller called pethidine. She used it too much and got addicted to the point where she did the injections herself.

She told the prefects that if she falls sick and needs an IV, the only place it would be put is in her neck, as the veins in her arms or limbs are dead. She lost her husband, and her music career was almost failing because she had lost the morale of going to the studio and writing songs; all she wanted was pethidine.

She mentioned a person who helped her through these trying times was the MC for the event, Paul Waluya, a clinic therapist and mental health specialist.

The event ended quite successfully as the theme was discussed fully, not to forget the memorable ice breakers, particularly the one that had the whole hall acting like a banana plantation in a windy situation with Waluya blowing air into the microphone for the wind sound effect.

Source: https://www.observer.ug/index.php/education/82054-experts-turn-to-school-leaders-in-fight-against-drug-abuse

Filed under: Addiction,Drug use-various effects,Others (International News),Prescription Drugs,Youth :

Suicide rate among Native American population is second-highest in the state

By  | byarbrough@scng.com | San Bernardino Sun
UPDATED: 

In 2020, Assemblymember James C. Ramos, D-San Bernardino, celebrated the creation of the state’s new Office of Suicide Prevention.

Four years later, more work remains to be done, he and other Native American leaders say.

Despite making up only 3.6% of Californians in 2020, American Indians or Alaskan Natives made up 9.8% of those who killed themselves that same year, according to the California Department of Public Health. Nationally, Native American populations are more than twice as likely as Black or White populations to die due to deaths of “despair” — suicide, drug overdoses and alcoholic liver disease — according to a UCLA Health survey released in April.

On Wednesday, July 17, Ramos — author of  Assembly Bill 2112, which created the Office of Suicide Prevention — gathered with representatives of Inland Empire tribes at the Morongo Band of Mission Indians’ Tribal Council Chambers in a roundtable to discuss the need for more help preventing suicide among Native Americans.

“We’ve had incidents where young members have taken their lives,” said Soboba Band of Luiseno Indians Chairperson Isaiah Vivanco. “Life is so precious, and when we have young ones taking their own lives, it has to be (a warning), it has to be an issue.”

Tribal leaders said that, too often, health professionals don’t understand native culture, and end up pushing those who need help away.

“Culture is healing as well,” said Soboba tribal secretary Monica Herrera. “Sometimes (mental health) facilities don’t recognize that (patients) are Native American and that sweat lodge or praying or some type of cultural healing is not encouraged. ‘We can’t take you to the sweat lodge; it’s against our policies.’ “

California health officials vowed to do better at the meeting.“Our traditional behavioral health system has woefully failed Native American populations,” California Health and Human Services Deputy Secretary of Behavioral Health Stephanie Welch told the tribal leaders. “There are high rates of suicide, there are high rates of self-harm as I have heard in the room, and there are high rates of drug misuse and overdose.”

Native communities aren’t using existing mental and behavioral health resources, state officials reported.

“When I see statistics around low utilization of behavioral health services, that’s on us,” Welch said. “Behavioral health services has not traditionally reflected the acceptance of (the) cultural, linguistic and geographical diversity that’s needed to address the needs of Native Americans communities.”

The department knows that it isn’t reaching many groups that need its mental health services and has embarked on a new initiative, “Mental Healthcare for All,” she said.

“And that truly means all of us and it needs to be inclusive of California Native Americans,” Welch said. “Everybody should have access to affordable, equitable, and most importantly, culturally responsive mental health and substance use disorder (treatment).”

As part of the effort, the state is investing in mobile clinics to bring services directly to tribal communities.

Within five years, Welch said, her agency hopes to have culturally appropriate mental health counselors available on mental health crisis lines in the state. In the meantime, her team is examining gaps in existing services when it comes to meeting the needs of California’s Native American population, along with identifying barriers that prevent the community from accessing healthcare options.

More mental health resources should be on the way.

Voters approved Proposition 1 in the March 5 primary election this year, authorizing a nearly $6.4 billion bond for facilities for mental health or substance abuse treatment.

“We want to make sure that California’s first people are not left out of that equation,” Ramos said.

Source: https://www.eastbaytimes.com/2024/08/04/california-needs-to-do-more-to-prevent-suicide-among-native-americans-tribal-leaders-say/

Filed under: Addiction,Brain and Behaviour,Drug use-various effects,Prevalence,USA :

BMC Public Health volume 24, Article number: 2103 (2024) Cite this article

Abstract

Background

Black individuals in the U.S. face increasing racial disparities in drug overdose related to social determinants of health, including place-based features. Mobile outreach efforts work to mitigate social determinants by servicing geographic areas with low drug treatment and overdose prevention access but are often limited by convenience-based targets. Geographic information systems (GIS) are often used to characterize and visualize the overdose crisis and could be translated to community to guide mobile outreach services. The current study examines the initial acceptability and appropriateness of GIS to facilitate data-driven outreach for reducing overdose inequities facing Black individuals.

Methods

We convened a focus group of stakeholders (N = 8) in leadership roles at organizations conducting mobile outreach in predominantly Black neighborhoods of St. Louis, MO. Organizations represented provided adult mental health and substance use treatment or harm reduction services. Participants were prompted to discuss current outreach strategies and provided feedback on preliminary GIS-derived maps displaying regional overdose epidemiology. A reflexive approach to thematic analysis was used to extract themes.

Results

Four themes were identified that contextualize the acceptability and utility of an overdose visualization tool to mobile service providers in Black communities. They were: 1) importance of considering broader community context; 2) potential for awareness, engagement, and community collaboration; 3) ensuring data relevance to the affected community; and 4) data manipulation and validity concerns.

Conclusions

There are several perceived benefits of using GIS to map overdose among mobile providers serving Black communities that are overburdened by the overdose crisis but under resourced. Perceived potential benefits included informing location-based targets for services as well as improving awareness of the overdose crisis and facilitating collaboration, advocacy, and resource allocation. However, as GIS-enabled visualization of drug overdose grows in science, public health, and community settings, stakeholders must consider concerns undermining community trust and benefits, particularly for Black communities facing historical inequities and ongoing disparities.

Peer Review reports

Background

The overdose crisis poses an unrelenting public health threat in the U.S. with fatal drug overdoses reaching a record high of over 100,000 in 2021 [1]. Record highs are especially prominent for Black individuals, who outpaced other racial/ethnic groups in rates of fatal drug overdose during the first two decades of the 2000s [2, 3] experiencing the highest increase in rate of overdose death from 2015–2020 [4]. Relative to White individuals, these disparities have continued to widen since the COVID-19 pandemic. American Indian/Alaska Native and Black populations have faced the highest rates of fatal drug overdose of all U.S. racial/ethnic groups since 2021 [5]. Disproportionate increases in fatal drug overdose rates among Black individuals coincide with the introduction of illicitly manufactured fentanyl and its analogues to the drug supply [2, 3] though fatal overdoses involving heroin and cocaine have also disproportionately increased among this group [6, 7]. Although racial disparities in fatal overdose are driven by the increasingly adulterated drug supply, they are exacerbated by social determinants of health (SDOH), including drug criminalization and inequitable enforcement by law enforcement [8, 9], racial residential segregation that contributes to Black neighborhood disinvestment [10], racialized service access that limits treatment options for Black individuals [11, 12], and inequitable availability of overdose prevention (e.g., naloxone) [13]. Indeed, fentanyl-related overdose deaths tend to cluster in low treatment-density, high-deprivation neighborhoods where residents are predominantly Black [14,15,16], emphasizing the impact of place-based SDOH on increasing racial inequities in the overdose crisis.

Racial inequities in overdose are generally attributed to SDOH, including features of one’s geographic location or built environment that impact well-being, such as aspects of neighborhood deprivation [17]. Black people in the United States are more likely than their White counterparts to live in neighborhoods that face high deprivation, including socioeconomic (e.g., high rates of poverty and unemployment) and physical deprivation (e.g., the deterioration of building structures and vacancies) due to policies that contribute to residential segregation and neighborhood disinvestment [18]. Both socioeconomic and physical deprivation are associated with fentanyl availability, drug overdose [11, 14, 19], and lower access to treatment and overdose prevention [13, 20, 21]. Predominantly Black neighborhoods are particularly vulnerable to overdose in the face of deprivation [11] with higher racial residential segregation (i.e., higher Black-to-White resident ratios) also predicting fatal overdose [15]. These racialized neighborhood-level inequities are not only associated with overdose, but also substance use treatment access. As the proportion of Black residents in an area increases, the proportion of substance use treatment facilities decreases [22], especially those providing medications for opioid use disorder (MOUD) [23,24,25].

To mitigate the impacts of racialized SDOH on drug overdose in Black neighborhoods, community-based efforts have used mobile outreach to service areas with low treatment access. Often these efforts dispatch peers, community health workers, and/or other lay advocates to provide harm reduction tools, overdose education, and service linkage [26,27,28,29]. Outreach services provided by peers and lay health workers with similar lived experiences (i.e., racial and/or drug use) not only address geographic barriers to treatment access, but also mitigate justifiable mistrust of systems that Black individuals in disinvested communities develop as a function of their experience with persistent systemic disinvestment [30,31,32]. Accordingly, drug-related outreach efforts have shown promising rates of engagement and follow-up with Black individuals in particular [26, 28, 29]. For example, one study found that a mobile unit providing MOUD enrolled a greater proportion of Black individuals relative to fixed-site clinics [33].

Overdose prevention outreach is typically limited by convenience- or funding-based location targets, rather than data-driven targets [26, 29]. This is despite extensive research using maps produced with geographic information systems (GIS) to characterize and visualize the epidemiology of drug overdose–with over 181 articles published on this topic since 2017 [34]. Indeed, GIS has been used to identify target populations and neighborhoods for health and social services [35,36,37], identify naloxone-distributing pharmacies that require improved pharmacist education [38], and inform location targets for overdose prevention services [39, 40]. However, few of these studies discuss implications for outreach or address how spatial data visualization (i.e., via maps) translates to organizations and individuals conducting outreach.

The present study takes the first step toward addressing the gap between research and community praxis by examining the acceptability and appropriateness of GIS to facilitate data-driven outreach for reducing overdose inequities facing Black individuals. We convened a focus group of community stakeholders leading overdose prevention outreach programs in Black communities in St. Louis, MO to assess how GIS tools can best characterize and visualize overdose to reflect practitioner needs. This formative study leveraged existing community partnerships to inform both the aims and recruitment with the goal of conducting a focus group that would guide the development of future community-engaged research adopting GIS in outreach settings. The aims were to 1) examine systemic and cultural barriers to implementing a GIS-facilitated overdose visualization tool among outreaching health workers and 2) understand the extent to which outreaching health workers would find such a tool acceptable and appropriate for overdose prevention.

Methods

Setting

Participants were stakeholders invited to participate due to their leadership role in organizations that conducted outreach in the neighborhoods of St. Louis, MO, locally referred to as “North City.” North City refers to the area of St. Louis City bordered by St. Louis County to the West, the Mississippi river to the East and North, and the east–west Delmar Blvd to the south. The latter is infamously called the “Delmar Divide” as it divides St. Louis City not only racially and socioeconomically but also in terms of health, with those neighborhoods north of the Divide having a higher concentration of Black residents and poverty, but a significantly lower life expectancy than those south of it [41]. St. Louis’s current racial and socioeconomic segregation is an enduring product of redlining and other segregationist policies of the mid-twentieth century [42], that contribute not only to economic and health inequities but also specifically to overdose inequities [43]. For example, from 2015 to 2021, drug-involved deaths among Black residents of St. Louis City and County increased at a rate eight times that of White residents, with overdoses among both races increasingly clustering in North City Black neighborhoods [43, 44]. Like others across the country, social service nonprofits and grassroots community organizations in and around North City St. Louis responded by launching or expanding existing services to include overdose prevention outreach.

Participants and procedures

Participants were recruited from partner agencies known to the research team funded by the Missouri Department of Mental Health’s State Opioid Response (Missouri SOR) to provide substance use services via outreach in North St. Louis neighborhoods. In 2021–2022, several agencies and funders inquired about the potential to visualize substance use/harm reduction service access (e.g., via Google Maps) and overdose risk (e.g., zip code-based heat maps) via mapping. However, some community partners and research staff were concerned that making these data public may attract bad actors and disproportionately negatively impact Black communities. These conversations led to the current research questions.

Using purposive convenience sampling, 17 potential participants from 11 organizations were emailed to provide a description of the study and invited to participate. Six of these organizations were current collaborators on other academic-community initiatives emerging in response to increasing overdose in North St. Louis, and thus also engaged with the research team on various other activities, including providing harm reduction resources and education, sharing data, conducting program evaluation, and co-engaging in legislative, funding, and media advocacy. The five other agencies were known entities in the community funded to provide substance-related services in predominantly Black neighborhoods, but not currently engaged with the research team. All potential participants were contacted over email with standardized information about the study; those who did not respond were followed up with by phone.

Enrolled participants (N = 8) were predominantly Black (88%); 50% were women and 50% were men (n = 4 each). Participants represented 7 organizations ranging from grassroots neighborhood nonprofits to large, regional social service and treatment agencies; 4 agencies were connected with the research team in other capacities and 3 agencies were new connections. All participants had an operational or supervisory role in their organization’s adult substance use treatment or harm reduction programming. People with these roles were sampled to speak to the acceptability and appropriateness of a GIS tool in the context of current organizational and program barriers and decision-making processes; however, all were experienced conducting street outreach.

Before the focus group, two staff met individually with each participant to obtain informed consent. The focus group was conducted in-person at a local university by MP, who was assisted by a notetaker and observer. It lasted approximately 120 min and was audio recorded. The focus group protocol was developed for the current study based on questions that emerged internally among the research team during initial work creating preliminary maps and a review of the available literature. The protocol included a semi-structured discussion of current outreach efforts to address overdose and attitudes toward mapping efforts in St. Louis [See Supplemental Materials: Appendix A]. Participants also provided feedback to preliminary maps created in Esri’s ArcGIS Online, including an overdose heat map by census tract, a substance use treatment and service map, and a map demonstrating individual overdose locations that could be filtered by race and other overdose characteristics (see Fig. 1). Participants responded to prompts focused on accessibility of the spatial information and usability to their work. Participants were provided $50 in compensation. This study was approved by the Institutional Review Board.

The focus group was transcribed verbatim by a professional transcription service. Three members of the research team (DEB, MP, and RG) read the transcript and notes taken by an observer and met several times to generate organizing codes that represented recurring concepts arising from different participants. Using an inductive reflexive approach to thematic analysis [45] informed by contextualism (a relativist perspective) [46], two coders independently coded the transcript semantically (MP, RG) in ATLAS.ti and met with the first author (DEB) to address any discrepancies, reaching consensus on 13 codes. Finally, MP organized codes into 4 preliminary themes by creating a visual table; themes were based on keyness (the ability of the theme to answer the research question) and meaningfulness (themes that identify underlying conceptualizations, not simply topical descriptions). The coding team met to review themes for internal homogeneity and external heterogeneity and check coherence with data before drafting the following results.

Results

We identified four themes that contextualize the acceptability and utility of an overdose visualization tool among community stakeholders providing services in Black communities. They were 1) importance of considering broader community context; 2) data manipulation and validity concerns; 3) potential for awareness, engagement, and community collaboration; and 4) ensuring data relevance to the affected community. Each is described below with illustrative quotes from respondents (expanded in Table 1).

Importance of broader community context

Although the researchers’ intent was to discuss a mapping tool, participant conversations frequently emphasized the context underlying racism-related SDOH in St. Louis’s Black neighborhoods. Specifically, participants discussed how current and historic policies have detrimentally impacted Black communities in the region, leading to striking disparities between White and Black communities in St. Louis with the latter seen as “depletion zones.” Participants highlighted the difference between White-majority communities that have “access to everything within five minutes” (Participant #1) including education, healthcare, and opportunities for physical activities and Black-majority communities, in which “weeds is high, vacant buildings” (Participant #2) and “you got to drive five miles to pick up lunch” (Participant #3). As one participant stated about the condition of Black neighborhoods: “That’s enough to make a person not see a future” (#2).

Participants reinforced an increasing need for substance use intervention in Black-majority communities due to the high community-level access to drugs paired with the unpredictable drug supply following the rise of synthetic opioids. They noted that open air-drug markets are disproportionately located in Black neighborhoods in St. Louis due to persistent neighborhood deprivation. Thus, illicit fentanyl can freely flow into North St. Louis while other resources such as nutritious food are unavailable. However, participants felt that overdose is just one manifestation of the impact of systemic racism on health:

In our community, it’s not just drugs, it’s not just bullets. From the day you’re born, you are faced with reasons and that manifests in so many things. It’s a struggle, honestly is a struggle to be Black in America. (Participant #4)

Ultimately, participants felt that until the disparities in SDOH related to systemic racism are more directly addressed, advocates such as themselves could never “get to the core or root of the problem [of overdose in] low-income minority communities” (#1).

This theme derived in part from participants’ previous experiences with initiatives that used mapping to visualize other health disparities (e.g., sexually transmitted infections [STIs]) that ended up stalling or having limited impact on the community due to SDOH-related barriers that made it difficult to implement change or access services. Thus, participants emphasized that a mapping tool must not only show overdose, but also the SDOH that must be mitigated to effectively redress overdose, such as “the lack of quality services” (#4) ranging from addiction treatment to public transportation. Emphasizing specific SDOH that would put overdoses in Black neighborhoods in context, one participant stated, “Are there banks nearby? Are there businesses nearby? Are there grocery stores? Are there restaurants? Are there schools?” (#3).

Data manipulation and validity concerns

Decades of disinvestment and gentrification in St. Louis’s Black communities, led to concerns that organizations from outside of these communities may perpetuate similar harms. This included some skepticism about an overdose visualization tool created by an academic institution. Participants were concerned that a map highlighting a majority-Black area as a “high crime, high overdose neighborhood” may lead to further disinvestment and increased law enforcement presence. They described how a map could be used to justify and encourage gentrification and the displacement of Black residents rather than improving their circumstances, citing previous instances of entities using spatial data to do just that:

I lived for 30 years in the central corridor in the 17th ward…once [a local university] wanted our neighborhood, it was over with. We had really high rates of everything you can think of. And the population was 70:30, 70 African American, 30 White. Now it’s flipped. And what happened was [the university] wrote a bunch of grants showing that the demographics needed this money[, then] used that money to wipe that demographic out. (Participant #5)

Participants were also apprehensive about the validity of the overdose data that the visualization tool would display. They doubted whether the data would accurately represent the Black people who use drugs they work with, many of whom are unhoused and face other structural barriers that may leave them “invisible to the system.” One participant stated, “Usually with overdoses, people go to the hospital. African American brothers do not go to the hospital” (Participant #6), emphasizing the perception that many Black people die alone and are thus, not accurately represented in overdose surveillance. Thus, it was important for participants to understand who compiled overdose data and how it was gathered as they tended to trust first-hand experiences and local anecdotal information over overdose data. One participant shared, “I see 200 people a week and that number isn’t going down. If anything, it’s going up. So even if you brought me all kinds of statistics that said [drug overdose] was decreasing … I’m still seeing the same or more.” Despite this, they still saw an overdose visualization tool as something they could use to supplement first-hand experience:

It’s helpful in the sense that I can go now, myself, and see if [the data are] true. So, I don’t just take it at its face value, I go now to experience it for myself…The numbers showed us that these were the places that we needed to be for a lot of reasons. But I don’t just take a map at face value like, “Okay, that’s the way it is, let’s go see parts of it,” but let me check that, check that skepticism, take that and go learn from there. (#3)

Awareness, engagement, and community collaboration

Despite concerns about displaying overdose data using GIS, participants endorsed potential compatibility of an overdose visualization tool with current service and community needs, describing its appropriateness for supplementing their own service provision as well as for advocacy toward greater resources and systems change. Participants noted ways in which an overdose visualization tool could be appropriate for guiding their overall service provision, targeting specific overdose prevention resources, and collaborating with agencies that provided complementary resources (e.g., social services). A map would help them choose places to conduct outreach based on “where the most overdoses were taking place in these communities (#3). Mapping could help target specific resources, for example, to people who use stimulants, who several participants noted were “getting pushed to the side” (#6) in the context of a worsening opioid crisis.

However, participants most strongly viewed an overdose visualization tool as an advocacy tool at individual, organizational, and policy levels. At the individual level, they imagined using the tool to increase general awareness of overdose within the neighborhoods they work. They did not imagine the mapping tool as one they would use in the office, but instead in the community doing street outreach and engaging with community members (e.g., on a mobile phone or tablet). They cited drug stigma and a lack of knowledge within North St. Louis as a barrier to providing needed resources. Specifically, participants described how many community members they interacted with seemed to ignore or deny drug-related deaths in their own neighborhoods. Some attributed this to “old school…generations” who “don’t talk about stuff” (#6) like drug use and the overdose crisis, and thus, were unwilling to support the needed harm reduction services participants’ organizations provided. One participant was particularly frustrated with community members’ rejection of their harm reduction outreach services, stating, “You might choose to put your nose up to it, or blind yourself to it, but it’s real” (#3). Thus, this participant valued the potential of a map displaying fatal overdose to help increase understanding about the impact of the overdose crisis on the Black community and to generate collective action toward mitigating it:

There’s situations where we pull up in a place and they’re like, “we don’t want you here.” Well okay, but let me show you why I’m here. I can use that map to show there’s a reason why. “I came because look at these numbers right here”… Now I can get the whole community involved, in a way that I couldn’t before … because the communities we go to right now don’t acknowledge that there’s an [overdose] issue in their community. (#3)

In their positions as not only service providers, but also advocates for a severely under-resourced community, participants hoped an overdose visualization tool could increase community awareness of available services since they found residents and providers often unaware of them. Participants felt strongly that outreach efforts must connect residents affected by drug use to resources beyond treatment services to address the full range of health and social consequences of neighborhood deprivation. Thus, they saw potential for improved collaboration and referral across organizations and discussed how an overdose visualization tool could be used for community advocacy, problem solving, and planning across organizations:

With the mapping… [local government could] utilize the community organizations within those zip codes to be at the table to resolve problems in that zip code versus making their own plan of what they think is going to work … bring those people to the table, because those are the people that see and know that community. (#1)

At the policy level, an overdose mapping tool was also seen as a strategy to advocate for increased funding within their communities and for their organizations specifically. For example, they described how GIS data visualizations could be incorporated into grant applications to demonstrate the need for the services their organizations provide. They also hoped a mapping tool could help facilitate overall increased investment in North St. Louis, including for additional outpatient and inpatient treatment options, affordable housing development, and HIV/STI clinics.

Ensuring data relevance to the community

Participants stressed the importance of including people with lived experience in the development of any overdose mapping tool. People who use drugs and providers who serve them in communities targeted by the tool should be consulted during its development. Although participants valued spatial data, they believed that it should be paired with narrative data and storytelling. Focus group participants generated ideas such as including stories of how the overdose crisis has affected community members or testimonials of people who achieved recovery within the tool, emphasizing that “maps without a story are meaningless to the community” (#3). They also saw this mixed methods strategy as vital for framing the maps so that they do not perpetuate stigma toward people who use drugs or serve as a rationale for bad actors to further disinvest in Black-majority areas with high overdose rates.

Participants also reinforced that each neighborhood they work within is unique with different community assets, challenges, and histories. Regional, county, and city-level maps had much less perceived utility to this group than a tool that could examine neighborhood-level geography:

Each community has its own different thing that’s going to work. Baden, what works in Baden ain’t going to work in Hyde Park. Two totally different communities, even though they may be structured similar, … same thing is not going to work in those communities. (#1)

Discussion

The current qualitative study examined the acceptability and potential utility of using GIS to facilitate data-driven mobile outreach services for overdose prevention. Participants from organizations providing outreach services in predominantly Black neighborhoods pointed to the potential for a GIS tool displaying locations of drug overdose to inform their service provision and referrals, improve awareness of the Black overdose crisis among both community members and funder-stakeholders, and facilitate collaboration among service providers. Participants’ ability to resist a conversation focused solely on the GIS tool resulted in one that highlighted the importance of understanding the context of opioid use in St. Louis’s Black neighborhoods and the need to elevate community voice, both in features of and in the use of the tool.

Citing manifestations of systemic racism that have led to neighborhood-level inequities in SDOH–and in turn, drug overdose–findings also highlight that such a tool could be limited by data validity and misrepresentation. Participant recommendations for mitigating these concerns included making a mapping tool more relevant to Black communities by including qualitative data, such as storytelling, and involving stakeholders from those communities to incorporate hyper-local knowledge. Participants also noted ways that the GIS tool could be used to communicate with government officials and across community organizations, increase advocacy, and gain resource investments that mitigate SDOH contributing to overdose rates.

Our findings are aligned with previous research demonstrating that community organizations conducting overdose prevention via outreach see the benefit of mapping to inform linkages to treatment and related resources [39, 40]. Although previous research has pointed to the utility of GIS data for agencies conducting outreach to “underserved communities with high overdose burdens” (40 p. 1761), this study included voices from grassroots organizations with lived experience working in those communities. A unique contribution of including voices was discussion of how GIS could be used not only for targeted tertiary prevention, but also for more advocacy to address what participants saw as the “root cause” of the Black overdose crisis: racism related SDOH. As such, participants suggested GIS tools include historical and current characteristics associated with systemic racism and racialized neighborhood segregation (e.g., food deserts, vacancies, and limited access to health services). GIS is already used to identify environmental manifestations of racism impacting social, mental, and physical health disparities. Research has demonstrated how racialized health disparities derive from economic SDOH like poverty and unemployment, environmental SDOH like noise pollution and poor walkability, and historical SDOH like redlining [47, 48]. Using GIS to visualize manifestations of racism may be a promising strategy for educating the public about the source of health disparities and advocating for equity-focused funding and intervention [49].

Participants also suggested that GIS can be used to directly mitigate overdose by improving community awareness of the opioid crisis, helping to reduce stigma and empower residents in areas with high overdose burdens to recognize and respond to overdose. This may be particularly useful in racially minoritized communities who have been impacted by the false racialization of substance use or “double stigma” at the intersection of racial and drug-related discrimination [50, 51]. For example, in New Mexico, ethnically and culturally matched community health workers are dispatched to Latinx communities to provide overdose education, but also to reduce mental health and substance use related stigma, incorporating culturally-relevant concepts such as whole person health [52]. Such interventions provided by culturally congruent lay health workers and peers could be supplemented by local data visualization using GIS in Black communities overburdened by overdose.

Despite identified benefits of GIS, findings suggest community ambivalence about mapping. Previous research among research and clinician stakeholders have pointed to the potential for big data related to overdose to be framed or used to perpetuate inequities, including socioeconomic disinvestment [53, 54]. Like previous research, the result of this ambivalence tended to skew towards potential benefits rather than concerns [54]. Specifically, the devastation of the overdose crisis was perceived to be so severe that it was better to use the data in the hopes of attracting more awareness and resources:

We’ve got to recognize that [bad actors are] an inherent risk and roll with it, but there’s also so many benefits. We’ve all talked about all the different ways we can use this [mapping tool] and we’ve got to think about those more than we think about the harmful. (#3)

However, given the stigmatization of those affected by overdose, future spatial epidemiology and surveillance of the problem must consider integrating qualitative data and citizen science. Community-engaged approaches that incorporate the perspectives of people with lived experience with drug use and/or racism can highlight cultural strengths of underserved communities, mitigate racialized stigma, and provide practical recommendations to avoid data being used to perpetuate the deficit narrative. In the context of technology like GIS, one promising approach is digital storytelling, a researcher-facilitated process of capturing lived experience in multimedia formats often used for health promotion in marginalized groups [55, 56]. Digital storytelling has been integrated with GIS, exemplified by ArcGIS’s own “Story Maps” tool, but has been little used in geospatial science and drug surveillance. Integrating big data via GIS and qualitative lived experience via digital storytelling may help scientists, public health officials, and community members better understand and solution social and economic inequities driving the drug overdose crisis in Black communities [57].

Although not mentioned by those participating in the focus group, the inclusion of community voice might also enhance community trust of researchers and research institutions through the experience of authentic inclusion and elevation of community voice [54]. Community-engaged and GIS methods have been combined to identify areas for public health intervention for problems including chronic disease and nutrition [53, 58]. These participatory mapping approaches incorporate local knowledge into geospatial indices that may predict health outcomes and identify SDOH beyond those traditionally discussed [59, 60]. Thus, in addition to building trust toward and engagement with opioid big data, community-engaged approaches to opioid surveillance in Black communities may also improve scientific and applied outcomes, contributing to increased health equity.

Given increasing use of GIS in drug overdose epidemiology and research by local public health agencies, community organizations, and researchers alike, future GIS research should increase its public health application. The current study raises several implementation questions for future research. For example, participants suggested that a mobile tool could help supplement overdose education during outreach whereas a tool displaying drug trends (e.g., stimulant versus opioid-involved death) could help them target specific harm reduction resources. Thus, research involving the adoption of a GIS tool into outreach and other community-based interventions could examine the feasibility of mobile tools and the fidelity of community-based organizations to providing resources aligned with the drug trends observed. Consistent with participant recommendations from this project, adoption of GIS tools should include the ability to examine data at smaller levels of analysis (i.e., at the address level) to identify neighborhood-level gaps in overdose prevention and related services [61]. Future research should extend findings on acceptability of overdose mapping tools by evaluating the effectiveness of such maps for outreach. Although several studies have used GIS as a tool to evaluate the impact and effectiveness of outreach services, very few studies have evaluated how GIS tools can be used to improve such services. One recent study evaluated the implementation of GIS tools to target outreach services for opportunity youth (i.e., youth not engaged in school or work) in the Phoenix, AZ area [36]. The authors describe how three GIS-derived maps increased agency referrals and led to the opening of satellite centers to increase access in high need areas. Next steps include examining whether GIS can similarly facilitate the needed increase in resources, collaboration, and awareness to address the opioid crisis in Black communities.

This report must be considered given its limitations. The most significant limitation is that results are based on one focus group as the study was practically limited by the limited number of organizations conducting outreach in North St. Louis and recruitment challenges. These challenges included generating interest in research participation among potential participants and coordinating schedules for focus groups due to lack of capacity for staff coverage within many of the organizations. Although the group was homogenous given participants’ similar roles, conducting only one group certainly limited variability in perspectives as well as in thematic analysis. As participants were recruited from known partners, many were familiar with the focus group facilitator (MP). This may have enriched the conversation due to increased trust and rapport with the facilitator, but also could have biased the conversation toward participants who were more familiar with her. We also must acknowledge that the research team are culturally distinct from participants and hold relatively privileged social locations, despite some investigators sharing characteristics like racial and regional origin. Although our analysis approach was inductive, the current interpretation is limited as we are not members of the affected community of Black people who use drugs. Results also have limited transferability to other communities given the focus on the needs of North St. Louis. However, racialized neighborhood disinvestment is common in many cities and concerns about using big overdose data to perpetuate racist policies has been documented in previous research [54, 62]. Thus, the current study may inform future GIS-related research and practice focused on racial disparities in drug overdose.

Conclusions

The current study highlighted the potential utility of GIS to facilitate data-driven outreach for drug overdose prevention in underserved Black neighborhoods. As data visualization of overdose explodes in science, public health, and community settings, stakeholders must consider validity concerns that may undermine benefits and limit community trust. Those using GIS to illuminate service inequities and gaps in overdose among marginalized groups must consider the historical community context, minimize opportunities for data manipulation and misinterpretation, and seek to garner the knowledge and trust of affected communities.

Availability of data and materials

The data generated and analyzed during the current study are not publicly available as they reasonably be shared without compromising the privacy and confidentiality of participants. However, certain sections of the data are available from the corresponding author upon reasonable request.

Source: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-024-19541-3

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

In 2023, 1.5 million adolescents aged 12 to 17 initiated nicotine vaping in the past year.

The U.S. Department of Health and Human Services’ (HHS) Substance Abuse and Mental Health Services Administration (SAMHSA) released the results of its annual National Survey on Drug Use and Health (NSDUH), which shows how people living in America reported about their experience with mental health conditions, substance use, mental health and pursuit of treatment in 2023. The report includes selected estimates by race, ethnicity, and age group. The 2023 sample size was 67,679 and used varied collection methods in gathering data from respondents who are noninstitutionalized and age 12 or older.

Key findings of people aged 12 or older who used tobacco products or vaped nicotine in the past month:

  • Among people aged 12 or older- 22.7 % (or 64.4 million people) was highest among young adults aged 18 to 25 – 30.0 % or 10.2 million people
  • Adults aged 26 or older -23.4% or 52.3 million people
  • Adolescents aged 12 to 17 – 7.4% or 1.9 million people
  • Higher among American Indian or Alaska Native (34 %) or Multiracial people (30.6 %) than among White (24.7%), Black (24.2%), Hispanic (17.9%), or Asian people (10.3%)
  • The percentage of people who vaped nicotine was higher among young adults aged 18 to 25 (24.1% or 8.2 million people) than among adults aged 26 or older (7.4% or 16.6 million people) or adolescents aged 12 to 17 (6.8% or 1.8 million people)

Legislation in December 2019 raised the federal minimum age for sale of tobacco products (along with e-cigarettes) from 18 to 21 years.25 All 50 states and the District of Columbia prohibit the sale of tobacco products to people younger than 21.

  • In 2023, 1.5 million adolescents aged 12 to 17, 1.4 million young adults aged 18 to 25, and 3.1 million adults aged 26 or older initiated nicotine vaping in the past year.
  • About two thirds (62.5%) of the 5.9 million people in 2023 who initiated nicotine vaping in the past year did so at age 21 or older (3.7 million people) compared with 37.5 percent (or 2.2 million people) who did so before age 21.

It is evident that several safety and mental health concerns have arisen due to the growing popularity of e-cigarettes. E-cigarettes heat liquids known as vape juices or e-liquids and transform them into an inhalable vapor containing nicotine and other hazardous compounds. It has been purported by the National Institute on Drug Abuse (NIDA), that Vaping, which was originally marketed to quit smoking, has become a problematic behavior in itself. Vaping can be harmful to a person’s physical and mental health, self-control, mindfulness, and other interventions can help people resist the lure of vaping.

Vaping can be especially dangerous for young people because their brains are still developing. Nicotine is highly addictive and can harm brain development until around age 25 and can negatively impact a developing brain in terms of mood/impulse control disorders, interference with memory and attention processing and negatively affect planning and decision-making.

Find out what’s happening in Glen Covewith free, real-time updates from Patch.

As individuals, being mindful, prevention education and making health choices and cultivating self-control can play an important role safeguarding our well-being. At the societal level, grassroot efforts for increased regulation over entities seeking to profit from harmful products and promote interventions that are accessible and beneficial to all is most effective. There is a large body of research that tackling nicotine dependence with vaping with the same vigor as combustibles is a growing need.

According to SAFE, the best method of protecting is prevention education and encouraging a goal to “Live SAFE” and substance free and changing the societal norms regarding these products to help curb youth initiation and a lifelong nicotine addiction.

For information on how to quit smoking or vaping tobacco or nicotine, the NYS Smoker’ provides free and confidential services that include information, tools, quit coaching, and support in both English and Spanish. Services are available by calling 1-866-NY-QUITS (1-866-697-8487), texting (716) 309-4688, or visiting www.nysmokefree.com, for information, to chat online with a Quit Coach, or to sign up for Learn2QuitNY, a six-week, step-by-step text messaging program to build the skills you need to quit any tobacco product. Individuals aged 13 to 24 can text “DropTheVape” to 88709 to receive age-appropriate quit assistance.

SAFE, Inc. is the only alcohol and substance abuse prevention, intervention, and education agency in the City of Glen Cove. The Coalition is concerned about all combustible and electronic products with marijuana and tobacco. The Agency is employing environmental strategies to educate and update the community regarding the negative consequences in collaboration with Carol Meschkow, Manager- Tobacco Action Coalition of Long Island. To learn more about the SAFE Glen Cove Coalition please follow www.facebook.com/safeglencove or to learn more about electronic products visit the Vaping Facts and Myths Page of SAFE’s website to learn more about how vaping is detrimental to your health www.safeglencove.org.

Filed under: Addiction,Drug use-various effects,Education,Health,Prevalence,USA,Youth :

Key topics

 

Overdose prevention services should be offered through HIV care

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

Source: We should leverage the successes of HIV care to prevent overdose mortality (National Institute on Drug Abuse)

 

Hemp legalization opened the door to intoxicating products

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

Source: Congress Accidentally Legalized Weed Six Years Ago (The Atlantic)

 

Federal news

 

Expanded access to methadone is needed

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

Source: Guest Editorial: To Address the Fentanyl Crisis, Greater Access to Methadone Is Needed (American Society of Addiction Medicine)

 

CDC defends overdose prevention work before House committee

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

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

 

Task force releases recommendations to protect youth from social media harms

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

Source: Kids Online Health and Safety Task Force Announces Recommendations and Best Practices for Safe Internet Use (Substance Abuse and Mental Health Services Administration)

 

FDA allows sale of tobacco-flavored Vuse e-cigarettes

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

Source: FDA allows sale of best-selling tobacco e-cigarette Vuse (The Hill)

 

State and local news

 

Montana plans to install harm reduction vending machines

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

Source: Montana’s Plan To Curb Opioid Overdoses Includes Vending Machines (KFF Health News)

 

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

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

Source: Gov. Reynolds announces grant funding, education programs to support opioid prevention, treatment and recovery (Iowa Governor Kim Reynolds)

 

LAPPA releases model state laws to minimize harms of incarceration

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

Source: Model Medicaid Reentry Section 1115 Demonstration Waiver Act; Model Relief from Collateral Consequences of Conviction Act (Legislative Analysis and Public Policy Association)

 

Other news in addiction policy

 

Mobile treatment vans can help expand methadone access

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

 

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

Filed under: Addiction,Crime/Violence/Prison,Heroin/Methadone,Prevention and Intervention,Treatment and Addiction,USA,Youth :

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

  • By Allen Siegler | Mountain State Stoplight

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

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

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

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

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

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

Change opioid treatment program restrictions

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

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

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

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

Change restrictions on treatment for methamphetamine addiction

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

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

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

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

Repeal the federal funding ban for syringes and needles

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

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

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

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

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

Include West Virginia in the Ending the HIV Epidemic initiative

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

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

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

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

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

More funding for recovery residences

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

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

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

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

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

Reach reporter Allen Siegler at allen@mountainstatespotlight.org

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

Filed under: Addiction,Drug use-various effects,Heroin/Methadone,Prevalence,Prevention and Intervention,Treatment and Addiction,USA :

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

Posted July 29, 2024 |  Reviewed by Michelle Quirk

Key points

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

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

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

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

Evidence of an ongoing tragedy

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

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

Three developments that are helping to reduce deaths

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

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

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

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

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

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

Drug use prevention efforts must increase also

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

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

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

Final thoughts on turning the tide of addiction

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

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

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

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

Filed under: Addiction,Cocaine,Drug use-various effects,Fentanyl,Heroin/Methadone,HIV/Injecting-Drug-Users,Prevalence,Prevention and Intervention,Treatment and Addiction,USA :

By Nora D. Volkow and Tisha Wiley / July 9, 2024

 

Programs across the country are underway to offer naloxone, also sold as Narcan, in jails and prisons, paired with instruction, training, and social support

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

Related: Rigid rules at methadone clinics are jeopardizing patients’ path to recovery from opioid addiction

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

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

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

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

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

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

Related: Q&A: Nora Volkow on how to get ‘at least 50% less people dying’ from opioid overdose

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

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

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

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

The Authors

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

Tisha Wiley, Ph.D., is a social psychologist, associate director for justice systems at NIDA, and leads the NIH Justice Community Opioid Innovation Network initiative, which studies approaches to increase high-quality care for people in justice settings with opioid misuse or opioid use disorder.
Source: https://www.statnews.com/2024/07/09/providing-addiction-treatment-prisons-jails/
Filed under: Addiction,Crime/Violence/Prison,Treatment and Addiction,USA :

Vienna, 26 June 2024

The emergence of new synthetic opioids and a record supply and demand of other drugs has compounded the impacts of the world drug problem, leading to a rise in drug use disorders and environmental harms, according to the World Drug Report 2024 launched by the UN Office on Drugs and Crime (UNODC) today.

“Drug production, trafficking, and use continue to exacerbate instability and inequality, while causing untold harm to people’s health, safety and well-being,” said Ghada Waly, Executive Director of UNODC. “We need to provide evidence-based treatment and support to all people affected by drug use, while targeting the illicit drug market and investing much more in prevention.”

The number of people who use drugs has risen to 292 million in 2022, a 20 per cent increase over 10 years. Cannabis remains the most widely used drug worldwide (228 million users), followed by opioids (60 million users), amphetamines (30 million users), cocaine (23 million users), and ecstasy (20 million users).

Nitazenes – a group of synthetic opioids which can be even more potent than fentanyl – have recently emerged in several high-income countries, resulting in an increase in overdose deaths.

Though an estimated 64 million people worldwide suffer from drug use disorders, only one in 11 is in treatment. Women receive less access to treatment than men, with only one in 18 women with drug use disorders in treatment versus one in seven men.

In 2022, an estimated 7 million people were in formal contact with the police (arrests, cautions, warnings) for drug offences, with about two-thirds of this total due to drug use or possession for use. In addition, 2.7 million people were prosecuted for drug offences and over 1.6 million were convicted globally in 2022, though there are significant differences across regions regarding the criminal justice response to drug offences.

The Report includes special chapters on the impact of the opium ban in Afghanistan; synthetic drugs and gender; the impacts of cannabis legalization and the psychedelic “renaissance”; the right to health in relation to drug use; and how drug trafficking in the Golden Triangle is linked with other illicit activities and their impacts.

Drug trafficking is empowering organized crime groups

Drug traffickers in the Golden Triangle are diversifying into other illegal economies, notably wildlife trafficking, financial fraud, and illegal resource extraction. Displaced, poor, and migrant communities are suffering the consequences of this instability, sometimes forced to turn to opium farming or illegal resource extraction to survive, falling into debt entrapment with crime groups, or using drugs themselves.

These illicit activities are also contributing to environmental degradation through deforestation, the dumping of toxic waste, and chemical contamination.

Consequences of cocaine surge

A new record high of 2,757 tons of cocaine was produced in 2022, a 20 per cent increase over 2021. Global cultivation of coca bush, meanwhile, rose 12 per cent between 2021 and 2022 to 355,000 hectares. The prolonged surge in cocaine supply and demand has coincided with a rise in violence in states along the supply chain, notably in Ecuador and Caribbean countries, and an increase in health harms in countries of destination, including in Western and Central Europe.

Impact of cannabis legalization

As of January 2024, Canada, Uruguay, and 27 jurisdictions in the United States had legalized the production and sale of cannabis for non-medical use, while a variety of legislative approaches have emerged elsewhere in the world.

In these jurisdictions in the Americas, the process appears to have accelerated harmful use of the drug and led to a diversification in cannabis products, many with high-THC content. Hospitalizations related to cannabis use disorders and the proportion of people with psychiatric disorders and attempted suicide associated with regular cannabis use have increased in Canada and the United States, especially among young adults.

Psychedelic “renaissance” encourages broad access to psychedelics

Though interest in the therapeutic use of psychedelic substances has continued to grow in the treatment of some mental health disorders, clinical research has not yet resulted in any scientific standard guidelines for medical use.

However, within the broader “psychedelic renaissance”, popular movements are contributing to burgeoning commercial interest and to the creation of an enabling environment that encourages broad access to the unsupervised, “quasi-therapeutic” and non-medical use of psychedelics. Such movements have the potential to outpace the scientific therapeutic evidence and the development of guidelines for medical use of psychedelics, potentially compromising public health goals and increasing the health risks associated with the unsupervised use of psychedelics.

Implications of opium ban in Afghanistan

Following the drastic decrease of Afghanistan’s opium production in 2023 (by 95 per cent from 2022) and an increase in production in Myanmar (by 36 per cent), global opium production fell by 74 per cent in 2023. The dramatic contraction of the Afghan opiate market made Afghan farmers poorer and a few traffickers richer. Long-term implications, including on heroin purity, a switch to other opioids by heroin users, and/or a rise in demand for opiate treatment services may soon be felt in countries of transit and destination of Afghan opiates.

Right to health for people who use drugs

The report outlines how the right to health is an internationally recognized human right that belongs to all human beings, regardless of a person’s drug use status or whether a person is imprisoned, detained or incarcerated. It applies equally to people who use drugs, their children and families, and other people in their communities.

Source: https://www.unodc.org/unodc/en/press/releases/2024/June/unodc-world-drug-report-2024_-harms-of-world-drug-problem-continue-to-mount-amid-expansions-in-drug-use-and-markets.html

Filed under: Addiction,Cannabis/Marijuana,Cocaine,Effects of Drugs,Global Drug Legalisation Efforts,Others (International News) :
Original Investigation – Substance Use and Addiction
July 17, 2024

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

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

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

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

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

Abstract

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

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

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

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

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

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

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

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

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

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

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

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

Methods
Data Sources and Searches

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

Study Selection

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

Definitions of Intervention Type and Reluctance Reasons

Intervention type and definition

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

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

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

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

Reason and definitiona

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

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

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

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

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

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

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

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

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

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

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

 

Data Analysis

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

Results
Study Characteristics

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

Physician Reluctance

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

Institutional Environment

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

Lack of Knowledge

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

Lack of Skill

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

Lack of Cognitive Capacity

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

Facilitators

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

Discussion

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

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

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

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

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

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

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

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

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

Limitations

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

Conclusions

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

Article Information

Accepted for Publication: May 7, 2024.

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

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

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

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

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

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

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

Largest consumers of opioids per capita

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

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

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

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

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

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

No special prescription, no time limit, no supervision

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

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

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

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

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

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

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

No medical instruction on the issue

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

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

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

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

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

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

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

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

Stopping after six months

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

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

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

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

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

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

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

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

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

Medication for reversing overdose is life-saving—if used quickly and correctly.

 

Mark S. Gold M.D.
Addiction Outlook

Posted June 4, 2024

KEY POINTS

  • Fentanyl is a major threat causing overdose deaths in the United States.
  • Young people are unknowingly taking fentanyl and dying.
  • Fentanyl smoking is contributing to overdose and speedballing deaths.
  • Government and private agencies are cracking down on illegal fentanyl, but it’s an uphill fight.
Seized Fentanyl Pills
Source: National Institute on Drug Abuse

 “It is the deadliest drug threat our country has ever faced.” says Anne Milgram, Administrator, Drug Enforcement Administration (DEA), referring to the threat of fentanyl in the United States. She should know.

We still have record deaths, and that’s after the DEA seized more than 80 million fentanyl-laced fake pills and nearly 12,000 pounds of fentanyl powder so far in 2024 . The fentanyl seizures represent more than 157.6 million deadly doses; 70% of the counterfeit pills contain a lethal dose of fentanyl. Sometimes, the drug is smoked and as with intravenous injection, speeds access to the brain, further endangering users.

The best new prevention approach, the “One Pill Can Kill” initiative led by the DEA, is amplified by the Community Anti-Drug Coalitions of America (CADCA) and other volunteers educating the public and seeking to prevent flooding of the U.S. with fentanyl and fentanyl-laced fake pills resembling Xanax, Oxycontin, Adderall, Vicodin and other popular prescription medications—but with a deadly twist. The counterfeit pills, more often than not, contain a lethal dose of fentanyl.

“CADCA and its 7,000 coalition members across the nation have worked tirelessly to address the issue of fentanyl-laced fake pills that are poisoning our nation’s youth by planning and implementing comprehensive, data-driven strategies, with multiple public and private partners to address community conditions causing this problem,” said CADCA’s president and CEO, retired Army general Barrye L. Price.

Across the country, fentanyl has largely fueled a more than doubling of overdose deaths among children ages 12-17 since the start of the pandemic. The deaths were inadvertently hidden by “good news” reported by the CDC on May 15, 2024, announcing that there were an estimated 107,543 drug overdose deaths in the U.S. during 2023—a decrease of 3% from the 111,029 deaths estimated in 2022.

Fentanyl is killing adolescents and people of color, many with no idea they are taking fentanyl. The counterfeit drugs are easy to obtain from friends or buy through social media. Sold online for $2 to $10 apiece, their lethal potency caught policy leaders, emergency rooms, addiction experts, family health providers, and pediatricians nationwide by surprise.
 Such is the fentanyl crisis as of June 2024. As i will describe in this blog post, there are treatments of last resort and medications designed to reverse the effects of fentanyl when education, prevention, and treatment have failed. An estimated 80,000 deaths per year are attributed to opioid-induced respiratory depression (OIRD) caused by fentanyl alone. Wonder medicines that counter the effects include the widely-used naloxone (Narcan) and much-less-used (but also effective) opioid overdose reversal drug nalmefene (Opvee).

The Life-Saving Role of Naloxone

Naloxone has gained attention as a wonder drug capable of reviving a person who has overdosed, appeared to have died, or nearly died. I adminishtered, intravenously, my first dose of naloxone in 1975 while working in the Yale New Haven Hospital emergency room.. At the time, naloxone was most often given intravenously by anesthesiologists during surgery to reverse the sedative effects of opioids doctors had administered earlier. When naloxone was approved by the FDA in 1971, total drug overdose deaths in the U.S. were 6,771, rare enough that there was no national call to add it to emergency rooms to reverse overdoses. Since then, the number of overdoses has catastrophically escalated.

When Individuals Overdose on Opioids

What are signs of an opioid overdose? They include unconsciousness, very small eye pupils, slow or shallow breathing, vomiting, inability to speak, faint heartbeat, limp arms and legs, pale skin, and purple lips and fingernails. When a person overdoses on opioids, breathing slows or altogether stops. The overdosed person appears sleepy and is unresponsive.

Opioids

interfere with receptors in the brain, slowing breathing so that insufficient oxygen reaches the brain and other vital organs like the heart; the heart rate may slow or even stop. As breathing slows, oxygen levels fall, which may trigger abnormal heart rhythms. Blue lips and fingernails signal the lack of oxygen. Because insufficient oxygen reaches the brain and heart, the consequences are coma, brain damage, or death.

The antidote, naloxone, attaches to opioid receptors, reversing and blocking effects of opioids. Naloxone can quickly restore normal breathing. Naloxone is so safe we give it immediately to anyone with signs of opioid overdose or when an overdose is suspected. However, the drug has no effect on someone with no opioids in their system.

Reversing Respiratory Depression

The specific mechanism that drives opioid death by overdose is stimulation of one class of endogenous opioid receptors—mu-opioid receptors—in cells in the brainstem; it inhibits breathing. Respiratory depression, or decreased (or terminated) breathing, is a direct effect of opioid use, and, in the case of fentanyl, it appears extremely quickly.

Intravenous naloxone is not available in the community, where first responders depend on intranasal or intramuscular administration. Yet naloxone must be administered much sooner for fentanyl than for heroin because the window for saving the overdosed person is much shorter than with heroin. So, the right dose of naloxone must be given by a friend, loved one, or first responder almost immediately.

Other opioid antagonists, like nalmefene, may be expected to do a better job in fentanyl overdoses. After the person recovers, they should be offered long-term treatment resources, including the ability to initiate treatment for opioid use disorder in the emergency department, as Yale’s Brian Fuerhlein described in an earlier blog post.

Renarcotization

Researchers, addiction experts, and other healthcare providers have documented that when fentanyl is taken chronically, the drug may be absorbed into fat tissue and stay there, accumulating and forming a reservoir of fentanyl. Naloxone might reverse a “normal” fentanyl overdose, but due to the “depot effect,” after a person becomes conscious, they may lose consciousness again and stop breathing. This event is called re-narcotization.

If it is suspected that someone has overdosed on fentanyl and they are given naloxone, they may start breathing again and become conscious. With less potent opioids, naloxone can cover someone for 60 minutes. But someone with a supply of fentanyl in body fat depots can renarcotize several times. It is important to call 911. Additional doses of naloxone may be given as the patient is transported to the ER or hospital, where oxygen and other life support is available.

Narcan Nasal Spray

Naloxone can now be administered by non-health professionals via nasal spray to save lives. Intranasal naloxone works within two to three minutes. If the person has not responded after three minutes, another dose should be given. After administering naloxone, it’s very important to always call 911 because experts need to determine whether respiratory support, more naloxone, or other measures are necessary to reverse the overdose.

The FDA approved Narcan (naloxone) as a nasal spray for over-the-counter use because it is safe, easy to use, and saves lives. In 2021, the Food and Drug Administration approved an 8-mg intranasal naloxone product, twice the amount than the usual 4-mg dose. The FDA also granted a second over-the-counter naloxone agent in early 2024. This drug, RiVive, is a generic naloxone nasal spray available from Harm Reduction Therapeutics, a nonprofit pharmaceutical organization. Nasal naloxone is currently available in 3mg (Revive), 4mg (Narcan), and 8mg (Kloxxado) dosages.

Making naloxone available without a prescription expands its availability to people with an opioid-dependent loved one or who themselves have opioid use disorder (OUD). To save someone from an opioid overdose, you need naloxone or nalmefene. Steps for responding to an opioid overdose can be found here.

Another Opioid Overdose Reversal Drug: Nalmefene

Nalmefene has been saving lives from opioid overdoses since May 2023, when the FDA approved nalmefene hydrochloride nasal spray (Opvee). Nalmefene is a long-duration opioid antagonist first approved for injection in 1995. The original injectable nalmefene was removed from the market for commercial reasons in 2008. However, the dramatic rise in opioid overdose deaths and the emergence of powerful synthetic opioids catalyzed the development of an intranasal (IN) form of nalmefene for emergency treatment of opioid, and especially fentanyl, overdoses.

Nalmefene is an opioid receptor antagonist particularly well-suited for fentanyl overdoses. One reason is it has a longer half-life than naloxone, which means it stays in the body longer. This may protect against re-intoxication but may also make withdrawal symptoms last longer in those with opioid use disorders.

Synthetic opioids like fentanyl are now the most common drugs involved in drug overdose deaths in the U.S. Nalmefene is 10 times more potent than naloxone and has an 8- to 10-fold longer half-life (8 to 11 hours), reducing the likelihood of re-overdosing from long-acting opioids.

Xylazine and other adulterants illegally added to opioids in the U.S. have also received attention for generating zombie-like behavior in people. Such additives make overdose reversal more difficult. However, the key to harm reduction is reversing the effects of synthetic opioids on the heart, lungs, and brain.

The efficacy of frontline, community-based reversal of poisoning events with antidotes such as naloxone has been questioned due to the rise of highly potent synthetic opioids, primarily illicitly manufactured fentanyl (IMF), which causes 90% or more of opioid deaths in the U.S.

In many cases today, community-based first responders have improvised or evolved strategies to cope with fentanyl. Typically, multiple naloxone doses are given to individuals who overdosed on opioids. That was definitely not the case when I was giving naloxone to patients in the Yale emergency department in the 1970s or even back when the opioid crisis was primarily either a prescription-opioid or heroin crisis.

However, it’s unclear whether giving opioid overdose patients more doses sequentially is the optimal strategy in dealing with fentanyl. A very nice study by Strauss suggests it’s a good idea to have higher doses of intranasal naloxone available, as it appears that a large first dose at once is superior to the same dose given sequentially.

Some overdoses might be relatively naloxone-resistant and more easily respond to nalmefene. Additional research is needed to determine the optimal naloxone-dosing schedule for fentanyl overdose reversal. Multi-site studies directly comparing nalmefene to naloxone in the community setting are needed.

Conclusion

More than 1 in 8 Americans have had their lives disrupted by a drug overdose. Nearly 49 million Americans (more than 17%) age 12 and older have a substance use disorder. Among young adults aged 18-25, the share jumps to 28%. More than 6 million people had an opioid use disorder, and another 1.8 million had a methamphetamine use disorder in 2022.

The evolving opioid epidemic has morphed into a counterfeit-pill, multi-drug crisis centered on fentanyl, often paired—knowingly or unknowingly—with other illicit drugs. Smoking fentanyl is the newest opioid crisis or problem we have not prevented.

Overdose deaths are only one measure of the drug epidemic’s severity. An estimated 321,566 children lost a parent to drug overdose between 2011 and 2021.

Since 2000, more than 1.1 million overdose deaths have been reported in the U.S. Overdose reversal with intranasal anti-opioids like naloxone and nalmefene has made a big difference but should not be the centerpiece of opioid crisis strategy. Education and prevention are needed and, as we develop new and better treatments for OUDs, so are overdose reversal and relapse prevention. Some very effective means to reverse opioid overdoses are available today, and future research should provide further information on the best medication and dosages for fentanyl overdose situations.

References

Skolnick P. On the front lines of the opioid epidemic: Rescue by naloxone. Eur J Pharmacol. 2018 Sep 15;835:147-153. doi: 10.1016/j.ejphar.2018.08.004. Epub 2018 Aug 7. PMID: 30092179.

Ellison M, Hutton E, Webster L, Skolnick P. Reversal of Opioid-Induced Respiratory Depression in Healthy Volunteers: Comparison of Intranasal Nalmefene and Intranasal Naloxone. J Clin Pharmacol. 2024 Mar 4. doi: 10.1002/jcph.2421. Epub ahead of print. PMID: 38436495.

Crystal R, Ellison M, Purdon C, Skolnick P. Pharmacokinetic Properties of an FDA-approved Intranasal Nalmefene Formulation for the Treatment of Opioid Overdose. Clin Pharmacol Drug Dev. 2024 Jan;13(1):58-69. doi: 10.1002/cpdd.1312. Epub 2023 Jul 27. PMID: 37496452; PMCID: PMC1081801

Source:  https://www.psychologytoday.com/us/blog/addiction-outlook/202406/the-fentanyl-death-crisis-in-america

Filed under: Addiction,Drug Specifics,Health,USA :

Ricky Klausmeyer-Garcia’s friends struggled to get him addiction treatment, leading to the creation of a law in his name. A year after his death, profound questions remain about how best to help those with substance use disorder

by Katia Riddle in Seattle

Mon 13 May 2024 15.00 BST

Sitting at his dining room table, Kelsey Klausmeyer, 41, looks at a picture of his late husband, Enrique Klausmeyer-Garcia, known to most as Ricky. He died almost exactly a year ago, at the age of 37.

Kelsey can’t make sense of it.

When they met, Kelsey was awed by Ricky’s story: his long battle with addiction, his years of sobriety, his advocacy for recovery.

Now, after his death and in the midst of a nationwide addiction crisis, the narrative around Ricky’s life is less tidy.

Ricky is the inspiration for a Washington state law – known as Ricky’s law – passed in 2017 that enables loved ones and public safety officials to compel people experiencing substance abuse to undergo treatment, even if they are unable or unwilling to do it themselves.

The US has been experimenting with these forced-commitment laws for decades. The debate over their efficacy, practicality and ethicality is seeing renewed urgency in states such as New York, California and Washington, where addiction and severe mental health disorders have become a highly visible and highly political issue.

Ricky’s story brings into sharp relief one of the fundamental and difficult questions that officials in these places are grappling with: to what extent should society override an individual’s rights in the name of saving their life and protecting public safety?

I thought so highly of Ricky, to suffer with that disease and then turn around and do something for the greater good

Kelsey Klausmeyer, Ricky’s husband

For Kelsey, Ricky’s story is not primarily about public policy. It’s a story of immense personal joy and loss, laid before him in a handful of pictures. Here they are with their dog, Otis, whom Ricky “treated like our child”, chuckles Kelsey. Here they are in 2022 on their wedding day, both smiling, fit and handsome at a sunny mountain resort 90 minutes from their home in Seattle. Two hundred of their friends and family came to spend three days celebrating.

Here is Ricky with members of his sprawling family. When the couple first started dating, they discovered, remarkably, that they were both from families of nine siblings, both raised Catholic. “We always thought we were kind of destined in a way,” says Kelsey.

Kelsey grew up in Kansas; Ricky’s family immigrated from Mexico. They met online. Ricky was direct about what he wanted, a quality Kelsey, a naturopathic doctor, found attractive. “He shared that his dream was to have a family, to have kids, have a dog, have a house, have a husband,” remembers Kelsey. Those were prizes neither of them had felt certain were winnable. Together, they brought that picture into focus.

In those early, heady weeks of dating, Ricky was candid with Kelsey about his history with substance use disorder and his journey of recovery. Kelsey was undaunted.

“I just thought so highly of that, for somebody to have suffered with that disease as much as Ricky did, and then to turn around and do something for the greater good like he did,” remembers Kelsey. “That got me. That was the moment I fell in love with Ricky.”

But within the first year of their marriage, and despite Kelsey’s relentless attempts to help him, Ricky would be gone.

Seventy-five hospital visits, and increasing desperation

With his good looks, his authenticity, his goofy enthusiasm for life and willingness to be vulnerable, Ricky was a charmer. Kelsey wasn’t the first person to fall for him.

More than a decade before he met his future husband, Ricky met Lauren Davis. Their friendship would become one of the most important relationships in his life, and the driving force behind the involuntary-commitment law created in his name.

The two were in their late teens in 2004, working as assistant preschool teachers in Redmond, Washington. “I had an enormous crush on Ricky and spent several failed years attempting to woo him,” says Davis of their early friendship. Once they’d established she wasn’t his type, Davis became his “wing woman” and accompanied him to gay clubs. “I’m a white girl who grew up in Washington,” she says. “I can’t dance to save my life, but I sure tried.”

In the next few years, as the two grew into young adults, Davis would become a different kind of wing woman for her friend. Ricky spiraled into a serious problem with alcohol and occasional opioids. “I knew I was feeling depressed,” he recalled years later, in a public radio interview with the Seattle station KNKX. “I was feeling really anxious; most of the time I just wanted to escape all that. I just started to self-medicate and take whatever it took to escape reality.”

The first time Davis called 911 and had her friend taken to the hospital, she remembers his blood alcohol was dangerously high – she would find out it was at a near fatal level. He was admitted to the hospital’s psychiatric unit. Davis sat with him in his room from 8am to 8pm. She described trying to leave Ricky’s hospital room, “hugging him and he wouldn’t let me go”.

Davis and Ricky hiking on Mt Rainier in the summer of 2007. They two met in their early 20s and quickly became friends. Photograph: Courtesy of Lauren Davis

This episode set off a corrosive cycle of hospitalization, brief sobriety and relapse. Eventually, Ricky became suicidal.

“I found myself consistently in a position of trying to catch him, before he died, essentially,” says Davis. “In the course of those two years, he was in the emergency department over 75 times. I was at his bedside for most of those visits.” Numerous doctors told her to plan for his funeral. Davis refused. She would not stand by and watch her friend die.

Ricky’s father had terminal cancer during this period and despite family members’ efforts to help Ricky, his addiction stressed relationships. Davis became his primary advocate and champion.

Watching Ricky’s struggle, Davis was horrified at how little she could do to help him. What she wanted was to put her friend into an addiction treatment facility, because he was too sick to do it himself.

But at that time, in 2011, Washington law only allowed for involuntary commitment based on a psychiatric diagnosis, not for a substance abuse disorder. Other states had more expansive criteria.

Davis remembers Ricky on his sixth psychiatric hospitalization. “He had this young psychiatrist who looked across at him and said, ‘You know, if we were in another state and I could involuntarily commit you for your addiction, I would.’”

But in Washington state, the doctor said, “his hands were tied”.

A contentious history

American public policy has grappled with the concept of involuntary commitment since at least the 1850s. As many as 14 states had laws on the books before the turn of the 20th century allowing for civil commitment for “habitual drunkenness”. Often, offenders would be locked in asylums.

Over time, enthusiasm for this approach began to fade “because of the lack of evidence that the facilities were really able to cure substance abuse”, says psychiatrist and historian Paul Appelbaum, who teaches at Columbia University and studies medicine and ethics. Legislators – and the public – stopped supporting the investment. The country saw another wave of these statutes in the 1960s. Today, though roughly two-thirds of states have civil commitment laws that specifically include substance use, many are rarely used.

In part, that’s because there is still little consensus about the efficacy of committing someone to treatment against their will. “There are almost no data indicating whether it works or for whom it works,” says Appelbaum. Policymakers, he says – chronically guilty of short-term thinking – have been reluctant to invest in meaningful efforts to evaluate these kinds of programs. Those that have tried have shown mixed outcomes, and they often don’t measure long-term results.

Many who study addiction and substance use have ethical concerns. Holding someone long enough for treatment to possibly be effective, say some, is immoral.

Dr Liz Frye, who practices addiction medicine in Pittsburgh, explains that substances such as alcohol and opioids hijack the brain’s decision-making abilities. Regaining them can take months. “I have not seen an involuntary hold that would be long enough to help people regain their choice about substances,” she says. “I have a hard time with involuntarily committing someone for that length of time.”

Another complicating factor is that treatment and recovery itself can vary widely. “A lot of times, the perception is that everybody needs residential treatment,” says Michael Langer, who works in behavioral health for the state of Washington. “That’s not true.” Often the best course of treatment, says Langer, is outpatient, or medication-based.

Ordering someone into treatment is just based on a delusion that there’s somewhere for them to go

Keith Humphreys, addiction researcher

But staffing and funding for treatment facilities of all kinds is in short supply, and getting someone to a short-term treatment facility, with or without their consent, is only a first step on a successful path to recovery. Incentivizing and supporting the individual’s choice to maintain treatment is an equally critical part of the process. That can only happen with a robust and well-funded system that includes many different pathways and interventions.

“I think people imagine there’s this whole massive treatment system,” says Keith Humphreys, who studies addiction and public health at Stanford University. The truth is, he says, most systems across the country – privately and publicly funded – for treatment of addiction are frail and underfunded and can’t accommodate the demand, even from those who are pursuing it voluntarily.

In the United States, a recent report shows that 43% of people willingly seeking treatment for substance use were unable to access it. “Ordering them into treatment is just based on a delusion that there’s somewhere for them to go,” says Humphreys.

Police check on a man who said he has been smoking fentanyl in downtown Seattle. The addiction crisis sweeping US cities has raised complex questions about how to get people treatment. Photograph: John Moore/Getty Images

Ricky’s law takes shape

Lauren Davis helped to save her friend. In turn, he laid out the path for what would become her life’s work.

“I started to tell his story to anyone who would listen to me,” says Davis. Some of the people she demanded listen to her were legislators. They helped her introduce a bill for what became Ricky’s law.

After he eventually found his own way into treatment and long-term recovery, Ricky too became an advocate for his bill and Davis’s work. “If this law would have been in place back when I was in active addiction, I believe that my journey would have been cut that much shorter,” he would say in the interview with KNKX. “For a lot of addicts, they want to stop but they can’t. You could have loved ones tell you to stop. You could have all these consequences being behind your actions, and yet you won’t and can’t stop.”

The law amended Washington’s existing rule to allow for short-term, involuntary commitment not only for psychiatric disorders but also for those related to substance use. That meant people “gravely disabled” by addiction – and considered a danger to themselves – could now be committed against their will.

It designated tens of millions of dollars to creating a kind of holding place for detaining people under the law; there are now close to 50 “Ricky’s law” beds in four treatment facilities across the state.

But today, who needs these beds – and how to get them there – is not always clear.

“Someone who comes into the emergency department intoxicated on any substance who is a danger to themselves could be referred right off the bat under Ricky’s law,” says Paul Borghesani, medical director of psychiatric emergency services at Harborview medical center, Seattle’s public hospital. “Practically, that doesn’t happen.”

The reasons are numerous, says Borghesani. Often after 12-36 hours in detox, people who were previously at risk of great harm to themselves “appear much calmer”. Many even say they plan to quit using. This puts the clinicians in a bind, he explains, forcing them to reckon with a philosophical question: is someone a danger to themselves if they claim not to be?

The law is also dependent on a team of mental health professionals called designated crisis responders, employed through state contracts with regional behavioral health agencies and counties. These responders are deployed when someone – often a loved one, community member or medical provider, though it can be anyone – requests an evaluation of an individual in a substance use-related crisis. It’s at the discretion of these crisis responders to decide whether that individual is in enough danger, or endangering others enough, to commit them to a treatment facility – sometimes for just a few days but up to several weeks.

But waits are long for these responders; some advocates for those struggling with substance use disorders report enduring weeks before a designated crisis responder arrives. Sometimes that’s time they don’t have.

Another reason Borghesani says the law isn’t used: hospitals are busy. “Physicians are rightfully very eager to keep people flowing through the emergency departments,” he explains. “So they might look at this as something that would just take a lot of time and not be beneficial.”

Despite these obstacles, Ricky’s law is put to regular use in Washington. According to the Washington health authority, the state has been admitting roughly 700 people annually to substance-use facilities under Ricky’s law.

That number does not reveal how many people have elected to stay in recovery after their forced detention – a fact that makes it hard to say with certainty how effective it has been in galvanizing sustained recovery.

New dilemmas for a new crisis

In 2024, the complex questions raised by Ricky’s law – and what helpful, compassionate addiction policy actually looks like – are more relevant than ever across the country. Recent CDC data shows a stunning national rise in alcohol-related deaths; more than 11% of adults had alcohol use disorder at some point in 2022, according to the National Institutes of Health.

A far more visible catastrophe of addiction is playing out in US cities overwhelmed in recent years by cheap, synthetic fentanyl. In Washington’s King county, home of Seattle, there were more than 1,000 overdose deaths in 2023, a nearly 50% increase from the previous year. Whole blocks are taken over by people buying, using and selling fentanyl. Arguably any one of these people is a grave danger to themselves.

Some outreach workers and medical providers on the frontlines of this problem would like to use the law to help this population, but say it’s not currently possible.

“We get stuck in this place of: what do we do?” says Cyn Kotarski, the medical director with a program called CoLead that helps people with housing and treatment. Kotarski often sees people with abscess wounds, days away from becoming septic. But with long waitlists for designated crisis responders, there’s no way to reach people in these crisis moments. “The option quite literally becomes: they stay outside until they die,” she says.

Frye, the addiction-medicine expert, says the problem is one of more than resources. The US, she says, needs an entirely new orientation to addiction treatment to underpin public policy, one that embraces methods such as harm reduction. “We have to stop being the moral police of people,” says Frye.

Public health addiction crises like the one that Seattle is battling, she argues, would be better addressed by tackling the surrounding problems – housing crises, trauma and mental health issues that give rise to substance use disorders. She imagines coupling this approach with accessible, compassionate therapeutic outpatient settings.

“The best way to help people reduce or stop using substances is to put the patient in the driver’s seat,” she says. “And we as healthcare providers are working towards helping them identify their own reasons to want to come back and quit.” Forced captivity, she argues, doesn’t meet that criterion.

But even Frye acknowledges a utility to saving a person’s life in certain circumstances without their consent. Sometimes her own patients are facing imminent death otherwise. “Transporting someone to the hospital involuntarily, getting that condition assessed, and helping make the hospital stay tolerable for the person – that’s warranted,” she says.

The exact circumstances in which to make this call are hard to define. Maybe impossible.

We get stuck in this place of: what do we do? The option quite literally becomes: they stay outside until they die

Cyn Kotarski, medical director with CoLead

Inspired by her work creating Ricky’s law, Lauren Davis decided to run for office, and was elected as a state representative in 2018. She has focused her policy efforts on expanding the state’s fragile system of treatment for substance abuse, an endeavor she continues today.

Davis acknowledges Ricky’s law needs course correction to be more useful, and she agrees that even if it’s improved, the law is not enough to adequately address the scope of addiction in places like Seattle.

“Do we just massively scale up Ricky’s law to address the scourge of fentanyl on the streets of Seattle?” she says. “No.”

Instead she’s focusing her current efforts on building a robust system of treatment that addresses comprehensive needs including housing and access to medications like methadone and Suboxone that can be provided over the counter to treat addiction. This effort also includes expanding a recovery navigator program, in which outreach workers build trust with people on the street and help them access resources – willingly.

Still, she firmly believes in the potential and power of Ricky’s law in certain circumstances. She’s seen it work first-hand, saying: “At the end of the day, I believe without a doubt that it has saved lives, that it has changed lives, that it has restored families.”

A devastating turn of events

By late 2020, Ricky had been sober nine years. Then came an episode that would test both Ricky’s relationship with Kelsey and the law created in his name.

Kelsey recalls coming home one day from work and finding his then boyfriend passed out in the stairwell of their condo. Kelsey believes the pandemic triggered the relapse. Ricky had built a network of friends and family in the world of recovery, support that quickly dissolved in social isolation.

“I had heard him talk about what active disease looked like,” says Kelsey. “When it showed up, I was like: ‘Oh my God, what is happening?’”

During that event, according to both Davis and Kelsey, Ricky’s law worked the way it was supposed to. He was put in a temporary, involuntary hold. After a number of days of sobriety, says Davis, her friend re-emerged. “His brain came back online. He was able to make healthy choices,” Davis recounts.

Kelsey says: “He chose our life together.” Kelsey worked to help Ricky gain access to a residential treatment program.

It was more than two years later, after he and Kelsey were married, that relapse came again for Ricky. To Kelsey, it seemed out of the blue. Ricky had gone back to school and had a new job working for an organization supporting recovery for others. “We were really living the dream we always wanted,” he says.

He wonders if his husband was suffering from a kind of existential vertigo. “The only way that I can make sense out of it is that sometimes when things are so good, it’s the fear of losing it,” he says. “That’s what Ricky would talk to me about sometimes.”

This time, in post-pandemic 2023, systems of emergency and crisis support were stressed. Kelsey spent hours on the phone trying to make the legal and healthcare wheels turn in his favor. One night, worried that Ricky was literally going to drink himself to death, he drove his husband to the emergency room. The following day, when there was a staff change, says Kelsey, “the attending physician was going to just release him back out onto the street”.

“I would beg and plead with healthcare staff, police officers. I would say: ‘Ricky’s law is literally named after him,’” says Kelsey.

After Kelsey finally had him committed, Ricky became far less reachable, even after days of forced withdrawal and sobriety. At one point, he fled all the way to Oregon, out of the reach of his own law. Kelsey spent nights with no idea where he was. “I really can’t see anyone living on the side of the street or under an overpass without thinking about Ricky,” he says.

Eventually, Ricky ended up in a residential treatment facility in a Seattle suburb. He went there willingly; Kelsey was expecting to see his husband the next day. Instead, Ricky was found dead.

The cause of Ricky’s death is under investigation. Kelsey is now suing the facility, alleging wrongful death.

