Drug use-various effects

People smoke the stuff perfectly openly, without fear, with the threatened £90 fine seemingly a remote possibility.                                                                                                                           

by Zoe Strimpel – The Telegraph London author – 14 December 2024 4:09pm GMT

Sir Elton John Credit: Ben Gibson

Zoe Strimpel writes: I was about 23 and was still finding my feet socially in London. I’d always really been a champagne girl at heart but cannabis smoking was common in some of the circles I spent time in. It seemed so tacky and boring, the province of the sorts of bores one met while “travelling”, so I usually said no.

But one night in a run-down flat somewhere in north London, I went along with everyone else. Not long afterwards my heart began to pound like never before and a wave of horrible panic crashed over me, like I was trapped in a physiological nightmare and might die.

This was combined with a much more familiar sense of self-recrimination: why had I got myself into this? It wasn’t tempting in the first place and it could never have been worth it. And now I was paying the price – and so was the friend, now more like a sister to me, who had to tend to me in my tearful panic.

Since then, the pressure to imbibe cannabis has only grown and spread, from tatty student settings to (upper)-middle class and middle-aged environs.

Those who prefer to avoid the smoke element can still mainline the active ingredient – THC – by choosing from a wide range of edibles, which are generally like jelly babies. These make you (me) feel just as dreadful as the smoke sort, though mercifully without the stink.

All of which is why I am in full agreement with Elton John who, as Time magazine’s “icon of the year”, has lambasted the legalisation of pot in North America as “one of the greatest mistakes of all time”.

Sir Elton, himself an addict until he got sober 34 years ago, pointed out that: “It leads to other drugs. And when you’re stoned – and I’ve been stoned – you don’t think normally.”

This is a statement of blinding obviousness, and yet in our strange society it sounds reactionary, refreshing, courageous. How is it that a drug known – outside of carefully managed medical settings where it can help with pain and sleep – to trigger psychosis and turn people into paranoiacs and dullards, and, when smoked, to cause damage to the lungs and body, came to be considered safe by North American lawmakers?

To be seen as so perfectly respectable, fine and dandy that states explicitly give their blessing to recreational use of it? And this in an America that doesn’t let people drink until they are 21 or even touch containers of alcohol till that age, or in public.

In the UK, it is not legal and classed as a class B drug. But that does not mean that ‘it is not ubiquitous’.

This is depressing. I’m all for the exploration and titration of psychoactive drugs to help people in desperate need of pain relief. I am interested in, though not yet convinced by, use of mushrooms (psilocybin) and ecstasy (MDMA) in treating depression.

But the general prevalence of cannabis is a much drearier, bigger, more worrying issue, connected to a general sense of inconsistency and disconnected logic among law-makers and enforcers on one hand, and a sense that all we want to do is bury ourselves in escapist hedonism that alters our minds and our worlds so as to reduce the stress associated with, for instance, responsibility, reality and work.

Labour has indicated that it does not wish to legalise cannabis. But it seems happy, as do the police, with the fact that nobody cares about its technical illegality. People smoke the stuff perfectly openly, without fear, with the threatened £90 fine seemingly a remote possibility. Children therefore have to inhale it in parks. It is a gateway drug for hard drugs and criminality, and forms a familiar backdrop for the insouciant menace of gangs.

But according 2023 figures from the ONS, cannabis was by far the most-commonly used recreational drug in the UK, with 7.4 per cent of adults aged 16 to 59 saying they had consumed it in the last year.

The counter-currents in state attitudes to recreational drugs are just weird. Why does the state look benignly on the smoking of this illegal substance, and fail to promote information about the dangers of inhaling it via smoke (and edibles), but noisily pursue the outlawing of cigarette smoking for those born after a certain date?

Fags are toxic and cancer-causing, and nobody should have to regularly breathe second-hand smoke. But so long as the harm of smoking (the tar in tobacco) is limited to the smoker, and those who voluntarily inhale their smoke, the wider mental effects are not disturbing.

Nicotine alone doesn’t tend to ‘alter personality beyond recognition’ or induce fits of paranoia, depression, criminality or addiction to other substances.

And let’s face it: a waft of cigarette smoke is quite pleasant. Cigarettes retain a kind of aesthetic glamour; their use is not at odds with beauty, comfort, decadence and good conversation. Pot-smokers, instead, give off a polluting stink that lowers the tone of whatever environment one is in, makes conversation a thousand times more inane, and seems to celebrate the urge to do less, or nothing, smugly. Cannabis is deadening, however it is consumed.

Even among those who work hard and have children, cannabis rules, becoming a fixation without which no relaxation is possible, whipped out as soon as the working day ends or the children are asleep. Perhaps what we need is to find other ways to relax, like reading a good book. Or, of course, to stop chasing relaxation and indolence at all costs, full stop.

SOURCE: https://www.telegraph.co.uk/news/2024/12/14/elton-john-is-right-cannabis-deadening-to-soul/

Filed under: Cannabis/Marijuana,Drug use-various effects,Health,Latest News,Marijuana and Medicine,Mental Health,Prevention and Intervention,UK :

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

Fact Sheet 

Projects:Substance Use Prevention and Treatment
Overview

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

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

Figure 1

Alcohol‑Related Deaths Have Increased Since 2016

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

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

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

© 2024 The Pew Charitable Trusts

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

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

The Spectrum of Unhealthy Alcohol Use

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

Consumption patterns exceeding these recommended levels are considered:

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

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

Identifying and preventing AUD

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

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

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

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

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

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

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

Withdrawal management

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

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

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

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

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

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

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

Treating AUD

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

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

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

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

Medications

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

The FDA has approved three medications to treat AUD:

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

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

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

Behavioral therapies

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

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

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

Recovery supports

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

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

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

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

American Indian and Alaska Native communities

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

Figure 2

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

Alcohol‑related deaths per 100,000 people

© 2024 The Pew Charitable Trusts View image

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

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

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

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

People living in rural areas

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

Figure 3

Alcohol‑Related Deaths Have Increased Faster in Rural Areas

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

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

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

Next steps

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

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

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

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

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

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

PublishedContact:Jared Culligan – jculligan@nahb.org
This December, join NAHB in recognizing National Drunk and Drug Impaired Driving Prevention Month and be aware of the devastating consequences that result from impaired driving.

From 2018 to 2022, the National Highway Traffic Safety Administration (NHTSA) recorded more than 4,700 deaths in drunk driving traffic crashes during the month of December. In addition, a study by NHTSA found more than 54% of injured drivers had some amount of alcohol or drugs in their system at the time of the incident.

Although this month focuses primarily on reducing impaired driving on the road, it’s also crucial to extend this conversation to safety in the workplace and how drunk and drug-impaired driving can impact the construction industry.

What can your organization do to prevent drunk and drug-impaired driving incidents?

  • Provide education and training materials on the effects of certain substances.
  • Perform post-incident drug and alcohol testing and have a recovery-ready workplace to engage and support employees in stopping substance misuse whenever possible.

NAHB has several Video Toolbox Talks available in English and Spanish regarding drunk and drug-impaired driving. Please be sure to check out our content and help spread awareness as we approach the holidays:

In addition, several government establishments are promoting materials during this time of year. Check out their available resources:

If you know of anybody that needs immediate help, please reach out to the 988 Suicide and Crisis Lifeline or SAMHSA’s National Helpline, 1-800-662-HELP (4357).

Source: https://www.nahb.org/blog/2024/12/promote-safe-driving-resources

 

Filed under: Alcohol,Crime/Violence/Prison,Drug use-various effects,Drugs and Accidents,Latest News,Prevention and Intervention,USA :
NIH/National Institute on Drug Abuse   Dec 30 2024

A study of nearly 10,000 adolescents funded by the National Institutes of Health (NIH) has identified distinct differences in the brain structures of those who used substances before age 15 compared to those who did not. Many of these structural brain differences appeared to exist in childhood before any substance use, suggesting they may play a role in the risk of substance use initiation later in life, in tandem with genetic, environmental, and other neurological factors.

This adds to some emerging evidence that an individual’s brain structure, alongside their unique genetics, environmental exposures, and interactions among these factors, may impact their level of risk and resilience for substance use and addiction. Understanding the complex interplay between the factors that contribute and that protect against drug use is crucial for informing effective prevention interventions and providing support for those who may be most vulnerable.”

Nora Volkow M.D., Director of NIDA

Among the 3,460 adolescents who initiated substances before age 15, most (90.2%) reported trying alcohol, with considerable overlap with nicotine and/or cannabis use; 61.5% and 52.4% of kids initiating nicotine and cannabis, respectively, also reported initiating alcohol. Substance initiation was associated with a variety of brain-wide (global) as well as more regional structural differences primarily involving the cortex, some of which were substance-specific. While these data could someday help inform clinical prevention strategies, the researchers emphasize that brain structure alone cannot predict substance use during adolescence, and that these data should not be used as a diagnostic tool.

The study, published in JAMA Network Open, used data from the Adolescent Brain Cognitive Development Study, (ABCD Study), the largest longitudinal study of brain development and health in children and adolescents in the United States, which is supported by the NIH’s National Institute on Drug Abuse (NIDA) and nine other institutes, centers, and offices.

Using data from the ABCD Study, researchers from Washington University in St. Louis assessed MRI scans taken of 9,804 children across the U.S. when they were ages 9 to 11 – at “baseline” – and followed the participants over three years to determine whether certain aspects of brain structure captured in the baseline MRIs were associated with early substance initiation. They monitored for alcohol, nicotine, and/or cannabis use, the most common substances used in early adolescence, as well as use of other illicit substances. The researchers compared MRIs of 3,460 participants who reported substance initiation before age 15 from 2016 to 2021 to those who did not (6,344).

They assessed both global and regional differences in brain structure, looking at measures like volume, thickness, depth of brain folds, and surface area, primarily in the brain cortex. The cortex is the outermost layer of the brain, tightly packed with neurons and responsible for many higher-level processes, including learning, sensation, memory, language, emotion, and decision-making. Specific characteristics and differences in these structures – measured by thickness, surface area, and volume – have been linked to variability in cognitive abilities and neurological conditions.

The researchers identified five brain structural differences at the global level between those who reported substance initiation before the age of 15 and those who did not. These included greater total brain volume and greater subcortical volume in those who indicated substance initiation. An additional 39 brain structure differences were found at the regional level, with approximately 56% of the regional variation involving cortical thickness. Some brain structural differences also appeared unique to the type of substance used.

While some of the brain regions where differences were identified have been linked to sensation-seeking and impulsivity, the researchers note that more work is needed to delineate how these structural differences may translate to differences in brain function or behaviors. They also emphasize that the interplay between genetics, environment, brain structure, the prenatal environment, and behavior influence affect behaviors.

Another recent analysis of data from the ABCD study conducted by the University of Michigan demonstrates this interplay, showing that patterns of functional brain connectivity in early adolescence could predict substance use initiation in youth, and that these trajectories were likely influenced by exposure to pollution.

Future studies will be crucial to determine how initial brain structure differences may change as children age and with continued substance use or development of substance use disorder.

“Through the ABCD study, we have a robust and large database of longitudinal data to go beyond previous neuroimaging research to understand the bidirectional relationship between brain structure and substance use,” said Alex Miller, Ph.D., the study’s corresponding author and an assistant professor of psychiatry at Indiana University. “The hope is that these types of studies, in conjunction with other data on environmental exposures and genetic risk, could help change how we think about the development of substance use disorders and inform more accurate models of addiction moving forward.”

Authors: NIH/National Institute on Drug Abuse
Journal reference:

Miller, A. P., et al. (2024). Neuroanatomical Variability and Substance Use Initiation in Late Childhood and Early Adolescence. JAMA Network Open. doi.org/10.1001/jamanetworkopen.2024.52027.

Source: https://www.news-medical.net/news/20241230/Structural-brain-differences-in-adolescents-may-play-a-role-in-early-initiation-of-substance-use.aspx

Filed under: Brain and Behaviour,Drug use-various effects,Education,Latest News,Mental Health,Prevention and Intervention,Treatment and Addiction,USA,Youth :

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

Published: December 31, 2024

DOI: 10.7759/cureus.76659

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

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Abstract

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

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

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

 

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

Filed under: Addiction,Drug use-various effects,Education,Effects of Drugs,Latest News,Mental Health,Prevention and Intervention,Social Affairs,Treatment and Addiction,USA :
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January 03, 2025

DEA Headquarters Division – Public Information Office

Drugs of Abuse Cover 2024

The U.S. Drug Enforcement Administration has released the 2024 edition of Drugs of Abuse, A DEA Resource Guide, which is designed to be a reliable resource on the most commonly used and misused drugs in the United States.

