Addiction

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,Latest News,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,Latest News,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,Latest News,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,Latest News,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,Latest News,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,Latest News,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,Latest News,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,Latest News,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,Latest News,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,Latest News,Mental Health,USA,Youth :

Source: The Sunday Mail

Filed under: Addiction,Australia,Environment,Latest News,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,Latest News,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,Latest News,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