Kelsey’s faith in the law named for his husband remains steadfast, as does his belief in the power of recovery. “For anyone dealing with this,” he says, “please know there is hope.”

That optimism has not made his first year as a widower easier. It’s been “hell”, as Kelsey describes it. “I just miss him.”

This story is part of a reporting fellowship sponsored by the Association of Health Care Journalists and supported by the Commonwealth Fund

 

Source:  https://www.theguardian.com/society/article/2024/may/13/rehab-forced-addiction-treatment#navigation

Filed under: Addiction,Legal Sector,USA :

May 17, 2024
Paul Larkin
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.

 SUMMARY

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.

KEY TAKEAWAYS

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.

 

Source: https://www.heritage.org/crime-and-justice/report/twenty-first-century-illicit-drugs-and-their-discontents-the-challenges

 

Filed under: Addiction,Prevention and Intervention,Social Affairs :

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: https://www.wsj.com/articles/what-you-arent-reading-about-marijuana-permanent-brain-damage-biden-schedule-iii-9660395e May 2024

Filed under: Addiction,Alcohol,Brain and Behaviour,Cannabis/Marijuana,Drug use-various effects on foetus, babies, children and youth,Global Drug Legalisation Efforts,Health,Marijuana and Medicine :

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)

December 11, 2023

Source: https://health.ucdavis.edu/news/headlines/teens-use-cannabis-for-coping-enjoyment/2023/12

Filed under: Addiction,Cannabis/Marijuana,Prevention and Intervention,USA,Youth :

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.”

Source: https://psychnews.psychiatryonline.org/doi/10.1176/appi.pn.2024.03.3.10

Filed under: Addiction,Health,Social Affairs,USA,Youth :

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.

 

Source: https://eu.usatoday.com/story/news/health/2024/02/21/methamphetamine-plays-increasing-role-in-addiction-crisis/72661430007/

Filed under: Addiction,Methamphetamine/GHB/Hallucinogens/Oxycodone,Social Affairs,USA :
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.

Source:  https://dailymontanan.com/2024/03/17/fourth-wave-of-opioid-epidemic-crashes-ashore-propelled-by-fentanyl-and-meth/

Filed under: Addiction,Drug Specifics,Methamphetamine/GHB/Hallucinogens/Oxycodone,USA :

Jim Carroll is the former director of the White House Office of National Drug Control Policy — informally known as the U.S. Drug Czar — and said the three biggest factors in dealing with the drug epidemic locally and nationally is enforcement, treatment, and prevention.

“It’s the only way to really tackle this issue is one, reducing the availability of drugs in our community, recognizing that there are people who are suffering from addiction and that recovery is possible that if we can get them in to help, that they can recover,” Carroll said. “It’s important to do all three; it’s possible to reduce the number of fatalities.”

Carroll said the issue is getting worse, with the number of fentanyl deaths going up 50% in the last four years, up to around 115,000 from around 70,000 in 2019.

Uttam Dhillon is the former acting director of the Drug Enforcement Agency, and said that the reason the drug epidemic has become such a serious issue is because of the crisis at the southern border.

“The two biggest cartels are the Sinaloa cartel and the…CJNG, and they fight for territory and the ability to bring precursor chemicals in from China to make methamphetamine and fentanyl, and then transport those drugs into the United States,” Dhillon said. “The battle between the cartels is actually escalated and they are now actually using landmines in Mexico… so this is a brutal war in Mexico between the cartels.”

Dhillon said the reason the stakes are so high in Mexico is because the demand for illicit drugs in the United States is so large.

“Basically every state in the union has activity from the drug cartels in Mexico in them, and that’s really important to understand, because that’s why we are being flooded by drugs,” Dhillon said. “We never declared Mexico a narco state during the Trump Administration, but as I stand here today, I would say in my opinion, Mexico is a narco state.”

In terms of dealing with the nation’s drug epidemic, Dhillon said we first have to start by enforcing the law, which in part begins at the southern border.

Increased enforcement at the border, however, does not fully solve America’s drug epidemic. That is where the panel said local partners in prevention and recovery come in.

Kaitlyn Krolikowski is the director of administrative services at the Purchase District Health Department and said that prevention and treatment is about more than keeping people out of jail.

In January and February, there have been four overdoses in west Kentucky, according to the McCracken County coroner.

“Dead people don’t recover,” Krolikowski said. “We are here to help people recover and to help our community.  For our community to prosper, we need healthy community members and the way that we’re going to get that is by offering them treatment, saving lives, and giving them the resources that they need to be members of our community that we’re proud of.”

While many members of the audience were police officers, non-nursing students, and community leaders, the event was designed to help give clinicians more context about the world they will practice in after graduation.

Dina Byers is the dean of the School of Nursing and Health Professions at MSU, and said that its important to hear what is going on at the national, state, and local level when it comes to illicit drugs.

“It was important that they hear what’s going on,” Byers said. “And that was the purpose of this event was to provide a collaborative effort, a collaborative panel discussion around many topics today.”

If you or someone you know is struggling with addiction, you can call the police without fear of being arrested, or call your local health department to get resources that can help saves lives.

Source: https://www.wpsdlocal6.com/news/dead-people-don-t-recover-msu-panel-discusses-drug-epidemic-solutions-in-america/article_aa168e78-ebcf-11ee-9f07-0385030995de.html
Filed under: Addiction,Drug Specifics,Political Sector,USA :

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.

Summary

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.

 

Source:  https://www.addictiongroup.org/resources/addiction-statistics/#:~:text=An%20estimated%2048.7%20million%20Americans%20aged%2012%20or,substance%20use%20disorder%20%28SUD%29%20in%20the%20past%20year

Filed under: Addiction,USA :
Colorado appears doomed to repeat failure

After two fouled attempts to sway the Colorado Legislature that these sites will curb the state’s overdose crisis, harm reduction advocates persuaded a majority in the House Health and Human Services Committee to pass the bill on a 9-4 party-line vote.

These sites are illegal under federal law; the bill, however, appears poised to pass the House in the same party-line fashion.

While persistence may be on the proponents’ side, the facts, when thoroughly considered, are not in their corner.

Bill advocates use a sole metric of “effectiveness” to support their claim that these sites will reduce overdose deaths.

In the North American communities where these sites have been piloted, including Vancouver, British Columbia, San Francisco, and New York’s Harlem neighborhood, there are virtually no reported overdose deaths on the sites themselves. Conveniently omitted is the data showing that drug overdose rates have soared in the communities surrounding the pilot sites.

In Vancouver, where the normalization of such behavior over 20 years is likely to have had some effect, deaths due to illicit drug toxicity have risen by 840% since its first site opened in 2004. Heroin possession and trafficking incidents increased by nearly 170% from 2004 to 2018.

Still, a more thorough look at the overdose death rate should not be the sole metric used by the Colorado Legislature to evaluate comprehensive effectiveness.

One consideration is whether these sites reduce overall harm to a person struggling with addiction.

The Centers for Disease Control and Prevention classifies addiction as a medical condition, a brain disease that needs treatment.

San Francisco’s site experiment revealed that “revived” drug abusers often continue to take the drugs and overdose. There are documented cases of the same person being revived from an overdose more than 30 times, making them further subject to toxic brain injury, according to the Brain Injury Association. Repeated drug abuse destroys frontal lobe tissue, the source of motor function and judgment, and can lead to further injury to the brain, including hypoxia or brain anoxia, in which the body forgets how to breathe. Enabling the disease is hardly a benign effort.

Further, legislators should evaluate the impact on the surrounding neighborhoods. The neighbors of the sites in Harlem reported an uprising of drug markets where dealers have unlimited access to customers. At the same time, Harlem’s children are forced to navigate used syringes along the sidewalks. In San Francisco, the neighbors endured a similar experience, which led the city to shut down the site within one year of operations.

The linking of site visitors to treatment programs must also be considered. In Vancouver, less than 2% of the site visitors access treatment of any sort. In the San Francisco pilot program, it was less than 1%. Notably, the site operators in Harlem don’t measure this indicator.

Finally, Colorado legislators must consider last week’s bipartisan repeal of Oregon’s Measure 110 by its Legislature. In 2020, Measure 110 was overwhelmingly passed by Oregon voters, who were told that the decriminalization of drugs would “reduce stigma” and reduce use for those struggling with addiction. In three short years, Oregon is now one of the nation’s leaders in addiction and overdose death rates and now has the second-highest increase in homelessness in the country.

More than 1 in 10 Coloradoans struggle with addiction — one of the highest rates in the nation. Colorado’s homeless population grew by nearly 40% in 2023 over 2022. Colorado can ill afford another public policy experiment that rejects recovery and restoration that is not only possible for the individual struggling with addiction but also necessary for a functioning society.

Colorado lawmakers must serve as the backstop to this failed policy. They must look through the portal of experience versus through the narrow lens imparted by the bill’s authors to see the broad implications to all Coloradoans if HB 24-1028 were to pass.

 

Source: https://www.iwf.org/2024/03/29/safe-injection-sites-are-no-answer-to-addiction/

Filed under: Addiction,Drug use-various effects,Environment,USA :

A CONVERSATION WITH … Dr. Nora Volkow, who leads the National Institutes of Drug Abuse, would like the public to know things are getting better. Mostly. Volkov says:  “People don’t really realize that among young people, particularly teenagers, the rate of drug use is at the lowest risk that we have seen in decades,” 

By Matt Richtel    NYTimes    April 6, 2024

Historically speaking, it’s not a bad time to be the liver of a teenager. Or the lungs.

Regular use of alcohol, tobacco and drugs among high school students has been on a long downward trend.

In 2023, 46 percent of seniors said that they’d had a drink in the year before being interviewed; that is a precipitous drop from 88 percent in 1979, when the behavior peaked, according to the annual Monitoring the Future survey, a closely watched national poll of youth substance use. A similar downward trend was observed among eighth and 10th graders, and for those three age groups when it came to cigarette smoking. In 2023, just 15 percent of seniors said that they had smoked a cigarette in their life, down from a peak of 76 percent in 1977.

Illicit drug use among teens has remained low and fairly steady for the past three decades, with some notable declines during the Covid-19 pandemic.

In 2023, 29 percent of high school seniors reported using marijuana in the previous year — down from 37 percent in 2017, and from a peak of 51 percent in 1979.

Dr. Nora Volkow has devoted her career to studying use of drugs and alcohol. She has been the director of the National Institute on Drug Abuse since 2003. She sat down with The New York Times to discuss changing patterns and the reasons behind shifting drug-use trends.

What’s the big picture on teens and drug use?

People don’t really realize that among young people, particularly teenagers, the rate of drug use is at the lowest risk that we have seen in decades. And that’s worth saying, too, for legal alcohol and tobacco.

What do you credit for the change?

One major factor is education and prevention campaigns. Certainly, the prevention campaign for cigarette smoking has been one of the most effective we’ve ever seen.

Some of the policies that were implemented also significantly helped, not just making the legal age for alcohol and tobacco 21 years, but enforcing those laws. Then you stop the progression from drugs that are more accessible, like tobacco and alcohol, to the illicit ones. And teenagers don’t get exposed to advertisements of legal drugs like they did in the past. All of these policies and interventions have had a downstream impact on the use of illicit drugs.

Does social media use among teens play a role?

Absolutely. Social media has shifted the opportunity of being in the physical space with other teenagers. That reduces the likelihood that they will take drugs. And this became dramatically evident when they closed schools because of Covid-19. You saw a big jump downward in the prevalence of use of many substances during the pandemic. That might be because teenagers could not be with one another.

The issue that’s interesting is that despite the fact schools are back, the prevalence of substance use has not gone up to the prepandemic period. It has remained stable or continued to go down. It was a big jump downward, a shift, and some drug use trends continue to slowly go down.

Is there any thought that the stimulation that comes from using a digital device may satisfy some of the same neurochemical experiences of drugs, or provide some of the escapism?

Yes, that’s possible. There has been a shift in the types of reinforcers available to teenagers. It’s not just social media, it’s video gaming, for example. Video gaming can be very reinforcing, and you can produce patterns of compulsive use. So, you are shifting one reinforcer, one way of escaping, with another one. That may be another factor.

Is it too simplistic to see the decline in drug use as a good news story?

If you look at it in an objective way, yes, it’s very good news. Why? Because we know that the earlier you are using these drugs, the greater the risk of becoming addicted to them. It lowers the risk these drugs will interfere with your mental health, your general health, your ability to complete an education and your future job opportunities. That is absolutely good news.

But we don’t want to become complacent.

The supply of drugs is more dangerous, leading to an increase in overdose deaths. We’re not exaggerating. I mean, taking one of these drugs can kill you.

What about vaping? It has been falling, but use is still considerably higher than for cigarettes: In 2021, about a quarter of high school seniors said that they had vaped nicotine in the preceding year. Why would teens resist cigarettes and flock to vaping?

Most of the toxicity associated with tobacco has been ascribed to the burning of the leaf. The burning of that tobacco was responsible for cancer and for most of the other adverse effects, even though nicotine is the addictive element.

What we’ve come to understand is that nicotine vaping has harms of its own, but this has not been as well understood as was the case with tobacco. The other aspect that made vaping so appealing to teenagers was that it was associated with all sorts of flavors — candy flavors. It was not until the F.D.A. made those flavors illegal that vaping became less accessible.

My argument would be there’s no reason we should be exposing teenagers to nicotine. Because nicotine is very, very addictive.

We also have all of this interest in cannabis and psychedelic drugs. And there’s a lot of interest in the idea that psychedelic drugs may have therapeutic benefits. To prevent these new trends in drug use among teens requires different strategies than those we’ve used for alcohol or nicotine.

For example, we can say that if you take drugs like alcohol or nicotine, that can lead to addiction. That’s supported by extensive research. But warning about addiction for drugs like cannabis and psychedelics may not be as effective.

While cannabis can also be addictive, it’s perhaps less so than nicotine or alcohol, and more research is needed in this area, especially on newer, higher-potency products. Psychedelics don’t usually lead to addiction, but they can produce adverse mental experiences that can put you at risk of psychosis.

Matt Richtel is a health and science reporter for The Times, based in Boulder, Colo. More about Matt Richtel

Filed under: Addiction,Education,Prevention and Intervention,Social Affairs,Treatment and Addiction :

In 2020 Oregon voters approved Measure 110, the nation’s first law decriminalizing possession of small amounts of drugs, including fentanyl, heroin and methamphetamines. Under Measure 110, people cited for drug possession had the option of paying a $100 fine or calling a hotline for treatment. Oregon committed marijuana tax revenue to addiction and recovery services, but in the first year after decriminalization, only 136 people in the state chose to enter treatment. Instead, the state saw a proliferation of open-air drug markets and a rise in crime, homelessness and overdoses.

A public backlash ensued, and last summer a poll of 1,000 registered voters found that two-thirds wanted a major change in the law. A campaign to “fix and improve” Measure 110 has proposed to recriminalize the possession of fentanyl, methamphetamine and cocaine, prohibit the use of these drugs in public, and make drug treatment mandatory.

Popular opinion holds that an addict cannot be helped until he or she wants to quit, and there is overwhelming agreement among experts that it is preferable for people to choose to enter care rather than be forced into it. But research has borne out the conclusion of a 1990 Institute of Medicine report that “criminal justice pressure does not seem to vitiate treatment effectiveness, and it probably improves retention.”

Most people who are addicted do not want to enter a treatment program. Data from the federal Substance Abuse and Mental Health Services Administration show that in 2022, a staggering 94.8% of people with a drug or alcohol use disorder within the past year “did not seek treatment and did not think they should get treatment.” Those who do voluntarily enter treatment usually don’t complete it. About one-third of voluntary patients drop out of treatment before completion, according to government data. Other studies show that up to 80% leave by the end of the first year. Among dropouts, relapse within a year is the rule.

One of the earliest demonstrations of the value of compelled treatment comes from the California Civil Addict program, established in the 1960s for both criminal and non-criminal drug addicts. The program included an average of 18 months in residential treatment. Patients received drug treatment, job training and education with transition services. Upon release, they were to spend up to five additional years being closely monitored and undergoing weekly urine toxicology tests. During the program’s first two years, however, judges and other officials mistakenly released about half the patients from mandatory treatment after only minimal exposure to the initial, residential part of the program.

A natural experiment was born, allowing researchers to compare people who finished treatment with those who were inadvertently released. After reviewing records and interviewing almost 1,000 “out of control” heroin-addicted participants, the researchers found that, seven years after admission to the program, participants who were prematurely released went back to using heroin at more than twice the rate of those who completed 18 months of compulsory residential care.

Today the U.S. has about 4,000 drug courts that offer an alternative to incarceration for addicts who commit nonviolent crimes. Defendants who choose drug court remain in treatment for one to two years under close supervision, including routine urine testing. Once participants complete the treatment program, their record is expunged—a big dangling carrot. A 2002 study in the Journal of Research in Crime and Delinquency looked at 235 arrestees in Baltimore who were randomly assigned to either drug court or typical community supervision, which might include regular meetings with probation officers and referral to drug treatment services. The study found that those in drug court were one-third as likely to be rearrested after a year.

These and other studies show that people who are mandated to undergo addiction treatment fare at least as well as those who volunteer. In the 2000s, a group of Stanford researchers compared a group of patients required by a court attend drug treatment with others who entered care voluntarily. At one year and five years following enrollment, the mandated and voluntary patients made similar improvements in areas such as drug use, criminal activity and employment status. Notably, the groups were equally satisfied with their treatment experience.

Compulsory treatment offers a chance to rescue people earlier in their “careers” of drug addiction, when intervention can produce greater lifetime benefits. And mandated care can ensure that people remain in treatment and don’t drop out, which is consistently shown to be one of the best predictors of a successful outcome. The longer participants stay in care, the more likely they are to internalize the values and goals of recovery.

Some critics say that compelling treatment for addiction is unethical because addiction is a disease. But it is not a classic, involuntary illness; it is a behavior that entails choice and responds to consequences. An approach known as “contingency management” offers people undergoing drug treatment a positive incentive by offering small rewards for meeting expectations; for instance, a negative drug test might earn movie tickets or a gift cards.

As for negative incentives, almost everyone who enrolls in Dr. Satel’s methadone clinic arrives under pressure, whether from a fed-up spouse, an angry boss or a probation officer. And mandatory treatment is far less restrictive than jail, where many addicts end up when they commit drug-related crimes such as theft, child neglect or threatening public safety.

For people who are so chronically intoxicated that they can’t meet their own basic needs, there is also the alternative of civil commitment. In October, California Gov. Gavin Newsom signed a law reforming the state’s conservatorship system to make it easier to compel treatment for people suffering from mental illness or drug addiction.

 PHOTO: MARY HUDETZ/ASSOCIATED PRESS
Workers clear syringes and other drug paraphernalia from a vacant lot in Albuquerque, N.M.,August 2019. Mandatory treatment programs can offer accountability when drug users threaten public safety.

Critics are correct, however, to point to the inconsistent quality of addiction treatment programs. Until relatively recently, many drug courts were reluctant to allow participants to use proven medications such as methadone or buprenorphine for opioid addiction. In Oregon, the effort to expand treatment under Measure 110 failed in part because the infrastructure was not put in place quickly enough. If mandated treatment becomes more common nationwide, services will need to ramp up quickly.

Oregon may no longer incarcerate people solely for possessing a small amount of drugs, but there is still a need for accountability when someone with a substance use disorder threatens public safety. By mandating high-quality treatment programs for offenders, and providing care for those who can’t otherwise maintain their own safety, the state could turn its failed experiment into a valuable lesson.

Dr. Sally Satel is a senior fellow at the American Enterprise Institute and medical director of a methadone clinic in Washington, D.C. Kevin Sabet, Ph.D., is a former White House adviser and President and CEO of the Foundation for Drug Policy Solutions.

Source:  https://www.wsj.com/health/healthcare/addiction-treatment-can-work-even-when-its-not-voluntary-a81f86ac

Filed under: Addiction,Treatment and Addiction :

The study by Sadananda et al published in the current issue of the IJMR highlights the neurophysiological basis of altered cognition in subjects with opioid addiction. The study demonstrated aberrant network activity between the default mode network (DMN) and fronto-parietal attentional network (FAN) as a major cause for working memory deficits in drug addiction. Working memory is an important to retain the cognitive information essential for goal directed behaviours. Human beings are endowed with an efficient cognitive faculty of working memory, essential for efficient functioning of the executive network system of the brain. As working memory is the key to carry out any cognitive process involving attention, volition, planning, goal directed behaviour, etc., consciousness is linked largely to working memory processing. The importance of integrating neuroscience knowledge especially the executive functions of human brain in leadership has been taught in neuro-leadership programs as a mean to maximize the human capabilities, productivity, creativity, leadership, wellness, positive attitude.

Aberrant network activities and structural deficits in brain areas of executive functioning impede most of our intellect including mental flexibility, novel problem solving, behavioural inhibition, memory, learning, planning, judgement, emotion regulation, self-control and other social functioning. Deficits in working memory and attention owing to reduced fronto-parietal network (FPN) activity is reported in schizophrenia, autism, attention deficit hyperactive disorder (ADHD) and anxiety disorders. Opioid addiction is reported to impede such dynamicity of the executive system leading to a wide range of deficits in cognition. Opioid addiction alters the network integrity between DMN and FPN networks and weakens the cognitive information processing in cognitively challenging paradigms. Dysfunctional dynamics of DMN activity is believed to contribute to impaired self-awareness, negative emotions and addiction related ruminations. Aberrant DMN activity and reduced medial prefrontal cortical functions are common neural phenotypes of cognitive deficits in conditions like mental illness, drug addiction, sleep deprivation and neurodegenerative disorders. People with substance use disorders develop mental illnesses as a serious comorbidity that in turn, leads to severe behavioural impairments at the social, emotional and cognitive domains. Chronic sleep deprivation associated with drug addiction and substance abuse is another predisposing factor that worsen the behavioural impairments. Over all, drug addiction, substance abuse and the subsequent maladaptive behaviours including mental illness and sleep deprivation trigger a complex set of network instability in the domains of cognition and affect. The euphoria and hallucinating experience of drugs of abuse would soon lead to psychological distress and to cognitive and emotional behavioural impairments due to the disruption of various top down and bottom-up network dynamics.

Substance use disorders are an imminent socio-economic burden and have become a major public health concern worldwide. Despite knowing the harmful effects and consequences of drug use, reports say that the youth especially the adolescents have a tendency to continue the habit. There is a need to have effective measures in place such as educational programmes to improve the self-efficacy of parents and family members to help their children to develop the right behavioural attitude, enhance the capacity building in teachers to strengthen the self-esteem and wellness of students to organize substance use control awareness programmes in coordination with NGOs at educational institutions, involvement of television and other visual and social media platforms to organise substance abuse control programmes and for interactive opportunity for children/youth with educators, researchers and professionals, organization of knowledge dissemination programmes to the public/schools/colleges to highlight the adverse effects of drug abuse on mental health and cognition. Introduction to such knowledge sharing platforms such as the Virtual Knowledge Network (VKN) at NIMHANS, Bengaluru, provide interactive skill building opportunities to safeguard them from substance abuse and addiction. People should have easy access to such services and rehabilitation centers. Various behavioural intervention strategies such as cognitive retraining, psychotherapy, yoga therapy, mindfulness-based intervention programmes etc. are reported to improve cognitive abilities, regulation of negative emotions and restoration of motivational behaviours. A study on single night exposure to olfactory aversive conditioning during sleep helped to quit addiction to cigarette smoking temporarily. Such studies highlight the possibility of learning new behaviours during sleep and its positive impact on wake associated behaviours. Such approaches are quite useful, easily testable and cost-effective. Thanks to the incredible phenomenon of adult brain plasticity, it is possible to re-establish social intelligence, prosocial motivation among people with substance abuse.

Source: Drug addiction – How it hijacks our cognition & consciousness – PMC (nih.gov) October 2021

Filed under: Addiction,Brain and Behaviour,Drug use-various effects,Heroin/Methadone,Nicotine,Treatment and Addiction :

Substance use has often been described as “bad learning” linked with impairments in reward processing and decision-making, but there is little substantial research to support this idea. A recent study by Byrne et al. suggests that substance misuse not only promotes harmful habit formation, which might undermine survival, but also makes it difficult to stop using.

Model-free vs. Model-based Learning

The “Dual Systems” theory of reinforcement learning defines two distinct systems:

  1. The model-based, or goal-directed system, where actions are planned and purposeful, and we learn about the connection between actions and outcomes, and how to modify our behavior to achieve the desired outcome. This system requires more cognitive processing and is more flexible and controlled.

  2. The model-free, or habit-based system, where learning is informed by reflexive responses to stimuli – like compulsive substance use and cravings. This system of learning is less flexible and is more controlled by automatic processing.

The differences between the two systems of learning have been highlighted by researchers in relation to harmful habitual behaviors such as substance use. One school of thought suggests that learning informed by the model-free system, with more of a focus on instinctual response to stimuli and less of a focus on conscious and informed decision-making, sets a person up to be more likely to engage in detrimental behaviors like substance use.

There is evidence that progressing from first use to misuse and addiction is paralleled by a shift from planned, purposeful, and goal-directed behavior to behavior that is habitual and reflexive. This progression and subsequent loss of control has been discussed by National Institutes on Drug Abuse Director Dr. Nora Volkow in her keynote speech at the APA and in her blog about free will. Model-free, conditioned learning means it is harder for a person to engage their frontal lobes, the part of the brain that helps us prioritize healthy, long-term and rational decisions. Repeated problematic substance use initiates a process where humans begin to respond more instinctually to the substance, wanting more and more of it over time. Use begets use, which leads to maladaptive behaviors centered around obtaining and using the substance to trigger the very same dopamine response that drives and reinforces model-free, habitual learning.

Substance Use and Reward Devaluation

Reward devaluation is a process that occurs in the brain where the value of a desirable outcome, like singing in a band, mentoring, or maintaining sobriety is reduced significantly. This process plays into why improving treatment outcomes can be so hard – treatment for addiction is not as “reinforcing” in the brain as substance use. Compulsive drug use is considered “highly pleasurable” by the parts of the brain that control decision-making when people are heavily addicted and feel as though they need the substance to survive. But treatment? not so much — long-term treatment is difficult to complete without continual support and a long-term treatment plan. Many patients stop attending treatment and/or support groups, and taking prescribed medications unless they are compelled to follow a set treatment plan and have adequate supports in place to help keep them on track.

Addiction is correlated to a considerable decrease in a person’s ability to devalue or disengage from habits learned through the model-free system. This means that problematic substance use affects our ability to make decisions and as the disorder progresses, we begin to put less value on long-term rewards and more value on immediately satisfying a need. Gradually, short term needs, like substance use, override long-term needs, like maintaining employment or investing in personal relationships.

Goals of Study

  1. To examine the associations between model-based and model-free learning with a wide array of substance use behaviors. The process used to determine this was measuring individual variations in eye-blink rate, an indirect proxy for dopamine functioning, a key neural process related to model-free learning.

  2. To assess whether problematic substance use predicted reward disengagement.

Why is This Important?

Patients with substance use disorders are driven to use despite harmful consequences, and although addiction is understood more and more as an acquired brain disease, many are still mystified as to why those suffering can’t manage to break their “habit.” This study helps foster a greater understanding of the mechanisms that explain why. Use may be thought of as “recreational” by the user, but it poses a challenge to the brain, reinforcement systems, and reward hierarchies, which can change a person quickly and in a way that is hard for those around them to understand. Once reward-outcome associations are well established— i.e., taking drugs makes a person “feel good”— individuals with substance use disorders have changed the most basic mechanisms in their brain, and will have more difficulty disengaging from the habitual tendencies. It is not clear how individual experiences, genetics, trauma, and other factors change the speed of these changes. That said, the results of this study are consistent with previous data depicting how alcohol dependence indicates a greater likelihood that a person has habit-based learning strategies over goal-directed strategies. The results do not, however, provide us with more information about whether biological recovery is possible, and how we could make recovery more likely and sustainable for patients.

Authors state that current findings highlight how problems with substance use go beyond the realms of habit formation: they also influence the process of disengaging or “breaking” habits by making it more difficult for individuals with substance use disorders to stop using substances. A better understanding of the mechanisms in the brain that take over once substance use becomes problematic may help us create more effective prevention campaigns and treatments once substance use progresses to a harmful habit.

Source: Why are habits so hard to break? (addictionpolicy.org) May 2019, updated October 2022

Filed under: Addiction,Brain and Behaviour,Drug use-various effects,Treatment and Addiction :

DRP0013

 1.Aims Cannabis Skunk Sense (also known as CanSS Ltd) provides straight-forward facts and research-based advice on cannabis. We raise awareness of the continued and growing dangers to children, teenagers and their families of cannabis use.

2.We provide educational materials and information for community groups, schools, colleges and universities; and guidance to wide range of professions, Parliament and the general public – with a strong message of prevention not harm reduction.

3.The Inquiry document says: ‘Government’s stated intention in its 2017 drug strategy is to reduce all illicit and other harmful drug use…….’

4.Missing from this Inquiry document is the following 2017 Strategy statement: ‘preventing people – particularly young people – from becoming drug users in the first place’. Prevention should be first and foremost in any statement as well as in the minds of us all. FRANK was mentioned just once in this strategy; ‘develop our Talk to FRANK service so that it remains a trusted and credible source of information and advice for young people and concerned others’. This claim will be challenged in this report.

5.If prevention (pre-event) were to be successful, there would be little need for a policy of reducing harmful use. Unfortunately, for fifteen or sixteen years now, prevention has taken a back seat.

6.In 1995 Prime Minister John Major’s government produced ‘Tackling Drugs Together’ saying, ‘The new programme strengthens our efforts to reduce the demand for illegal drugs through prevention, education and treatment’.

7.Objectives included: ‘to discourage young people from taking drugs’ and to ensure that schools offer effective programmes of drug education, giving pupils the facts, warning them of risks, and helping them to develop the skills and attitudes to resist drug use – all good common sense.

8.On harm reduction, the government said, ‘The ultimate goal is to ensure people do not take drugs in the first place, but if they do, they should be helped to become and remain drug-free. Abstinence is the ultimate goal and harm reduction should be a means to that end, not an end in itself’.

9.In 1998 the Second National Plan for 2001-2, ‘Tackling Drugs to Build a Better Britain’ was published. Although prevention was still the aim, the phrase ‘informed choice’ appeared, the downhill slide from prevention had started.

10.The` Updated Strategy in 2002 contained the first high-profile mention of ‘Harm Minimisation (Reduction)’. David Blunkett in the Foreword said, ‘Prevention, education, harm minimisation, treatment and effective policing are our most powerful tools in dealing with drugs’.

Some bizarre statements appeared, e.g.: ‘To reduce the proportion of people under 25 reporting use of illegal drugs in the last month and previous year substantially’. Is  infrequent use of drugs acceptable?

In October 2002 at a European Drugs Conference, Ashford, Kent, Bob Ainsworth, drugs spokesman for the Labour government, said that harm reduction was being moved to the centre of their strategy. Prevention was abandoned, ‘informed choice’ and ‘harm reduction’ ruled.

The official government website for information on drugs is FRANK set up in 2003. It continued with the harm reduction policy of the Labour Government.

From the beginning, FRANK was heavily criticised. The Centre for Social Justice (CSJ), founded by Iain Duncan-Smith MP in 2004, consistently criticised FRANK for being ill-informed, ineffective, inappropriate and shamefully inadequate, whilst citing a survey conducted by national treatment provider Addaction who found that only one in ten children would call the FRANK helpline to talk about drugs. Quite recently, when asked about sources where they had obtained helpful information about alcohol or smoking cigarettes, young people put FRANK at the bottom.

The CSJ recommended that FRANK be scrapped, and an effective replacement programme developed to inform young people about the dangers of drug and alcohol abuse based on prevention rather than harm reduction.

The IHRA (International Harm Reduction Alliance) gives the following definition of harm reduction:

Harm reduction refers to policies, programmes and practices that aim to minimise negative health, social and legal impacts associated with drug use, drug policies and drug laws. Harm reduction is grounded in justice and human rights – it focuses on positive change and on working with people without judgement, coercion, discrimination, or requiring that they stop using drugs as a precondition of support.   

The use of Harm reduction instead of Prevention is tantamount to condoning drug use – a criminal activity. The legitimate place for harm reduction is with ‘known users’ on a one to one basis as part of a treatment programme to wean them off completely and attain abstinence in a safer manner than abrupt stoppage which can be very dangerous. One example of this is to inhale the fumes of heroin rather than injection, thus avoiding blood-borne diseases such as AIDS, hepatitis and septicaemia.

An opioid substitute drug for heroin addiction, methadone has the advantage of being taken orally and only once/day. As the dosage is reduced, abstinence will be attained more safely. However, methadone users are often ‘parked’ for months on this highly addictive drug without proper supervision or monitoring. In 2008 in Edinburgh, more addicts died of methadone than heroin.

Harm reduction is a green light. If children are encouraged to use drugs by being given tips on how to use them more safely, many will do it. The son of a friend told his mother. ‘It’s OK we go on to the FRANK website and find out how to take skunk safely by cutting our use and inhaling less deeply’. He is now psychotic!

Prevention works. Between 1997 and 1991 America saw drug use numbers plummet from 23 to 14 million, cocaine and cannabis use halved, daily cannabis use dropped by 75%.

In 2005, Jonathan Akwue of In-Volve writing in Drink and Drugs News, criticised the campaign for lacking authenticity; its ill-judged attempts at humour which try to engage with youth culture; and diluting the truth to accommodate more socially acceptable messages.

The conservatives regained power under David Cameron. FRANK did not change.

In 2005, Mr Iain Duncan Smith again criticised FRANK, saying “Drugs education programmes, such as Talk to FRANK, have failed on prevention and intervention, instead progressively focussing on harm reduction and risk minimisation, which can be counter-productive”

In 2011 it was announced FRANK would be re-launched and the team commissioned ‘A Summary of Health Harms of Drugs’ from The John Moore’s University Liverpool, a hotbed of harm reduction. A psychiatrist from The FRANK Team was involved. Their section on cannabis is totally inadequate, out of date, no recognition of deaths, brain shrinkage, violence, homicides, suicides, the huge increase of strength of THC etc. Professor Sir Robin Murray’s research on mental illness (2009) and the discovery that CBD is virtually absent from skunk are of vital importance.

Many worrying papers have been written since, especially about brain development, all of which are ignored.  CanSS met with the FRANK team prior to their re-launch in 2011 where it was agreed that the cannabis section would, with their assistance, be re-written. All but two very small points were ignored, one about driving after taking alcohol with cannabis and the effect on exam results. The harm reduction advice about cannabis was removed at the request of CanSS.

Scientific evidence detailing FRANK’s inaccuracies was given to the Government by CanSS and other drug experts over the years – all of it ignored. Complaints and oral evidence were submitted to the HASC in April and September 2012 and the Education Select Committee in 2014. Government drugs spokesmen have also been contacted with concerns about FRANK.

As the official government source of information on drugs for the UK public, the FRANK site must be regularly updated and contain the many new accurate findings from current scientific research. The public is owed a duty of care and protection from the harm of drugs, especially cannabis, the most commonly used.

The following list contains some of the glaring omissions and vital details from the FRANK website:

Deaths from cancers except lung, road fatalities, heart attacks/strokes, violent crime, homicides, suicides. Tobacco doesn’t cause immediate deaths either.

Alcohol with cannabis can be fatal. An alcohol overdose can be avoided by vomiting but cannabis suppresses the vomiting reflex.

Cases of severe poisoning in the USA in toddlers are increasing, mostly due to ‘edibles’ left within reach. Accidental ingestion by children should be highlighted.

Hyperemesis (violent vomiting) is on the increase.

Abnormally high levels of dopamine in the brain cause psychosis (the first paper on this was written in 1845) and schizophrenia, especially in those with genetic vulnerabilities, causing violence, homicides and suicides. Skunk-induced schizophrenia costs the country around £2 billion/year to treat.

Young people should understand how THC damps down the activities of the whole brain by suppressing the chemical messages for several weeks. It is fat soluble and remains in the cells. Messages to the hippocampus (learning and memory) fail to reach its cells, some die, causing permanent brain damage. IQ points are lost. Few children using cannabis even occasionally will achieve their full potential.

Serotonin is depleted, causing depression and suicides. The huge increase in the strength of THC in cannabis due to the prevalence of skunk (anything from 16% to over 20%) and the almost total lack of CBD is ignored as is the gateway theory, medical cannabis, passive smoking and lower bone mineral density, bronchitis, emphysema and COPD.

They need to be taught that there is reduced ability to process information, self-criticise and think logically. Users lack attention and concentration, can’t find words, plan or achieve routines, have fixed opinions, whilst constantly feeling lonely and misunderstood. They should know of the risk of miscarriages and ectopic pregnancies.

Amazingly, the fact THC damages our DNA is virtually unknown among the public. In the 1990s, scientists found new cells being made in the adult body (white blood, sperm and foetal cells), suffered premature ‘apoptosis’ (programmed cell death) so were fewer in number. Impotence, infertility and suppressed immune systems were reported.  This is important.

In 2016 an Australian paper discovered THC badly interferes with cell division i.e. where chromosomes replicate to form new cells. They fail to segregate properly causing numerous mutations as chromosomes shatter and randomly rejoin.  Many cells die (about 50% of fertilized eggs (zygotes). Any affected developing foetus will suffer damage. Resultant foetal defects include gastroschisis (babies born with intestines outside the body), now rising in areas of legalisation, anencephaly (absence of brain parts) and shortened limbs (boys are about 4 inches shorter). Oncogenes (cancer-causing) can be switched on. Bladder, testicle and childhood cancers like neuroblastoma have all been reported. The DNA in mitochondria (energy producers in cells) can also be damaged.

Parliament controls the drug laws, so why are the police able to decide for themselves how to deal with cannabis possession?

Proof of the liberalisation of the law on cannabis possession appeared in the new Police Crime Harm Index in April 2016, where it appeared 2nd bottom of the list of priorities. In the following November it fell to the bottom. Class ‘A’ drug possession was immediately above. Possession has clearly become a very low priority. In 2015, Durham Police decided they would no longer prosecute those smoking the drug and growing it ‘for their own use’. Instead, officers will issue a warning or a caution. Then Durham Chief Constable Mike Barton announced that his force will stop prosecuting all drug addicts from December 2017 and plans to use police money to give free heroin to addicts to inject themselves twice a day in a supervised ‘shooting gallery’.  This surely constitutes dealing. The police can it seems, alter and ‘soften’ laws at will. 

Several weeks ago, I happened to check the FRANK website. Quietly, stealthily and without fanfare, a new version had appeared – completely changed. Absent were the patronising videos, games and jokes. Left were A to Z of Drugs, News, Help and Advice (e.g. local harm reduction information) and Contact.

There is poor grammar, i.e. ‘are’ instead of ‘is’ and ‘effect’ where it should be ‘affect’. Mistakes like these do not enhance its credibility.

The drug information is still inadequate with scant essential detail, little explanation and still out of date. This is especially true of cannabis. THC can stay in the brain for many weeks – still sending out its damping-down signals.

What shocked me though were the following:

Our organisation recently received an email about a call to FRANK requesting advice. A friend, a user who also encouraged others to use as well, had lied in a court case where her drug use was a significant factor. He contacted FRANK about her disregard for the law for a substance that was illegal. The advisor raised his voice whilst stating the friend has the right to do what she wants in her own home and mocked him about calling the police. He was shocked and upset by the response.

Ecstasy – Physical health risks

  • Because the strength of ecstasy pills are so unpredictable, if you do decide to take ecstasy, you should start by taking half or even a quarter of the pill and then wait for the effects to kick in before taking anymore – you may find that this is enough.
  • If you’re taking MDMA, start by dabbing a small amount of powder only, then wait for the effects to kick in.
  • Users should sip no more than a pint of water or non-alcoholic drink every hour.

The ‘NEWS’ consisted of 8 pictures with text. In 2 of the 8 items, opportunity is taken to give more ecstasy harm reduction advice. One is titled, ‘Heading out this weekend with Mandy or Molly?’ This is blatant normalisation. The others aren’t ‘news’ items either, but more information about problems.

The section on each drug entitled, ‘Worried about drug x’ mostly consists of giving FRANK’s number. ‘If you are worried about your use, you can call FRANK on 0300 1236600 for friendly, confidential advice’. Any perceptions that FRANK is anything but a Harm Reduction advice site are dispelled completely.

Mentor International is a highly respected worldwide Prevention Charity.  Government-funded Mentor UK is in charge of school drug-education with their programme, ADEPIS (Alcohol and Drug Education and Prevention Information Service). Mentor UK masquerades as a ‘Prevention’ charity but practices ‘Harm Reduction’ and has done so from its inception in 1998. A founding member, Lord Benjamin Mancroft, is currently prominent in the APPG: Drug Policy Reform, partly funded by legaliser George Soros’s Open Society Foundation.

Professor Harry Sumnall of John Moores University Liverpool, a trustee on Mentor UK’s board, signed a ‘Legalisation’ letter in The Telegraph 23rd November 2016 along with the university, Professor David Nutt, The Beckley Foundation, Nick Clegg, Peter Lilley, Transform, Volte-face and other well-known legalisation advocates. Eric Carlin, former Mentor UK CEO (2000-2009), is now a member of Professor David Nutt’s Independent Scientific Committee on Drugs (ISCD). At a July 2008 conference in Vienna, he said “we are not about preventing drug use, we are about preventing harmful drug use”.

Examples of their activities:

The ‘Street Talk’ programme, funded by the Home Office, carried out by the charities Mentor UK and Addaction and completed in March 2012 was aimed to help vulnerable young people aged 10 – 19, to reduce or stop alcohol and drug misuse. Following the intervention, the majority of young people demonstrated a positive intention to change behaviour as follows: “I am confident that I know more about drugs and alcohol and can use them more safely in the future” – 70% agreed, 7% disagreed’.

 Two CanSS members attended a Mentor UK meeting on 7th January 2014 at Kent University, where Professor Alex Stevens, a sociology professor favouring the opening of a ‘coffee shop’ in Kent and supporting ‘grow your own’ was the main speaker. The audience consisted mainly of young primary school teachers. He became increasingly irritated as CanSS challenged his views, becoming incandescent when told knowledge of drug harms is the most important factor in drug education. The only mention of illegality (by CanSS) was met by mirth!

In a Mentor UK project ‘Safer at school’ (2013), the greatest number of requests from pupils, by 5 to 6 times, were: – effects of drugs, side-effects, what drugs do to your body and consequences. Clearly it had been ignored. Coggans 2003 said that, ‘the life skills elements used by Mentor UK may actually be less important than changing knowledge, attitudes and norms by high quality interactive learning’.

Paul Tuohy, the Director of Mentor UK in February 2013 emailed CanSS, ‘Harm reduction approaches are proven and should be part of the armoury for prevention……..there are many young people harming their life chances who are already using and need encouragement to stop, or where they won’t, to use more safely’.

In 2015 Mentor incorporated CAYT (Centre for Analysis of Youth Transitions) with their ‘The Climate Schools programmes’. Expected Outcomes: ‘To show that alcohol and drug prevention programmes, which are based on a harm minimisation approach and delivered through the internet, can offer a user-friendly, curriculum-based and commercially-attractive teaching method’.

In November 2016, Angelus and Mentor UK merged, ‘The Mentor-Angelus merger gives us the opportunity to reach a wider audience through the delivery of harm-prevention programs that informs young people of the harms associated with illicit and NPS drug-taking, to help support them in making conscientious healthy choices in the future’.

The under-developed brains in young people are quite incapable of making reasoned choices. Nor should they. Drug-taking is illegal.

Michael O’Toole (CEO 2014 –2018) said in an ACMD Briefing paper.

‘Harm reduction may be considered a form of selective prevention – reducing frequency of use or supporting a narrowing range of drugs used’. “It is possible to reduce adverse long-term health and social outcomes through prevention without necessarily abstaining from drugs”. 

It is a puzzle that any organisation, including the Government, can condone drug-taking, an illegal activity, either by testing drugs or dishing out harm reduction advice, without being charged with ‘aiding and abetting’ a crime.

Mary Brett, Chair CanSS and Lucy Dawe,Administrator CanSS www.cannabisskunksense.co.uk    

Source: http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/health-and-social-care-committee/drugs-policy/written/97965.html March 2019

Filed under: Addiction,Alcohol,Cannabis/Marijuana,Drug use-various effects,Ecstasy,Education,Legal Sector,Political Sector,Prevention and Intervention,Youth :

NEARLY 800 babies were born suffering the effects of their mother’s drug addiction in the past three years in Scotland – with experts warning the true toll is likely to be higher.

New figures show 774 babies were recorded as affected by addiction or suffering withdrawal symptoms from drugs between 2014 and 2017.

The drugs pass from mother to foetus through the bloodstream, resulting in babies suffering a range of withdrawal symptoms after birth and developmental delays in childhood.

Consultant neonatologist Dr Helen Mactier, honorary secretary of the British Association of Perinatal Medicine, said there was a “hidden” number of women who took drugs in pregnancy and varying definitions of drug misuse in pregnancy which meant figures were likely to be an underestimate.

She said: “The problem largely in Scotland is opioid withdrawal – heroin and methadone.

“The baby withdraws from these substances and they are very irritable, cross, unhappy children who can be quite difficult to feed until they finally get over the withdrawal.”

Dr Mactier said at birth the babies were usually small, and had small heads and visual problems. She added there is evidence they suffer developmental delays in early childhood.

The figures, revealed in a written parliamentary answer, show an increase of 80% in cases from the three-year period from 2006-9, when 427 babies were born with the condition.

However, it said the data over time should be treated with caution as there has been an improvement in recording drug misuse.

The highest numbers over the past three years were recorded in Grampian, which had 169 cases. Glasgow had 137 cases, while Tayside recorded 90, Lanarkshire 78 and Lothian 72.

Numbers have been dropping since 2011-14, when a peak of 1,073 cases were recorded.

Dr Mactier, who works at Glasgow’s Princess Royal Maternity Hospital, said having to treat babies born addicted to drugs was becoming less common in recent years.

She said: “The numbers are coming down, but we are not sure why. It is partly because women who use drugs intravenously tend to be older, so are becoming too old to have children.”

However, she pointed out one controversial area was stabilising pregnant addicts on heroin substitutes such as methadone.

She added: “That may be good for the mum, to keep her more stable and out of criminality. It is not entirely clear if that is safe for the babies, so we need more research.”

Scottish Conservative health spokesman Miles Briggs, who obtained the figures, said: “It’s a national tragedy that we see such numbers of babies being born requiring drug dependency support – we need to see action to help prevent this harm occurring.”

Martin Crewe, director of Barnardo’s Scotland, said: “We know how important it is for children to get a good start in life. We would like to see no babies born requiring drug dependency support.”

Source: https://www.sundaypost.com/fp/hundreds-of-babies-suffering-because-of-mums-drug-addiction October 2018

Filed under: Addiction,Drug use-various effects on foetus, babies, children and youth,Heroin/Methadone :

Abstract

The recent demonstration that addiction-relevant neuronal ensembles defined by known master transcription factors and their connectome is networked throughout mesocorticolimbic reward circuits and resonates harmonically at known frequencies implies that single-cell pan-omics techniques can improve our understanding of Substance Use Disorders (SUD’s). Application of machine learning algorithms to such data could find diagnostic utility as biomarkers both to define the presence of the disorder and to quantitate its severity and find myriad applications in a developmental pipeline towards therapeutics and cure. Recent epigenomic studies have uncovered a wealth of clinically important data relating to synapse-nucleus signalling, memory storage, lineage-fate determination and cellular control and are contributing greatly to our understanding of all SUD’s. Epigenetics interacts extensively with glycobiology. Glycans decorate DNA, RNA and many circulating critical proteins particularly immunoglobulins. Glycosylation is emerging as a major information-laden post-translational protein modification with documented application for biomarker development. The integration of these two emerging cutting-edge technologies provides a powerful and fertile algorithmic-bioinformatic space for the development both of SUD biomarkers and novel cutting edge therapeutics.

Hypotheses: These lines of evidence provide fertile ground for hypotheses relating to both diagnosis and treatment. They suggest that biomarkers derived from epigenomics complemented by glycobiology may potentially provide a bedside diagnostic tool which could be developed into a clinically useful biomarker to gauge both the presence and the severity of SUD’s. Moreover they suggest that modern information-based therapeutics acting on the epigenome, via RNA interference or by DNA antisense oligonucleotides may provide a novel 21st century therapeutic development pipeline towards the radical cure of addictive disorders. Such techniques could be focussed and potentiated by neurotrophic vectors or the application of interfering electric or magnetic fields deep in the medial temporal lobes of the brain.

Source: Pathways from epigenomics and glycobiology towards novel biomarkers of addiction and its radical cure – PubMed (nih.gov) July 2018

Filed under: Addiction,Brain and Behaviour,Drug use-various effects :

Abstract

Background: Inconsistent findings exist regarding long-term substance use (SU) risk for children diagnosed with attention-deficit/hyperactivity disorder (ADHD). The observational follow-up of the Multimodal Treatment Study of Children with ADHD (MTA) provides an opportunity to assess long-term outcomes in a large, diverse sample.

Methods: Five hundred forty-seven children, mean age 8.5, diagnosed with DSM-IV combined-type ADHD and 258 classmates without ADHD (local normative comparison group; LNCG) completed the Substance Use Questionnaire up to eight times from mean age 10 to mean age 25.

Results: In adulthood, weekly marijuana use (32.8% ADHD vs. 21.3% LNCG) and daily cigarette smoking (35.9% vs. 17.5%) were more prevalent in the ADHD group than the LNCG. The cumulative record also revealed more early substance users in adolescence for ADHD (57.9%) than LNCG (41.9%), including younger first use of alcohol, cigarettes, marijuana, and illicit drugs. Alcohol and nonmarijuana illicit drug use escalated slightly faster in the ADHD group in early adolescence. Early SU predicted quicker SU escalation and more SU in adulthood for both groups.

Conclusions: Frequent SU for young adults with childhood ADHD is accompanied by greater initial exposure at a young age and slightly faster progression. Early SU prevention and screening is critical before escalation to intractable levels.

Keywords: ADHD; Attention deficit disorder; adolescence; drug abuse.

Conflict of interest statement

Conflict of Interest Disclosures: J.M.S. acknowledges research support, advisory board/speaker’s bureau and/or consulting for Alza, Richwood, Shire, Celgene, Novartis, Celltech, Gliatech, Cephalon, Watson, CIBA, UCB, Janssen, McNeil, Noven, NLS, Medice, and Lilly. J.T.M. received royalties from New Harbinger Press. L.E.A. received research funding from Curemark, Forest, Lilly, Neuropharm, Novartis, Noven, Shire, Supernus, and YoungLiving and consulted with or was on advisory boards for Gowlings, Neuropharm, Novartis, Noven, Organon, Otsuka, Pfizer, Roche, Seaside Therapeutics, Sigma Tau, Shire, and Tris Pharma and received travel support from Noven. L.H. received research support, served on advisory boards and was speaker for Eli Lilly, Glaxo/Smith/Kline, Ortho Janssen, Purdue, Shire and Ironshore. Other authors have no disclosures.

Source: https://www.ncbi.nlm.nih.gov/pubmed/29315559 June 2018

Filed under: Addiction,Brain and Behaviour,Cannabis/Marijuana,Drug use-various effects,Nicotine,Youth :

Legalization advocates and the weed industry can support necessary reforms while being honest about the risks of marijuana use, the study’s author says.

A large percentage of marijuana users around the world report signs of dependence, even as cannabis appears to be one of the safest and most commonly used drugs overall, according to the results of a survey released on Wednesday.

The findings are contained in the 2018 Global Drug Survey, a detailed questionnaire that compiled responses from more than 130,00 people in over 40 countries in the past year. One section of the survey used the “Severity of Dependence Scale,” or SDS, a popular tool that asks respondents five questions regarding impaired control over drug use and anxieties related to consumption and quitting.

Around 50,000 of the survey respondents reported having used marijuana in the last 12 months. Only alcohol and tobacco use were more common.

Of all cannabis users, 20.2 percent showed substantial signs of dependence, measured by affirmative answers to at least four of the five SDS questions. Crystal methamphetamine was the drug most closely associated with dependence, with nearly 25 percent of users scoring four or higher on the SDS.

A positive SDS score is not the same as a clinical diagnosis of dependence, Adam Winstock, a British addiction psychiatrist and founder of the Global Drug Survey, told HuffPost. But it does suggest that many marijuana users have considerable misgivings about their habits.

“You’ve got 20 percent of the people who are significantly worried about the impact of their use on their life,” said Winstock. “It’s a measure of subjective worry and concern, but those questions tap into things like how much you use, how often, your sense of control and your desire to stop.”

The responses to individual SDS questions offer a window into some of those feelings of dependence.

Cannabis was the substance most frequently associated with anxiety over the prospect of quitting, for example. Although nearly 74 percent of users said the idea of stopping “never or almost never” made them anxious, 19.7 percent said it “sometimes” did, with the rest reporting that it “often” or “always” did.

A total of 21.4 percent of marijuana users said it would be “quite difficult” for them to stop using, with 6.4 percent responding that it would be either “very difficult” or “impossible.” Around 72 percent said quitting would not be difficult.

Nearly 30 percent of cannabis users reported that their cannabis use was at least occasionally “out of control,” with 22.6 percent of respondents saying it was only “sometimes” an issue, 5.3 percent saying it was “often” an issue and 1.6 percent saying it was “always or nearly always” an issue.

The survey also sought to measure the overall safety of substances by asking respondents if they’d sought emergency medical treatment after using various drugs. Just 0.5 percent of all cannabis users reported seeking treatment after use, the second-lowest rate of any substance. Magic mushrooms appeared to be the safest recreational drug for the second year in a row, with just 0.2 percent of users saying they’d pursued medical intervention.

The cannabis dependence results were particularly surprising to Winstock, who said he would’ve expected to see around 10 to 15 percent of marijuana users report signs of dependence.

“You’re legalizing a drug that a fair number of people who use it have worries about themselves,” Winstock said. “The question is what do you do about that?”

The Global Drug Survey may hold some answers. Since 2014, the independent research company has partnered with medical experts and media groups to conduct an annual survey with the goal of making drug use safer through increased access to education and treatment resources.

Around 300,000 marijuana users have partaken in Global Drug Surveys over the years, said Winstock. Those respondents have consistently shown high levels of support for establishing government guidelines around safe marijuana use. Among cannabis users who have expressed a desire to use less frequently or quit entirely, many have said they’d like assistance in doing so. But very few end up seeking help.

Taken together, the surveys suggest elected officials and the marijuana industry should be engaging in a more honest discussion about the risks associated with cannabis use so they can better address issues that may arise as laws are liberalized, said Winstock.

That advice may be particularly salient in the U.S., where a number of states are considering legalizing recreational marijuana in the face of growing public opposition to prohibition. Eight states, as well as Washington, D.C., have already legalized weed.

“Clearly arresting someone and giving them a criminal record for smoking a joint is a futile and pointless exercise and … nothing I’m suggesting is me saying cannabis is a bad drug and the government made a mistake,” said Winstock.

“What I’m saying is that at the point they regulated cannabis, they should have mandated a whole bunch of things that allowed it to be easier for people to reflect on their cannabis use and how it impacted on them and how to control their use,” he went on. “There should have been mandated health warnings and advice and an index of harm for different products.”

Among the 3,400 U.S. marijuana users surveyed this year, just under 25 percent expressed a desire to use less ― compared to 29.3 percent of users globally. Just over 25 percent reported getting high more than 300 days out of the past year, though that may not be reflective of broader marijuana trends, because the survey didn’t randomly sample users nationwide.

Sixteen percent of the American marijuana users who said they wanted to cut back also responded that they’d like help doing so. Nearly 50 percent of all U.S. users said they’d attempted to quit at some point, with 67 percent of those saying they’d tried in the previous year.

Winstock says it makes sense to increase access to harm reduction tools in order to reach those who say they want help with their dependence on cannabis. But broad support for this sort of comprehensive approach requires people on all sides to confront the fact that marijuana, like pretty much any drug, can lead to dependence with some frequency.

Instead, the legalization debate has played out in a far more polarized fashion, with advocates often pushing back against decades of government anti-weed hysteria by claiming cannabis is a harmless drug, especially when compared to alcohol or tobacco.

In light of the cataclysmic failures of the nation’s war on drugs, there is plenty of reason to be tempted by that portrayal.

“It could just be that so many people are saying we’ve raised billions in taxes, saved thousands of hours of police time, saved loads of innocent young lives from having their careers ruined and being banged up in prison,” said Winstock. “Those are such huge wins that I could see people going, ‘That’s enough.’”

But just because the status quo has been so bad for so long and marijuana is less harmful than alcohol or tobacco ― legal drugs that kill more people each year than all illicit drugs combined ― doesn’t mean the push to legalize cannabis can’t learn from past mistakes.

For Winstock, it’s not too late for legal weed states and leaders in the marijuana industry to place more focus on public health.

“Stop for a moment and think about how you cannot become the tobacco industry or the alcohol industry,” said Winstock. “Be the best you can be, don’t just make the biggest profit. Be the most responsible industry you can, and that means be honest.”

Source: Marijuana Users Report High Rates Of Dependence In Global Drug Survey | HuffPost UK Health (huffingtonpost.co.uk) May 2018

Filed under: Addiction,Brain and Behaviour,Cannabis/Marijuana,Drug use-various effects,Global Drug Legalisation Efforts,Methamphetamine/GHB/Hallucinogens/Oxycodone :
Michael Weaver, MD Medical director, Center for Neurobehavioral Research on Addiction Dr. Weaver has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

I first met 32-year-old Miranda after a drug relapse that followed a stay in a residential addiction treatment facility. She had begun experimenting recreationally with prescription opioids in her early 20s, but her use escalated after she was involved in a car accident a few years later and a doctor began prescribing opioids for pain. Because of her increased use, Miranda decided on her own to enter a 28-day detox and rehab, but relapsed immediately upon discharge. Several months later, she made an appointment with me to discuss opioid agonist treatment. I prescribed buprenorphine, and for the first few months of treatment she appeared to be doing well.

Addiction treatment often begins with high hopes and apparent success, but it’s important to remember that addiction is a disease with a relapse rate of 40%–60% (McLellan et al, JAMA 2000;284(13):1689–1695; Dawson DA et al, Alcohol Clin Exp Res 2007;31:2036–2045). Be realistic: Expect that patients will go through cycles of relapse and recovery. Learn the warning signs for relapse, the measures you can take to prevent it, and what to do after it has occurred.

Recognizing relapse

There are a number of clues that someone has relapsed—or may be headed that way:

    • Reduced eye contact during a ­session
    • A more anxious demeanor than usual
    • Less engagement, or a sense of holding back from the treatment process
    • Exacerbated emotional distress or worsening co-anxiety or depression
    • Vague answers to questions
    • Reduced attendance at 12-step programs or therapeutic groups
    • Missed visits with a psychiatrist or other caregiver

None of these red flags individually spell impending relapse—instead, it’s the pattern of behavior that tells the story. Your patient may not actually have used yet, but (wittingly or unwittingly) is starting to go down that road. This is known as desire thinking (Martino F et al, Addict Behav 2017;64:118–122), and in 12-step programs, it’s called “drinking thinking.”

After three months of buprenorphine treatment, I began to notice worrisome signs of potential relapse during one of our sessions. Miranda’s answers to my questions were more vague than usual, her eye contact faltered, and she seemed a little more anxious. Before that session, we had started talking about smoking cessation, but that day she didn’t seem interested.

At that point, I told Miranda I would need a urine sample. She hemmed and hawed for a minute, then admitted that she had started using again within the past few days. She had been spending time with her sister, who also abused a variety of illegal and prescription drugs; while there, her sister had told her, “I know you can’t use opioids, but here are some benzodiazepines. Why don’t you try those?” Miranda acquiesced, and that quickly escalated to use of marijuana and finally opioids.

Miranda’s story is fairly typical. Pressure from peers not in recovery, or simply spending time with old friends not in recovery, is cause for concern. In fact, if a patient divulges spending time with past friends to you, this can be a clue that’s just as telling as poor eye contact or unusual jitteriness.

The marijuana Miranda’s sister provided only complicated things more. For many people, using marijuana or alcohol provides a false sense of confidence. They think, “I can smoke some pot or have a couple of drinks because they aren’t my problems, and I can handle them.” But these substances are called gateway drugs for a reason—they can impair judgment and lead people to the very drugs they want to avoid.

Proactive is better than reactive
It’s much easier to prevent a problem than to treat one, so I spend a lot of time teaching patients how to ­identify their own risk factors for relapse. The key is reminding patients that any unusual event can reduce their resolve because if they are caught off guard, it is hard to stay focused on abstinence goals. Examples of such events include things like visits by a disliked in-law, a chance meeting with someone from the patient’s drug-using past, and waylaid plans for a vacation.

I find it helpful to talk to patients about potential challenges they might face, and then help them cope with the stress of such situations by rehearsing responses and planning tactics. For a troublesome in-law, for example, you can encourage the patient to express concerns to her spouse and to explain the need to keep away for much of the visit. You can do some role-playing to simulate a chance conversation with a past friend who still uses so the patient has a script that will make saying “no” easier and more automatic. Responses can range from, “No thanks, I’ve decided not to use because I don’t want any problems at my new job” to, “Maybe another time,” which is non-judgmental and helps avoid confrontation.

Relapse triggers are often situational. For instance, if everyone from work is going out for a drink, a patient might feel obligated to drink too. Walk the patient through a discussion about whether attending the event but not imbibing alcohol would actually affect his job security. For example, if he nursed a club soda rather than an alcoholic beverage, would anybody really care?

To help patients deal with temptations, I encourage them to write daily in a journal, even if it’s only half a page. This helps them identify what might be troubling them, put the issues in perspective, and work out solutions. (Ed note: For more information about relapse prevention skills based on cognitive behavioral therapy, see Cognitive Behavioral Skills Therapy Manual: A Clinical Research Guide for Therapists Treating Individuals With Alcohol Abuse and Dependence: https://pubs.niaaa.nih.gov/publications/ProjectMatch/match03.pdf.)

If a relapse is already in progress
You can’t always capture the problem before it has occurred. If your patient has relapsed, the most important task is to help minimize the severity of the relapse. Substance-using patients often slip into an all-or-nothing attitude, in which they say to themselves, “I’ve relapsed; I’ve failed treatment. My abstinence is over, so I might as well give in to the drugs and forget about treatment altogether.” (For more information on cognitive distortions in substance use disorder, see Beck A et al, Cognitive Therapy of Substance Abuse. New York: Guilford Press, 1993.)

In such cases, it’s important to reassure patients that a relapse doesn’t mean the end of the world—in fact, it doesn’t even mean the treatment didn’t work. Just like any chronic disease process, addiction treatment involves remissions and exacerbations, and sometimes all that’s needed is a change of approach. I will often give patients the analogy of treating an infection: “Say you have an infection that requires oral antibiotics. If the infection comes back, you don’t decide that the treatment was worthless. Instead, you talk about it with your doctor, who might need to prescribe stronger oral antibiotics, or even recommend a hospital stay for intravenous ­antibiotics. It’s the same thing here. Our first approach to maintaining recovery only worked for so long, so now we’ll try a different approach.”

How do you step up your treatment game to help a relapsing patient? There are many next steps, depending on the circumstances:

    • Seeing the patient more frequently on an outpatient basis
    • Requiring more frequent urine testing to keep the patient accountable and provide an incentive to think twice about using
    • Having the patient go to more 12-step meetings or more group or individual therapy sessions
    • Increasing the dosage of medication-assisted therapy, such as an opioid antagonist
    • Having the patient undergo a brief inpatient stay for detox

After Miranda’s relapse, I increased her dose of buprenorphine/naloxone from 12 mg/3 mg to 16 mg/4 mg daily to help with cravings and prevent any withdrawal from her recent opioid use. I also asked her to commit to seeing her therapist more frequently. We worked on some of the issues that led to the relapse; specifically, I talked with her about avoiding contact with her sister. In this case, I didn’t suggest 12-step meetings, because she wasn’t particularly interested in that approach. However, because her depression had started to worsen, I made an adjustment to her antidepressant medication.

These steps worked. Miranda went to see her therapist more often, and she responded to the adjustments in her buprenorphine dose. She also stayed away from her sister for a while and worked on refusal skills: “I know you’re trying to be helpful, but it’s not what I want or need right now. Please don’t offer me anything.”

Miranda was highly motivated—more than many other patients. But this doesn’t mean she’s immune to problems leading to other relapses (hopefully short-lived ones), even months or years down the road. That’s often part of the process of recovery—it doesn’t always happen in a straight line.

Like what you just read? Dr. Weaver’s new book, Addiction Treatment, is replete with practical tips for helping addicted patients yourself rather than losing them to follow-up when referring them elsewhere. The 14 brief chapters contain detailed instructions on how to frame sensitive questions to elicit honest answers, user-friendly charts to help you describe what drugs to prescribe in which circumstances, and much more. Feel great about helping your patients pull their lives together. Go to https://thecarlatreport.com/AddictionGuide for more information.

Source: Recognizing and Reversing Relapse | 2017-05-01 | CARLAT PUBLISHING (thecarlatreport.com) May 2017
Filed under: Addiction,Prescription Drugs,Treatment and Addiction :

A pilot programme at Shanghai’s rehab centres taps the technology to measure addiction and determine how to treat it.

In a treatment room at a suburban Shanghai drug rehabilitation centre, “Victor Wu”, a recovering addict, sits in front of a computer screen, viewing assorted scenes through a virtual reality headset.

Wu (not his real name) takes in a lifelike image of a young man and a woman sitting on a sofa drinking a clear liquid through a straw from a small bottle. As he does so, clips attached to three of the fingers on his left hand pick up his physical reactions.

The data reveals to his observers – including police officers who can see on the computer screen what Wu sees – the degree to which this stimulus excites him.

As the woman in this VR-enhanced scene holds her straw out to Wu, enticing him to drink with her and the man, Wu remains captivated for at least 10 seconds – a detail the observers note with interest.

Although he can choose the scenes to view and their duration by using the switch he holds in his right hand, “Wu’s attention is stuck on this scene for a while before [he moves on] to look at other no-drug scenes”, an officer told the South China Morning Post.

“It means he is still a bit interested in having drugs.”

It is all part of a revolutionary effort to use VR technology to reveal the extent of drug users’ addiction – and the type of treatment they need – to help them to turn their lives around.

Clad in the centre’s official inmate uniform of green sleeveless T-shirt, shorts and sandals, Wu and his fellow addicts are part of a trial of VR technology that was expanded this summer to all five of Shanghai’s rehab facilities, from just two in October.

Although the Shanghai centres were not the first in China to begin using VR – some rehab institutes in the eastern province of Zhejiang had employed it last year – their application of the technology is nevertheless distinctive in its application of eyeball movement tracking science.

Being able to read how an inmate’s eyeballs move over certain images gives staff a clearer idea of whether the addict’s gaze is fixed squarely on the repulsive “educational” images of drug addicts he or she must watch.

Tracking eyeball movement also gives staff extra information they can use to gauge the accuracy of the self-evaluations that inmates are required to fill out; many have been known to lie about the degree of their drug dependency in an attempt to speed up their release from the programme.

“In the rehab centre we see those awful pictures of drug addicts through VR helmet several times a month, as part of our education here,” Wu told the Post. “I really abhor drugs now.”

While it is not known how many addicts in China ultimately are to be exposed to the VR programme, the number is expected to be considerable. The five centres in Shanghai and one at Qingdong alone treat 1,800 male addicts.

Xu Ding, a drug rehab veteran from Shanghai Drug Rehabilitation Management Bureau who spearheads the VR project, said the technology’s use has helped alleviate “a major frustration” encountered when trying to treat drug addicts by showing them revolting images of other addicts.

 “In the past, to depress the addicts’ desire for drugs, we let them watch TV or presented them horrible pictures of people whose health was seriously affected after long-term consumption of drugs,” Xu said. “But both TV or pictures on papers don’t look real enough.

“What’s more, we can’t tell if these people are really focusing on our education,” Xu said. “They would look at other places, or just close their eyes.”

In 2015, when the VR industry was beginning to get a lot of attention in China, Xu and his colleagues moved to incorporate it in treating addicts. “VR is a kind of embedded viewing experience and is so real,” Xu said.

The VR system that was first used in two of the city’s rehab centres in October was jointly developed by Shanghai Mental Health Centre, East China Normal University’s School of Psychology and Cognitive Science, eyeball movement tracking company Shanghai Qing Tech and the Shanghai drug rehabilitation authority.

In the system, an instrument to trace eyeball movement is installed in the VR headset along with devices to measure electrodermal activity (EDA) and pulse phase, to make observers aware when addicts refuse to look at what they are supposed to see.

EDA measures the change in the electrical characteristics of a person’s skin in response to sweat secretion.

 “Shanghai is the first in the world to introduce an eyeball-movement tracking machine to drug rehabilitation, according to the literature I can find on the internet,” Xu said.

Cao Lei, director of the psychotherapeutic department of Shanghai Qingdong Drug Rehab Centre, said the reports on addiction level based on inmates’ responses to watching VR scenes “are objective and people can’t fool the system since they can’t control their EDA and pulse speed”.

Previously, inmates could lie when filling out a questionnaire on their drug dependency to get released early, Cao said.

Under mainland law, people caught possessing drugs must spend two years undergoing treatment at a rehab centre. Inmates who “perform very well” in treatment can get out early.

So far, assessing the VR programme’s effectiveness is difficult, given the lack of concrete results.

Last year, however, the Ministry of Justice said many rehab centres across the country were using innovative methods to try to help people kick drug habits, including virtual reality technology, people.com.cn reported.

The measures, which also included Tibetan medicine, traditional Chinese medicine, massage and physical exercise, had achieved good results, according to the ministry.

Some 2.55 million people in China had possessed illegal drugs as of the end of last year, according to the 2017 China Drug Situation Report issued in June by the China National Narcotics Control Commission.

Among them, 321,000 were put in rehab centres across the country, about 2 per cent more than in the previous year. More than 60 per cent of addicts possessed synthetic drugs such as methamphetamine, a central nervous system stimulant known in the illicit drug trade as “ice”.

Wu, 28, said his drug habit began six years ago at a pub where a friend offered him ketamine – a synthetic drug that induces a trancelike state and is usually referred to on the street as “K powder”.

“I knew drugs are bad, but at that time I was confident that I could control myself [and would] not become addicted to drugs,” said Wu, a former sales representative with an insurance company.

But he failed to do that. Last year, police, tipped off by his friend that Wu had illegal drugs at home, raided Wu’s house and took him away.

“I think I will not touch drugs after I get out [of the rehab centre],” Wu said. “I don’t want to come back again. I hate losing my freedom.”

Source: How China is using virtual reality to help drug addicts turn their lives around | South China Morning Post (scmp.com) July 2018

Filed under: Addiction,Ketamine,Methamphetamine/GHB/Hallucinogens/Oxycodone,Treatment and Addiction :

It’s no secret that substance use disorders (SUDs) can negatively impact the individual struggling, even putting their life in jeopardy.

“For persons with SUDs, their brain is telling them this lie that, ‘You’ve got to use to stay alive,'” said Sterling Shumway, chair of the Texas Tech University Department of Community, Family & Addiction Sciences and director of the Institute for the Study of Addiction, Recovery & Families.

Likewise, groundbreaking new research now indicates that the same thing is happening in the brains of the people caring for those with addiction.

“To further understand the etiology of SUDs and their associations with family systems, research must expand beyond examining the individual struggling with an SUD,” said Shumway, co-principal investigator (P.I.) for the ongoing project. “This includes research that helps us understand the neurological impact of stress, fear and the impairment found in the family system.”

The original hypothesis was that if the person struggling with an SUD’s brain is compelling them to use as a survival mechanism, perhaps the family member’s brain is doing the same thing as it relates to their loved one’s survival, thus leading to the mostly ineffective and compulsive attempts to rescue their loved one.

“It’s really first-of-a-kind research,” Shumway said, “looking to see if the person and their family member have become similarly, what we call, ‘co-impaired.'”

Looking inside the brain

Over the last four years, Shumway and co-P.I. Spencer Bradshaw, director of the Center for Addiction Recovery Research and an assistant professor in the department, have been using functional near-infrared spectroscopy (fNIR) to monitor reactions in the frontal cortex of both those in recovery from an SUD and family members as they participate in a research protocol presenting certain audio and visual cues meant to stimulate the prefrontal cortex (PFC).

“For the person who struggles with alcoholism, this protocol involves sounds and a variety of images that evoke strong emotional responses, including images associated with alcohol. We look at how their brain lights up differently in response to these various images,” Shumway said. “When family members come in, they aren’t presented a picture of a glass of alcohol, they see instead a current image of their loved one seeking recovery. That’s what makes this research groundbreaking, in that a family member’s PFC lights up in a similar way when looking at their addicted loved one as the PFC of someone with an SUD when looking at their substance of choice.”

When the fNIR results showed that family members often exhibited similar impairment and decision-making difficulties as those with an SUD, Shumway and Bradshaw realized they needed to look deeper inside the brain to explain this phenomenon.

“This is the next step in our research: to look at the family member brain at the level of the midbrain – a much deeper, more primitive part of the brain – and compare it with the brains of those struggling with an SUD,” Shumway said. “We want to know if a similar process is also occurring there with respect to these deeper brain structures and their interaction with the PFC.”

Now, with the help of the Texas Tech Neuroimaging Institute, the two are using functional magnetic resonance imaging (fMRI) to do just that.

“What comes from the midbrain is what causes addicts to use – it’s this intense pain associated with craving. Craving is the means by which the brain compels a person to do something they wouldn’t normally do as part of a survival response – that is, to use despite harmful consequences,” Shumway said. “In relation to a person struggling with an SUD, their brain is telling them, ‘You must use drugs and alcohol, or you’re going to die.'”

This message becomes so intrusive that it overrides the more rational frontal cortex, which is attempting to get them to consider the negative consequences. Unfortunately, when the disease of addiction is present, the midbrain wins the battle.

“With family members, particularly those who’ve been fighting the longest to keep their loved one alive, we believe similarly that their midbrain begins to compel them toward behaviors that may enable rather than resolve SUD behavior,” Shumway said. “In other words, they’re reacting to keep their loved one alive. They may know it’s not helping, but they’re going to do it anyway just like the person with an SUD is going to find and use their substance. This, because the midbrain is requiring it of them out of a perceived need for survival.”