Released on a periodic basis, Drugs of Abuse provides important science-based information about the harms and consequences of drug use, describing a drug’s effects on the body and mind, overdose potential, origin, legal status, and other key factors.  In addition, the guide outlines U.S. drug regulation, including drug scheduling and chemical controls.  The 2024 edition updates the 2022 Drugs of Abuse publication with the most current information on new and emerging trends in drug misuse and abuse, including fentanyl, methamphetamine, marijuana concentrates, vaping, stimulant drugs, and fake pills.       

Because education plays a critical role in preventing substance abuse, this comprehensive guide is intended as a tool not just for medical practitioners and law enforcement officials, but also for educators, families, and communities.  Drugs of Abuse also offers a list of additional drug education and prevention resources, including the DEA websites: www.DEA.gov, www.getsmartaboutdrugs.com for parents, www.justthinktwice.com for teens, www.campusdrugprevention.govfor colleges and universities, and www.operationprevention.com for school and work curriculum.

For more information and to view the 2024 Drugs of Abuse resource guide in both English and Spanish, visit www.getsmartaboutdrugs.com/publications.

DEA Contact Center: (202) 307-1000info@dea.gov

Source: https://www.dea.gov/stories/2025/2025-01/2025-01-03/dea-releases-2024-edition-drugs-abuse-resource-guide

Filed under: Drug use-various effects,Latest News,USA :

Updated: Jan. 03, 2025, 12:02 p.m.|

By Julie Washington, cleveland.com

CLEVELAND, Ohio — Do music therapy and acupuncture help patients manage pain without opioids? University Hospitals will use a nearly $1.5 million federal grant to find out.

The grant allows UH to develop an Alternatives to Opioids program that educates caregivers about how music therapy and acupuncture can be used to decrease the use of opioids in the emergency department, the hospital system recently announced. The program also includes outpatient follow-up.

The goal is to reduce the use of prescribed opioids in emergency departments, UH said.

“When prescribing opioids there is always the potential for abuse,” said Dr. Kiran Faryar, director of research in the department of emergency medicine. “Data shows both music therapy and acupuncture improve pain and anxiety for patients with short-term and long-term pain. This will be an evidence-based technique we can offer patients without the potential risk of substance use disorder.”

UH’s comprehensive approach to combating the opioid crisis comes as the Centers for Disease Control and Prevention reported that 2023 drug overdose deaths in the United States decreased 3% from 2022. It was the first annual decrease in drug overdose deaths since 2018, the CDC said.

The trend was also seen in Ohio.

The number of people who died of drug overdoses in Ohio was 4,452 in 2023, a 9% decrease from the previous year, according to the state’s latest unintentional drug overdose report.

This was the second consecutive year of a decrease in deaths in Ohio. In 2022, overdose deaths declined by 5%, state officials said. Early data for 2024 suggest unintentional drug overdose deaths are falling even further this year.

In November, the state announced that agencies across Ohio would split $68.7 million in grants to combat opioid use and overdoses. The state is distributing the federal funding, part of the fourth round of the State Opioid and Stimulant Response grants, to support local organizations that offer prevention, harm reduction, treatment, and long-term recovery services for Ohioans struggling with an opioid or stimulant use disorder, the state announced.

Julie Washington covers healthcare for cleveland.com.

Source: https://www.cleveland.com/metro/2025/01/can-music-therapy-replace-opioids-for-pain-university-hospitals-investigates-with-15m-federal-grant.html

Filed under: Drug use-various effects,Heroin/Methadone,Latest News,Prevention and Intervention,USA :
By Sherry Larson, People’s Defender –

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

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

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

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

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

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

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

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

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

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

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

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

Dec 9, 2024 8:00 am by Diana Yates  | Life Sciences Editor, U. of I. News BureauLife SciencesSocial Sciences

“I don’t think we’ve had truly robust public policy actions in the U.S. that we can point to that would have resulted in such a sudden and profound downturn in mortality,” says U. of I. health and kinesiology professor Rachel Hoopsick about the recent decline in drug-overdose deaths. “Although fentanyl-only deaths have declined, we’re seeing increases in deaths that co-involve fentanyl and stimulants, like methamphetamine. There have also been increases in nonopioid sedative adulterants, like xylazine.”

  • Preliminary data from the U.S. Centers for Disease Control and Prevention suggests that drug-overdose deaths declined more than 16% between June 2023 and June 2024, the biggest drop in a decade marked by staggering increases. University of Illinois Urbana-Champaign health and kinesiology professor Rachel Hoopsick, an epidemiologist who studies mental health challenges and substance use in populations at risk, spoke with News Bureau life sciences editor Diana Yates about recent drug-use trends.

    Media reports about new data suggest the fentanyl epidemic, which drove a lot of the recent increases in drug-overdose deaths, has peaked and is now in decline. Is this true, and if so, do we know why?

    It’s true that overall, drug overdose deaths in the U.S. have recently declined. At face value, this looks encouraging, but this doesn’t tell the whole story.

    Can leaders point to any public policy actions that are contributing to the decline in fentanyl use or drug-overdose deaths?

    While pundits point to increased law enforcement efforts or strides in prevention and treatment efforts, the reality is that there are multiple explanations for this trend and a number of nuanced factors at play. I don’t think we’ve had truly robust public policy actions in the U.S. that we can point to that would have resulted in such a sudden and profound downturn in mortality.

    What factors might be at play?

    If you ask any epidemiologist about the examination of complex health-related phenomena, you’ll often get the answer: “It depends.” There are several major factors to consider:

    First, whenever we observe sudden and steep changes in overdose mortality — in either direction — we should first look at the toxicity of the street drug supply before assuming that there have been drastic population-level changes in behavior. Some data suggests that there have been recent shifts in the types and concentrations of the substances, called adulterants, that street drugs are “cut” with. Although fentanyl-only deaths have declined, we’re seeing increases in deaths that co-involve fentanyl and stimulants, like methamphetamine. There have also been increases in nonopioid sedative adulterants, like xylazine. This underscores the importance of public health lab research that monitors the pharmacoepidemiology of the street drug supply, which can serve as an early warning system.

    Second, although there have been population-level declines in overdose mortality, these numbers have largely been driven by a steep reduction in overdose deaths among white people, while drug-related deaths in communities of color continue to increase, particularly among Black and Native American adults. This widening disparity isn’t reflected in overall trends.

    Third, it’s a depressing concept, but another factor is what we call “depletion of susceptibles.” In this context, it’s possible that we’re seeing such a decline in overdose deaths because those who were most vulnerable to overdose have already died, meaning that over time, we observe fewer and fewer overdose deaths.

    Tens of thousands of people are still dying each year in the U.S. from preventable drug overdoses. Is the decline just a normal fluctuation in complex data, or might it be a sign of a long-term trend?

    The data suggest that this is more than normal fluctuation, but it remains to be seen whether this trend will continue. Despite the overall downward trend at the population level, the reality for individuals who use drugs is that the street drug supply remains highly toxic, overdose risk remains incredibly high and access to harm reduction and treatment services remains low. I think it’s too early to celebrate the decline in overdose deaths. We shouldn’t accept 100,000 needless deaths a year.

    What policy, harm reduction or treatment approaches might help the trend continue?

    Looking at past data from the U.S. and other countries, we should be wary of the direction of where our drug policies will go from here. The next administration is focused on stricter border control measures and criticizing harm-reduction programs, which have been instrumental in addressing the overdose crisis. Rolling back these programs and doubling down on punitive strategies that have proven ineffective — see The Iron Law of Prohibition: “the harder the enforcement, the harder the drugs”— is unlikely to sustain progress or save lives, but rather runs the risk of exacerbating the problem.

    Editor’s notes:
    Hoopsick is lead author of the paper “Methamphetamine-related mortality in the United States: Co-involvement of heroin and fentanyl, 1999-2021.” The study is available online.

    DOI: 10.2105/AJPH.2022.307212

    To contact Rachel Hoopsick, email hoopsick@illinois.edu.

    Source: https://news.illinois.edu/view/6367/2075718277

Filed under: Drug Specifics,Drug use-various effects,Drugs and Accidents,Latest News,Political Sector,Prevalence,Prevention and Intervention,Treatment and Addiction,USA :

EXECUTIVE HIGHLIGHTS
Today’s highly potent marijuana represents a growing and significant threat to public health and safety, a threat that is amplified by a new
marijuana industry intent on profiting from heavy use.
State laws allowing marijuana sales and consumption have permitted the marijuana industry to flourish, and in turn, the marijuana industry has influenced both policies and policy-makers. While the consequences of these policies will not be known for decades, early indicators are
troubling.
This report, reviewed by prominent scientists and researchers, serves as an evidence-based guide to what we currently observe in various states. We attempted to highlight studies from all the “legal” marijuana states (i.e., states that have legalized the non-medical use of marijuana). Unfortunately, data does not exist for several “legal” states, and so this document synthesizes the latest research on marijuana impacts in states where information is available

For more information please read the full information below:

2019LessonsFinal

Source: https://learnaboutsam.org/wp-content/uploads/2019/07/2019LessonsFinal.pdf July 2019

Filed under: Cannabis/Marijuana,Drug use-various effects,Economic,Global Drug Legalisation Efforts,Health,Latest News,Political Sector,USA :

Emphatic Rejection by DrugWatch International

COMMENT BY JOHN J. COLEMAN Ph.D, PRESIDENT, DRUGWATCH INTERNATIONAL – 01 December 2024 

From: drug-watch-international@googlegroups.com

The proposal from the Secretary of HHS and the Attorney General to reschedule marijuana from Schedule I to Schedule III – responding to President Biden’s request to take a second look at marijuana scheduling – is probably DOA at this point. The hearing at DEA tomorrow is closed except to media and designated participants (apparently, though, it will be online for the public). They may go through some of the motions because that’s what they are supposed to do, but the usual time of several months to go from hearing to Final Order or Final Rule will place the resolution of this matter well into the next administration. When there’s a change of parties, as in this case, the new administration is not eager to adopt or implement the changes or proposals of the old one.

The current move to reschedule marijuana amount to a political hoax because Congress is not about to add the number of federal employees that would be needed to enforce a Schedule III status for marijuana. Every “dispensary” in all the states (est. 38 of 50, plus D,C.) would immediately or within a time set by a Final Rule must register with DEA, pay a registration fee, meet certain requirements, before being able to fill and dispense valid prescriptions for marijuana. The Controlled Substances Act imposes strict controls on imports and exports of controlled substances, as well as its packaging, labeling, distribution, and storage.

The federal government that in 1993 abdicated its responsibility for controlling marijuana (per the infamous Cole Memorandum) has neither the resources nor the desire to enforce new marijuana provisions of the CSA because it no longer enforces even a modicum of the old ones. This is nothing but a cruel joke perpetrated by insincere leaders contemptuous of those who disagree with them. The DEA administrator refused to sign the Notice of Proposed Rulemaking leaving the Attorney General to regain his authority and issue the NPRM in the form of an Attorney General’s Order. That, alone, disqualifies this rescheduling exercise, assuming, that is, that this lunacy ever reaches a judicial review.

As for tomorrow’s meeting at DEA’s administrative law court, I think it will be perfunctory and simply set the agenda for the following two or three months when there may be a hearing. I say “may” because the incoming AG and DEA administrator could very well put the kibosh on this nutty move by the Biden administration. As our late friend and colleague Otto Moulton used to say, “read what the other side is saying!” According to Cannabis.net, a pro-marijuana website, the headline of their alarming article says it all: “Trump’s Not So Cannabis Friendly Cabinet Picks – His VP, AG, Head of the CDC and FDA Nominees all Hate Legal Weed: The cannabis scorecard for Trump’s new cabinet is not shaping up well for legalization fans!”

That pretty much says it all.

John Coleman

************************

Submission by Maggie Petito to DrugWatch International –  mlp3@starpower.net
Sent: Sunday, December 1, 2024 7:21 AM
To: drug-watch-international@googlegroups.com
Subject: Chronister12-1-24

From The Washington Post: “ Chronister would enter an agency that has been roiled by the convictions of several former agents in corruption cases and scrutiny of Milgram’s hiring practices.