Testing the hypothesis

Shumway and Bradshaw will use the fMRI to examine different parts of the brain, how they are connected to one another and which parts are being activated by different activities or presentations.

“Brain structures, their connectivity and their functioning are key to what we now understand about the brain of the person with an SUD and are what we are similarly interested in examining with respect to the family member brain,” Bradshaw said.

As before, Shumway and Bradshaw intend to include a control group.

“With a control group, we’ll be able to compare those who have never been around addiction, never been impacted by addiction, and never have had to make the difficult decisions like those in families where addiction is present,” Bradshaw said.

Shumway emphasized the research is likely one-of-a-kind.

“We’re probably the only ones, perhaps in the world, who have looked at the frontal cortex of family members related to the way it is responding,” he said. “And we probably will be one of the first to look at family members and functioning of the midbrain when given certain stimuli.”

‘They need help, too.’

One of the biggest reasons for this research is to try to help the family members of those with an SUD find their own recovery, which also gives their loved one a better chance

.

“You’ve got two brains – the family member’s and the loved one’s brain –that are trying to keep one person alive. The problem is the family members also suffer

,” Shumway said. “They don’t take care of themselves, and they struggle as well. We’re not very good at taking care of those who struggle with substance use disorders; we’re even worse at taking care of the family members.”

Because dynamics differ between families, the person who is the primary caregiver differs as well – and sometimes that role switches between people within a family.

“It’s often those who have cared for these people the longest who have the most personal investment in their lives and their success,” Bradshaw said. “This person could, at times, be a grandparent, a parent or even a sibling. While we usually find this person to be a close family member, it may include a wide umbrella of people who care about this person.”

This so-called “systems approach” to addiction recovery values everybody in the system. The idea is that if the parents, siblings, etc., are doing well, the person with the disorder has a better chance of doing well. And, reciprocally, if the person with the disorder is doing well, that helps the others in the system do well.

“With SUDs and recovery, it’s a team sport,” Shumway said. “The more people on the team who are healthy makes a big difference in terms of the trajectory of success.”

While the researcher say society if often most concerned about the identified patient with the SUD, and that’s important, it’s not the whole story.

“The health of every family member is important,” Bradshaw said. “Research shows that when family members are impacted by the stress of addiction, they go to the doctor more often, they have higher medical claims and services and they get diagnosed with higher rates of depression.”

Therefore, resources are needed for both the loved one with the SUD and the family member.

“Both deserve happiness and quality of life,” Bradshaw said.

Brain Research: In the Same Way Addiction Sufferers Crave Substances, Their Family Members Crave Them | Texas Tech Today | TTU

Filed under: Addiction,Brain and Behaviour,Drug use-various effects :

Sometimes when your son or daughter is struggling with substance use, it feels like you’ve tried absolutely everything to help. What if you’ve nearly given up hope?

In this short video, Master Addictions Counselor Mary Ann Badenoch, LPC, offers some new ways to think about opportunities for change. For example, instead of focusing on the end goal, be sure to notice the small victories along the way. This can lead to larger positive change and help you remain hopeful.

Filed under: Addiction,Intervention (including testing) (Papers),Parents :

 

Is addiction a biological disease that is driven by environmental factors or not

Posted Mar 11, 2019

It will come as no surprise to you that childhood trauma, particularly unresolved trauma, can lead to mental health issues and addiction later in life. While less was known about the specific correlation in decades past, today we have a pretty good understanding of just how damaging adverse childhood experiences (ACEs) can be on development and coping.

The first few years of life are full of many important developmental milestones in terms of brain pathways, attachment, coping mechanisms and in generally learning how to relate to others and to stress. Those who experience trauma in their early years often develop survival mechanisms that are less than helpful in adulthood. For some people, such interference early on can even drive them towards addiction.

This is an area of addiction that I like to talk about, because people with an addiction are often judged at face-value by who they are right now, without any compassion or understanding of where they have come from or what has happened to them (for more on this mistake see HERE and HERE). Understanding these underlying issues however, becomes KEY in unlocking the secrets of addiction recovery.

“Treat people with respect instead of blaming or shaming them. Listen intently to what they have to say. Integrate the healing traditions of the culture in which they live. Use prescription drugs, if necessary. And integrate adverse childhood experiences science: ACEs.”  – Dr. Daniel Sumrok

What are ACEs?

Adverse Childhood Experiences (ACEs) are traumatic events that occur in childhood.

This may include:

  • Abuse (physical, emotional, sexual) and/ or neglect
  • Exposure to parental domestic violence
  • Household dysfunction e.g. parent with an untreated mental health condition or substance use disorder
  • Parental separation or divorce
  • Loss of parent through death, deportation, incarceration or being removed from the family home by child protection services

Stressful experiences in childhood may also stem from outside the family home, for example: bullying, witnessing violence, racism, being an immigrant, homelessness, living in a war zone and moving house often (such as in the case of military families).

A substantial portion of the people I’ve worked with over the past 11 years have experienced at least one of these ACEs. Most have experienced two or more.

What does research say about ACEs and long-term

Much of the research has stemmed from the original CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study, the most prominent investigation to date into childhood abuse and neglect and its impact on adult health and wellbeing. Data was collected between 1995 to 1997 from over 17,000 participants.

The ACE study looks at types of early trauma and the long-term outcomes for these children in later life. Participants were required to answer ten questions about specific forms of childhood trauma and mark whether they had experienced this or not. For each type of trauma, they received a score of 1, the highest being 10. For example, a person who was sexually abused, was exposed to domestic violence and had a parent with a substance use disorder, would have an ACE score of three.

The study found that a person with an ACE score of 4 has nearly double the risk of cancer and heart disease than someone without an adverse childhood experience. What’s more, the likelihood of developing an alcohol use disorder increases 7-fold percent and the likelihood of suicideincreased 12-fold.

People who have had an ACE are two to four times more likely to start using alcohol or drugs at an early age, compared to those without an ACE score. People with an ACE score of 5 or higher are up to ten times more likely to experience addiction compared with people who haven’t experienced childhood trauma.

The research has also revealed that people with higher ACE scores are more likely to experience chronic pain and misuse prescription medication, and are at increased risk of serious health conditions such as:

In the United States, 60% of adults had experienced at least one traumatic event in their childhood and 25% had experienced at least 3 ACEs.

How do we make sense of all the research?

There’s an overwhelming amount of evidence supporting this notion: the majority of people currently experiencing mental health or addiction problems have a history of adverse childhood experiences. That’s not to say that all children who experience trauma will go on to have a substance use disorder, because there are a lot of other factors at play, but it is a nearly-necessary component of a person’s history that requires serious consideration in treatment.

“Ritualized compulsive comfort-seeking (what traditionalists call addiction) is a normal response to the adversity experienced in childhood, just like bleeding is a normal response to being stabbed.” – Dr. Daniel Sumrok, director of the Center for Addiction Sciences at the University of Tennessee Health Science Center’s College of Medicine.

It’s also important to note that the ACE study simply reports on correlations, not causal links. We cannot say that experiencing physical abuse or a messy divorce in childhood will directly lead to a substance use disorder.

What we do know is this: Adverse childhood experiences are bad for your emotional and physical health and wellbeing in adulthood.

We must also consider all the other factors that influence a person’s behavior including socioeconomic factors such as income, education and access to resources.

Now, I don’t want to overwhelm you with all the research that points toward the power of our trauma histories. Your ACE score is not destiny. With help, you can learn healthy coping mechanisms, and how to have healthy relationships. We also need to account for genetic, environmental and spiritual factors that influence our behavior.

And while the research sheds light on how powerful childhood trauma can be in our life’s trajectory, it also helps inform government, communities and individuals about the importance of compassion. The link between adverse childhood experiences and later health problems is even more of a reason to reduce stigma and shame associated surrounding addiction. Children do not have control over their home environment, so therefore, we cannot expect them to overcome their difficulties as adults without compassion and support.

How can we help people with ACEs overcome addiction?

We need to focus on providing resources to the people at greatest risk and making sure those resources go into programs that reduce or mitigate adversity.

Dr. Daniel Sumrock says we can do these things to help people change addiction by:

  • Address a person’s unresolved childhood trauma through individual and/ or group therapy
  • Treat people with compassion and respect
  • Use harm minimization principles such as providing medication treatments for addiction (such as buprenorphine or methadone)
  • Help people with an addiction find a ‘ritualized compulsive comfort-seeking behavior’ (addiction) that is less harmful to their health.

IGNTD Recovery takes ACEs into account, getting to the “why” of the addiction, not just putting a Band-Aid on the compulsive seeking symptom. Indeed, we believe that focusing on the symptoms is harmful.

So if this is something you’d like to address either for yourself or for someone you know then find out more about my approach to addiction at IGNTD Recovery or in my book The Abstinence Myth.

Read more about the ACE study:

Source:  https://www.psychologytoday.com/ca/blog/all-about-addiction/201903/linked-adverse-childhood-experiences-health-addiction

Filed under: Addiction,Drug use-various effects on foetus, babies, children and youth,Youth :

We are pleased to announce that a new online course at Auburn University Outreach will feature The Marijuana Report website and e-newsletter. Titled “The Harmfulness of Marijuana Use and Public Policy Approaches to Address the Challenges,” the three-week course will be taught by Paula Gordon, PhD, who has worked as a staff member and/or consultant to several federal agencies concerned about addiction treatment and prevention. Course topics will address:

  • The need to defend the brain while nurturing mental and physical well-being: fostering a mental and public health approach to addressing the challenges of drug use and addiction.
  • An extraordinary look at the addiction cycle: the lessons and insights from an October 30, 2013, videotaped exchange between Dr. Nora Volkow and the Dalai Lama in Dharamshala, the morning of Day 3 of the workshop series (See the link here).
  • Comprehensive coordinated strategies aimed at stopping the use of marijuana and other psychoactive and addictive substances in the US: proposed comprehensive and coordinated public health oriented strategies involving all sectors of society, including government, the justice system, and educational institutions.

Register here

Source: Email from National Families In Action The Marijuana Report The Marijuana Report.Org August 2017

Filed under: Addiction,Brain and Behaviour,Cannabis/Marijuana,Education :

The authors of this ‘Before and After’ library (American Addiction Centers) have obviously spent a great deal of time in merging several still photographs which have produced a strikingly progressive presentation for each user, as time progresses.

 

Millions of Americans are trapped in a cycle of drug abuse and addiction: In 2013, over 24 million reported that they had abused illicit drugs or prescription medication in just the past month. More than 1.7 million were admitted to treatment programs for substance abuse in 2012. The pursuit of a drug habit can cost these people everything – their friends and family, their home and livelihood. And nowhere is that impact more evident than in the faces of addicts themselves.

Here, the catastrophic health effects of drug abuse are plain to see, ranging from skin scabs to decayed and missing teeth. While meth is often seen as one of the most visibly destructive drugs, leading to facial wasting and open sores,various other illicit drugs, and even prescription medications can cause equally severe symptoms when continuously abused. The use of opioids like OxyContin or heroin can cause flushing and a rash of red bumps all over the skin, while cocaine abuse can result in a significant drop in appetite and dangerous malnutrition and weight loss. Ecstasy may cause grinding of teeth, and smoking cannabis releases carcinogens and other chemicals that can diminish skin collagen and produce an appearance of premature aging. Even alcohol abuse can lead to wrinkles, redness, and loss of skin elasticity.

Beyond the direct effects of substance abuse, perhaps its most damaging result is addiction itself. The compulsion of addiction makes drug use the most important purpose in an addict’s life, leading them to pursue it at any cost and treat anything else as secondary. Self-neglect becomes normal – an accepted cost of continuing to use drugs. And the consequences of addiction can remain etched in their very skin for years.

Click here for an animated infographic

Disclaimer

The individuals in these before and after drug addiction photos were arrested on drug charges or related charges. There may be errors in arrest record reporting. All persons are considered innocent of these charges until proven guilty. These photos do not necessarily just show people after drugs and addiction; rather, they depict the physical deterioration of individuals who have been involved in repeated arrests, indicative of a life of crime and/or substance abuse.

Source: https://www.rehabs.com/explore/faces-of-addiction/

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ADDITIONAL INFORMATION ON PROGRESSIVE EFFECTS OF DRUG ABUSE

Thanks must go to the Daily Telegraph (London) for this second format.

This presents still photographs, in contrast with the animated presentation above.

https://www.telegraph.co.uk/news/health/pictures/8345461/From-Drugs-to-Mugs-Shocking-before-and-after-images-show-the-cost-of-drug-addiction.html?image=31255

 

Filed under: Addiction,Alcohol,Cannabis/Marijuana,Cocaine,Drug use-various effects,Ecstasy,Heroin/Methadone,Methamphetamine/GHB/Hallucinogens/Oxycodone :

Abstract

Tobacco and alcohol use are leading causes of mortality that influence risk for many complex diseases and disorders1. They are heritable2,3 and etiologically related4,5 behaviors that have been resistant to gene discovery efforts6,7,8,9,10,11. In sample sizes up to 1.2 million individuals, we discovered 566 genetic variants in 406 loci associated with multiple stages of tobacco use (initiation, cessation, and heaviness) as well as alcohol use, with 150 loci evidencing pleiotropic association.
Smoking phenotypes were positively genetically correlated with many health conditions, whereas alcohol use was negatively correlated with these conditions, such that increased genetic risk for alcohol use is associated with lower disease risk. We report evidence for the involvement of many systems in tobacco and alcohol use, including genes involved in nicotinic, dopaminergic, and glutamatergic neurotransmission. The results provide a solid starting point to evaluate the effects of these loci in model organisms and more precise substance use measures.

Source: Nature Genetics (2019) 14th Jan.201

Filed under: Addiction,Nicotine :

People suffering from opioid addiction in New Jersey and the U.S. have been increasingly abusing Imodium, an over-the-counter anti-diarrhea medicine, to combat their withdrawal symptoms, experts say.
While Imodium and similar medications are harmless when taken at the recommended dose, experts say the medication can stop the heart if it’s taken at an extremely high dose.
Several fatal or near-fatal overdoses have been reported in New Jersey over the past year, said Diane P. Calello, executive and medical director of New Jersey Poison Information and Education System, which recently consulted on several cases.

Imodium’s active ingredient, loperamide, is actually an opioid. The poison control center said that while its effects do not get you high like other opioids (heroin, fentanyl, oxycodone), in extremely high doses it does “stimulate the brain in the same way.”
It’s been known for some years that people sometimes use loperamide to get high. But using it to alleviate opioid withdrawal symptoms is something experts have only begun to see within the past five years, Calello said.

“It’s become clear that people are increasingly using (loperamide) to avoid withdrawal,” she said.
While only a few people have died from loperamide overdoses in New Jersey in the past three years, Calello said, it’s becoming a growing problem in the state and nation. She worries that the lack of knowledge about the dangers of the medication may contribute to more deaths. A recent study of loperamide abuse, in which Calello was involved, tied the increasing misuse of the drug to the internet and online forums filled with people casually recommending it as a cheap and readily available alternative to legitimate opioid withdrawal medications like Suboxone, which requires a prescription.
While federal regulations require other medications prone to misuse, like Sudafed, to be purchased behind the counter at pharmacies, Imodium can be bought cheaply and in unlimited amounts.
Because of that, poison control officials are seeing people taking 100 or even 400 times the recommended dose, which can cause fatal heart rhythms and death, Calello said.

“If you take Imodium for diarrhea, you’re not going to have a problem. But if you take 100 times the therapeutic dose, this is what can happen: cardiac arrest,” she said.
Withdrawing from opioids is often an agonizing process. Calello said that may drive people in pain to do desperate and unusual things to alleviate their symptoms, particularly if they don’t have a prescription for legitimate medications.

“People with opioid abuse disorder, they have a significant problem with withdrawal,” she said. “It’s one of the primary burdens of that illness. It’s exceedingly uncomfortable, an insatiable craving for the drug … body aches, flu-like symptoms, vomiting. You feel awful. You can’t function.”
Calello believes the increasing misuse of loperamide should signal that some restrictions should be put into place.
She said too many people are dying. “I think it makes sense.”

Source: https://www.nj.com/healthfit/2019/01 8th Jan.2019

Filed under: Addiction,Drug use-various effects,Health,Prescription Drugs :

Smaller cities and towns carry a unique burden when it comes to drug addiction.

I grew up in Mounds, Ill. It’s a small farming community of about 800 people in the southernmost part of the state. It may seem an unlikely place for a drug epidemic, but opioid addiction and substance abuse have plagued families there for decades. Years ago, the first of my close relatives died after a long struggle with prescription opioids.

That’s one reason why, as deputy secretary of the U.S. Department of Health and Human Services, or HHS, I keep the victims of this crisis close to my heart.

Under President Donald Trump, HHS has made the opioid crisis a top priority because it leaves no corner of our country untouched. When the crisis began, we worked mostly in rural areas to address overdoses and opioid-use disorder. The opioid crisis is nationwide and claimed approximately 116 American lives every day in 2016.

The most recent data from the Centers for Disease Control and Prevention provides even more grim details. Nearly 64,000 Americans died of drug overdoses in 2016, a 21 percent increase from the previous year and the largest increase on record. More than 42,000 of those deaths involved opioids, more than the total number of all drug overdose deaths in 2012. Further, provisional data indicate that approximately 72,000 Americans died of drug overdoses in 2017. In 2015, there were more than 1 million opioid-related hospital stays and emergency-room visits in the U.S.

A publication from the University of Minnesota’s College of Pharmacy brings the crisis closer to this region. Titled “Combating the Opioid Crisis in Northern Minnesota,” it found that the Duluth area in particular has been hit hard. St. Louis County has the highest opioid overdose death rate in the state.

As part of the Trump administration’s focused mission to support states and local communities on the front lines of this fight, one of our primary strategies is to learn directly from those on the ground so we may be able to benefit from the experience and understanding of local leaders and communities. Over the last few months I have traveled to Illinois, Ohio, Florida, Texas, California, Kentucky, Minnesota, and Wisconsin to exchange ideas with medical experts, local officials, and, especially, individuals currently receiving treatment for opioid addiction.

My visit to Duluth in July was part of the same journey — and a personal one as well. My mother was born in Esko. I consider your remarkable region a second home.

While I was there, one family told me of tragic loss. Their son was injured on the job, was prescribed opioids for pain, and soon became addicted. After only a few months, he lost his life to opioid overdose.

I also heard inspiring stories of people in recovery and how well they know the severe hurdles to battling addiction. They are now providing crucial help by connecting others to treatment and educating the public about lifesaving overdose-reversing drugs.

I was particularly encouraged visiting Duluth’s Lake Superior Health Clinic and learning how grants from the Health Resources and Services Administration at HHS are aiding in the clinic’s vital mission of care.

My message that day was clear: HHS stands ready to assist local heroes helping to end this epidemic in their communities. We are backing up that commitment in Minnesota by awarding more than $10.7 million in state-targeted opioid-crisis grants, $6 million in medication-assisted treatment, and more than $24 million in substance-abuse prevention and treatment block grants last year. Additional awards will be announced in the coming months.

As an indication of the priority he places on this effort, President Trump donated a quarter of his salary last year to the planning and design of a large-scale public-awareness campaign to enhance understanding of the dangers of opioid misuse and addiction. He hopes his example will spur Congress to take even more action.

We at HHS recognize that the American people, in local communities like Duluth and all across our great country, will be the ones to end this terrible crisis. It will require nothing less than a united effort from not just government but the business community, our churches, our schools, and all of civil society.

We can win this battle in Minnesota and all across the country.

Source: https://www.duluthnewstribune.com/opinion/columns/4481662-deputy-secretarys-view-opioids-battle-can-be-won-beginning-minnesota-and August 2018

Filed under: Addiction,Drug use-various effects,Heroin/Methadone,Political Sector :

You’re aware America is under siege, fighting an opioid crisis that has exploded into a public-health emergency. You’ve heard of OxyContin, the pain medication to which countless patients have become addicted. But do you know that the company that makes Oxy and reaps the billions of dollars in profits it generates is owned by one family?

The newly installed Sackler Courtyard at London’s Victoria and Albert Museum is one of the most glittering places in the developed world. Eleven thousand white porcelain tiles, inlaid like a shattered backgammon board, cover a surface the size of six tennis courts. According to the V&A;’s director, the regal setting is intended to serve as a “living room for London,” by which he presumably means a living room for Kensington, the museum’s neighborhood, which is among the world’s wealthiest. In late June, Kate Middleton, the Duchess of Cambridge, was summoned to consecrate the courtyard, said to be the earth’s first outdoor space made of porcelain; stepping onto the ceramic expanse, she silently mouthed, “Wow.”

The Sackler Courtyard is the latest addition to an impressive portfolio. There’s the Sackler Wing at New York’s Metropolitan Museum of Art, which houses the majestic Temple of Dendur, a sandstone shrine from ancient Egypt; additional Sackler wings at the Louvre and the Royal Academy; stand-alone Sackler museums at Harvard and Peking Universities; and named Sackler galleries at the Smithsonian, the Serpentine, and Oxford’s Ashmolean. The Guggenheim in New York has a Sackler Center, and the American Museum of Natural History has a Sackler Educational Lab. Members of the family, legendary in museum circles for their pursuit of naming rights, have also underwritten projects of a more modest caliber—a Sackler Staircase at Berlin’s Jewish Museum; a Sackler Escalator at the Tate Modern; a Sackler Crossing in Kew Gardens. A popular species of pink rose is named after a Sackler. So is an asteroid.

The Sackler name is no less prominent among the emerald quads of higher education, where it’s possible to receive degrees from Sackler schools, participate in Sackler colloquiums, take courses from professors with endowed Sackler chairs, and attend annual Sackler lectures on topics such as theoretical astrophysics and human rights. The Sackler Institute for Nutrition Science supports research on obesity and micronutrient deficiencies. Meanwhile, the Sackler institutes at Cornell, Columbia, McGill, Edinburgh, Glasgow, Sussex, and King’s College London tackle psychobiology, with an emphasis on early childhood development.

The Sacklers’ philanthropy differs from that of civic populists like Andrew Carnegie, who built hundreds of libraries in small towns, and Bill Gates, whose foundation ministers to global masses. Instead, the family has donated its fortune to blue-chip brands, braiding the family name into the patronage network of the world’s most prestigious, well-endowed institutions. The Sackler name is everywhere, evoking automatic reverence; the Sacklers themselves, however, are rarely seen.

The descendants of Mortimer and Raymond Sackler, a pair of psychiatrist brothers from Brooklyn, are members of a billionaire clan with homes scattered across Connecticut, London, Utah, Gstaad, the Hamptons, and, especially, New York City. It was not until 2015 that they were noticed by Forbes, which added them to the list of America’s richest families. The magazine pegged their wealth, shared among twenty heirs, at a conservative $14 billion. (Descendants of Arthur Sackler, Mortimer and Raymond’s older brother, split off decades ago and are mere multi-millionaires.) To a remarkable degree, those who share in the billions appear to have abided by an oath of omertà: Never comment publicly on the source of the family’s wealth.

That may be because the greatest part of that $14 billion fortune tallied by Forbes came from OxyContin, the narcotic painkiller regarded by many public-health experts as among the most dangerous products ever sold on a mass scale. Since 1996, when the drug was brought to market by Purdue Pharma, the American branch of the Sacklers’ pharmaceutical empire, more than two hundred thousand people in the United States have died from overdoses of OxyContin and other prescription painkillers. Thousands more have died after starting on a prescription opioid and then switching to a drug with a cheaper street price, such as heroin. Not all of these deaths are related to OxyContin—dozens of other painkillers, including generics, have flooded the market in the past thirty years. Nevertheless, Purdue Pharma was the first to achieve a dominant share of the market for long-acting opioids, accounting for more than half of prescriptions by 2001.

According to the Centers for Disease Control, fifty-three thousand Americans died from opioid overdoses in 2016, more than the thirty-six thousand who died in car crashes in 2015 or the thirty-five thousand who died from gun violence that year. This past July, Donald Trump’s Commission on Combating Drug Addiction and the Opioid Crisis, led by New Jersey governor Chris Christie, declared that opioids were killing roughly 142 Americans each day, a tally vividly described as “September 11th every three weeks.” The epidemic has also exacted a crushing financial toll: According to a study published by the American Public Health Association, using data from 2013—before the epidemic entered its current, more virulent phase—the total economic burden from opioid use stood at about $80 billion, adding together health costs, criminal-justice costs, and GDP loss from drug-dependent Americans leaving the workforce. Tobacco remains, by a significant multiple, the country’s most lethal product, responsible for some 480,000 deaths per year. But although billions have been made from tobacco, cars, and firearms, it’s not clear that any of those enterprises has generated a family fortune from a single product that approaches the Sacklers’ haul from OxyContin.

Even so, hardly anyone associates the Sackler name with their company’s lone blockbuster drug. “The Fords, Hewletts, Packards, Johnsons—all those families put their name on their product because they were proud,” said Keith Humphreys, a professor of psychiatry at Stanford University School of Medicine who has written extensively about the opioid crisis. “The Sacklers have hidden their connection to their product. They don’t call it ‘Sackler Pharma.’ They don’t call their pills ‘Sackler pills.’ And when they’re questioned, they say, ‘Well, it’s a privately held firm, we’re a family, we like to keep our privacy, you understand.’ ”

The family’s leaders have pulled off three of the great marketing triumphs of the modern era: The first is selling OxyContin; the second is promoting the Sackler name; and the third is ensuring that, as far as the public is aware, the first and the second have nothing to do with one another.

To the extent that the Sacklers have cultivated a reputation, it’s for being earnest healers, judicious stewards of scientific progress, and connoisseurs of old and beautiful things. Few are aware that during the crucial period of OxyContin’s development and promotion, Sackler family members actively led Purdue’s day-to-day affairs, filling the majority of its board slots and supplying top executives. By any assessment, the family’s leaders have pulled off three of the great marketing triumphs of the modern era: The first is selling OxyContin; the second is promoting the Sackler name; and the third is ensuring that, as far as the public is aware, the first and the second have nothing to do with one another.

If you head north on I-95 through Stamford, Connecticut, you will spot, on the left, a giant misshapen glass cube. Along the building’s top edge, white lettering spells out ONE STAMFORD FORUM. No markings visible from the highway indicate the presence of the building’s owner and chief occupant, Purdue Pharma.

Originally known as Purdue Frederick, the first iteration of the company was founded in 1892 on New York’s Lower East Side as a peddler of patent medicines. For decades, it sustained itself with sales of Gray’s Glycerine Tonic, a sherry-based liquid of “broad application” marketed as a remedy for everything from anemia to tuberculosis. The company was purchased in 1952 by Arthur Sackler, thirty-nine, and was run by his brothers, Mortimer, thirty- six, and Raymond, thirty-two. The Sackler brothers came from a family of Jewish immigrants in Flatbush, Brooklyn. Arthur was a headstrong and ambitious provider, setting the tone—and often choosing the path—for his younger brothers. After attending medical school on Arthur’s dime, Mortimer and Raymond followed him to jobs at the Creedmoor psychiatric hospital in Queens. There, they coauthored more than one hundred studies on the biochemical roots of mental illness. The brothers’ research was promising—they were among the first to identify a link between psychosis and the hormone cortisone—but their findings were mostly ignored by their professional peers, who, in keeping with the era, favored a Freudian model of mental illness.

Concurrent with his psychiatric work, Arthur Sackler made his name in pharmaceutical advertising, which at the time consisted almost exclusively of pitches from so-called “detail men” who sold drugs to doctors door-to-door. Arthur intuited that print ads in medical journals could have a revolutionary effect on pharmaceutical sales, especially given the excitement surrounding the “miracle drugs” of the 1950s—steroids, antibiotics, antihistamines, and psychotropics. In 1952, the same year that he and his brothers acquired Purdue, Arthur became the first adman to convince The Journal of the American Medical Association, one of the profession’s most august publications, to include a color advertorial brochure.

In the 1960s, Arthur was contracted by Roche to develop an advertising strategy for a new antianxiety medication called Valium. This posed a challenge, because the effects of the medication were nearly indistinguishable from those of Librium, another Roche tranquilizer that was already on the market. Arthur differentiated Valium by audaciously inflating its range of indications. Whereas Librium was sold as a treatment for garden- variety anxiety, Valium was positioned as an elixir for a problem Arthur christened “psychic tension.” According to his ads, psychic tension, the forebear of today’s “stress,” was the secret culprit behind a host of somatic conditions, including heartburn, gastrointestinal issues, insomnia, and restless-leg syndrome. The campaign was such a success that for a time Valium became America’s most widely prescribed medication—the first to reach more than $100 million in sales. Arthur, whose compensation depended on the volume of pills sold, was richly rewarded, and he later became one of the first inductees into the Medical Advertising Hall of Fame.

As Arthur’s fortune grew, he turned his acquisitive instincts to the art market, quickly amassing the world’s largest private collection of ancient Chinese artifacts. According to a memoir by Marietta Lutze, his second wife, collecting, exhibiting, owning, and donating art fed Arthur’s “driving necessity for prestige and recognition.” Rewarding at first, collecting soon became a mania that took over his life. “Boxes of artifacts of tremendous value piled up in numerous storage locations,” she wrote, “there was too much to open, too much to appreciate; some objects known only by a packing list.” Under an avalanche of “ritual bronzes and weapons, mirrors and ceramics, inscribed bones and archaic jades,” their lives were “often in chaos.” “Addiction is a curse,” Lutze noted, “be it drugs, women, or collecting.”

When Arthur donated his art and money to museums, he often imposed onerous terms. According to a memoir written by Thomas Hoving, the Met director from 1967 to 1977, when Arthur established the Sackler Gallery at the Metropolitan Museum of Art to house Chinese antiquities, in 1963, he required the museum to collaborate on a byzantine tax-avoidance maneuver. In accordance with the scheme, the museum first soldArthur a large quantity of ancient artifacts at the deflated 1920s prices for which they had originally been acquired. Arthur then donated back the artifacts at 1960s prices, in the process taking a tax deduction so hefty that it likely exceeded the value of his initial donation. Three years later, in connection with another donation, Arthur negotiated an even more unusual arrangement. This time, the Met opened a secret chamber above the museum’s auditorium to provide Arthur with free storage for some five thousand objects from his private collection, relieving him of the substantial burden of fire protection and other insurance costs. (In an email exchange, Jillian Sackler, Arthur’s third wife, called Hoving’s tax-deduction story “fake news.” She also noted that New York’s attorney general conducted an investigation into Arthur’s dealings with the Met and cleared him of wrongdoing.)

In 1974, when Arthur and his brothers made a large gift to the Met—$3.5 million, to erect the Temple of Dendur—they stipulated that all museum signage, catalog entries, and bulletins referring to objects in the newly opened Sackler Wing had to include the names of all three brothers, each followed by “M.D.” (One museum official quipped, “All that was missing was a note of their office hours.”)

Hoving said that the Met hoped that Arthur would eventually donate his collection to the museum, but over time Arthur grew disgruntled over a series of rankling slights. For one, the Temple of Dendur was being rented out for parties, including a dinner for the designer Valentino, which Arthur called “disgusting.” According to Met chronicler Michael Gross, he was also denied that coveted ticket of arrival, a board seat. (Jillian Sackler said it was Arthur who rejected the board seat, after repeated offers by the museum.) In 1982, in a bad breakup with the Met, Arthur donated the best parts of his collection, plus $4 million, to the Smithsonian in Washington, D. C.

Arthur’s younger brothers, Mortimer and Raymond, looked so much alike that when they worked together at Creedmoor, they fooled the staff by pretending to be one another. Their physical similarities did not extend to their personalities, however. Tage Honore, Purdue’s vice-president of discovery of research from 2000 to 2005, described them as “like day and night.” Mortimer, said Honore, was “extroverted—a ‘world man,’ I would call it.” He acquired a reputation as a big-spending, transatlantic playboy, living most of the year in opulent homes in England, Switzerland, and France. (In 1974, he renounced his U. S. citizenship to become a citizen of Austria, which infuriated his patriotic older brother.) Like Arthur, Mortimer became a major museum donor and married three wives over the course of his life.

Mortimer had his own feuds with the Met. On his seventieth birthday, in 1986, the museum agreed to make the Temple of Dendur available to him for a party but refused to allow him to redecorate the ancient shrine: Together with other improvements, Mortimer and his interior designer, flown in from Europe, had hoped to spiff up the temple by adding extra pillars. Also galling to Mortimer was the sale of naming rights for one of the Sackler Wing’s balconies to a donor from Japan. “They sold it twice,” Mortimer fumed to a reporter from New York magazine. Raymond, the youngest brother, cut a different figure—“a family man,” said Honore. Kind and mild-mannered, he stayed with the same woman his entire life. Lutze concluded that Raymond owed his comparatively serene nature to having missed the worst years of the Depression. “He had summer vacations in camp, which Arthur never had,” she wrote. “The feeling of the two older brothers about the youngest was, ‘Let the kid enjoy himself.’ ”

Raymond led Purdue Frederick as its top executive for several decades, while Mortimer led Napp Pharmaceuticals, the family’s drug company in the UK. (In practice, a family spokesperson said, “the brothers worked closely together leading both companies.”) Arthur, the adman, had no official role in the family’s pharmaceutical operations. According to Barry Meier’s Pain Killer, a prescient account of the rise of OxyContin published in 2003, Raymond and Mortimer bought Arthur’s share in Purdue from his estate for $22.4 million after he died in 1987. In an email exchange, Arthur’s daughter Elizabeth Sackler, a historian of feminist art who sits on the board of the Brooklyn Museum and supports a variety of progressive causes, emphatically distanced her branch of the family from her cousins’ businesses. “Neither I, nor my siblings, nor my children have ever had ownership in or any benefit whatsoever from Purdue Pharma or OxyContin,” she wrote, while also praising “the breadth of my father’s brilliance and important works.” Jillian, Arthur’s widow, said her husband had died too soon: “His enemies have gotten the last word.”

The Sacklers have been millionaires for decades, but their real money—the painkiller money—is of comparatively recent vintage. The vehicle of that fortune was OxyContin, but its engine, the driving power that made them so many billions, was not so much the drug itself as it was Arthur’s original marketing insight, rehabbed for the era of chronic-pain management. That simple but profitable idea was to take a substance with addictive properties—in Arthur’s case, a benzo; in Raymond and Mortimer’s case, an opioid—and market it as a salve for a vast range of indications.

In the years before it swooped into the pain-management business, Purdue had been a small industry player, specializing in over-the-counter remedies like ear-wax remover and laxatives. Its most successful product, acquired in 1966, was Betadine, a powerful antiseptic purchased in industrial quantities by the U. S. government to prevent infection among wounded soldiers in Vietnam. The turning point, according to company lore, came in 1972, when a London doctor working for Cicely Saunders, the Florence Nightingale of the modern hospice movement, approached Napp with the idea of creating a timed-release morphine pill. A long-acting morphine pill, the doctor reasoned, would allow dying cancer patients to sleep through the night without an IV. At the time, treatment with opioids was stigmatized in the United States, owing in part to a heroin epidemic fueled by returning Vietnam veterans. “Opiophobia,” as it came to be called, prevented skittish doctors from treating most patients, including nearly all infants, with strong pain medication of any kind. In hospice care, though, addiction was not a concern: It didn’t matter whether terminal patients became hooked in their final days. Over the course of the seventies, building on a slow-release technology the company had already developed for an asthma medication, Napp created what came to be known as the “Contin” system. In 1981, Napp introduced a timed-release morphine pill in the UK; six years later, Purdue brought the same drug to market in the U. S. as MS Contin.

“The Sacklers have hidden their connection to their product,” said Keith Humphreys, a professor of psychiatry at Stanford University School of Medicine. “They don’t call it ‘Sackler Pharma.’ They don’t call their pills ‘Sackler pills.’”

MS Contin quickly became the gold standard for pain relief in cancer care. At the same time, a number of clinicians associated with the burgeoning chronic-pain movement started advocating the use of powerful opioids for noncancer conditions like back pain and neuropathic pain, afflictions that at their worst could be debilitating. In 1986, two doctors from Memorial Sloan Kettering hospital in New York published a fateful article in a medical journal that purported to show, based on a study of thirty-eight patients, that long-term opioid treatment was safe and effective so long as patients had no history of drug abuse. Soon enough, opioid advocates dredged up a letter to the editor published in The New England Journal of Medicine in 1980 that suggested, based on a highly unrepresentative cohort, that the risk of addiction from long-term opioid use was less than 1 percent. Though ultimately disavowed by its author, the letter ended up getting cited in medical journals more than six hundred times.

As the country was reexamining pain, Raymond’s eldest son, Richard Sackler, was searching for new applications for Purdue’s timed-release Contin system. “At all the meetings, that was a constant source of discussion—‘What else can we use the Contin system for?’ ” said Peter Lacouture, a senior director of clinical research at Purdue from 1991 to 2001. “And that’s where Richard would fire some ideas—maybe antibiotics, maybe chemotherapy—he was always out there digging.” Richard’s spitballing wasn’t idle blather. A trained physician, he treasured his role as a research scientist and appeared as an inventor on dozens of the company’s patents (though not on the patents for OxyContin). In the tradition of his uncle Arthur, Richard was also fascinated by sales messaging. “He was very interested in the commercial side and also very interested in marketing approaches,” said Sally Allen Riddle, Purdue’s former executive director for product management. “He didn’t always wait for the research results.” (A Purdue spokesperson said that Richard “always considered relevant scientific information when making decisions.”)

Perhaps the most private member of a generally secretive family, Richard appears nowhere on Purdue’s website. From public records and conversations with former employees, though, a rough portrait emerges of a testy eccentric with ardent, relentless ambitions. Born in 1945, he holds degrees from Columbia University and NYU Medical School. According to a bio on the website of the Koch Institute for Integrative Cancer Research at MIT, where Richard serves on the advisory board, he started working at Purdue as his father’s assistant at age twenty-six before eventually leading the firm’s R&D; division and, separately, its sales and marketing division. In 1999, while Mortimer and Raymond remained Purdue’s co-CEOs, Richard joined them at the top of the company as president, a position he relinquished in 2003 to become cochairman of the board. The few publicly available pictures of him are generic and sphinxlike—a white guy with a receding hairline. He is one of the few Sacklers to consistently smile for the camera. In a photo on what appears to be his Facebook profile, Richard is wearing a tan suit and a pink tie, his right hand casually scrunched into his pocket, projecting a jaunty charm. Divorced in 2013, he lists his relationship status on the profile as “It’s complicated.”

When Purdue eventually pleaded guilty to felony charges in 2007 for criminally “misbranding” OxyContin, it acknowledged exploiting doctors’ misconceptions about oxycodone’s strength.

Richard’s political contributions have gone mostly to Republicans—including Strom Thurmond and Herman Cain—though at times he has also given to Democrats. (His ex-wife, Beth Sackler, has given almost exclusively to Democrats.) In 2008, he wrote a letter to the editor of The Wall Street Journaldenouncing Muslim support for suicide bombing, a concern that seems to persist: Since 2014, his charitable organization, the Richard and Beth Sackler Foundation, has donated to several anti-Muslim groups, including three organizations classified as hate groups by the Southern Poverty Law Center. (The family spokesperson said, “It was never Richard Sackler’s intention to donate to an anti-Muslim or hate group.”) The foundation has also donated to True the Vote, the “voter-fraud watchdog” that was the original source for Donald Trump’s inaccurate claim that three million illegal immigrants voted in the 2016 election.

Former employees describe Richard as a man with an unnerving intelligence, alternately detached and pouncing. In meetings, his face was often glued to his laptop. “This was pre-smartphone days,” said Riddle. “He’d be typing away and you would think he wasn’t even listening, and then all of the sudden his head would pop up and he’d be asking a very pointed question.” He was notorious for peppering subordinates with unexpected, rapid-fire queries, sometimes in the middle of the night. “Richard had the mind of someone who’s going two hundred miles an hour,” said Lacouture. “He could be a little bit disconnected in the way he would communicate. Whether it was on the weekend or a holiday or a Christmas party, you could always expect the unexpected.”

Richard also had an appetite for micromanagement. “I remember one time he mailed out a rambling sales bulletin,” said Shelby Sherman, a Purdue sales rep from 1974 to 1998. “And right in the middle, he put in, ‘If you’re reading this, then you must call my secretary at this number and give her this secret password.’ He wanted to check and see if the reps were reading this shit. We called it ‘Playin’ Passwords.’ ” According to Sherman, Richard started taking a more prominent role in the company during the early 1980s. “The shift was abrupt,” he said. “Raymond was just so nice and down-to-earth and calm and gentle.” When Richard came, “things got a lot harder. Richard really wanted Purdue to be big—I mean really big.”

To effectively capitalize on the chronic-pain movement, Purdue knew it needed to move beyond MS Contin. “Morphine had a stigma,” said Riddle. “People hear the word and say, ‘Wait a minute, I’m not dying or anything.’ ” Aside from its terminal aura, MS Contin had a further handicap: Its patent was set to expire in the late nineties. In a 1990 memo addressed to Richard and other executives, Purdue’s VP of clinical research, Robert Kaiko, suggested that the company work on a pill containing oxycodone, a chemical similar to morphine that was also derived from the opium poppy. When it came to branding, oxycodone had a key advantage: Although it was 50 percent stronger than morphine, many doctors believed—wrongly—that it was substantially less powerful. They were deceived about its potency in part because oxycodone was widely known as one of the active ingredients in Percocet, a relatively weak opioid- acetaminophen combination that doctors often prescribed for painful injuries. “It really didn’t have the same connotation that morphine did in people’s minds,” said Riddle.

A common malapropism led to further advantage for Purdue. “Some people would call it oxy-codeine” instead of oxycodone, recalled Lacouture. “Codeine is very weak.” When Purdue eventually pleaded guilty to felony charges in 2007 for criminally “misbranding” OxyContin, it acknowledged exploiting doctors’ misconceptions about oxycodone’s strength. In court documents, the company said it was “well aware of the incorrect view held by many physicians that oxycodone was weaker than morphine” and “did not want to do anything ‘to make physicians think that oxycodone was stronger or equal to morphine’ or to ‘take any steps . . . that would affect the unique position that OxyContin’ ” held among physicians.

Purdue did not merely neglect to clear up confusion about the strength of OxyContin. As the company later admitted, it misleadingly promoted OxyContin as less addictive than older opioids on the market. In this deception, Purdue had a big assist from the FDA, which allowed the company to include an astonishing labeling claim in OxyContin’s package insert: “Delayed absorption, as provided by OxyContin tablets, is believed to reduce the abuse liability of a drug.”

The theory was that addicts would shy away from timed-released drugs, preferring an immediate rush. In practice, OxyContin, which crammed a huge amount of pure narcotic into a single pill, became a lusted-after target for addicts, who quickly discovered that the timed-release mechanism in OxyContin was easy to circumvent—you could simply crush a pill and snort it to get most of the narcotic payload in a single inhalation. This wasn’t exactly news to the manufacturer: OxyContin’s own packaging warned that consuming broken pills would thwart the timed-release system and subject patients to a potentially fatal overdose. MS Contin had contended with similar vulnerabilities, and as a result commanded a hefty premium on the street. But the “reduced abuse liability” claim that added wings to the sales of OxyContin had not been approved for MS Contin. It was removed from OxyContin in 2001 and would never be approved again for any other opioid.

The year after OxyContin’s release, Curtis Wright, the FDA examiner who approved the pharmaceutical’s original application, quit. After a stint at another pharmaceutical company, he began working for Purdue. In an interview with Esquire, Wright defended his work at the FDA and at Purdue. “At the time, it was believed that extended-release formulations were intrinsically less abusable,” he insisted. “It came as a rather big shock to everybody—the government and Purdue—that people found ways to grind up, chew up, snort, dissolve, and inject the pills.” Preventing abuse, he said, had to be balanced against providing relief to chronic-pain sufferers. “In the mid-nineties,” he recalled, “the very best pain specialists told the medical community they were not prescribing opioids enough. That was not something generated by Purdue—that was not a secret plan, that was not a plot, that was not a clever marketing ploy. Chronic pain is horrible. In the right circumstances, opioid therapy is nothing short of miraculous; you give people their lives back.” In Wright’s account, the Sacklers were not just great employers, they were great people. “No company in the history of pharmaceuticals,” he said, “has worked harder to try to prevent abuse of their product than Purdue.”

Purdue did not invent the chronic-pain movement, but it used that movement to engineer a crucial shift. Wright is correct that in the nineties patients suffering from chronic pain often received inadequate treatment. But the call for clinical reforms also became a flexible alibi for overly aggressive prescribing practices. By the end of the decade, clinical proponents of opioid treatment, supported by millions in funding from Purdue and other pharmaceutical companies, had organized themselves into advocacy groups with names like the American Pain Society and the American Academy of Pain Medicine. (Purdue also launched its own group, called Partners Against Pain.) As the decade wore on, these organizations, which critics have characterized as front groups for the pharmaceutical industry, began pressuring health regulators to make pain “the fifth vital sign”—a number, measured on a subjective ten-point scale, to be asked and recorded at every doctor’s visit. As an internal strategy document put it, Purdue’s ambition was to “attach an emotional aspect to noncancer pain” so that doctors would feel pressure to “treat it more seriously and aggressively.” The company rebranded pain relief as a sacred right: a universal narcotic entitlement available not only to the terminally ill but to every American.

The company rebranded pain relief as a sacred right: a universal narcotic entitlement available not only to the terminally ill but to every American. By 2001, annual OxyContin sales had surged past $1 billion.

OxyContin’s sales started out small in 1996, in part because Purdue first focused on the cancer market to gain formulary acceptance from HMOs and state Medicaid programs. Over the next several years, though, the company doubled its sales force to six hundred—equal to the total number of DEA diversion agents employed to combat the sale of prescription drugs on the black market—and began targeting general practitioners, dentists, OB/GYNs, physician assistants, nurses, and residents. By 2001, annual OxyContin sales had surged past $1 billion. Sales reps were encouraged to downplay addiction risks. “It was sell, sell, sell,” recalled Sherman. “We were directed to lie. Why mince words about it? Greed took hold and overruled everything. They saw that potential for billions of dollars and just went after it.” Flush with cash, Purdue pioneered a high-cost promotion strategy, effectively providing kickbacks—which were legal under American law—to each part of the distribution chain. Wholesalers got rebates in exchange for keeping OxyContin off prior authorization lists. Pharmacists got refunds on their initial orders. Patients got coupons for thirty- day starter supplies. Academics got grants. Medical journals got millions in advertising. Senators and members of Congress on key committees got donations from Purdue and from members of the Sackler family.

It was doctors, though, who received the most attention. “We used to fly doctors to these ‘seminars,’ ” said Sherman, which were, in practice, “just golf trips to Pebble Beach. It was graft.” Though offering perks and freebies to doctors was hardly uncommon in the industry, it was unprecedented in the marketing of a Schedule II narcotic. For some physicians, the junkets to sunny locales weren’t enough to persuade them to prescribe. To entice the holdouts—a group the company referred to internally as “problem doctors”—the reps would dangle the lure of Purdue’s lucrative speakers’ bureau. “Everybody was automatically approved,” said Sherman. “We would set up these little dinners, and they’d make their little fifteen-minute talk, and they’d get $500.”

Between 1996 and 2001, the number of OxyContin prescriptions in the United States surged from about three hundred thousand to nearly six million, and reports of abuse started to bubble up in places like West Virginia, Florida, and Maine. (Research would later show a direct correlation between prescription volume in an area and rates of abuse and overdose.) Hundreds of doctors were eventually arrested for running pill mills. According to an investigation in the Los Angeles Times, even though Purdue kept an internal list of doctors it suspected of criminal diversion, it didn’t volunteer this information to law enforcement until years later.

As criticism of OxyContin mounted through the aughts, Purdue responded with symbolic concessions while retaining its volume-driven business model. To prevent addicts from forging prescriptions, the company gave doctors tamper-resistant prescription pads; to mollify pharmacists worried about robberies, Purdue offered to replace, free of charge, any stolen drugs; to gather data on drug abuse and diversion, the company launched a national monitoring program called RADARS.

Critics were not impressed. In a letter to Richard Sackler in July 2001, Richard Blumenthal, then Connecticut’s attorney general and now a U. S. senator, called the company’s efforts “cosmetic.” As Blumenthal had deduced, the root problem of the prescription-opioid epidemic was the high volume of prescriptions written for powerful opioids. “It is time for Purdue Pharma to change its practices,” Blumenthal warned Richard, “not just its public-relations strategy.”

It wasn’t just that doctors were writing huge numbers of prescriptions; it was also that the prescriptions were often for extraordinarily high doses. A single dose of Percocet contains between 2.5 and 10mg of oxycodone. OxyContin came in 10-, 20-, 30-, 40-, and 80mg formulations and, for a time, even 160mg. Purdue’s greatest competitive advantage in dominating the pain market, it had determined early on, was that OxyContin lasted twelve hours, enough to sleep through the night. But for many patients, the drug lasted only six or eight hours, creating a cycle of crash and euphoria that one academic called “a perfect recipe for addiction.” When confronted with complaints about “breakthrough pain”—meaning that the pills weren’t working as long as advertised—Purdue’s sales reps were given strict instructions to tell doctors to strengthen the dose rather than increase dosing frequency.

Sales reps were encouraged to downplay addiction risks. “It was sell, sell, sell,” recalled Sherman. “We were directed to lie. Why mince words about it?”

Over the next several years, dozens of class-action lawsuits were brought against Purdue. Many were dismissed, but in some cases Purdue wrote big checks to avoid going to trial. Several plaintiffs’ lawyers found that the company was willing to go to great lengths to prevent Richard Sackler from having to testify under oath. “They didn’t want him deposed, I can tell you that much,” recalled Marvin Masters, a lawyer who brought a class-action suit against Purdue in the early 2000s in West Virginia. “They were willing to sit down and settle the case to keep from doing that.” Purdue tried to get Richard removed from the suit, but when that didn’t work, the company settled with the plaintiffs for more than $20 million. Paul Hanly, a New York class-action lawyer who won a large settlement from Purdue in 2007, had a similar recollection. “We were attempting to take Richard Sackler’s deposition,” he said, “around the time that they agreed to a settlement.” (A spokesperson for the company said, “Purdue did not settle any cases to avoid the deposition of Dr. Richard Sackler, or any other individual.”)

When the federal government finally stepped in, in 2007, it extracted historic terms of surrender from the company. Purdue pleaded guilty to felony charges, admitting that it had lied to doctors about OxyContin’s abuse potential. (The technical charge was “misbranding a drug with intent to defraud or mislead.”) Under the agreement, the company paid $600 million in fines and its three top executives at the time—its medical director, general counsel, and Richard’s successor as president—pleaded guilty to misdemeanor charges. The executives paid $34.5 million out of their own pockets and performed four hundred hours of community service. It was one of the harshest penalties ever imposed on a pharmaceutical company. (In a statement to Esquire, Purdue said that it “abides by the highest ethical standards and legal requirements.” The statement went on: “We want physicians to use their professional judgment, and we were not trying to pressure them.”)

Fifty-three thousand Americans died from opioid overdoses in 2016, more than the thirty-six thousand who died in car crashes in 2015 or the thirty-five thousand who died from gun violence that year.

No Sacklers were named in the 2007 suit. Indeed, the Sackler name appeared nowhere in the plea agreement, even though Richard had been one of the company’s top executives during most of the period covered by the settlement. He did eventually have to give a deposition in 2015, in a case brought by Kentucky’s attorney general. Richard’s testimony—the only known record of a Sackler speaking about the crisis the family’s company helped create—was promptly sealed. (In 2016, STAT, an online magazine owned by Boston Globe Media that covers health and medicine, asked a court in Kentucky to unseal the deposition, which is said to have lasted several hours. STAT won a lower-court ruling in May 2016. As of press time, the matter was before an appeals court.)

In 2010, Purdue executed a breathtaking pivot: Embracing the arguments critics had been making for years about OxyContin’s susceptibility to abuse, the company released a new formulation of the medication that was harder to snort or inject. Purdue seized the occasion to rebrand itself as an industry leader in abuse-deterrent technology. The change of heart coincided with two developments: First, an increasing number of addicts, unable to afford OxyContin’s high street price, were turning to cheaper alternatives like heroin; second, OxyContin was nearing the end of its patents. Purdue suddenly argued that the drug it had been selling for nearly fifteen years was so prone to abuse that generic manufacturers should not be allowed to copy it.

On April 16, 2013, the day some of the key patents for OxyContin were scheduled to expire, the FDA followed Purdue’s lead, declaring that no generic versions of the original OxyContin formulation could be sold. The company had effectively won several additional years of patent protection for its golden goose.

Opioid withdrawal, which causes aches, vomiting, and restless anxiety, is a gruesome process to experience as an adult. It’s considerably worse for the twenty thousand or so American babies who emerge each year from opioid-soaked wombs. These infants, suddenly cut off from their supply, cry uncontrollably. Their skin is mottled. They cannot fall asleep. Their bodies are shaken by tremors and, in the worst cases, seizures. Bottles of milk leave them distraught, because they cannot maneuver their lips with enough precision to create suction. Treatment comes in the form of drops of morphine pushed from a syringe into the babies’ mouths. Weaning sometimes takes a week but can last as long as twelve. It’s a heartrending, expensive process, typically carried out in the neonatal ICU, where newborns have limited access to their mothers.

But the children of OxyContin, its heirs and legatees, are many and various. The second- and third-generation descendants of Raymond and Mortimer Sackler spend their money in the ways we have come to expect from the not-so-idle rich. Notably, several have made children a focus of their business and philanthropic endeavors. One Sackler heir helped start an iPhone app called RedRover, which generates ideas for child-friendly activities for urban parents; another runs a child- development center near Central Park; another is a donor to charter-school causes, as well as an investor in an education start-up called AltSchool. Yet another is the founder of Beespace, an “incubator for emerging nonprofits,” which provides resources and mentoring for initiatives like the Malala Fund, which invests in education programs for women in the developing world, and Yoga Foster, whose objective is to bring “accessible, sustainable yoga programs into schools across the country.” Other Sackler heirs get to do the fun stuff: One helps finance small, interesting films like The Witch; a second married a famous cricket player; a third is a sound artist; a fourth started a production company with Boyd Holbrook, star of the Netflix series Narcos; a fifth founded a small chain of gastropubs in New York called the Smith.

Holding fast to family tradition, Raymond’s and Mortimer’s heirs declined to be interviewed for this article. Instead, through a spokesperson, they put forward two decorated academics who have been on the receiving end of the family’s largesse: Phillip Sharp, the Nobel-prize-winning MIT geneticist, and Herbert Pardes, formerly the dean of faculty at Columbia University’s medical school and CEO of New York-Presbyterian Hospital. Both men effusively praised the Sacklers’ donations to the arts and sciences, marveling at their loyalty to academic excellence. “Once you were on that exalted list of philanthropic projects,” Pardes told Esquire, “you were there and you were in a position to secure additional philanthropy. It was like a family acquisition.” Pardes called the Sacklers “the nicest, most gentle people you could imagine.” As for the family’s connection to OxyContin, he said that it had never come up as an issue in the faculty lounge or the hospital break room. “I have never heard one inch about that,” he said.

Pardes’s ostrichlike avoidance is not unusual. In 2008, Raymond and his wife donated an undisclosed amount to Yale to start the Raymond and Beverly Sackler Institute for Biological, Physical and Engineering Sciences. Lynne Regan, its current director, told me that neither students nor faculty have ever brought up the OxyContin connection. “Most people don’t know about that,” she said. “I think people are mainly oblivious.” A spokesperson for the university added, “Yale does not vet donors for controversies that may or may not arise.”

In May, a dozen lawmakers in Congress sent a bipartisan letter to the World Health Organization warning that Sackler-owned companies were preparing to flood foreign countries with legal narcotics.

The controversy surrounding OxyContin shows little sign of receding. In 2016, the CDC issued a startling warning: There was no good evidence that opioids were an effective treatment for chronic pain beyond six weeks. There was, on the other hand, an abundance of evidence that long-term treatment with opioids had harmful effects. (A recent paper by Princeton economist Alan Krueger suggests that chronic opioid use may account for more than 20 percent of the decline in American labor-force participation from 1999 to 2015.) Millions of opioid prescriptions for chronic pain had been written in the preceding two decades, and the CDC was calling into question whether many of them should have been written at all. At least twenty-five government entities, ranging from states to small cities, have recently filed lawsuits against Purdue to recover damages associated with the opioid epidemic.

The Sacklers, though, will likely emerge untouched: Because of a sweeping non-prosecution agreement negotiated during the 2007 settlement, most new criminal litigation against Purdue can only address activity that occurred after that date. Neither Richard nor any other family members have occupied an executive position at the company since 2003.

The American market for OxyContin is dwindling. According to Purdue, prescriptions fell 33 percent between 2012 and 2016. But while the company’s primary product may be in eclipse in the United States, international markets for pain medications are expanding. According to an investigation last year in the Los Angeles Times, Mundipharma, the Sackler-owned company charged with developing new markets, is employing a suite of familiar tactics in countries like Mexico, Brazil, and China to stoke concern for as-yet-unheralded “silent epidemics” of untreated pain. In Colombia, according to the L.A. Times, the company went so far as to circulate a press release suggesting that 47 percent of the population suffered from chronic pain.

Napp is the family’s drug company in the UK. Mundipharma is their company charged with developing new markets.

In May, a dozen lawmakers in Congress, inspired by the L.A. Timesinvestigation, sent a bipartisan letter to the World Health Organization warning that Sackler-owned companies were preparing to flood foreign countries with legal narcotics. “Purdue began the opioid crisis that has devastated American communities,” the letter reads. “Today, Mundipharma is using many of the same deceptive and reckless practices to sell OxyContin abroad.” Significantly, the letter calls out the Sackler family by name, leaving no room for the public to wonder about the identities of the people who stood behind Mundipharma.

The final assessment of the Sacklers’ global impact will take years to work out. In some places, though, they have already left their mark. In July, Raymond, the last remaining of the original Sackler brothers, died at ninety-seven. Over the years, he had won a British knighthood, been made an Officer of France’s Légion d’Honneur, and received one of the highest possible honors from the royal house of the Netherlands. One of his final accolades came in June 2013, when Anthony Monaco, the president of Tufts University, traveled to Purdue Pharma’s headquarters in Stamford to bestow an honorary doctorate. The Sacklers had made a number of transformational donations to the university over the years—endowing, among other things, the Sackler School of Graduate Biomedical Sciences. At Tufts, as at most schools, honorary degrees are traditionally awarded on campus during commencement, but in consideration of Raymond’s advanced age, Monaco trekked to Purdue for a special ceremony. The audience that day was limited to family members, select university officials, and a scrum of employees. Addressing the crowd of intimates, Monaco praised his benefactor. “It would be impossible to calculate how many lives you have saved, how many scientific fields you have redefined, and how many new physicians, scientists, mathematicians, and engineers are doing important work as a result of your entrepreneurial spirit.” He concluded, “You are a world changer.”

Source: https://www.esquire.com/news-politics/a12775932/sackler-family-oxycontin/ October 2017

Filed under: Addiction,Economic,Heroin/Methadone,Legal Sector,Prescription Drugs,Social Affairs,Social Affairs (Papers) :

Last week Scotland’s leading law officer, the Lord Advocate, brought a shuddering halt to a proposal from Glasgow City Council to develop a safe injecting centre in the city. Such a centre would have required a change in UK drug laws to enable individuals in possession of illegal drugs to use those drugs within the centre without fear of prosecution. Supporters of this initiative will be disappointed by the outcome, but they need to recognise that the provision of some level of legal protection covering the possession of illegal drugs within the injecting centre would also, by implication, need to be extended to all of those who might claim, legitimately or otherwise, that their drug possession should be green-lighted because they were en route to the injecting centre. In effect, such an initiative would deliver what many of its supporters actually desire – the legalisation of illegal drugs within at least some part of the UK.

In his judgement, the Lord Advocate has not ruled against setting up a centre where doctors can prescribe opiate drugs to addicts. Rather he has simply pointed out that he is not prepared to offer legal protection to a centre where illegal drugs are being used. The Glasgow proposal sought unwisely to tie the proposal for a doctor-led heroin prescribing clinic, which would be legal, with a setting where individuals are allowed to use illegal drugs which would break UK drug laws. There will be many who rightly question the wisdom (and the cost to the public purse) of linking those two proposals.

It is often said by the supporters of these centres that where they have been established in other countries no individual has actually died in a drug consumption room. That might be so, but the lack of such deaths is not the high-water mark of success for drug treatment services. The rise in addict deaths in Scotland and in England shows that we need to do much more by way of engaging drug users in services. Doing more should entail taking services to drug users themselves wherever they are living and wherever they are using illegal drugs. Setting up a city-centre location where people can use illegal drugs under some level of legal protection betrays a worrying lack of knowledge both about Glasgow itself and about the life of an addict. Glasgow is a territorial city par excellence and there are addicts who cross into different parts of the city at their genuine peril. Similarly, when addicts secure the drugs they so desperately need their first thought is not ‘How do I travel to a city-centre location where I may use these drugs without fear of prosecution?’ but ‘Where is the needle that will enable me to inject now?’ It is for both of those reasons that we should be talking about how to take services to the addicts rather than how to get the addicts to go to the services.

Glasgow’s addiction services have been slow to adopt a focus on recovery, and even to date they are unable to report how many drug users they have treated have managed to overcome their addiction – this despite having a strategy which for the last ten years has emphasised the importance of enabling drug users to become drug-free. That strategy is now being reviewed by the Scottish Government with the real risk that the commitment to abstinence-based recovery will be diluted in preference to the much woollier goal of seeking to reduce the harm associated with addicts’ continued drug use.

Within Scotland we spend more than £100million a year on drug treatment. We should be asking why our services seem to be achieving so little in terms of getting addicts into long-term recovery and why, in the face of that failure, public officials are seeking to promote centres where illegal drug use can take place without fear of prosecution. Injecting on the streets is a terrible reality but the response to that problem should not be the provision of a centre where injecting can occur beyond public view, but actively to discourage injecting at all.

The reason we need to be doing much more to discourage drug injecting is because the substances addicts are injecting are often manufactured, stored, and transported in dreadfully unhygienic conditions with the result that they often contain serious and potentially fatal bacterial contaminants. These drugs do not become safe when they are used in a drug consumption room, but remain harmful wherever they are injected. We need to do all we can to discourage drug use, to discourage injecting, and to ensure that as many addicts as possible are in contact with services focused on assisting their recovery. We need to be very wary of developing initiatives that run the real risk of normalising illegal drug use and driving a possible further increase in the number of people using illegal drugs.

Professor Neil McKeganey is Director of the Centre for Substance Use Research, Glasgow

Source: https://www.conservativewoman.co.uk/neil-mckeganey-good-sense-kills-not-safe-injecting-centre/ November 2017

 

Filed under: Addiction,Global Drug Legalisation Efforts,Heroin/Methadone,Needle Exchange :

Legalizing opioids may give Americans greater freedom over their decision-making, but at what cost? One painful aspect of the public debates over the opioid-addiction crisis is how much they mirror the arguments that arise from personal addiction crises.

If you’ve ever had a loved one struggle with drugs — in my case, my late brother, Josh — the national exercise in guilt-driven blame-shifting and finger-pointing, combined with flights of sanctimony and ideological righteousness, has a familiar echo. The difference between the public arguing and the personal agonizing is that, at the national level, we can afford our abstractions.

When you have skin in the game, none of the easy answers seem all that easy. For instance, “tough love” sounds great until you contemplate the possible real-world consequences. My father summarized the dilemma well. “Tough love” — i.e., cutting off all support for my brother so he could hit rock bottom and then start over — had the best chance of success. It also had the best chance for failure — i.e., death. There’s also a lot of truth to “just say no,” but once someone has already said “yes,” it’s tantamount to preaching “keep your horses in the barn” long after they’ve left.

But if there’s one seemingly simple answer that has been fully discredited by the opioid crisis, it’s that the solution lies in wholesale drug legalization. In Libertarianism: A Primer, David Boaz argues that “if drugs were produced by reputable firms, and sold in liquor stores, fewer people would die from overdoses and tainted drugs, and fewer people would be the victims of prohibition-related robberies, muggings and drive-by-shootings.”

Maybe. But you know what else would happen if we legalized heroin and opioids? More people would use heroin and opioids. And the more people who use such addictive drugs, the more addicts you get. Think of the opioid crisis as the fruit of partial legalization. In the 1990s, for good reasons and bad, the medical profession, policymakers, and the pharmaceutical industry made it much easier to obtain opioids in order to confront an alleged pain epidemic. Doctors prescribed more opioids, and government subsidies made them more affordable. Because they were prescribed by doctors and came in pill form, the stigma reserved for heroin didn’t exist. When you increase supply, lower costs, and reduce stigma, you increase use.

And guess what? Increased use equals more addicts. A survey by the Washington Post and the Kaiser Family Foundation found that one-third of the people who were prescribed opioids for more than two months became addicted. A Centers for Disease Control study found that a very small number of people exposed to opioids are likely to become addicted after a single use. The overdose crisis is largely driven by the fact that once addicted to legal opioids, people seek out illegal ones — heroin, for example — to fend off the agony of withdrawal once they can’t get, or afford, any more pills. Last year, 64,000 Americans died from overdoses. Some 58,000 Americans died in the Vietnam War.

Experts rightly point out that a large share of opioid addiction stems not from prescribed use but from people selling the drugs secondhand on the black market, or from teenagers stealing them from their parents. That’s important, but it doesn’t help the argument for legalization. Because the point remains: When these drugs become more widely available, more people avail themselves of them. How would stacking heroin or OxyContin next to the Jim Beam lower the availability? Liquor companies advertise — a lot. Would we let, say, Pfizer run ads for their brand of heroin? At least it might cut down on the Viagra commercials. I think it’s probably true that legalization would reduce crime, insofar as some violent illegal drug dealers would be driven out of the business.

 I’m less sure that legalization would curtail crimes committed by addicts in order to feed their habits. As a rule, addiction is not conducive to sustained gainful employment, and addicts are just as capable of stealing and prostitution to pay for legal drugs as illegal ones. The fundamental assumption behind legalization is that people are rational actors and can make their own decisions. As a general proposition, I believe that. But what people forget is that drug addiction makes people irrational. If you think more addicts are worth it in the name of freedom, fine. Just be prepared to accept that the costs of such freedom are felt very close to home.

 Source: http://www.nationalreview.com/article/453304/opioid-crisis-legalization-not-solution November 2017

Filed under: Addiction,Global Drug Legalisation Efforts,Heroin/Methadone :

The Washington County drug court graduation ceremony for Maria Kestner. Photograph: Fred R Conrad

Photographer  visited a Virginia drug court last year and saw how individuals and families had been given a second chance – so when he went back this summer he had a question: did they take it?

“Opioid and methamphetamine abuse tore through this area like a wildfire.”

This is the view of Rebecca Holmes, who is responsible for mental health and drug use outpatient treatment in Abingdon, Washington County, Virginia, as she looks back at the decision to set up a drug court.

Holmes, the medical director of Highlands Community Services, had seen how the growing crisis around opioids had taken such a heavy toll on families in the town, which is home to just over 8,000 people.

 

There was a growing need for a small group of addicts that did not respond to treatment or programs offered by the existing court or probation, she said, so five years ago she applied for a grant to use a federal model for a drug court that had first emerged in 1989.

The county’s drug court has been in place for several years now and Holmes feels that it has never been more needed. Last year in Virginia there were more deaths from heroin and opioids than highway fatalities for the first time, and the governor declared a public health emergency.

Nationally, opioids are said to be killing 90 people a day.

  • The Washington County court house. Inside the county court room where the drug court meets every week.

Judge Lowe presides over the court and the program, which is a year and half long for those who are placed on it. It combines therapy with a structured program of court visits, random drug screens, curfews and full-time employment for participants.

  • Judge Lowe poses with Wayne Smith, who has completed the second phase of the four-phase drug court. Participants are rewarded for good behavior.

There is the ever-present threat of court sanctions if a participant relapses. Lowe says: “The point of drug court is not just to treat the addict, it’s to make that person a model for the rest of their family so that they can break the cycle of drug abuse.”

The Guardian visited last year and again this year in late summer to see how people who had gone through the court – and who worked there – were getting on.

Bubba

  • Bubba and Ginger in their bedroom.

Bubba Rouse started abusing painkillers when he was a young teenager. He then stole various pills he could get his hands on. At 17 Bubba started smoking meth. He also became a father for the first time.

Bubba continued to use drugs and found a new girlfriend, Ginger, whose father had been sent to prison for meth when she was eight years old. Bubba and Ginger were both using meth and heroin when Ginger got pregnant. “The reason I stopped using was because I knew I had a future coming with my baby and I didn’t want to bring a child into a world like the one I grew up in.”

  • Family pictures of the Rouse family are displayed throughout the home where Bubba Rouse grew up.
  • Playing with her Barbie dolls.

Ginger was able to get sober and her baby was born without any complications while Bubba was in prison. While in prison he was offered a place in the Washington County drug court program. Drug court can be very difficult, especially at the beginning. There are mandatory therapy meetings, frequent random drug screens, curfew calls in the middle of the night and you have to have to be employed full time. It was even more difficult for Bubba because he could not legally drive. Ginger became both chauffeur and workmate for Bubba this past year.

  • Bubba with his daughter. 

They have managed to work together in a factory, on a construction crew and now at a fast-food restaurant. Bubba and Ginger moved in with Bubba’s parents where Bubba was able to able to get closer to his oldest daughter. For most of the year his younger daughter, with Ginger, was taken care of by Ginger’s mother.

The family is now reunited and Bubba and Ginger have taken over the payments on a double wide trailer that they hope to move next to Bubba’s parents home. After drug court graduation in six months, Bubba hopes to start working construction with Ginger’s stepfather.

Bubba said: “Drug court has been good for me but there are not many programs in this area and I wish there were more things to help people quit early rather than when things get really bad.”

Chris Brown

  • Maria Kestner is hugged by Chis Brown at her drug court graduation ceremony.

Chris Brown is a retired police officer with nearly 30 years on the job. “As a police officer you get jaded after a while. You go to the same addresses and visit the same families all the time. It hit me when I started arresting the grandchildren of people I arrested when I was a rookie cop. You realize early on that you can’t incarcerate your way out of this drug problem.”

After retiring from the police force, Chris was looking for a job where he could help people. “When the job of drug court coordinator became available, I jumped at the chance.

  • Bubba hands a drug test cup filled with his urine to Chris Brown.

“This is a wonderful way to help people. I found my humanity with this job.” Chris takes his job very seriously. He’s on call 24/7. He handles compliance with spot drug screens, curfew calls as well as issues of transportation, housing and dealing with family issues of those in the program.

You realize early on that you can’t incarcerate your way out of this drug problem

He is not judgmental and he is a good listener. “I remember talking with a drug addict years ago and asking him how he wanted to be treated. He told me he just wanted to be treated like a human being. That’s what I try to do with everyone in the program: treat them like human beings rather than drug addicts.”

Joyce Yarber

  • Joyce Yarber manages a cattle ranch and hay farm with her husband.

Joyce Yarber, age 59, has always walked with a limp. She has suffered with hip dysplasia and osteoarthritis for most of her life. For over 20 years, her doctor had prescribed a painkilling cocktail that included Lortab, Percocet and oxycodone. When her doctor was arrested for over prescribing opiates she became desperate and eventually wrote half a dozen prescriptions for herself. She was arrested and offered drug court. Because she had written scripts in both Virginia and Tennessee, it took two years of legal wrangling before she could start the drug court program in Washington County, Virginia.

Before starting drug court, she was required to get a hip replacement operation, the hope being that the operation would eliminate the pain that caused her to become a drug addict. Determined to stay sober, Joyce refused to take any opiates after the operation. Her only post-operation painkiller was an over-the-counter one. That determination impressed the drug court team. “When I first started drug court, I was a drug snob. I thought that because I got my drugs from a doctor rather than buying them on the street, I was somehow better. It didn’t take long for me to realize I was wrong. I was no better than anyone else in the program. I was just as much an addict as they all were.”

  • The start of a therapy session at Highlands Community Services for drug court participants.

Joyce has been a model client in drug court and because of her age and her outgoing personality, she has become a mother figure for the group. The only time she missed a therapy meeting was when she was trapped in a tree without her cellphone by a young bull on the cattle farm that she and her husband operate. That bull was culled from the herd the next day.

I thought that because I got my drugs from a doctor rather than buying them on the street, I was somehow better. It didn’t take long for me to realize I was wrong

A few months into the drug court program, Joyce went to her doctor and was diagnosed with stage four lung cancer. Because the pain caused by the cancer was so great, she knew that she would have to go back on to opiate pain medication just to get through her chemotherapy. She offered to resign from the program but the team insisted that she stay. Her medication level is monitored by the drug court and she still attends all of the meetings. “I got a call from the probation office in Tennessee and they gave me a date that I need to call them by after I complete drug court. I sure hope I’m around and that I can remember to call. This chemo brain is a real pain.”

Zac Holt

Zac Holt was always a gifted athlete. His goal after graduating from college was to attend seminary and become a Presbyterian minister. Those plans were delayed after Zac fell 45ft while free climbing. He broke a leg and fractured a vertebra. While in hospital, he was given narcotic pain medication. Zac had experimented with marijuana and cocaine in high school and college but drugs were never a major part of his life.

  • Zac trains daily and has competed in two triathlons since beginning drug court

That changed after he was exposed to percocet and oxycodone. After he was released from the hospital, he began doctor shopping and getting multiple prescriptions. He went off to seminary and continued using drugs. “I became a raging drug addict. I would do anything for my drugs. I lied, cheated and stole, mostly from my family. I dropped out of school. I went through therapy several times but always came back to my drugs.” Zac’s drug use went on for nine years.

  • Zac Holt was addicted to opioids for nearly nine years.

When he was arrested for possession and put on probation he continued to use drugs. He confessed this to his probation officer who then sent him to jail. While in jail his jaw was broken in a lunch room fight. He had reached bottom when he was offered drug court earlier this year. “Drug court was the best thing in the world for me. I wanted to change my life and drug court gave me a way to change.” Zac embraced the discipline and structure of drug court. He went back to live with his parents and started reconnecting with his family. He also started training for a triathlon. It seemed like an impossible goal for someone who had never competed in one. The regimen of drug court and constant training fills every waking moment. Zac has 10 more months of drug court before graduating. He is active in his church and is contemplating a return to seminary. He has also completed two triathlons.

  • Zac is thinking about returning to seminary and becoming a Presbyterian minister after he completes drug court.

Drug use in south-western Virginia shows no sign of decline. Use of Suboxone is on the rise and meth is still entrenched in the hills of Appalachia. Brown, the drug coordinator for the Washington County drug court said: “You can’t let yourself get discouraged by the numbers. You just work and fight drug addiction one family at a time.”

Source: https://www.theguardian.com/us-news/2017/oct/23/drug-court-opioids-virginia-second-chance October 2017

Filed under: Addiction,Crime/Violence/Prison,Heroin/Methadone,Prescription Drugs,Social Affairs,Treatment and Addiction :

From afar, America’s opioid epidemic may seem like just another sensationalised scare story in a country constantly at war with drugs. But this is not a fad, nor an overblown segment on morning television. It is real, it is decimating entire counties, and it represents the summation of the country’s failures towards its own citizens over decades.

Twenty million Americans have some form of opioid addiction, and those addictions kill almost 150 people every day.

The CDC estimates that 64,000 Americans died of drug overdoses last year

Twenty million is a shocking number of people for whom the ordinary act of living is crushing. An opioid addiction is fundamentally an instinct to numb, to sleep, to exist unencumbered. It is made possible by over-prescription from doctors and aggressive lobbying from pharmaceutical companies, but it reflects the deeper malaise of places and people whose lives have few prospects for dramatic improvement.

As we saw last November, that malaise has become desperation, and that desperation now covers a vast swathe of the electorate.

America was never a feudal society, and so our national mythology does not include a character who exemplifies the nobility of poverty; in a country of pilgrims and pioneers, driven by Calvinist mores, being poor suggests that you’re just not working hard enough.

Faced with a society where poverty is considered a deficiency of both morals and material wealth, and where it has become more difficult to outdo your parents, it is easy to see how a life enslaved to the brief release of opioids seems preferable to one spent in the ugly realities of hardship.

The death toll has been staggering. The Centers for Disease Control estimates that 64,000 Americans died of drug overdoses last year – the whole 20 years of the Vietnam War, by contrast, cost 58,000 American lives.

Between 1999 and 2015, drugs killed 560,000 Americans; over the next decade, they are expected to take another half million lives. These are the kind of numbers that make you sit up and wonder how there aren’t daily protests outside the Food and Drug Administration’s headquarters – until you realise that many of those affected by this crisis gave up on the idea of change, or even hope, a long time ago.

If you believe, as so many Americans do, that everything from voting to the economic system itself is rigged, why would you bother trying to change things?

In the wake of the financial crisis, when a generation (my generation) was told that the white-collar jobs for which they’d spent 20 years and a small fortune preparing were no longer available, many dissembled entirely. In previous generations, being a middle-class white kid in America guaranteed a life devoid of difficult decisions; suddenly, the system (and the social contract which came with it) collapsed.

President Donald Trump announced in August that he would declare opioid abuse a national emergency

With the purposeful numbness of the corporate world out of reach, many chose a different sort of numbing agent. And so what began as “hillbilly heroin” went mainstream, snaking its way through leafy suburbs up and down the East Coast.

Nevertheless, the reinvention of heroin and opioids as scourges of “nice” families means that drug reform and rehabilitation are stamped in bold type on to the conservative political agenda.

Nearly every GOP candidate in the crowded 2016 primary spent time stomping around New England and the Rust Belt, partaking in the grief of families who had lost children or spouses to this epidemic, and offering aggressive plans for reform.

President Donald Trump announced in August thathe would declare opioid abuse a national emergency, a mechanism ordinarily deployed after natural disasters. It appears that this declaration could be coming early next week, although its parameters, and thus its efficacy in addressing a problem as systemic as opioid abuse, remain unclear.

It is difficult to imagine any successful intervention in this crisis which stops at methadone clinics, naloxone for overdoses and needle exchanges. Addiction perpetuates the cycles of poverty, but it is also a symptom of that poverty and the despair that accompanies it.

Creating hope in communities where the lights went out years ago is key to preventing the creation of future addicts, and to convincing current addicts that society can offer them something better than a few hours of escape.

It is time for this administration to move past flashy announcements, and to settle into the grunt work of crafting policy that tackles the effects, but also the root causes, of opioid addiction.

Molly Kiniry is a researcher at the Legatum Institute

Source: https://www.telegraph.co.uk/news/2017/10/21/opioid-epidemic-crushing-americas-middle-class-need-action-not/ October 2017

Filed under: Addiction,Heroin/Methadone,Political Sector,USA :

By Mark Gold, MD

Knowing is not enough; we must apply. Willing is not enough; we must do. —Johann Wolfgang von Goethe

The Harvard Review of Psychiatry has recently chronicled important advances in understanding mental health disorders and, to a lesser extent Substance Use Disorder (SUD). This clinical review highlights the important contributions of Harvard experts over the past 25 years.

Addiction Research: What Have We Learned

Through my nearly 40 years of work in translational research and through the work of my colleagues, I have seen tremendous advances that changed how we understand the etiology and pathophysiology of SUD. Specifically, establishing the neurobiological basis of SUD, and the development of new and novel evidence-based pharmacologic and behavioral treatments including the discovery of the game changing and lifesaving drug, naltrexone, and thus establishing the neurobiological foundations for Medically Assisted Treatment (MAT), which resulted in important changes in the DSM.

As research established risk factors for SUD, we discovered that this disease is largely determined (40-60%) by genetic factors. Certainly, the Human Genome Project has unlocked the door to the field of epigenetics and the recognition that subtle variants in genetic transcription and coding are associated with numerous diseases, including SUD. The neuro-mechanisms and environmental stressors that conspire to “switch on” particular genes that increase the risk for SUD are not well established. Yet, our understanding of how specific neuronal circuitry mediates substance-induced reward, drug craving, compulsions and withdrawal is becoming clear. For example, when hedonically driven dopaminergic and opioidergic systems are disrupted, via the chronic use of intoxicants, neuroadaptation results in drug seeking, craving, anhedonia, depression, and chronic deficits in mood, memory and self-control. In other words, addiction.

Most recently, the discovery of ketamine’s efficacy in acute suicidality and treatment resistant depression represents a new and novel direction for research and the development of new therapeutics via the NDMA system. This discovery may supplant the 50-year-old catecholamine hypothesis for understanding addiction, mood disorders, pain and perhaps more.
But knowing is never enough in medicine—we must do.

So, in spite of all we have learned in the past few decades, the neurobiology and epigenetic risks for addiction remain underestimated and virtually unaddressed in current clinical guidelines for treating SUD. For example, we now know that early childhood trauma produces potentially heritable epigenetic changes that are highly correlated with SUD and other psychopathologies in adolescence and early adulthood. In addition, survey data reveals that approximately 70% of women in SUD treatment have suffered trauma, yet only a few of the top centers are professionally equipped to treat trauma as a comorbid disorder. Unaddressed, trauma almost always results in relapse.

Challenges

The increasing prevalence and severity of SUD and the lack of available treatment is a formidable gap that is widening. By treatment, we do not mean SUD CPR or Naloxone, but rather prevention and when that fails, treatment that is safe and effective for five years. Efforts to close this gap involve many nonclinical variables (cost, access, harm reduction vs. medical model, politics, etc.), over which we have little control–but this is not to say we don’t have influence.

These are exciting times, as there is much to be learned about addictive disease and its numerous comorbidities. But, unless much more of the 23+ million currently addicted people in the US get help, research will remain simply academic.

Source: https://www.rivermendhealth.com/resources/addiction-research/ July 2017

Filed under: Addiction :

Anybody wondering what happens to the 8 per cent of the skunk-smoking population who develop mental illness should visit any psychiatric hospital in Britain or speak to somebody who has done so What is really needed in dealing with cannabis is a “tobacco moment”, as with cigarettes 50 years ago, when a majority of people became convinced that smoking might give them cancer and kill them. Since then the number of cigarette smokers in Britain has fallen by two-thirds.

A depressing aspect of the present debate about cannabis is that so many proponents of legalisation or decriminalisation have clearly not taken on board that the causal link between cannabis and psychosis has been scientifically proven over the past ten years, just as the connection between cancer and cigarettes was proved in the late 1940s and 1950s.

The proofs have emerged in a series of scientific studies that reach the same grim conclusion: taking cannabis significantly increases the risk of schizophrenia. One study in The Lancet Psychiatry concludes that “the risk of individuals having a psychotic disorder showed a roughly three times increase in users of skunk-like cannabis, compared with those who never used cannabis”. As 94 per cent of cannabis seized by the police today is super-strength skunk, compared to 51 per cent in 2005, almost all those who take the drug today will be vulnerable to this three-fold increase in the likelihood that they will develop psychosis.

Mental health professionals have long had no doubts about the danger. Five years ago, I asked Sir Robin Murray, professor of psychiatric research at the Institute of Psychiatry in London, about them. He said that studies showed that “if the risk of schizophrenia for the general population is about one per cent, the evidence is that, if you take ordinary cannabis, it is two per cent; if you smoke regularly you might push it up to four per cent; and if you smoke ‘skunk’ every day you push it up to eight per cent”.

Anybody wondering what happens to this 8 per cent of the skunk-smoking population should visit any mental hospital in Britain or speak to somebody who has done so. Dr Humphrey Needham-Bennett, medical director and consultant psychiatrist of Cygnet Hospital, Godden Green in Sevenoaks, explained to me that among his patients “cannabis use is so common that I assume that people use or used it. It’s quite surprising when people say ‘no, I don’t use drugs’.”

The connection between schizophrenia and cannabis was long suspected by specialists but it retained its reputation as a relatively benign drug, its image softened by the afterglow of its association with cultural and sexual liberation in the 1960s and 1970s.

This ill-deserved reputation was so widespread that even 20 years ago, the possible toxic side effects of cannabis were barely considered. Zerrin Atakan, formerly head of the National Psychosis Unit at the Maudsley Psychiatric Hospital and later a researcher at the Institute of Psychiatry,

said: “I got interested in cannabis because I was working in the 1980s in an intensive care unit where my patients would be fine after we got them well. We would give them leave and they would celebrate their new found freedom with a joint and come back psychotic a few hours later.”

She did not find it easy to pursue her professional interest in the drug. She recalls: “I was astonished to discover that cannabis, which is the most widely used illicit substance, was hardly researched in the 1990s and there was no research on how it affected the brain.” She and fellow researchers made eight different applications for research grants and had them all turned down, so they were reduced to taking the almost unheard of course of pursuing their research without the support of a grant.

Studies by Dr Atakan and other psychiatrists all showed the connection between cannabis and schizophrenia, yet this is only slowly becoming conventional wisdom. Perhaps this should not be too surprising because in 1960, long after the link between cigarettes and lung cancer had been scientifically established, only a third of US doctors were persuaded that this was the case.

A difficulty is that people are frightened of mental illness and ignorant of its causes in a way that is no longer true of physical illnesses, such as cancer or even HIV. I have always found that three quarters of those I speak to at random about mental health know nothing about psychosis and its causes, and the other quarter know all too much about it because they have a relative or friend who has been affected.

Even those who do have experience of schizophrenia do not talk about it very much because they are frightened of a loved one being stigmatised. They may also be wary of mentioning the role of cannabis because they fear that somebody they love will be dismissed as a junkie who has brought their fate upon themselves.

This fear of being stigmatised affects institutions as well as individuals. Schools and universities are often happy to have a policy about everything from sex to climate change, but steer away from informing their students about the dangers of drugs. A social scientist specialising in drugs policy explained to me that the reason for this is because “they’re frightened that, if they do, everybody will think they have a drugs problem which, of course, they all do”.

The current debate about cannabis – sparked by the confiscation of the cannabis oil needed by Billy Caldwell to treat his epilepsy and by William Hague’s call for the legalisation of the drug – is missing the main point. It is all about the merits and failings of different degrees of prohibition of cannabis when it is obvious that legal restrictions alone will not stop the 2.1 million people who take cannabis from going on doing so. But the legalisation of cannabis legitimises it and sends a message that the government views it as relatively harmless. The very fact of illegality is a powerful disincentive for many potential consumers, regardless of the chances of being punished.

The legalisation of cannabis might take its production and sale out of the hands of criminal gangs, but it would put it into the hands of commercial companies who would want to make a profit, advertise their product and increase the number of their customers. Commercialisation of cannabis has as many dangers as criminalisation.

A new legal market in cannabis might be regulated and the toxicity of super-strength skunk reduced. But the argument of those who want to legalise cannabis is that the authorities are unable to enforce regulations when the drug is illegal, so why should they be more successful in regulating it when its production and sale is no longer against the law?

The problem with these rancorous but sterile arguments for and against legalisation and decriminalisation is that they divert attention from what should and can be done: a sustained campaign to persuade people of all ages that cannabis can send them insane. To a degree people are learning this already from bitter experience. As Professor Murray told me five years ago, the average 19- to 23-year-old probably knows more about the dangers of cannabis than the average doctor “because they have a friend who has gone paranoid. People know a lot more about bad trips than they used to.”

Patrick Cockburn is the co-author of Henry’s Demons: Living With Schizophrenia, A Father and Son’s Story

A depressing aspect of the present debate about cannabis is that so many proponents of legalisation or decriminalisation have clearly not taken on board that the causal link between cannabis and psychosis has been scientifically proven over the past ten years, just as the connection between cancer and cigarettes was proved in the late 1940s and 1950s.

The proofs have emerged in a series of scientific studies that reach the same grim conclusion: taking cannabis significantly increases the risk of schizophrenia. One study in The Lancet Psychiatry concludes that “the risk of individuals having a psychotic disorder showed a roughly three times increase in users of skunk-like cannabis, compared with those who never used cannabis”. As 94 per cent of cannabis seized by the police today is super-strength skunk, compared to 51 per cent in 2005, almost all those who take the drug today will be vulnerable to this three-fold increase in the likelihood that they will develop psychosis.

Home Secretary Sajid Javid: The government will carry out a review of the scheduling of cannabis for medicinal use

Mental health professionals have long had no doubts about the danger. Five years ago, I asked Sir Robin Murray, professor of psychiatric research at the Institute of Psychiatry in London, about them. He said that studies showed that “if the risk of schizophrenia for the general population is about one per cent, the evidence is that, if you take ordinary cannabis, it is two per cent; if you smoke regularly you might push it up to four per cent; and if you smoke ‘skunk’ every day you push it up to eight per cent”.

Filed under: Addiction,Brain and Behaviour,Cannabis/Marijuana,Drug use-various effects,Health,Marijuana and Medicine,Psychiatric drugs :

Supporters of the drug claim it is harmless, but an official report now warns the ‘increased dominance of high-potency herbal cannabis’ – known as skunk – is causing more young people to seek treatment.

The revelation comes amid growing concerns that universities – and even some public schools – are awash with high-strength cannabis and other drugs.

The findings also back up academic research, revealed in The Mail on Sunday over the past three years, that skunk is having a serious detrimental impact on the mental health of the young. At least two studies have shown repeated use triples the risk of psychosis, with sufferers repeatedly experiencing delusional thoughts. Some victims end up taking their own lives.

The latest UK Focal Point on Drugs report, drawn up by bodies including Public Health England, the Scottish Government and the Home Office, found that:

Cannabis is responsible for 91 per cent of cases where teenagers end up being treated for drug addiction, shocking new figures reveal (file photo)
Cannabis is responsible for 91 per cent of cases where teenagers end up being treated for drug addiction, shocking new figures reveal 
  • Over the past decade, the number of under-18s treated for cannabis abuse in England has jumped 40 per cent – from 9,043 in 2006 to 12,712 in 2017;
  • Treatment for all narcotics has increased by 20 per cent – up from 11,618 to 13,961;
  • The proportion of juvenile drug treatment for cannabis use is up from four in five cases (78 per cent) to nine in ten (91 per cent);
  • There has been a ‘sharp increase’ in cocaine use among 15-year-olds, up 56 per cent from 16,700 in 2014 to 26,200 in 2016.

Last night, Lord Nicholas Monson, whose 21-year-old son Rupert Green killed himself last year after becoming hooked on high-strength cannabis, said: ‘These figures show the extent of the damage that high-potency cannabis wreaks on the young.

‘The big danger for young people – particularly teens – is that their brains can be really messed up by this stuff because they are still developing biologically. If they develop drug-induced psychosis – as Rupert did – the illness can stick for life.’

The large rise in the number of youngsters treated for cannabis abuse comes despite the fact that total usage is falling slightly.

The report concludes: ‘While fewer people are using cannabis, those who are using it are experiencing greater harm.’

Almost all cannabis on Britain’s streets is skunk, which is four times more powerful than types that dominated the market until the early 2000s. It can even trigger hallucinations.

Lord Monson said: ‘We really need Ministers to get a grip and launch a major publicity campaign about the dangers.’ 

Source: https://www.dailymail.co.uk/news/article-5642917/Nine-ten-teens-drug-clinics-treated-marijuana-use.html  April 2018

Filed under: Addiction,Brain and Behaviour,Cannabis/Marijuana,Youth :
By William Ross Perlman, Ph.D., CMPP, NIDA Notes Contributing Writer

This research:

  • Identified a gene variant that promotes impulsive behavior and enhanced responses to heroin in rats.
  • Linked the corresponding human gene variant to increased risk for impulsivity and drug use.

People who are highly impulsive and those diagnosed with ADHD are at increased risk for substance use disorders (SUD). Recent research implicates a variant of the gene for a protein called cAMP-response element modulator (CREM) in these associations. Drs. Michael L. Miller and Yasmin L. Hurd from the Icahn School of Medicine at Mount Sinai in New York, with colleagues from several other institutions, showed that the gene variant promotes impulsive and hyperactive behavior in both animals and humans, and can contribute to a person’s risk for developing SUD.

Of Rats…

The Icahn researchers began their investigations with a strain of rats that exhibit impulsive behaviors resembling human attention-deficit/hyperactivity disorder (ADHD). Initial experiments confirmed that, compared with a strain (Western Kyoto) of rats that are not known for impulsivity, these “spontaneously hypertensive” (SH) rats:

  • Were more impatient to receive rewards, fidgeted more while waiting to receive rewards, ran around more, and were more attracted to novel experiences.
  • Self-administered more heroin and, when it was made unavailable, gave up seeking it less readily.  
  • Had enhanced elevation of dopamine levels in response to heroin.

The researchers screened the rats’ DNA for genetic differences that might contribute to these behavioral differences. The results revealed that the two strains carried different variants of the gene for CREM. As a result, the SH rats had lower concentrations of CREM in the core of the nucleus accumbens—a key brain region governing reward and movement.

…And People

 

Figure 1. A CREM Gene Variant Increases HyperactivityHyperactivity scores were higher in ADHD subjects than in control subjects. In addition, ADHD subjects who carried at least one copy of the less highly expressed A variant (i.e., with the G/A or A/A CREM genotype) reported significantly higher hyperactivity than did those carrying only the more highly expressed G variant (i.e., with the G/G genotype). Genotype had no effect on hyperactivity in non-ADHD control subjects

The researchers used genetic and behavioral evidence from previous studies conducted by other researchers to demonstrate that the corresponding variant in the human CREM gene similarly predisposes people to impulsivity. This variant occupies approximately the same position on the human gene that the rodent variant occupies on the rodent gene. At this site, known as rs12765063, the CREM gene exists in two versions—called A and G—and the A variant dials down CREM production. In one study, preschool children with the A variant were found to be more distractible and to engage in more dangerous activities than peers with only the G variant (Figure 1). In another, among adolescents with ADHD, those who carried the A variant reported more symptomatic hyperactivity than those who did not.

The researchers further found that by promoting impulsivity, the variant raises the risk of drug use. Thus, in two studies of adolescents, neither the A variant alone nor ADHD alone increased the risk for drug use, but the two together did. The first analysis looked at adolescents with ADHD, and found higher rates of drug use among those with the A variant than among those with only the G variant. The second analysis looked at adolescents who had the A variant of rs12765063 and histories of childhood ADHD. It found that those whose childhood ADHD still persisted reported more use of alcohol, tobacco, marijuana, and prescription stimulants than those who had outgrown their ADHD (Figure 2). Moreover, those who no longer had ADHD reported no more drug use than a comparison group who did not carry the A variant.

 

Figure 2. The A Variant of the CREM Gene Is Associated With Increased Drug Use in People With Persistent ADHD Among a cohort whose childhood ADHD persisted through adolescence, those with the CREM A variant reported more drug use than those with only the G variant. Genotype was not linked to risk for drug use in people without ADHD (i.e., those who never had ADHD or those with remitted ADHD).

A Key to Prevention and Treatment?

Dr. Hurd suggests that CREM may be a key link between impulsivity and vulnerability to addiction. Understanding these relationships may help identify new ways of treating or preventing SUD. The protein is known to regulate multiple gene networks and their biological functions, and to influence the growth of structures that neurons use to communicate with each other.

Dr. Hurd says, “These results highlight that CREM is a mediating factor between impulsivity and substance abuse vulnerability. It brings attention to CREM in the nucleus accumbens as a regulator of impulsive action and structural plasticity.”

The study was supported by NIH grants DA015446, DA030359, DA006470, DA038954, DA031559, and DA007135.

Source: https://www.drugabuse.gov/news-events/nida-notes/2018/06/gene-links-impulsivity-drug-use-vulnerability June 2018

Filed under: Addiction,Addiction (Papers),Brain and Behaviour,Effects of Drugs (Papers),Medical Studies :

Another day, another troubling headline.

If you believe that the access to “safer” drugs is the problem, maybe vending machines will “fix Vancouver’s drug crisis.”

For more than a decade, we’ve been told that Vancouver is the model the US should emulate. No North American city has been more aggressive in implementing harm reduction practices—safe injection rooms, heroin maintenance, hydromorphone (dilaudid) maintenance, crack pipe vending machines and, of course, all the less sensational forms of harm reduction.

So . . . all these years later, where are they at?

“Last year, overdoses killed 1,422 people in British Columbia, the highest number ever, a 43 per cent increase over 2016.”

Pretty discouraging.

The provincial CDC’s conclusion is that they have not gone far enough.

“. . . sometime in the next several weeks, in March or April, Tyndall will launch a pilot program to distribute hydromorphone pills (a pharmaceutical narcotic derived from morphine) to registered users . . .”

What’s it like there?

“Vancouver’s Downtown Eastside, defined as a de facto colony for people who inject or smoke hard drugs, is smaller than it used to be—maybe half the 20 blocks it used to cover, with condo developments looming on all sides. On the warm January day when I visited, a lot of people are out, lining the sidewalks of East Hastings Street, a few side streets and many wide alleys off the main artery. Many are openly smoking or injecting drugs. It’s a shocking sight the first time you visit. You get used to it pretty quickly.”

How many times does recovery come up in this article? 1 time, as a glib rebuttal that equates questioning the approach to malignant neglect.

“You can’t ask people to recover if they’re dead. But the stigma goes so deep that I think a lot of people go, ‘Well, who gives a shit? They die. Better for us. We don’t have to pay their medical bills.’ ”

What’s the animating belief? (emphasis mine)

“Addiction, he says, is a chronic relapsing disease. Most addicts don’t stop.”

If you believe that addicts don’t want to and are unable to stop, then this seems like a pragmatic and compassionate approach.

If you know that addicts hate their lives and that there is hope for recovery, this is very, very sad. If you know that the hopelessness of most addicts requires that professional helpers acts as hope carriers, this will make you angry.

This does not have to be an either/or matter. There is room for a both/and approach. However, as a casual observer, I have not seen BC public health officials, politicians, researchers, or policy advocates address the need and hope for recovery.

 

 

Source: https://addictionandrecoverynews.wordpress.com/2018/02/14/another-day-another-disappointing-headline/
Februrary 2018

Filed under: Addiction,Heroin/Methadone :

Interviewed by Mark Gold, MD

FEATURED ADDICTION EXPERT:
Frederick S. Southwick, MD
Professor of Internal Medicine and Former ​Chief of Infectious Diseases at the University of Florida
2010 Harvard University Advanced Leadership Fellow
Expert in Medicine, Infectious Disease and Medical Errors​

We see patients who smoke cigarettes, drink and/or abuse drugs. How does this affect their immune status or ability to fight common infections? Any association between a drug dependency like cigarettes and/or marijuana, smoking and/or alcohol drinking?

Smoking is a major risk factor for developing pneumonia. Those who smoke 20 or more cigarettes a day have three times the risk of developing pneumonia. Cigarette smoke damages the tracheal lining of the lungs, alters the consistency of the fluid that coats this lining, and destroys the cilia that move bacteria and other foreign substances out of the lung. When the fluid coating the tubes of the lung becomes thicker as a consequence of the inflammatory reaction to smoke, cilia can no longer transport this fluid, and the foreign particles, including bacteria, usually trapped by this fluid can no longer be transported out of the lungs. Damage to the cilia also interferes with this important protective mechanism.

Alcohol and other sedating drugs interfere with the function of the epiglottis. This large flap of tissue covers the trachea to prevent saliva, food and liquids from entering the lungs. We have all accidently choked on water when our epiglottis malfunctions and water enters the lung. We quickly cough it out. When drugs lead to sedation our epiglottis is more likely to malfunction and food, saliva and bacteria from the mouth can more easily enter the lungs. Sedation also interferes with our cough reflex, and as a consequence, severe aspiration pneumonia can follow an overdose or an episode of heavy drinking.

Drug abuse often leads to malnutrition and some drugs, particularly alcohol, can depress the body’s ability to produce white blood cells. Malnutrition and the loss of these cells can depress the normal acute immune response to infection, and as a consequence, infections are often more severe and life threatening in alcoholics and patients who suffer drug abuse.

Do substance abusers or addicts have more mono, flu, pneumonia, TB or other Infectious Diseases (ID)?

The incidence of mononucleosis is not known to be higher. Influenza is more severe in addicts with depressed immune responses. Tuberculosis may have a higher incidence in addicts because their depressed immune function allows the organism to more readily spread in the lungs and throughout the body.

What are some IDs associated with intravenous drug users?

Another major risk for infection is the use of intravenous drugs. Too often the drugs being injected into the blood stream are contaminated with bacteria, particularly Staphylococcus aureus (found on the skin) and Pseudomonas (found in tap water). These bacteria can infect the heart valves leading to endocarditis, a very serious and potentially fatal infection. Once bacteria enter the blood stream they can also lodge in small vessels of the bones, particularly the vertebral bodies or back bones resulting in bone infection or osteomyelitis. This infection is associated with chronic pain, fever and loss of energy. Osteomyelitis is very difficult to treat and requires six weeks of high dose intravenous antibiotics. Despite prolonged therapy, this infection often relapses resulting in years of pain and suffering.

In addition to bacteria contaminating intravenous drug preparations, shared needles can transmit viruses – Hepatitis B, Hepatitis C, and HIV virus.  Hepatitis B and Hepatitis C both can lead to severe liver inflammation that causes scaring of the liver called cirrhosis. Eventually the liver fails resulting in ascites (filling of the abdominal cavity with fluid), dilatation and bleeding of the esophageal veins (esophageal varices) resulting in gastrointestinal bleeding, and difficulty detoxifying substances in the blood resulting in the loss of alertness and eventually coma (called Hepatic encephalopathy).

HIV is another dreaded and all too common complication of IV drug use.

What would you evaluate all IV addicts for?

All IV addicts should be screened for Hepatitis B, Hepatitis C and HIV. They should also be screened for STDs.

What vaccinations would you suggest for patients with substance use disorders?

They should receive the influenza vaccine annually and the two pneumococcal vaccines. Also, if they are Hepatitis B antibody negative, they should receive the Hepatitis B vaccine.

Can you explain Hepatitis C. What is it? Who gets it? Why do so many addicts and abusers have it? What can you do to prevent it? Diagnose it? Treat it?

Hepatitis C is a virus that specifically infects the liver. This virus is transmitted by blood and blood products. Before the virus was recognized in the early 1990s, it contaminated our blood supply. Risk factors associated with an increased risk of Hepatitis C include:

Addicts who use intravenous drugs and share needles are at very high risk, because the virus is transmitted by needles contaminated with virally infected blood. Individuals infected with Hep C have very high numbers of viral particles in their blood, and when they share a needle with an uninfected person, that person is at high risk of inadvertently injecting those viral particles intotheir own blood stream and infecting their liver. The best way to prevent the spread of Hep C is to avoid IV drug use.

Another alternative is to use a clean needle, and never share needles. In some areas of the country, needle exchange programs have been instituted to prevent the spread of Hep C, Hep B, and HIV. The diagnosis can be readily made with a blood test that measures antibodies directed against the virus. This is a very sensitive and specific test and anyone who falls into the above risk groups should undergo testing because we now have excellent antiviral therapy for this infection. Direct acting antiviral therapy offers high cure rates of over 95% in most cases. Treatment usually takes 8-12 weeks of a single pill once per day. In more complicated cases, treatment may be continued for 24 weeks. The cost of treatment is very high ($1,000/ pill) usually costing between $80,000-100,000 to achieve a cure.

Is there a new epidemic of STDs. Which? Who gets which? Why do so many addicts and abusers have it? What can you do to prevent it? Diagnose it? Treat it?

Drug abuse is associated with increased sexual activity and the more sexual partners one has the greater the risk of STDs. The incidence of syphilis in the U.S. has increased among women by 36% from 2015 to 2016 and 15% in men during this same period. Also, the incidence of newborn syphilis has increased by 28% as a consequence of transmission from mother to child.

The group with the highest incidence of this infection is men having sex with men (MSM), and about ½ of MSM who have syphilis also have HIV. The incidence of gonorrhea has also increased during this time period by 22%. This is a particularly worrisome development because strains of gonorrhea are increasingly becoming drug resistant meaning that we are at risk of running out of antibiotic treatments for this infection in the future. Condoms prevent the spread of these diseases; and should always be used given the high risk of STDs among drug abusers.

Public health workers try to identify contacts when a STD case is reported so that these contacts can be tested and treated to prevent the further spread of infection. All patients who have more than one sexual partner or who use illicit drugs should be screened for syphilis, gonorrhea, chlamydia, Hepatitis B and HIV, particularly sexually active women under 25, pregnant women, and men having sex with men.

Syphilis, Hepatitis B and HIV are detected primarily through blood tests. Gonorrhea and chlamydia are tested using vaginal and urethral (opening of the penis) swabs. These tests are all very sensitive and specific. Syphilis, gonorrhea and chlamydia are treated with antibiotics and can be cured. Hepatitis B, like Hepatitis C, can now be cured using antiviral agents, but at great expense. HIV requires lifelong treatment.

Can you explain HIV? AIDS? What is it? Who gets it? Why do so many addicts and abusers have it? What can you do to prevent it? Diagnose it? Treat it?

HIV stands for Human Immunodeficiency Virus and is caused by a retrovirus that is transmitted primarily through blood and through sexual contact as an STD. HIV is a lifelong infection that over time destroys immune cells and results in opportunistic infections (infections by organisms that rarely infect people with normal immune systems) including cryptococcal (fungal) meningitis, pneumocystis pneumonia, and toxoplasmosis brain infections.

When the immune system deteriorates to the point of allowing these infections to develop, HIV infection is said to have progressed to AIDS or Acquired Immune Deficiency Syndrome.  Anti-retroviral medications can lower the viral counts and reverse this immunodeficiency; however, these medications cannot completely eradicate the infection, and they must be taken for life. If anti-retroviral medications are discontinued, the infection reactivates.

Can you explain what is HPV?  Is it just a woman’s problem? Who gets it? Why do so many addicts and abusers have it? What can you do to prevent it? Diagnose it? Treat it?

Human papilloma virus (HPV) is a wart causing virus that is transmitted by close skin to skin contact and is most commonly transmitted by vaginal or anal sex. A high percentage of people become infected but our immune system often clears the virus; however, when the virus remains active it can cause genital warts that have a cauliflower like appearance. This virus can cause mouth and throat, penis, anal, vaginal and cervical cancer. The diagnosis of HPV is usually made based on examination. Cervical pap smears are recommended periodically for women to look for atypical precancerous cells. Treatment consists of removing the precancerous cells through surgical procedures. When cancer develops, chemotherapy and surgical resection are required.

There is no medical treatment for HPV. However, a very effective vaccine is now available that can prevent HPV induced cancer. The vaccine is recommended for all children at age 11-12 years and can be given up to age 21 for women and up to age 26 for men. This vaccine is strongly recommended for men who intend to have sex with men, transgenders, and adolescents who are immunocompromised, including patients with HIV.

For many years, we treated cigarette-related cancers rather than identifying smokers and helping people stop smoking. Is that still happening today with alcohol and drugs? With no drug testing or limited in Pediatrics and Medicine, how can asking the patient if they use or inject drugs identify and help treat the primary disease or users?

The newspapers and television news are now publicizing the worsening drug epidemic in our country. This epidemic has spread to people in every socioeconomic class. Given the many health risks of drug addiction, physicians and nurses have an obligation to ask questions about this potentially life-threatening behavior. Drug addiction is a disease, and to identify and treat this disease, medical caregivers are obligated to inquire about this important health issue. And those who suffer from drug addiction need not be ashamed. They should be open to help. The infectious disease risks of continuing addiction are real and potentially life threatening. Therapy for addiction is available and can be effective. Why wait until the damage has been done?

Source:

https://www.rivermendhealth.com/resources/qa-frederick-southwick-infections-and-addiction/  May 2018

Filed under: Addiction,Alcohol,Health,HIV/Injecting-Drug-Users,Nicotine :

The proliferation of retail boutiques in California did not really bother him, Evan told me, but the billboards did. Advertisements for delivery, advertisements promoting the substance for relaxation, for fun, for health. “Shop. It’s legal.” “Hello marijuana, goodbye hangover.” “It’s not a trigger,” he told me. “But it is in your face.”

When we spoke, he had been sober for a hard-fought seven weeks: seven weeks of sleepless nights, intermittent nausea, irritability, trouble focusing, and psychological turmoil. There were upsides, he said, in terms of reduced mental fog, a fatter wallet, and a growing sense of confidence that he could quit. “I don’t think it’s a ‘can’ as much as a ‘must,'” he said.

Evan, who asked that his full name not be used for fear of the professional repercussions, has a self-described cannabis-use disorder. If not necessarily because of legalization, but alongside legalization, such problems are becoming more common: The share of adults with one has doubled since the early aughts, as the share of cannabis users who consume it daily or near-daily has jumped nearly 50 percent-all “in the context of increasingly permissive cannabis legislation, attitudes, and lower risk perception,” as the National Institutes of Health put it.

Public-health experts worry about the increasingly potent options available, and the striking number of constant users. “Cannabis is potentially a real public-health problem,” said Mark A. R. Kleiman, a professor of public policy at New York University. “It wasn’t obvious to me 25 years ago, when 9 percent of self-reported cannabis users over the last month reported daily or near-daily use. I always was prepared to say, ‘No, it’s not a very abusable drug. Nine percent of anybody will do something stupid.’ But that number is now [something like] 40 percent.” They argue that state and local governments are setting up legal regimes without sufficient public-health protection, with some even warning that the country is replacing one form of reefer madness with another, careening from treating cannabis as if it were as dangerous as heroin to treating it as if it were as benign as kombucha.

But cannabis is not benign, even if it is relatively benign, compared with alcohol, opiates, and cigarettes, among other substances. Thousands of Americans are finding their own use problematic-in a climate where pot products are getting more potent, more socially acceptable to use, and yet easier to come by, not that it was particularly hard before.

For Keith Humphreys, a professor of psychiatry and behavioral sciences at Stanford University, the most compelling evidence of the deleterious effects comes from users themselves. “In large national surveys, about one in 10 people who smoke it say they have a lot of problems. They say things like, ‘I have trouble quitting. I think a lot about quitting and I can’t do it. I smoked more than I intended to. I neglect responsibilities.’ There are plenty of people who have problems with it, in terms of things like concentration, short-term memory, and motivation,” he said. “People will say, ‘Oh, that’s just you fuddy-duddy doctors.’ Actually, no. It’s millions of people who use the drug who say that it causes problems.”

Users or former users I spoke with described lost jobs, lost marriages, lost houses, lost money, lost time. Foreclosures and divorces. Weight gain and mental-health problems. And one other thing: the problem of convincing other people that what they were experiencing was real. A few mentioned jokes about Doritos, and comments implying that the real issue was that they were lazy stoners. Others mentioned the common belief that you can be “psychologically” addicted to pot, but not “physically” or “really” addicted. The condition remains misunderstood, discounted, and strangely invisible, even as legalization and white-marketization pitches ahead.

The country is in the midst of a volte-face on marijuana. The federal government still classifies cannabis as Schedule I drug, with no accepted medical use. (Meth and PCP, among other drugs, are Schedule II.) Politicians still argue it is a gateway to the use of things like heroin and cocaine. The country still spends billions of dollars fighting it in a bloody and futile drug war, and still arrests more people for offenses related to cannabis than it does for all violent crimes combined.

Yet dozens of states have pushed ahead with legalization for medical or recreational purposes, given that for decades physicians have argued that marijuana’s health risks have been overstated and its medical uses overlooked; activists have stressed prohibition’s tremendous fiscal cost and far worse human cost; and researchers have convincingly argued that cannabis is far less dangerous than alcohol. A solid majority of Americans support legalization nowadays.

Academics and public-health officials, though, have raised the concern that cannabis’s real risks have been overlooked or underplayed-perhaps as part of a counter-reaction to federal prohibition, and perhaps because millions and millions cannabis users have no problems controlling their use. “Part of how legalization was sold was with this assumption that there was no harm, in reaction to the message that everyone has smoked marijuana was going to ruin their whole life,” Humphreys told me. It was a point Kleiman agreed with. “I do think that not legalization, but the legalization movement, does have a lot on its conscience now,” he said. “The mantra about how this is a harmless, natural, and non-addictive substance-it’s now known by everybody. And it’s a lie.”

Thousands of businesses, as well as local governments earning tax money off of sales, are now literally invested in that lie. “The liquor companies are salivating,” Matt Karnes of GreenWave Advisors told me. “They can’t wait to come in full force.” He added that Big Pharma was targeting the medical market, with Wall Street, Silicon Valley, food businesses, and tobacco companies aiming at the recreational market.

Sellers are targeting broad swaths of the consumer market-soccer moms, recent retirees, folks looking to replace their nightly glass of chardonnay with a precisely dosed, low-calorie, and hangover-free mint. Many have consciously played up cannabis as a lifestyle product, a gift to give yourself, like a nice crystal or an antioxidant face cream. “This is not about marijuana,” one executive at the California retailer MedMen recently argued. “This is about the people who use cannabis for all the reasons people have used cannabis for hundreds of years. Yes for recreation, just like alcohol, but also for wellness.”

Evan started off smoking with his friends when they were playing sports or video games, lighting up to chill out after his nine-to-five as a paralegal at a law office. But that soon became couch-lock, and he lost interest in working out, going out, doing anything with his roommates. Then came a lack of motivation and the slow erosion of ambition, and law school moving further out of reach. He started smoking before work and after work. Eventually, he realized it was impossible to get through the day without it. “I was smoking anytime I had to do anything boring, and it took a long time before I realized that I wasn’t doing anything without getting stoned,” he said.

His first attempts to reduce his use went miserably, as the consequences on his health and his life piled up. He gained nearly 40 pounds, he said, when he stopped working out and cooking his own food at home. He recognized that he was just barely getting by at work, and was continually worried about getting fired. Worse, his friends were unsympathetic to the idea that he was struggling and needed help. “[You have to] try to convince someone that something that is hurting you is hurting you,” he said.

Other people who found their use problematic or had managed to quit, none of whom wanted to use their names, described similar struggles and consequences. “I was running two companies at the time, and fitting smoking in between running those companies. Then, we sold those companies and I had a whole lot of time on my hands,” one other former cannabis user told me. “I just started sitting around smoking all the time. And things just came to a halt. I was in terrible shape. I was depressed.”

Lax regulatory standards and aggressive commercialization in some states have compounded some existing public-health risks, raised new ones, and failed to tamp down on others, experts argue. In terms of compounding risks, many cite the availability of hyper-potent marijuana products. “We’re seeing these increases in the strength of cannabis, as we are also seeing an emergence of new types of products,” such as edibles, tinctures, vape pens, sublingual sprays, and concentrates, Ziva Cooper, an associate professor of clinical neurobiology in the Department of Psychiatry at Columbia University Medical Center, told me. “A lot of these concentrates can have up to 90 percent THC,” she said, whereas the kind of flower you could get 30 years ago was far, far weaker. Scientists are not sure how such high-octane products affect people’s bodies, she said, but worry that they might have more potential for raising tolerance, introducing brain damage, and inculcating dependence.

As for new risks: In many stores, budtenders are providing medical advice with no licensing or training whatsoever. “I’m most scared of the advice to smoke marijuana during pregnancy for cramps,” said Humphreys, arguing that sellers were providing recommendations with no scientific backing, good or bad, at all.

In terms of long-standing risks, the lack of federal involvement in legalization has meant that marijuana products are not being safety-tested like pharmaceuticals; measured and dosed like food products; subjected to agricultural-safety and pesticide standards like crops; and held to labelling standards like alcohol. (Different states have different rules and testing regimes, complicating things further.)

Health experts also cited an uncomfortable truth about allowing a vice product to be widely available, loosely regulated, and fully commercialized: Heavy users will make up a huge share of sales, with businesses wanting them to buy more and spend more and use more, despite any health consequences.

“The reckless way that we are legalizing marijuana so far is mind-boggling from a public-health perspective,” Kevin Sabet, an Obama administration official and a founder of the non-profit Smart Approaches to Marijuana, told me. “The issue now is that we have lobbyists, special interests, and people whose motivation is to make money that are writing all of these laws and taking control of the conversation.”

This is not to say that prohibition is a more attractive policy, or that legalization has proven a public-health disaster. “The big-picture view is that the vast majority of people who use cannabis are not going to be problematic users,” said Jolene Forman, an attorney at the Drug Policy Alliance. “They’re not going to have a cannabis-use disorder. They’re going to have a healthy relationship with it. And criminalization actually increases the harms related to cannabis, and so having like a strictly regulated market where there can be limits on advertising, where only adults can purchase cannabis, and where you’re going to get a wide variety of products makes sense.”

Still, strictly regulated might mean more strictly regulated than today, at least in some places, drug-policy experts argue. “Here, what we’ve done is we’ve copied the alcohol industry fully formed, and then on steroids with very minimal regulation,” Humphreys said. “The oversight boards of a number of states are the industry themselves. We’ve learned enough about capitalism to know that’s very dangerous.”

A number of policy reforms might tamp down on problem use and protect consumers, without quashing the legal market or pivoting back to prohibition and all its harms. One extreme option would be to require markets to be non-commercial: The District of Columbia, for instance, does not allow recreational sales, but does allow home cultivation and the gifting of marijuana products among adults. “If I got to pick a policy, that would probably be it,” Kleiman told me. “That would be a fine place to be if we were starting from prohibition, but we are starting from patchwork legalization. As the Vermont farmer says, I don’t think you can get there from here. I fear its time has passed. It’s generally true that the drug warriors have never missed an opportunity to miss an opportunity.”

There’s no shortage of other reasonable proposals, many already in place or under consideration in some states. The government could run marijuana stores, as in Canada. States could require budtenders to have some training or to refrain from making medical claims. They could ask users to set a monthly THC purchase cap and remain under it. They could cap the amount of THC in products, and bar producers from making edibles that are attractive to kids, like candies. A ban or limits on marijuana advertising are also options, as is requiring cannabis dispensaries to post public-health information.

Then, there are THC taxes, designed to hit heavy users the hardest. Some drug-policy experts argue that such levies would just push people from marijuana to alcohol, with dangerous health consequences. “It would be like saying, ‘Let’s let the beef and pork industries market and do whatever they wish, but let’s have much tougher restrictions on tofu and seitan,'” said Mason Tvert of the Marijuana Policy Project. “In light of the current system, where alcohol is so prevalent and is a more harmful substance, it is bad policy to steer people toward that.” Yet reducing the commercial appeal of all vice products-cigarettes, alcohol, marijuana-is an option, if not necessarily a popular one.

Perhaps most important might be reintroducing some reasonable skepticism about cannabis, especially until scientists have a better sense of the health effects of high-potency products, used frequently. Until then, listening to and believing the hundreds of thousands of users who argue marijuana is not always benign might be a good start.

Source: info@learnaboutsam.org   20th August 2018

www.learnaboutsam.org

Filed under: Addiction,Cannabis/Marijuana,Drug use-various effects,Global Drug Legalisation Efforts,Social Affairs (Papers) :

Researchers map out a cellular mechanism that offers a biological explanation for alcoholism, and could lead to treatments

Credit: Getty Images

You can lead a lab rat to sugar water, but you can’t make him drink—especially if there’s booze around.

New research published Thursday in Science may offer insights into why some humans who drink alcohol develop an addiction whereas most do not. After caffeine, alcohol is the most commonly consumed psychoactive substance in the world. For the majority of people the occasional happy hour beer or Bloody Mary brunch is where it stops. Yet we all know that others will drink compulsively, despite whatever consequence or darkness it brings.

The new research confirms earlier work showing this is true for rats; but it takes things a step further and supports a study design that could help scientists better understand addiction biology, and possibly develop more effective therapies for human addictive behaviors. Led by a team at Linköping University in Sweden, the researchers found that when given a choice between alcohol and a tastier, more biologically desirable sugar substitute, a subgroup of rats consistently preferred the alcohol. The authors further identified a specific brain region and molecular dysfunction most likely responsible for these addictive tendencies. They believe their findings and study design could be steps toward developing an effective pharmaceutical therapy for alcohol addiction, a kind of treatment that has eluded researchers for years.

A taste for sweetness is evolutionarily embedded in the mammalian brain; in the wild, sugar translates into fast calories and improved survival odds. For the new study, 32 rats were trained to sip a 20 percent alcohol solution for 10 weeks until it became habit. They were then presented with a daily choice between more alcohol or a solution of the noncaloric sweetener saccharine. (The artificial sweetener provides sugary-tasting enticement without the potential confounding variable of actual calories.) The majority of rats vastly preferred the faux sugar over the alcohol option.

But the fact that four rats—or 12.5 percent of the total—stuck with the alcohol was telling to senior author Markus Heilig, director of the Center for Social and Affective Neuroscience at Linköping, given the rate of alcohol misuse in humans is around 15 percent. So Heilig expanded the study. “There were four rats who went for alcohol despite the more natural reward of sweetness,” he says. “We built on that, and 600 animals later we found that a very stable proportion of the population chose alcohol.” What’s more, the “addicted” rats still chose alcohol even when it meant receiving an unpleasant foot shock.

To get a better sense of what was going on at a molecular level, Heilig and his colleagues analyzed which genes were expressed in the rodent subjects’ brains. The expression of one gene in particular—called GAT-3—was found to be greatly reduced in the brains of those who opted for alcohol rather than saccharine. GAT-3 codes for a protein that normally controls levels of a neurotransmitter called GABA, a common chemical in our brains and one known to be involved in alcohol dependence.

In collaboration with co-author and University of Texas at Austin research scientist Dayne Mayfield, Heilig’s team found that in brain samples from deceased humans who had suffered from alcohol addiction, GAT-3 levels were markedly lower in the amygdala—generally considered the brain’s emotional center. One might assume that any altered gene expression contributing to addictive behaviors would instead manifest in the brain’s reward circuitry—a network of centers involved in pleasurable responses to enticements like food, sex and gambling.

Yet the decrease in GAT-3 expression in both rats and humans was by far strongest in the amygdala. “Figuring out the reward circuitry has been a fantastic success story, but it’s probably of limited relevance to clinical addiction,” Heilig says. “The rewarding effect of drugs happens in everybody. It’s a completely different story in the minority of people who continue to take drugs despite adverse consequences.” He believes altered activity in the amygdala makes perfect sense, given that addiction—in both rats and humans—often brings with it negative emotions and anxiety.

Much previous addiction research has relied on models in which rodents learn to self-administer addictive substances, but without other options that could compete with drug use. It was French neuroscientist Serge Ahmed who recognized this as a major limitation to understanding addition biology given that, in reality, only a minority of humans develops addiction to a particular substance. By offering an alternative reward (that is, sweet water), his team showed only a minority of rats develop a harmful preference for drug use—a finding that has now been confirmed with several other commonly abused drugs.

Building on Ahmed’s concept, Heilig added the element of choice to his research. “You can’t determine the true reward of an addictive drug in isolation; it’s dependent on what other options are available—in our case a sugar substitute.” He says most models that have been used to study addiction, and to seek ways to treat it, were probably too limited in their design. “The availability of choice,” he adds, “is going to be fundamental to studying addiction and developing effective treatments for it.”

Paul Kenny, chair of neuroscience at Icahn School of Medicine at Mount Sinai, agrees. “In order to develop novel therapeutics for alcoholism it is critical to understand not just the actions of alcohol in the brain, but how those actions may differ between individuals who are vulnerable or resilient to the addictive properties of the drug,” he says. “This Herculean effort to impressively map out a cellular mechanism that likely contributes to alcohol dependence susceptibility will likely provide important new leads in the search for more effective therapeutics.” Kenny was not involved in the new research.

Heilig and his team believe they have already identified a promising addiction treatment based on their latest work,  and have teamed up with a pharmaceutical company in hopes of soon testing the compound in humans. The drug suppresses the release of GABA and thus could restore levels of the neurotransmitter to normal in people with a dangerous taste for alcohol. With any luck, one of civilization’s oldest  vices might soon loosen its grip.. Illumination.

Source:  www.scientificamerican.com/article/scientists-pinpoint-brain-region-that-may-be-center-of-alcohol-addiction/   June 21st 2018

Filed under: Addiction,Addiction (Papers),Alcohol,Brain and Behaviour :

The opioid crisis is unlike any drug epidemic America has ever known. It’s claiming lives at an almost unimaginable rate.

But to get an idea of why these drugs are taking such a toll, you have to look at the people who are dying.

This is not just the curse of the stereotypical addict.

Many of those admitted to the country’s fast swelling mortuaries were middle class professionals whose first fix was dealt to them by a doctor.

Back in the 90s and early 2000s, pharmaceutical firms began a major lobbying exercise, persuading doctors to prescribe their synthetic forms of heroin for pain relief.

Soon GPs across the country were handing out powerful prescriptions for relatively minor ailments.

The drugs worked, but they proved highly addictive and when patients’ prescriptions ran out, many took to the streets to feed what had fast become a habit.

That’s where the problem really starts. In pill form, this medication could be controlled, but by going to “street chemists” for their fix, people were taking a huge risk.

They’d buy the drugs, illegally imported from China, ready mixed with harmless powders. Just a few grains of opioid in each capsule, which they’d either snort, smoke or inject.

Most of the powders are phenomenally potent. One, Carfentanil, is said to be 10,000 times stronger than heroin.

Originally created as an elephant tranquiliser, a couple of grains could be enough to kill.

Others are less powerful but still deadly, and here’s the real issue – most addicts have no idea which kind of opioid they’re taking.

Yet across America people are seeking out dealers and buying this stuff for as little as two dollars per fix.

Some have reached a truly hopeless stage.

Ian Blackburn, a long-time addict, told me he’s never known anything like it. He’s felt in control of his drug habit in the past. Not any more.

“Three hits, that’s all it takes”, he told me: “You take this stuff three times and it’s forever”.

He explained how he doesn’t get a buzz from the drug any more, he simply takes it to feel normal, to take the pain of withdrawal away. Without it, his legs start to cramp, his stomach wrenches and he loses control of his functions.

“Every couple of hours you need a hit”, he says “no ifs ands or buts, you’re going to find it and you’re going to get money to get it, no matter what”.

Source: http://www.itv.com/news/2017-06-27/opioid-crisis-claiming-record-number-of-addicts-lives-in-the-us/

September 2017

Filed under: Addiction,Prescription Drugs,USA :

Submitted by Livia Edegger

Earlier this month Germany celebrated the results of the 2014 drug report which revealed a rapid decline in smoking, drinking and marijuana use among youth over the past ten years. Smoking among German teens aged 12 – 17 has halved in ten years (11.7%). Smoking rates have also dropped among 18 – 25 year olds, not as significantly though. Drinking rates have fallen from 17.9% in 2001 to 13.6% in 2012 among 12 – 17 year olds. In terms of gender differences, teenage boys are twice more likely to consume alcohol than their female counterparts. Little has changed among 18 – 25 year olds, the group that accounts for the highest alcohol consumption rate. Drinking in that age group was reported at 38.4% in 2012 which means it only dropped by a little over 1%. Cannabis ranks first among illicit drugs used with 5.6% of 12 – 17 year old teenagers using it compared to 9.2% in 2001. After years of steady consumption rates, cannabis use among 18 – 25 year olds is on the rise again and at 15.8% resembles figures of 2001.

Source:

http://preventionhub.org/en/prevention-update/germany-releases-drug-report

23rd July 2014

Filed under: Addiction,Alcohol,Cannabis/Marijuana,Nicotine,Youth :

By HAEYOUN PARK and MATTHEW BLOCH JAN. 19, 2016

Deaths from drug overdoses have jumped in nearly every county across the United States, driven largely by an explosion in addiction to prescription painkillers and heroin.

Some of the largest concentrations of overdose deaths were in Appalachia and the Southwest, according to new county-level estimates released by the Centers for Disease Control and Prevention.

The number of these deaths reached a new peak in 2014: 47,055 people, or the equivalent of about 125 Americans every day.

Deaths from overdoses are reaching levels similar to the H.I.V. epidemic at its peak.

The death rate from drug overdoses is climbing at a much faster pace than other causes of death, jumping to an average of 15 per 100,000 in 2014 from nine per 100,000 in 2003.

The trend is now similar to that of the human immunodeficiency virus, or H.I.V., epidemic in the late 1980s and early 1990s, said Robert Anderson, the C.D.C.’s chief of mortality statistics.

H.I.V. deaths rose in a shorter time frame, but their peak in 1995 is similar to the high point of deaths from drug overdoses reached in 2014, Mr. Anderson said. H.I.V., however, was mainly an urban problem. Drug overdoses cut across rural-urban boundaries.

In fact, death rates from overdoses in rural areas now outpace the rate in large metropolitan areas, which historically had higher rates.

Heroin abuse in states like New Hampshire make it a top campaign issue.

Drugs deaths have skyrocketed in New Hampshire. In 2014, 326 people died from an overdose of an opioid, a class of drugs that includes heroin and fentanyl, a painkiller 100 times as powerful as morphine.

Nationally, opioids were involved in more than 61 percent of deaths from overdoses in 2014. Deaths from heroin overdoses have more than tripled since 2010 and are double the rate of deaths from cocaine.

In New Hampshire, which holds this year’s first presidential primary, residents have repeatedly raised the issue of heroin addiction with visiting candidates.

“No group is immune to it — it is happening in our inner cities, rural and affluent communities,” said Timothy R. Rourke, the chairman of the New Hampshire Governor’s Commission on Alcohol and Drug Abuse.

Most of the deaths from overdose in the state are related to a version of fentanyl. “Dealers will lace heroin with it or sell pure fentanyl with the guise of being heroin,” Mr. Rourke said.  But fentanyl can be deadlier than heroin. It takes much more naloxone, a drug that reverses the effects of an opioid overdose, to revive someone who has overdosed on fentanyl.

Mr. Rourke said that high death rates in New Hampshire were symptomatic of a larger problem: The state is second to last, ahead of only Texas, in access to treatment programs. New Hampshire spends $8 per capita on treatment for substance abuse. Connecticut, for example, spends twice that amount.

Appalachia has been stricken with overdose deaths for more than a decade, in many ways because of prescription drug addiction among its workers.  West Virginia and neighboring states have many blue-collar workers, and “in that group, there’s just a lot of injuries,” said Dr. Carl R. Sullivan III, the director of addiction services at the West Virginia University School of Medicine.

“In the mid-1990s, there was a social movement that said it was unacceptable for patients to have chronic pain, and the pharmaceutical industry pushed the notion that opioids were safe,” he said.

A few years ago, as laws were passed to address the misuse of prescription painkillers, addicts began turning to heroin instead, he said. Because of a lack of workers needed to treat addicts, overdose deaths have continued to afflict states like West Virginia, which has the highest overdose death rate in the nation.

“Chances of getting treatment in West Virginia is ridiculously small,” Dr. Sullivan said. “We’ve had this uptick in overdose deaths despite enormous public interest in this whole issue.”

While New Mexico has avoided the national spotlight in the current wave of opioid addiction, it has had high death rates from heroin overdoses since the early 1990s.

Heroin addiction has been “passed down from generation to generation in small cities around New Mexico,” said Jennifer Weiss-Burke, executive director of Healing Addiction in Our Community, a non-profit group formed to curb heroin addiction. “I’ve heard stories of grandparents who have been heroin users for years, and it is passed down to younger generations; it’s almost like a way of life.”

Dr. Michael Landen, the state epidemiologist, said the state recently began grappling with prescription opioids. Addictions have shifted to younger people and to more affluent communities.

Ms. Weiss-Burke, whose son died from a heroin overdose in 2011, said it was much harder to treat young people. “Some young people are still having fun and they don’t have the desire to get sober, so they end up cycling through treatment or end up in jail,” she said.

Her center recently treated a 20-year-old man who was sober for five months before relapsing, then relapsed several more times after that.  “When you go right back to the same environment, it’s hard to stay clean,” she said. “Heroin craving continues to haunt a person for years.”

Source : https://www.nytimes.com/interactive/2016/01/07/us/drug-overdose-deaths-in-the-us.html

 

Filed under: Addiction,Heroin/Methadone,Prescription Drugs,USA :

A pair of new studies has revealed that marijuana use could lead to abuse of other drugs and alcohol. Experts said that these risks need to be considered not only by doctors and patients but by policy makers as well particularly in states where marijuana is legalized for recreational or medical use.

For the first study, which was published in the journal Drug and Alcohol Dependence, the results showed that adults who smoke marijuana have five times increased odds of developing alcohol use disorder (AUD) compared with their counterparts who do not smoke.

By looking at the data of more than 27,000 adults, researchers found that the participants who did not have AUD but reported using cannabis during the first survey were 5.4 times more likely to have an AUD three years later.  The participants who already battle with an alcohol use disorder and were using marijuana were also found to aggravate their dependence on alcohol.

“Among adults with no history of AUD, cannabis use at Wave 1 was associated with increased incidence of an AUD three years later relative to no cannabis use,” study researcher Renee Goodwin, from Columbia University, and colleagues wrote. “Among adults with a history of AUD, cannabis use at Wave 1 was associated with increased likelihood of AUD persistence three years later relative to no cannabis use.”

The second study, which was published in JAMA Psychiatry and involved more than 34,000 subjects, revealed that participants who used cannabis during the first survey were about six times as likely to suffer from substance use disorder after three years.

Researchers also found an increased risk for drug use disorders and nicotine dependence among pot smokers.   Although the study authors said that their findings do not establish a cause and effect relationship between pot use and substance abuse, they noted that there may be an overlap in brain circuitry that influence drug use and dependence.

“Our study indicates that cannabis use is associated with increased prevalence and incidence of substance use disorders,” Carlos Blanco, from the National Institute on Drug Abuse, and colleagues wrote. “These adverse psychiatric outcomes should be taken under careful consideration in clinical care and policy planning.”

 Source:  http://www.techtimes.com/articles/135554/20160222   22nd Feb 2016

Filed under: Addiction,Alcohol,Australia,Cannabis/Marijuana :

During the late 1970s, my colleague, Dr. Herb Kleber, and I introduced a novel neuroanatomical model to explain the pathophysiology of opioid withdrawal and put forth our contention that addiction was not simply a matter of avoiding withdrawal. Using what was then a novel new drug, clonidine, we were able to effectively detox heroin and methadone addicts in half the time, and without the surge of norepinephrine release from the locus coeruleus. This minimized the agitation and somatic anxiety that can be unbearable for some patients.

This helped prove our conviction that addictive disease was the result of numerous and largely unknown factors, and not simply to avoid withdrawal. In spite of effectively and humanely withdrawing addicts from opioids, we also discovered that something was clearly different and unique about their brain and behavior. After being clean and sober for 6-8 months in a safe and secure rehab environment, most addicts returned to using heroin as soon as the door was unlocked. This looked like Pavlovian principles on steroids. Although it was not due to avoidance of withdrawal symptoms, the answer remained unclear.

In some ways, we have travelled light years in furthering our understanding of the brain and addictive disease. Yet, relapse remains the norm and not the exception for opioid addicts. The development and use of naltrexone in the 1990s followed by buprenorphine has helped many addicts achieve a better quality of life. Yet, relapse remains the norm.

In a recent placebo-controlled clinical trial by Kowalczyk, et al, participants were given (0.3 mg/d) of clonidine or placebo during 18 weeks of Medication-Assisted Treatment (MAT) with buprenorphine, and documented their mood and activities via a pre-programmed smart phone.

Study participants receiving clonidine in addition to buprenorphine had increased abstinence from opioids and were able to decouple their stress from drug craving. Additionally, participants in the buprenorphine-plus-clonidine group, not only experienced longer periods of abstinence, but were also better in managing, or coping with their “unstructured” time. In other words, clonidine helped persons deal with their boredom and inability to create or engage in healthy activities, which is a strong predictor of relapse.

Why Does This Matter?

The study replicates previous research demonstrating that 1.) unstructured time, especially during early recovery is a trigger and predictor of relapse, 2.) engaging in responsible or helpful activities is associated with better outcomes among patients receiving Medication-Assisted Treatment, and 3.) clonidine helped participants engage in unstructured-time activities with less risk of craving or use than they might otherwise have experienced.

From a personalized-medicine perspective, these data are a good reminder that addiction is a multifaceted disease requiring a multimodal approach. It is not treatable with any singular intervention. At best, psychopharmacology is adjunctive. And remember before any MAT, many addicted persons enjoyed sustained recovery via 12-step programs.

Source: https://www.rivermendhealth.com/resources/clonidine-plus-mat-improves-treatment-outcomes/ November 2017

Filed under: Addiction,Brain and Behaviour,Treatment and Addiction :

The use of buprenorphine and other Medically-Assisted Treatments (MAT) for opioid use disorder has increased rapidly in response to the opioid epidemic in the United States. From the clinician’s perspective, buprenorphine seemed like a panacea. I remember feeling the same way about methadone in the 70s and Naltrexone in the 80s.

Buprenorphine’s unique chemistry, being a partial agonist and antagonist medication, meant patients were able to detox from heroin or powerfully addictive prescription pain medications using Suboxone (a trade name for buprenorphine) and then taper off with relative ease, compared to heroin or oxycodone. In some cases, patients were not able to come off of Suboxone and remained on a small maintenance dose for months, and even years, but had attained a quality of life they never believed was possible when addicted to illicit opioids.

However, a large study by the Johns Hopkins Bloomberg School of Public Health (2017) reports that a significant proportion of patients on Suboxone therapy, or shortly after the conclusion of their therapy, were attaining and filling prescriptions for other opioid medications. Outcome measures matter. Different treatments work if your outcome measure is one month of adherence to the treatment versus five years of drug-free outcome and return to work.

The methodology in the Johns Hopkins study reviewed pharmacy claims for over 38,000 persons who had been prescribed Suboxone between 2006 and 2013. The results were shocking. Two-thirds of these patients had filled a prescription for an opioid painkiller in the first 12 months following Suboxone treatment—while 43 percent had received a prescription for an opioid during Suboxone therapy. In addition, approximately two-thirds of the patients who received Suboxone therapy stopped filling prescriptions for it after just three months.

What These Data Cannot Tell Us

At first glance these data are disappointing. Just looking at patient return to the program over a short time like six months, it is very clear that most methadone patients come back and many Suboxone patients do not. However, there is much the study results don’t tell us.

In a clinical and policy environment where the number of prescribers, the volume and nature of opioid prescriptions, overdoses, prescribing policies, laws and regulations are changing frequently and dramatically, data loses some of their value. In Florida, for example, the legislature, in response to the “Pill Mills,” enacted a monitoring program whereby all prescribed scheduled medications were on a single database, accessible by any licensed physician.

Twelve months after implementation, the outcomes were evaluated. Overall opioid prescriptions decreased by 1.4%. Opioid volume decreased by 2.5%, and a decrease of 5.6% in MME per transaction was observed. These data were limited to prescribers and patients with the highest baseline opioid prescribing and usage. The findings also accounted for potential confounding variables including sensitivity analyses, varying time windows and dynamic enrolment criteria. The opioid landscape in Florida continues to improve, and the pill mills are virtually gone. This is just one example of how a state’s policies impact the data and the outcome in longitudinal research.

In addition, prescription drug monitoring programs (PDMPs) are associated with reductions in all drug use (including opioids). Data culled from adult Medicare beneficiaries in states that utilize PDMPs compared with states that do not have PDMPs show significant reductions in prescription opioid transactions. Moreover, the top treatment centers may prescribe buprenorphine but also set up voluntary drug monitoring and continuing care programs for their patients, much as the programs do for impaired physicians, nurses and pilots who mandate random and for-cause drug testing for five years.

Most heroin addicts have multiple drug dependencies and problems. They also have multiple medical co-morbidities. It is not as simple as switching the patient’s heroin for buprenorphine. But street heroin is more than a drug, it is many drugs and dangerous adulterants. Over 80 percent of the Physician Health Program participants are treated effectively, monitored and never had a positive drug test throughout the five years of post-treatment outpatient monitoring.

Lastly, the Institute of Medicine released their exhaustive report on Pain in America, revealing that 100 million Americans currently suffer from chronic or intractable pain syndromes. The Johns Hopkins study does not indicate what percent of the study participants have a pain syndrome, requiring treatment with opioid medication, hopefully under the supervision of a specialist in pain managements and addiction medicine.

Why Does This Matter?

The findings certainly raise questions about the effectiveness and the appropriateness of Suboxone for addiction treatment. Clearly, if we were to adopt an oncology standard of five years, Suboxone is not likely to be considered an effective treatment. But it is a viable and important option and part of an arsenal of treatment modalities used to individualize treatment for our patients.

The study researchers noted, and I agree, that the continued use of pain medication during and after addiction treatment indicates that too many patients did not receive a multimodal, integrated treatment plan for their addiction or concurrent chronic pain or co-occurring mental illness, which approximately 50-65% of those with Substance Use Disorder (SUD) have.

Dr. Alexander, the lead author of the study noted: “There are high rates of chronic pain among patients receiving opioid agonist therapy, and thus concomitant use of buprenorphine and other opioids may be justified clinically. This is especially true as the absence of pain management among patients with opioid use disorders may result in problematic behaviors such as illicit drug use and misuse of other prescription medications.”

Addicts are quick to discover the probabilities of attaining a “high” from just about any drug they come across. Buprenorphine, while not commonly abused or sold on the streets, can be used to get high or to ease the pangs of withdrawal when heroin and other opioids are scarce.

The efficacy of treatment for SUD, regardless of the drug, is largely dependent upon non-medical factors. Yes, monitoring is important, but only if the potential for losing something one values is at stake. Surrendering, which cannot be described in medical or psychological language, is the single most important factor in determining recovery. Adjunctive treatments such as Suboxone, Methadone, N.A., A.A., CBT, yoga, meditation, diet and exercise can help a highly motivated individual. When treatment is

individualized and a bond of trust is established between a counselor and patient, good and even improbable things happen, and lives are restored.

MATs are not a replacement for the traditional foundations of treatment and recovery. At best, they can provide a specific need for a specific patient. They are not for everyone. When people ask me what the elements of success are in treatment, I often start with long-term. If a person has been abusing and addicted for years, it is difficult to imagine treatment in weeks. But, as a shortcut to what works, I tell them the 3 M’s: treatment that is high-dose, intense multimodal, multidisciplinary and multifaceted, staffed by dedicated professionals who are experienced and really do care about the patients.

Suboxone and the similar medications that will be developed are inherently not good or bad and certainly don’t work for every opioid addict. But I am thankful we have them. I believe they have saved thousands of lives. The real trick of successful treatment is to know your patients and collaborate with him or her in developing a plan that gives them the best shot at recovery.

Source: https://www.rivermendhealth.com/resources/buprenorphine-saves-lives-but-its-far-from-a-panacea/? Author: Mark Gold, MD

Filed under: Addiction,Heroin/Methadone,Treatment and Addiction :

Pain and pleasure rank among nature’s strongest motivators, but when mixed, the two can become irresistible. This is how opioids brew a potent and deadly addiction in the brain. Societies have coveted the euphoria and pain relief provided by opioids since Ancient Sumerians referred to opium poppies as the “joy plant” circa 3400 B.C. But the repercussions of using the drugs were ever present, too. For centuries, Chinese patients swallowed opium cocktails before major surgeries, but by 1500, they described the recreational use of opium pipes as subversive. The Chinese emperor Yung Cheng eventually restricted the use of opium for medical purposes in 1729. Less than 100 years later, a German chemist purified morphine from poppies, creating the go-to pain reliever for anxiety and respiratory conditions. But the Civil War and its many wounds spawned mass addiction to the drugs, a syndrome dubbed Soldier’s Disease. A cough syrup was concocted in the late 1800s — called heroin — to remedy these morphine addictions. Doctors thought the syrup would be “non-addictive.” Instead, it turned into a low-cost habit that spread internationally. More than 70 percent of the world’s opium — 3,410 tons — goes to heroin production, a number that has more than doubled since 1985. Approximately 17 million people around the globe used heroin, opium or morphine in 2016.

Today, prescription and synthetic opioids crowd America’s medicine cabinets and streets, driving a modern crisis that may kill half a million people over the next decade. Opioids claimed 53,000 lives in the U.S. last year, according to preliminary estimates from the Centers for Disease Control and Prevention — more than those killed in motor vehicle accidents.

How did we arrive here? Here’s a look at why our brains get hooked on opioids.

The pain divide

Let’s start with the two types of pain. They go by different names depending on which scientist you ask. Peripheral versus central pain. Nociceptive versus neuropathic pain.

The distinction is the sensation of actual damage to your body versus your mind’s perception of this injury.

Your body quiets your pain nerves through the production of natural opioids called endorphins.

Stuff that damages your skin and muscles — pin pricks and stove burns — is considered peripheral/nociceptive pain.

Pain fibers sense these injuries and pass the signal onto nerve cells — or neurons — in your spine and brain, the duo that makes up your central nervous system.

In a normal situation, your pain fibers work in concert with your central nervous system. Someone punches you, and your brain thinks “ow” and tells your body how to react.

Stress-relieving hormones get released. Your immune system counteracts the inflammation in your wounded arm.

Your body quiets your pain nerves through the production of natural opioids called endorphins. The trouble is when these pain pathways become overloaded or uncoupled.

One receptor to rule them all

Say you have chronic back pain. Your muscles are inflamed, constantly beaming pain signals to your brain. Your natural endorphins aren’t enough and your back won’t let up, so your doctor prescribes an opioid painkiller like oxycodone.

Prescription opioids and natural endorphins both land on tiny docking stations — called receptors — at the ends of your nerves. Most receptors catch chemical messengers — called neurotransmitters — to activate your nerve cells, triggering electric pulses that carry the signal forward.

But opioid receptors do the opposite. They stop electric pulses from traveling through your nerve cells in the first place. To do this, opioids bind to three major receptors, called Mu, Kappa and Delta. But the Mu receptor is the one that really sets everything in motion.

The Mu-opiate receptor is responsible for the major effects of all opiates, whether it’s heroin, prescription pills like oxycodone or synthetic opioids like fentanyl, said Chris Evans, director of Brain Research Institute at UCLA. “The depression, the analgesia [pain numbing], the constipation and the euphoria — if you take away the Mu-opioid receptor, and you give morphine, then you don’t have any of those effects,” Evans said.

Opioids receptors trigger such widespread effects because they govern more than just pain pathways. When opioid drugs infiltrate a part of the brain stem called the locus ceruleus, their receptors slow respiration, cause constipation, lower blood pressure and decrease alertness. Addiction begins in the midbrain, where opioids receptors switch off a batch of nerve cells called GABAergic neurons.

GABAergic neurons are themselves an off-switch for the brain’s euphoria and pleasure networks.

When it comes to addiction, opioids are an off-switch for an off-switch. Opioids hold back GABAergic neurons in the midbrain, which in turn keep another neurotransmitter called dopamine from flooding a brain’s pleasure circuits. Image by Adam Sarraf

Once opioids shut off GABAergic neurons, the pleasure circuits fill with another neurotransmitter called dopamine. At one stop on this pleasure highway — the nucleus accumbens — dopamine triggers a surge of happiness. When the dopamine rolls into amygdala, the brain’s fear center, it relieves anxiety and stress. Both of these events reinforce the idea that opioids are rewarding.

These areas of the brain are constantly communicating with decision-making hubs in the prefrontal cortex, which make value judgments about good and bad. When it hears “This pill feels good. Let’s do more,” the mind begins to develop habits and cravings.

Taking the drug soon becomes second nature or habitual, Evans said, much like when your mind zones out while driving home from work. The decision to seek out the drugs, rather than participate in other life activities, becomes automatic.

The opioid pendulum: When feeling good starts to feel bad

Opioid addiction becomes entrenched after a person’s neurons adapt to the drugs. The GABAergic neurons and other nerves in the brain still want to send messages, so they begin to adjust. They produce three to four times more cyclic AMP, a compound that primes the neuron to fire electric pulses, said Thomas Kosten, director of the division of alcohol and addiction psychiatry at the Baylor College of Medicine.

That means even when you take away the opioids, Kosten says, “the neurons fire extensively.”

The pendulum swings back. Now, rather than causing constipation and slowing respiration, the brain stem triggers diarrhoea and elevates blood pressure. Instead of triggering happiness, the nucleus accumbens and amygdala reinforce feelings of dysphoria and anxiety. All of this negativity feeds into the prefrontal cortex, further pushing a desire for opioids.

While other drugs like cocaine and alcohol can also feed addiction through the brain’s pleasure circuits, it is the surge of withdrawal from opioids that makes the drugs so inescapable.

Could opioid addiction be driven in part by people’s moods?