The incoming DEA administrator will also helm the agency as it handles a Biden Justice Department proposal to loosen restrictions on marijuana — a measure supported by Trump despite objections from other GOP leaders…

The Justice Department has proposed to reclassify marijuana from a tier reserved for substances such as heroin and LSD. The move to reclassify marijuana would not legalize the drug but would move it to Schedule III, a category that includes prescription drugs such as ketamine, anabolic steroids and testosterone. The proposal met pushback internally at the DEA, which questioned whether reclassification violated international treaty obligations regarding drug control and if a federal health agency used the wrong legal standard in making its determination, according to a Justice Department legal opinion that sided with the Department of Health and Human Services. When officials submitted the proposed rule to reclassify marijuana in April, the paperwork was signed by Attorney General Merrick Garland, not Milgram.

The marijuana proposal will be considered in DEA administrative court; a preliminary hearing is scheduled for Monday, 2nd December 2024.  The proposal, if it goes through, would not be finalized until after Trump becomes president.”

************************

Washington Post     David Ovalle and Anumita Kaur    November 30, 2024                    Hillsborough Sheriff Chad Chronister picked to lead DEA under Trump – The Washington Post

President-elect Donald Trump on Saturday tapped Hillsborough County Sheriff Chad Chronister to lead the Drug Enforcement Administration, replacing Anne Milgram.

The incoming DEA administrator will also helm the agency as it handles a Biden Justice Department proposal to loosen restrictions on marijuana — a measure supported by Trump despite objections from other GOP leaders.

The Justice Department has proposed to reclassify marijuana from a tier reserved for substances such as heroin and LSD. The move to reclassify marijuana would not legalize the drug but would move it to Schedule III, a category that includes prescription drugs such as ketamine, anabolic steroids and testosterone.

The proposal met pushback internally at the DEA, which questioned whether reclassification violated international treaty obligations regarding drug control and if a federal health agency used the wrong legal standard in making its determination, according to a Justice Department legal opinion that sided with the Department of Health and Human Services. When officials submitted the proposed rule to reclassify marijuana in April, the paperwork was signed by Attorney General Merrick Garland, not Milgram.

The marijuana proposal will be considered in DEA administrative court; a preliminary hearing is scheduled for Monday. The proposal, if it goes through, would not be finalized until after Trump becomes president.

Source: COMMENT BY JOHN J. COLEMAN Ph.D, PRESIDENT, DRUGWATCH INTERNATIONAL

Filed under: Cannabis/Marijuana,Drug Specifics,Drug use-various effects,Latest News,Marijuana and Medicine,Political Sector,USA :

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:

<https://links-1.govdelivery.com/CL0/https:%2F%2Fwww.facebook.com%2FNIDANIH/1/010001935f514dad-3bc896f6-09a3-4a99-9a57-650fc67cd8ad-000000/gZawcxuqmqpVxlDYl5KRA6aAb0F6qaVMf-PxgI6LnuI=380>  <https://links-1.govdelivery.com/CL0/https:%2F%2Fx.com%2FNIDAnews/1/010001935f514dad-3bc896f6-09a3-4a99-9a57-650fc67cd8ad-000000/mpqUEYpIuhc9JFHxEKtJYgd0sO2MkRK2lTyjYLfCx1E=380>  <https://links-1.govdelivery.com/CL0/https:%2F%2Fwww.linkedin.com%2Fcompany%2Fthe-national-institute-on-drug-abuse-nida/1/010001935f514dad-3bc896f6-09a3-4a99-9a57-650fc67cd8ad-000000/MDAOeV4b9UqgdTQKqsv8NP1IxaNy1-VJZf0pPGIdSLM=380>  <https://links-1.govdelivery.com/CL0/https:%2F%2Fwww.youtube.com%2Fuser%2FNIDANIH/1/010001935f514dad-3bc896f6-09a3-4a99-9a57-650fc67cd8ad-000000/XDdTYlTHjOr7nahEQDBsHClsGu3q7NdUBzatmgv6P7E=380>

 

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 :

Policy News Roundup: November 14, 2024

by drugfree.org

The main point: Overall, a Trump administration is likely to be more focused on law enforcement and supply side responses to the overdose crisis, rather than approach the challenge from a public health perspective.

The details:

  • Treatment: We do not expect there will be efforts to remove barriers and expand access to methadone. There could be some efforts to expand buprenorphine (particularly telemedicine models).
  • Harm Reduction: Harm reduction received unprecedented federal support under the Biden administration. It is unlikely that such support will continue. Efforts to expand naloxone distribution may continue, but other harm reduction strategies (e.g., syringe service programs, overdose prevention sites) are not likely to receive support in a Trump administration.
  • Criminal Legal System: The use of Medicaid to provide medications for opioid use disorder in jails/prisons will likely face increased scrutiny. As part of a broader effort to limit Medicaid costs, a Trump administration may push to restrict federal funding for these programs. Drug courts and diversion programs will likely continue to receive support.
  • Insurance: There could be major changes to the Affordable Care Act (ACA), which includes some of the strongest insurance protections available for addiction, and Medicaid, which covers more addiction treatment than any other insurer. The enhanced ACA premium subsidies that led to record levels of insurance enrollment are not likely to be extended after they expire next year, and there may be efforts to slash funding for enrollment outreach, promote short-term health plans with skimpier coverage and allow insurers to charge sicker people higher premiums. Medicaid is likely to be targeted for funding cuts, and the Trump administration is likely to revive efforts to implement work requirements for Medicaid coverage.
  • Marijuana: It is not clear what a Trump administration will mean for marijuana. While previously strongly opposed to easing restrictions, Trump more recently came out in support of the legalization initiative in Florida (his home state) and the Biden administration’s push to reschedule marijuana.
  • Penalties: A Trump administration could push for harsher penalties for drug offenses.
  • Drug Trafficking: Combatting drug trafficking is likely to be the main focus for the administration on this issue. Rhetoric will likely focus on the U.S.-Mexico border, even though evidence has shown that most drugs are brought into the U.S. at legal ports of entry by U.S. citizens. There is likely to be continued pressure on Mexico and China for their role in fentanyl and precursor trafficking.
  • Federal Agencies: If the Trump administration takes action on plans to scale back federal agencies, it could lead to a reduced role for the Office of National Drug Control Policy, potentially in favor of the Department of Justice or Drug Enforcement Administration. Department of Health and Human Services agencies are also likely in for budget cuts and major changes in authority and focus, which could reduce the role of health agencies like the Centers for Disease Control and Prevention, the National Institutes of Health and the Food and Drug Administration in addressing the addiction crisis and the funding available to do so.

Why it’s important:

  • Federal funding for addiction has remained stable but shifts between law enforcement/interdiction and treatment, depending on the administration’s priorities. An increased focus on law enforcement/interdiction could mean less funding and focus on treatment. Funding for prevention has remained small and relatively the same.

A caveat: It is early. Trump’s campaign did not focus heavily on policy proposals or on this issue, and we do not know yet who will be appointed to top health roles in the administration.

In the states: drug policy backlash

Several states also had drug-related ballot initiatives on their ballots this election.

The main point: In recent elections, ballot measures focused on liberalizing drug policies (e.g., legalizing marijuana, decriminalizing drugs) have passed. This time, however, these types of measures failed, signaling concerns about these drug policies.

The details:

  • Marijuana: Florida, North Dakota and South Dakota all rejected measures to legalize recreational marijuana. Nebraska did approve a measure to legalize medical marijuana, but a judge could invalidate the results due to a pending lawsuit. Opponents cited concerns about crime, addiction and becoming like liberal states that have legalized marijuana. While most Americans continue to support marijuana legalization, the downsides of marijuana production and negative health impacts of high-potency marijuana and teen use have recently been in the spotlight.
  • Psychedelics: Massachusetts rejected a measure to legalize therapeutic use of certain psychedelics (psilocybin, psilocin, DMT, ibogaine, mescaline). Voters in more than a dozen Oregon cities also voted to ban sales and use of psilocybin, after the state approved licensed psilocybin treatment centers four years ago. Psychedelics have gained increased support across the political spectrum, but concerns are growing about allowing psychedelics to proliferate before there has been adequate research.
  • Penalties: California passed a measure to repeal a 2014 ballot initiative that had lessened penalties for certain drug offenses. The new measure reclassifies certain theft- and drug-related crimes as felonies, rather than misdemeanors. It also establishes court-mandated treatment for those with repeat drug offenses. Voters perceive social disruption from public drug use and want more law and order.

Another thing: Daniel Lurie won his race to be mayor of San Francisco, beating incumbent London Breed. Much of the campaign focused on debates about how to address public drug use in the city. Lurie ran on promises to expand police staffing, build more homeless shelter beds and shut down open-air drug markets.

Why it’s important: This is part of the broader recent backlash toward efforts to liberalize drug policies and emphasize treatment and harm reduction over punitive responses.

  • Increases in visible homelessness, mental illness and substance use following COVID, the rise of fentanyl and the continuing high level of overdose deaths have led many to feel that recent efforts are not working. This is exacerbated by rhetoric tying “failed” drug policies to supposed spikes in crime and drug use.

 

California report warns of high-potency marijuana health dangers

What’s new: A report by scientists convened by the California Department of Public Health suggests that state policymakers must do more to warn consumers of the health dangers of high-potency marijuana and deter its use.

The background:

  • Most of the marijuana sold in California is high potency, with a concentration of THC five to ten times greater than the marijuana of the 1970s and 1980s.
  • High-potency marijuana is more likely to be addictive and cause serious health problems, like psychosis or cannabis hyperemesis syndrome.

The takeaways: The authors say policymakers should take lessons from successful campaigns to reduce smoking and drinking. Among other ideas, they recommend:

  • Restricting marijuana advertising, packaging and marketing
  • Barring flavored products that appeal to kids
  • Limiting THC content
  • Raising taxes on high-potency products
  • Launching a public education campaign about high-potency marijuana’s health effects

What’s next: The authors say they are lobbying the California Department of Public Health, the California Department of Cannabis Control, the state legislature and other state agencies to boost regulation.

 

Source: https://drugfree.org/drug-and-alcohol-news/policy-news-roundup-november-14-2024/

Filed under: Cannabis/Marijuana,Drug use-various effects,Latest News,Political Sector,USA :
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 :
 – PERSPECTIVE

 CO-AUTHORS:

Albert Stuart Reece1,2 | Gary Kenneth Hulse1,2
1University of Western Australia, Crawley,
Western Australia, Australia

2School of Health Sciences, Edith Cowan
University, Joondalup, Western Australia,
Australia

Correspondence:
Albert Stuart Reece, University of Western
Australia, 35 Stirling Hwy, Crawley, WA 6009,
Australia.
Email: stuart.reece@uwa.edu.au

ABSTRACT:

Whilst mitochondrial inhibition and micronuclear fragmentation are well established
features of the cannabis literature mitochondrial stress and dysfunction has recently
been shown to be a powerful and direct driver of micronucleus formation and chromosomal
breakage by multiple mechanisms. In turn genotoxic damage can be
expected to be expressed as increased rates of cancer, congenital anomalies and
aging; pathologies which are increasingly observed in modern continent-wide studies.
Whilst cannabinoid genotoxicity has long been essentially overlooked it may in fact
be all around us through the rapid induction of aging of eggs, sperm, zygotes, foetus
and adult organisms with many lines of evidence demonstrating transgenerational
impacts. Indeed this multigenerational dimension of cannabinoid genotoxicity
reframes the discussion of cannabis legalization within the absolute imperative to
protect the genomic and epigenomic integrity of multiple generations to come.