Cathy Cahill, a pain and addiction researcher at UCLA, said these big swings in emotions likely factor into the learned behaviors of opioid addiction, especially with those with chronic pain. A person with opioid use disorder becomes preoccupied with the search for the drugs. Certain contexts become triggers for their cravings, and those triggers start overlapping in their minds.

“The basic view is some people start with the pain trigger [the chronic back problem], but it gets partially substituted with the negative reinforcement of the opioid withdrawal,” Cahill said.

That’s why Cahill, Evans and other scientists think the opioid addiction epidemic might be driven, in part, by our moods.

Chronic pain patients have a very high risk of becoming addicted to opioids if they are also coping with a mood disorder. A 2017 study found most patients — 81 percent — whose addiction started with a chronic pain problem also had a mental health disorder. Another study found patients on morphine experience 40 percent less pain relief from the drug if they have mood disorder. They need more drugs to get the same benefits.

People with mood disorders alone are also more likely to abuse opioids. A 2012 survey found patients with depression were twice as likely to misuse their opioid medications.

“So, not only does a mood disorder affect a person’s addiction potential, but it also influences if the opioids will successfully treat their pain,” Cahill said.

Meanwhile, the country is living through sad times. Some research suggests social isolation is on the rise. While the opioid epidemic started long before the recession, job loss has been linked to a higher likelihood of addiction, with every 1 percent increase in unemployment linked to a 3.6 percent rise in the opioid-death rate.

Can the brain swing back?

As an opioid disorder progresses, a person needs a higher quantity of the drugs to keep withdrawal at bay. A person typically overdoses when they take so much of the drug that the brain stem slows breathing until it stops, Kosten said.

Many physicians have turned to opioid replacement therapy, a technique that swaps highly potent and addictive drugs like heroin with compounds like methadone or buprenorphine (an ingredient in Suboxone).

These substitutes outcompete heroin when they reach the opioid receptors, but do not activate the receptors to the same degree. By doing so, they reduce a person’s chances for overdosing. These replacement medications also stick to the receptors for a longer period of time, which curtails withdrawal symptoms. Buprenorphine, for instance, binds to a receptor for 80 minutes while morphine only hangs on for a few milliseconds.

For some, this solution is not perfect. The patients need to remain on the replacements for the foreseeable future, and some recovery communities are divided over whether treating opioids with more opioids can solve the crisis. Plus, opioid replacement therapy does not work for fentanyl, the synthetic opioid that now kills more Americans than heroin. Kosten’s lab is one of many working on a opioid vaccine that would direct a person’s immune system to clear drugs like fentanyl before they can enter the brain. But those are years away from use in humans.

And Evans and Cahill said many clinics in Southern California are combining psychological therapy with opioid replacement prescriptions to combat the mood aspects of the epidemic.

“I don’t think there’s going to be a magic bullet on this one,” Evans said. “It’s really an issue of looking after society and looking after of people’s psyches rather than just treatment.

Source: http://www.pbs.org/newshour/updates/brain-gets-hooked-opioids/

Filed under: Addiction,Brain and Behaviour,Heroin/Methadone,Treatment and Addiction :

Legalizing opioids may give Americans greater freedom over their decision-making, but at what cost? One painful aspect of the public debates over the opioid-addiction crisis is how much they mirror the arguments that arise from personal addiction crises.

If you’ve ever had a loved one struggle with drugs — in my case, my late brother, Josh — the national exercise in guilt-driven blame-shifting and finger-pointing, combined with flights of sanctimony and ideological righteousness, has a familiar echo. The difference between the public arguing and the personal agonizing is that, at the national level, we can afford our abstractions.

When you have skin in the game, none of the easy answers seem all that easy. For instance, “tough love” sounds great until you contemplate the possible real-world consequences. My father summarized the dilemma well. “Tough love” — i.e., cutting off all support for my brother so he could hit rock bottom and then start over — had the best chance of success. It also had the best chance for failure — i.e., death. There’s also a lot of truth to “just say no,” but once someone has already said “yes,” it’s tantamount to preaching “keep your horses in the barn” long after they’ve left.

But if there’s one seemingly simple answer that has been fully discredited by the opioid crisis, it’s that the solution lies in wholesale drug legalization. In Libertarianism: A Primer, David Boaz argues that “if drugs were produced by reputable firms, and sold in liquor stores, fewer people would die from overdoses and tainted drugs, and fewer people would be the victims of prohibition-related robberies, muggings and drive-by-shootings.”

Maybe. But you know what else would happen if we legalized heroin and opioids? More people would use heroin and opioids. And the more people who use such addictive drugs, the more addicts you get. Think of the opioid crisis as the fruit of partial legalization. In the 1990s, for good reasons and bad, the medical profession, policymakers, and the pharmaceutical industry made it much easier to obtain opioids in order to confront an alleged pain epidemic. Doctors prescribed more opioids, and government subsidies made them more affordable. Because they were prescribed by doctors and came in pill form, the stigma reserved for heroin didn’t exist. When you increase supply, lower costs, and reduce stigma, you increase use.

And guess what? Increased use equals more addicts. A survey by the Washington Post and the Kaiser Family Foundation found that one-third of the people who were prescribed opioids for more than two months became addicted. A Centers for Disease Control study found that a very small number of people exposed to opioids are likely to become addicted after a single use. The overdose crisis is largely driven by the fact that once addicted to legal opioids, people seek out illegal ones — heroin, for example — to fend off the agony of withdrawal once they can’t get, or afford, any more pills. Last year, 64,000 Americans died from overdoses. Some 58,000 Americans died in the Vietnam War.

Experts rightly point out that a large share of opioid addiction stems not from prescribed use but from people selling the drugs secondhand on the black market, or from teenagers stealing them from their parents. That’s important, but it doesn’t help the argument for legalization. Because the point remains: When these drugs become more widely available, more people avail themselves of them. How would stacking heroin or OxyContin next to the Jim Beam lower the availability? Liquor companies advertise — a lot. Would we let, say, Pfizer run ads for their brand of heroin? At least it might cut down on the Viagra commercials. I think it’s probably true that legalization would reduce crime, insofar as some violent illegal drug dealers would be driven out of the business.

I’m less sure that legalization would curtail crimes committed by addicts in order to feed their habits. As a rule, addiction is not conducive to sustained gainful employment, and addicts are just as capable of stealing and prostitution to pay for legal drugs as illegal ones. The fundamental assumption behind legalization is that people are rational actors and can make their own decisions. As a general proposition, I believe that. But what people forget is that drug addiction makes people irrational. If you think more addicts are worth it in the name of freedom, fine. Just be prepared to accept that the costs of such freedom are felt very close to home.

Source: http://www.nationalreview.com/article/453304/opioid-crisis-legalization-not-solution

 

Filed under: Addiction,Global Drug Legalisation Efforts,Heroin/Methadone,Political Sector,USA :

St. Petersburg, FL – Thursday, August 31, 2017 – Drug Free America Foundation today introduced a first-of-its-kind Opioid Tool Kit in an effort to help address the opioid epidemic gripping the United States.

The Opioid Tool Kit was unveiled in conjunction with International Overdose Awareness Day, a global event held on August 31st each year that aims to raise the awareness of the problem of drug overdose-related deaths.

“With more than 142 people dying each day, drug overdoses are now the leading cause of death for Americans under the age of 50,” according to Calvina Fay, Executive Director of Drug Free America Foundation. “Moreover, deaths from drug overdose are an equal opportunity killer, with no regard to race, religion or economic class,” she said.

“While alcohol and marijuana still remain the most common drugs of abuse, the nonmedical use of prescription painkillers and other opioids has resulted in a crisis-level spike in drug overdose deaths,” said Fay.

The Opioid Tool Kit has been designed to educate people about the opioid epidemic and offer strategies that can be used to address this crisis. “The Tool Kit is also intended to encourage collaboration with different community sectors and stakeholders to make successful and lasting change,” Fay continued.

The Opioid Tool Kit is a comprehensive guide that defines what an opioid is, examines the scope of the problem, and addresses why opioids are a continuing health problem.  The Tool Kit also provides strategies for the prevention of prescription drug misuse and overdose deaths and includes a community advocacy and action plan, as well as additional resources.

Fay emphasized that the best way to prevent opioid and other drug addiction is not to abuse drugs in the first place.  “The chilling reality is that the long-term use and abuse of opioids and other addictive drugs rewire the brain, making recovery a difficult and often a life-long struggle,” she concluded. The Opioid Tool Kit can be found on Drug Free America Foundation’s website at https://dfaf.org/Opioid%20Toolkit.pdf.

Source:   https://dfaf.org/Opioid%20Toolkit.pdf..  August 2017

Filed under: Addiction,Health,Heroin/Methadone,Treatment and Addiction,USA :

Just a few miles from where President Trump will address his blue-collar base here Tuesday night, exactly the kind of middle-class factory jobs he has vowed to bring back from overseas are going begging.

It’s not that local workers lack the skills for these positions, many of which do not even require a high school diploma but pay $15 to $25 an hour and offer full benefits. Rather, the problem is that too many applicants — nearly half, in some cases — fail a drug test.

The fallout is not limited to the workers or their immediate families. Each quarter, Columbiana Boiler, a local company, forgoes roughly $200,000 worth of orders for its galvanized containers and kettles because of the manpower shortage, it says, with foreign rivals picking up the slack.

“Our main competitor in Germany can get things done more quickly because they have a better labor pool,” said Michael J. Sherwin, chief executive of the 123-year-old manufacturer. “We are always looking for people and have standard ads at all times, but at least 25 percent fail the drug tests.”

Source:   https://mobile.nytimes.com/2017/07/24/business/economy/drug-test-labor-hiring.html

Filed under: Addiction,Economic,USA :

In his last article for Pro Talk, Renaming and Rethinking Drug Treatment, psychologist Robert Schwebel, Ph.D., author and developer of The Seven Challenges program, expressed his views about problems in typical drug and alcohol treatment. In this interview, he focuses on changes that he thinks would better meet the needs of individuals with substance problems.

The Seven Challenges Program

The Seven Challenges is described as “a comprehensive counselling program for teens and young adults that incorporates work on alcohol and other drug problems.” The program addresses much more than substance issues because it also helps young people develop better life skills, as well as manage their situational and psychological problems. Although there is an established structure for each session and a framework for decision-making (see website for the youth version of “The Seven Challenges”), it is not pre-scripted as in many traditional programs. Rather it is “exceptionally flexible, in response to the immediate needs of the clients.”

Independent studies funded by The Center for Substance Abuse Treatment and published in peer-reviewed journals have provided evidence that The Seven Challenges significantly decreases substance use of adolescents and greatly improves their overall mental health status. The program has been shown to be especially effective for the many young people with drug problems who also have trauma issues.

Just recently, a new version of The Seven Challenges program was introduced for adults and is being piloted in a research project. Soon, a book geared toward the general public by Dr. Schwebel that incorporates much of the philosophy of the program, as well as many of the decision-making and behavior change strategies, will be available.

Q&A: What Should Treatment Look Like?

Q: In your last article for Pro Talk, you argued strongly against the word “treatment” and suggested that we use the word “counselling” instead. Will you reiterate why you prefer using “counselling” when talking about professional help for people with substance problems?

Dr. S.: Counselling is an active and interactive process that’s responsive to the needs of individuals. It may include education, but it’s more than that because the information is personalized and offered in the context of a discussion about what’s happening in a person’s life. Effective counsellors help clients become aware of their options, expand those options, and make their own informed choices.

Treatment, on the other hand, sounds like something imposed and passive that an authority (say a doctor) does to someone else or tells them to do. It also implies recipients receive a standardized protocol or regime with a preconceived goal, usually abstinence when we’re talking about addiction. It doesn’t suggest autonomy of choice or collaboration.

 

Q: You stress the importance of choice and collaboration, suggesting both are important in addiction counselling. Please tell us more.

Dr. S.: In collaborative counselling that allows choices, clients get to identify the issues they want to work on. They make the decisions. We make it clear that we’re not there to make them quit using drugs…and couldn’t even if we tried. We tell them, “We’re here to support you in working on your issues, things that are important to you; things that are not going well in your life or as well you would like them to be going.”

We also support clients in decision-making about drugs. They set their own goals about using. One person might want to quit using, while another might want to set new limits. For those who want to change their drug use behavior, we check in with them about how they’re doing regarding their decision on a session-by-session basis. If they have setbacks, we’ll provide individualized support to help them figure out why, We’re not doubting them or trying to “catch” them. Rather, we’re helping them succeed with their own decisions to change. This type of check-in would not apply to individuals who have not yet decided to make changes.

 

Q: Many addiction programs feel that dealing with addiction should be the first priority and that other issues are secondary. What are your thoughts about this?

Dr. S.: I’ll start by saying that they have equal importance. Drug problems have everything to do with what is going on in a person’s life. And, a person’s life is very much affected by drug problems. I do want to say, however, that not everyone who winds up in an addiction program has an addiction. That’s a ridiculous generalization. They may be having problems with binge drinking, issues with family or jobs because of substance misuse, or legal problems because they were unlucky and got caught. (For instance they got arrested for another crime and tested positive for drugs.) They often wind up in places that require abstinence and wonder, “What am I doing here?” Then they’re told they’re “in denial.”

Traditional treatment tends to focus narrowly on drug problems, usually pushing an agenda of immediate abstinence. However, drug problems – whether or not they qualify as “addiction,” are very much connected to the rest of life. Therefore, clients need comprehensive counselling that addresses what’s happening in their overall lives and helps clients make their lives better. So it’s not all about use of substances and making the individual quit. The goal is to support clients and to help them make their own decisions about life and substance use.

We use the term “issues” – not “problems.” Whatever is most important to the individual that day is what we work on. A client might say, “I have an issue with my mother.” We don’t just want to have a discussion about the issue; we want to set a session goal so that a client gets practical help with an issue each time. Ideally we try to facilitate a next step, some sort of action that can be taken between sessions. We want to support our clients in making their own lives better. We like to reassure clients that we won’t be harping on drugs all the time: At least half of what we do is about everything else besides drugs. This means that counsellors need to know how to help people with their other problems. Unfortunately, many have a narrow background in drug treatment and don’t yet know how to do that.

 

Q: How do you address the issue of “powerlessness” which a number of young people have told me they struggled with in12-step treatment programs they’ve attended? Don’t adolescents by nature resist anything that threatens to take away their autonomy?

Dr. S.: One of our main messages is “You are powerful; people do take control over their drug use. You have that power within you.” We also say, “You don’t need to do it alone. You are entitled to support. We’re behind you. We’re not saying it’s easy and

there won’t be setbacks along the way. If there are, we’ll help you figure out why and how to handle it differently the next time. At the same time we’ll help you with other issues in your life so you’ll have less need for drugs.”

I think there is great harm in the all-or-nothing approach to drug and alcohol problems and that more people would come for help if they were not told that they’re powerless. Also, many more would come if they felt they could make a choice about drugs and did not expect to be coerced.

 

A New Version of The Seven Challenges

Following is the new adult version of Dr. Schwebel’s The Seven Challenges program:

· Challenging Yourself to Make Thoughtful Decisions About Your Life, Including Your Use of Alcohol and Other Drugs

· Challenging Yourself to Look at Your Responsibility and the Responsibility of Others for Your Problems

· Challenging Yourself to Look at What You Like About Alcohol and Other Drugs, and Why You Use Them

· Challenging Yourself to Honestly Look at Your Life, Including Your Use of Alcohol and Other Drugs

· Challenging Yourself to Look at Harm That Has Happened or Could Happen From Your Use of Alcohol and Other Drugs

· Challenging Yourself to Look at Where You Are Headed, Where You Would Like to Go, and What You Would Like to Accomplish

· Challenging Yourself to Take Action and Succeed With Your Decisions About Your Life and Use of Alcohol and Other Drugs

Source:  http://www.rehabs.com/pro-talk-articles/what-drug-and-alcohol-treatment-should-look-like-an-interview-with-dr-robert-schwebel/     17th July 2017

Filed under: Addiction,Addiction (Papers),Health,Treatment and Addiction,Youth :

Medication-assisted treatment is often called the gold standard of addiction care. But much of the country has resisted it.

If you ask Jordan Hansen why he changed his mind on medication-assisted treatment for opioid addiction, this is the bottom line.

Several years ago, Hansen was against the form of treatment. If you asked him back then what he thought about it, he would have told you that it’s ineffective — and even harmful — for drug users. Like other critics, to Hansen, medication-assisted treatment was nothing more than substituting one drug (say, heroin) with another (methadone).

Today, not only does Hansen think this form of treatment is effective, but he readily argues — as the scientific evidence overwhelmingly shows — that it’s the best form of treatment for opioid addiction. He believes this so strongly, in fact, that he now often leads training sessions for medication-assisted treatment across the country.

“It almost hurts to say it out loud now, but it’s the truth,” Hansen told me, describing his previous beliefs. “I was kind of absorbing the collective fear and ignorance from the culture at large within the recovery community.” Hansen is far from alone. Over the past few years, America’s harrowing opioid epidemic — now the deadliest drug overdose crisis in the country’s history — has led to a lot of rethinking about how to deal with addiction. For addiction treatment providers, that’s led to new debates about the merits of the abstinence-only model — many of which essentially consider addiction a failure of willpower — so long supported in the US.

The case for prescription heroin

The Hazelden Betty Ford Foundation, which Hansen works for, exemplifies the debate. As one of the top drug treatment providers in the country, it used to subscribe almost exclusively to the abstinence-only model, based on an interpretation of the 12 steps of Alcoholics Anonymous and Narcotics Anonymous popularized in American addiction treatment in the past several decades. But in 2012, Hazelden announced a big switch: It would provide medication-assisted treatment.

“This is a huge shift for our culture and organization,” Marvin Seppala, chief medical officer of Hazelden, said at the time. “We believe it’s the responsible thing to do.”

From the outside, this might seem like a bizarre debate: Okay, so addiction treatment providers are supporting a form of treatment that has a lot of evidence behind it. So what?

But the growing embrace of medication-assisted treatment is demonstrative of how the opioid epidemic is forcing the country to take another look at its inadequate drug treatment system. With so many people dying from drug overdoses — tens of thousands a year — and hundreds of thousands more expected to die in the next decade, America is finally considering how its response to addiction can be better rooted in science instead of the moralistic stigmatization that’s existed for so long.

The problem is that the moralistic stigmatization is still fairly entrenched in how the US thinks about addiction. But the embrace of medication-assisted treatment shows that may be finally changing — and America may be finally looking at addiction as a medical condition instead of a moral failure.

The research is clear: Medication-assisted treatment works

One of the reasons opioid addiction is so powerful is that users feel like they must keep using the drugs in order to stave off withdrawal. Once a person’s body grows used to opioids but doesn’t get enough of the drugs to satisfy what it’s used to, withdrawal can pop up, causing, among other symptoms, severe nausea and full-body aches. So to avoid suffering through it, drug users often seek out drugs like heroin and opioid painkillers — not necessarily to get a euphoric high, but to feel normal and avoid withdrawal. (In the heroin world, this is often referred to as “getting straight.”)

Medications like methadone and buprenorphine (also known as Suboxone) can stop this cycle. Since they are opioids themselves, they can fulfil a person’s cravings and stop withdrawal symptoms. The key is that they do this in a safe medical setting, and when taken as prescribed do not produce the euphoric high that opioids do when they are misused. By doing this, an opioid user significantly reduces the risk of relapse, since he doesn’t have to worry about avoiding withdrawal anymore. Users can take this for the rest of their lives, or in some cases, doses may be reduced; it varies from patient to patient.

The research backs this up: Various studies, including systemic reviews of the research, have found that medication-assisted treatment can cut the all-cause mortality rate among addiction patients by half or more. Just imagine if a medication came out for any other disease — and, yes, health experts consider addiction a disease — that cuts mortality by half; it would be a momentous discovery.

“That is shown repeatedly,” Maia Szalavitz, a long time addiction journalist and author of Unbroken Brain: A Revolutionary New Way of Understanding Addiction, told me. “There’s so much data from so many different places that if you add methadone or Suboxone in, deaths go down, and if you take it away, deaths go up.” That’s why the biggest public health organizations — including the Centers for Disease Control and Prevention, the National Institute on Drug Abuse, and the World Health Organization — all acknowledge medication-assisted treatment’s medical value. And experts often describe it to me as “the gold standard” for opioid addiction care.

The data is what drove Hansen’s change in perspective. “If I wanted to view myself as an ethical practitioner and doing the best that I could for the people I served, I needed to make this change based on the overwhelming evidence,” he said. “And I needed to separate that from my personal recovery experience.”

Medication-assisted treatment is different from traditional forms of dealing with addiction in America, which tend to demand abstinence. The standards in this field are 12-step programs, which combine spiritual and moralistic ideals into a support group for people suffering from addiction. While some 12-step programs allow medication-assisted treatment, others prohibit it as part of their demand for total abstinence. The research shows this is a particularly bad idea for opioids, for which medications are considered the standard of care.

There are different kinds of medications for opioids, which will work better or worse depending on a patient’s circumstances. Methadone, for example, is only administered in a clinic, typically one to four times a day — but that means patients will have to make the trip to a clinic on a fairly regular basis. Buprenorphine is a take-home drug that’s taken once or twice a day, but the at-home access also means it might be easier to misuse and divert to the black market.

One rising medication, known as naltrexone or its brand name Vivitrol, isn’t an opioid — making it less prone to misuse — and only needs to be injected once a month. But it doesn’t work in the same way as methadone or buprenorphine. It requires full detoxification to use (usually three to 10 days of no opioid use), while buprenorphine, for example, only requires a partial detoxification process (usually 12 hours to two days). And instead of preventing withdrawal — indeed, the detox process requires going through withdrawal — it blocks the effects of opioids up to certain doses, making it much harder to get high or overdose on the drugs. It’s also relatively new, so there’s less evidence for its real-world effectiveness.

One catch is that even these medications, though the best forms of opioid treatment, do not work for as much as 40 percent of opioid users. Some patients may prefer not to take any medications because they see any drug use whatsoever as getting in the way of their recovery, in which case total abstinence may be the right answer for them. Others may not respond well physically to the medications, or the medications may for whatever reason fail to keep them from misusing drugs.

This isn’t atypical in medicine. What works for some people, even the majority, isn’t always going to work for everyone. So these are really first-line treatments, but in some cases patients may need alternative therapies if medication-assisted treatment doesn’t work. (That might even involve prescription heroin — which, while it’s perhaps counterintuitive, the research shows it works to mitigate the problems of addiction when provided in tightly controlled, supervised medical settings.)

Medication can also be paired with other kinds of treatment to better results. It can be used in tandem with cognitive behavioral therapy or similar approaches, which teach drug users how to deal with problems or settings that can lead to relapse. All of that can also be paired with 12-step programs like AA and NA or other support groups in which people work together and hold each other accountable in the fight against addiction. It all varies from patient to patient.

It is substituting one drug for another, but that’s okay

The main criticism of medication-assisted treatment is that it’s merely replacing one drug with another. Health and Human Services Secretary Tom Price recently echoed this criticism, saying, “If we’re just substituting one opioid for another, we’re not moving the dial much. Folks need to be cured so they can be productive members of society and realize their dreams.” (A spokesperson for Price later walked back the statement, saying Price supports all kinds of drug treatment.)

On its face, this argument is true. Medication-assisted treatment is replacing one drug, whether it’s opioid painkillers or heroin, with another, such as methadone or buprenorphine.

But this isn’t by itself a bad thing. Under the Diagnostic and Statistical Manual of Mental Disorders, it’s not enough for someone to be using or even physically dependent on drugs to qualify for a substance use disorder, the technical name for addiction. After all, most US adults use drugs — some every day or multiple times a day — without any problems whatsoever. Just think about that next time you sip a beer, glass of wine, coffee, tea, or any other beverage with alcohol or caffeine in it, or any time you use a drug to treat a medical condition.

The qualification for a substance use disorder is that someone is using drugs in a dangerous or risky manner, putting himself or others in danger. So someone with a substance use disorder would not just be using opioids but potentially using these drugs in a way that puts him in danger — perhaps by feeling the need to commit crimes to obtain the drugs or using the drugs so much that he puts himself at risk of overdose and inhibits his day-to-day functioning. Basically, the drug use has to hinder someone from being a healthy, functioning member of society to qualify as addiction.

The key with medication-assisted treatment is that while it does involve continued drug use, it turns that drug use into a much safer habit. So instead of stealing to get heroin or using painkillers so much that he puts his life at risk, a patient on medication-assisted treatment can simply use methadone or buprenorphine to meet his physical cravings and otherwise go about his day — going to school, work, or any other obligations.

Yet this myth of the dangers of medication-assisted treatment remains prevalent — to deadly results.

In 2013, Judge Frank Gulotta Jr. in New York ordered an opioid user arrested for drugs, Robert Lepolszki, off methadone treatment, which he began after his arrest. In January 2014, Lepolszki died of a drug overdose at 28 years old — a direct result, Lepolszki’s parents say, of failing to get the medicine he needed. In his defense,  Gulotta has continued to argue that methadone programs “are crutches — they are substitutes for drugs and drug cravings without enabling the participant to actually rid him or herself of the addiction.”

This is just one case, but it shows the real risk of denying opioid users medication: It can literally get them killed by depriving them of lifesaving medical care.

The myth is also a big reason why there are still restrictions on medication-assisted treatment. For example, the federal government still caps how many patients doctors can prescribe buprenorphine to, with strict rules about raising the cap. This limits how accessible the treatment is. A Huff Post analysis found that even if every doctor who can prescribe buprenorphine did so at the maximum rate in 2012, more than half of Americans with opioid use disorders could not get the medication. That’s on top of barriers to addiction treatment in general. According to a 2016 report by the surgeon general, just 10 percent of Americans with a drug use disorder obtain specialty treatment. The report attributed the low rate to severe shortages in the supply of care, with some areas of the country, particularly rural counties, lacking affordable options for treatment — which can lead to waiting periods of weeks or even months. Only recently has there been a broader push to fix this gap in care.

The medications used in treatment do carry some risks

None of this is to say that the medications used in these treatments are without any problems whatsoever. Methadone is tied to thousands of deadly overdoses a year, although almost entirely when it’s used for pain, not addiction, treatment — since it’s much more regulated in addiction care. Buprenorphine is safer in that, unlike common painkillers, heroin, and methadone, its effect has a ceiling — meaning it has no significant effect after a certain dose level. But it’s still possible to misuse, particularly for people with lower tolerance levels. And there are some reports of buprenorphine mills, where patients can get buprenorphine for misuse from unscrupulous doctors — similar to how pill mills popped up during the beginning of the opioid epidemic and provided patients easy access to painkillers.

Naltrexone, meanwhile, can heighten the risk of overdose and death in case of full relapse. Overdose and death are risks in any case of relapse, but they’re particularly acute for naltrexone because it requires a full detox process that eliminates prior tolerance. (Although this would typically require someone to stop taking naltrexone, since otherwise it blocks the effects of opioids up to certain doses.)

But when taken as prescribed, the medications are broadly safe and effective for addiction treatment. For regulators, it’s a matter of making sure the drugs aren’t diverted into misuse, while also providing good access to people who genuinely need them.

The fight over medication-assisted treatment is really about how we see addiction

Behind the arguments about medication-assisted treatment is a simple reality of how Americans view addiction: Many still don’t see it, as public health officials and experts do, as a disease.

With other diseases, there is no question that medication can be a legitimate answer. That medication is not viewed as a proper answer by many to addiction shows that people believe addiction is unique in some way — particularly, they view addiction as at least partly a moral failing instead of just a disease.

I get emails all the time to this effect. Here, for example, is a fairly representative reader message: “Darwin’s Theory says ‘survival of the fittest.’ Let these lost souls pay the price of their criminal choices and criminal actions. Society does not owe them multiple medical resuscitations from their own bad judgment, criminal activity, and self-inflicted wounds.”

This contradicts what addiction experts broadly agree on. As Stanford psychiatrist and Drug Dealer, MD author Anna Lembke put it, “If you see somebody who continues to use despite their lives being totally destroyed — losing their jobs, losing loved ones, ending up in jail — nobody would choose that. Nobody anywhere would ever choose that life. So clearly it is beyond this individual’s control on some level.”

Many Americans may understand this with, say, depression and anxiety. We know that people with these types of mental health problems are not in full control of their thoughts and emotions. But many don’t realize that addiction functions in a similar way — only that the thoughts and emotions drive someone to seek out drugs at just about any cost.

Some of the sentiment against medications, as Hansen can testify, is propagated by people suffering from addiction. Some of them believe that any drug use, even to treat addiction, goes against the goal of full sobriety. They may believe that if they got sober without medications, perhaps others should too. Many of them also don’t trust the health care system: If they got addicted to drugs because a doctor prescribed them opioid painkillers, they have a good reason to distrust doctors who are now trying to get them to take another medication — this time for their addiction.

The opioid epidemic, however, has gotten a lot of people in the addiction recovery world to reconsider their past beliefs. Funeral after funeral and awful statistic after awful statistic, there is a sense that there has to be a better way — and by looking at the evidence, many have come to support medication-assisted treatment.

“I remember sitting there,” Hansen said, speaking to his experience at a funeral, as a mother sang her dead son a lullaby, “thinking that we have to do better.”

Source:  German Lopez@germanrlopezgerman.lopez@vox.com  Jul 20, 2017

 

Filed under: Addiction,Addiction (Papers),Heroin/Methadone,Treatment and Addiction :

Medical Illness Model:

Near the end of the Second World War researchers and leaders in the recovery community jointly formulated the problem of uncontrolled drinking into what is now known as the Disease Model of alcoholism. This model postulates that, like medical illnesses, alcoholism–more specifically alcohol dependence, or addiction—can be diagnosed, its course observed, and its physical causes understood.

Further, scientific trials can be undertaken to identify the best treatments for those who suffer from it. The diagnosis of Alcohol Dependence, in this model, rested on four symptoms: 1) a tolerance to alcohol in which a person needs to drink ever greater amounts to reach a desired effect, 2) withdrawal symptoms, such as “the shakes” and others, on stopping use, 3) the Loss of Control phenomenon in which affected persons lose the ability to control how much they drink at a sitting and thereby can no longer predict how much they will drink from one episode to the next, and 4) social or physical impairment resulting from combinations of the first three symptom categories1.

This model pictures a condition from which many alcohol dependent people emerge every year, and into which many others return. View as a disease, alcoholism takes on the characteristics of a remitting-relapsing illness with primary symptoms that direct us to brain functioning. And, because ethyl alcohol is a very small molecule with easy access to most parts of the body, moderate to heavy alcohol use often injures other organs, such as the liver and heart among others.

Uncontrolled, or dependent, alcohol use also affects the social network setting of family as well as work activities, friendships, and legal involvement. Last, however, the Disease model brings with it the possibilities of treatment and of hope. At this date, effective medicinal agents against alcoholism are very few. But hope, that necessary ingredient for recovery, waxes strong in the illness model. In the words of the alcoholic patient quoted in the Part 2, “It is much easier to think of myself as an ill person working to become well, rather than a bad person trying to become good.”

Genetic Models:

From the Disease model has come another, that of genetic influence. The observation that alcoholism often runs in families for many years meant that family cultures or mores determined who would become alcoholic and who would not. While it is clear that cultural and family life influences are very powerful, more recent studies have noted that an underlying genetic disposition may be at play in some genealogical lines2. If so, the evidence suggests a confluence of many gene effects rather than the dominant/recessive results of inheritance in Mendelian models of genetic death, as for example, in Huntington’s Disease.

Instead, the gene effects seem to have more to do with the vulnerability towards alcoholism. One form appears in those who have a genetically-based insensitivity to alcohol—an “inborn tolerance,” and develop alcohol dependence at much higher rates than alcohol sensitive comparison groups. Another form may require a combination of

gene influences and environment conditions to come together to result in alcohol-plus-multiple drug dependence, sometimes referred to as Type 2 or Type B alcoholics.

Unexpectedly, the news of gene involvement was greeted with enthusiasm among some quarters of the actively drinking alcoholic public: “Since alcoholism is genetic, we can’t escape our genes and may as well keep drinking.” As with older models however, the element of choice remains present in the sober periods between drinking episodes. As some of the other models suggest, healing from alcoholism remains an individual process.

Psychological Adaptation Models in Illness and Recovery:

Further modern research asks that we look at individuals and their abilities to adapt to the stresses of life. Careful observation has established that individual humans have the ability to adapt creatively to the painful thoughts and feelings of living and to do so in ways that connect us together rather than drive us apart3. This model of Mature human psychological adaptation, however, emphasizes that the brain function at its healthy best. Heavy, continuous use of alcohol carries often subtle, if severe, effects on the brain that are as yet poorly understood.

But we know they exist because of their effects in driving down the ability to adapt, from psychological Maturity to much more rigid Primitive mechanisms of coping, such as when an alcoholic “denies” that an obvious problem exists at all. This kind of Denial can occur in the actively drinking alcoholic who understands that resolving his or her ambivalence toward drinking is too painful to contemplate; therefore, a failure to perceive the problem seems preferable than facing it.

So it is that the Adaptation model views the First of the Twelve Steps as addressing primitive Denial in coming to recognize that the individual’s alcoholism exists. Progressing along the continuum of the Steps leads finally to the Twelfth: helping others who have the same problem. In the Psychological Adaptation model, this exemplifies the Mature mechanism of Altruism: selflessly helping others. The occurrence of brain healing as abstinence continues—along with the progression towards psychological maturity, whether viewed in the Psychological Adaptation or the Twelve Step models—suggests that brain recovery process are at work. We can only recognize their existence at this point, and need to understand their biology if we are to improve treatments in the Disease model.

Many Models, More Questions:

With this overview of the different model formulations of the problem of alcoholism and what to do about it, we are now ready to look as specific questions from a scientific point of view. As this series unfolds, we will have recourse to use all of the models mentioned—now adding the crucial ingredient of evidence, systematically gathered. In future Updates, the discussion will focus on specific problems and what we can learn about them.

Source:  https://www.ncadd.org/blogs/research-update/models-of-alcoholism-medical-physiological-causes  14th Jan. 2014

Filed under: Addiction,Addiction (Papers),Alcohol,Brain and Behaviour :

Blue Cross Blue Shield issued a report on the opioid crisis with their data from all members in their commercial plans.  Early in the document, they report a pair of striking numbers.

First, that 21% of members filled a prescription for an opioid in 2015. I’ve heard these kinds of numbers before, but I never get numb. That’s 1 in 5 members, despite growing attention to excessive prescribing of opioids.

Second, a 493% increase in diagnosis of opioid use disorders over 7 years. My reaction is that this has to reflect changes in coding or diagnostic practices rather than the population. It’s implausible that there was an increase this large in the number of people with an opioid use disorder.

The document then devotes a great deal of attention to opioid prescribing.

Toward the end, there are a couple of graphics that caught my attention.

First, a map showing rates of opioid use disorders.

 

Then, this:

Though critical to treating opioid use disorder, the use of medication-assisted treatments (e.g., methadone) does not always track with rates of opioid use disorder (compare Exhibits 10 and 11). For example, New England leads the nation in use of medication-assisted treatments but it has lower levels of opioid use disorder than other parts of the country

 

So . . . they note that New England has average rates of opioid use disorders, yet they have high rates of utilization of medication-assisted treatment. This caught my attention because New England has higher rates of overdose, as depicted in the CDC graphics below.

Number and age-adjusted rates of drug overdose deaths by state, US 2015

 

Statistically significant drug overdose death rate increase from 2014 to 2015, US states

(It’s worth noting that BCBS is not among the top 3 insurers in Maine or New Hampshire, but they are the biggest in Massachusetts and Vermont.)

It begs questions about what the story is, doesn’t it?

I don’t presume to know the answers.

§ What was the sequence of events for the high OD rates and the utilization of MAT? And, what impact, if any, has the expansion of MAT had on overdose rates?

§ Is the BCBS data representative? (This brand new SAMHSA report suggest that the data about use is representative.)

§ We know that opioid maintenance meds reduce risk of OD, but we also know that people stop taking these meds at high rates. Does this imply that, in the real world, these meds end up providing less OD protection than hoped?

§ What are the policies and practices of the other insurers in the state?  (For example, we know that Anthem [the largest insurer in Maine and Vermont] recently ended prior authorization requirements for MAT. It’s not clear how restrictive they had been. They also are attempting to institute reformsto address the fact that, “only about 16 to 19 percent of the members taking the medications for opioid use disorder also were getting the recommended in-person counseling.”)

§ Are there regional differences in drug potency that explain this?

Let’s hope that more insurers follow suit and share their data.

Source:   https://addictionandrecoverynews.wordpress.com/2017/07/16/blue-cross-blue-shield-publishes-major-opioid-report/

Filed under: Addiction,Addiction (Papers),Heroin/Methadone,USA :

A study by researchers from the Murdoch Children’s Research Institute (MCRI) that followed a sample of almost 2000 Victorian school children from the age of 14 until the age of 35 found that social disadvantage, anxiety, and licit and illicit substance use (in particular cannabis), were all more common in participants who had reported self-harm during adolescence.

The longitudinal study, the Victorian Adolescent Health Cohort Study, was the first in the world to document health-related outcomes in people in their 30s who had self-harmed during their adolescence. Until now, very little has been known about the longer-term health and social outcomes of adolescents who self-harm.

Published in the new Lancet Child and Adolescent Health journal, the study found the following common elements:

· People who self-harmed as teenagers were more than twice as likely to be weekly cannabis users at age 35

· Anxiety, drug use, and social disadvantage were more common at age 35 among participants who had self-harmed during their teenage years. While most of these associations can be explained by things like mental health problems during adolescence and substance use during adolescence, adolescent self-harm was strongly and independently associated with using cannabis on a weekly basis at age 35 years

· Self-harm during the adolescent years is a marker for distress and not just a ‘passing phase’

The findings suggest that adolescents who self-harm are more likely to experience a wide range of psychosocial problems later in life, said the study’s lead author, Dr Rohan Borschmann from MCRI. “Adolescent self-harm should be viewed as a conspicuous marker of emotional and behavioural problems that are associated with poor life outcomes,” Dr Borschmann said.

The study found that anxiety, drug use, and social disadvantage were more common at age 35 among participants who had self-harmed during their teenage years. “While most of this can be explained partly by things like mental healthduring adolescence and substance use during adolescence, adolescent self-harm was strongly and independently associated with using cannabis on a weekly basis at age 35 years,” Dr Borschmann said.

Interventions during adolescence which address multiple risk-taking behaviours are likely to be more successful in helping this vulnerable group adjust to adult life.

More information: Rohan Borschmann et al. 20-year outcomes in adolescents who self-harm: a population-based cohort study, The Lancet Child & Adolescent Health (2017). DOI: 10.1016/S2352-4642(17)30007-X

Source:  https://medicalxpress.com/news/2017-07-twenty-year-outcomes-adolescents-self-harm-substance.htm

Filed under: Addiction,Australia,Brain and Behaviour,Health,Social Affairs,Youth :

Residential treatment has received a lot of criticism and scepticism over the last several years, especially for opioid use disorders. (Some of it is deserved. Too many providers are hustlers and others provide little more than detox with inadequate follow-up. Of course, many of the same criticisms have been directed at medication-assisted treatment. But, that’s not what this post is about.)

At any rate, the Recovery Research Institute recently posted about a study looking at completion rates for outpatient and residential treatment.   The study looked at A LOT of treatment admissions, 318,924.  Residential completion rates appear to have surprised a lot of people:

Results: Residential programs reported a 65% completion rate compared to 52% for outpatient settings. After controlling for other confounding factors, clients in residential treatment were nearly three times as likely as clients in outpatient treatment to complete treatment.

But, what really surprised some readers was this:

Compared to clients with a primary alcohol use disorder:
Clients with marijuana use disorder were only 74% as likely to complete residential treatment.
Clients with an opioid use disorder were 1.29x MORE likely to complete residential treatment.

So opioid users were much more likely to benefit from residential treatment compared to alcohol users. . . .

We speculate that for opioid abusers, the increased structure and cloistering of residential treatment provide some protection from the environmental and social triggers for relapse or that otherwise lead to the termination of treatment that outpatient treatment settings do not afford. Indeed, environmental risk characteristics in drug abusers’ residential neighbourhoods, such as the presence of liquor stores and indicators of concentrated disadvantage at the neighbourhood level, have been found to be associated with treatment non-continuity and relapse.

Such environmental triggers may play a particularly substantial role for those addicted to opioids compared to those seeking treatment for marijuana abuse. Since opioid users have the lowest raw completion rates in general, this finding that residential treatment makes a greater positive difference for opioid users than it does for any of the other substances represents an important result that merits further investigation. Given the current epidemic of opioid-related overdoses in the U.S., our results suggest that greater use of residential treatment should be explored for opioid users in particular.

For the differences between residential and outpatient, they say the following:

In general, residential treatment completion rates are usually higher compared to outpatient settings, but what is particularly noteworthy is that even after controlling for various client characteristics and state level variations, the likelihood of treatment completion for residential programs was still nearly three times as great as for outpatient settings. Given the more highly structured nature and intensity of services of residential programs compared to outpatient treatment, it is understandable that residential treatment completion rates would be higher. It requires far less effort to end treatment prematurely in outpatient settings com-pared to residential treatment.

Given the strong association between treatment completion and positive post-treatment outcomes such as long term abstinence, the large magnitude of difference between outpatient and residential treatment represents a potentially important consideration for the choice of treatment setting for clients.

Source:  https://addictionandrecoverynews.wordpress.com/2017/07/13/opioid-users-complete-residential-at-higher-rates

Filed under: Addiction,Alcohol,Health,Heroin/Methadone,Treatment and Addiction :

Smart Approaches to Marijuana’s 2017 publication references academic studies which suggest that marijuana primes the brain for other types of drug usage.  Here’s the summary on that subject from page 4, Marijuana and Other Drugs: A Link We Can’t Ignore :

MORE THAN FOUR in 10 people who ever use marijuana will go on to use other illicit drugs, per a large, nationally representative sample of U.S. adults.(1) The CDC also says that marijuana users are three times more likely to become addicted to heroin.(2)

Although 92% of heroin users first used marijuana before going to heroin, less than half used painkillers before going to heroin.

And according to the seminal 2017 National Academy of Sciences report, “There is moderate evidence of a statistical association between cannabis use and the development of substance dependence and/or a substance abuse disorder for substances including alcohol, tobacco, and other illicit drugs.”(3)

RECENT STUDIES WITH animals also indicate that marijuana use is connected to use and abuse of other drugs. A 2007 Journal of Neuropsychopharmacology study found that rats given THC later self -administered heroin as adults, and increased their heroin usage, while those rats that had not been treated with THC maintained a steady level of heroin intake.(4) Another 2014 study found that adolescent THC exposure in rats seemed to change the rodents’ brains, as they subsequently displayed “heroin-seeking” behaviour. Youth marijuana use could thus lead to “increased vulnerability to drug relapse in adulthood.”(5)

National Institutes of Health Report

The National Institutes of Health says that research in this area is “consistent with animal experiments showing THC’s ability to ‘prime’ the brain for enhanced responses to other drugs. For example, rats previously administered THC show heightened behavioral response not only when further exposed to THC, but also when exposed to other drugs such as morphine—a phenomenon called cross-sensitization.”(6)

Suggestions that one addictive substance replaces another ignores the problem of polysubstance abuse, the common addiction of today.

Additionally, the majority of studies find that marijuana users are often polysubstance users, despite a few studies finding limited evidence that some people substitute marijuana for opiate medication. That is, people generally do not substitute marijuana for other drugs. Indeed, the National Academy of Sciences report found that “with regard to opioids, cannabis use predicted continued opioid prescriptions 1 year after injury.  Finally, cannabis use was associated with reduced odds of achieving abstinence from alcohol, cocaine, or polysubstance use after inpatient hospitalization and treatment for substance use disorders” [emphasis added].(7)

Moreover, a three-year 2016 study of adults also found that marijuana compounds problems with alcohol. Those who reported marijuana use during the first wave of the survey were more likely than adults who did not use marijuana to develop an alcohol use disorder within three years.(8) Similarly, alcohol consumption in Colorado has increased slightly since legalization. (9)

Source:   http://www.poppot.org/2017/07/03/replacing-one-addiction-another-will-not-work/

Filed under: Addiction,Brain and Behaviour,Cannabis/Marijuana,Drug use-various effects :

INTRODUCTION

Drug addiction is a chronic and relapsing disease that often begins during adolescence.

Epidemiological evidence documents an association between marijuana use during adolescence and subsequent abuse of drugs such as heroin and cocaine (1, 2). While many factors including societal pressures, family, culture, and drug availability can contribute to this apparent `gateway’ association, little is known about the neurobiological basis underlying such potential vulnerability.

Of the neural substrates that have been investigated, the enkephalinergic opioid system is  consistently altered by developmental marijuana exposure (3–5), perhaps reflecting neuroanatomical interactions between cannabinoid receptor type 1 and the enkephalinergic system (6, 7).

Debates exist, however, regarding the relationship between proenkephalin (Penk) dysregulation and opiate susceptibility. We previously reported that adult rats exposed to Δ9-tetrahydrocannabinol (THC; primary psychoactive component of marijuana) during adolescence exhibit increased heroin self administration (SA) as well as increased expression of Penk, the gene encoding the opioid neuropeptide enkephalin, in the nucleus accumbens shell (NAcsh), a mesolimbic structure critically involved in reward-related behaviors (3).

Although these data suggest that increased NAcsh Penk expression and heroin SA behavior are independent consequences of adolescent THC exposure, they do not address a possible causal relationship between THCinduced  Penk upregulation in NAcsh and enhanced behavioral susceptibility to opiates.

Moreover, insights regarding the neurobiological mechanisms by which adolescent THC exposure maintains upregulation of Penk into adulthood remain unknown.

Here, we take advantage of viral-mediated gene transfer strategies to show that adulthood addiction-like behaviors induced by adolescent THC exposure are dependent on discrete regulation of NAcsh Penk gene expression. A number of recent studies have demonstrated an important role for histone methylation in the regulation of drug-induced behaviors and transcriptional plasticity, particularly alteration of repressive histone H3 lysine 9 (H3K9) methylation at NAc gene promotors (8, 9).

We report here that one mechanism by which adolescent THC exposure may mediate Penk upregulation in adult NAcsh is through reduction of H3K9 di- and trimethylation, a functional consequence of which may be decreased transcriptional repression of Penk.

ABSTRACT

Background

Marijuana use by teenagers often predates the use of harder drugs, but the neurobiological underpinnings of such vulnerability are unknown. Animal studies suggest enhanced heroin self-administration (SA) and dysregulation of the endogenous opioid system in the nucleus accumbens shell (NAcsh) of adults following adolescent Δ9-tetrahydrocannabinol (THC) exposure. However, a causal link between Penk expression and vulnerability to heroin has yet to be established.

Methods

To investigate the functional significance of NAcsh  Penk tone, selective viral mediated knockdown and overexpression of Penk was performed, followed by analysis of subsequent heroin SA behavior. To determine whether adolescent THC exposure was associated with chromatin alteration, we analyzed levels of histone H3 methylation in the NAcsh via ChIP atfive sites flanking the Penk gene transcription start site.

Results

Here, we show that regulation of the proenkephalin (Penk) opioid neuropeptide gene in NAcsh directly regulates heroin SA behavior. Selective viral-mediated knockdown of Penk in striatopallidal neurons attenuates heroin SA in adolescent THC-exposed rats, whereas Penk overexpression potentiates heroin SA in THC-naïve rats. Furthermore, we report that adolescent THC exposure mediates Penk upregulation through reduction of histone H3 lysine 9 (H3K9) methylation in the NAcsh, thereby disrupting the normal developmental pattern of H3K9 methylation.

Conclusions

These data establish a direct association between THC-induced NAcsh Penk upregulation and heroin SA and indicate that epigenetic dysregulation of Penk underlies the long term effects of THC.

Source:  Biol Psychiatry. 2012 November 15; 72(10): 803–810. doi:10.1016/j.biopsych.2012.04.026.

Filed under: Addiction,Addiction (Papers),Brain and Behaviour,Cannabis/Marijuana,Drug use-various effects on foetus, babies, children and youth :

Cannabis Use, Gender and the Brain

Cannabis is the most widely used illicit drug in the U.S. and, as a result of legalization efforts for both medical remedy and for recreational use, is now the second leading reason (behind alcohol) for admission to addiction treatment in the U.S. The health consequences, cognitive changes, academic performance and numerous neuroadaptations have been debated ad nauseam. Like other drugs and medications, effects are different if exposure occurs in the young vs. the old or in males vs. females. Exposure in utero, early childhood, adolescence-young adult, adult and elderly may have different effects on the brain and outcomes. Yet the best available independent research shows that marijuana use is associated with consistent regionally specific alterations to important brain circuitry in the striatum and pre-frontal and post orbital regions. In this study, Chye and colleagues have investigated the association between marijuana use and the size of specific brain regions that are vitally important in goal-directed behavior, focus and learning within in the orbitol frontal cortex (OFC) and caudate. This investigation suggests that marijuana dependence and recreational use have distinct and region-specific effects.

Why Does This Matter?

This is an important finding, but distinction between cannabis use, abuse and dependence is not always clear, objective, linear or well understood. However, dependence-related medial OFC volume reduction was robust and highly significant. Lateral OFC volume reduction was associated with monthly marijuana use. Greater reductions in brain volume of specific regions were stronger among females who were marijuana dependent. This finding correlates with previous evidence of gender-dependent differences towards the various physiological, behavioral and the reinforcing effect of marijuana for both recreational use and addiction.

The results highlight important neurological distinctions between occasional cannabis use and addiction. Specifically, Chye and colleagues found that smaller medial OFC volume may be driven by marijuana addiction-related mechanisms, while smaller lateral OFC volume may be due to ongoing exposure to cannabinoids. The results highlight a distinction between cannabis use and dependence and warrant future examination of gender-specific effects in studies of marijuana use and dependence.

Source: http://www.rivermendhealth.com/resources/cannabis-use-gender-brain/   June 2017  Author: Mark Gold, MD

Filed under: Addiction,Brain and Behaviour,Cannabis/Marijuana,Drug use-various effects,USA :

Author: Mark Gold, MD

Mortality resulting from opioid use (over 33,000 in 2015) is now epidemic in the U.S., exceeding drug-related deaths from all other intoxicants. Dr. Ted Cicero of Washington University, Dr. William Jacobs, Medical Director of Bluff Plantation, and I discussed the opioid over-prescribing and switch to heroin at DEA Headquarters on November 17, 2015. Things have gone from bad to worse. In a recent JAMA article (March 2017), Dr. Bertha Madras, Professor in the Department of Psychiatry at Harvard Medical School, offers compelling analysis and recommendations to rein in this crisis.

Physicians have increasingly prescribed opioids for pain since the AMA added pain as the “fifth vital sign,” which, like blood pressure, mandated assessment during each patient encounter. As a result of this and acceptance of low-quality evidence touting opioids as a relatively benign remedy for managing both acute and chronic pain, prescriptions for opioids have risen threefold over the past two decades.

Addiction, overdose and mortality resulting directly from opioid misuse increased rapidly. In addition, the influx of cheap heroin, often combined with homemade fentanyl analogues, became increasingly popular as prescription opioids became harder to attain and cost prohibitive on the streets. Consequently, a proportion of prescription opioid misusers transitioned to cheaper, stronger and more dangerous illicit opioids.

Opioid Mortality

The breakdown in mortality was confirmed by surveys (2015) revealing a disproportionate rise in deaths specifically attributable to: fentanyl/analogs (72.2%) and heroin (20.6%) compared with only prescription opioids, at less than eight percent. The unprecedented rise in overdose deaths and association with the heroin trade catalyzed the formation of federal and state policies to reduce supply and increase the availability of treatment and of a life saving opioid antagonist overdose medication Naloxone, a short-acting, mu 1, opioid receptor antagonist. Naloxone quickly reverses the effect of opioids and acute respiratory failure provoked by overdose.

Yet, according to Dr. Madras, the current federal and state response is woefully inadequate. She writes: “Of more than 14,000 drug treatment programs in the United States, some funded by federal block grants to states, many are not staffed with licensed medical practitioners. An integrated medical and behavioral treatment system, under the supervision of a physician and substance abuse specialist, would foster comprehensive services, provide expedient access to prescription medicines, and bring care into alignment with current medical standards of care.”

Why Does This Matter?

As baby boomers age and live longer, chronic non-cancer pain is highly prevalent. Opioids for legitimate non-cancer pain are not misused or abused by most patients under proper medical supervision. Yet there is no effective, practical means in this managed care climate whereby Primary Care Physicians (PCPs) can determine who is at risk for abuse and addiction and who is not. And frankly, addicts lie to their doctors to get opioids. Without proper training, physicians, who genuinely want to help their patients, get in over their heads and don’t know how to respond.

Further complicating the issue is that many of the affordable treatment programs do not employ medical providers who are trained and Board Certified in Addiction and Pain

Medicine, not to mention addiction psychiatry, or addiction medicine physicians. Thus the outcomes are dismal, which fosters doubt and mistrust of treatment.

Lastly, the lack of well-trained providers is due, in part, to the lack of training for medical doctors in addiction and behavioral medicine. At the University of Florida, we developed a mandatory rotation for all medical students in “the Division of Addiction Medicine.” We also started Addiction as a sub-specialty within psychiatry, where residents and post-doctoral fellows were immersed in both classroom and clinical training.

Since 1990, many other similar fellowship programs have started, yet few are training all medical students in the hands-on, two-week clerkship experience in Addiction Medicine like they have in obstetrics. We took this a step further when we developed a jointly run Pain and Addiction Medicine evaluation and treatment program which focused on prevention and non-opioid treatments. Many more are needed, as well as increased CME in addictive disease for physicians in any specialty.

Source:   http://www.rivermendhealth.com/resources/chronic-pain-opioid-use-consequences   June 2017

Filed under: Addiction,Health,Heroin/Methadone,USA :

One in 5 adolescents at risk of tobacco dependency, harmful alcohol consumption and illicit drug use

Researchers from the University of Bristol have found regular and occasional cannabis use as a teen is associated with a greater risk of other illicit drug taking in early adulthood.   The study by Bristol’s Population Health Science Institute, published online in the Journal of Epidemiology & Community Health, also found cannabis use was associated with harmful drinking and smoking.

Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), the researchers looked at levels of cannabis use during adolescence to determine whether these might predict other problematic substance misuse in early adulthood — by the age of 21.

The researchers looked at data about cannabis use among 5,315 teens between the ages of 13 and 18. At five time points approximately one year apart cannabis use was categorised as none; occasional (typically less than once a week); or frequent (typically once a week or more).

When the teens reached the age of 21, they were asked to say whether and how much they smoked and drank, and whether they had taken other illicit drugs during the previous three months. Some 462 reported recent illicit drug use: 176 (38%) had used cocaine; 278 (60%) had used ‘speed’ (amphetamines); 136 (30%) had used inhalants; 72 (16%) had used sedatives; 105 (23%) had used hallucinogens; and 25 (6%) had used opioids.

The study’s lead author, Dr Michelle Taylor from the School of Social and Community Medicine said:

“We tend to see clusters of different forms of substance misuse in adolescents and young people, and it has been argued that cannabis acts as a gateway to other drug use. However, historically the evidence has been inconsistent.

“I think the most important findings from this study are that one in five adolescents follow a pattern of occasional or regular cannabis use and that those individuals are more likely to be tobacco dependant, have harmful levels of alcohol consumption or use other illicit drugs in early adulthood.”

In all, complete data were available for 1571 people. Male sex, mother’s substance misuse and the child’s smoking, drinking, and behavioural problems before the age of 13 were all strongly associated with cannabis use during adolescence. Other potentially influential factors were also considered: housing tenure; mum’s education and number of children she had; her drinking and drug use; behavioural problems when the child was 11 and whether s/he had started smoking and/or drinking before the age of 13.

After taking account of other influential factors, those who used cannabis in their teens were at greater risk of problematic substance misuse by the age of 21 than those who didn’t.

Teens who regularly used cannabis were 37 times more likely to be nicotine dependent and three times more likely to have a harmful drinking pattern than non-users by the time they were 21. And they were 26 times more likely to use other illicit drugs.

Both those who used cannabis occasionally early in adolescence and those who starting using it much later during the teenage years had a heightened risk of nicotine dependence, harmful drinking, and other illicit drug use. And the more cannabis they used the greater was the likelihood of nicotine dependence by the age of 21.

This study used observational methods and therefore presents evidence for correlation but not does not determine clear cause and effect — whether the results observed are because cannabis use actually causes the use of other illicit drugs. Furthermore, it does not identify what the underlying mechanisms for this might be. Nevertheless, clear categories of use emerged.

Dr Taylor concludes:

“We have added further evidence that suggests adolescent cannabis use does predict later problematic substance use in early adulthood. From our study, we cannot say why this might be, and it is important that future research focuses on this question, as this will enable us to identify groups of individuals that might as risk and develop policy to advise people of the harms.

“Our study does not support or refute arguments for altering the legal status of cannabis use — especially since two of the outcomes are legal in the UK. This study and others do, however, lend support to public health strategies and interventions that aim to reduce cannabis exposure in young people.”

Journal Reference:

1. Michelle Taylor, Simon M Collin, Marcus R Munafò, John MacLeod, Matthew Hickman, Jon Heron. Patterns of cannabis use during adolescence and their association with harmful substance use behaviour: findings from a UK birth cohort. Journal of Epidemiology and Community Health, 2017; jech-2016-208503 DOI: 10.1136/jech-2016-208503

Source:   www.sciencedaily.com/releases/2017/06/170607222448<.htm>. 7 June 2017.

Filed under: Addiction,Addiction (Papers),Alcohol,Cannabis/Marijuana,Youth :

Study Finds Users Are 26 Times More Likely To Turn To Other Substances By The Age Of 21

Study is first clear evidence that cannabis is gateway to cocaine and heroin

Teen marijuana smokers are 37 times more likely to be hooked on nicotine

Findings from Bristol University provide authoritative support for those warning against the liberalisation of drugs laws

Teenagers who regularly smoke cannabis are 26 times more likely to turn to other drugs by the age of 21.

The study of the lives of more than 5,000 teenagers produced the first resounding evidence that cannabis is a gateway to cocaine, amphetamines, hallucinogens and heroin.

It also discovered that teenage cannabis smokers are 37 times more likely to be hooked on nicotine and three times more likely to be problem drinkers than non-users of the drug.

The findings from Bristol University provide authoritative support for those warning against the liberalisation of drugs laws.

Medical researchers have argued for years that cannabis is far from harmless and instead carries serious mental health risks.

Dr Michelle Taylor, who led the study, said: ‘It has been argued that cannabis acts as a gateway to other drug use. However, historically the evidence has been inconsistent.

‘The most important findings from this study are that one in five adolescents follow a pattern of occasional or regular cannabis use and that those individuals are more likely to be tobacco dependent, have harmful levels of alcohol consumption or use other illicit drugs in early adulthood.

‘Our study does not support or refute arguments for altering the legal status of cannabis use.

‘This study and others do, however, lend support to public health strategies and interventions that aim to reduce cannabis exposure in young people.’

The Bristol evidence was gathered from a long-term survey of the lives of young people around the city, the Avon Longitudinal Study of Parents and Children.

The survey, which was published in the Journal of Epidemiology & Community Health, examined 5,315 teenagers between the ages of 13 and 18. One in five used cannabis.

Dr Tom Freeman of King’s College London said: ‘This is a high quality study using a large UK cohort followed from birth. It provides further evidence that early exposure to cannabis is associated with subsequent use of other drugs.’

The study of the lives of more than 5,000 teenagers produced the first resounding evidence that cannabis is a gateway to cocaine amphetamines, hallucinogens and heroin .

Ian Hamilton, who is a mental health researcher at York University, said: ‘It adds to evidence that cannabis acts as a gateway to nicotine dependence, as the majority of people using cannabis in the UK combine tobacco with cannabis when they roll a joint.

‘This habit represents one of the greatest health risks to the greatest number of young people who use cannabis.  It suggests that adolescent cannabis use serves as a gateway to a harmful relationship with drugs as an adult.’

The report said: ‘After taking account of other influential factors, those who used cannabis in their teens were at greater risk of problematic substance misuse by the age of 21.

‘Teens who regularly used cannabis were 37 times more likely to be nicotine dependent and three times more likely to have a harmful drinking pattern than non-users by the time they were 21. And they were 26 times more likely to use other illicit drugs.

‘Both those who used cannabis occasionally early in adolescence and those who started using it much later during the teenage years had a heightened risk of nicotine dependence, harmful drinking, and other illicit drug use.

‘And the more cannabis they used the greater was the likelihood of nicotine dependence by the age of 21.’

Source:  http://www.dailymail.co.uk/news/article-4582548/Proof-cannabis-DOES-lead-teenagers-harder-drugs.html   8th June 2017

 

Filed under: Addiction,Cannabis/Marijuana,Drug use-various effects on foetus, babies, children and youth,Health,Youth :

Ohio had the most overdose fatalities in the United States in 2014 and 2015.

A newspaper’s survey of county coroners has painted a grim picture of fatal overdoses in Ohio: more than 4,000 people died from drug overdoses in 2016 in the state badly hit by a heroin and opioid epidemic.

At least 4,149 died from unintentional overdoses last year, a 36 percent climb from the previous year, or a time when Ohio had the most overdose fatalities in the United States so far.

“They died in restaurants, theaters, libraries, convenience stores, parks, cars, on the streets and at home,” wrote The Columbus Dispatch in its report revealing the findings.

Survey Findings

It’s likely getting worse, too, as coroners warned that overdose deaths this year are fast outpacing these figures brought on by overdoses from heroin, synthetic opioids fentanyl and carfentanil, and other drugs.

The Dispatch obtained the number by getting in touch with coroners’ offices in all 88 Ohio counties. Coroners in six smaller counties, according to the paper, did not provide the requested figures.

Leading the counties in rapid drug overdose rises are counties such as Cuyahoga, where there were 666 deaths in 2016, as well as Franklin, Hamilton, Lucas, Montgomery, and Summit.

The devastation, added the survey, did not discriminate against big or small cities and towns, urban or rural areas, and rich and poor enclaves.

“It’s a growing, breathing animal, this epidemic,” said Medina County coroner and ER physician Dr. Lisa Deranek, who has sometimes revived the same overdose patients a few times each week.

Fentanyl Overdoses

Cuyahoga County, which covers Cleveland, had its death toll largely blamed on fentanyl use. Heroin remains a leading killer, but the autopsy reports reflected the major role of fentanyl, a synthetic opiate 50 times stronger than morphine, and animal tranquilizer carfentanil.

“We’ve done so much, but the numbers are going the other way. I don’t see the improvement,” said William Denihan, outgoing CEO of Cuyahoga County Alcohol, Drug Addiction and Mental Health Services Board.

Cuyahoga County had 400 fentanyl-linked deaths from Nov. 21 in 2015 to Dec. 31 last year, more than double related deaths of all previous years in combination. The opioid crisis, too, no longer just affected mostly white drug users, but also minority communities.

Dr. Thomas Gilson, medical examiner of Cuyahoga County, warned that cocaine is now getting mixed into the fentanyl distribution and fentanyl analogs in order to bring the drugs closer to the African-American groups.

Plans And Prospects

The state’s Department of Mental Health and Addiction Services stated that the overdose death toll back in 2015 would have been higher if not for the role of naloxone, an antidote use for opioid overdose cases. It has been administered by family members, other drug users, and friends to revive dying individuals.

State legislature moved to make naloxone accessible in pharmacies without a prescription. Ohio topped the nation’s drug overdose death numbers in 2014 and 2015. In the latter year, it was followed by New York, according to an analysis by the Kaiser Family Foundation using statistics from the U.S. Centers for Disease Control and Prevention.

Experts are pushing for expanding drug prevention as well as education initiatives from schoolkids to young and middle-aged adults, which also make up the bulk of dying people.

And while the state pioneered in crushing “pill mills” that issue prescription painkillers, health officials warned that this sent addicts to heroin and other stronger substances.

Naloxone, too, is merely an overdose treatment and not a cure for the growing addiction. Last May 22 in Pennsylvania, two drug counselors working to help others battle their drug addiction were found dead from opioid overdose at the addiction facility in West Brandywine, Chester County.

Source:  http://www.techtimes.com/articles/208540/20170529/ohio-leads-in-nations-fatal-drug-overdoses-with-4-000-dead-in-2016-survey.htm  29.05.17

Filed under: Addiction,Drug use-various effects,Drugs and Accidents,Health,Heroin/Methadone,USA :

“I wish that all families would at least consider investigating medication-assisted treatment and reading about what’s out there,” says Alicia Murray, DO, Board Certified Addiction Psychiatrist. “I think, unfortunately, there is still stigma about medications. But what we want people to see is that we’re actually changing the functioning of the patient.” Essentially, medication-assisted treatment (MAT) can help get a patient back on track to meeting the demands of life – getting into a healthy routine, showing up for work and being the sibling, spouse or parent that they once were. “If we can change that with medication-assisted treatment and with counselling,” says Murray, “that’s so valuable.” The opioid epidemic is terrifying, especially so for a parent of someone already struggling with prescription pills or heroin use. It’s so important to consider any and all options for helping your child recover from their opioid dependence.

Part of the reason it’s so hard to overcome an opioid addiction is because it rewires your brain to focus almost exclusively on the drug over anything else, and produces extreme cravings and withdrawal symptoms as a result. By helping to reduce those feelings of cravings and withdrawal, medication-assisted treatment can help your son or daughter’s brain stop thinking constantly about the drug and focus on returning to a healthier life.

Medication-assisted treatment is often misunderstood. Many traditional treatment programs and step-based supports may tell you that MAT is simply substituting one addictive drug for another. However, taking medication for opioid addiction is like taking medication for any other chronic disease, such as diabetes or asthma. When it is used according to the doctor’s instructions and in conjunction with therapy, the medication will not create a new addiction, and can help.

As a parent, you want to explore all opportunities to get your child help for his or her opioid addiction, and get them closer and closer to functioning as a healthy adult – holding down a job, keeping a regular schedule and tapering, and eventually, stopping their misuse of opioids. Medication-assisted treatment helps them do that.

“MAT medications are most effective when they are used in conjunction with therapy and recovery work. We would never recommend medication over other forms of treatment. We would recommend it in addition to it.”

The three most-common medications used to treat opioid addiction are:

· Naltrexone (Vivitrol)

· Buprenorphine (Suboxone)

· Methadone

NALTREXONE

Naltrexone, known by its brand-name Vivitrol, is administered by a doctor monthly through an injection. Naltrexone is an opioid antagonist. Antagonists attach themselves to opioid receptors in the brain and prevent other opioids such as heroin or painkillers from exerting the effects of the drug. It has no abuse potential.

BUPRENORPHINE

Buprenorphine, known by its brand-name Suboxone, is an oral tablet or film dissolved under the tongue or in the mouth prescribed by a doctor in an office-based setting. It is taken daily and can be dispensed at a physician’s office or taken at home. Buprenorphine is a partial agonist. Partial agonists attach to the opioid receptors in the brain and activate them, but not to the full degree as agonists. If used against the doctor’s instructions, it has the potential to be abused.

METHADONE

Methadone is dispensed through a certified opioid treatment program (OTP). It’s a liquid and taken orally and usually witnessed at an OTP clinic until the patient receives take-home doses. Methadone is an opioid agonist. Agonists are drugs that activate opioid receptors in the brain, producing an effect. If used against the doctor’s instructions, it has the potential to be abused. There is no “one size fits all” approach to medication-assisted treatment, or even recovery. Recovery is individual.

The most important thing to do is to consider all of your options, and speak to a medical professional to determine the best course of action for your family. The best path is the path that helps and works for your child.

Source:  http://drugfree.org/parent-blog/medication-assisted-treatment/  19th May 2017

Filed under: Addiction,Brain and Behaviour,Heroin/Methadone,Treatment and Addiction,Youth :

 A New Agenda to  Turn Back the Drug Epidemic

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

A. Thomas McLellan, PhD, Senior Strategy Advisor , Institute for Behavior and Health, Inc.  May 2017

Institute for Behavior and Health, Inc. , 6191 Executive Blvd , Rockville, MD 20852 , www.IBHinc.org 1

Background 

The Institute for Behavior and Health, Inc. (IBH) is a 501(c)3 non-profit substance use policy and research organization that was founded in 1978. Non-partisan and non-political, IBH develops new ideas and serves as a force for change.

Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs and Health was published in November 2016. Four months later, in March 2017, IBH held a meeting of 25 leaders in addiction treatment, health care, insurance, government and research to discuss the scope and implications of this historic document. The US Surgeon General, VADM Vivek H. Murthy, MD, was an active participant in the meeting. The significance of this new Surgeon General’s Report is analogous to the historic 1964 Surgeon General’s report, Smoking and Health, a document that inspired an extraordinarily successful public health response in the United States that has reduced the rates of cigarette smoking by over 64% and continues its impact even today, more than 50 years following its release.

The following is a summary of the discussion at the March 2017 meeting and the conclusions and recommendations that were developed.

Introduction: The 2016 Surgeon General’s Report 

The two primary objectives of the US Surgeon General’s Report of 2016 are first to provide scientific evidence that shows that in addition to nicotine, other substance misuse and addiction issues (e.g., alcohol, opioids, marijuana, etc.) also are best understood and addressed as public health problems; and second to encourage the inclusion of addiction – its prevention, early recognition and intervention, treatment and active long-term recovery management – into the mainstream of American health care. At present these elements are not integrated either as a stand-alone continuum or within the general medical system. As is true for other widespread illnesses, addiction to nicotine, alcohol, marijuana, opioids, cocaine and other substances is a serious chronic illness. This perspective is contrary to the common perception that addiction reflects a moral failing, a personal weakness or poor parenting. Such opinions have stigmatized individuals who are suffering from these often deadly substance use disorders and have led to expensive and ineffective public policies that segregate prevention and treatment outside of mainstream medical care. A better public health approach encourages afflicted individuals and their family members to seek and receive help within the current health care system for these serious health problems.

An informed public health approach to reducing the prevalence and the harms associated with substance use disorders requires more than the brief treatment of serious cases. Particularly important are substance use prevention programs in schools, healthcare and in all other parts of the community to protect adolescents (ages 12 – 21), the group most at risk for the initiation of substance-related harms and substance use disorders.  Importantly, abundant tragic experience and accumulating science show that substance use disorders are not effectively treated with only short-term care. Because substance use disorders produce 2 significant long-lasting changes in the brain circuits responsible for memory, motivation, inhibition, reward sensitivity and stress tolerance, addicted individuals remain vulnerable to relapse years following specialized treatment.1, 2, 3 Thus, as is true for all other chronic illnesses, long periods of personalized treatment and monitoring are necessary to assure compliance with care, continued sobriety, and improved health and social function. In combination, science-based prevention, early intervention, continuing care and monitoring comprise a modern continuum of public health care. The overall goals of this continuum comport well with those of other chronic illnesses:

1 US Department of Health and Human Services (HHS), Office of the Surgeon General. (2016). Chapter 2. The Neurobiology of Substance Use, Misuse, and Addiction. In: Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS. Available: https://addiction.surgeongeneral.gov/

2 US Department of Health and Human Services (HHS), Office of the Surgeon General. (2016). Chapter 5. Recovery: The Many Paths to Wellness. In: Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS. Available: https://addiction.surgeongeneral.gov/

3 Betty Ford Institute Consensus Panel. (2007). What is recovery? A working definition from the Betty Ford Institute. Journal of Substance Abuse Treatment, 33(3), 221-228.

4 White, W. L. (2012). Recovery/remission from substance use disorders: An analysis of reported outcomes in 415 scientific reports, 1868-2011. Philadelphia, PA: Philadelphia Department of Behavioral Health and Intellectual Disability Services.

· sustained reduction of the cardinal symptom of the illness, i.e., substance use;

· improved general health and function; and,

· education and training of the patient and the family to self-manage the illness and avoid relapses.

In the addiction field achieving these goals is called “recovery.” This word is used to describe abstention from the use of alcohol, marijuana and other non-prescribed drugs as well as improved personal health and social responsibility.3,4 Over 25 million formerly addicted Americans are in stable, long-term recovery of a year or longer.4 Understanding how to consistently accomplish the life-saving goal of recovery must inform health care decisions.

The 2016 Surgeon General’s Report offers a science-informed vision and path to recovery in response to the nation’s serious addiction problem, including specifically the opioid overdose epidemic. Research shows that it is possible to prevent or delay most cases of substance misuse; and to effectively treat even the most serious substance use disorders with recovery as an expectable result of comprehensive, continuous care and sustained monitoring. To do this, substance use disorders must be recognized as serious, chronic health conditions that are both preventable and treatable. The nation must integrate the short-term siloed episodes of specialty treatment that now are isolated from mainstream healthcare into a fully integrated continuum of care comparable to that currently available to those with other chronic illnesses such as diabetes, hypertension, asthma and chronic pain.

Meeting Discussion and Conclusions 

The Surgeon General’s Report and the meeting convened by the Institute for Behavior and Health, Inc. (IBH) to promote its recommendations are significant responses to the expanding epidemic of opioid 3 and other substance use disorders, an epidemic that struck nearly 21 million Americans aged 12 and older in 2015 alone.5 That year saw more than 52,000 overdose deaths.6 This drug epidemic has devastated countless families and communities throughout the US. Unlike earlier and smaller drug epidemics, the current opioid epidemic is not limited to a few regions or communities or a narrow range of ethnicities or incomes in the United States. Instead it afflicts all communities and all socioeconomic groups; its impacts include smaller communities and rural areas as well as suburban areas and inner cities. Fuelled by the suffering of countless grieving families, the nation is in the early stages of confronting the new epidemic. A growing national determination to turn back this deadly epidemic has opened the door to innovation that is sustained by strong bipartisan political support for new and improved efforts in both prevention and treatment of substance use disorders.