KEYWORDS:   cannabis, chromothripsis, micronucleus

MAIN ARTICLE TEXT:

Recent papers in Science provide penetrating and far-reaching insights
into the mechanisms underlying micronuclear rupture a key genotoxic
engine identified in many highly malignant tumours.1,2 Reactive
oxygen species (ROS) generated either by damaged mitochondria or
the hypoxic tumour microenvironment were shown to damage micronuclear
envelopes, which made them more sensitive to membrane
rupture. Damage occurred by both increased susceptibility to membrane
rupture and impaired membrane repair. Micronuclear rupture is
known to be associated with downstream chromosomal shattering,
pan-genome genetic disruption by chromothripsis, widespread epigenetic
dysregulation and cellular ageing. Clinical expressions of genotoxicity
are expected to appear as cancer, birth defects and ageing.
CHMP7 (charge multivesicular body protein 7) oxidation caused
heterodimerization by disulphide crosslinking and aberrant crosslinking
with membrane bound LEMD2 (LEM-domain nuclear envelope
protein 2) inducing membrane deformation and collapse. ROS-CHMP7
directly induced chromosomal shattering. Oxidized CHMP7 bound
covalently to the membrane repair scaffolding protein ESCRT-III
(endosomal sorting complex required for transport–III). ROS triggered
homo-oligomerization of the autophagic receptor p62/sequestome
re-routing the CMPH7-ESCRT-III complex away from membrane
repair into macroautophagy via the autophagosome and microautophagy
via lysozomes.1–3 Expected downstream consequences of
micronuclear rupture including chromosomal fragmentation, chromothripsis
and cGAS-STING (cyclic adenosine-guanosine synthase–
stimulator of interferon signalling) activation were demonstrated.
Cancer-related innate inflammation is known to drive tumour progression
and distant metastasis. These principles were tested both in normal
and also numerous malignant (including head and neck squamous,
cervical, gastric, ovarian and colorectal cancers) cell lines.1,2 Similar
processes including DNA damage and epigenomic derangements have
also been identified in TH1-lymphocytes during fever indicating that
mitochondriopathic-genotoxic mechanisms may in fact be widespread
and fundamental.4

Received: 26 September 2024 Accepted: 26 September 2024
DOI: 10.1111/adb.70003
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

 

Addiction Biology. 2024;29:e70003. wileyonlinelibrary.com/journal/adb
https://doi.org/10.1111/adb.70003

Cannabis has been known to be linked with both micronuclear
development and mitochondrial inhibition for many decades.5,6
All cannabinoids have been implicated in genotoxicity as the moiety
identified as damaging the genetic material is the central olivetol
nucleus on the C-ring itself.7 This finding implicates Δ8-, Δ9-, Δ10-,
Δ11-tetrahydrocannabinol, cannabigerol, cannabidiol and cannabinol
amongst all other cannabinoids.
Historically, the cancer-cannabis link has been controversial. Differing
results in published studies may be attributed to various factors
including multiple exposures (including tobacco), differences in
study design and the rapid rise of cannabis potency. One often quoted
study actually specifically excluded high level cannabis exposure, which
would now appear to have been a major methodological limitation.8 It
is widely documented that there has been a sharp increase in cannabis
concentration from the 1970s to the present day. THC concentrations
of 25%–30% are commonly noted in cannabis herb and flower sold
commercially, and 100% THC concentrations are well known for cannabinoid
based products such as dabs, waxes and ‘shatter’.
In this context, the recent appearance of a series of continentwide
epidemiological, space–time and causal inferential studies in
both Europe and North America is notable for many positive signals
for various cancers including breast, pancreas, liver, AML, thyroid, testis,
lymphoma, head and neck squamous cancer, total childhood cancer
and childhood ALL.9–15 The literature on cannabis and testicular
cancer is almost uniformly positive and has a relative risk of around
2.6-fold,16 this risk factor is now widely acknowledged17–19 and the
effect is quite fast since the median age of exposure may be about
20 years and the median age of testis cancer incidence is only
31 years. Testicular cancer is the adult cancer responsible for the most
years of life lost.17,18,20,21 The inclusion of several childhood cancers
in association with cannabis exposure obviously implicates transgenerational
transmission of malignant mutagenesis.
An intriguing finding in the case report literature is that in many
cases, cancers occur decades earlier and are very aggressive at diagnosis.
22 Mechanisms such as the synergistic mitochondriopathic–
micronuclear axis presently proposed in the recent Science papers1–4
may directly explain this very worrying observation.
Whilst cancer is thought to be a rare outcome amongst cannabis
exposed individuals, ageing effects are not. A dramatic acceleration
of cellular epigenetic age by 30% at just 30 years was recently
reported23 with indications this effect likely rises with age,24 and
the demonstration that cannabis exposed patients had adverse
outcomes across a wide range of physical and mental health outcomes
including myocardial infarction and emergency room presentations.
25 Importantly, the ageing process itself has been shown to
be due to redistribution of the epigenetic machinery in such a manner
as to produce dysregulation (and widespread reduction) of gene
expression and to be inducible by limited genetic damage resulting
from just a handful of DNA breaks.26 Extremely worryingly, agerelated
morphological changes have been described in both oocytes
and sperm.27,28
Epidemiological studies of European and American cannabiscancer
links are supported by epidemiological, space–time and causal
inferential studies of links between cannabis and congenital
anomalies.29–33 Reported congenital anomalies are clustered in the
cardiovascular, neurological, limb, chromosomal, urogenital and gastrointestinal
systems. The fact that all five chromosomal anomalies
studied here are represented in this list, notwithstanding their high
rate of known foetal loss, is strong evidence for chromosomal misegregation
during germ cell meiosis, which is the genetic precursor to
micronucleus development.34,35 The fact that almost identical results
were reported in both the United States and Europe provides strong
external validation to these findings.30
This is consistent with recent press reports of dramatic increases
in babies and calves born without limbs in both France and
Germany36,37 raising the public health spectre of downstream implications
of food chain contamination. Melbourne, Australia, is a multiethnic
city, which heads the global leaderboard for babies born with
the serious limb anomalies amelia and phocomelia.37–40 This pattern
of elevated rates of major birth defects is not seen in the host nations
from which these migrant populations are derived. Cannabis farms are
increasingly common around Melbourne, just as they are in the
French province of Ain, which has similar concerns.37,41–43
Major epigenetic changes have been found in human sperm,44
which have also been identified in exposed rodent offspring.44–46
Indeed, 21 of the 31 congenital anomalies described following prenatal
thalidomide exposure have also been observed epidemiologically
following prenatal cannabis exposure and 12 of 13 cellular pathways
by which thalidomide operates have been similarly identified in the
cannabis mechanistic literature.47 Both human and rodent epigenomic
studies44–46 and epidemiological studies show that adult cannabis
exposure is linked with the incidence of autism48–53 and cerebral processing
difficulties54–57 in children prenatally exposed. Together, this
data is clear and robust evidence for the transgenerational transmission
of major genotoxic outcomes.
Notwithstanding the well-known ambiguities in the epidemiological
literature for cannabis, it is clear from the above brief overview
that there is strong and compelling evidence that cannabis genotoxic
outcomes are well substantiated and form a remarkably congruent
skein of interrelated evidence across all three domains of genotoxic
pathology including cancer, congenital anomalies and ageing.
So too compelling epidemiological, morphological and epigenetic
evidence of transgenerational transmission of cannabinoid genotoxicity
to foetus, egg, sperm and offspring carries far reaching and
transformative implications and indeed reframes the discussion surrounding
cannabis legalization from merely personal-hedonistic to the
protection of the national genomic integrity for multiple subsequent
generations.
The present time therefore represents a watershed moment.
The new profoundly insightful studies from Science point the way and
provide the trigger. Clearly, there is a great need for a new
and updated cohort of epidemiological studies on these issues at the
population level in the modern context of the widespread availability
of much more potent cannabinoid preparations.
However, our first responsibility is to act on the evidence we do
have. Given the uniform picture painted by data from myriad directions.

It can be said that the evidence for cannabinoid genotoxicity
is at once so clinically significant, robust and compelling as to constitute
a resounding clarion call to action: The only outstanding
question is ‘Will we rise to the challenge?’

13691600, 2024, 11, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/adb.70003 by National Health And Medical Research Council, Wiley Online Library on [14/11/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

 

CONFLICT OF INTEREST STATEMENT:
The authors declare no conflicts of interest.

ORCID:
Albert Stuart Reece https://orcid.org/0000-0002-3256-720X

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54. Fried PA, Watkinson B, Gray R. Neurocognitive consequences of
marihuana—a comparison with pre-drug performance. Neurotoxicol
Teratol. 2005;27(2):231-239. doi:10.1016/j.ntt.2004.11.003
55. Smith AM, Fried PA, Hogan MJ, Cameron I. Effects of prenatal marijuana
on visuospatial working memory: an fMRI study in young
adults. Neurotoxicol Teratol. 2006;28(2):286-295. doi:10.1016/j.ntt.
2005.12.008
56. Smith AM, Longo CA, Fried PA, Hogan MJ, Cameron I. Effects of marijuana
on visuospatial working memory: an fMRI study in young
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s00213-010-1841-8
57. Smith AM, Mioduszewski O, Hatchard T, Byron-Alhassan A, Fall C,
Fried PA. Prenatal marijuana exposure impacts executive functioning
into young adulthood: an fMRI study. Neurotoxicol Teratol. 2016;58:
53-59. doi:10.1016/j.ntt.2016.05.010
How to cite this article: Reece AS, Hulse GK. Key insights into
cannabis-cancer pathobiology and genotoxicity. Addiction
Biology. 2024;29(11):e70003. doi:10.1111/adb.70003

13691600, 2024, 11, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/adb.70003 by National Health And Medical Research Council, Wiley Online Library on [14/11/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

Source: ORCID, Inc 10411 Motor City Drive, Suite 750, Bethesda, MD 20817, USA

Filed under: Australia,Cannabis/Marijuana,Drug use-various effects,Latest News,Marijuana and Medicine,USA :

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 :

 Supporters of psilocybin expressed dismay at the bans after thousands of people reported benefits from using the psychedelic drug

Oregon Capital Chronicle, November 7, 2024- by Ben Botkin and Lynne Terry.

                                 Image: PIXABAY

 Voters in more than a dozen Oregon cities, including in the Portland area, voted to ban the regulated sales and use of psilocybin mushrooms.

Anti-psilocybin measures were on the ballots in 16 cities and unincorporated Clackamas County, and are passing in coastal communities to urban Portland and central and southern Oregon by 55% to 70% of the vote.

Bans against psilocybin businesses are passing in  Brookings, Rogue River, Sutherlin, Redmond, Lebanon, Jefferson, Sheridan, Amity, Hubbard, Mount Angel, Estacada, Oregon City, Lake Oswego, Seaside and Warrenton. Redmond’s measure would enact a two-year moratorium on psilocybin businesses.

There was one notable outlier. The measure to ban psilocybin could fail in Nehalem, a small community in Tillamook County, according to initial returns. But it is failing by only three votes. The unofficial results on Wednesday were close: 80 voters oppose the ban and 77 voters support.

Comment was not immediately available from psilocybin opponents. Supporters of the drug expressed disappointment with the results Wednesday.

“I think it’s really unfortunate that local communities, often rural communities continue to prevent access to psilocybin services, especially given that we’ve seen over 7,000 people go through the Oregon program, and there’s been so many stories of healing and benefit for those who have done it,” said Sam Chapman, a longtime psilocybin advocate who is policy and development director for the Microdosing Collective, a nonprofit supporting use of the drug in small doses.

Chapman played a big role in getting Oregonians to approve licensed psilocybin treatment centers, facilitators and manufacturers with the passage of Measure 109 four years ago by 56% of the vote. The measure required the Oregon Health Authority to start a program to allow providers to administer psilocybin mushrooms and fungi products to people 21 or older.

To date, the health authority has licensed about 1,000 staff, including 350 facilitators who work directly with clinics while they’re on the hallucinogen. The agency has also licensed 30 psilocybin centers – from the Portland area to Eugene to Ashland and beyond – along with a dozen manufacturers and one lab.

Chapman said these centers give the state another “tool in the toolbox” to treat mental illness, especially depression, anxiety and PTSD, especially for veterans.

“We’re actually seeing the proof of concept for the people who are going through Oregon’s service centers now,” Chapman said. “I think the mental health crisis in rural communities is especially unique in that these rural communities are struggling not just for mental health but economically as well.”

The economy of the psilocybin industry has been soft, caused mainly by the cost of a single session, which can range from hundreds to several thousand dollars, with many customers flocking to Oregon from out of state.

Chapman said rejection of psilocybin is linked to a lack of education about the drug and how the industry works in Oregon. Consumers cannot buy the drug in stores, as they can for marijuana, and treatments are regulated.

“They don’t understand psilocybin. They don’t understand the research and they don’t understand the Oregon program. And so in addition to the lack of that understanding, they make some assumptions. The biggest assumption is that this is just the same thing as cannabis. They assume this is for retail sales, which is not true,” Chapman said.

Healing Advocacy Fund, a nonprofit in Oregon and Colorado, will continue to push for the programs to grow, with state-regulated access to psychedelic healing. Heidi Pendergast, the group’s Oregon director, said the rollout in Oregon has been safe, with only four people needing emergency services out of thousands served.

“So while there may be some concerns, we haven’t seen that play out right now whatsoever in the program,” Pendergast said.