5 Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series H-50). Available: http://www.samhsa.gov/data/

6 Rudd, R. A., Seth, P., David, F., & Scholl, L. (2016, December 30). Increases in drug and opioid-involved overdose deaths – United States. Morbidity and Mortality Weekly Report, 65(50-51), 1445-1452. Available: https://www.cdc.gov/mmwr/volumes/65/wr/mm655051e1.htm

7 Levy, S. J., Williams, J. F., & AAP Committee on Substance Use and Prevention. (2016). Substance use screening, brief intervention, and referral to treatment. Pediatrics, 138(1), e20161211. Available: http://pediatrics.aappublications.org/content/138/1/e20161211

8 US Department of Health and Human Services (HHS), Office of the Surgeon General. (2016). Chapter 3. Prevention Programs and Policies. In: Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS. Available: https://addiction.surgeongeneral.gov/

Abstinence is an Achievable Goal, both for Prevention and for Treatment 

Embracing and synthesizing the 30 years of science supporting the findings of the 2016 Surgeon General’s Report, the group discussed a single goal for the prevention of addiction: no use of alcohol, nicotine, marijuana or other non-prescribed drugs by youth for reasons of health. This goal should be the core prevention message to all children from a very young age. Health care professionals, educators and parents should understand the importance of this simple, clear health message. They should continue to reinforce this message of no-use for health as children grow to adulthood. Even when prevention fails, it is possible for parents, other family members, friends, primary care clinicians, educators and others to identify and to intervene quickly to stop youth substance use from becoming addiction.7

The science behind this ambitious but attainable prevention goal is clear. Alcohol, nicotine products, marijuana and other non-prescribed drug use is uniquely harmful to the still-developing brains of adolescents. Thus any substance “use” among youth must be considered “misuse” – use that may harm self or others. The goal of no substance use is not just for the purpose of preventing addiction, though that is one clear and important by product of successful prevention. Addiction is a biological process that can take years to develop. In contrast, even a single episode of high-dose use of alcohol or other substance could immediately produce an injury, accident or even death. While it is true that most episodes of substance misuse among adults do not produce serious problems, it is also true that substance misuse is associated with 70% or more of the injuries, disabilities and deaths of young people.8 These figures are even higher for minority youth. Many adolescent deaths are preventable 4 because most are related to substance use – including substance-related motor vehicle crashes and overdose.9

9 Subramaniam, G. A., & Volkow, N. D. (2014). Substance misuse among adolescents. To screen or not to screen? JAMA Pediatrics, 168(9), 798-799. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4827336/

10 Data analyzed by the Center for Behavioral Health Statistics and Quality. CBHS. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15- 4927, NSDUH Series H-50).

11 2014 data obtained by IBH from the Monitoring the Future study. For discussion of data through 2013 see DuPont, R. L. (2015, July 1). It’s time to re-think prevention; increasing percentages of adolescents understand they should not use any addicting substances. Rockville, MD: Institute for Behavior and Health, Inc. Available: https://www.ibhinc.org/s/IBH_Commentary_Adolescents_No_Use_of_Substances_7-1-15.pdf

Youth who use any one of the three most common “gateway” substances, i.e., alcohol, nicotine and marijuana, are many times more likely than those who do not use that single drug to use the other two substances as well as other illegal drugs.10 The use of any drug opens the door to an endless series of highly risky decisions about which drugs to use, how much to use, and when to use them. This perspective validates the public health goal for youth of no use of any drug.

Complete abstinence from the use of alcohol or any other drug among adolescents is not simply an idealistic goal – it is a goal that can be achieved. Data were presented at the meeting from the nationally representative Monitoring the Future study showing that 26% of American high school seniors in 2014 reported no use of alcohol, cigarettes, marijuana or other non-prescribed drugs in their lifetimes. 11 This is a remarkable increase from only 3% reported by American high school seniors in 1983. Moreover, in the same survey, 50% of high school seniors had not used any alcohol, cigarettes, marijuana or other non-prescribed substance in the past 30 days, up from 16% in 1982. These largely overlooked and important findings show that youth abstinence from any substance use is already widespread and steadily increasing.

In parallel with the goal of abstinence for prevention, the recommended goal for the treatment of those who are addicted is sustained abstinence from the use of alcohol and other drugs, with the caveat, explicitly acknowledged by the group, that individuals who are taking medications as-prescribed in the treatment of substance use disorders (e.g., buprenorphine, methadone and naltrexone) and who do not use alcohol or other non-prescribed addictive substances – are considered to be abstinent and ”in recovery.” Abstinence from all non-prescribed substance use is the scientifically-informed goal for individuals in addiction treatment. This treatment goal is widely accepted in the large national recovery community. The long-lasting effects of addiction to drugs are easily seen among cigarette smokers: smoking only a single cigarette is a serious threat to the former smoker, even decades after smoking the last cigarette. There is incontrovertible evidence from brain and genetic research showing the long-term effects of substance misuse on critical brain regions.2 It is unknown when or if these brain changes will return to being entirely normal following cessation of substance use; however, it is known that the recovering brain is particularly vulnerable to the effects of return to any substance use, often leading to overdose or rapid re-addiction. 5

Participants in the IBH meeting supported the idea that abstinence is the high-value outcome in addiction treatment; and that while any duration of abstinence is valuable, longer-term, stable abstinence of 5 years is analogous to the widely-used standard in cancer treatment of 5-year survival. The scientific basis for the value of sustained recovery is validated by the experience of the estimated 25 million Americans now in recovery. This increasingly visible recovery community is a remarkable and very positive new force in the country.

Measuring and Attaining these Goals 

The mantra from the IBH meeting was, if you don’t measure it, it won’t happen. The group of leaders recognized the paucity of current models for systematic integration of addiction treatment and general healthcare. The group encouraged the identification of promising models and the promotion of innovation to achieve the goal of sustained recovery. Even programs that include fully integrated care of other diseases, managed care and other comprehensive health programs do not reliably achieve the goal of sustained or even temporary recovery for substance use disorders. The meeting participants noted the absence of long-term outcome studies of the treatment of substance use disorders and encouraged all treatment programs not only to extend the care of discharged patients but also to systematically study the trajectories of discharged patients to improve their long-term treatment outcomes. The increasing range of recovery support services after treatment is an important and promising new trend that is now actively promoting sustained recovery.

Meeting participants noted one particularly promising model of public health goal measurement and attainment – the 90-90-90 goals for the treatment of HIV/AIDS: 90% of people with HIV will be screened to know their infection status; 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy; and 90% of all patients receiving antiretroviral therapy will have viral suppression (i.e., zero viral load).12 These measurable goals provide an operational definition of public health success for the country, states and individual healthcare organizations.

12 UNAIDS. (2014). 90-90-90: An Ambitious Treatment Target to Help End the AIDS epidemic. Geneva, Switzerland: Joint United Nations Programme on HIV/AIDS. Available: http://www.unaids.org/sites/default/files/media_asset/90-90-90_en_0.pdf

With this model as background, the IBH group concluded that a similar public health approach and similarly specific numeric goals should be established for preventing and treating substance use disorders. Examples of parallel national prevention goals could include 90% rates of screening for substance misuse among adolescents; 90% provision of interventions and follow-up for those screening positive; and 90% total abstinence rates among youth aged 12-21. While these are admittedly ambitious prevention goals, adoption of them could incentivize families, schools and communities to increase the percentage of youth who do not use any alcohol, nicotine, marijuana or other drugs every year.

A similar approach was adopted by the IBH group to improve the impact of addiction treatment. Again, there would be significant public health value if the US adopted the following goals: 90% of individuals aged 12 or older receive annual screening for substance misuse and substance use disorders; 90% of those who receive a diagnosis of a substance use disorder are referred and meaningfully engaged (at 6 least three sessions) in some form of addiction treatment; and 90% of those engaged in treatment achieve sustained abstinence as measured by drug testing, during and for six months following treatment.

Source:  IBH-Report-A-New-Agenda-to-Turn-Back-the-Drug-Epidemic  May 2017

Filed under: Addiction,Addiction (Papers),Drug use-various effects,Health,Social Affairs,Social Affairs (Papers),USA :

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

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

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

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

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

Hence the bad week.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Filed under: Addiction,Addiction (Papers),Drug use-various effects on foetus, babies, children and youth,Effects of Drugs,Effects of Drugs (Papers),Social Affairs,Social Affairs (Papers),USA :

COLUMBUS, Ohio — It’s being called “gray death” — a new and dangerous opioid combo that underscores the ever-changing nature of the U.S. addiction crisis.

Investigators who nicknamed the mixture have detected it or recorded overdoses blamed on it in Alabama, Georgia and Ohio. The drug looks like concrete mix and varies in consistency from a hard, chunky material to a fine powder.

The substance is a combination of several opioids blamed for thousands of fatal overdoses nationally, including heroin, fentanyl, carfentanil – sometimes used to tranquilize large animals like elephants – and a synthetic opioid called U-47700.

“Gray death is one of the scariest combinations that I have ever seen in nearly 20 years of forensic chemistry drug analysis,” Deneen Kilcrease, manager of the chemistry section at the Georgia Bureau of Investigation, said.  Gray death ingredients and their concentrations are unknown to users, making it particularly lethal, Kilcrease said. In addition, because these strong drugs can be absorbed through the skin, simply touching the powder puts users at risk, she said.

Last year, the U.S. Drug Enforcement Administration listed U-47700 in the category of the most dangerous drugs it regulates, saying it was associated with dozens of fatalities, mostly in New York and North Carolina. Some of the pills taken from Prince’s estate after the musician’s overdose death last year contained U-47700.

Gray death has a much higher potency than heroin, according to a bulletin issued by the Gulf Coast High Intensity Drug Trafficking Area. Users inject, swallow, smoke or snort it.

Georgia’s investigation bureau has received 50 overdose cases in the past three months involving gray death, most from the Atlanta area, said spokeswoman Nelly Miles.

In Ohio, the coroner’s office serving the Cincinnati area says a similar compound has been coming in for months. The Ohio attorney general ‘s office has analyzed eight samples matching the gray death mixture from around the state.

The combo is just the latest in the trend of heroin mixed with other opioids, such as fentanyl, that has been around for a few years.  Fentanyl-related deaths spiked so high in Ohio in 2015 that state health officials asked the federal Centers for Disease Control and Prevention to send scientists to help address the problem.

The mixing poses a deadly risk to users and also challenges investigators trying to figure out what they’re dealing with this time around, said Ohio Attorney General Mike DeWine, a Republican.

“Normally, we would be able to walk by one of our scientists, and say ‘What are you testing?’ and they’ll tell you heroin or ‘We’re testing fentanyl,’” DeWine said. “Now, sometimes they’re looking at it, at least initially, and say, ‘Well, we don’t know.’”

Some communities also are seeing fentanyl mixed with non-opioids, such as cocaine. In Rhode Island, the state has recommended that individuals with a history of cocaine use receive supplies of the anti-overdose drug naloxone.

These deadly combinations are becoming a hallmark of the heroin and opioid epidemic, which the government says resulted in 33,000 fatal overdoses nationally in 2015. In Ohio, a record 3,050 people died of drug overdoses last year, most the result of opioid painkillers or their relative, heroin.

Most people with addictions buy heroin in the belief that’s exactly what they’re getting, overdose survivor Richie Webber said.  But that’s often not the case, as he found out in 2014 when he overdosed on fentanyl-laced heroin. It took two doses of naloxone to revive him. He’s now sober and runs a treatment organization, Fight for Recovery, in Clyde, about 45 miles (72 kilometers) southeast of Toledo.

A typical new combination he’s seeing is heroin combined with 3-methylfentanyl, a more powerful version of fentanyl, said Webber, 25. It’s one of the reasons he tells users never to take drugs alone.

“You don’t know what you’re getting with these things,” Webber said. “Every time you shoot up you’re literally playing Russian roulette with your life.”

Source:  https://www.statnews.com/2017/05/04/opioid-gray-death-overdoses/  4th May 2017

Filed under: Addiction,Health,Social Affairs,USA :

A new study released today by JAMA Psychiatry found that rates of marijuana use and marijuana addiction increased significantly more in states that passed medical marijuana laws as compared to states that have not. Examining data from 1992 to 2013, researchers concluded that medical marijuana laws likely contributed to an increased prevalence of marijuana and marijuana-addicted users.

“Politicians and pro-pot special interests are quick to tout the benefits of medical marijuana legalization, but it’s time to see through the haze —     medical marijuana has gone completely unregulated,” said SAM President Kevin Sabet. “More people in these states are suffering from an addiction to marijuana that harms their lives and relationships, while simultaneously more have begun using marijuana. No one wants to see patients denied something that might help them, but this study underscores the fact that “medical” and “recreational” legalization are blurred lines. Smoked marijuana is not medicine, and has not been proven safe and effective as other FDA-approved medications have.”

The study’s researchers wrote that increases in marijuana use in states with medical marijuana laws “may have resulted from increasing availability, potency, perceived safety, [or] generally permissive attitudes.” They conclude that “changing state laws (medical or recreational) may also have adverse public health consequences.”  Evidence demonstrates that marijuana —     which has skyrocketed in average potency over the past decades —     is addictive and harmful to the human brain, especially when used by adolescents. Moreover, in states that have already legalized the drug, there has been an increase in drugged driving crashes and youth marijuana use. States that have legalized marijuana have also failed to shore up state budget shortfalls with marijuana taxes, continue to see a thriving black market, and are experiencing a continued rise in alcohol sales.

Source:  http://www.learnaboutsam.org.  Alexandria, VA, April 26, 2017

About SAM

Smart Approaches to Marijuana (SAM) is a nonpartisan, non-profit alliance of physicians, policy makers, prevention workers, treatment and recovery professionals,  scientists, and other concerned citizens opposed to marijuana legalization who want health and scientific evidence to guide marijuana policies. SAM has affiliates in more than 30 states. For more information about marijuana use and its effects, visit http://www.learnaboutsam.org.

Filed under: Addiction,Cannabis/Marijuana,Marijuana and Medicine,USA :

A disturbing majority of businesses in the U.S. are being negatively impacted by prescription painkiller abuse and addiction among employees.

A survey recently released by the National Safety Council reveals more than 70 percent of workplaces are feeling the negative effects of opioid abuse. Nearly 40 percent of employers said employees are missing work do to painkiller abuse, with roughly the same percent reporting employees abusing the drugs on the job. Despite the prevalence of addiction in offices across the country, employers are doing little to mitigate risk. Record pill abuse in workplaces is coming at a time when Americans are taking more opioids than ever before, reports The Washington Post.

A recent survey from Truven Health Analytics and NPR reveals more than half of the U.S. population reports receiving a prescription for opioids at least once from their doctor, a 7 percent increase since 2011. Data released by the Centers for Disease Control and Prevention (CDC) Friday reveals that almost half of non-cancer patients prescribed opioids for a month or more are still dependent on the pills a year later.

Experts say that current opioid and heroin abuse is driven in large part by the over-prescribing of pain pills from doctors. Despite the problems opioid abuse is causing in the workplace, many employee drug tests do not look for the substance. Fifty-seven percent of businesses test for drugs, but 41 percent of those businesses do not test for opioids.

“Employers must understand that the most dangerously misused drug today may be sitting in employees’ medicine cabinets,” Deborah Hersman, president and CEO of the National Safety Council, said in a statement. “Even when they are taken as prescribed, prescription drugs and opioids can impair workers and create hazards on the job.”

Among people not currently taking opioids, nearly half view addiction as the biggest threat from using painkillers. Among current patients on opioids, fears over unwanted side effects still dwarf fears about long-term dependence and addiction. Medical professionals say doctors need to start by prescribing the least potent and least addictive pain treatment option, and then cautiously go from there.

Experts also say the patient must take greater responsibility when they visit their doctor and always ask “why” before accepting a prescription.

Addicts may begin with a dependence on opioid pills before transitioning to heroin after building up a tolerance that makes pills too expensive. States hit particularly hard by heroin abuse are beginning to crackdown on doctors liberally doling out painkillers.

“When four out of five new heroin users are getting their start by abusing prescription drugs, you have to attack the problem at ground zero – in irresponsibly run doctors’ offices,” New Jersey Attorney General Porrino said in a statement March 1. “Physicians who grant easy access to the drugs that are turning New Jersey residents into addicts can be every bit as dangerous as street-corner dealers. Purging the medical community of over-prescribers is as important to our cause as busting heroin rings and locking up drug kingpins.”

A record 33,000 Americans died from opioid related overdoses in 2015, according to the CDC. Opioid deaths contributed to the first drop in U.S. life expectancy since 1993 and eclipsed deaths from motor vehicle accidents in 2015. Combined, heroin, fentanyl and other opiate-based painkillers account for roughly 63 percent of drug fatalities, which claimed 52,404 lives in the U.S. in 2015.

Source:  http://dailycaller.com/2017/03/19/opioid-addiction-is-infiltrating-a-majority-of-us-workplaces/

Filed under: Addiction,Prescription Drugs,Social Affairs,USA :

Meet Ryan Hampton, 36, recovery advocate, political activist and recovering heroin addict igniting America’s social media feeds with stories of hope, recovery and activism. From his advocacy that led Sephora to take their eyeshadow branded “druggie” off the shelves to the activism that urged an Arizona politician to apologize for a statement stigmatizing addiction, he’s certainly become a social media powerhouse for all things addiction, recovery and policy. And with an estimated 7 out of 10 people on social media platforms, it’s no coincidence he’s found success taking the addiction advocacy fight digital.

Today, more than 22 million people are struggling with addiction, and it’s estimated that as a result, more than 45 million people are affected. But what many people don’t realize is that there are more than 23 million people living in active, long-term recovery today. Yet, because of shame and stigma, many stay silent. To fight this often-lethal silence, Hampton has urged the public to speak up and share personal stories of recovery through his recently launched Voices Project. The project, a collaborative effort to encourage people across the nation to share their story, exists to put real faces and names behind the addiction epidemic.

A Personal Struggle

Before becoming a national recovery advocate and social media powerhouse, Hampton himself faced a personal struggle with addiction. A former staffer in the Clinton White House, Hampton did not appear to be a likely candidate for heroin addiction, or so stigma would say. But after an injury and subsequent prescription for pain medication, Hampton found himself addicted to opiates, eventually leading to a heroin addiction that would span more than a decade.  After a long struggle, Hampton decided to get help.

It was the phone call that started his recovery journey that changed everything – his life and his view on the power of his phone. After getting sober, he began connecting with others in recovery, amazed at the magnitude of the digital community. But still, while uncovering these online stories of recovery, Hampton lost four friends to opioid addiction.

It was a breaking point for Hampton – one that led to the beginning of a movement that would someday reach and impact millions.

A Notable Partner

Hampton began reaching out to others in recovery and started realizing the power of digital tools to connect and build an online recovery community. And as he was slowly networking and meeting others in recovery, on October 4, 2015, Hampton’s advocacy met its catalyst: Facing Addiction.   The non-profit organization hosted a concert at the National Mall in Washington, D.C., an event that drew thousands to the capitol with celebrities, musicians and other well-known names willing to publicly celebrate the reality of recovery and call for reform in the addiction industry. Hampton, a Los Angeles resident, tuned into the event from across the country through Facebook Live and was again inspired by the content delivered through his mobile phone.

After meeting co-founders of Facing Addiction, Jim Hood and Greg Williams, Hampton plugged in, partnered and even joined the Facing Addiction team as a recovery advocate.

The importance of online advocacy aligns with Facing Addictions’ national priorities, shares CEO Jim Hood, “When enough people tell enough stories and the people who are impacted by addiction look like all of us and our kids and neighbors and relatives, the stigma has to start going away. And then we can get to work.”

After partnering with Facing Addiction, Hampton understood the priorities, the strategy and the mechanism. Said by Hampton, “I stand on the shoulders of giants”.

Leveraging the power of the algorithms at his fingertips every day, Hampton has grown his online presence to be one of the most influential in the recovery movement. Digital communication helped him get to treatment, connected him with Facing Addiction, and now is the platform in which he is sharing recovery stories from across the nation.

In just one week, more than 200 stories were submitted to the Voices Project and over 500 people sent in personal messages to express their support. Among those speaking up are notable voices such as pro skateboarder and former Jackass member Brandon Novak;   Grammy Award-winning musician Sirah;  rapper Royce da 5’9’’;   American politician and mental health advocate Patrick Kennedy;  former child actress and now-addiction counselor Mackenzie Phillips, and more.

According to Royce da 5’9’’, “Addiction is a problem that we all have to deal with. It affects us all in one way or another, and having someone giving it a voice, a name and a face not only helps get rid of the stigma regarding addiction, but he’s [Ryan] on the forefront letting people know there are solutions out there and recovery is real.”

Patrick Kennedy shares the importance of building a digital recovery movement to influence and support political reform in the addiction recovery space. “With the push of a button we’ll be able to have others show up to support communities across the nation,” says Kennedy, “because their fight is our fight.”

“The face of addiction is everyone,” Sirah shares. “The Voices Project gives people a voice and a connection to hope.”

The hope offered through open dialogue about addiction and recovery has now grown into a digital movement.

The pages that Hampton started with $20 and an old computer have gained more than 200,000 followers across platforms, reaching nearly 1 million people each week. “We’re the fastest-growing social movement in history – and the funny thing is, we’re a community that nobody ever wanted to be a part of,” Novak says.

“This is the one space where we cannot be ignored. The time has come for us to speak out, and we’re a community that speaks loudly. With addiction, we’re dealing with imminent death every day,” Hampton says. “Through social media, we’ve found an innovative way to communicate with each other and connect with people we haven’t met, and now, we’re having this conversation with the rest of the world.”

Perhaps the most intriguing impact of Hampton’s work is the paradoxical ability to bring the work of addiction recovery advocacy online – only to take it back offline through real-world change in communities across the country. According to Hampton, the work he’s doing shouldn’t stay digital – it should impact community laws, help new non-profits emerge and influence real people to seek treatment and find it.

“No matter if you have social media or not – your way of doing this is talking about addiction at the dinner table, to a parent or a friend or an employer. You should not be afraid to tell your story of recovery or loss and, most importantly, your story of struggle and how you need help. It may not just change your life, it may change someone else’s life,” Hampton says.

At the crux of digital advocacy in the addiction recovery realm are real lives being saved – people finding treatment, families finding hope and those in recovery being freed of stigma that can keep them in shame and silence.  This is the mission that has fuelled Hampton’s work since the beginning. And Hampton’s reason is hard to refute: “My story is powerful, but our stories are powerful beyond measure.”

Source: https://www.forbes.com/sites/toriutley/2017/04/18/the-recovering-heroin-addict-shaking-social-media/2/#273606f0689c

Filed under: Addiction,Heroin/Methadone,Internet,Social Affairs (Papers),Treatment and Addiction :

Formerly inconceivable ideas—like providing drug users a safe place to inject—are gaining traction.

America’s opioid problem has turned into a full-blown emergency now that illicit fentanyl and related synthetic drugs are turning up regularly on our streets. This fentanyl, made in China and trafficked through Mexico, is 25 to 50 times as potent as heroin. One derivation, Carfentanil, is a tranquilizer for large animals that’s a staggering 1,000 to 5,000 times as powerful.

Adding synthetic opioids to heroin is a cheap way to make it stronger—and more deadly. A user can die with the needle still in his arm, the syringe partly full. Traffickers also press these drugs into pills that they sell as OxyContin and Xanax. Most victims of synthetic opioids don’t even realize what they are taking. But they are driving the soaring rate of overdose—a total of 33,091 deaths in 2015, according to the Centers for Disease Control and Prevention.

Hence the ascendance of a philosophy known as “harm reduction,” which puts first the goal of reducing opioid-related death and disease. Cutting drug use can come second, but only if the user desires it. As an addiction psychiatrist, I believe that harm reduction and outreach to addicts have a necessary place in addressing the opioid crisis. But as such policies proliferate—including some that used to be inconceivable, such as providing facilities where drug users can safely inject—Americans shouldn’t lose sight of the virtues of coerced treatment and accountability.

What does harm reduction look like? One example is Maryland’s Overdose Survivor Outreach Program. After an overdose survivor arrives in the emergency room, he is paired with a “recovery coach,” a specially trained former addict. Coaches try to link patients to treatment centers. Generally this means counseling along with one of three options: methadone; another opioid replacement called buprenorphine, which is less dangerous if taken in excess; or an opioid blocker called naltrexone. Overdose survivors who don’t want treatment are given naloxone, a fast-acting opioid antidote. Coaches also stay in touch after patients leave the ER, helping with court obligations and social services.

Similar programs operate across the country. In Chillicothe, Ohio, police try to connect addicts to treatment by visiting the home of each person in the county who overdoses. In Gloucester, Mass., heroin users can walk into the police station, hand over their drugs, and walk into treatment within hours, without arrest or charges. It’s called the Angel Program. Macomb County, Mich., has something similar called Hope Not Handcuffs.

Another idea gaining traction is to provide “safe consumption sites,” hygienic booths where people can inject their own drugs in the presence of nurses who can administer oxygen and naloxone if needed. No one who goes to a safe consumption site is forced into treatment to quit using, since the priority is reducing risk.

In Canada, staffers at Vancouver’s consumption site urge patrons to go into treatment, but they also distribute clean needles to reduce the spread of viruses such as HIV and hepatitis C. Naloxone kits are on hand in case of overdose. One study found that opening the site has reduced overdose deaths in the area, and more than one analysis showed reduced injection in places like public bathrooms, where someone can overdose undiscovered and die.

There are no consumption sites in the U.S., but in January the board of health in King County, Wash., endorsed the creation of two in the Seattle area. A bill in the California

Assembly would allow cities to establish safe consumption sites. Politicians, physicians and public-health officials have called for them in Baltimore; Boston; Burlington, Vt.; Ithaca, N.Y.; New York City; Philadelphia and San Francisco. Drug-war-weary police officers and harm reductionists would rather see addicts opt for treatment and lasting recovery, but they’ll settle for fewer deaths.

When all else fails, handcuffs can help, too. A problem with treatment is that addicts often stay with the program only for brief periods. Dropout rates within 24 weeks of admission can run above 50%, according to the National Institute on Drug Abuse. Courts can provide unique leverage. Many drug users are involved in addiction-related crime such as shoplifting, prescription forgery and burglary. Shielding them from the criminal-justice system often is not in society’s best interests—or theirs.

Drug courts, for example, keep offender-patients in treatment through immediately delivered sanctions (e.g., a night in jail) and incentives (e.g., looser supervision). Upon successful completion of a 12- to 18-month program, many courts erase the criminal record. This seems to work. The National Association of Drug Court Professionals reports that 75% of drug court graduates nationwide “remain arrest-free at least two years after leaving the program.”

What’s more, if the carrot-and-stick method used by drug courts is scrupulously applied, treatment may not always be necessary. This approach, called “swift, certain and fair,” has been successful with methamphetamine addicts in Hawaii and alcoholics in South Dakota. Some courts in Massachusetts and New Hampshire have now adopted it with opioid addicts. I predict that the combination of anti-addiction medication plus “swift, certain, and fair” will be especially effective.

With synthetic drugs similar to fentanyl turbocharging the opioid problem, the immediate focus should be on keeping people safe and alive. But for those revived by antidotes and still in a spiral of self-destruction, the criminal-justice system may be the ultimate therapeutic safety net.

Source:  https://www.wsj.com/articles/saving-lives-is-the-first-imperative-in-the-opioid-epidemic-1491768767  April 9, 2017

Filed under: Addiction,Heroin/Methadone,Synthetics,USA :

The Director of the NDPA, Peter Stoker, visited Vancouver East Side in 1999.  It was tragic to see drug dependent men and women living rough on the streets – in the alleys behind the main road – injecting in public.  A team of police officers called The Odd Squad worked the area and did everything they could to help these people – producing a great video called ‘Through the Blue Lens’ – we took this video into schools and it was the most powerful drug prevention message we had ever used.  We would urgently ask you to see this video on You Tube – https://www.youtube.com/watch?v=gwFRsfATaag

The article below is covering the same story – 19 years later.  Isn’t it about time that Canada began to promote good drug prevention instead of relaxing their drug laws? 

As overdose deaths spike, provincial health officials say more overdose prevention sites will soon open across the province.

The number of overdose deaths related to illicit drugs in British Columbia leapt to 755 by the end of November, a more than 70-per-cent jump over the number of fatalities recorded during the same time period last year.

In August, 50 people died of drug overdoses in British Columbia.  In September, 57 died. In October, the number jumped to 67 — an increase that worried health officials, who had thought that increasing the supply and training for administering the overdose reversal drug naloxone was making a difference.

In November, drug overdoses caused 128 deaths — 61 more than the previous month, and nearly double the October total. That spike has brought the total number of deaths between January and November to 755, the highest number ever recorded by the BC Coroner and a 70 per cent increase over this time last year

“We’re quite fearful that the drug supply is increasingly toxic, it’s increasingly unpredictable, and it’s very, very difficult to manage,” said Lisa Lapointe, B.C.’s chief coroner, referring to the increasing prevalence of the synthetic opioid fentanyl being added to many illicit drugs.  “Those who…attempt to use drugs safely, it’s almost impossible.”

With advance notice from the coroner that November numbers would be much higher, provincial health officials announced three weeks ago that several overdose prevention sites would open in Vancouver, Surrey and Victoria. People can go inside the sites to inject drugs, and are given first aid if they overdose.

An unofficial safe consumption site located in the alley behind the Downtown Eastside Market off East Hastings Street.

Health officials have insisted the sites are temporary and are not supervised injection sites, which are currently difficult to open because of a strict Conservative-era law that current federal health minister Jane Philpott has promised to change.

If there is any good news to be found within the grim statistics, it is that no deaths have occurred at any of those overdose prevention sites. And no one has died at a volunteer-run tent that has been operating since September, without official permission or government funding, out of an alley in the heart of the Downtown Eastside. People can smoke or snort drugs at that site, not just inject.

“We’re pretty steady, we get about 100 people a day,” said Sarah Blyth, the Downtown Eastside market coordinator and one of the organizers of the tent. “We’re coming up to welfare (day)…it’s happening this Wednesday, so I imagine up until Christmas it’s going to be pretty busy.”

A sign on the front door of VANDU’s storefront at 380 E. Hastings advertises that the location is an overdose prevention site, with volunteers trained in first aid

“A lot of people use during Christmas,” Blyth added. “Not everybody’s Christmas is as happy as others.”  At the Vancouver Area Network of Drug Users storefront further down East Hastings Street, Linda Bird confirmed the overdose prevention site located there has been busy, with around 60 people a day passing through. Volunteers, who are paid a small stipend by Vancouver Coastal Health, work two to four hour shifts. Overdoses are common, small stipend by Vancouver Coastal Health, work two to four hour shifts. Overdoses are a small stipend by Vancouver Coastal Health, work two to four hour shifts. Overdoses are common, Bird said.

“A lot of them are taking this very, very seriously,” Bird said of the volunteers. “It’s a crisis and a lot of them have seen their friends dropping.”

Vancouver Coastal Health has announced a fourth overdose prevention site in Vancouver, while Fraser Health has added more sites in Langley, Abbotsford and Maple Ridge.

Overdose deaths in November were nearly double the number seen in October

Health authorities in the Interior, Vancouver Island and the north are also planning to open sites in the future, said Perry Kendall, B.C.’s health officer.  “We’re still struggling in many communities with the idea of having these (overdose prevention) sites open,” Kendall said. “That doesn’t help.”

He urged the federal government to introduce the new legislation as soon as possible.

“You must use (drugs) in the presence of somebody who can help you,” Lapointe emphasized. “We are seeing people die with a naloxone kit open beside them, but they haven’t even had time to use it. We are seeing people die with a needle in their arm or a tablet nearby…You must go somewhere where someone is able to give you immediate medical assistance.”

Source:  http://www.metronews.ca/news/vancouver/2016/12/19/bc-drug-deaths

Filed under: Addiction,Addiction (Papers),Canada,Social Affairs (Papers) :

Utah, more than other area of the nation, is suffering from a silent epidemic.  From 2000 to 2014, Utah has experienced a nearly 400% increase in deaths from the misuse and abuse of prescription drugs. Each month there are 24 individuals who die from prescription drug overdoses.

What can we do to help alleviate this growing epidemic? Constant education of the public is essential to prevent drug and alcohol abuse. There is great danger in legal prescription medications and illicit drugs.

What is addiction? As defined by the American Society of Addiction Medicine: “Addiction is a biological, psychological, social and spiritual illness.”   We are learning more and more that opioids now kill more young adults than alcohol. Yet, these deaths are preventable.

Addictionologist, Dr. Sean A. Ponce, M.D., at Salt Lake Behavioral Health Hospital is an advocate of prevention and clinical expert in the treatment of addiction.    Dr. Ponce relates having cancer to that of drug or alcohol addiction. “For cancer, we want to know the prognosis, how far it’s spread… we want to hear the word remission.  Do we talk about that with addiction?”

He goes onto say, “Addiction is a disease that can also spread.  It is a disease that can be mild, moderate or severe.  We want to put it into remission. When cancer reoccurs everyone rallies around that patient to help. When addiction reoccurs what happens?  We send a mixed message.  It is also a disease and we need to be able to help.”

Dr. Ponce also tells us that, “Surviving isn’t really a way to live.  Thriving is.”

Intermountain Health Care recently kicked off a prescription opioid misuse awareness campaign with new artwork in the main lobby of McKay-Dee Hospital including a chandelier built entirely of pill bottles.

This artwork highlights the hospital’s efforts to raise awareness about prescription opioid misuse and represents the 7,000 opioid prescriptions filled each day in Utah. It’s aim: to inform visitors that the risk of opioid addiction “hangs over everyone.”

The campaign’s partners include: Bonneville Communities That Care, Weber Human Services, Use Only as Directed, and Intermountain’s Community Benefit team.

There are also several elevator doors, in McKay Dee Hospital, covered with warnings against opioid use. It definitely sends a strong message to stop and think about the dangers involved.

As previously mentioned, Salt Lake Behavioral Health is a private, freestanding psychiatric hospital specializing in mental health and substance abuse treatment.

You may use this link to learn more about how to help prevent the spread of this deadly epidemic.   www.saltlakebehavioralhealth.com

Source:  http://www.sentinelnews.net/article/3-3-2017/education-key-prevention-alcohol-and-drug-abuse

Filed under: Addiction,Health,Prescription Drugs,Prevention and Intervention :

(Comment by NDPA:  Some shocking figures from the USA in this article)

In 1964 the Surgeon General’s report on smoking and health began a movement to shine the bright light on cigarette smoking and dramatically change individual and societal views. Today, most states ban smoking in public spaces.

Most of us avoid private smoky places and sadly watch as the die-hard huddle 15 feet from the entrance on rainy, snowy or frigid coffee breaks. Employers often charge higher health insurance premiums to employees who smoke, and taxes on cigarettes are nearly triple a gallon of gas. Yet, some heralded progressive states have passed referendums to legalize the recreational use of a different smoked drug.

Now, more than 50 years later, another very profound statement has been made in the introduction to the recent report, “Substance misuse is one of the critical public health problems of our time.”

“Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health,” was released in November 2016 and is considered to hold the same landmark status as that report from 1964. And maybe, just maybe, it will have the same impact.

Many key findings are included that are critical to garnering support in the health care and substance abuse treatment fields. But the facts are just as important for the general public to know:

— In 2015, substance use disorders affected 20.8 million Americans — almost 8 percent of the adolescent and adult population. That number is similar to the number of people who suffer from diabetes, and more than 1.5 times the annual prevalence of all cancers combined (14 million).

— 12.5 million Americans reported misusing prescription pain relievers in the past year.

— 78 people die every day in the United States from an opioid overdose, nearly quadruple the number in 1999.

— We have treatments we know are effective, yet only 1 in 5 people who currently need treatment for opioid use disorders is actually receiving it.

— It is estimated that the yearly economic impact of misuse and substance use disorders is $249 billion for alcohol misuse and alcohol use disorders and $193 billion for illicit drug use and drug use disorders ($442 billion total).

— Many more people now die from alcohol and drug overdoses each year than are killed in automobile accidents.

— The opioid crisis is fuelling this trend with nearly 30,000 people dying due to an overdose on heroin or prescription opioids in 2014. An additional roughly 20,000 people died as a result of an unintentional overdose of alcohol, cocaine or non-opioid prescription drugs.

Our community has witnessed many of these issues first hand, specifically the impact of the heroin epidemic. The recent Winnebago County Coroner’s report indicated that of 96

overdose deaths in 2016, 42 were a result of heroin, and 23 from a combination of heroin and cocaine.

We know that addiction is a complex brain disease, and that treatment is effective. It can manage symptoms of substance use disorders and prevent relapse. More than 25 million individuals are in recovery and living healthy, productive lives. I, myself, know many. Most of us do.

Locally, the disease of addiction hits very close to many of us. I’ve had the privilege of being part of Rosecrance for over four decades, and I have seen the struggle for individuals and families — the triumphs and the tragedies. Seldom does a client come to us voluntarily and without others who are suffering with them. Through research and evidence-based practices at Rosecrance, I have witnessed the miracle of recovery on a daily basis. Treatment works!

If you believe you need help, or know someone who does, seek help.  Now. Source: http://www.rrstar.com/opinion/20170304/my-view-addiction-is-public-health-issue-treatment-works.  4th March 2017

Filed under: Addiction,Health,Nicotine,Prevention and Intervention,Treatment and Addiction :

In this pilot study:

* Patients who received transcranial magnetic stimulation (TMS) were more likely to abstain from cocaine than patients who received medications for symptoms associated with abstinence.

* Researchers concluded that TMS appears to be safe and its efficacy as a treatment for cocaine addiction deserves to be evaluated in a larger clinical trial.

Transcranial magnetic stimulation (TMS) projects electromagnetic fields into the brain and can be used to either increase or decrease neuronal responsiveness in targeted brain areas. Researchers have hypothesized that administering TMS to strengthen activity in the prefrontal cortex (PFC) and downstream brain regions can alleviate cocaine addiction (see Narrative of Discovery: Can Magnets Treat Cocaine Addiction?). Previous findings that support the hypothesis include:

* Studies in animals and people have demonstrated that exposure to cocaine weakens neuronal activity in the PFC, and have linked that decreased activity to some of the primary manifestations of addiction, such as craving and compulsive drug-seeking.

* In a recent study, rats stopped seeking cocaine after researchers experimentally increased activity levels in their prelimbic cortex, a sub region of the rat cortex that shares functional similarities with the human dorsolateral PFC (see Prefrontal Cortex Stimulation Stops Compulsive Drug Seeking in Rats).

Figure. Patients Receiving TMS for Cocaine Addiction Achieve Higher Rates of Abstinence During a 21-day assessment period, higher proportions of TMS-receiving patients than of control patients always gave urine samples that tested negative for cocaine. At completion of the assessment period, 69 percent of those treated with TMS had been continuously abstinent from cocaine versus 19 percent of control patients.

A new pilot trial sets the stage for testing the hypothesis definitively in a large-scale placebo-controlled clinical trial. In the trial, Dr. Antonello Bonci of NIDA’s Intramural Research Program, Dr. Alberto Terraneo, Dr. Luigi Gallimberti and colleagues in Italy and the United States, administered a 29-day course of TMS to 16 patients in an outpatient clinic in Padua, Italy. Of the 16, 11 (69 percent) produced 6 cocaine-negative urine samples, and no positive samples, during a 21-day assessment period that started on treatment day 9 (to allow cocaine that the patients had taken before the study to clear their systems) (see Figure). Among a comparison group of 16 patients who received only medications to control symptoms of depression, anxiety, and insomnia, only 3 (19 percent) made it through the assessment period without using cocaine. The TMS-treated patients also reported less craving for cocaine.

In a second phase of the trial, the researchers administered TMS to 10 patients from the original comparison group, 8 of whom had used cocaine during the first phase. Of the

10, 7 (70 percent) then were followed for 63 days post-TMS and achieved abstinence—an outcome nearly identical to that of the patients who received TMS in the first phase.

The researchers have maintained contact with most of the patients in the study. Dr. Bonci says, “While this observation is not part of a rigorous clinical trial follow-up, and should be taken cautiously, the majority of patients who achieved abstinence during the stimulation pilot protocol report that they have maintained that abstinence for more than 2 years. During that time, some patients have requested additional TMS therapy once a week, twice a month, or monthly, and patients can always request additional therapy if they experience cravings. Others report that they have maintained abstinence without additional TMS after the initial set of treatments.”

Aiming and Tuning the Machine

Dr. Terraneo and colleagues’ protocol focuses the TMS electromagnetic field on the left dorsolateral region of the patients’ PFC. Dr. Bonci explains, “This region is accessible and is involved in a number of addiction processes.” In particular, it has been strongly associated with drug craving. In contrast, he adds, “Stimulating the right side can cause anxiety or discomfort in some patients.” (See “A Case for Studying Brain Asymmetry in Drug Use”).

The researchers set the TMS machine to emit magnetic pulses with a frequency of 15 Hz and an amplitude based on each patient’s baseline neuronal responsiveness. The treatment schedule was designed to induce enduring, rather than brief, increases in neuronal responsiveness. Patients underwent TMS on 5 consecutive days during the first study week, then once during each of the remaining 3 study weeks. Each session lasted 13 minutes, during which the patient’s brain was exposed to 2,400 pulses.

Dr. Bonci emphasizes the safety of TMS: “Properly administered, TMS is very safe. The magnetic pulses are much weaker than those generated in an MRI.” Some patients have experienced headaches or pain at the site of stimulation in the first couple of sessions, but, these adverse effects are generally mild and temporary. Dr. Bonci says, “Few medications have such mild side effects.”

The researchers are planning a larger trial with a more rigorous design, which will address some considerations that limit the interpretation of this pilot trial. Because patients’ responses in the pilot trial may have been influenced by knowing whether they were getting TMS or medication, all patients in the new trial will receive either active TMS or sham TMS without knowing which. The new trial will also examine the possibility that TMS helped participants in the pilot trial abstain from cocaine by reducing depression that is experienced by many cocaine users. Dr. Bonci says, “This region [the dorsolateral PFC] has been a TMS target for the treatment of depression for many years.”

“Most likely, TMS should be coupled with behavioral interventions and medication. I would expect a beneficial synergistic effect. Medication may be particularly necessary for difficult cases when TMS alone is not sufficient,” Dr. Bonci adds. Dr. Harold Gordon, of NIDA’s Epidemiology Research Branch, emphasizes the potential clinical advantages of TMS. “A non-pharmaceutical treatment for addiction would be not only cost-effective but patient-friendly in terms of both compliance and convenience.”

Source:Transcranial magnetic stimulation of dorsolateral prefrontal cortex reduces cocaine use: A pilot study. European Neuropsychopharmacology: 2016.  26(1):37-44. Epub 2015 Dec 4. PMD 26655188.

Filed under: Addiction,Cocaine :

The letter below speaks of the heroin epidemic in the USA.  The figure of heroin and opioid addiction that has destroyed countless families and killed more than 50,000 Americans in 2015 alone is salutary.

A chronicle of President Barack Obama’s tenure must include the heroin epidemic that he leaves us with. Our nation is plagued with a systemic heroin and opioid addiction that has destroyed countless families and killed more than 50,000 Americans in 2015 alone. This one-year death toll is greater than the total number of Americans killed in action during the Vietnam War.

The opioid casualty count only tells part of the story. More than half a million Americans admit to being addicted to heroin, and each of them has a very difficult, if not impossible, road to recovery. Yet, heroin flows into our nation every day and is readily available for $5 a bag 24/7 on street corners throughout the cities and suburbs of America.

How was this level of accessibility not reason enough for President Obama to make slowing our porous borders a priority?  Obama, in his final days as president is now becoming more vocal about the epidemic he leaves behind. However, this is too little, too late in the extreme. His record-setting pardoning and lessening of drug dealer sentences, which have included heroin dealers, further erodes his record on the heroin epidemic. Classifying a heroin dealer as a nonviolent criminal in the face of the American opioid death toll is nonsense.

Perhaps Obama was one of the lucky ones that didn’t have a close friend or relative addicted or taken by heroin and he just didn’t notice the plague that took root under his watch.

Robert Cochran Stafford

Source:  http://www.app.com/story/opinion/readers/2017/01/14/letter-obama-legacy-includes-drug-addiction-epidemic/96557686/

Filed under: Addiction,Drug use-various effects,Health,Heroin/Methadone,Political Sector,USA :

ASK THE DOCTOR  column –  – by Dr. Robert Ashley – Erie Times-News, December 30, 2016

Q:  Marijuana seems to be increasingly accepted in our country.  But I worry about my kids using it.  Is it addictive?

A:  Marijuana has gained greater acceptance in this country, not in small part because its medical use can stimulate appetite, control nausea and control pain.  One potential problem with this degree of acceptance is how adolescents view the drug.

In 2015, 70 percent of high school seniors viewed marijuana as not harmful, according to the National Institute on Drug Abuse’s Monitoring the Future survey;  in 1990, only 20 percent felt this way.

Perhaps the biggest risk with marijuana is how it affects the adolescent brain.  The endocannabinoid system, a vast system of receptors within the brain, spinal cord and smaller nerves, affects multiple brain and body functions.  The system continues to develop in humans until the age of 21 or so.

If used frequently in adolescence, marijuana can rewire many of these nerve pathways.  These changes aren’t seen as much in the adult brain and, if they surface, can be easily reversed by stopping use.  In adolescents, however, this rewiring of the nervous system may create addiction.  According to the NIDA, only 9 percent of people who try marijuana become addicted.  However, this number increases to 16 percent among those who start using marijuana in adolescence.  It increases further if marijuana is used daily in adolescence.

Marijuana not only causes short–term memory loss, it also affects mental abilities for days after its use.  That means a person’s ability to plan, organize, solve problems and make decisions is impaired, which has significant ramifications for adolescents trying to retain information learned in school.

Further, for those predisposed to schizophrenia, marijuana can induce psychosis and, in younger users, can decrease the age of schizophrenia’s onset.  People with a familial predisposition to schizophrenia should certainly avoid use.

Send your questions to askthedoctors@mednet.ucla.edu,, or Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles CA  90095.

Filed under: Addiction,Cannabis/Marijuana,Drug use-various effects on foetus, babies, children and youth :

National statistics show 2,367 users aged 18 to 24 sought treatment in 2015-16 as drug becomes increasingly unfashionable.   A total of 149,807 opiate addicts came for treatment in England during 2015-16, down 12% on a peak of 170,032 in 2009-10.

The number of 18 to 24-year-olds in England entering treatment for addiction to heroin has plummeted 79% in 10 years, as the stigma surrounding the drug and changing tastes in intoxication have made it increasingly unfashionable.

In the year to March, 2,367 people from that age group presented with heroin and opiate addiction at the approximately 900 drug treatment services in England, compared with 11,351 10 years earlier, according to statistics from the National Drug Treatment Monitoring System (NDTMS).

They constituted a tiny fraction of the 149,807 opiate addicts who came for help to kick their habit throughout the year, a number that is itself 12% down on a peak of 170,032 who came for treatment in 2009-10. The median age of those users was 39, the statistics showed.  Michael Linnell, the coordinator of UK DrugWatch, a network of drug treatment professionals, said many of the heroin users currently accessing treatment would have become addicted during a boom in the drug’s popularity in the late 1980s. Young addicts were “as rare as hen’s teeth”, he said.

Our neglect of ageing heroin users has fuelled the rise of drug-related deaths

“For the Thatcher generation who didn’t see a future and there were no jobs or employment and the rest of it, it was an alternative lifestyle in that you were really, really busy being a heroin user: getting up, scoring, nicking stuff to get the money to score and the rest of it,” Linnell said.

“There was a whole series of factors until you got to that point where people from those communities – the poorest communities – where you were likely to get heroin users, could see the visible stigma of the scarecrow effect, as some people called it.

“They didn’t want to aspire to be a heroin user because a heroin user just had negative connotations, rather than someone who was rebelling against something.”

Overall, 288,843 adults aged 18 to 99 came into contact with structured treatment for drug addiction during 2015-16, 52% of whom were addicted to heroin or some other opiate. Among opiate addicts, 41% were also addicted to crack cocaine, with the next highest adjunctive drugs being alcohol (21%) and cannabis (19%).

About half of those presenting to treatment – 144,908 – had problems with alcohol, a fall of 4% compared with the previous year. Among those, 85,035 were treated for alcohol treatment only and 59,873 for alcohol problems alongside other substances.

The most problematic drug among the 13,231 under-25s who came into contact with drug treatment services in the past year was cannabis, which was cited as a problem by 54%, followed by alcohol (44%) and cocaine (24%).

The numbers from this age group accessing treatment had fallen 37% in 10 years, which the Public Health England report accompanying the statistics said reflected shifts in the patterns of drinking and drug use over that time, with far fewer young people experimenting with drugs than in the past.  Karen Tyrell, the spokeswoman for the drug treatment charity Addaction, said the decline in problem drug use among young people reflected what drugs workers see on a daily basis, and credited evidence-based education, prevention and early intervention programmes for the change.

The shift, though, was precarious, Tyrell said, warning that yearly spending cuts to treatment services risked reversing the gains.

She added: “Of course, what this also means is that we have an ageing population of heroin users, many of whom have been using since the 80s or 90s, and who are now dealing with poor physical health and increasing vulnerability. In an environment of ever rising drug-related deaths, it’s imperative we don’t lose sight of their needs.”

Source:  https://www.theguardian.com/society/2016/nov/03/

Filed under: Addiction,Heroin/Methadone,Social Affairs,Treatment and Addiction,Youth :

If Marijuana is Medicine, How Come it Makes People So Sick?

There’s a great irony that comes from the pot industry’s claims that marijuana is medical and it’s supposed to help with nausea.   It’s called Cannabis Hyperemesis, and it hits with a vengeance.

This past week a parent wrote to PopPot, saying: “Parents should watch for red flags of pot use in their children including frequent, long hot showers; weight loss; unexplained nausea and vomiting.”

“I took my teen to the doctor assuming the stress of a rigorous course load combined with the demands of an after school sport were taking a physical toll on my child, ” the mom wrote.  “In hindsight, these were the signs of escalating pot use as described in this Pub Med article about cannabinoid hyperemesis. Unfortunately many in the medical community are ignorant of the detrimental effects of pot use on our young people —  ranging from psychotic breaks to debilitating gastrointestinal symptoms.”

From another mother in Pueblo, Colorado who also wrote this past week:  “Last week I met a 14-year-old girl suffering from Cannabis Hyperemesis Syndrome.  When I met her, at first I thought she had an addiction to meth because she was so very thin and malnourished.  She was asking me how can she return to live with her parents who are marijuana users when marijuana is so toxic for her.”

Incidences of this severe illness appear to be on the rise since the rollout of legal weed.  The high THC content of today’s weed — 5x the amount in the 1980s — seems to be involved also.  Because of misdiagnosis or denial of drug use by patients, this syndrome is going undetected.  Furthermore, users self-medicate and exacerbate this severe illness, as a medical marijuana patient was doing for more than eight months.

From veterans hospitals to addiction specialists as well as gastroenterologists, there’s suddenly an increased interest in and diagnoses of this condition.  Further research into this mysterious illness turns up numerous medical journal articles on the link between excessive and/or long-term cannabis use and hyperemesis.

Cannabis Hyperemesis: How to Know if You or Someone You Love is Afflicted

This syndrome is still largely unknown throughout the medical profession and even among cannabis users. The most prominent cases are among long-term users that started using the drug at a very early age and have used daily for over 10 years, according to the MedScape article, Emerging Role of Chronic Cannabis Use and Hyperemesis Syndrome. The article goes on to say that it can also effect newer users and even non-daily users.

In Practical Gastroenterology, there’s a case of a 19 year old Hispanic man who contracted the problem within only two years of marijuana use.  Symptoms reported in a Current Psychiatry article include cyclic vomiting, abdominal pain, nausea, gastric pain and compulsive hot bathing or showers to ease pain.  Frequent bathing and vomiting can also lead to dehydration and excessive thirst. Mild fever, weight loss, and a drop in blood pressure upon standing are other symptoms.

Sufferers find they need to take many showers or baths a day just to get relief from the chronic nausea and vomiting. The bouts of illness are so severe and frightening they lead to frequent trips to the emergency room. And finally, this debilitating illness can be very disruptive to life and relationships. The many absences from work lead to job loss and the inability to hold down a job.

Parents may mistake this situation as bulimia, particularly if the teens hide the vomiting.  Another common way this disease is misdiagnosed as cyclic vomiting syndrome. According to the Current Psychiatry article, 50% of those diagnosed with CVS are daily cannabis users.  Another common misreading by doctors of the compulsive habit of frequent hot baths is as Obsessive Compulsive Disorder.

Further complicating matters, doctors find that even when cannabis use is consistent, the bouts of hyperemesis come and go, which further serves to keep the patient in denial about the connection to their drug use.

In Spite of Cannabis Hyperemesis, Addiction is a Stronghold

Complete cessation of marijuana use is the only known cure for Cannabis Hyperemesis Syndrome.

Sadly, even those who have greatly suffered over a long period of time, still want to be able to consume marijuana. The claim by the industry that marijuana is not addictive is easily disproved when you see the comments to a High Times article, What is Cannabinoid Hyperemesis Syndrome?  Not only do many commenters admit they suffer from this detrimental effect of this drug, they confess they still love marijuana. The commenters lament having to give up their stoner lifestyle even after years of disabling illness! A number of them state that once they are well, they plan to return to the habit, albeit to a lesser degree.

Source:  http://www.poppot.org/2016/11/19/cannabis-hyperemesis-toxic-side-effect-of-dangerous-drug/   19th Nov. 2016

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Filed under: Addiction,Drug use-various effects,Effects of Drugs,Health :

Teens who take opioid painkillers without a prescription also often use cannabis, according to a new study.

Researchers analyzed information from more than 11,000 children and teens ages 10 to 18, in 10 U.S. cities. Participants were asked whether they had used prescription opioids in the past 30 days, and whether they had ever used cannabis.

Overall, about 29 percent of the teens said they had used cannabis at some point in their lives. But among the 524 participants who said they had used prescription opioids in the past 30 days, nearly 80 percent had used cannabis. The findings show that among young opioid users, the prevalence of cannabis use is high, said Vicki Osborne, a doctoral student in epidemiology at the University of Florida. Osborne presented the study Oct. 31 at the meeting of the American Public Health Association in Denver.

Among teens who said they used opioids without a prescription (meaning they obtained the drugs through a friend, family member or other avenue), about 88 percent had used cannabis, compared with 61 percent of those who did have a prescription for the opioids they used.

The study also found that the teens who reported having used alcohol or tobacco in addition to opioids were much more likely to use cannabis as well. Of the participants who had used opioids, those who also reported recent alcohol use were nearly 10 times more likely to have used cannabis, compared with those who didn’t use alcohol recently. And those who currently smoked tobacco were 24 times more likely to have used cannabis than those who were not tobacco users, the study found.

Efforts to prevent young people who use opioid painkillers from also using cannabis should target those who use alcohol and tobacco, Osborne said. Efforts should also target males, who were more likely to report using cannabis than females were, she said.

Interventions should also target young people who use opioids without a prescription, Osborne said. Even though such use of opioids among youth is not as high as it is among adults, the proportion of youth using opioids without a prescription is still concerning, she said.

The researchers plan to study the data further, and look at when young people start using cannabis versus when they start using opioids, Osborne said. Previous studies have found that legalizing medical marijuana actually appears to lead to a reduction in opioid use among adults. However, Osborne said the new findings among youth may be different from those in adults, because even in states that have legalized the use of marijuana, the drug is still illegal for teens to use.

Source:  http://www.livescience.com/56784-teen-opioid-cannabis-use.html  7 Nov16

Filed under: Addiction,Cannabis/Marijuana,Drug use-various effects on foetus, babies, children and youth,Prescription Drugs :

There is renewed interest in the role of sex or gender in drug use. Two recent publications stand out, the first is an editorial from the journal of Addiction which argues that females have been under represented in many disciplines including addiction research (Del Boca, 2016). This not only impacts on females but may have implications for males. For example, men may be more stigmatised or viewed as vulnerable to drug related problems as a consequence of research attention and reporting. In effect, both groups have been disadvantaged by this phenomenon.

The second article from the sister publication (Addiction Biology) explores the differences and similarities between the sexes in relation to starting drug use and the risk of developing problems (Sanchis-Segura et al, 2016). As the journal title implies this is through a more biological lens with a brief nod to other factors. They conclude that it is important to report sex sameness as well as sex differences in research findings. Highlighting the lack of any attention given to reporting of sex in some studies.

The recent attention given to such a basic factor reveals the state of our collective knowledge about who is at risk of developing problems as a result of drug use. To be blunt, we know very little. So it is good to see that our ignorance is being acknowledged in the academic literature.

How has this happened?

It seems staggering that we have ignored this very basic variable in addiction research. Is it deliberate, or accidental?

In some ways it has been deliberate as it is more convenient to recruit participants from treatment settings. Unfortunately these settings tend to have more men. But that shouldn’t be interpreted as men necessarily having a greater need than women for treatment. This phenomenon needs greater scrutiny as it may be that females avoid treatment fearing that there will be consequences for their role as a mother (Lott-Lavigna 2016). Also it is possible that they perceive treatment to be dominated by males and not an environment they would feel safe in (Torrence, J 2016).

So we need to consider how females start their journey into a career of problematic drug use and how this progresses. As it stands, if we carry on recruiting research participants via treatment settings we will perpetuate a tradition that has left us ignorant of the female journey.

Cannabis and psychosis

Whether male or female, millions worldwide use cannabis. So it is important to understand and communicate the risks to mental health of using the drug. But this is an area that exemplifies the problems we have as a result of not attending to sex.

Cannabis use has been associated with psychosis for some time, but has there been equal attention given to the sexes? In short no, the seminal study by Andreasson of Swedish conscripts included no females, this study has been hugely influential in research, cited more than 1,000 times by research that followed its publication in 1987 (Andreasson et al, 1987).

Unfortunately this trend in over sampling of males has continued since this point; the only Medical Research Council funded trial in the United Kingdom on this issue included a sample of over 80% of males (Barrowclough et al, 2010).

Yet there are only twice as many men admitted to hospital with psychosis and schizophrenia as women. This potentially distorts the attention given to males and certainly limits the intelligence we gather about females (Hamilton et al 2015).

One of the few studies that does provide some information about gender differences and the risks of developing cannabis psychosis found a risk ratio of 2.6 males to every female, although this was based on data from the late 1990s. This matters as cannabis potency has changed over time, which might also increase the risk of developing psychosis for both sexes.

Sex matters

All this matters as research informs treatment, policy and commissioning of services. If we ignore females in research it is likely this has a consequence for the way mental health and addiction treatment is organised and delivered. But most importantly, it leaves men and women with inadequate information on the potential risks of using substances.

Research needs to look beyond the treatment setting, challenging as this might be, there is a pressing need for equality.

Source: http://www.nationalelfservice.net/mental-health/   21st Sept.2016

Filed under: Addiction,Social Affairs :

Highlights

* •Motives for cannabis use can predict problematic use and use-related problems.

* •A MET/CBT intervention was associated with significant reductions in motives.

* •Reductions in a subset of motives significantly predicted change in outcomes.

Abstract

Background

Heavy cannabis use has been associated with negative outcomes, particularly among individuals who begin use in adolescence. Motives for cannabis use can predict frequency of use and negative use-related problems. The purpose of the current study was to assess change in motives following a motivational enhancement therapy (MET) and cognitive behavioral therapy (CBT) intervention for adolescent users and assess whether change in motives was associated with change in use and self-reported problems negative consequences.

Methods

Participants (n = 252) were non-treatment seeking high school student cannabis users. All participants received two sessions of MET and had check-ins scheduled at 4, 7, and 10 months. Participants were randomized to either a motivational check-in condition or an assessment-only check-in. Participants in both conditions had the option of attending additional CBT sessions. Cannabis use frequency, negative consequences, and motives were assessed at baseline and at 6, 9, 12, and 15 month follow-ups.

Results

There were significant reductions in motives for use following the intervention and reductions in a subset of motives significantly and uniquely predicted change in problematic outcomes beyond current cannabis use frequency. Change in motives was significantly higher among those who utilized the optional CBT sessions.

Conclusions

This study demonstrates that motives can change over the course of treatment and that this change in motives is associated with reductions in use and problematic outcomes. Targeting specific motives in future interventions may improve treatment outcomes.

Source: http://www.drugandalcoholdependence.com/article   1st October 2016

Filed under: Addiction,Cannabis/Marijuana,Treatment and Addiction,Youth :

New research from the Icahn School of Medicine at Mount Sinai using electroencephalography, or EEG, indicates that adults addicted to cocaine may be increasingly vulnerable to relapse from day two to one month of abstinence and most vulnerable between one and six months. The findings, published online today in JAMA Psychiatry, suggest that the most intense periods of craving for illicit substances often coincide with patients’ release from addiction treatment programs and facilities.

It is not known why individuals with substance use disorders relapse even after remaining abstinent from illicit substances for long periods of time. However, it is clear that cue-induced craving—craving elicited by the exposure to cues previously associated with drug use—plays a major role in relapse. Until now, studies have used self-reported measures to assess cue-induced craving. This is the first study that uses EEG to quantify cue-induced craving in humans with cocaine use disorder, showing a similar trajectory of craving demonstrated in previous studies using animal models. In this study and in contrast to the EEG measures, self-reported craving showed a gradual decline with increasing abstinence duration, underscoring a potential disconnect between the physiological response to drug-related cues in addicted individuals and their perception of this response.

“Our results are important because they identify an objectively ascertained period of high vulnerability to relapse,” says Muhammad Parvaz, PhD, Assistant Professor of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, and the study’s lead author. “Unfortunately, this period of vulnerability coincides with the window of discharge from most treatment programs, perhaps increasing a person’s propensity to relapse.”

Over five and a half years, the research team collected data from EEG recordings in 76 adults addicted to cocaine with varying durations of abstinence (two days, one week, one month, six months, and one year). EEG was recorded while participants looked at different types of pictures, including pictures that depicted cocaine and individuals preparing, using, and simulating use of cocaine. After EEG, participants also self-rated their level of craving for each cocaine-related picture.

“Results of this study are alarming in that they suggest that many people struggling with drug addiction are being released from treatment programs at the time they need the most support,” said Rita Goldstein, PhD, Professor of Psychiatry and Neuroscience at the Icahn School of Medicine and Principal Investigator of the study. “Our results could help guide the implementation of alternative, individually tailored and optimally timed intervention, prevention, and treatment strategies.”

Source:  http://img.medicalxpress.com/newman/gfx/news/hires/2015/cocaine.jpg  7th Sept.2016

Filed under: Addiction,Brain and Behaviour,Cocaine,Drug use-various effects :

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

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

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

Sound familiar?

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

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

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

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

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

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

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

Source:    

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

Filed under: Addiction,Brain and Behaviour,Effects of Drugs :
leonard-nimoy-5774458356-1-bynimoy

Photo:Gage Skidmore/Wikimedia Commons*

 “Live long and prosper.” The Vulcan salute is immediately identifiable with the actor Leonard Nimoy  and his most famous character, Mr. Spock. The  beloved cultural icon was admired for his sterling character on Star Trek and off-screen as well. In  recent years and up until his last few months, while  suffering the debilitating effects of a respiratory illness, he took steps to ensure that others would indeed “live long and prosper” by speaking clearly about the role that smoking played in the illness that caused his death.

Nimoy started smoking, like many, when he was young. He managed to quit more than 30 years before his death, but not early enough to prevent the respiratory disease that took his life late February. Nimoy took great pains to show us that cigarettes are a deadly addiction – encouraging followers on Twitter to quit or never start. While he was just one of the 480,000 people in the U.S. who will die prematurely from tobacco-related diseases in 2015, he will surely be among the most well-known and widely missed by an admiring public. That makes the steps took to tell his story so vital.

Tobacco is one of the toughest addictions to overcome and by far the most deadly product available. About 14 million major medical conditions in the U.S. can be blamed on smoking. Yet, despite that inescapable fact, more than 42 million Americans still smoke.

And it isn’t just smoking. Smokeless tobacco products, like those used by sports legend,Tony Gwynn, and other professional baseball players, are linked to oral cancer and other illnesses. Like Nimoy, Gwynn was outspoken before his death last year in naming chewing tobacco as the cause of his cancer. His efforts to speak the truth give meaning to the efforts of a coalition working to eliminate tobacco consumption on and around American baseball fields. Knock Tobacco Out of the Park will succeed, in part, because icons like Gwynn and Nimoy shared their stories and demonstrated the painful cost of tobacco-related illness.

The glamour and appeal of smoking and the power of nicotine addiction are forces that we work to counter every day at Legacy. Even that first cigarette does damage to your body and can spur a life-long addiction and struggle. Nimoy could not imagine what would happen to him five decades after he smoked his first cigarette. By sharing his story, he may help other smokers comprehend the illness and death that lie in wait for them.

As fans remember Leonard Nimoy and Tony Gwynn for cherished memories and contributions to our shared culture, we celebrate them as ambassadors of truth and of knowledge in the fight to build a future where illness and death, caused by the use of tobacco, are things of the past.

Source: www.drugfree.org 18th March 2015

Filed under: Addiction,Drug use-various effects,Health,Nicotine :

A few years ago Dr. Diana Martinez and Dr. Marco Diana decided to investigate a new technology that uses magnetic pulses to stimulate brain cells. Both had been trying to develop medications to treat cocaine addiction, and both had come to feel that the pace of progress—their own and others’—was unequal to the urgency of the need. In the new technology, transcranial brain stimulation (TMS), they saw a potential treatment that might be developed relatively rapidly for clinical use.

Dr. Martinez, a neuroimaging specialist at Columbia University Health Center in New York City, planned a preclinical study. She was using a relatively new type of TMS coil (magnetic pulse generator), and her first objective was to identify machine settings with potential clinical efficacy.

Participants in her study were cocaine users who did not want to stop. They came into the hospital research unit, and attended a self-administration session in which they repeatedly chose between smoking a dose of the drug and receiving a sum of money. They then underwent TMS for 3 weeks, after which they repeated the self-administration session. If they chose cocaine less often after treatment than they had before, the setting that was used would be a good candidate for further testing.

Dr. Diana, a research pharmacologist at the University of Sassari, Italy, designed a pilot clinical trial. Sixty people who were trying to quit cocaine would receive TMS, real or sham, every other day for a month. Dr. Diana would assess their cocaine use though interviews and hair analysis before they started TMS, at the end of the treatment month, and every 3 months thereafter for a year. He hoped that the patients who received real TMS would reduce their cocaine use.

Both researchers’ projects hit snags early on. In this installment, we follow Dr. Martinez as she resolves an initial impasse and advances her project to a new stage. Meanwhile, circumstances close in on Dr. Diana. He is forced to cut short his trial, but comes away with encouraging data and increased enthusiasm for TMS.

Frequency and Intensity

The first TMS settings Dr. Martinez tested appeared to reduce cocaine intake among participants who completed the course of treatment. However, only one third completed the course. The rest complained of pain and anxiety during their first treatment session, and refused to continue.

Dr. Martinez adjusted one of her settings to try to prevent patient dropout. Reducing the magnetic pulse frequency from 10 Hz to 1 Hz abolished the aversive responses, but also the reductions in cocaine use.

Dr. Martinez considered testing an intermediate frequency. In the end, she decided to look for a way to make 10 Hz more tolerable. She says, “If you look at the literature on TMS in psychiatric disorders, there’s a strong rationale for using 10 Hz, or even 15 or 20 Hz.”

She asked herself why so many participants hadn’t tolerated TMS at 10 Hz, when many other researchers had used it without problems. Of several possible explanations, one stood out: Cocaine users tend to have exceptionally high motor thresholds.

Dr. Martinez explains, “A person’s motor threshold is the lowest TMS intensity that will stimulate his or her motor neurons to fire and contract a muscle. The TMS technician ascertains the motor threshold to determine how much stimulus to apply in treatment. If the stimulus is strong enough to activate motor neurons, it’s presumably enough to activate neurons in other cortical areas as well.”

To ascertain the motor threshold, the technician directs the TMS pulse at an area of motor cortex that controls a muscle, for example a hand or calf muscle. The technician delivers a pulse at a low intensity setting, then dials the intensity up in small steps until the target muscle twitches. The twitch gives visible proof that motor neurons have fired.

Dr. Martinez says, “The motor thresholds of the cocaine users in our study were in the range of 80 percent to 84 percent of the power output of our TMS coil. That’s higher than the thresholds that have been recorded in other studies with coils of this type. It’s also been reported in the literature that cocaine users have high motor thresholds.”

Because of their high motor thresholds, Dr. Martinez’ study participants received exceptional amounts of stimulation during the ascertainment procedure. She says, “We had to keep turning up the intensity of the stimulus, and it would often take us a good 40 minutes to work up to the threshold.” Maybe, she thought, so much stimulation during the ascertainment, plus the additional stimulation applied during treatment, hyper-excited neurons in a way that caused pain and alarm.

Dr. Martinez tested her conjecture on herself. She recounts, “When we first started working with TMS, I was curious about the experience, so I went under the coil to ascertain my motor threshold. I found out that, like cocaine users, I tend to have a higher threshold than the average person. During the ascertainment procedure I developed a headache and some other mild symptoms, but nothing too unpleasant. Now I decided to see how I would feel if I underwent what our study participants were getting—motor threshold ascertainment followed by a 10-Hz treatment. I was miserable.”

Tweak and Succeed

Dr. Martinez considered how she might adjust her study protocol to make TMS at 10 Hz comfortable for cocaine users despite their high motor thresholds. She could obtain no guidance from colleagues or the scientific literature, because no one had ever before used the specific TMS coil she was using, called the H coil, with cocaine users.

Dr. Martinez turned for advice to Dr. Abraham Zangen, of Ben-Gurion University of the Negev, in Israel, a researcher and developer of the H coil. Brainstorming together, the two came up with two adjustments:

* Dr. Martinez had been administering TMS treatment directly after motor threshold ascertainment. Going forward, she would separate the two:  ascertain the motor threshold in the morning and deliver treatment in the afternoon. Doing so would spread the stimulation over a longer time.

* She would lower the intensity of the TMS treatment. Dr. Zangen had been using the H coil to treat patients with obsessive compulsive disease, and had found that intensities lower than the motor threshold could be effective.

Dr. Martinez says that when she returned to the TMS laboratory, “We weren’t sure that these adjustments would work. We were nervous. And the participants picked up on our unease. They were looking at us like, ‘Why are you nervous?'” The adjustments worked (see Figure). Participants no longer reported pain, and most now stayed on to complete the treatment. A further protocol adjustment—spreading motor threshold ascertainment over 4 days—further increased the completion rate.

Dr. Martinez says, “These adjustments to our protocol give people time to acclimate to the stimulation. We’ve seen that TMS definitely gets less painful over time.”

With the amended protocol, Dr. Martinez quickly reached her goal of treating 6 participants with TMS at 10 Hz. These patients reduced their choices for cocaine, from about 5.5 before the treatment to 2.2 after it. No changes in the choice for cocaine were seen in the groups that received sham or low-frequency TMS.

Dr. Martinez says, “I must thank Dr. Zangen, who spent a lot of time discussing ways to fix my protocol. I’m also grateful to Brainsway Corporation, makers of the H coil, who have a real interest in treating addiction, and provided me with the equipment to do this work.”

Judging that she had enough evidence that her TMS protocol was efficacious to warrant a pilot clinical trial, Dr. Martinez began to prepare a grant proposal. In the next installment of this Narrative of Discovery, we’ll follow Dr. Martinez into this next stage of her project.

Figure. TMS Frequency and Intensity Settings Determine Efficacy and Tolerability In Dr. Martinez’ study, participants who completed a course of TMS with a frequency of 10 hertz (Hz, pulses per second) (A) reduced their cocaine use, but many found the treatment intolerable. Participants tolerated TMS with a frequency of 1 Hz well (B), but did not reduce their cocaine use. Dr. Martinez adjusted the schedule of her TMS protocol and tried 10 Hz again, this time with success. For her final settings, she also lowered the TMS pulse intensity (amplitude) from 120 percent of motor threshold to 110 percent of motor threshold (C).

Bad News

Dr. Diana’s recruitment effort ran into a deep fund of suspicion. When Dr. Diana showed potential trial participants the TMS machine and explained its purpose, many accused him of intending to subject them to electroshock. Some declined to participate. In 2 years, he enrolled only 20 patients.

In mid-2015, Dr. Diana applied to the Italian Department of Anti-Drug Policies for an extension of his funding for the project. Weeks, then months, passed with no response. Dr. Diana’s remaining funds from the past year dwindled. In July, he stopped recruiting patients because he was out of money to pay the laboratory to test hair samples for cocaine metabolites. He continued to provide his existing patients with psychological support and ask them about their cocaine use. Without biological confirmation, however, the scientific community would accord less weight to his patients’ self-reports.

“Finally, in November, the Agency was forced to respond because I was making thousands of phone calls,” Dr. Diana says. “I reminded them that we knew from the start this was going to be a 3-year project. It would be a shame not to finish, because we had encouraging preliminary findings. They told me, ‘Look, we wish you all the luck you certainly deserve, but we don’t have money to give you.”

Striking the Tent

Unable to continue his study, Dr. Diana set out to reap what he could from his years of work.  He had administered real or sham TMS to 19 patients, far short of the 60 he needed to establish that his TMS approach was effective. “I can’t do any statistics on such a small number and hope to persuade my colleagues that our findings are predictive,” he says.

Nevertheless, Dr. Diana says, “We didn’t have any choice. We had to either analyze our data and see what was there or just throw everything out.” Although he could prove nothing with results from so few patients, at least he would find out if their outcomes were consistent with TMS being effective. If they were, his work might inspire others to try TMS.

The outcomes were indeed consistent. Patients in both the TMS- and sham-treated groups were using less cocaine 1 and 3 months after starting the treatment. The difference in the amount of reductions was not statistically significant, but a significant difference emerged at the 6-month follow-up. At that time, the patients in the TMS-treated groups were using about 70 percent less cocaine than they had before starting the trial, and the sham-treated group about 45 percent less.

In addition, Dr. Diana says, “The study participants commonly reported that their mood was much better. They were more comfortable with life. They didn’t feel overwhelmed with guilt. Their anxiety levels went down significantly after the treatment. Some also described regularization of sleep, with better circadian rhythms.”

For Dr. Diana, the persisting effect of TMS past 6 months hints that his most ambitious hope for TMS may pan out:  The treatment may not just temporarily remit cocaine addiction, but actually restore the patient’s brain to a pre-addicted state (see “Can Neurons Be Reeducated?”).

Enthused and wishing to share his findings, Dr. Diana wrote a report to submit for publication. He knew the chances were slim that a journal would accept it. As of this writing, one journal has turned down the manuscript, and Dr. Diana awaits a decision from a second journal. (Update: In July 2016, Dr. Diana’s manuscript was accepted for publication in the journal Frontiers in Psychiatry−Addictive Disorders.)