Oregon was the first state to decriminalize psilocybin in licensed settings and Colorado has followed suit. Massachusetts voters rejected a proposal to legalize the mushrooms and allow people to grow small quantities at their homes, National Public Radio reported.

Oregon Capital Chronicle is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. 

 

Source: The Lund Report – Latest Headlines | November 7, 2024

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

October 31, 2024

 

Scotland’s drug and alcohol deaths remain among Europe’s highest – despite an increase in spending and better national leadership.

The Scottish Government has made progress in increasing residential rehabilitation capacity and implementing treatment standards. However, it has been slow to progress key national strategies, such as a workforce plan and alcohol marketing reform. People in need still face many barriers to getting support. The workforce is under immense strain. And the increased focus on drug harm is shifting attention from tackling alcohol issues.

In 2023, there were 1,277 alcohol-specific deaths – the highest since 2008. And there were 1,172 drug misuse deaths, the second lowest number in the last six years. Scotland’s figures remain high compared to the rest of Europe despite alcohol and drug funding rising from £70.5 million in 2014/15 to £161.6 million in 2023/24.

Alcohol and drug services are co-ordinated by Alcohol and Drug Partnerships at a local level. But they have limited powers to influence change and direct funding, and their funding is falling in real terms due to inflation. Most alcohol and drug funding goes to NHS specialist services to treat people at crisis point. This means there is limited money to put into preventing people getting so ill in the first place.

Stephen Boyle, Auditor General for Scotland, said:

The Scottish Government needs to develop more preventative approaches to tackling Scotland’s harmful relationship with alcohol and drugs. That means helping people before they get to a crisis point.

Ministers also need to understand which alcohol and drug services are most cost-effective, and plan how they will be funded when the National Mission ends in 2026. That’s especially important at a time of increasing strain on the public finances.

With many alcohol and drug workers reporting feeling under-valued and at risk of burn-out, there is also an urgent need to put a timeline against plans to address the sector’s staffing challenges.

Christine Lester, a member of the Accounts Commission, said:

Alcohol and drug services are complex and delivered by a wide range of partners. But there needs to be more collective accountability across the system for how each body is helping people whose lives have been blighted by alcohol and drugs.

Better information is needed to inform service planning and where funding should be prioritised. There is also more to do to tailor services to individual needs, using the experience of service users. Right now, not everyone can access the services they need, and that experience is worse for people facing disadvantage.

Source: https://audit.scot/news/prevention-focus-needed-to-tackle-alcohol-and-drug-harm

Filed under: Alcohol,Drug use-various effects,Latest News,Prevention and Intervention,UK :

Weekly / November 7, 2024 / 73(44);1010–1012

Alana M. Vivolo-Kantor, PhD1; Christine L. Mattson, PhD1; Maria Zlotorzynska, PhD1

What is already known about this topic?

Expanded availability of ketamine for management of treatment-resistant depression has resulted in increased use.

What is added by this report?

During July 2019–June 2023, ketamine was detected in <1% of overdose deaths and was the only drug involved in 24 deaths. During this period, the percentage of overdose deaths with ketamine detected in toxicology reports increased from 0.3% (47 deaths) to 0.5% (107 deaths). Approximately 82% of deaths with ketamine detected in toxicology reports involved other substances, including illegally manufactured fentanyls, methamphetamine, or cocaine.

What are the implications for public health practice?

Further investigation is needed to better understand the role of ketamine in drug overdoses, particularly when multiple substances are used before death.

Ketamine, a Schedule III controlled substance* that is Food and Drug Administration (FDA)–approved for general anesthesia, can produce mild hallucinogenic effects and cause respiratory, cardiovascular, and neuropsychiatric adverse events (1). In 2019, a form of ketamine (esketamine) was approved by FDA for use in treatment-resistant depression among adults† (2). Ketamine use, poison center calls for ketamine exposure, and ketamine drug reports from law enforcement have increased through 2019 (3), but recent trends in ketamine involvement in fatal overdoses are unknown. Data from CDC’s State Unintentional Drug Overdose Reporting System (SUDORS) were analyzed to describe characteristics of and trends in overdose deaths with ketamine detected or involved during July 2019–June 2023.

Investigation and Findings

Data on drug overdose deaths with unintentional or undetermined intent come from SUDORS, which includes information from death certificates, medical examiner or coroner reports, and postmortem toxicology reports.§ Data are abstracted on all substances reported to cause death (i.e., involved) and substances detected through toxicology testing. Decedent demographics and other overdose characteristics were analyzed among 45 jurisdictions (44 states and the District of Columbia [DC]),** and trend analyses were conducted among 28 jurisdictions (27 states and DC).†† Analyses were restricted to deaths with toxicology reports or with ketamine listed as a cause of death on the death certificate. Ketamine detection included toxicology results for ketamine or its metabolites.§§ Among deaths with ketamine detected, drug involvement was analyzed to ascertain which drug or drugs caused death. This activity was reviewed by CDC, deemed not research, and was conducted consistent with applicable federal law and CDC policy.¶¶

During July 2019–June 2023, a total of 228,668 drug overdose deaths were identified in 45 jurisdictions. Ketamine was detected in 912 (0.4%) overdose deaths, listed as involved in 440 (0.2%) deaths, and was the only substance involved in 24 (0.01%) deaths (Table). A majority of deaths with ketamine detected involved illegally manufactured fentanyls (IMFs) (58.7%), followed by methamphetamine (28.8%) and cocaine (27.2%). Overall, 82.4% of deaths involved either IMFs, methamphetamine, or cocaine. Approximately one third (34.8%) of decedents in whom ketamine was detected were aged 25–34 years, and approximately three quarters were males (71.3%) and non-Hispanic White persons (73.7%).

Among 172,475 overdose deaths in 28 jurisdictions during July 2019–June 2023, <1% had ketamine detected (692 deaths; 0.4%) or were classified as ketamine-involved (348 deaths; 0.2%). The number and percentage of deaths with ketamine detected increased during July 2019–June 2023 from 47 (0.3%) to 107 (0.5%), with notable increases as early as July–December 2020

Conclusions and Actions

During July 2019–June 2023, although ketamine was detected or involved in <1% of all drug overdose deaths, overdose deaths with ketamine detected increased. Almost all overdose deaths with ketamine detected involved other substances, mostly IMFs or stimulants; however, the source of ketamine (e.g., illegally purchased or prescribed) is unknown. Because analyses included a subset of jurisdictions, findings might not be generalizable to the entire United States. In addition, the scope of postmortem toxicology testing varies within and across jurisdictions, and ketamine might not be included in testing panels or be tested for in all postmortem samples (4), which could lead to an underestimation of ketamine detection. Despite the lack of uniform testing, ketamine detection among overdose deaths has increased over time, yet both detection and involvement accounted for a small proportion of overdose deaths. As polysubstance use (5) and use of ketamine for treatment-resistant depression and in compounded formulations*** increase, continued monitoring is needed to identify potential changes in the detection and involvement of ketamine in overdose deaths and to better understand potential drug interactions or circumstances leading to death.

Source: https://www.cdc.gov/mmwr/volumes/73/wr/mm7344a4.htm?s_cid=mm7344a4_w

Filed under: Drug use-various effects,Ketamine,Latest News,Prevalence,USA :

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 :

November 6, 2024 by 

Experts in Nigeria are increasingly concerned about the country’s rising drug abuse rates, urging the Federal Government to adopt a public health-centred approach. 

This proposed strategy prioritizes reducing drug use while establishing a supportive legal framework to empower health interventions.

With roughly 14.4 percent of the population or about 14.3 million Nigerians, affected by drug use, public health experts argued that a comprehensive legal structure is critical for the Federal Ministry of Health to address this crisis effectively.

At a one-day media sensitization workshop in Abuja, themed ‘Public Health Approach to Drug Control Response in Nigeria’ and organized by the Federal Ministry of Health and Social Welfare in partnership with Youth Rise Nigeria, experts advocated for treating drug dependency as a health issue rather than a criminal offence.

They stressed that many individuals struggling with drug dependency are dealing with health-related challenges.

The workshop highlighted the urgent need for a health-oriented approach to tackle what experts now view as a national drug dependency epidemic and the crucial role of the media in shaping public perception and reaction to drug abuse.

Chukwuma Anyaike, the Director of Public Health at the Federal Ministry of Health, argued that a public health approach is crucial for controlling drug issues in Nigeria.

He noted that existing supply-focused measures have limited access to treatment and prevention services, which has led to increased rates of HIV, tuberculosis, and hepatitis among people who inject drugs.

Anyaike called for a multidisciplinary approach integrating public health, legal, and social welfare frameworks and urged Nigeria to align with international standards such as the World Health Organization’s guidelines, the 2016 UN General Assembly Special Session on Drugs UNGASS), and the African Union (AU) Plan of Action to improve its response to drug abuse.

“This approach includes preventing drug use, providing treatment and care for individuals with substance use disorders, implementing harm reduction strategies, and ensuring access to controlled medications,” Anyaike explained.

Echoing these sentiments, Nonso Maduka, a Consultant with Youth Rise Nigeria, stressed the need for legislation that would facilitate a health-centered response to drug control.

Related News

Maduka argued that a supportive legal framework would help provide better resources and care for individuals, families, and communities affected by drug dependency, shifting away from the current punitive focus.

“Unfortunately, we have an unbalanced approach that targets mainly supply reduction, and the health sector lacks the legal authority to address demand, prevention, treatment, and harm reduction,” Maduka noted.

He highlighted that Nigeria’s current drug laws treat drug use as a criminal issue, which restricts health interventions and puts more strain on affected communities.

A public health perspective, he noted, could help curb drug dependency and reduce associated health risks like HIV and hepatitis.

Maduka also emphasized the importance of empowering local health initiatives and granting States authority to address drug challenges in their communities.

A health-focused legal framework, he noted, would allow targeted responses, including treatment, rehabilitation, and palliative care.

Such a framework, according to him, would create a balanced approach that not only reduces drug abuse but also mitigates its harmful effects, ultimately supporting a healthier future for the nation.

“If you want to solve it, it must be driven by evidence,” Maduka added, calling for an evidence-based approach that balances criminal justice with health-focused interventions, which includes drug demand reduction, harm reduction, and access to necessary medications.

“Understanding underlying causes, such as pain management needs and rural challenges, is essential for developing compassionate and comprehensive responses,” he added.

Oluwafisayo Alao, the Executive Director of Youth Rise Nigeria, underscored the crucial role of the media in changing public perceptions around drug dependency, saying, “The way we approach substance use in Nigeria impacts the lives of millions of people.

“This media partnership is a vital step toward a compassionate, health-focused response. By creating a framework that prioritizes health over punishment, we aim to protect individuals, families, and communities”.

Source: https://thenationonlineng.net/experts-propose-all-inclusive-approach-legal-framework-to-combat-drug-abuse/

Filed under: Drug use-various effects,Latest News,Legal Sector,Others (International News),Prevention and Intervention :

United Nations  –  Office on Drugs and Crime

PRESS RELEASE  – Kabul / Vienna, 6 November 2024

Opium cultivation in Afghanistan in 2024 increased by an estimated 19 per cent year-on-year to cover 12,800 hectares, according to a new survey released by the UN Office on Drugs and Crime (UNODC) today.

The increase follows on a 95 per cent decrease in cultivation during the 2023 crop season, when the de-facto Authorities of Afghanistan enforced a ban that virtually eliminated poppy cultivation across much of the country. Despite the increase in 2024, opium poppy cultivation remains far below 2022, when an estimated 232,000 hectares were cultivated.

“With opium cultivation remaining at a low level in Afghanistan, we have the opportunity and responsibility to support Afghan farmers to develop sustainable sources of income free from illicit markets,” said Ghada Waly, Executive Director of UNODC. “The women and men of Afghanistan continue to face dire financial and humanitarian challenges, and alternative livelihoods are urgently needed.”

According to the survey findings, the geographic centre of opium cultivation has also shifted, from the south-western provinces – long the heart of Afghanistan’s opium cultivation up to and including 2023 – to the north-eastern provinces, where 59 per cent of cultivation occurred in 2024. This represents a sharp 381 per cent increase in these provinces over 2023.

Dry opium prices have stabilized to around US $730 per kilogram in the first half of 2024, up from a pre-ban average of US $100 per kilogram.

The high prices and dwindling opium stocks may encourage farmers to flout the ban, particularly in areas outside of traditional cultivation centers, including neighboring countries.

“This is important further evidence that opium cultivation has indeed been reduced, and this will be welcomed by Afghanistan’s neighbours, the region and the world,” said Roza Otunbayeva, Special Representative of the Secretary-General and head of the United Nations Assistance Mission in Afghanistan.

“But this also requires us to recognize that rural communities across Afghanistan have been deprived of a key income source in addition to the many other pressures they are facing, and they desperately need international support if we want this transition to be sustainable,” Otunbayeva said.

Read the Afghanistan Drug Insights Volume 1 here.

Note to Editors: The remaining reports in the Afghanistan Drug Insights series will cover a range of topics related to the drug situation in Afghanistan, including opium production and rural development; the socioeconomic situation of farmers after the drugs ban; drug trafficking and potential opium stocks; and treatment availability and drug use.

* *** *

For further information please contact:

Sonya Yee
Chief, UNODC Advocacy Section
Mobile: (+43-699) 1459-4990
Email: unodc-press[at]un.org

* *** *

Source: https://www.unodc.org/unodc/en/press/releases/2024/October/afghanistan_-opium-cultivation-increased-by-19-per-cent-in-second-year-of-drugs-ban–according-to-unodc.html

Filed under: Crime/Violence/Prison,Drug use-various effects,Heroin/Methadone,Latest News,Others (International News),Prevalence :

Cultural, systemic and historical factors have converged to create the perfect storm when it comes to Black overdose deaths.

      By Liz Tung – June 14, 2024 Reporter at The Pulse

In this Jan. 23, 2018 photo, Leah Hill, a behavioral health fellow with the Baltimore City Health Department, displays a sample of Narcan nasal spray in Baltimore. The overdose-reversal drug is a critical tool to easing America’s coast-to-coast opioid epidemic. (AP Photo/Patrick Semansky)

From Philly and the Pa. suburbs to South Jersey and Delaware, what would you like WHYY News to cover? Let us know!

A recent study from the Pennsylvania Department of Health has found that Black people who died from opioid overdoses were half as likely as white people to receive the life-saving drug naloxone, otherwise known as Narcan. The study also found that Black overdose deaths in Pennsylvania increased by more than 50% between 2019 and 2021, compared with no change in white overdose deaths.

In an email, a representative with the Department of Health said that similar rises in overdose deaths are being seen across the country, especially among Black, American Indian and Alaska Native populations. But researchers are still investigating what’s behind the spike.

“There does not appear to be a single reason why rates are increasing for Black populations and holding steady among white populations,” the statement reads. “The volatile and rapidly changing drug supply certainly has been a challenge as fentanyl is now found in every type of drug. Inequities in terms of treatment for substance use disorder may also play a factor as white people are more likely to have better access to the most evidence-based treatments and are more likely to stay in treatment.”

Fear of arrest

Abenaa Jones, an epidemiologist and assistant professor of human development and family studies at Penn State who was not involved in the study, has conducted similar research in Baltimore. She agreed that fentanyl-contaminated drugs — which are more common in lower-income neighborhoods — and less access to health care are likely factors in the growing number of overdose deaths among Black populations.

Jones said the criminal justice system, and its unequal treatment of Black people, also plays a role.

“We know that the intersection of criminal justice and substance use, and criminalization of drug use and how that disproportionately impacts minorities, can limit the accessibility of harm reduction services to racial-ethnic minorities for fear of harassment by police for drug paraphernalia,” Jones said, adding that even syringes obtained through needle-exchange programs can be considered illegal paraphernalia.

Fear of arrest, in turn, leads more people to using drugs in isolation.

“That may protect you from criminal legal involvement, but then in the event of an overdose, you may not have someone to help you,” Jones said. “So it could be that by the time the EMS come, it’s been too long for them to even consider administering naloxone.”

Contaminated drug supplies

An unexpected observation that Jones made in the course of her research could also be a factor in rising death rates — the fact that many of the Black people dying of opioid overdoses are older.

“For any other racial groups, overdose deaths peak around midlife — 35, 45,” she said. “For Black individuals, it’s more like 55, 64, and we were wondering what was going on with that.”

After investigating that question, Jones and her colleagues formulated a working theory.

“The running hypothesis for us is that this is a cohort effect,” she said. “Individuals who’ve been using drugs over time, particularly Black individuals back from the ‘80s and ‘90s with the cocaine epidemic, never stopped using.”

Those individuals may have remained relatively stable until fentanyl began to contaminate their drug supply without them knowing.

“So whatever harm reduction tools that you were using for so many years that’s been helping you, when fentanyl’s involved, it’s a different game,” Jones said. “You have to use less, but you have to also know that you have fentanyl in your drugs, right?

It’s a problem that Marcia Tucker, the program director of Pathways to Recovery — a partial hospitalization program focused on co-occurring substance use and mental health challenges — sees frequently among their mostly Black clients.

“If you come into treatment saying that I’m a cocaine user, or I’m a crack cocaine user, or I use marijuana, you’re not even thinking that an opioid overdose or fentanyl overdose could possibly happen to you,” Tucker said. “And it does happen.”

Fear, stigma and miseducation

In fact, Tucker said, she’s seen more of these kinds of overdoses over the past two years than in the three decades she’s spent working in addiction treatment. Despite that, there’s still a lack of education — and even stigma — surrounding both medication-assisted treatments (MATs) for opioid addiction, and the use of naloxone.

“I think sometimes culturally with the African American community, as far as MATs are concerned, there are some taboos about getting that extra help when they decide to come into treatment and get clean,” she said. “A lot of people feel like they want to do it from the muscle. They see it as another form of using.”

She said others may not know how to use naloxone, what kinds of effects it has or how to get it.

“I think a lot of folks don’t even know that they can walk into a pharmacy and get naloxone — you don’t have to have a prescription for that,” Tucker said. “And I think that information is just not always presented to communities, especially poor communities that don’t have a lot of resources.”

Other sources of hesitation are more immediate. Aaron Rice, a therapist at Pathways to Recovery, said that many of their clients fear naloxone because of its physical effects.

“I think they associate it with precipitated withdrawal at times,” Rice said, referring to the rapid-onset withdrawal that can cause symptoms including anxiety, pain, seating, nausea, vomiting and diarrhea.

“The only thing they’re thinking about is feeling better. And that feeling is going to supersede logic at that moment. It always does.”

Overcoming disparities in health care and mistrust of the system

The Department of Health acknowledged that the study only paints a partial picture, as it doesn’t include individuals whose overdoses were reversed by naloxone, and added that during the years of the study (2019–2021), naloxone was available by prescription only — a fact that likely played into the race-based disparity.

“There are recognized inequities in access to health care among persons of color, the concept of which likely extends to access to naloxone,” the Department of Health statement reads. “Historically, many public health materials and messaging more narrowly focused on persons using opioids. With people now taking two or more drugs together (whether intentionally or unintentionally), public health materials and messaging need to be more inclusive of all persons using drugs, regardless of the type.”

The study, researcher Abenaa Jones, Marcia Tucker and Aaron Rice all agreed on at least one intervention that could increase Black people’s access to naloxone — relying on trusted community leaders and institutions, like churches, to help educate residents and distribute the overdose-reversing drug.

“I just can’t stress enough how it’s a lifesaver — it’s the difference between life and death,” Tucker said. “I think people who aren’t medical professionals and find themselves in a situation where it might need to be used would probably be a little fearful — fearful about how to use it or how the person is going to react or whether it’s really going to work — just know that you’re better off with it and trying it. You don’t want to have to second guess yourself later and say, ‘I wish we had it. I wish we had gotten it,’ or, ‘I wish we had used it.’”

Source: https://whyy.org/articles/black-pennsylvanians-overdoses-naloxone-less-likely-to-receive/

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

Submission to the Joint Select Committee on Social Media and Australian Society

Executive Summary
Social media platforms have become a major part of young Australians’ lives. While these
platforms have many benefits, they also expose youth to content that promotes substance use,
including alcohol, tobacco, e-cigarettes, and illicit drugs. This is concerning because:
1. There are often no effective age restrictions on this content.
2. Substance-related posts are widely available and mostly show drug use in a positive
light.
3. Young people are seeing alcohol related advertisements on social media every few
minutes.
4. Exposure to this content can normalise substance use by young people and undermine
the perceived harms of substance use.

The Australian government and social media companies need to work together to protect
young people from this harmful content. This could include better age verification, stricter
content policies, and using technology to detect and remove posts promoting illegal
substances.

>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

To access the full document:

  1. Click on the ‘Source’ link below.
  2. An image  – the front page of the full document will appear.
  3. Click on the image to open the full document.

 

Source: National Centre for Youth Substance Use Research

 

Filed under: Alcohol,Australia,Cannabis/Marijuana,Drug use-various effects,Mental Health,Youth :

By Ian Webster  Oct 28, 2024

Ian W Webster AO is Emeritus Professor of Public Health and Community Medicine of the University of New South Wales. He has worked as a physician in public and regional hospitals in Australia and UK and in NGOs dealing with homelessness, alcohol and drug problems and mental illness.

Please review Ian Webster’s paper which clearly shows that we need to learn from our success in the past that Prevention is the best way forward.

The second New South Wales Drug Summit will be held in regional centres for two days in October and the final two days will be in Sydney on the 4th and 5th December to be co-chaired by Carmel Tebbutt and John Brogden – a balance of politics.

Do summits achieve worthwhile outcomes?

The first Drug Summit in 1985 was national. It worked. It established the enduring principle of harm minimisation. It brought police, health, and education together, canvassed all drugs – including alcohol and tobacco, and it started funding for practicable and policy-based research.

It worked because Prime Minister Hawke needed it to, for family reasons. It worked because the Health Minister, Neal Blewett, needed it to work as he had carriage of its outcomes and the national response to burgeoning HIV/AIDS epidemic.

The 1999 NSW Drug Summit was in response to the rising prevalence of heroin use and opiate deaths. It worked because there was a political will to succeed. It included measures to deal with blood borne infections of HIV, hepatitis B and C; it expanded the state’s opioid treatment programs; expanded needle-syringe programs; introduced the antidote naloxone; and three seminal firsts – the first medically supervised injecting centre, drug courts, and court referral into treatment.

It worked because the Premier Bob Carr wanted it to. Which meant that the summit’s recommendations were managed through the Cabinet Office, supported by a ministerial expert advisory group. The ‘piper called the tune’ for all the state government departments; and they were made to work together.

The Alcohol Summit of 2003 was not as effective. Politicians were too close to the alcohol problem and implementation was handed to the Department of Health which meant other departments washed their hands of involvement. Police, on the other hand, carried the day with counterattacks on alcohol violence and behaviours at liquor outlets.

Contemporary drug problems

Now other substances must be dealt with – amphetamine type stimulants, especially crystalline methamphetamine, cocaine, hallucinogens, MDMA, pharmaceutical stimulants, the potent drug fentanyl, the even more potent nitrazenes, ketamine and unsanctioned use of psychiatric/neurological drugs. Cocaine is flooding the drug markets.

Heroin and alcohol remain as major problems. The Pennington Institute estimated there were 2,356 overdose deaths in 2022, 80% of which were unintended. And alcohol, not only damages the drinker, and the bystander, but creates extensive social harms in the lives of others.

NSW Ice Inquiry

Four and half years ago Commissioner, Dan Howard, reported on his Inquiry into the Drug Ice; he had started the Inquiry six years previously. His recommendations provide a scaffold for the upcoming Summit. The earlier NSW Drug Summit (1999) was followed by a strong impetus to implement its recommendations, but the Government dropped the ball 20 years ago. The last formal drug and alcohol plan was 10 years before the Ice Inquiry.

Fundamental to drug law reform is the decriminalisation of personal use and possession of drugs. This recommendation stands above all others in Dan Howard’s Report.

The thrust of the Inquiry’s recommendations centre on harm minimisation:

  • drug problems are health problems,
  • government departments across the board have responsibilities,
  • treatment, diversion, workforce initiatives, education and prevention programs must be adequately resourced,
  • accessible and timely data are needed,
  • Aboriginal communities, and other vulnerable communities, those in contact with the criminal justice system, all disproportionally affected by alcohol and other drugs, must be high priority population groups.

The NSW Liberal Government pushed back against decriminalising low-level personal drug use, against medically supervised injecting centres, against pill testing, cessation of drug detection dogs at music festivals, and needle and syringe programmes in prisons. Later it gave in-principle support to 86 of the recommendations.

Will the Summit achieve?