Lessons and Plans

Dr. Diana sees his loss of funding in perspective. He notes that Italy is experiencing tight economic times and the government has reduced its investment in research: “We have a new prime minister who looks very efficient, very pragmatic. Everybody seems to be reporting that the country’s situation is improving economically. But when you apply for funding for research, many times the answer you get is, ‘We are now fixing things more important than research.’ Unfortunately, they don’t understand that it’s through research and innovation that you generate more jobs and well-being for people.”

Dr. Diana’s broad perspective has not precluded disappointment. He says, “I worked on this study for five years. Before I even started to recruit patients, I worked 2 years to get it approved by the ethics committee and the hospital director, plus paperwork for this and that, endless paperwork. So it’s very frustrating. But what can I say?”  Despite his disappointment, Dr. Diana remains excited about TMS. He has already teamed up with a collaborator, Dr. Giorgio Corona, in Cagliari, Sardinia. “We are set to continue this work and to replicate my observations with a larger sample,” Dr. Diana says.

For Dr. Diana, starting over, although far from what he would have wished, presents opportunities to implement new knowledge and lessons learned. In his new trial, for example, he will measure patients’ central dopamine levels, using a technique that came to his attention too late to be used in his previous trial (see “Windows Into the Brain”).

The new trial’s recruitment protocol will incorporate another lesson, this one learned at great cost: To put to rest misperceptions and mistrust, potential recruits will receive a thorough orientation designed to put them at ease about TMS. Dr. Diana says, “Our strategy will be to persuade patients that TMS really is safe and without side effects. We’ll show them the machine. We’ll show them videos of other people who have taken the treatment. And we’ll tell them that if they perceive anything is wrong, they can leave the study whenever they decide.”

Dr. Diana is eager to get his new trial underway. He says, “The idea that TMS can be useful has been reinforced in me. Comparing the effects we observed with TMS to what others are reporting with medications, I think TMS is the way to go. The new machine is being delivered as we speak.”

Can Neurons Be Reeducated?

Dr. Diana explains, “We know from studies by Nora Volkow, Diana Martinez, and others that cocaine use over time weakens dopamine neurons. These neurons fire less often and less vigorously in the addicted brain, and this accounts for a person’s cocaine craving and compulsive responses to cocaine cues. We administer TMS to increase those neurons’ firing rate and strength back to their pre-cocaine levels. That might be therapeutic, but it won’t be so great if the neurons just revert to their weakened state after the treatment, and the patient has to keep coming back indefinitely. We want an effect that lasts for a long time.

“Therefore our aim with TMS is to induce an effect called long-term potentiation, LTP, of the dopamine neurons. LTP is something that occurs naturally when a neuron repeatedly receives intense high-frequency stimulation from other neurons. The neuron develops structural changes that make it more active and sensitive to future stimulation, and that endure for extended periods.

“In my personal opinion, the results of my trial, although they are preliminary, indicate that TMS produced LTP of our patients’ dopamine neurons. Our TMS-treated patients continued to use much less cocaine for 5 months after our 1-month treatment. The contrast in outcomes between our TMS-and sham-treated groups also supports this idea. We think that the sham TMS had a strong placebo effect that lasted 2 months after the treatment, possibly because the experience of sitting under the apparatus makes a powerful impression. After 5 months, however, the placebo effect began to wear off, while LTP kept the neurons in the TMS-treated group strong.’

Dr. Diana adds, “With TMS we were trying to tell the dopamine neurons, ‘Okay. You fire faster, and remember that you are able to fire faster.’ I think the neurons got the message.”

Windows Into the Brain

The underlying idea of using TMS to treat cocaine addiction is that stimulation with magnetic pulses can re-invigorate hypofunctional dopamine signaling in the prefrontal cortex. To make the best case for TMS’ efficacy, Dr. Martinez and Dr. Diana would like to show not only that TMS reduces cocaine use, but also that the reductions are paralleled by increases in dopamine. Retinography is a tool—albeit a tricky one—for accomplishing this. With retinography, researchers measure dopamine levels in the retina, and interpret them as indicators of levels in other parts of the central nervous system.

Source:  www.drugabuse.gov/news-events/nida-notes/articles/term/836/narrative-of-discovery  July 2016

Filed under: Addiction,Brain and Behaviour,Cocaine :

COBURG, Ore.  Serenity Lane says they’re seeing a growing number of people battling “Marijuana Use Disorder.” Many people have become habitual users to start their day by using the drug In Oregon, marijuana is legal for recreational and medical use, but one local drug rehab facility is concerned about pot addiction. Serenity Lane is an alcohol and drug treatment facility in Coburg.  Staff members said they’re seeing an increase in people with what they call “Marijuana Use Disorder.”

Manager Jerry Gjesvold at Serenity Lane said they see addiction trends years in advance. “Just like the opioid epidemic”, Gjesvold , “said we are seeing the beginning stages of a growing marijuana addiction”.

“Well, we know now that in the DSM-5, which is the manual that’s used to diagnose substance use disorders, there’s a specific marijuana use disorder diagnosis,” said Gjesvold.   Gjesvold said they see more patients as young as 18 years old even though the legal age for recreational marijuana use is 21.

“[Marijuana use] has become a much more acceptable, and because of that there’s more people that are using it,” Gjesvold said.   He said youth tend to be at higher risk for addiction. It’s because they use devices like vaping and assortments of marijuana like hash oil.

Products with higher THC concentration are more dangerous, but are easier to hide from parents.  “The universal response on the part of parents is that, ‘I had no clue,'” Gjesvold said.

The interim medical director, Paul Steier, at Serenity Lane says highly concentrated levels of THC can have a negative impact on the developing brains of young people. “They have trouble sequencing, doing numbers, word recollection,” Steier said.

Steier said in some cases it creates schizophrenic types of behavior. He said side effects from marijuana use disorder persist for a minimum of five months.  “But there clearly is a withdrawal experience from cannabis, especially in the habitual users, who are the people who sort of wake and bake,” said Steier.

Steier said the withdrawal experience is the same as other addictions causing changes in heart rate, blood pressure, and body temperature.

Source:  http://kval.com/news/local/rehab-facility-says-more-people-are-battling-marijuana-use-disorder    11th July 2016

Filed under: Addiction,Cannabis/Marijuana,USA :

Hospital maternity units and new-born care nurseries would have to report the number of infants born addicted to drugs under a bill headed to Ohio’s governor. The state Senate unanimously passed the measure Wednesday, and Gov. John Kasich was expected to sign it.

The measure is one of several aimed at reducing the state’s prescription painkiller addiction epidemic. Supporters say tracking the number of drug-addicted babies will help the state monitor Ohio’s progress in fighting drug addiction.

The facilities would be required to report the information to the state Health Department every three months. Patients would not be identified, and the information could not be used for law enforcement purposes. Should a maternity unit, maternity home or new-born care nursery fail to comply with the requirement, the state could impose a fine or revoke or suspend its license.

Overdose drug deaths have been the leading cause of accidental death in Ohio since 2007, surpassing car crashes. Many of those deaths are from painkillers and heroin.

Opiates and narcotics taken by the mother during pregnancy can pass through the placenta through the baby, causing the infant to be born dependent on harmful drugs. The babies experience neonatal abstinence syndrome and face an array of health complications, said state Sen. Shannon Jones, a Springboro Republican.

“These new-borns are thrown into painful withdrawal symptoms, such as rapid breathing, vomiting and seizures immediately following their birth,” she said.  Jones told her colleagues on the Senate floor that she had witnessed children withdrawing. “It is the most horrifying thing that I have personally experienced,” she said.

Caring for the drug-addicted new-borns and mothers, who are often on Medicaid, can be costly to the system.  Jones said officials hope to use the information to help measure opiate and illegal drug abuse across the state and better target resources to help women and babies struggling from addiction.

Source:    www.sfgate.com Wednesday, April 2, 2014

Filed under: Addiction,Drug use-various effects on foetus, babies, children and youth,Prescription Drugs,USA :

For most people, the idea of winning some money will ignite a rush of emotions – joy, anticipation, excitement.

If you were to scan their brains at that very moment, you would see a surge of activity in the part of the brain that responds to rewards.

But, for people who’ve been smoking cannabis, that rush is not as big – and gets smaller and smaller over time, new research suggests.

And that dampened, blunted response may actually increase the risk that marijuana users are more likely to become addicted to pot and other drugs.

Dr Mary Heitzeg, senior author of the new study, a neuroscientist from the University of Michigan Medical School, said: ‘What we saw was that over time, marijuana use was associated with a lower response to a monetary reward.

‘This means that something that would be rewarding to most people was no longer rewarding to them, suggesting but not proving that their reward system has been “hijacked” by the drug, and that they need the drug to feel reward – or that their emotional response has been dampened.’

The findings come from the first long-term study of young marijuana users, that tracked brain responses to rewards over time, and is published in the JAMA Psychiatry.

They reveal measurable changes in the brain’s reward system with cannabis use – even when other factors like alcohol use and cigarette smoking were taken into account.

The study involved 108 people in their early 20s – the prime age for cannabis use.

All were taking part in a larger study of substance abuse, and all had brain scans at three points over a four-year period.

Three-quarters were men, and nearly all were white.

While MRI scans were performed, participants were invited to play a game.

People who smoke cannabis regularly show less activity in the area of the brain that releases the ‘pleasure’ hormone, dopamine

They were required to click a button when they saw a target on a screen in front of them.

Before each round, they were told they could win 20 cents, or $5 – or that they might lose that amount, have no reward or loss.

The researchers were most interested in assessing what happened to the volunteers’ brains – specifically activity in the reward center – the area called the nucleus accumbens.

And the moment that was deemed most important, was the moment of anticipation – when the volunteers knew they might win some money, and were anticipating what it would take to win the simple task.

In that moment of anticipating reward, that area of the brain should spark into action, pumping out the ‘pleasure’ hormone, dopamine.

The greater a person’s response, the more pleasure or thrill a person feels – and the more likely they will be to repeat the behavior later.

The researchers found that the more marijuana use a volunteer reported, the smaller the response in this part of the brain over time.

Past research has shown the brains of people who use a high-inducing drug repeatedly respond more prominently when they are shown cues related to that drug.

That increased response means the drug has been associated in their brains with positive, rewarding feelings.

And, that can make it harder for users to stop seeking out the drug and using it.

First author, Meghan Martz, doctoral student in developmental psychology, said: ‘It may be that the brain can drive marijuana use, and that the use of marijuana can also affect the brain.

‘We’re still unable to disentangle the cause and effect in the brain’s reward system, but studies like this can help that understanding.’

Regardless of that fact, the new findings show there is a change in the reward system over time, when a person regularly uses cannabis, the researchers noted.

Dr Heitzeg and her colleagues also showed recently in a paper in Developmental Cognitive Neuroscience that marijuana use impacts emotional functioning.

The new data on response to potentially winning money may also be further evidence that long-term marijuana use dampens a person’s emotional response – something scientists call anhedonia.

‘We are all born with an innate drive to engage in behaviors that feel rewarding and give us pleasure,’ said co-author Dr Elisa Trucco, a psychologist at the Center for Children and Families at Florida International University.

‘We now have convincing evidence that regular marijuana use impacts the brain’s natural response to these rewards.

‘In the long run, this is likely to put these individuals at risk for addiction.’

Marijuana’s reputation as a ‘safe’ drug, and one that an increasing number of states are legalizing for small-scale recreational use, means that many young people are trying it – as many as a third of college-age people report using it in the past year.

But Dr Heitzeg said that her team’s findings, and work by other addiction researchers, has shown that it can cause effects including problems with emotional functioning, academic problems, and even structural brain changes.

And, the earlier in life someone tries marijuana, the faster their transition to becoming dependent on the drug, or other substances.

‘Some people may believe that marijuana is not addictive or that it’s ‘better’ than other drugs that can cause dependence,’ said Dr Heitzeg.

‘But this study provides evidence that it’s affecting the brain in a way that may make it more difficult to stop using it.

‘It changes your brain in a way that may change your behavior, and where you get your sense of reward from.’

Source: http://www.dailymail.co.uk/health/article    6th July  2016

Filed under: Addiction,Brain and Behaviour,Cannabis/Marijuana,Drug use-various effects :

Ingenious pill formulations and the latest manufacturing technologies are helping to stem the tide of painkiller addiction.

Mary Marcuccio’s life was turned upside down by drug misuse and addiction. Her son, now 26, started with alcohol and marijuana. Then came cocaine and hallucinogens. By 14, he was stealing prescription painkillers from friends’ medicine cabinets, crushing and snorting the pills to achieve a quick and euphoric high. Within one year, he had graduated to injecting heroin.

This progression is “so stereotypical”, says Marcuccio, founder of My Bottom Line, a Florida-based consulting business for families dealing with substance misuse. According to US survey data, 77% of heroin users say that, like Marcuccio’s son (who remains addicted to heroin), they misused prescription opioids — derivatives of natural or synthetic forms of opium or morphine — before trying heroin.

“It behooves us to make a greater effort at creating unabusable formularies.”

But substance-misuse specialists think that this chain of addiction might be broken with the aid of the latest manufacturing processes to make powerful opioid pain medication more resistant to various forms of tampering. Such drug preparations could also save lives. The death toll from misusing prescription opioids has skyrocketed around the world in the past 20 years, with opioid-linked overdoses exceeding fatalities from road accidents or deaths from heroin and cocaine in countries including the United Kingdom, the United States and Australia. “It behooves us to make a greater effort at creating unabusable formularies,” Marcuccio says.

Fortunately, the science and manufacturing of misuse-deterrence are advancing rapidly — and so is the political climate. In the United States — a country that consumes more than 80% of the global opioid supply — politicians are beginning to craft bills to incentivize the development of misuse-resistant formulations. “The idea is to transition the market,” says Dan Cohen, chair of the Abuse Deterrent Coalition, a network of advocacy organizations, technology manufacturers and drug companies based in Washington DC. “There are now so many different abuse-deterrent formulations that are either in products or in development that there’s enough variety out there for any product to be able to put abuse-deterrence in it.”

The new guard

Some of the latest tablet formulations are so hard that even a hammer-blow cannot pulverize them. Many pills form a gelatinous goo when dissolved that renders them difficult to inject. Others contain reversal agents that negate the high when the tablets are messed with. The idea is to create pain-relief medicines that are less prone to misuse yet work when taken as directed.

The technologies in place today are not ironclad, though. A quick perusal of online message boards and videos reveals numerous tips on how to circumvent the defences of even the most reinforced tablets. What is more, not all prescription opioids on the market are misuse-resistant. “We’re still in abuse-deterrent formulations 1.0,” says Richard Dart, director of the Rocky Mountain Poison and Drug Center in Denver, Colorado. But, he adds with a touch of hyperbole, “there are a zillion abuse-deterrent formulations coming”.

Manufacturers have been worried about prescription-drug misuse for decades. When the first controlled-release formulation of the opioid oxycodone hit the US market 20 years ago, the drug’s manufacturer, Purdue Pharma of Stamford, Connecticut, touted the twice-a-day medicine as a less-addictive alternative to the faster-acting painkillers that provide a big opioid hit all at once. In reality, however, Purdue’s longer-lasting pill, sold under the trade name OxyContin, had the opposite effect.

Drug users easily defeated OxyContin’s time-release mechanism by crushing or chewing it. Just one OxyContin could contain more oxycodone than a dozen instant-release pills but no extra ingredients such as paracetamol that make people sick if taken at high doses. OxyContin quickly became the number one addiction problem in many parts of the world, particularly in the United States and Australia. The drug was so popular among the rural poor of Appalachia in West Virginia and Kentucky that it earned the street name ‘hillbilly heroin’.

Purdue set to work to guard against some of the worst forms of misuse. In 2010, the company introduced a misuse-averting version of OxyContin that contains a polymer made of long-chain molecules. This makes the new tablet more difficult to crush — although it is not rock hard. “It behaves more like plastic,” explains Richard Mannion, executive director of pharmaceutics and analytical development at Purdue. “So, it will deform if subjected to force, but it doesn’t break into a powder easily.” The revised formulation is thus much harder to snort. Plus, Mannion says, when combined with water, the polymer forms a gummy substance that makes it very difficult to draw into a syringe (although misuse is still possible).

The new version of OxyContin has proved to reduce the incidence of therapeutic misuse. A study1 of more than 140,000 people treated at rehabilitation centres across the United States found that misuse by injection, snorting or smoking declined by two-thirds in the two years after the reformulation. In light of these results, in 2013, Purdue won the right from the US Food and Drug Administration (FDA) to describe the misuse-deterrent benefits of OxyContin on the drug’s label and to make marketing claims accordingly. The FDA said at the time that any future generic versions of OxyContin would have to incorporate equivalent misuse-deterrent protection. (In April 2015, the FDA released a guidance document outlining the types of study needed to establish misuse-deterrence, but the report stopped short of addressing generic opioid products.)

Other painkillers that now have FDA-approved misuse-deterrent labelling include Embeda, an extended-release morphine from New York-based pharmaceutical firm Pfizer, and Targiniq, another long-acting preparation of oxycodone from Purdue. Both contain antagonist agents — offsetting ingredients that remain largely inactive when the drugs are taken as directed, but that will annul the opioid’s effects if the drugs are snorted or injected.

“These new technologies are showing some positive results,” notes Robert Jamison, a pain psychologist at the Brigham and Women’s Hospital Pain Management Center in Chestnut Hill, Massachusetts. In Australia, for example, OxyContin users accounted for more than 60% of the visits to the Medically Supervised Injecting Centre in Sydney. After the tamper-resistant version of OxyContin hit the Australian market in April 2014, a team led by Louisa Degenhardt, a drug-addiction researcher at the University of New South Wales in Sydney, found2 that the number dropped to 5%. In the United States, levels of opioid misuse have decreased from their peak in 2010, when the new formulation of OxyContin arrived on the market. Rates of opioid dispensing and overdoses have dropped appreciably, too.

These public-health benefits come with an economic bonus. According to calculations from Noam Kirson and his colleagues at Analysis Group, a consulting firm in Boston, Massachusetts, the reformulated OxyContin has reduced misuse-related medical expenses and indirect societal costs by more than US$1 billion per year in the United States3. “These are substantial savings,” Kirson says.

 

Old habits die hard

Despite the gains, the misuse-deterrence field still has a long way to go. Drug users who have been thwarted by one technology can switch to another prescription medicine that lacks anti-tampering defences. That is what happened in rural Appalachia following the introduction of reformulated OxyContin. Opioid misusers simply started snorting and injecting the less potent immediate-release preparations of oxycodone, most of which lack misuse-deterrence characteristics. “It’s kind of a whack-a-mole situation,” says Jennifer Havens, an epidemiologist at the University of Kentucky Center for Drug and Alcohol Research in Lexington.

Plus, even with the latest physical defences it is still possible to get high by swallowing lots of OxyContin or Embeda pills at once. Preventing oral misuse requires a different approach — which a company called Signature Therapeutics, based in Palo Alto, California, is pursuing.

Signature Therapeutics’ technology uses prodrugs, which are inactive until they undergo the appropriate chemical conversion in the body. When these pills are taken by mouth as directed, a digestive enzyme in the gut called trypsin releases part of the prodrug, initiating the process of opioid drug release. But because trypsin is not found elsewhere in the body, the prodrug remains inert when injected, snorted or smoked. Signature Therapeutics has already tested its painkilling hydromorphone prodrug in a phase I trial of healthy volunteers; the company plans to begin evaluating its oxycodone prodrug in human studies later this year.

Prodrugs alone do not prevent excessive pill-popping, but scientists at Signature Therapeutics have another trick up their sleeves. If the prodrugs look promising in the clinic, the company will add a second compound that blocks trypsin activity. This might seem counterintuitive, but it is all about threshold levels. The amount of trypsin inhibitor found in one or two pills will not interfere with the prodrug modification, but a handful of pills collectively contain enough inhibitor to shut down the conversion process. With this approach, Signature Therapeutics can create either extended-release or immediate-release opioids. Bill Schmidt, chief medical officer at the company, says that the potential of these drugs is “maximum therapeutic benefit with very low abuse liability”.

New formulations such as these could ultimately prove to be almost addiction-proof, but they are not cheap. And their benefits might not be fully realized unless authorities require drug companies to include them. “The problem with abuse-deterrence right now is the lack of incentives,” Cohen says.

Lawmakers in the US House of Representatives previously proposed legislation that would have barred the approval of any new pharmaceuticals that did not use formulas resistant to tampering. That bill died in committee, but, according to Cohen, revised legislation should be introduced again “soon”. Individual US states have also begun to pass laws that compel pharmacists exclusively to dispense, and insurers to cover, misuse-deterrent versions of opioids unless instructed otherwise by a physician.

Ultimately, the success of long-term efforts to rein in opioid addiction could depend on the regulations surrounding generic painkillers. In December 2014, Australia allowed the sale of a generic long-acting oxycodone without misuse-deterrence characteristics. Degenhardt, who is monitoring the drug-misuse data, worries that many of the gains of OxyContin’s reformulation will now be lost. By contrast, US authorities have already said that they will not approve such a product.

All of these efforts should help to bring down the number of overdose deaths and also prevent experimentation with prescription pills. In her study population in rural Appalachia, Havens has met so many young people like Marcuccio’s son — for whom easily misused opioids were the gateway to addiction — that she has reached a simple, but absolute, conclusion: “The only way that abuse-deterrent formulations are going to work is if they’re all abuse-deterring,” she says. “It can’t just be piecemeal. It’s got to be all or nothing.”

Source:   Nature  522, S60–S61 doi:10.1038/522S60a  (25 June 2015)

Filed under: Addiction,Drug Specifics,Prescription Drugs :

A stressed rat will seek a dose of cocaine that is too weak to motivate an unstressed rat. The reason, NIDA researchers report, is that the stress hormone corticosterone increases dopamine activity in the brain’s reward center. When an animal is stressed, the cocaine-induced dopamine surge that drives drug seeking rises higher because it occurs on top of the stress-related elevation.

Graduate student Evan N. Graf, Dr. Paul J. Gasser, and colleagues at Marquette University in Milwaukee, Wisconsin, traced the physiological pathway that links stress and corticosterone to increased dopamine activity and heightened responsiveness to cocaine. Their findings provide new insight into cocaine use and relapse, and point to possible new medication strategies for helping people stay drug free.

Stress Increases Sensitivity to Relapse Triggers

Former drug users who relapse often cite stress as a contributing factor. The Marquette researchers observed that when stress figures in relapse, other relapse promoters are almost always present as well. Dr. Gasser explains, “It’s never one single event that triggers relapse. It’s the convergence of many events and conditions, such as the availability of the drug, cues that remind people of their former drug use, and also stress.” On the basis of this observation, the researchers hypothesized that stress promotes relapse by making a person more sensitive to other relapse triggers.

To test their hypothesis, the researchers put stressed and unstressed rats through an experimental protocol that simulates regular drug use in people followed by abstinence and exposure to a relapse trigger. As the stressor, they used a mild electric foot shock; as the relapse trigger, they administered a low dose of cocaine (2.5 milligrams per kilogram).

The results confirmed the hypothesis. The stressed rats, but not the stress-free animals, responded to the small cocaine dose with a behavior that parallels relapse in people: They resumed pressing a lever that they had previously used to self-administer the drug (see Figure 1, top graph).

stress_hormone

 

Text Description of Graphic

A Stress Hormone Underlies the Effect

Mr. Graf and colleagues turned their attention to the question of how stress sensitizes animals to cocaine’s motivational effect. One likely place to start was with the hormone corticosterone. In stressful situations, the adrenal glands release corticosterone into the blood, which carries it throughout the body and to the brain. Among corticosterone’s physiological roles is that it affects glucose metabolism and helps to restore homeostasis after stress. The Marquette researchers demonstrated that increasing cocaine’s potential to induce relapse also belongs on the list of corticosterone’s effects. Reprising their original experimental protocol with a couple of new twists, they showed that:

Enhanced Dopamine Activity…

The researchers next took up the question: What does corticosterone do in the NAc to increase cocaine’s potency to induce relapse? A hypothesis that suggested itself immediately was that the hormone enhances dopamine activity. Dopamine is an important neuromodulator in the NAc, and all addictive drugs, including cocaine, produce their motivating effects by increasing dopamine concentrations in the NAc.

The Marquette team showed that, indeed, stress-level concentrations of corticosterone enhance the cocaine-induced rise in extracellular dopamine in the NAc. In this experiment, the researchers exposed two groups of rats to low-dose cocaine, then measured their NAc dopamine levels with in vivo microdialysis. One group, which was pretreated with corticosterone injections, had higher dopamine levels than the other, which was not pretreated.

The Marquette team firmed up their hypothesis with a further experiment. They reasoned that if corticosterone promotes relapse behavior by increasing dopamine activity, then preventing that enhancement should prevent the behavior. This indeed turned out to be the case. When the researchers injected animals with corticosterone but also gave them a compound (fluphenazine) that blocks dopamine activity, exposure to low-dose cocaine did not elicit relapse behavior.

…Due To Reduced Dopamine Clearance

So far the Marquette team had established that the stress hormone corticosterone promotes relapse behavior by increasing dopamine activity in the NAc. Now they moved on to the next question: How does corticosterone enhance dopamine activity?

To address this question, the researchers considered the cycle of dopamine release and reuptake. In the NAc, as elsewhere in the brain, dopamine activity depends on the concentration of the neurotransmitter in the extracellular space (space between neurons): the higher the concentration, the more activity there will be. In turn, the extracellular dopamine concentration depends on the balance between two reciprocal ongoing processes: specialized neurons releasing dopamine molecules into the space, and specialized proteins drawing molecules back inside the neurons.

Mr. Graf and colleagues discovered that corticosterone interferes with the removal of dopamine molecules from the extracellular space back into cells. It shares this effect with cocaine, but achieves it by a different mechanism.

In this experiment, the researchers measured real-time changes in dopamine concentration in the NAc in response to electrical stimulation of dopamine release in the area. This technique allowed the team to measure both A) the rate of increase in dopamine concentration, indicating the amount of dopamine released; and B) the rate of decrease in dopamine concentration, indicating the rate of dopamine clearance. The scientists measured stimulation-induced increases and decreases in extracellular dopamine concentrations under three conditions: at baseline, after giving the animals a compound that blocks the dopamine transporter (DAT), which is the mechanism whereby cocaine inhibits dopamine removal; and, last, after injecting the animals with corticosterone. They found that:

 

A Candidate Mechanism

One question remained outstanding to complete the picture of how stress potentiates the response to cocaine: What is the mechanism whereby corticosterone reduces dopamine clearance?

Mr. Graf and colleagues noted that previous research provides a likely answer: Corticosterone has been shown to inhibit the functioning of the organic cation transporter 3 (OCT3), which is another of the specialized proteins that, like DAT, remove dopamine from the extracellular space. To confirm this hypothesis, the researchers resorted again to their initial experimental protocol. This time, they injected rats with a compound (normetanephrine) that blocks OCT3, followed by low-dose cocaine. The animals responded by resuming their previously abandoned lever pressing  behavior, proving that OCT3 blockade is sufficient to potentiate the response to cocaine (see Figure 1, bottom graph).

The Marquette researchers say that further studies will be required to definitively establish that OCT3 plays the role their evidence points to. Taken together, however, their experiments trace a complete pathway connecting stress to an animal’s enhanced responses to cocaine (see Figure 2):

 

streee_relapse

Figure 2. Stress Amplifies Cocaine’s Effect on Dopamine Release in the Nucleus Accumbens (NAc) The schematic illustrates how stress may enhance cocaine’s motivational effect and increase the risk for relapse. A) Cocaine binds to the dopamine transporter (DAT) on dopamine-releasing neurons in the NAc, reducing dopamine (DA) clearance and, in turn, increasing extracellular dopamine. B) Stress causes release of corticosterone, which inhibits the OCT3 transporter, further reducing dopamine clearance and increasing extracellular dopamine. The resulting heightened dopamine stimulation of medium spiny neurons (MSNs) enhances drug seeking.

Text Description of Graphic

Stress–Relapse Connection Unraveled

“Our findings show that stress doesn’t just cause relapse behavior by itself, but interacts with other ongoing behaviors to influence relapse,” Dr. Gasser says. “This insight provides a better picture of how stress can affect addiction. It helps us understand why treating cocaine addiction is so difficult and will help in designing therapies whether they be based on pharmacotherapy or counseling.” The researchers believe—and are testing as a hypothesis—that stress increases the power of environmental drug-associated cues to trigger relapse, just as it does the power of low-dose cocaine.

Although researchers have long known that stress plays an important role in relapse, pinning down its role experimentally has been a challenge, says Dr. Susan Volman, program officer and health science administrator at NIDA’s Behavioral and Cognitive Science Research Branch. “This study provides a perspective of stress as a stage-setter or modulator for relapse, and it gets all the way down to the molecular mechanism. Based on this team’s findings, OCT3 offers a potential new target for developing pharmacological therapies to help with treating addiction,” Dr. Volman says.

This work was supported by NIH grants DA017328, DA15758, and DA025679.

Source:

Graf, E.N.; Wheeler, R.A.; Baker, D.A. et al. Corticosterone acts in the nucleus accumbens to enhance dopamine signalling and potentiate reinstatement of cocaine seeking. Journal of Neuroscience 33(29):11800-11810, 2013. Full text

Filed under: Addiction,Brain and Behaviour,Effects of Drugs (Papers),Treatment :

Genetic differences may protect some who experienced childhood trauma from later marijuana dependence, study finds

WASHINGTON UNIVERSITY IN ST. LOUIS

Genetic variation within the endocannabinoid system may explain why some survivors of childhood adversity go on to become dependent on marijuana, while others are able to use marijuana without problems, suggests new research from Washington University in St. Louis.

“We have long known that childhood adversity, and in particular sexual abuse, is associated with the development of cannabis dependence. However, we understand very little about the individual difference factors that leave individuals vulnerable or resilient to these effects,” said Ryan Bogdan, PhD, assistant professor of psychological and brain sciences in Arts & Sciences and a senior author of the study.

Forthcoming in the Journal of Abnormal Psychology, the study is among the first to pinpoint a specific genetic variant that may influence susceptibility to cannabis dependence in the context of childhood trauma.

THC, the main psychoactive ingredient in marijuana, influences an array of mental and bodily functions because it closely mimics chemical enzymes that the endocannabinoid system naturally produces to send signals between neurons and other individual cells throughout the body. These signals trigger the production of other internal chemicals, such as adrenalin, which help the body modulate its response to external influences, such as fear, stress and hunger.

Like most bodily functions, the workings of the endocannabinoid system are closely programmed and controlled by a set of genetically coded instructions.

“In this study, we investigated whether variation in genes within the endocannabinoid system may be particularly important in setting the stage for cannabis dependence, especially in the context of childhood trauma,” said lead author Caitlin E. Carey, a PhD student working with Bogdan.

In phase one of the study, researchers examined genetic data from 1,558 Australian marijuana users who self-reported various types of sexual abuse as children. Carey and colleagues examined whether Single Nucleotide Polymorphisms (SNPs, pronounced “snips”) located in or near endocannabinoid system genes were associated with the

development of marijuana dependence symptoms in the context of childhood sexual abuse.

SNPs represent differences in a single DNA building block called a nucleotide and are the most common form of genetic variation in people, with an estimated 10 million SNPs in the human genome.

While little is known about many SNPs, some have been identified as key biological markers for genetic diseases. When SNPs occur within a gene or in a regulatory region near a gene, they may affect how that gene functions, perhaps raising disease risk or changing how an individual responds to certain environmental factors such as drugs or trauma.

The vast majority of SNPs, including those looked at in this study, have two different alleles at each locus; one of these alleles is inherited from the biological mother, with the other being inherited from the biological father. Alleles with two matching pieces of genetic information are called homozygotes (for example A/A or G/G), while those with mixed pairs are called heterozygotes (A/G).

Of the endocannabinoid variants examined, a single variant within the monoacylglycerol lipase (MGLL) gene demonstrated a significant interaction with childhood sexual abuse and later cannabis dependence.

More specifically, the study found that variation within this SNP (known as rs604300) in MGLL showed a clear association between child sexual abuse and cannabis dependence, such that increasing exposure to childhood sexual abuse was associated with a greater number of cannabis dependence symptoms only among individuals who were homozygous for the more common G allele. There was no association between child sexual abuse and cannabis dependence symptoms in heterozygotes, and a negative relationship between childhood sexual abuse and cannabis dependence symptoms in A allele homozygotes.

“As we expected, childhood sexual abuse was overall associated with individuals reporting a greater number of cannabis dependence symptoms,” Carey said. “But what was particularly intriguing is that this association was only seen among people with two copies of the more common G allele. People with at least one copy of the less common A allele did not show this pattern, so these data suggest that the A allele may provide some form of resiliency to the development of dependence.

The endocannabinoid system is known to play an important role in the body’s response to stress. Monoacylglycerol lipase, which MGLL codes for, regulates the availability of 2-

AG, an endocannabinoid neurotransmitter that binds to the same receptors as the THC in plant-based cannabis.

Findings replicated in second sample

In phase two of the study, Carey and colleagues attempted to replicate the findings using data from 859 American participants obtained from the Study of Addiction: Genetics and Environment. Here again, they found the same interaction between the rs604300 genotype and child abuse to be significantly associated with cannabis dependence symptoms.

Carey and colleagues speculate that the rs604300 minor A allele’s role in buffering against later cannabis dependence may be related to how the brain reacts to threat.

As Bogdan said: “The amygdala is a region of the brain critical for behavioral vigilance, including coordinating our behavioral responses to threat in the environment. Heightened amygdala reactivity has been consistently linked to anxiety disorders. Prior research has shown that endocannabinoids and marijuana, as well as prior childhood adversity, affect amygdala function. Endocannabinoid signaling, in particular, regulates reactivity to threat by facilitating a dampening of amygdala response (i.e., habituation) when threats are repeatedly presented with no adverse consequence.”

The amygdala (shown in red) is a region of the brain critical for behavioral vigilance, including coordinating physiologic and behavioral responses to threat. The A allele at rs604300 within MGLL, which conferred protection to cannabis dependence in the context of elevated childhood adversity, was associated with heightened threat-related amygdala habituation (i.e., a increased dampening of response over time) among those exposed to elevated childhood adversity. Such elevated amygdala habituation is associated with recovery from environmental stress.

If the rs604300 A allele is associated with relative increased amygdala habituation (such as a dampening of response over time) to threat in the context of childhood adversity, it is possible that child abuse survivors with this allele may be less prone to later use cannabis in an attempt to achieve the same mood-altering result, they speculated.

In a third phase of this study, they tested for this connection in an independent group of 312 undergraduate students from the Duke Neurogenetics Study and found increased amygdala habituation as a function of early life stress in minor A allele carriers, but not in GG individuals. The finding reinforces the possibility that MGLL rs604300 genotype may play a key role in decoupling the neurobiological link between early life stress and mental health outcomes in later life.

Collectively, while speculative, these data suggest that elevated amygdala habituation among individuals with the A allele who were exposed to childhood trauma may result in decreased reliance on marijuana to cope with future stressors and negative affect.

“It’s important to mention that these findings are unlikely to be informative at an individual level,” Carey said. “We won’t see a genetic test for cannabis dependence anytime soon, if ever, but it’s a start.”

Source:   http://www.eurekalert.org/pub_releases/2015-11/wuis-mdi111015.php

Filed under: Addiction,Brain and Behaviour,Cannabis/Marijuana,USA,Youth :

Abstract

BACKGROUND:

Cannabis use is decreasing in England and Wales, while demand for cannabis treatment in addiction services continues to rise. This could be partly due to an increased availability of high-potency cannabis.

METHOD:

Adults residing in the UK were questioned about their drug use, including three types of cannabis (high potency: skunk; low potency: other grass, resin). Cannabis types were profiled and examined for possible associations between frequency of use and (i) cannabis dependence, (ii) cannabis-related concerns.

RESULTS:

Frequent use of high-potency cannabis predicted a greater severity of dependence [days of skunk use per month: b = 0.254, 95% confidence interval (CI) 0.161-0.357, p < 0.001] and this effect became stronger as age decreased (b = -0.006, 95% CI -0.010 to -0.002, p = 0.004). By contrast, use of low-potency cannabis was not associated with dependence (days of other grass use per month: b = 0.020, 95% CI -0.029 to 0.070, p = 0.436; days of resin use per month: b = 0.025, 95% CI -0.019 to 0.067, p = 0.245). Frequency of cannabis use (all types) did not predict severity of cannabis-related concerns. High-potency cannabis was clearly distinct from low-potency varieties by its marked effects on memory and paranoia. It also produced the best high, was preferred, and most available.

CONCLUSIONS:

High-potency cannabis use is associated with an increased severity of dependence, especially in young people. Its profile is strongly defined by negative effects (memory, paranoia), but also positive characteristics (best high, preferred type), which may be important when considering clinical or public health interventions focusing on cannabis potency.

Source:  http://www.ncbi.nlm.nih.gov/PMID: 26213314   July 27th 2015

Filed under: Addiction,Cannabis/Marijuana,Treatment and Addiction :

These remarkable scans clearly reveal how smoking during pregnancy harms an unborn baby’s development.

New ultrasound images show how babies of mothers who smoke during pregnancy touch their mouths and faces much more than babies of non-smoking mothers.

Foetuses normally touch their mouths and faces much less the older and more developed they are. Experts said the scans show how smoking during pregnancy can mean the development of the baby’s central nervous system is delayed. Doctors have long urged pregnant women to give up cigarettes because they heighten the risk of premature birth, respiratory problems and even cot death.

Now researchers believe they can show the effects of smoking on babies in the womb – and use the images to encourage mothers who are struggling to give up.

Image shows the 4-D ultrasound scan of two foetuses at 32 weeks gestation, one whose mother was a smoker (top) and the other carried by a non-smoker (bottom). The foetus carried by the smoker touches its face and mouth much more, indicating its development is delayed

As part of the study, Dr Nadja Reissland, of Durham University, used 4-D ultrasound scan images to record thousands of tiny movements in the womb.

She monitored 20 mothers attending the James Cook University Hospital in Middlesbrough, four of whom smoked an average of 14 cigarettes a day.

After studying their scans at 24, 28, 32 and 36 weeks, she detected that foetuses whose mothers smoked continued to show significantly higher rates of mouth movement and self-touching than those carried by non-smokers. Foetuses usually move their mouths and touch themselves less as they gain more control the closer they get to birth, she explained.

The pilot study, which Dr Reissland hopes to expand with a bigger sample, found babies carried by smoking mothers may have delayed development of the central nervous system. Dr Reissland said: ‘A larger study is needed to confirm these results and to investigate specific effects, including the interaction of maternal stress and smoking.’

She believed that videos of the difference in pre-birth development could help mothers give up smoking.

But she was against demonising mothers and called for more support for them to give up. Currently, 12 per cent of pregnant women in the UK smoke but the rate is over 20 per cent in certain areas in the North East. All the babies in her study were born healthy, and were of normal size and weight.

Dr Reissland, who has an expertise in studying foetal development, thanked the mothers who took part in her study, especially those who smoked. ‘I’m really grateful, they did a good thing,’ she said. ‘These are special people and they overcame the stigma to help others.’

Co-author Professor Brian Francis, of Lancaster University, added: ‘Technology means we can now see what was previously hidden, revealing how smoking affects the development of the foetus in ways we did not realise.

‘This is yet further evidence of the negative effects of smoking in pregnancy.’ The research was published in the journal Acta Paediatrica. 


Read more: http://www.dailymail.co.uk  23 March 2015

Filed under: Addiction,Drug Specifics,Drug use-various effects,Drug use-various effects on foetus, babies, children and youth,Education,Health,Parents :

“Even at normal doses, taking psychiatric drugs can produce suicidal thinking, violent behavior,  aggressiveness, extreme anger,  hostility, irritability, loss of ability to control impulses, rage reactions, hallucinations, mania, acute psychotic episodes, akathisia, and bizarre, grandiose, highly elaborated destructive plans, including mass murder.

“Withdrawal from psychiatric drugs can cause agitation, severe depression, hallucinations, aggressiveness, hypomania, akathisia, fear, terror, panic, fear of insanity, failing self-confidence, restlessness, irritability, aggression, an urge to destroy and, in the worst cases, an urge to kill.” -  From “Drug Studies Connecting Psychotropic Drugs with Acts of Violence” – unpublished.

My previous article on Global Research discussed the frustration of large numbers of aware observers around the world that were certain that Andreas Lubitz, the suicidal mass murderer of 149 passengers and crewmembers of the of the Lufthansa airliner crash, was under the intoxicating influence of brain-disabling, brain-altering, psychotropic medicines that had been prescribed for him by his German psychiatrists and/or neurologists who were known to have been prescribing for him.

These inquiring folks wanted and needed to know precisely what drugs he had been taking or withdrawing from so that the event could become a teachable moment that would help explain what had really happened and then possibly prevent other “irrational” acts from happening in the future. For the first week after the crash, the “authorities” were closed mouthed about the specifics, but most folks were willing to wait a bit to find out the truth.

However, another week has gone by, and there has still been no revelations from the “authorities” as to the exact medications, exact doses, exact combinations of drugs, who were the prescribing clinics and physicians and what was the rationale for the drugs having been  prescribed. Inquiring minds want to know and they deserve to be informed.

There are probably plenty of reasons why the information is not being revealed. There are big toes that could be stepped on, especially the giant pharmaceutical industries. There are medico-legal implications for the physicians and clinics that did the prescribing and there are serious implications for the airline corporations because their industry is at high risk of losing consumer confidence in their products if the truth isn’t adequately covered up. And the loss of consumer confidence is a great concern for both the pharmaceutical industry and its indoctrinated medical providers.

It looks like heavily drugged German society is dealing with the situation the same way the heavily drugged United States has dealt with psychiatric drug-induced suicidality and drug-induced mass murders (such as have been known to be in a cause and effect relationship in the American epidemic of school shootings – see www.ssristories.net).

The Traffickers of Illicit Drugs That Cause Dangerous and Irrational Behaviors Such as Murders and Suicides are Punished. Why not Legal Drug Traffickers as Well?

But there is a myth out there that illegal brain-altering drugs are dangerous but prescribed brain-altering drugs are safe. But anyone who knows the molecular structure and understands the molecular biology of these drugs and has seen the horrific adverse effects of usage or withdrawal of legal psychotropic drugs knows that the myth is false, and that there is a double standard being applied, thanks to the cunning advertising campaigns from Big Pharma.

But there is an epidemic of legal drug-related deaths in America, so I submit a few questions that people – as well as journalists and lawyers who are representing drug-injured plaintiffs – need to have answered, if only for educational and preventive practice purposes:

1) What cocktail of 9 different VA-prescribed psych drugs was “American Sniper” Chris Kyle’s Marine Corps killer taking after he was discharged from his psychiatric hospital the week before the infamous murder?

2) What were the psych drugs that Robin Williams got from Hazelden just before he hung himself?

3) What were the myriad of psych drugs, tranquilizers, opioids, etc that caused the overdose deaths of Philip Seymour Hoffman, Michael Jackson, Whitney Houston, Heath Ledger, Anna Nicole Smith, etc, etc, etc (not to mention Jimi Hendrix, Bruce Lee, Elvis Presley and Marilyn Monroe) – and who were the “pushers” of those drugs?

4) What was the cocktail of psychiatric and neurologic brain-altering drugs that Andreas Lubitz was taking before he intentionally crashed the passenger jet in the French Alps – and who were the prescribers?

5) What are the correctly prescribed drugs that annually kill over 100,000 hospitalized Americans per year and are estimated to kill twice that number of out-patients?

(See http://www.collective-evolution.com/2013/05/07/death-by-prescription-drugs-is-a-growing-problem/)

Because the giant pharmaceutical companies want these serious matters hushed up until the news cycle blows over (so that they can get on with business as usual), and because many prescribing physicians seem to be innocently unaware that any combination of two or more brain-altering psychiatric drugs have never been tested for safety (either short or long-term), even in the rat labs, future celebrities and millions of other patient-victims will continue dying – or just be sickened from a deadly but highly preventable reality.

But what about “patient confidentiality”, a common excuse for withholding specific information about patients (even if crimes such as mass murder are involved)? It turns out that what is actually being protected by that assertion are the drug providers and manufacturers. Common sense demands that such information should not be withheld in a criminal situation.

America’s corporate controlled media makes a lot of money from its relationships with its wealthy and influential corporate sponsors, contributors, advertisers, political action committees and politicians, but, tragically, the media has been clearly abandoning its historically-important investigative journalistic responsibilities (that are guaranteed and protected by the Constitution). It is obvious that the media has allied itself with the corporate “authorities” that withhold, any way they can, the important information that forensic psychiatrists (and everybody else) needs to know.

We should be calling out and condemning the authorities that are withholding the information about the reported “plethora of drugs” that is known to have been prescribed for Lubitz by his treating “neurologists and psychiatrists”, drugs that were found in his apartment on the day of the crash and identified by those same authorities who have not revealed the information to the people who need to know. Two weeks into the story and there still has been no further information given, or as far as I can ascertain, or asked for by journalists.

So, since the facts are being withheld by the authorities, I submit some useful lists of common adverse effects of commonly prescribed crazy-making psych drugs that Lubitz may have been taking. Also included are a number of withdrawal symptoms that are routinely  and conveniently mis-diagnosed as symptoms of a mental illness of unknown cause.

And at the end of the column are some excerpts from the FAA on psych drug use for American pilots. I do not know how different are the rules in Germany, but certainly both nations have to rely on voluntary information from the pilots.

1) Common Adverse Symptoms of Antidepressant Drug Use

Agitation, akathisia (severe restlessness, often resulting in suicidality), anxiety, bizarre dreams, confusion, delusions, emotional numbing, hallucinations, headache, heart attacks  hostility, hypomania (abnormal excitement), impotence, indifference (an “I don’t give a damn attitude”), insomnia, loss of appetite, mania, memory lapses, nausea, panic attacks, paranoia, psychotic episodes, restlessness, seizures, sexual dysfunction, suicidal thoughts or behaviors, violent behavior, weight loss, withdrawal symptoms (including deeper depression)

2) Common Adverse Psychological Symptoms of Antidepressant Drug Withdrawal

Depressed mood, low energy, crying uncontrollably, anxiety, insomnia, irritability, agitation, impulsivity, hallucinations or suicidal and violent urges. The physical symptoms of antidepressant withdrawal include disabling dizziness, imbalance, nausea, vomiting, flu-like aches and pains, sweating, headaches, tremors, burning sensations or electric shock-like zaps in the brain

3) Common Symptoms of Minor Tranquilizer Drug Withdrawal

Abdominal pains and cramps, agoraphobia , anxiety, blurred vision, changes in perception (faces distorting and inanimate objects moving), depression, dizziness, extreme lethargy, fears, feelings of unreality, heavy limbs, heart palpitations, hypersensitivity to light, insomnia, irritability, lack of concentration, lack of co-ordination, loss of balance, loss of memory, nightmares, panic attacks, rapid mood changes, restlessness, severe headaches, shaking, sweating, tightness in the chest, tight-headedness

4) Common (Usually Late Onset) Adverse Psychological Symptoms From Anti-Psychotic Drug Use

Blurred vision, breast enlargement/breast milk flow,  constipation, decreased sweating, dizziness, low blood pressure, imbalance and falls, drowsiness, dry mouth, headache, hyperprolactinemia (pituitary gland dysfunction), increased skin-sensitivity to sunlight, lightheadedness, menstrual irregularity (or absence of menstruation), sexual difficulty, (decline in libido, anorgasmia, genital pain).

The lethal adverse effects of antipsychotic drugs include Catatonic decline, Neuroleptic Malignant Syndrome (NMS, a condition marked by muscle stiffness or rigidity, dark urine, fast heartbeat or irregular pulse, increased sweating, high fever, and high or low blood pressure); Torsades de Pointes (a condition that affects the heart rhythm and can lead to sudden cardiac arrest”; Sudden death

5) Late and Persistent Adverse Effects of Antipsychotic Drug Use  (Some of these symptoms may even start when tapering down or discontinuing the drug!)

Aggression, akathisia (inner restlessness, often intolerable and leading to suicidality), brain atrophy (shrinkage), caffeine or other psychostimulant addiction, cataracts, creativity decline, depression, diabetes, difficulty urinating, difficulty talking, difficulty swallowing, fatigue and tiredness, hypercholesterolemia, hypothyroidism, intellectual decline (loss of IQ points), obesity, pituitary tumors, premature death, smoking – often heavy – (nicotine addiction), tardive dyskinesia (involuntary, disfiguring movement disorder), tongue edge “snaking” (early sign of movement disorder), jerky movements of head, face, mouth or neck, muscle spasms of face, neck or back, twisting the neck muscles, restlessness – physical and mental (resulting in sleep difficulty), restless legs syndrome, drooling, seizure threshold lowered, skin rashes (itching, discoloration), sore throat, staring, stiffness of arms or legs, swelling of feet, trembling of hands, uncontrollable chewing movements, uncontrollable lip movements, puckering of the mouth, uncontrollable movements of arms and legs, unusual twisting movements of body, weight gain, liver toxicity

6) Common Symptoms of Antipsychotic Drug Withdrawal

Nausea and vomiting, diarrhea, rhinorrhea (runny nose), heavy sweating, muscle pains, odd sensations such as burning, tingling, numbness,  anxiety, hypersexuality, agitation, mania, insomnia, tremor, voice-hearing

FAA Medical Certification Requirements for Psychotropic Medications

https://www.leftseat.com/psychotropic.htm

Pilots can only take one of four antidepressant drugs – Celexa (Citalopram), Lexapro (Escitalopram), Prozac (Fluoxetine) and Zoloft (Sertraline).

Most psychiatric drugs are not approved under any circumstances.

These include but are not limited to:

To assure favorable FAA consideration, the treating physician should establish that you do not need psychotropic medication. The medication should be discontinued and the condition and circumstances should be evaluated after you have been off medication for at least 60 and in most cases 90 days.

Should your physician believe you are an ideal candidate, you may be considered by the FAA on a case by case basis only. Applicants may be considered after extensive testing and evidence of successful use for one year without adverse effects. Medications used for psychiatric conditions are rarely approved by the FAA. The FAA has approved less than fifty (50) airmen under the FAA’s SSRI protocol.

After discontinuing the medication, a detailed psychiatric evaluation should be obtained. Resolved issues and stability off the medication are usually the primary factors for approval.

Dr Kohls is a retired physician who practiced holistic mental health care for the last decade of his family practice career. He writes a weekly column on various topics for the Reader Weekly, an alternative newsweekly published in Duluth, Minnesota, USA. Many of Dr Kohls’ weekly columns are archived at http://duluthreader.com/articles/categories/200_Duty_to_Warn.

Source:  http://www.globalresearch.ca/the-connections-between-psychotropic-drugs-and-irrational-acts-of-violence/5441484  April 08, 2015

 

Filed under: Addiction,Brain and Behaviour,Drug use-various effects,Effects of Drugs,Europe,Global Drug Legalisation Efforts,Health,Psychiatric drugs,Social Affairs,USA :

Some good news, some not-so-good news about brain recovery from alcohol use disorders

According to a recent review article on recovery of behavior and brain function after abstinence from alcohol[1], individuals in recovery can rest assured that some brain functions fully recover; but others may require more work. In this article, authors looked at 22 separate studies of recovery after alcohol dependence, and drew some interesting conclusions.

First, the good news; studies show improvement or even complete recovery to the performance level of healthy participants who had never had an alcohol use disorder in many important areas, including short-term memory, long-term memory, verbal IQ, and verbal fluency. Even more promising, not only behavior, but the structure of the brain itself may recover; an increase in the volume of the hippocampus, a brain region involved in many memory functions, was associated with memory improvement.

Another study showed that after 6 months of abstinence, alcohol-dependent participants showed a reduction in a “contextual priming task” with alcohol cues; in day to day terms, this could mean that individuals in early recovery from alcohol dependence may be less likely to resume drinking when confronted with alcohol and alcohol-related cues in their natural environment because these alcohol-related triggers are eliciting less craving.- a good thing for someone seeking recovery!

Still other studies showed that sustained abstinence was associated with tissue gain in the brain; in other words, increases in the volumes of brain regions such as the insula and cingulate cortex, areas which are important in drug craving and decision-making, were seen in abstinent alcoholics. This increase is a good thing, because more tissue means more recovery from alcohol-induced damage. A greater volume of tissue in these areas may be related to a greater ability to make better decisions.

Now, the not-so-good news: these studies reported no improvement in visuospatial skills, divided attention (e.g. doing several tasks at once), semantic memory, sustained attention, impulsivity, emotional face recognition, or planning.  This means that even after abstinence from alcohol, people in recovery may still experience problems with these neurocognitive functions, which may be important for performing some jobs that require people to pay attention for long periods of time or remember long lists of requests. These functions may also be important for daily living (i.e. assessing emotions of a spouse, planning activities, etc.).

Importantly, there were many factors that influenced the degree of brain recovery; for example, the number of prior detoxifications. Those with less than two detoxifications showed greater recovery than those with more than two detoxifications.  A strong family history of alcohol use disorder was associated with less recovery. Finally, cigarette smoking may hinder recovery, as studies have shown that heavy smoking is associated with less recovery over time.

So what does all this mean? Recovery of brain function is certainly possible after abstinence, and will naturally occur in some domains, but complete recovery may be harder in other areas. Complete recovery of some kinds of behavior (e.g. sustained attention, or paying attention over long periods of time) may take more time and effort! New interventions, such as cognitive training or medication (e.g. modafinal, which improved neurocognitive function in patients with ADHD and schizophrenia, as well as in healthy groups), may be able to improve outcomes even more, but await further testing.

[1] Recovery of neurocognitive functions following sustained abstinence after substance dependence and implications for treatment

Source:  Mieke H.J. Schulte et al., Clinical Psychology Review 34 (2014) 531–550   October 2014

 

Filed under: Addiction,Addiction (Papers),Alcohol,Brain and Behaviour,Health,Prevention and Intervention,Treatment and Addiction,USA :

 Christopher Lapish, Ph.D. (left) and Alexey Kuznetsov, Ph.D. of the School of Science at Indiana University-Purdue University study how alcohol hijacks the brain’s reward system. Credit: School of Science at IUPUIWith the support of a $545,000 three-year grant from the National Institute on Alcohol Abuse and Alcoholism, researchers from the School of Science at Indiana University-Purdue University Indianapolis are conducting research on how the brain’s reward system—the circuitry that helps regulate the body’s ability to feel pleasure—is hijacked by alcohol.

Scientists have only a rudimentary understanding of how alcohol affects neurons in the brain. It is known that, as any addictive drug, alcohol directly or indirectly acts on a specific population of brain cells, called dopamine neurons. Through this action, the neurotransmitter dopamine is released, which evokes feelings of pleasure. However, the biological mechanisms of how alcohol evokes dopamine release have not been determined; exploring this question is the major goal of the grant. 

The synergistic approach of the IUPUI researchers—biomathematician Alexey Kuznetsov, Ph.D., associate professor of mathematical sciences, and neuroscientist Christopher Lapish, Ph.D., assistant professor of psychology—is novel as they marry the cutting-edge tools of mathematical modeling developed by Kuznetsov and the sophisticated experimental neuroscience experiments designed and conducted by Lapish to study the electrical properties that determine the release of the neurotransmitter dopamine in the brain. As a starting point, they are focusing on the brain’s initial exposure to alcohol. 

Kuznetsov has developed unique mathematical models as he homes in on why and how much dopamine is released when alcohol is consumed. With the same goal, Lapish is employing sophisticated tools and methods to measure and analyze electrical signals of dopamine neurons in rats. This synergy forms a two-way street with data from the recordings of the electrical impulses of the rat brains affecting how the mathematical models are constructed and the predictions generated by the mathematical models informing the study of the animal brains. 

IUPUI undergraduates and graduate students are assisting the investigators in their work.

“Our mathematical models go much further than simple logic,” Kuznetsov said. “What we are learning from experiments is critical. The direct connection of modeling and experiments enables us to test and refine our hypotheses.”

“As we begin our second year on this project we are gaining a better understanding of how the brain responds to alcohol,” Lapish said. “The cross talk between us drives this hypothesis-driven research. There are many unknowns to explore and interpret.”

The IUPUI researchers are also collaborating with French scientists. “We are working on the problem at different levels—we are modeling and studying the brains of live rodents—in vivo work—and they [the French researchers] are studying in vitro brain slices in the lab,” Kuznetsov added.

 “Alcohol addiction is among America’s largest public health concerns yet we know far less about it than most other addictions. If we are going to successfully treat alcohol addiction we need to begin with the basics and understand how alcohol directly acts on dopamine neurons in both the alcoholic and normal brain,” Lapish said. 

Provided by Indiana University-Purdue University Indianapolis School of Science

Source:  http://phys.org/wire-news/187100819     6th March  2015 

Filed under: Addiction,Alcohol,Brain and Behaviour,Health,USA :
Image

Painkiller addicted baby

 Doctors in the United States are seeing more infants born addicted to narcotic painkillers — a problem highlighted by a new Florida-based report.

These infants experience what’s called neonatal abstinence syndrome as they undergo withdrawal from the addictive drugs their mothers took during pregnancy. Most often these are narcotic painkillers, such as oxycodone, morphine or hydrocodone, according to the report from the U.S. Centers for Disease Control and Prevention.  Since 1995, the number of such newborns jumped 10-fold in Florida while tripling nationwide, the researchers said.

“These infants can experience severe symptoms that usually appear within the first two weeks of life,” said lead researcher Jennifer Lind, a CDC epidemiologist.    The symptoms can include seizures, fever, excessive crying, tremors, vomiting and diarrhea, she said. And withdrawal can take a few weeks to a month.

Dr. David Mendez is a neonatologist at Miami Children’s Hospital. He said, “Being in Florida, I can tell you there’s been an explosion in the number of babies going through neonatal abstinence syndrome. It’s clearly related to the exposure moms have to all narcotic painkillers.”

Mendez said the infants go through a difficult time, but they do recover.  Sometimes it’s enough to keep these babies in a quiet environment, but almost four out of five need treatment with morphine or the anticonvulsant phenobarbital to quell seizures and other withdrawal symptoms, Lind said.

The report — which used data from three Florida hospitals — cites a need for improved counseling and treatment of drug-abusing and drug-dependent women earlier in pregnancy.   Previous studies have found that addiction to narcotic painkillers can increase the risk for premature births, low birth weight and birth defects, Lind said. “Some of the birth defects are heart defects and defects of the brain and the spine,” she said.  “More studies are needed to look at long-term outcomes,” she added.

In 2009, the national incidence of neonatal abstinence syndrome was 3.4 per 1,000 births, less than Florida’s total of 4.4 per 1,000 births, according to background information in the report. Florida officials, alarmed by the increase, last year asked the CDC for help in assessing the problem.  According to the report, 242 infants with neonatal abstinence syndrome were identified in three Florida hospitals in the two-year period from 2010 to 2011.

The researchers found that 99.6 percent of these babies had been exposed to narcotic painkillers and had serious medical complications, according to the March 6 issue of the CDC’s Morbidity and Mortality Weekly Report.   Nearly all of the addicted infants required admission to the neonatal intensive care unit, and average length of stay was 26 days, the investigators found.  The condition is very expensive to treat, Lind said.

Mendez added that lengthy hospital stays aren’t just for treatment. “Some of it is due to the social issues that affect these babies,” he said.  The mothers are often incapable of caring for their babies, Mendez explained. “Hospitals become the babysitter while social services arrange for a new home for the baby,” he said.  Lind said that only about 10 percent of the babies’ mothers had been referred for drug counseling or rehabilitation during pregnancy, even though many tested positive for drugs in urine tests.

Neonatal abstinence syndrome is preventable simply by not taking drugs or by getting treatment for addiction, she said.  From conception on, a pregnant woman is responsible for another human being, Mendez stressed. “Anything a woman does to herself she does to her baby. So if you are engaged in high-risk behavior, if you are taking drugs, they are going to impact the baby,” he said.

Source:  health.usnews.com   6th March 2015

Filed under: Addiction,Drug use-various effects on foetus, babies, children and youth,Health,Legal Highs,USA :
 

A study published Wednesday found that consuming large flavored alcoholic beverages can increase risk for binge drinking and related alcohol injuries for underage drinkers. PHOTO BY EMILY ZABOSKI/DAILY FREE PRESS STAFF

Super-sized flavored alcoholic beverages can increase the risk of binge drinking and alcohol-related injuries for underage drinkers, researchers from Johns Hopkins University and Boston University found in a study, a Wednesday press release stated.

The study, published in the American Journal of Public Health on Feb. 25, found that underage drinkers who reported consuming malts, premixed cocktails and alcopops drank more on average and were more likely to experience “episodic heavy drinking,” the report stated. About 1,000 people ages 13 to 20 were surveyed online.

David Jernigan, an author of the study and director of the Center on Alcohol Marketing at Johns Hopkins, said heavier drinking occurs with these flavored beverages because of the serving sizes. Most of these beverages hold the equivalent of 4 to 5 beers in one container, he said.

“We particularly found the correlations between the largest size of these drinks and negative behaviors because one of these super-sized drinks is the equivalent of four to five beers,” he said. “Even though the can may have serving size though most don’t, teens are treating them as a single serving. Some people in the field call it a binge in a can.”

Study co-author Alison Albers, a professor in BU’s School of Public Health, said the study brings up important issues and will help determine future policies.

“These findings raise important concerns about the popularity and use of flavored alcoholic beverages among young people, particularly for the supersized varieties,” she said in the release. “Public health practitioners and policymakers would be wise to consider what further steps could be taken to keep these beverages out of the hands of youth.”

Jernigan said careful packaging should be implemented in the production of super-sized beverages.

“The re-sealable top is more of a joke,” he said. “These are being treated as a single serving, and the results suggest this may be a dangerous form of packaging.”

Katharine Mooney, director of Wellness and Prevention Services at BU, said the university takes steps to prevent the overconsumption of alcohol.

“We discourage against any kind of risky behavior, and these oversized sugar sweetened beverages definitely all into the category of risky,” she said. “[It’s] just like a punch bowl at a party.”

Mooney said because the drinks do not taste entirely like alcohol, it is difficult to determine how much alcohol is in them, which often leads to over drinking. Over drinking can affect students’ physical, social and academic wellbeing.

The Boston University Police Department has noted that the number of alcohol violations and transports for the spring 2015 semester has increased compared to numbers from the spring 2014 semester, The Daily Free Press reported Thursday.

Mooney said BU Student Health Services tries to do whatever possible to inform students about the dangers of binge drinking and learn how to drink in a less dangerous way.

“One of the things we work really hard to educate students about our standard drink portion. A standard beer has the same alcohol content as one shot,” she said. “A student needs to be particularly aware of what they are consuming when drinking these so that they don’t drink more than they intend to.”

Several students said they recognize how super-sized flavored drinks can be risky.

Brock Guzman, a freshman in the College of Engineering, said the drinks are popular because of their cheap prices, and because some items contain caffeine, young drinkers find them even more appealing.

“It’s appealing because you can get really drunk and you stay awake,” he said. “They have caffeine in them and don’t really taste like alcohol.”

Sergio Araujo, a junior in Metropolitan College, said he has seen a friend in a dangerous scenario after consuming Four Loko, a popular super-sized alcoholic beverage. Though Four Loko’s contents used to include caffeine, the company chose to remove caffeine from their product in 2010.

“One guy I know drank them a lot, and he left a party alone, then he got lost in a snowstorm and was too drunk to find his way home,” he said. “He almost had to sleep in the snow.”

Jaqui Manning, a freshman in the College of General Studies, said she has seen firsthand the consequences when others drink the types of alcoholic beverages described in the study, as well as the products that contain caffeine.

“I’ve heard a lot of people have had really bad experiences with them,” she said. “Especially drinking them really fast is really dangerous because not only is there alcohol, but there is so much sugar and caffeine that goes into it, and your body sometimes can’t handle it.”

Source:  http://dailyfreepress.com/flavored-alcohol     6th March 2015

Filed under: Addiction,Alcohol,Environment,Health,USA,Youth :

A lot of times, a simple “no thanks” may be enough. But sometimes it’s not. It can get intense, especially if the people who want you to join in on a bad idea feel judged. If you’re all being “stupid” together, then they feel less self-conscious and don’t need to take all the responsibility. 

But knowing they are just trying to save face doesn’t end the pressure, so here are a few tips that may come in handy.

1. Offer to be the designated driver. Get your friends home safely, and everyone will be glad you didn’t drink or take drugs.

2. If you’re on a sports team, you can say you are staying healthy to maximize your athletic performance—besides, no one would argue that a hangover would help you play your best.

3. “I have to [study for a big test / go to a concert / visit my grandmother / babysit / march in a parade, etc.]. I can’t do that after a night of drinking/drugs.”

4. Keep a bottled drink like a soda or iced tea with you to drink at parties. People will be less likely to pressure you to drink alcohol if you’re already drinking something. If they still offer you something, just say “I’m covered.”

5. Find something to do so that you look busy. Get up and dance. Offer to DJ.

6. When all else fails…blame your parents. They won’t mind! Explain that your parents are really strict, or that they will check up on you when you get home.

If your friends aren’t having it—then it’s a good time to find the door. Nobody wants to leave the party or their friends, but if your friends won’t let you party without drugs, then it’s not going to be fun for you.

Sometimes these situations totally surprise us. But sometimes we know that the party we are going to has alcohol or that people plan to do drugs at a concert. These are the times when asking yourself what you could do differently is key to not having to go through this weekend after weekend.

Source:   www.teens.drugabuse.gov      March  9th 2015

Filed under: Addiction,Alcohol,Brain and Behaviour,Drug use-various effects on foetus, babies, children and youth,Health :

Teens Affected by Addiction is a project aimed at raising awareness about the impact of alcoholism on families – here, they share some personal stories. 

Here, four people who grew up with an alcoholic parent share their stories.  These stories have been collected by ‘Teens Affected by Addiction’, a Young Social Innovators project from Mount Mercy College in Cork, Ireland,  with the aim of raising awareness about how addiction impacts children.

“I will never get my childhood back”

“My life as a child of an alcoholic parent was frightening and lonely. My dad was a chronic alcoholic. I had a different childhood to all my friends: no birthday parties, couldn’t invite friends over to the house, and Christmas was a nightmare.

There was no one I could talk to and no one could help me, I just had to put up with it.

When I was 17 I had no choice but to leave home. I had to live my own life. My mother was heartbroken but she knew I had to go.

When I was 18, I was able to get counselling which was a great help to me. I was able to understand that alcoholism was an illness. A few months after leaving home my dad turned his life around and stopped drinking.

I will never get my childhood back but I now have a great relationship with my father and my mother now has the life she deserves. I hope this story can give other children some hope and let them know that there is a light at the end of the tunnel.”

*******

“Missing you”

The following is a short poem a woman sent to us about her father’s alcoholism.

I don’t miss the sense of invisibility to you, 

I don’t miss listening constantly for the front door,
I don’t miss watching your face to decipher your mood,
I don’t miss dodging your verbal assaults,
I don’t miss the sense of being so small,
I don’t miss the enormity of you and your drink,
I don’t miss the deep shame,
I don’t miss everyone covering up for you,
I don’t miss everyone knowing but me,
I don’t miss the smell of drink,
I don’t miss the fear of drink,
I don’t miss my friends knowing,
I don’t miss no-one caring about me,
I don’t miss fear,
I don’t miss loving you,
I don’t miss hating you,
I don’t miss you.

******* 

 “We had food in the house but it wasn’t for us – it was for the social worker to see.”

“My alcoholic parent was my mother. She always drank. She started when she was young. When she was a child her father abused her and her brothers. They were battered by their father constantly. They locked their doors every night to keep their father out. She was beaten badly and was always expected to act like a lady. She started drinking to forget the pain she had to go through. This doesn’t make what she did to her children any bit forgivable.

When I was a child my uncle and aunts tried to take me away from my home by taking me on day trips with my sister. Back then I thought my mother would heal. My sister and I used to beg my uncle and aunts to bring us home so we could mind our mother. We didn’t want to upset her by being away for too long. One of my uncles was like a father to me. His oldest daughter and I look like brother and sister. We are just as close too. They tried to help me and give me a better life but they couldn’t.

My mom had a lot of ‘boyfriends’. They never really stayed too long. A small few used to beat me. These men were constantly in our house so we never really questioned a strange man in our house. It was normal for us.

At 15 years old I would come home from school and meet up with my mother and grandmother in the pub. My mother would buy me beer and I would sit in the pub with my drunken mother and help her get home. My home was filthy. There used to be dogs running through the house constantly and the house was never cleaned. We had food but it wasn’t for us. The food was perfect but we were not allowed eat it as it was only for when the social workers called so it would look like she was feeding us. In reality we were starving.

I started hanging out with a very rough group where I lived. They were drinking constantly and doing drugs. Eventually, I got away from them and my mother. I ran from Ireland at 16 to the States to my father. My sister was so upset with me for leaving her with my mother back in Ireland.

Now I’m living in America with a beautiful wife and three amazing children. Sometimes what happened still affects me but I try to block it out and ignore it and carry on. I’m honestly not recommending running away. I am planning on coming back to Ireland soon to sort out a few things with my mother.

*******

“I’ve never not known Mum to have her cans by her chair and her vodka stashed away under the bed”

Well to begin with there’s a common misconception that men are generally the alcoholics in a family but when it’s the mother, the nucleus of the family is destroyed and everything falling apart becomes an inevitable fate. I come from a small family with it just being my mum, dad and my brother and I. We’ve been battling with my mother’s alcoholism for as long as I remember, I’ve never not know her to have her cans by her chair and her vodka stashed away under the bed. It wasn’t that I always saw it as the norm but when you don’t know any different it does tend to be a bit more difficult to imagine the situation differently. I’m actually very happy to see the back of 2014 as from December 2013 my whole family spiralled out of control and I spent more times in hospital than anywhere else. My parents split in December 2013 after 21 years married (I am 20 years old) my mum’s alcoholism was at its peak. Having been in and out of hospital for the past six years due to liver failure, she was on a path to destruction. In those months, mum had fallen whilst drunk and tried to hit my father with a golf club and broke her femur. She had several serious operations and she nearly died as her blood is extremely thin due to medication and alcoholism. Mum came out of hospital and continued to drink and began running around saying that she was fine and could walk. She fell hundreds of times and it became so bad she now can’t walk properly. I live with my grandmother, having left school at 17 as I suffered from depression and I went back to do my Leaving Cert and moved out of my home. Within months a series of events led to both my father and brother leaving and moving into an apartment and my mum was left wallowing in her drunken states ringing and abusing everybody (she still does this).I contacted the HSE in January 2014 with several emails sent to all organisations that support victims of alcoholism, I got a lot of reaction. I was furious that I spent years sitting in my mothers’ doctor’s surgery with my dad begging for ways out. They would always look at us helplessly and say “move out”. I felt embarrassed and as if there were no light at the end of the tunnel. My grandmother who I live with and who’s been a mother to me all my life has had a nervous breakdown and right now I spend my days working eight hour shifts as a photographer in a studio and then I go home to this mess. 

My mum has been in hospital about eight times since February 2014 when a stomach ulcer burst and she was found in a pool of blood by my grandmother. I soon lost faith but I always tried to get help; my letter to the HSE got me six months with a councillor but I was so busy with my Leaving Cert and everything I just couldn’t find time to go.

Now I am still living with this situation but I try my very best to overcome it every day and I refuse any kind of medication such as an “anti depressant” as I believe it’s just a easy way for doctors to dose people up and make money. I wish to study politics and history and possibly then business in university in the future and I hope that one day I can actually help people.

These stories are shared by ‘Teens Affected by Addiction’, a Young Social Innovators project from Mount Mercy College in Cork. The students have recently received funding from the YSI Den to publish a book with the stories of adults who grew up with an addict in the home. 

 Please see www.teensaffectedbyaddiction.com or email:  affectedbyaddictionysi@gmail.com if you would like to share your story.

Follow Teens Affected by Addiction on Twitter: @affbyaddiction

Source:   www.thejournal.ie    March 2015

Filed under: Addiction,Alcohol,Drug use-various effects on foetus, babies, children and youth,Europe,Parents :

On Nov. 4, Alaskans will consider Ballot Measure 2, an initiative to legalize the sale and use of marijuana for recreational purposes. And those who support that commercial trade are investing heavily in hoping you will vote “yes.” Make no mistake about it, marijuana — like tobacco and alcohol — is big business.

Like alcohol and tobacco, the costs of marijuana to public health, public safety, our youth and lost productivity, are similarly high. It’s not surprising that Outside investors would regard Alaska as fertile territory for unconditional legalization.

In 1975, our Supreme Court found a right for Alaskans to consume small amounts of marijuana in their homes in the privacy provisions of the Alaska Constitution. And in 1998, Alaskans voted to legalize marijuana for medical purposes with 58 percent support. But Ballot Measure 2 is not about “medical marijuana,” nor is it necessary in order to protect adult Alaskans who consume marijuana in their homes from police intrusion. The measure is less about freedom than it is about profit at the expense of public health. That’s why I plan to vote “no” on Ballot Measure 2.

I came to this decision after careful consideration of the medical evidence. My guide through the scientific literature was Dr. Nora Volkow, the director of the National Institute on Drug Abuse (NIDA). Earlier this year, Dr. Volkow published a peer-reviewed paper about the health effects of marijuana in the New England Journal of Medicine, one of the nation’s most eminent medical publications. Volkow directs a component of our National Institutes of Health which is, of course, neutral on state level policy initiatives. Fortunately for all of us, NIH does not prohibit its scientists from entering the discussion by objectively sharing the science with policymakers and the public.

Here’s what Volkow has to say about the state of the evidence: “The popular notion seems to be that marijuana is a harmless pleasure, access to which should not be regulated or considered illegal.”

However popular notions are not always correct. One of the detrimental effects is addiction. “The evidence clearly indicates that long term marijuana usage can lead to addiction,” Volkow states. “About 16 (percent) of those who begin marijuana usage as teenagers will become addicted. And there seems to be a strong association between repeated use and addiction. About a quarter to a half of those who use marijuana everyday are addicted. …Marijuana use by adolescents is particularly troublesome.”