The hopes of the drug and alcohol sector are for easy access to naloxone (antidote to opiates), supervised drug-taking services, accessible sites for drug-checking, early surveillance on trends, better access to now available effective treatments, for the treatment of prisoners to equal that for all citizens, and a more equitable distribution of treatment and rehabilitation services across the state, and to ‘at-risk’ population groups.

Success will depend on the practicality of the recommendations and the preparedness of government to act on them in good faith.

It is trite to say, but this depends on political will. The will was strong in the earlier national Drug Summit (1985) and NSW Drug Summit (1999). But so far, Government responses to the Ice Inquiry have been late and weak-willed which does not bode well for the delivery of needed reforms.

There is now a Labor Government, also tardy in its response. It remains to be seen whether NSW Labor has the stomach to overturn past prejudicial stances on drug use and addiction, and whether it will put sufficient funds to this under-funded and stigmatised social and health problem.

What will not be achieved

The Summit and its outcome cannot attack the real drivers of drug problems – the incessant search by humankind for mind altering substances, the mysteries of addiction, and the abysmal treatment of people in unremitting pain.

The root causes of drug problems are socially determined. Action at this level will require an unimaginable upheaval of society and government. In western countries drug overdoses (including alcohol overdoses), suicide, and alcoholic liver disease, are regarded as ‘diseases of despair’. The desperation and despair which pervades vulnerable, and not so vulnerable, population groups, is the underground of drug use problems here and in other countries. Commissioner Howard said, we [society] are given “tacit permission to turn a blind eye on the factors driving the most problematic drug use: trauma, childhood abuse, domestic violence, unemployment, homelessness, dispossession, entrenched social disadvantage, mental illness, loneliness, despair and many other marginalising circumstances that attend the human condition.”

Somehow a better balance must be struck for law enforcement between the war on traffickers and the human rights of users. It is for the rest of us to treat drug using people as our fellow citizens.

Kind Regards

Herschel Baker

 

Source: Drug Free Australia

Filed under: Addiction,Alcohol,Australia,Cannabis/Marijuana,Cocaine,Drug use-various effects,Effects of Drugs,Health,Mental Health,Prevalence,Prevention and Intervention,Social Affairs :

Even as officials hope tech can stem the tide of solitary drug fatalities, they know deploying these warning strategies could face obstacles.

By    and   

They die alone in bedrooms, bathroom stalls and cars. Each year in the United States, tens of thousands of fatal overdoses unfold as tragedies of solitude — with no one close enough to call 911 or deliver a lifesaving antidote.

Technology new and old might save some of those lives.

Motion detectors blare alarms when someone collapses inside a bathroom at a shelter or clinic. Biosensors detect slowed breathing triggered by an overdose and one day may be capable of automatically injecting overdose reversal medication. Simpler approaches — chat apps and hotlines — keep users connected to help if drugs prove too potent.

Source: https://www.washingtonpost.com/health/2024/10/19/fatal-drug-overdoses-alarms-sensors/
Filed under: Drug use-various effects,Prevalence,Treatment and Addiction,USA :

Washington, D.C. – Today, White House Office of National Drug Control Policy (ONDCP) Director Dr. Rahul Gupta released the following statement on the latest provisional data from the Centers for Disease Control and Prevention (CDC), showing drug overdose deaths decreased by 12.7% year-over-year (in the 12-months ending May 2024). This is the largest recorded reduction in overdose deaths, and the sixth consecutive month of reported decreases in predicted 12-month total numbers of drug overdose deaths.

“When President Biden and Vice President Harris took office, the number of drug overdose deaths was increasing 31% year-over-year. They immediately took action: making beating the overdose epidemic a key pillar of their Unity Agenda for the Nation and taking a comprehensive, evidence-based approach to strengthening public health and public safety. As an Administration, we have removed more barriers to treatment for substance use disorder than ever before and invested historic levels of funding to help crack down on illicit drug trafficking at the border. Life-saving opioid overdose reversal medications like naloxone are now available over-the-counter and at lower prices. We are at a critical inflection point. For the sixth month in a row, we are continuing to see a steady decline in drug overdose deaths nationwide. This new data shows there is hope, there is progress, and there is an urgent call to action for us all to continue working together across all of society to reduce drug overdose deaths and save even more lives.”

Source: https://www.whitehouse.gov/ondcp/briefing-room/2024/10/16/white-house-drug-policy-director-statement-on-latest-drug-overdose-death-data/

Filed under: Drug use-various effects,Health,Treatment and Addiction,USA :

Source: https://static1.squarespace.com/static/599a426ee45a7ccab72c77d2/t/5f3ad99ce4a6280272c97cb6/1597692318766/Marijuana_%2BA%2Bman%2Bmade%2Bdisaster.pdf April 2018

Filed under: Brain and Behaviour,Cannabis/Marijuana,Crime/Violence/Prison,Drug use-various effects,Drug use-various effects on foetus, babies, children and youth,Economic,Environment,Health :

At a glance

  • Cherokee Nation Action Network is using culture as prevention for youth substance use in Oklahoma.
  • The leading principle is “Walking in Balance,” which emphasizes balancing traditional Cherokee culture with modern contemporary culture in their everyday lives.

Cherokee Nation Community Action Network

The Cherokee Nation Community Action Network (CAN) coalition was originally developed in 2006 and became a Drug-Free Community coalition in 2018. The CAN uses culture as a strategy to prevent and reduce substance use in Cherokee communities. They partner with Sequoyah School, a tribal school in Tahlequah that young people can attend from anywhere within the reservation. The reservation includes some very rural and isolated communities with limited resources.

To increase community connectedness, the coalition teaches a National Association for Addiction Professionals-certified curriculum based on the book Walking in Balance by Abraham Bearpaw. Bearpaw was raised in one of the Cherokee Nation communities and, after coping with alcohol use for several years, decided it was time for a change. He reconnected with his culture by prioritizing mindfulness, health, and trust and has been in recovery for 12 years. He partners with different communities to teach his curriculum to young people in hopes of reducing the likelihood of them engaging in substance use. The curriculum includes 12 weekly lessons that teach students how to reconnect with culture, manage stress, and care for themselves. The leading principle is “Walking in Balance,” which emphasizes balancing traditional Cherokee culture with modern contemporary culture in their everyday lives.

The CAN coalition initially faced challenges with young people’s willingness to return to the ceremonial grounds. Due to some forbidden traditional practices, they felt they were too far removed. However, the coalition encouraged them to attend to learn and reconnect with their roots. Of the 100 young people living in the current town they serve, 75 showed up to participate in the curriculum. The day-to-day traditional and cultural activities include the making of clay beads, ribbon skirts, corn-bead necklaces, basket weaving, and stickball. The community activities are a source of Cherokee knowledge-building, sharing, and resiliency that helps build a culture of connectedness. The instructor teaches ceremonial values of youth and elder interaction, respect for ancestors, and the importance of taking care of the land. One community member said, “Our tribe has long known that building a sense of belonging, helping youth grow a connection to community, and cultural identity helps them grow into healthy adults.” The Cherokee Nation CAN will continue to foster safe and healthy environmental conditions, providing social support, encouraging school connectedness, and creating safe and caring communities on the reservation to improve the lives of those living there.

Source: https://www.cdc.gov/overdose-prevention/php/drug-free-communities/cherokee-nation.html

Filed under: Culture,Drug use-various effects,Mental Health,Prevention and Intervention,Social Affairs,Treatment and Addiction,USA,Youth :

Manuel Balce Ceneta/Associated Press by CARMEN PAUN – 10/27/2024 04:00 PM EDT

 

Traffickers are to blame, the candidates say. Virtually no one’s talking about treatment.

The Harris and Trump campaigns said the presidential candidates are talking about drug treatment, albeit more quietly than they are border security. |

There’s a rare point of agreement among Republican and Democratic candidates this election year: America has a drug problem and it’s fentanyl traffickers’ fault.

Republicans, including former President Donald Trump, are hammering Democrats over border policies they say have allowed fentanyl to surge into the country. Democrats, including Vice President Kamala Harris, respond that they, too, have cracked down on traffickers and want stricter border enforcement.

The consensus reflects the resonance of border control among voters — most of the country’s fentanyl comes from Mexico — and a hardening of the nation’s attitude toward addiction. Troubled by drug use, homelessness and crime, voters even in the country’s most progressive states favor cracking down. Politicians from Trump and Harris on down the ballot say they will.

“It’s one of those things that people don’t want in their community,” said Rep. Jahana Hayes, a Democrat running for a fourth term representing a district including suburbs of Hartford, Connecticut, and rural areas to their west, of illicit drugs. “They want a tough-on-crime stance on it. They want it to go away. They’re afraid for their families, they’re afraid for their children.”

That view worries public health experts and treatment advocates, who see a backsliding toward the law enforcement focus that once looked futile in the face of Americans’ insatiable appetite for drugs. They fear it bodes ill for additional efforts from Washington to expand addiction care.

“There are a lot of things that both parties can point to, as far as progress that’s been made in addressing overdoses: We’ve seen bipartisan efforts to expand access to treatment, to expand access to health services for people who use drugs, and I wish they would talk about that more,” said Maritza Perez Medina, federal affairs director at Drug Policy Action, an advocacy group that opposes the law enforcement-first approach.

Six years ago, when a bipartisan majority in Congress passed the SUPPORT Act to inject billions of dollars into treatment and recovery services, and then-President Trump signed it, the vibes in Washington around drug use were more empathetic.

President Donald Trump declared the opioid crisis a nationwide public health emergency in October 2017. | Brendan Smialowski/AFP via Getty Images But after it passed, fatal drug overdoses driven by illicit fentanyl skyrocketed, hitting a record 111,451 in the 12 months ending in August 2023 before starting to recede. Homelessness, sometimes tied to drug addiction, also spiked.

When the SUPPORT Act came up for renewal last year, Congress wasn’t as motivated. The Democratic Senate hasn’t voted on a bill, while a House-passed measure from the chamber’s GOP majority offers few new initiatives and no new money.

Attitudes are similar in the states. Oregon, where voters legalized drugs for personal use in 2020, reimposed criminal penalties this year after its largest city, Portland, was overrun with homeless drug users. Polls indicate California voters, frustrated, too, by homelessness and crime, are likely to boost penalties for drug users by ballot initiative next month.

Candidates aim to prove they share voters’ frustration.

Republicans have spent more than $11 million on TV ads in the past month attacking Democratic opponents on fentanyl trafficking, according to a tally by tracking firm AdImpact. And Democrats have spent nearly $18 million defending themselves, mostly by highlighting their efforts or plans to provide more resources and personnel to combat trafficking.

“It’s an easy shortcut in a 30-second commercial to tie a broader issue to one that has an easy explanation,” said Erika Franklin Fowler, a professor of government at Wesleyan University who directs a project analyzing political advertising.

Trump’s not talking about the SUPPORT Act, one of his most consequential legislative successes. Vice President Kamala Harris is not touting the treatment policies of the president she serves, Joe Biden, who expanded access to medications that help people addicted to fentanyl, as well as to drugs that can reverse overdoses. Some public health specialists credit increased access to the drugs with reducing overdose death rates in the past 12 months after years of grim ascent.

Trump used his first anti-Harris ad this summer to blame her for the more than 250,000 deaths from fentanyl during the Biden-Harris administration.

Vice President Kamala Harris met state attorneys general in July 2023 to discuss possible actions against fentanyl. | Saul Loeb/AFP via Getty Images Harris responded by touting her prosecution of drug traffickers when she was California’s attorney general and a promise to strengthen the border.

“Here’s her plan,” a deep-voiced narrator intoned in Harris’ ad: “Hire thousands more border agents, enforce the law and step up technology — and stop fentanyl smuggling.”

‘A political cudgel’

Similar attacks and responses have played out in Senate and House races across the country.

In the tight Arizona race to replace Sen. Kirsten Synema (I-Ariz.), Republican Kari Lake has accused her opponent, Democratic Rep. Ruben Gallego, of empowering drug cartels to import fentanyl by supporting Biden-Harris administration border policies.

“We’re losing an entire generation of people, and you should know better, Ruben,” Lake told Gallego in a debate earlier this month, referencing the deaths of teens who took counterfeit pills laced with fentanyl.

Gallego, who was elected to Congress in 2014 as a progressive but has shied from that label in his Senate run, responded by touting bills he’s supported or introduced to fund more technology at the border and track fentanyl money flows across Mexico and China, where chemicals to make the drug are manufactured.