Those who begin using marijuana as teenagers, when the brain is still developing, are two to four times more likely to demonstrate dependence symptoms within two years of first use than those who first use marijuana as adults. And since marijuana use “impairs critical cognitive functions … for days after use many students could be functioning at a cognitive level that is below their natural capability for considerable period of times,” according to Volkow.

These effects could be even longer lasting. Adults who smoked marijuana during adolescence have fewer fibers in specific brain regions that are important to things like alertness, self-consciousness, learning and memory.

NIDA-funded research provides some support for long standing fears that use of marijuana may be a gateway to use of other drugs with even greater known adverse health effects. Truthfully, the same may be said of alcohol and tobacco. Whether the mechanism is chemical, cultural or some combination of the two, is less well known. No evidence is cited to suggest that marijuana use keeps young people away from other drugs.

The prevalence of impaired driving in Alaska is well known and deeply troublesome. On this, Volkow observes that “both immediate and long term exposure to marijuana impair driving ability; marijuana is the illicit drug most frequently reported in connection with impaired driving and accidents, including fatal accidents.” Moreover, the mixing of marijuana and alcohol can further exacerbate the dangers to public safety.

Perhaps the most startling revelation of Volkow’s research is that all marijuana is not alike. The potency of marijuana is determined by its Tetrahydrocannabinol, or THC, content. Analysis of seized marijuana for sale on the street demonstrates that THC concentrations have been rising from about 3 percent in 1980 to about 12 percent today. Volkow suggests that this may be the reason for increased emergency room visits associated with marijuana and a higher level of fatal crashes. Also, the initiative specifically defines marijuana to include concentrates, which can contain 80-90 percent THC. Marijuana edibles would also be legalized and commercialized under the initiative. In Colorado, child-attractive edibles like lollipops, flavored drinks and gummy bears, with multiple doses of THC, are being sold.

Marijuana is a drug and with all drugs there are risks and benefits. Research suggests that use of marijuana or some of its component chemicals can be beneficial for the alleviation of a variety of medical conditions. But patients with these conditions benefit from discussions with their healthcare providers about the risks and benefits.

The state should examine the most appropriate access for this class of users. That said, the evidence that marijuana is harmful for non-medical use is growing. That should give Alaskans pause as we enter the voting booth.

I believe strongly in working for the health, safety, educational achievement, productivity and community welfare of Alaskans. That is why I am voting “no” on Ballot Measure 2.

• Lisa Murkowski is a Republican U.S. Senator representing Alaska.

Source: www.juneauempire.com/opinion/2014-10-22

Filed under: Addiction,Cannabis/Marijuana,Drug use-various effects on foetus, babies, children and youth,Effects of Drugs,Health,Social Affairs,USA :

Excessive alcohol consumption is a leading cause of premature death in the U.S. and responsible for one in every 10 deaths. The statistics that describe the ways in which we drink ourselves to death are staggering. A study published in the journal Preventing Chronic Disease found that nearly 70% of deaths due to excessive drinking involved working-age adults. The study also found that about 5% of the deaths involved people younger than age 21.  Moreover, excessive alcohol use shortened the lives of those who died by about 30 years. Yes, 30 years.

One strong factor that reinforces the popular culture surrounding drinking is the glamour of advertising. Researchers at the Johns Hopkins Bloomberg School of Public Health examined alcohol-advertising placements to determine whether the alcohol industry had kept its word to refrain from advertising targeting young people. This included television programs for which more than 30% of the viewing audience is likely to be younger than 21 years, the legal drinking age in every state.

The study found that alcohol related advertising increased by 71% in the last decade; this is largely attributed to exposure on cable television. That increase coincided with a reported upsurge of alcohol consumption by high school students. In conclusion, the study suggested that if the National Research Council/Institute of Medicine’s proposed threshold of 15% exposure to advertising was implemented, young viewers would see 54% fewer alcohol ads and society would see a correlating decrease in alcohol related deaths.

What about those “drink responsibly” admonitions on so many commercials? Federal regulations do not require responsibility statements in alcohol advertising. The alcohol industry’s voluntary codes for marketing and promotion emphasize responsibility, but they provide no definition for responsible drinking. So when you see the admonition to “drink responsibly” at the end of an alcohol-related television commercial, there is no idea given as to exactly what that may mean, particularly to someone under the legal drinking age.

David Jernigan, PhD, director of the Center on Alcohol Marketing and Youth at the Johns Hopkins Bloomberg School of Public Health said:

“The contradiction between appearing to promote responsible drinking and the actual use of ‘drink responsibly’ messages to reinforce product promotion suggests that these messages can be deceptive and misleading.”

Youth who start drinking before age 15 years are five times more likely to develop alcohol dependence or abuse later in life than those who begin drinking at or after age 21 years according to the Centers for Disease Control and Prevention.

Alcohol advertising influences many people across a wide range of demographics. Regardless of the warning labels on alcohol containers, community prevention programs and general public knowledge of the risks of excessive alcohol consumption, people continue to drink in health-damaging ways. Drinking in public, at sporting events, in parks, during celebrations, etc., is firmly embedded in society as acceptable behavior. At the same time, the large number of alcohol related deaths among all age groups is a concern, especially when this drinking behavior is generally developed while individuals are underage.

Alcohol use is a major public health problem that can lead to social, financial, and health related setbacks and premature death. Talk to health care professional if you or someone close to you is struggling with excessive alcohol consumption.

Source: www.psychcentral.com/science-addiction/2014/10

Filed under: Addiction,Alcohol,Drug use-various effects,Health,USA,Youth :

The polarized legalization debate leads to exaggerated claims and denials about pot’s potential harms. The truth lies in between.

Pretty much everyone who has spent time smoking marijuana knows at least one diehard stoner. The guy whose eyes are always red, the girl who doesn’t use the term “wake and bake” ironically, the person who just can’t seem to ever get it together. These heavy smokers might work at a low-level job or they may be unemployed—but everyone who knows them well knows that they are capable of much more, if only they had any ambition.

Is this really addiction? I believe that it is (and I don’t think that’s an argument against legalization). In fact, the reasons why marijuana is addictive elucidate the true nature of addiction itself.  Addiction is a relationship between a person and a substance or activity; addictiveness is not a simple matter of a drug “hijacking the brain.” In fact, with all potentially addictive experiences, only a minority of those who try them get hooked—and people can even become addicted to apparently “nonaddictive” things, like carrots. Addiction depends on learning, context and psychology, not just neurotransmitters.

With two states having already legalized recreational marijuana use and several more considering doing so, understanding the nature of addiction is more important than ever. Partisans on both sides of the debate have made extreme claims here; some legalizers saying there’s no such thing as marijuana addiction, while some prohibitionists claim “cannabis as addictive as heroin.”

Our concepts of addiction, however, come primarily from cultural experience with alcohol, heroin and, later, cocaine. No one has ever argued that opioids like heroin don’t have the potential to cause addiction because the withdrawal symptoms—vomiting, shaking, pallor, sweating and diarrhea—are objectively measurable. Opioids cause physical dependence that is evident when they become unavailable. The same is true for alcohol, where withdrawal is even more severe and can sometimes even be deadly.

So early researchers focused on these measurable symptoms related to alcoholism and opioid addictions in defining addiction: Using a drug could lead to becoming tolerant to it, tolerance could lead to dose escalation, which could in turn lead to physical dependence, and then the addiction could be driven by the need to avoid the painful symptoms of withdrawal. It was simple and physical.

In this view, however, cocaine and marijuana were not “really” addictive. While people can experience withdrawal symptoms like irritability, depression, craving and sleep problems when quitting these drugs, these are much more subjective and therefore can be dismissed as “psychological” rather than physical. You might really want coke or pot, but you didn’t need it like a real junkie, the thinking went.

And since most of us like to believe that we have much more control over our minds than we do over physical symptoms, “psychological” addiction is seen as far less serious than the “physical” type. It’s the remnants of this kind of thinking that mainly underlie the idea that marijuana addiction doesn’t exist. Unfortunately, that view of addiction is stuck in the 1970s.

In the 1980s—ironically, not long after Scientific American caused a big controversy by arguing that snorted cocaine is no more addictive than eating potato chips—entrepreneurs began marketing a ready-made smokeable form of the drug. The birth of crack shattered the idea that “physical” dependence is more serious than psychological dependence because people with cocaine addictions don’t vomit or have diarrhea when they quit; while they may appear desperate, it’s not in the physically obvious way of heroin or alcohol withdrawal. And so, if you are going to argue that marijuana is not addictive because you don’t get sick when you quit, you also have to argue the same for crack.

In the 1970s view, cocaine and marijuana were not “really” addictive: You might really want coke or pot, but you didn’t need it like a real junkie, the thinking went.

Good luck with that one, I say. Clearly, crack-addicted people are every bit as compulsive as those with heroin problems—and their criminal involvement if they can’t afford the drug is at least equally likely, though not as common as has been claimed. Crack dealt a deathblow to the “psychological” vs. “physical” distinction—and if it hadn’t, neuroscience was creeping up to show that the psychological and the physical aren’t exactly distinct anyway.

In the ‘70s and ‘80s, researchers also began recognizing that simply detoxing heroin addicts—getting them through the two-week period of intense physical withdrawal symptoms—is not effective treatment. If heroin addiction was driven primarily by the need to avoid withdrawal, addicted people should be out of the woods after they complete cold turkey. But as those of us who have been through it know, that is far from the hardest part.

While kicking heroin isn’t fun, staying off it in the long run is the problem—those “mere” psychological cravings are what drive addiction. Physical dependence isn’t the main problem; it isn’t even necessary. Indeed, we now know that you can actually have physical dependence without any addiction at all: There are some blood pressure medications, for example, that can have deadly withdrawal symptoms if not tapered properly, but people on these meds don’t crave them even though they are quite dependent. Similarly, antidepressants like Paxil have physical withdrawal symptoms, but because they don’t produce a high, you don’t see people robbing drug stores to get them.

So what is addiction, then, if tolerance, withdrawal and physical dependence aren’t essential to it? All of these facts point to one definition that can sum up the problem: Addiction is compulsive use of a substance or engagement in a behavior despite negative consequences. (Put more in neuroscience, addiction is a learned distortion in the brain’s motivational systems that make us persist in pursuing things linked to evolutionary fitness like food and sex.) Anything that causes pleasure via these systems—and that’s basically anything that is possible to enjoy—can be addictive to some person at some time. And that includes marijuana (and, for that matter potato chips).

This doesn’t mean that marijuana addiction is necessarily as severe as cocaine, heroin or alcohol addiction—in fact, it typically isn’t. If given the choice, most families would vociferously prefer having a member addicted to marijuana rather than to cocaine, heroin or alcohol. The negative consequences associated with marijuana addiction tend to be subtler: lost promotions, for example, rather than lostjobs; worse relationships, not no relationships. And of course, no risk of overdose death.

Marijuana addiction may quietly make your life worse without ever getting bad enough to seem worth addressing; it may not destroy your life but it may make you miss opportunities.

But this is also what can make it insidious. Marijuana addiction may quietly make your life worse without ever getting bad enough to seem worth addressing; it may not destroy your life but it may make you miss opportunities. With any pattern of regular drug use, it’s important to continually track whether the risks outweigh the benefits, keeping in mind that addiction itself may distort this calculation. This is especially true with marijuana.

However, as with all other drugs, only a minority of marijuana users ever struggle with addiction. Research suggests that about 10% get hooked—and on average, marijuana addiction lasts six years. Even more than other addictions, marijuana addiction seems to be driven by self-medication of mental health problems—90% of people with marijuana addiction also have another addiction or mental illness, typically alcoholism or antisocial personality disorder.

This suggests that exposing more of the population to marijuana won’t necessarily increase the addicted population. First, people with antisocial personality disorder, by definition, tend not to be law abiding, so most have probably already tried it. Second, the percent of people with other pre-existing mental illness will not change because marijuana becomes legal—in fact, in the UK, when they reversed their prior liberalization of marijuana law because of fears related to increased schizophrenia, psychosis rates actually went up. (The link probably wasn’t causal, but it does suggest that legal crackdowns on cannabis don’t prevent related psychosis).

If some people with alcohol, cocaine or heroin addiction switch to marijuana instead, overall harm would be reduced. As I and others have been reporting at least since 2001, using marijuana as an “exit” drug is a real phenomenon, both in cocaine and opioid addiction.

When we consider the risks of various substances, we tend to do so in isolation—but that’s not how choices are made in the real world. Most people would rather their partners have no addictions—but again, some are clearly worse than others. Marijuana craving is rarely as severe as crack craving, as is obvious.

Still, like anything that can be pleasurable, marijuana can be addictive. This doesn’t mean all addictions are the same or that it is as addictive as the currently legal drugs alcohol and tobacco—the data shows it is less so.

Pretending it can’t do any harm at all, however—or that there aren’t people who are addicted to it—does no one any good. If we want better drug policy, as with other types of recovery, we need to avoid denial.

Maia Szalavitz is one of the nation’s leading neuroscience and addiction journalists, and a columnist at Substance.com. She has contributed to Time, the New York Times, Scientific American Mind, the Washington Post and many other publications. She has also published five books, including Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids (Riverhead, 2006), and is currently finishing her sixth, Unbroken Brain, which examines why seeing addiction as a developmental or learning disorder can help us better understand, prevent and treat it. Her last column for Substance.com was about why the oft-documented fact that most people age, or grow, out of substance misuse is not common knowledge.

Source: www.substance.com 15th October 2014

Filed under: Addiction,Alcohol,Cannabis/Marijuana,Cocaine,Drug use-various effects,Effects of Drugs,Health,Heroin/Methadone,Social Affairs,USA :

As social acceptance and public policy around marijuana shift, and especially if legalized recreational use becomes more widespread, we will need to consider the influence and potential regulation of its marketing.  For this, we should use what we already know from the science to guide our decisions and policies to minimize harm, because inevitably, advertising is going to reach children and adolescents, people who are addicted to marijuana, and those of all ages who are on their way to becoming addicted.

Ads for addictive substances—including tobacco and alcohol and fattening foods—have the obvious intent of generating new customers as well as enticing current users to use more, but that’s not all they do. Marketers know that by associating such products with other pleasurable stimuli and situations, ads contribute to reinforcing those positive associations in the brains of users, and thus contribute to the process of developing an addiction. 

Drug addiction is a disease of learning—learning to associate drugs with positive feelings and to associate cues that signal drug availability with similar feelings, ultimately leading to craving for the drug.  This part of the addictive progression is known as conditioning, discovered in the 1890s by Pavlov. Today we also understand the brain mechanisms that underlie the phenomenon: Once a person becomes conditioned to drug-related stimuli, those stimuli independently become associated with increases in dopamine in the brain’s reward pathway (i.e., without the drug even being present). These dopamine bursts fuel drug-seeking and craving. The same process can cause such stimuli to act as triggers contributing to relapse in those who are already addicted and are struggling to recover.

When there are salient advertisements for a product, it’s very hard to contain them, because images don’t even need to reach the level of conscious awareness to stimulate the urge to use that product. Recent neuroimaging research has confirmed the brain’s extraordinary sensitivity to “unseen” rewarding stimuli: A 2008 fMRI study by Anna Rose Childress and colleagues confirmed that limbic circuitry respond to drug (as well as sexual) reward cues that are too fleeting to be consciously registered. Also, because of the reach of the Internet, it will be hard to restrict exposure to marijuana advertising just to people in states where it is legal, or just to people old enough to purchase it.

For decades we have seen the harmful effects that alcohol and tobacco ads can have, especially those that target young people; similar associations have been found between exposure to food advertising and obesity. The relative harm of marijuana compared to other legal drugs remains hotly contested, but its potential addictiveness—especially to young people—is undisputed. Thus, it is crucial that states consider the lessons learned from tobacco and alcohol policy research and restrict (or preclude) marijuana advertising to reduce as much as possible the development of newly addicted individuals and avoid inducing relapse in people who are already addicted.

Source: www.drugabuse.gov October 23, 2014

Filed under: Addiction,Economic,Social Affairs,Youth :

Pot smokers say marijuana is a mind-expanding drug, but a new study conducted at The University of Texas at Dallas links heavy, long-term use of marijuana with smaller volume in the orbitofrontal cortex–a brain region associated with decision-making and addiction. 

The same research shows that the brains of long-term users have greater connectivity in this region than do the brains of people who don’t use pot, although this connectivity seems to disappear over time with prolonged use. The research also shows that the earlier an individual starts using marijuana, the more pronounced the brain abnormalities.

Whether these brain abnormalities cause any mental or emotional deficits isn’t yet clear.

“The orbital frontal cortex is a key part of the brain’s reward system/network and instrumental in our motivation, decision-making and adaptive learning,” study leader Dr. Francesca Filbey, director of the university’s Center for BrainHealth and an associate professor in the university’s School of Behavioral and Brain Sciences, told The Huffington Post in an email. “As such, our finding that chronic marijuana users had smaller brain volume in the orbital frontal cortex, might manifest behaviorally making it difficult for them to change learned behavior.”

For the study, Filbey and her colleagues used MRI scanners to compare the brains of 48 adults who had smoked marijuana three times a day for 10 years, on average, to the brains of 62 non-users.  While their findings are provocative, the researchers acknowledge that they do not prove that marijuana use directly causes changes in the brain–a point of view shared by Dr. Asaf Keller, a professor of anatomy and neurobiology at the University of Maryland School of Medicine, who was not involved in the study. 

“As this is a retrospective study—and not a prospective one—it is impossible to determine whether individual differences in brain anatomy are related to genetic or environmental factors other than marijuana use,” he told HuffPost Science in an email. “In sum, there is not indication that the anatomical differences in the brains of marijuana users are caused by marijuana use.”  Keller has been critical of previous research linking casual marijuana use to changes in the brain.

Still, some researchers argue that this new study is an important step forward for marijuana research.  “This is important, well-conducted research that can serve as a reminder that marijuana use may not be without risks,” Dr. Susan F. Tapert, a psychiatry professor at the University of California, San Diego, who was not involved in the study, told HuffPost Science in an email. “These findings point to the need for definitive longitudinal studies that assess future users prior to the onset of marijuana use, then again after use has started.”

Source: Journal Proceedings of the National Academy of Sciences  10th Nov  2014

Filed under: Addiction,Cannabis/Marijuana,Drug use-various effects on foetus, babies, children and youth :

Cocaine addicts can’t recognise loss – such as the consequences of a break-up or being sent to jail – because the drug changes their brain, according to a new study.

Researchers found cocaine addicts may continue their destructive drug habit despite such huge personal setbacks because their brain circuits responsible for predicting emotional loss are impaired. They say the find could be used to develop new treatments, and spot those most at risk of relapsing. 

Cocaine

The new study recorded the brain activity of 75 people – 50 cocaine users and 25 healthy controls – using EEG, a test that detects electrical activity in the brain, while subjects played a gambling game.  Each person had to predict whether or not they would win or lose money on each trial. 

The study, published in The Journal of Neuroscience, focuses on the difference between a likely reward, or loss, related to a given behaviour and a person’s ability to predict that outcome – a measurement known as Reward Prediction Error, or RPE.Such RPE signalling is believed to drive learning in humans, which guides future behaviour. After learning from an experience, we can, in the best case, change our behaviour without having to go through it again.

Previous research determined that predictions of actual reward or loss are managed by shifting levels of the nerve signaling chemical dopamine produced by nerve cells in the brain, where changes in dopamine levels accompany unexpected gains and losses.The new study recorded the brain activity of 75 people – 50 cocaine users and 25 healthy controls – using EEG, a test that detects electrical activity in the brain, while subjects played a gambling game. Each person had to predict whether or not they would win or lose money on each trial.

Results showed that the group of cocaine users had impaired loss prediction signaling, meaning they failed to trigger RPE signals in response to worse-than-expected outcomes compared to the 25 healthy people.

Researchers say their findings offer insights into the compromised ability of addicts to learn from unfavourable outcomes, potentially resulting in continued drug use and relapse, even after suffering major losses.

Study lead author Doctor Muhammad Parvaz, Assistant Professor of Psychiatry at the Icahn School of Medicine in the US, said: ‘We found that people who were addicted to cocaine have impaired loss prediction signalling in the brain.

‘This study shows that individuals with substance use disorder have difficulty computing the difference between expected versus unexpected outcomes, which is critical for learning and future decision making.

‘This impairment might underlie disadvantageous decision making in these individuals.’

Half had used cocaine within 72 hours of the study and the other half had abstained for at least 72 hours. 

The cocaine addicts with the more recent use had higher electrical activity associated with the brain’s reward circuit when they had an unpredicted compared to a predicted win, a pattern that was similar to the 25 healthy controls. The cocaine users who had abstained for at least 72 hours did not show the higher activity in response to an unpredicted win.

The researchers said these findings are consistent with the hypothesis that in addiction the drug is taken to normalise a certain brain function, which in this case is RPE signalling of better-than-expected outcomes. Principal investigator Doctor Rita Goldstein said: ‘This is the first time a study has targeted the prediction of both gains and losses in drug addiction, showing that deficits in prediction error signalling in cocaine addicted individuals are modulated by recent cocaine use.

‘The reductions in prediction of loss across all cocaine addicted individuals included in this study are also of great interest; they could become important markers that can be used to predict susceptibility for addiction or relapse or to develop targeted interventions to improve outcome in this devastating, chronically relapsing disorder.’ 

Source: http://www.dailymail.co.uk/sciencetech/article-2938830/Cocaine-changes-addict-s-brains-t-recognise-loss-partner-leaves-sent-jail.html#ixzz3QuR3dTvL 

4th Feb.2015

Filed under: Addiction,Cocaine,Drug use-various effects :

Grant JD1, Scherrer JF, Neuman RJ, Todorov AA, Price RK, Bucholz KK.

Abstract

BACKGROUND:

Little empirical evidence exists to determine if there are alternative classification schemes for cannabis abuse and dependence beyond the definitions provided by Diagnostic and Statistical Manual (DSM) criteria. Current evidence is not conclusive regarding gender differences for cannabis use, abuse and dependence. It is not known if symptom profiles differ by gender.

METHODS:

Latent class analysis (LCA) was used to assess whether cannabis abuse and dependence symptom patterns suggest a severity spectrum or distinct subtypes and to test whether symptom patterns differ by gender. Data from 3312 men and 2509 women in the National Longitudinal Alcohol Epidemiologic Survey (NLAES) who had used cannabis 12 + times life-time were included in the present analyses. The comparability of the solutions for men and women was examined through likelihood ratio chi(2) tests.

RESULTS:

Based on the Bayesian information criterion and interpretability, a four-class solution was selected, and the classes were labeled as ‘unaffected/mild hazardous use’, ‘hazardous use/abuse’, ‘abuse/moderate dependence’ and ‘severe abuse/dependence’. The solutions were generally suggestive of a severity spectrum. Compared to men, women were more likely to be in the ‘unaffected/mild hazardous use’ class and less likely to be in the ‘abuse/moderate dependence’ or ‘severe abuse/dependence’ classes. The results were generally similar for men and women. However, men had consistently and substantially higher endorsements of hazardous use than women, women in the ‘abuse/moderate dependence’ class had moderately higher rates for four dependence symptoms, and women in two of the classes were more likely to endorse withdrawal.

CONCLUSION:

Our findings generally support the severity dimension for DSM-IV cannabis abuse and dependence symptomatology for both men and women. While our results indicate that public health messages may have generic and not gender-specific content, treatment providers should focus more effort on reducing hazardous use in men and alleviating withdrawal in women.

Source: Addiction. 2006 Aug;101(8):1133-42.

Filed under: Addiction,Brain and Behaviour,Cannabis/Marijuana,Drug use-various effects,Prevention and Intervention :

Day NL1, Goldschmidt L, Thomas CA.

Abstract

AIM:

To evaluate the effects of prenatal marijuana exposure (PME) on the age of onset and frequency of marijuana use while controlling for identified confounds of early marijuana use among 14-year-olds.

DESIGN:

In this longitudinal cohort study, women were recruited in their fourth prenatal month. Women and children were followed throughout pregnancy and at multiple time-points into adolescence.

SETTING AND PARTICIPANTS:

Recruitment was from a hospital-based prenatal clinic. The women ranged in age from 18 to 42, half were African American and half Caucasian, and most were of lower socio-economic status. The women were generally light to moderate substance users during pregnancy and subsequently. At 14 years, 580 of the 763 offspring-mother pairs (76%) were assessed. A total of 563 pairs (74%) was included in this analysis.

MEASUREMENTS:

Socio-demographic, environmental, psychological, behavioral, biological and developmental factors were assessed. Outcomes were age of onset and frequency of marijuana use at age 14. PME predicted age of onset and frequency of marijuana use among the 14-year-old offspring. This finding was significant after controlling for other variables including the child’s current alcohol and tobacco use, pubertal stage, sexual activity, delinquency, peer drug use, family history of drug abuse and characteristics of the home environment including parental depression, current drug use and strictness/supervision.

CONCLUSIONS:

Prenatal exposure to marijuana, in addition to other factors, is a significant predictor of marijuana use at age 14.

Source:   Addiction. 2006 Sep;101(9):1313-22.

Filed under: Addiction,Brain and Behaviour,Cannabis/Marijuana,Drug use-various effects on foetus, babies, children and youth :

Neurobiology of Addiction: PET Scans Show Changes in the Brain.

 
The world tends to look at addicts as people who have a character flaw. Are they poor decision makers? Are they narcissists? Are they anti-social? For the most part, we don’t do that with other people and their diseases.

“Oh, you’re diabetic, you must be narcissistic. You have high blood pressure, you’re a poor decision maker. No, we don’t do that. So we’ve got to really come forward with drug addiction as a disease,” said JeanAnne Johnson Talbert, DHA, APRN-BC, FNP, CARN-AP, medical director of Steps Recovery Center, Payson, UT, at the American Psychiatric Nurses Association 28th Annual Conference, held October 22-25, 2014, in Indianapolis, IN.

In the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) that was published last year, addiction is classified as a “substance abuse disorder.” According to Talbert, “the newly revised edition took out the ‘legal ramifications’ criteria and substituted ‘craving.’ And that’s where you’re starting to see some progression with treating this disease.”

What’s the big deal? Nearly 23 million Americans are addicted to alcohol or other drugs. Tobacco, alcohol, and illegal drug addiction costs this country $524 billion a year in direct and indirect costs. The economic burden is twice as much as any other disease affecting the brain.

You may know people who can drink a whole bottle of wine in one evening and then not touch it again for months. And you may know people who can drink socially or on the weekends or holidays. People can also abuse substances, but not all of those people are actually addicted. Then there is full addiction, which involves changes to structures of the brain. “A person can fluctuate in and out of occasional or social abuse, but once you get into the actual addiction, you don’t fluctuate. You’re stuck,” said Talbert.

No one starts out wanting to become an addict, she added. “You may just want to feel good or better, but the younger you are when you start using, the more likely it is that you’ll become addicted,” said Talbert.

Addiction is a chronic and progressive brain disease of the reward, motivation, and memory pathway that moves from an impulse or positive reinforcement to compulsive and negative reinforcement. Brain structure and function change.

Addiction can also affect clinicians. “What really happens in the brain to cause an addicted doctor to lose control and his license to practice medicine? Addiction hijacks your brain and makes you do things that you normally wouldn’t do,”” said Talbert. The thing that’s really important with addiction is this term ‘plasticity,’ which means that the brain actually changes in response to experiences.  This involves both excitatory and inhibitory influences,” she said.

Positron emission tomography (PET) scans and other research over the past 20 years have increased our understanding of the neurologic processes that underlie addiction. Addiction affects the brain circuits involved in reward, motivation, memory, and even inhibitory control.

Talbert said drugs release dopamine‑‑the same chemical you feel after good sex, food, and relationships‑‑in the nucleus accumbens. “You want more. But over time in an addict’s brain, the same drug of choice no longer has that appeal. Then compulsion rears its ugly head and cravings control the addict, sometimes even after years of abstinence,” she said.

Source: http://www.hcplive.com/conferences/apna-2014/Neurobiology-of-Addiction-PET-Scans-Show-Changes-in-the-Brain-#sthash.1OhEsrGb.dpuf

Filed under: Addiction,Brain and Behaviour :

 An early onset of drinking is a risk factor for subsequent heavy drinking and negative outcomes among high school students, finds a new study. 

Researchers asked 295 adolescent drinkers (163 females, 132 males) with an average age of 16 years to complete an anonymous survey about their substance use. These self-report questions assessed age at first intoxication – for example, “How old were you the first time you tried alcohol/got drunk?”  They also took stock of the previous month’s consumption of alcohol, including an assessment of the frequency of engaging in binge drinking.

“Teenagers who have their first drink at an early age drink more heavily, on average, than those who start drinking later on,” said Meghan E. Morean, an assistant professor of psychology at the Oberlin College, Ohio and adjunct assistant professor of psychiatry at Yale School of Medicine. The findings also suggest that how quickly teenagers move from having their first drink to getting drunk for the first time is an important piece of the puzzle.

“In total, having your first drink at a young age and quickly moving to drinking to the point of getting drunk are associated with underage alcohol use and binge drinking, which we defined as five or more drinks on an occasion in this study,” Morean noted. We would expect a teenager who had his first drink at age 14, and who got drunk at 15, to be a heavier drinker than a teenager who had his first drink at age 14, and waited to get drunk until age 18, researchers emphasised.

“The key finding here is that both age of first use and delay from first use to first intoxication serve as risk factors for heavy drinking in adolescence,” said William R. Corbin, associate professor and director of clinical training in the department of psychology at Arizona State University

The study is scheduled to be published in the journal Alcoholism: Clinical and Experimental Research.

Source:  www.business-standrd.com  20th Sept 2014

Filed under: Addiction,Addiction (Papers),Alcohol,Drug use-various effects on foetus, babies, children and youth,Education Sector (Papers),Prevention (Papers),Prevention and Intervention,Youth :

Researchers link a gene already tied to alcohol dependence with a neurotransmitter involved in anxiety and relaxation.

The neurofibromatosis type 1 (Nf1) gene, which has been previously linked to alcohol dependence, may exert its influence on alcohol intake through the regulation of gamma-aminobutyric acid (GABA), a neurotransmitter known to decrease anxiety and boost feelings of relaxation, according to a mouse study published this month (August 18) in Biological Psychiatry. The research, led by scientists at The Scripps Research Institute (TSRI), also links variations in the human Nf1 with the risk and severity of alcohol dependence.

“Despite a significant genetic contribution to alcohol dependence, few risk genes have been identified to date, and their mechanisms of action are generally poorly understood,” co-author Vez Repunte-Canonigo said in a press release.

The team decided to look for a connection with the neurotransmitter GABA as a result of previous work that has shown GABA release in the central amygdala, a brain area involved in decision making, stress, and addiction, is “critical in the transition from recreational drinking to alcohol dependence,” said co-author Melissa Herman. Examining mouse models of alcohol dependence, the team found that mice with functional Nf1 genes started to increase their alcohol intake after a single period of withdrawal, while those with one copy of the gene knocked out did not increase their ethanol consumption. Moreover, in heterozygous Nf1 mice, intake of alcohol did not result in higher GABA release in the central amygdala, which was observed in mice with two functional copies of the Nf1 gene.

The researchers also explored variation in human Nf1 using data from some 9,000 people and found the gene correlated alcohol-dependence risk and severity. “A better understanding of the molecular processes involved in the transition to alcohol dependence will foster novel strategies for prevention and therapy,” co-author Pietro Paolo Sanna said in the release.

Source: the-scientist.com August 27, 2014

Filed under: Addiction,Alcohol,Brain and Behaviour :

NHS figures show increase of 22% in number of cases over last 10 years, from 1,192 in 2004-5 to 1,536 in past 12 months

More than 7,800 babies have been born with ‘neonatal withdrawal symptons’ in the past five years, after becoming dependent on drugs their mothers took during pregnancy. Photograph: Alamy

More than 1,500 babies a year are born addicted to drugs, NHS figures show. They include cases where doctors have been forced to give opiates to babies in order to wean them off heroin.

More than 7,800 newborns have been recorded with “neonatal withdrawal symptoms” in the last five years, effectively putting them into cold turkey after becoming dependent on drugs their mothers took during pregnancy.

They include 6,599 cases in England, 738 in Scotland and 464 cases in Wales, according to data obtained by the Mirror.

The figures show a 22% increase in cases over the last 10 years, from 1,192 in 2004-5 to 1,536 in the past 12 months.

Christian Guy, director of the Centre for Social Justice thinktank, said: “The 1,500 innocent babies born into the trauma of addiction each year are being given a tragic start in life. It demonstrates that addiction is not just about individual choice – it affects children, families, communities and public services.”

Vivienne Evans, chief executive of the family support charity Adfam, said: “If pregnant women think they will be mistreated, stigmatised or have their children taken away, they will be scared to access the health services that they and their babies need. We need specialist doctors, midwives and social workers to work with them.”

A study published this year found that more than half of women drink more than the recommended amount of alcohol during the first three months of pregnancy. Women who had more than two units a week were twice as likely to give birth to unexpectedly small or premature babies as women who did not drink at all.

Source: theguardian.com, Saturday 2 August 2014

Filed under: Addiction,Health :

Excessive alcohol use is usually associated with damage to the liver. While that is a common side effect, researchers are now warning that heavy drinking can also take a toll on the lungs.

Alcohol can break down the immune system in the lungs, making them more vulnerable to infection, and the damage it causes. It’s why alcoholics are at increased risk of developing pneumonia and life-threatening acute respiratory distress syndrome (ARDS), for which there is no treatment.

Researchers at Thomas Jefferson University say they have discovered that one of the keys to immune system failure in the lung is a build-up of fat. It’s significant, they say, because it not only explains why alcohol is linked to lung disease but offers the possibility of a new treatment.

Alcoholic fatty lung

“We call it the alcoholic fatty lung,” said lead researcher Ross Summer, M.D. “The fat accumulation in the lungs mimics the process that causes fat to build up and destroy the liver of alcoholics.”

When you over-consume alcohol your liver cells begin to produce fat – most likely a defense against the toxic effects of alcohol. Over time that fat accumulates to the point that heavy drinkers develop so called “fatty liver disease.”

The fat build-up at first impairs liver function but can also cause scarring that eventually leads to liver failure. So, what does this have to do with the lungs?

The lungs also contain cells that produce fat. These cells expel a fatty secretion onto the inner lining of the lung to keep the airways properly lubricated during breathing. Summer and his teams speculated that these cells might act the same way liver cells do after extended alcohol exposure.

The study

Laboratory rats were enlisted for experiments and the researchers noted the lung cells increased production of triglycerides by 100% and free fatty acids by 300%. The researchers also noticed that immune cells in the lungs were less effective against infection.

From this, the researchers conclude that lipid lowering drugs might be an effective tool for doctors treating alcohol-related pneumonia. They think it might also head off development of ARDS.

Increased scrutiny

Alcohol only recently has received new scrutiny as a serious health threat. The Centers for Disease Control and Prevention (CDC) says there are approximately 88,000 deaths in the U.S. each year that can be attributed to excessive alcohol use, making it the third leading lifestyle cause of death in the nation.

“Excessive alcohol use is responsible for 2.5 million years of potential life lost (YPLL) annually, or an average of about 30 years of potential life lost for each death,” the CDC said in a report.

In 2006, there were more than 1.2 million emergency room visits and 2.7 million physician office visits due to excessive drinking, the agency said. The economic costs of excessive alcohol consumption in 2006 were estimated at $223.5 billion.

Then there is the whole category of deaths and injuries due to accidents caused by excessive alcohol consumption. And there is some evidence that the current statistics understate the problem.

In March researchers writing in the Journal of Studies on Alcohol and Drugs suggested a lot of highway deaths – and other accidents in which alcohol was a factor – might not make it into the alcohol-related statistics.

Between 1999 and 2009, more than 450,000 Americans were killed in a traffic crashes. The researchers maintain that in cases where alcohol was involved, death certificates very often failed to list alcohol as a cause of death.

Defining problem drinking

What constitutes excessive drinking? Heavy drinking is defined as 8 or more drinks per week for women and 15 or more drinks for men.

But don’t think only drinking on Saturday night – but polishing off 12 beers – will qualify you as a moderate drinker. Binge drinking, according to the CDC, is the worst kind.

Binge drinking is defined as 4 or more drinks on a single occasion for women and 5 drinks for men.

Source:  www.consumeraffairs.com  7th July 2014

Filed under: Addiction,Alcohol,Health :

People affected by binge eating, substance abuse and obsessive compulsive disorder all share a common pattern of decision making and similarities in brain structure, according to new research  from the University of Cambridge. “Compulsive disorders can have a profoundly disabling effect of individuals. Now that we know what is going wrong with their decision making, we can look at developing treatments, for example using psychotherapy focused on forward planning or interventions such as medication which target the shift towards habitual choices,” authors said.

In a study published in the journal Molecular Psychiatry and primarily funded by the Wellcome Trust, researchers show that people who are affected by disorders of compulsivity have lower grey matter volumes (in other words, fewer nerve cells) in the brain regions involved in keeping track of goals and rewards.

In our daily lives, we make decisions based either on habit or aimed at achieving a specific goal. For example, when driving home from work, we tend to follow habitual choices — our ‘autopilot’ mode — as we know the route well; however, if we move to a nearby street, we will initially follow a ‘goal-directed’ choice to find our way home — unless we slip into autopilot and revert to driving back to our old home. However, we cannot always control the decision-making process and make repeat choices even when we know they are bad for us — in many cases this will be relatively benign, such as being tempted by a cake whilst slimming, but extreme cases it can lead to disorders of compulsivity.

In order to understand what happens when our decision-making processes malfunction, a team of researchers led by the Department of Psychiatry at the University of Cambridge compared almost 150 individuals with disorders including methamphetamine dependence, obesity with binge eating and obsessive compulsive disorder, comparing them with healthy volunteers of the same age and gender.

Study participants first took part in a computerised task to test their ability to make choices aimed a receiving a reward over and above making compulsive choices. In a second study, the researchers compared brain scans taken using magnetic resonance imaging (MRI) in healthy individuals and a subset of obese individuals with or without binge eating disorder (a subtype of obesity in which the person binge eats large amounts of food rapidly).

The researchers demonstrated that all of the disorders were connected by a shift away from goal-directed behaviours towards automatic habitual choices. The MRI scans showed that obese subjects with binge eating disorder have lower grey matter volumes — a measure of the number of neurons — in the orbitofrontal cortex and striatum of the brain compared to those who do not binge eat; these brain regions are involved in keeping track of goals and rewards. Even in healthy volunteers, lower grey matter volumes were associated with a shift towards more habitual choices.

Dr Valerie Voon, principal investigator of the study, says: “Seemingly diverse choices — drug taking, eating quickly despite weight gain, and compulsive cleaning or checking — have an underlying common thread: rather that a person making a choice based on what they think will happen, their choice is automatic or habitual.

“Compulsive disorders can have a profoundly disabling effect of individuals. Now that we know what is going wrong with their decision making, we can look at developing treatments, for example using psychotherapy focused on forward planning or interventions such as medication which target the shift towards habitual choices.”

Source: University of Cambridge. “Creatures of habit: Disorders of compulsivity share common pattern, brain structure.” ScienceDaily. ScienceDaily, 29 May 2014. <www.sciencedaily.com/releases/2014/05/140529100717.htm>.

Filed under: Addiction,Brain and Behaviour :

Dr. Robert DuPont, President, Institute for Behavior and Health   |   March 28, 2014

In a recent National Public Radio interview, Dr. Lance Dodes, co-author of a new book that attacks the efficacy of Alcoholics Anonymous (AA) and the many 12-step groups it has inspired, declared that AA — which he repeatedly misidentified as a “treatment” — probably has “the worst success rate in all of medicine,” and is “harmful” to those who do not do well within its program.

He told NPR that AA’s success rate was “between 5 and 10 percent,” and that AA harms people because “everyone believes that AA is the right treatment. AA is never wrong … If you fail in AA, it’s you that’s failed,” he said.

Moreover, Dodes criticized AA and Narcotics Anonymous’ (NA) “tally” system, which recognizes incremental periods of continued sobriety by awarding chips. “The dark side is, if you have a beer after six months of sobriety, you’re back to zero in AA,” Dodes said. “That makes no sense. It’s unscientific. It’s simply crazy. If you have only a beer in six months, you’re doing beautifully.”

I couldn’t disagree more. His message is not only inaccurate and distorted, but also dangerous. No one should be discouraged from participating in these fellowships. They save lives every day.

When people ask me the percentage of success of AA and NA, the 12-step fellowships, I say it is 100 percent — for those who follow the programs as they’re intended to be followed. This means not just going to an occasional meeting, but to many meetings every week, having a sponsor — who is similar to a sober companion — “working” each of the 12 steps in depth, specifically as they apply to the recovering addict, and making recovery the No. 1 priority.  This group of related fellowships is a modern miracle. There are many reasons to be proud of America, but none is more personally important to me — or more unique — than the founding of Alcoholics Anonymous in 1935 in Akron, Ohio.

AA is not “treatment,” and it cannot be meaningfully compared to any treatment. When can anyone find a treatment program located in virtually every part of the world? A treatment program where someone calls you daily? A treatment program where you can call someone at 3 a.m.? And a “treatment” that not only is free to the suffering addict and alcoholic, but that requires no insurance, government funding or a license, and is not subject to any regulation?

No one makes money from it. Rich folks cannot even give money to it, because it needs none, other than the few dollars for administrative costs that its members donate during the meetings themselves. No one writes books about it. The groups actually seek no publicity; in fact, publicity goes against its principles. The word “anonymous” is part of its name for a reason; members respect the anonymity of those who participate, as well as their personal stories.

Moreover, unlike what Dodes apparently believes, no one judges you if you relapse. No one makes you feel as if you’ve failed. Rather, you receive unconditional support. I know of no other programs like these. They are not treatment, nor are they religion. The only requirement is a desire to stop drinking and using drugs.

But to say, as Dodes seems to be suggesting, that AA merely is a supportive social organization completely misses what this miracle is: AA and NA are well-established, sophisticated and effective paths to “recovery,” a term adopted by these fellowships to make clear that AA does not offer to help members get back to their “premorbid” state, but rather to reach an entirely new and better state of living. Its members are not “reformed,” which has a negative connotation, but “recovering,” which is — and must be — a lifelong process.

Those in recovery serve as an inspiration, not only to drug addicts and alcoholics, but to everyone they encounter — a striking and remarkable contrast to the response they would receive if they were still using alcohol and drugs.

The bright line drawn by AA and NA — the sobriety date that marks the last time a recovering addict used alcohol or other drugs — is essential. It differs radically from the academic and professional standard for drug and alcohol addiction , which tolerates slips and relapses. The bright line of the sobriety date is a matter of importance and of huge pride for fellowship members — it is a core marker of identity in the fellowships, and a fundamental defining part of the disease of addiction. One of the true joys of this fellowship is attending a group celebration that commemorates a recovering addict’s “clean time” anniversary.

The all too common academic, professional views on addiction, well represented by Dodes, run counter to the AA and NA goal of sobriety. Many professionals and academics see continued alcohol and drug use as OK but “problem-generating use” as not quite as acceptable. They encourage controlled, responsible alcohol and drug use. They encourage cutting down, but not stopping. They view drug and alcohol use by addicts as a lifestyle alternative that, like sexual orientation, should not be “stigmatized.”

That is a reckless view. An addict who has one beer after six months of sobriety is not doing “beautifully.” Instead, he or she is courting catastrophe, and likely to easily fall back into active addiction. An addict cannot just have one beer, or one cigarette, or one pill. True lifelong recovery does not happen that way, and anyone who believes that it does is heading for a major relapse.

There are endless examples of skeptics like Dodes who seek alternatives to AA, or approaches that attack AA. I suggest to my patients who reject AA that they find one of these alternatives, and see what they think of it. They tell me that such programs are hard to find. I ask them, “Why do you think that is the case? Doesn’t that tell you something?” When they go to these alternative meetings and hear little beyond AA-bashing, I ask them, “How will this help keep you sober?”

AA and NA do not replace treatment; they enhance it. I see this daily in my own practice. Some addicts do get well without AA or NA, but far more of them fail. I encourage my patients to join the fellowships, and I rejoice with them when they do, confident that they have a better chance at lifelong recovery.

When patients tell me they have attended AA or NA meetings but they haven’t helped, it doesn’t take long to discover that their attendance was brief. I urge them to find a sponsor and speak to their sponsor daily. I tell them to work the steps with a life-or-death intensity, and to do what is known as “90/90” — attend 90 meetings in 90 days. Those who follow these suggestions almost always end up with a new outlook on life and the potential for long-term sobriety. [Most Alcoholics in ‘Serious Denial’ About Treatment ]

Clinicians like me all have come to believe that these fellowships are a blessing — not just for our patients, but for all of us.

The wisdom of the 12-step fellowships does not come simply from Bill Wilson or Bob Smith, AA’s founders. It is wisdom distilled from the experiences of millions of suffering addicts and alcoholics. That source makes it utterly different from the academic studies of addiction. With the 12 steps, what works sticks, and what doesn’t disappears. The leaders don’t abandon the latter; the entire community does.

The 12-step approach is ever-changing and growing. It also is endlessly diverse, fitting in with every culture and subculture in the world. It is adaptable and sensitive to vast diversity. It is unlicensed and uncensored. Anyone can start an AA or NA meeting anywhere he or she chooses. Those groups that meet real needs of real people will thrive and grow.

To be sure, attacking AA probably sells books. Sadly, Dodes’ view of the 12-step fellowships, while misguided and ill-informed, is held by many otherwise sensible and well-informed individuals. I never have understood their skepticism. Think about it. Why have these programs endured so long and become so widespread?

The answer: It works if you work it.

Source:  www. livescience.com 28th March 2014

Filed under: Addiction,Alcohol,Treatment and Addiction :

There’s a long-standing observation that not everyone who tries drugs becomes addicted. Some people are more vulnerable to addiction and some are more resilient. Our goal is to try to understand the individual differences that contribute to whether or not someone who takes a drug will become addicted to it.

Many factors contribute to those differences, and we break them down into three sets. One set is environmental—how a person’s experiences and exposures to drugs or other influences affect his or her risk for addiction. A simple example would be that if your friends smoke, you might be more likely to become a regular smoker and incur the risk for nicotine addiction that comes with regular smoking.  A second set of factors is developmental. The impact of an experience or an exposure often depends on when in a person’s life it occurs. Because the brain is very pliant from early life through adolescence, exposures during this period can make a profound difference in how vulnerable or resilient we are to addiction in the long run.

And finally, we are working to understand the genetics, epigenetics, and other biological processes that underlie drug use and addiction. Addictive drugs can hijack our brain circuitry and cause a rewiring that motivates a person to take more of the drug or make him crave it. So this area of research focuses on how the brain is constituted and how it works, how its neurons and other cells such as glia communicate with each other in these circuits, and then how drugs infiltrate and divert these circuits.

Do genes play a large role in addiction?

Genetic factors account for about 40 to 60 percent of a person’s vulnerability to drug addiction. Genetic studies have begun to identify gene variants that influence a person’s risk for drug use and addictive behaviors. We’ve made the most progress in relating gene variants to smoking behaviors.

We’re working toward a day when a physician might be able to review a patient’s genetic information and predict how she will respond to a particular treatment, for example an antismoking medication. Is it likely to help her, or will she experience side effects and maybe do better with an alternative treatment? There’s still a lot of work to be done in this area, but the evidence is building up and leading toward that goal.

Genetic studies are also giving us leads to the molecular and biological processes that underlie addiction. When we see which genes are involved, then we know which proteins are involved, and we can look at what those proteins do.

Using gene therapy to actually treat drug addiction is a long way off, however, and probably not a main goal. Studies have shown that addiction is a complex disease, with a large number of genes each contributing a little bit. It’s not like, for example, Huntington’s disease, where a single gene is responsible, and the problem is to find an answer to what that one gene does. And even that is a huge challenge.

What are the most promising pathways to new addiction treatments?

Nongenetic factors offer the most hope. They account for 40 to 60 percent of a person’s likelihood of becoming addicted, and they’re much more malleable than genetic factors.

Our overall strategy is to understand how addictive drugs act in the brain to produce and maintain addiction. We can then look for medications, behavioral therapies, or other interventions that will reverse or overcome those effects. This is how our current medications for smoking cessation and treating heroin dependence were developed. We’re now making a major push to identify molecules and processes involved in cocaine addiction and validate them as potential targets for pharmacological interventions.

A relatively new and very promising line of research looks at drugs’ effects on the activity levels of genes. These effects, called “epigenetic” effects, alter brain structure and function in ways that affect cognition and can give rise to addictive behavior. For example, they contribute to neuronal priming, whereby an initial drug exposure primes the brain’s reward system to react more intensely to subsequent exposures. They also underlie the long-lasting changes that distinguish addicted brains from nonaddicted brains.

Epigenetic studies, by pinpointing which genes drugs activate or silence, can shed light on the specific proteins and processes involved in addiction. And, if we can then prevent or reverse those effects, we may have powerful tools for preventing and treating addiction.

Unlike gene therapy, epigenetic treatment approaches would not involve actual manipulation of the DNA in genes. Instead, they would utilize epigenetic mechanisms that control how accessible genetic DNA is to transcription and translation into proteins. There are a number of epigenetic mechanisms at work in the body at all times. Just as drugs engage them to cause addiction, research may show us how to engage them to combat addiction.

What makes your work exciting?

One reason this is an exciting time to be studying addiction is that researchers are uncovering new knowledge at a truly unprecedented pace. That’s happening in large part because we have many new, truly cutting-edge tools and technologies at our disposal. Optogenetics is a great example. With this technology, scientists are using light to stimulate or shut down specific neurons in the brains of experimental animals. They then can observe the effects of that change on animals’ behavior, or they can track neurocircuitry by observing the fallout in other parts of the brain. We also have the ability to create very fine-tuned molecular tools—for example, molecules that we can use to modulate those epigenetic processes and observe the effects.

We’re also benefiting from the huge advances in data storage and computing power that have taken place. That’s given rise to what we call “Big Science.” The promise of Big Science is that we will be able to integrate all of our behavioral, molecular, genetic, epigenetic, and other findings into a multidimensional, reasonably complete picture of addiction—what it is, and how to prevent and cure it.

Source:  www.drugabuse.gov   May 2014

Filed under: Addiction :

Abstract

This article discusses addiction and formation of the Addiction Memory. Addiction has been described as a brain disorder involving brain structures and neural circuits. Addiction impacts long term associative memory including multiple memory systems. Addiction has pathological associations with learning, memory, attention, reasoning, and impulse control. People with addictions suffer from high levels of early maladaptive schemas. The Addiction Memory (AM) plays a crucial role in relapse occurrence and maintaining the addictive behavior. Healing the addiction memory is imperative in treating addictions. Pharmacological and psychological methods are being used to treat addictions. Among the psychological interventions Cognitive Behavior Therapy, Eye movement desensitization and reprocessing (EMDR) and Schema-Focused Therapy (SFT) can be used to heal the addiction memory.

Drug addiction has become an increased phenomenon in the modern civilization. Addiction habits have impacted individuals, families and the society. Addiction has been regarded as an individual disease as well as a social condition. Addictions cause structural changes in cultural, social, political, and economic system in society (Ajami et al., 2014). Addiction is almost universally held to be characterized by a loss of control over drug-seeking and consuming behavior (Levy, 2014).

Addiction is defined as compulsive drug use despite negative consequences (Hyman, 2005). Addiction is a multifactorial phenomenon (Shaghaghy et al., 2011). McLellan and colleagues (2000) conceptualize addiction as a brain disease. Leshner (1997) views addiction as a chronic, relapsing brain disorder that involves complex interactions between biological and environmental variables. According to Mate (2014) addictions are experience based and it has close links with pain, distress, negative emotions, loss of meaning and often connected with adverse early childhood experiences.  Drug addiction leads to profound disturbances in an individual’s behavior that affect his/her immediate environment, usually resulting in isolation, marginalization, or incarceration (Volkow et al., 2004).

 Addictions and Brain Structures

There are numerous brain structures and neural circuits involved in the addiction process. Several studies using a whole brain analysis approach have demonstrated how sensorimotor brain networks contribute to addiction (Yalachkov et al., 2010). Drug addiction causes important derangements in many areas, including pathways affecting reward and cognition (Fowler et al., 2007). Tomkins & Sellers (2001) specify that multiple neurotransmitter systems may play a key role in the development and expression of drug dependence.

Studies indicate that The ventral striatum, a region implicated in reward, motivation, and craving, and the inferior frontal gyrus and orbitofrontal cortex, regions involved in inhibitory control and goal-directed behavior become affected in addictions (Konova et al., 2013). A central concept in drug abuse research is that increased dopamine (DA) in limbic brain regions is associated with the reinforcing effects of drugs (Di Chiara andImperato, 1988; Koob &Bloom, 1988; Volkow et al., 2004). Pharmacological and behavioral studies have indicated that modulation of locus coeruleus (LC) (which is the largest noradrenergic nucleus in brain, located bilaterally on the floor of the fourth ventricle in the anterior pons) neuronal firing rates contributes to physical aspects of opiate addiction, namely, physical dependence and withdrawal, in several mammalian species, including primates (Redmond and Krystal, 1984; Rasmussen et al.,1990;Nestler, 1992).

Memory and Addiction

Inter connection between human memory process and addiction has been speculated by numerous researchers in the past few decades. Theories of addiction have mainly been developed from neurobiologic evidence and data from studies of learning behavior and memory mechanisms (Cami & Farre, 2003). Wang and colleagues (2003) hypothesized that addiction can be resulted by the abnormal engagement of long term associative memory. Volkow et al. (2003) highlight that multiple memory systems have been proposed in drug addiction, including conditioned-incentive learning (mediated in part by the NAc and the amygdala), habit learning (mediated in part by the caudate and the putamen), and declarative memory (mediated in part by the hippocampus). According to Hyman(2005)addiction represents a pathological usurpation of the neural mechanisms of learning and memory that under normal circumstances serve to shape survival behaviors related to the pursuit of rewards and the cues that predict them.

The Process of Learning and Memory in Addiction

The process of learning and memory in addiction has been proposed to involve strengthening of specific brain circuits when a drug is paired with a context or environment (Klenowski et al., 2014). Addiction has pathological associations with learning, memory, attention, reasoning, and impulse control. Addiction related behaviors arise as a result of maladaptive learning process. Following learning pathways individuals with addictions become sensitive and strongly respond to drug cues (Robinson & Berridge, 2000). Drug use in the addicted individual is controlled by automatized action schemata (Tiffany, 1990).

Robbins and colleagues (2002) point out that pathological subversion of normal brain learning and memory processes in drug addiction. They further emphasize that drug related habits evolve through a cascade of complex associative processes with Pavlovian and instrumental components that may depend on the integration and coordination of output from several somewhat independent neural systems of learning and memory, each contributing to behavioral performance.

Tiffany (1990) concluded that drug urges and drug use result from distinct cognitive processes. Some experts believe that addiction related behaviors can be explained via the Feeling-State Theory. According to the Feeling-State Theory positive feelings and behavior are fixated in the body during an intense experience such as drug ingestion creating the feeling-state (Miller, 2005).

A considerable number of researchers point out that subcortical brain region plays a key role in formation of normal as well as drug related behavioral habits. Chronic drug exposure causes stable changes in the brain at the molecular and cellular levels (Nestler, 2001). Drug abusing habits can change the structure and function of the synaptic connections allowing synaptic plasticity for long periods even for a lifetime. Synaptic plasticity may play key roles in the addiction process (Winder et al., 2002). Kelley (2004) states that the process of drug addiction shares striking commonalities with neural plasticity associated with natural reward learning and memory.

 Addictions and Maladaptive Schemas

Segal (1988) viewed schemas as the residue of past reactions and experience that often effect subsequent perception and appraisals. Bakhshi Bojed and Nikmanesh,   (2013) pointed out that drug users suffer from some early maladaptive schemas which can be the potential for drugs abuse. A study done by Shaghaghy and colleagues (2011) indicated that people with addictions suffer from high levels of early maladaptive schemas and they had a more pessimistic attributional style. Maladaptive schemas and inefficient ways the patient learns to adapt with others often lead to chronic symptoms of anxiety, depression and substance abuse (Kirsch, 2009: Shaghaghy et al., 2011).

 Memory and Craving

Craving is often depicted as the subjective experience; craving tends to be highly situationally specific, readily triggered by stimuli previously associated with drug use. Secondly, craving can persist well beyond the cessation of addicted substance (Tiffany & Conklin, 2000). Volkow and colleagues (2004) point out that drugs trigger a series of adaptations in neuronal circuits involved in saliency/reward, motivation/drive, memory/conditioning, and control/disinhibition, resulting in an enhanced (and long lasting) saliency value for the drug and its associated cues at the expense of decreased sensitivity for salient events of everyday life (including natural reinforces).

 The Addiction Memory

The Addiction Memory (AM) plays a crucial role in relapse occurrence and maintaining the addictive behavior. The drug-associated cues are highly connected with Addiction Memory and it helps to maintain drug seeking craving. Boening (2001) views the personal Addiction Memory as an individual acquired software disturbance in relation to selectively integrating “feedback loops” and “comparator systems” of neuronal information processing. The Addiction Memory becomes part of the personality represented on the molecular level via the neuronal level and the neuropsychological level, especially in the episodic memory (Boening, 2001).

 Working with the Addiction Memory

Böning (2009) discusses the difficulties in treating Addiction Memory since it is embedded above all in the episodic memory, from the molecular carrier level via the neuronal pattern level through to the psychological meaning level, and has thus meanwhile become a component of personality. Therefore healing the Addiction Memory is challenging and time consuming.

According to Leshner (1997) in addictions the most effective treatment approaches include biological, behavioral, and social-context components. Among the pharmaco-therapeutic methods Sittambalam, Vij, and Ferguson (2014) highlight Suboxone as an effective treatment method for heroin addiction and as a viable outpatient therapy option. In addition they recommend individualized treatment plans and counseling for maximum benefits.

Carroll & Onken (2005) argued that Cognitive behavior therapy, contingency management, couples and family therapy, and a variety of other types of behavioral treatment have been shown to be potent interventions for several forms of drug addiction. Kauer & Malenka (2007) suggest that reversing or preventing drug-induced synaptic modifications such as mesolimbic dopamine system is one of the key ways to treat addictions.

Gould (2010) stated that from a psychological and neurological perspective, addiction is a disorder of altered cognition. Restoration of altered cognition would be essential in working with the addiction memory. von der Goltz and colleagues (2009) conjectured   that disruption of drug-related memories may help to prevent relapses. Growing evidence from preclinical and clinical studies concur that specific treatments such as extinction training and cue-exposure therapy are effective (von der Goltz & Kiefer, 2008).

Recent researches suggest that EMDR is a potent therapeutic method to treat addictions. Addiction memory could be considered as a form of an unprocessed memory. Unprocessed memories stored in networks that govern explicit and implicit memories. EMDR helps to process unprocessed memories stored in networks. EMDR involves the transmutation of dysfunctionally stored experiences into an adaptive resolution (Solomon et al., 2008).

EMDR reprocessing sessions promote an associative process that clearly reveals the intricate connections of memories that are triggered by current life experiences (Shapiro, 2014). EMDR may be used to ameliorate the effects of earlier memories that contribute to the dysfunction, potential relapse triggers, and physical cravings. In addition, EMDR is used to incorporate new coping skills and assist in learning more adaptive behaviors (Shapiro et al. 1994).

Wide arrays of experimental studies are supportive of a working memory explanation for the effects of eye movements in EMDR therapy (de Jongh et al., 2013). EMDR therapy is guided by the adaptive information processing (AIP) model (Shapiro, 2014). Levin, Lazrov & van der Kol,k (1999) found increased activation of the anterior cingulated gyrus and of the left frontal lobe after 3 sessions of EMDR treatment. Brain scans have clearly demonstrated pre-post changes after EMDR therapy, including increases in hippocampal volume, which have implications for memory storage (Shapiro, 2012).

As reviewed by Andrade and colleagues (1997) EMDR reduces the vividness of distressing images by disrupting the function of the visuospatial sketchpad (VSSP) of working memory. Cecero& Carroll (2000) considered drug cravings as a form of disturbing thoughts and they used EMDR to reduce cocaine cravings.

Young, Zangwill,   and Behary,   (2002) proposed combination of Schema-Focused Therapy (SFT) and Eye Movement Desensitization and Reprocessing (EMDR) would give effectual results processing dysfunctional memories. According to Young , Klosko & Weishaar (2003) Schema-Focused Therapy is an integrative form of psychotherapy combining cognitive, behavioral, psychodynamic object relations, and existential/humanistic approaches. Schema-Focused Therapy helps to modify individual’s maladaptive thoughts about self and others and process the emotions connected with schemas, teach coping skills and break maladaptive behavioral patterns (Young et al., 2003).

 Conclusion

Addiction is a chronic, relapsing brain disorder. Addiction related behaviors are complex and these behaviors are strongly connected with the memory system. Formation Addiction Memory helps to maintain the addictive behavior and drug seeking craving. It becomes a component of personality. Therefore working with addiction memory could be challenging. Reduction in maladaptive schema, restoration of drug related altered cognitions help to combat addictions. Pharmacological and Psychological interventions proved to be effective in working with addiction memory. Among the psychological interventions Cognitive Behavior Therapy (CBT) Eye movement desensitization and Focused Therapy (SFT) seem to be useful in treating addiction memory.

Source:  www.lankaweb.com   4th May 2014

Filed under: Addiction,Brain and Behaviour,Treatment and Addiction :

Many people who undergo treatment for addiction will relapse and begin using drugs again soon after their therapy ends, but a new study suggests that meditation techniques may help prevent such relapses. In the study, 286 people who had been treated for substance abuse were assigned to receive one of three therapies after their initial treatment: a program that involved only group discussions, a “relapse- prevention” therapy that involved learning to avoid situations where they might be tempted to use drugs, and a mindfulness-based program that involved meditation sessions to improve self-awareness.

Six months later, participants in the both the relapse prevention and mindfulness group had a reduced risk of relapsing to using drugs or heavy drinking compared with participants in the group discussions group.

And after one year, participants in the mindfulness group reported fewer days of drug use, and were at reduced risk of heavy drinking compared with those in the relapse prevention group. This result suggests that the mindfulness-based program may have a more enduring effect, the researchers said. [Mind Games: 7 Reasons You Should Meditate]

The researchers emphasized that mindfulness-based programs are not intended to replace standard programs for preventing drug relapse.

“We need to consider many different approaches to addiction treatment. It’s a tough problem,” said study researcher Sarah Bowen, an assistant professor at the University of Washington’s department of psychiatry and behavioral sciences. Mindfulness therapy is “another possibility for people to explore,” she said.  More research is needed to identify which groups of people benefit most from the approach, Bowen said.

Meditation for addiction About 40 to 60 percent of people who undergo addiction treatment relapse within one year after their treatment ends, the researchers said.

Although 12-step and traditional relapse-prevention programs have value in preventing relapse, “we still have a lot of work to do,” Bowen said. Mindfulness-based relapse prevention, a program developed by Bowen and colleagues, is essentially a “training in awareness,” Bowen said.

In this program, each session is about two hours, with 30 minutes of guided meditation followed by discussions about what people experienced during meditation and how it relates to addiction or relapse, Bowen said. The meditation sessions are intended to bring heightened attention to things that patients usually ignore, such as how it feels to eat a bite of food, or other bodily sensations, as well as thoughts and feelings. The mindfulness program may work to prevent relapse in part because it makes people more aware of what happens when they have cravings.

“If you’re not aware of what’s going on, you don’t have a choice, you just react,” Bowen said.

The program also teaches people how to “be with” or accept uncomfortable feelings, such as cravings, rather than fight them, Bowen said. In this way, people learn skills that they can apply to their everyday lives, and not just situations in which they feel tempted, which is usually the focus of other prevention programs, she said.

Addiction and emotions

Dr. Scott Krakower, assistant unit chief of psychiatry at Zucker Hillside Hospital in Glen Oaks, N.Y., who was not involved in the study, said people with addiction often suffer from other conditions that involve problems regulating emotions, such as depression, anxiety or self-harm. Emotional problems, such as feelings of numbness with depression, can be a reason people turn to drugs, he said.

The mindfulness program helps teach people to “tolerate feelings of emotional distress, so when they feel like they’re going to use [drugs], they don’t,” Krakowe said. Krakower noted that mindfulness meditation programs have already been shown to be useful for depression.

Future studies are needed to examine the effectiveness of the therapy for substance abuse over longer periods, Krakower said. But at the very least, it seems that the program can be helpful for people with emotional dysregulation, which is the majority of the substance abuse population, Krakower said.

Source: JAMA Psychiatry. March 19 2014

Filed under: Addiction,Brain and Behaviour,Treatment and Addiction :

Adolescents’ Brains Respond Differently Than Adults’ When Anticipating Rewards, Increasing Teens’ Vulnerability to Addiction and Behavioral Disorders

Pitt research team finds region in the adolescent brain associated with learning and habit formation highly responsive to reward

Teenagers are more susceptible to developing disorders like addiction and depression, according to a paper published by Pitt researchers today, Jan. 16, in the Proceedings of the National Academy of Science.

The study was led by Bita Moghaddam, coauthor of the paper and a professor of neuroscience in Pitt’s Kenneth P. Dietrich School of Arts and Sciences. She and coauthor David Sturman, a MD/PhD student in Pitt’s Medical Scientist Training Program, compared the brain activity of adolescents and adults in rats involved in a task in which they anticipated a reward. The researchers found increased brain cell activity in the adolescent rats’ brains in an unusual area: the dorsal striatum (DS)—a site commonly associated with habit formation, decision-making, and motivated learning. The adult rats’ DS areas, on the other hand, did not become activated by an anticipated reward.

“The brain region traditionally associated with reward and motivation, called the nucleus accumbens, was activated similarly in adults and adolescents,” said Moghaddam. “But the unique sensitivity of adolescent DS to reward anticipation indicates that, in this age group, reward can tap directly into a brain region that is critical for learning and habit formation.”

Typically, researchers study the correlation between different behaviors of adolescents and adults. The Pitt team, however, used a method they call “behavioral clamping” to study if the brains of adolescents process the same behavior differently. To that end, the researchers implanted electrodes into different regions of rat adolescent and adult brains, allowing the researchers to study the reactions of both individual neurons and the sum of the neurons’, or “population,” activity.

The researchers’ predictions proved accurate. Even though the behavior was the same for both adult and adolescent rats, the researchers observed age-related neural response differences that were especially dramatic in the DS during reward anticipation. This shows that not only is reward expectancy processed differently in an adolescent brain, but also it can affect brain regions directly responsible for decision-making and action selection.

“Adolescence is a time when the symptoms of most mental illnesses—such as schizophrenia and bipolar and eating disorders—are first manifested, so we believe that this is a critical period for preventing these illnesses,” Moghaddam said. “A better understanding of how adolescent brain processes reward and decision-making is critical for understanding the basis of these vulnerabilities and designing prevention strategies.”

The Pitt team will continue to compare adolescent and adult behavior, especially as it relates to stimulants—such as amphetamines—and their influence on brain activity.

The National Institute of Mental Health funded this project.

The study was led by Bita Moghaddam, coauthor of the paper and a professor of neuroscience in Pitt’s Kenneth P. Dietrich School of Arts and Sciences. She and coauthor David Sturman, a MD/PhD student in Pitt’s Medical Scientist Training Program, compared the brain activity of adolescents and adults in rats involved in a task in which they anticipated a reward. The researchers found increased brain cell activity in the adolescent rats’ brains in an unusual area: the dorsal striatum (DS)—a site commonly associated with habit formation, decision-making, and motivated learning. The adult rats’ DS areas, on the other hand, did not become activated by an anticipated reward.

“The brain region traditionally associated with reward and motivation, called the nucleus accumbens, was activated similarly in adults and adolescents,” said Moghaddam. “But the unique sensitivity of adolescent DS to reward anticipation indicates that, in this age group, reward can tap directly into a brain region that is critical for learning and habit formation.”

Typically, researchers study the correlation between different behaviors of adolescents and adults. The Pitt team, however, used a method they call “behavioral clamping” to study if the brains of adolescents process the same behavior differently. To that end, the researchers implanted electrodes into different regions of rat adolescent and adult brains, allowing the researchers to study the reactions of both individual neurons and the sum of the neurons’, or “population,” activity.

The researchers’ predictions proved accurate. Even though the behavior was the same for both adult and adolescent rats, the researchers observed age-related neural response differences that were especially dramatic in the DS during reward anticipation. This shows that not only is reward expectancy processed differently in an adolescent brain, but also it can affect brain regions directly responsible for decision-making and action selection.

“Adolescence is a time when the symptoms of most mental illnesses—such as schizophrenia and bipolar and eating disorders—are first manifested, so we believe that this is a critical period for preventing these illnesses,” Moghaddam said. “A better understanding of how adolescent brain processes reward and decision-making is critical for understanding the basis of these vulnerabilities and designing prevention strategies.”

The Pitt team will continue to compare adolescent and adult behavior, especially as it relates to stimulants—such as amphetamines—and their influence on brain activity. The National Institute of Mental Health funded this project.

Source: Proceedings of the National Academy of Science.  Jan.16th 2012

 

Filed under: Addiction,Brain and Behaviour,Youth :

Addiction makes it difficult for people to look beyond immediate gratification to the longer term consequences of their actions. Accordingly, patients in drug abuse treatment are often coached to make and rehearse mental associations between situations that trigger drug cravings and the problems that are likely to ensue from succumbing to them. The cognitive behavioral programs that incorporate this strategy generally are effective, but researchers have shed little light on the neurological basis for their efficacy—until now.

In a study led by Dr. Kevin N. Ochsner of the Social Cognitive Neuroscience Laboratory at Columbia University, smokers reported milder cigarette cravings when they thought about smoking’s harmful effects while viewing smoking cues than when they focused on its pleasures. Brain imaging correlated the reductions in craving with altered activity levels in regions associated with emotional regulation and reward.

Mental Adjustment Alters Brain Activity

Dr. Ochsner and colleagues recruited smokers as study subjects because smoking accounts for more illness and death than any other addiction. To gain insight on the smokers’ ability to regulate cravings in general, the team also investigated their responses to cues for high-fat food.

The participants were 21 men and women who had smoked for 10 years, on average, and were not trying to quit. In preparation for the study, the participants practiced turning their thoughts to rewarding effects of cigarettes or high-fat food consumption when given the instruction “NOW” and to negative effects when given the instruction “LATER.” In the study itself, the researchers gave each participant 100 such instructions, in random order, each followed by a 6-second exposure to a screen image of either cigarettes or food. Then, after a 3-second delay with the screen blank, the participant reported how much he or she desired to smoke or eat, on a scale of 1 (not at all) to 5 (very much).

The power of thinking about negative effects proved to be considerable. The participants reported 34 percent less intense urges to smoke and 30 percent less intense food cravings after the LATER instruction compared with the NOW instruction.

Brain scans taken during the experiment showed how concentrating on long-term negative consequences alters brain activity to reduce craving. Functional magnetic resonance imaging (fMRI) of the participants’ whole brain revealed increased activity levels in areas—the dorsomedial, dorsolateral, and ventrolateral regions of the prefrontal cortex (PFC)—that support cognitive control functions, such as focusing, shifting attention, and controlling emotions. Activity decreased in regions that previous studies have linked with craving; these areas include the ventral striatum and ventral tegmental area, which are parts of the reward circuit; the amygdala; and the subgenual cingulate. Individual participants who reported larger reductions in craving exhibited these changes to a more marked degree. A specialized mediation analysis of the images found that the increase in PFC activity drove the decrease in ventral striatum activity, which, in turn, fully accounted for the reduction in craving.

“These results show that a craving-control technique from behavioral treatment influences a particular brain circuit, just as medications affect other pathways,” says Dr. Steven Grant of NIDA’s Division of Clinical Neuroscience and Behavioral Research.

The researchers noted that the study participants reduced their smoking and food cravings to the same extent, even though smoking cravings were initially more intense. This finding suggests that calling undesirable consequences to mind has potential to help people overcome a variety of unhealthy urges.

Scans Show Effects of Craving Regulation in the Brain When study participants thought of the long-term negative consequences of cigarette consumption (after receiving the instruction “LATER”), rather than short-term pleasures (“NOW”), they reduced their craving. Brain scans showed increased activity in the dorsolateral prefrontal cortex—a region critical to setting goals, planning, and controlling behavior—which, in turn, inhibited the ventral striatum, part of the reward pathway that generates craving. Text Description of Scans Show Effects of Craving Regulation in the Brain Graphic

Healing Perspectives

“Cognitive reappraisal—mentally changing the meaning of an event or object to lessen its emotional impact and therefore alter the behaviors it triggers—is a strategy that helps a variety of problems,” says Dr. Ochsner. Cognitive-behavioral therapists train patients to use this approach, among others, to cope with negative emotions, stress, and substance cravings. Dr. Ochsner says, “People may not realize that they can control cravings or emotions using cognitive strategies—for example, thinking of negative consequences and distracting and distancing oneself—but patients can learn these techniques and then must continue to apply them over time.”

Dr. Ochsner says there is broad scientific interest in the neurobiological mechanisms underlying cognitive control over thoughts and emotions that promote unhealthy behaviors. Such studies generally find that although there is some overlap in the regions of the PFC engaged when people exert cognitive control, different areas seem to support different strategies for the regulation of emotional responses.

“The mediation analysis that Dr. Ochsner and colleagues conducted is unique among imaging studies and is a particular strength of this research,” says Dr. Grant. “Because the researchers examined the interaction of brain regions, the results provide a perspective on the neural circuits involved in cognitive control of craving.”

Dr. Grant suggests two important next steps in this area of research: identifying why some people have more problems than others in controlling the desire for cigarettes and determining whether brain activity predicts the ability to quit smoking.

Sources

Kober, H., et al. Prefrontal-striatal pathway underlies cognitive regulation of craving. Proceedings of the National Academy of Sciences 107(33):14811–14816, 2010. Kober, H., et al. Regulation of craving by cognitive strategies in cigarette smokers. Drug and Alcohol Dependence 106(1):52–55, 2010.  NIDA Notes April 19, 2012

Filed under: Addiction,Brain and Behaviour,Nicotine :

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