A mother visit her son’s grave, who died of a fentanyl overdose at 15. | Jae C. Hong/AP In Colorado’s hotly contested 8th congressional district, which encompasses Denver suburbs and rural areas to the north, Republican state Rep. Gabe Evans has blamed the incumbent, Democrat Yadira Caraveo, for the fentanyl crisis.

“This is our reality now: a 100 percent increase in fentanyl deaths because liberals open the border, legalize fentanyl and let criminals out of jail,” says a police officer in an ad for Evans. “And Yadira Caraveo voted for it all,” Evans adds.

Caraveo defended herself in a debate with Evans earlier this month, noting the bill he’s referring to was state legislation that “tried to balance the need to punish drug dealers and cartels but not incarcerate every single person that is addicted.”

In Connecticut, the National Republican Congressional Committee attacked Hayes for voting against a bill to permanently subject fentanyl to the strictest government regulation, reserved for those drugs with high likelihood of abuse and no medical uses.

Hayes said she opposed the bill because it included mandatory minimum prison sentences for people caught with drugs and no provisions supporting prevention, treatment or harm reduction.

“I hate that this is being used as a political cudgel because we’re missing out on an opportunity to say: ‘How do we address the root causes?’” Hayes said in an interview.

Hayes said she has responded to the attacks on the campaign trail and talked to constituents about the need for treatment, despite some advice to the contrary.

“Even amongst Democrats, there were people who were like: ‘You don’t want the headache, you don’t want people to think that you’re soft on crime or soft on drugs.’ And I was like: ‘This has to be about more than optics if we truly are trying to save people’s lives,’” Hayes said. ‘If we don’t keep the momentum going’

Oregon, where voters legalized drugs for personal use in 2020, reimposed criminal penalties this year after its largest city, Portland, was overrun with homeless drug users. | Patrick T. Fallon/AFP via Getty Images The lesson the Drug Policy Action’s Medina takes from the campaigns is that talking about drug treatment doesn’t sell in American politics.

“People are struggling. Social services aren’t where they need to be, health services aren’t where they need to be,” she said. “It’s easier to run a fear-based campaign rather than talking about really tough issues,” like breaking the cycle of addiction.

Ironically, the tough talk on the border comes as policymakers, for the first time in years, have evidence that the tide of fatal drug overdoses is receding.

The CDC estimates that overdose deaths, most caused by fentanyl, declined by nearly 13 percent between May 2023 and May 2024, to just under 100,000.

Harris’ running mate, Tim Walz, mentioned the dip during his debate with Trump’s vice-presidential pick, JD Vance, earlier this month.

The number is now about where it was when Biden took office, though still 50 percent higher than when Trump did in January 2017.

Expanding access to treatment, the Food and Drug Administration’s decision to make the opioid-overdose-reversal medication naloxone available over the counter last year, increased fentanyl seizures at the border, and the arrest and sanctioning of Mexican drug cartel leaders have contributed to the recent drop, Biden said last month.

Advocates for drug treatment say that’s all good cause for candidates to tout their access-to-treatment efforts and promise to expand them.

“The worst outcome for overdose prevention coming out of this election would be if we don’t keep the momentum going,” said Libby Jones, who leads the Overdose Prevention Initiative, an advocacy group.

But there’s not the groundswell of interest on Capitol Hill that there was in 2018, when Congress passed the SUPPORT Act.

Congress has continued to fund opioid treatment authorized in that law, but it mostly hasn’t taken the law’s 2023 expiration as an opportunity to increase funding or try big new ideas.

The Food and Drug Administration decision to make the opioid-overdose-reversal medication naloxone available over the counter last year has contributed to a drop in fatal overdoses over the past year, President Joe Biden said last month. | Diane Bondareff/AP The 2024 federal funding law Congress passed in March included some minor changes in the form of bipartisan legislation to require state Medicaid plans to cover medication-assisted treatment for substance use disorder. It also created a permanent state Medicaid option allowing treatment of substance use disorder at institutions that treat mental illness, in an effort to expand access to care.

But bipartisan legislation approved by the Senate committee responsible for health care to make it easier for others to gain access to methadone, a drug effective in helping fentanyl users, hasn’t gone to the floor and faces opposition from key Republicans in the House.

The Harris and Trump campaigns said the presidential candidates are talking about drug treatment, albeit more quietly than they are border security.

Vice President Harris’ campaign pointed to her web site, where she touts her prosecution of drug traffickers and the Biden-Harris administration’s investment in “lifesaving programs.”

Republican National Committee spokesperson Anna Kelly said “President Trump is uniquely able to connect with families combating addiction,” pointing to times when he’s talked about his brother’s struggles with alcohol use disorder and to his administration’s efforts to contain the opioid crisis.

But she added that the tough talk on the border is relevant: “Combating fentanyl is a public health issue and stopping it begins with securing the border.”

 

Source: https://www.politico.com/news/2024/10/27/fentanyl-drugs-elections-00185576

Filed under: Drug use-various effects,Economic,Health,Political Sector,Prevention and Intervention,Treatment and Addiction,USA :

MEDICINAL cannabis has been the hottest of hot-button issues in medicine for some years now. It’s one the few medications where media hype and patient demand seem to have moulded – some would say muddied – the regulatory framework in a way that has troubled many clinicians.

In Australia, there are now three different pathways to legally accessing medicinal cannabis. The Category A Special Access Scheme (SAS) allows the importation of unregistered products on compassionate grounds, but requires import licences and customs clearance, while Category B SAS gives access to locally stored medicinal cannabis, but requires TGA and state review and approval. Specialists can also obtain an Authorised Prescriber status to prescribe cannabis – these will usually be either oncologists for cancer-related pain, or paediatric neurologists for the control of severe epilepsy in children.

But what is the evidence for medicinal cannabis, and is it sufficient for clinicians to feel comfortable prescribing it? These issues are explored in two articles published in the MJA, one a Perspective from the Royal Australasian College of Physicians (RACP) and the other a Narrative Review on the challenges of prescribing cannabis for paediatric epilepsy, authored by researchers from the Sydney Children’s Hospital.

The RACP comes down on the side of caution. It notes that Australia, along with the rest of the world, is “navigating unchartered waters with pharmaceutical grade cannabinoids”, and that more research is needed before we can say whether or not cannabis has a place in contemporary medical practice.

In paediatric epilepsy, some of that research seems to be coming into focus. Last May, a randomised, double-blind trial of cannabidiol, a cannabis derivative that does not contain the psychoactive ingredient tetrahydrocannabinol, provided hard data for the first time that the treatment may work in children with Dravet syndrome – a severe form of childhood epilepsy with often drug-resistant seizures. This was followed by another trial, published last month in the Lancet, that showed similar efficacy of cannabidiol in Lennox–Gastaut syndrome, another form of paediatric epilepsy characterised by multiple seizure types.

Laureate Professor Ingrid Scheffer, who is Chair of Paediatric Neurology Research at The University of Melbourne and co-author of the trial of cannabadiol in Dravet syndrome, says that although her study does provide solid evidence for the drug’s efficacy, it should in no way be considered a miracle cure.

“It’s been sold as a magic bullet by the media. And you have families who are on a terrible rollercoaster, they’re vulnerable and medicinal cannabis is being cast as this drug that may save their child. And the answer is that it often does not. It may help, and in our study cannabidiol had a 43% responder rate, defined as at least a 50% reduction in the seizure frequency. But that’s exactly the same as some of the other drugs we use.”

But she says that doesn’t mean it shouldn’t be prescribed.

“Dravet syndrome is usually drug-resistant and you don’t know which drugs will work, so it could be worth trying if others have failed. But the families should be aware of its chances of success and the fact that it can have side effects.”

She says the key is more research.

“What people are accessing is very variable. They’re importing it from all over the place, they may even be getting friends to grow it in their backyard, so we do not know what they’re giving their child. What we need to do is go forward with more trials in different populations and with different formulations. If we’re going to invest in this, we need to know it works and we’re not wasting our health dollar on it.”

Professor Scheffer says that another drug currently being trialled, fenfluramine, may end up the more successful treatment. Trial results have yet to be published, but interim findings suggest that fenfluramine may have a dramatically higher responder rate of up to 70%.

Dr John Lawson, a Sydney-based paediatric neurologist and co-author of the Narrative Review on cannabis and childhood epilepsy, agrees that cannabidiol, though worth trying in some children, is no wonder drug.

“I’m not hanging my hopes on cannabidiol,” he says in an exclusive podcast for MJA Insight.

“I came in as quite a sceptic, but my attitude has changed. I now believe that it is an antiepileptic, but I’m not sure what place it has. It’s the early stages of development, and there are other compounds that haven’t been looked at.”

Dr Lawson says that he wouldn’t suggest it to a family until many other antiepileptics had already failed, and the chances of the next drug working were already low.

“I’ve come around to bringing it up in conversation because everyone knows about it, and families know I’ve prescribed it. But the biggest reason to not prescribe is cost. For a small child, it will cost over $1000 every couple of weeks to give a Therapeutics Goods Administration-approved product. Almost the only people I have prescribed it for are those who have an absolute ‘bucketload’ of money. Or I form a contract with them, and I say look, this will cost you $3000, but all the trials say you will know very quickly if it’s working or not.”

He says that in the patients who are helped by cannabidiol, the effect is still relatively modest.

“Patients are very rarely seizure-free. It may have a role in the future, once the hype has died down, but it will be a very low [on a list of preferred antiepileptics].”

 

Source:  https://www.doctorportal.com.au/mjainsight/2018/6/medicinal-cannabis-miracle-cure-or-media-hype/

Filed under: Australia,Cannabis/Marijuana,Drug use-various effects,Marijuana and Medicine,Treatment and Addiction :

This is the opening of a submission by Dr Stuart Reece to the FDA relating to the re-scheduling of cannabis:

 

“I am very concerned about the potential for increased cannabis availability in USA implied by full drug legalization; however, a comprehensive and authoritative submission of the evidence would take weeks and months to prepare. Knowing what we know now and indeed, what has been available in the scientific literature for a growing number of years concerning a myriad of harmful effects of marijuana, marijuana containing THC should not be reclassified. These effects that are now well documented in the scientific literature include, alarmingly, harm involving reproductive function and birth anomalies as a result of exposure to or use of marijuana with THC.

In addition to all of the usual concerns which you will have heard from many sources including the following I have further particular concerns:
1) Effect on developing brains
2) Effect on driving
3) Effect as a Gateway drug to other drug use including the opioid epidemic
4) Effect on developmental trajectory and failure to attain normal adult goals(stable relationship, work, education)
5) Effect on IQ and IQ regression
6) Effect to increase numerous psychiatric and psychological disorders
7) Effect on respiratory system
8) Effect on reproductive system
9) Effect in relation to immunity and immunosuppression
10) Effect of now very concentrated forms of cannabis, THC and CBD which are widely available
11) Outdated epidemiological studies which apply only to the era before cannabis became so potent and so concentrated 

These issues are all well covered by a rich recent literature including reviews from such major international authorities as Dr Nora Volkow Director of NIDA at NIH, Professor Wayne Hall and others “

 

The full text can be read here

Source: Letter from Dr Stuart Reece to FDA April 2018

Filed under: Cannabis/Marijuana,Drug use-various effects,Global Drug Legalisation Efforts,Legal Sector,Political Sector,USA :

Armed with knowledge and tools, parents are making a big difference in local school districts  

by  Emily Green   February 1, 2024

  Mila Priest, 8, focuses on computer playing the PAX Good Behavior Game during class at Fern Hill Elementary School in Forest Grove, OR, Nov. 9, 2023.
Holly Pearce, 18, deploys a strategy at the West Linn High School club fair. If prospective members join her in-school club, she tells them, they need do little more than show up while receiving free food and an honors cord for their gown at graduation. What she doesn’t lead with is that it’s a drug and alcohol prevention club.

“The free food,” she said “that’s what gets people there in the first place.”

Once students are in the door, she said, it’s her mom, Pam, who gets them to stay.

Pam Pearce has been in recovery for 28 years. During lunchtime club meetings, she often shares her personal story with club members, she said, and she tells it to them straight.

She grew up nearby in Lake Oswego and attended the University of Southern California. The photos she displays of smiling youths from her high school and college years look much like the club members she shares the photos with.

“The only honors I had was biggest partier and best dressed,” she said. “And I like to say it because the end of the story is: that almost killed me.”The point is to dispel the myth that addiction only affects “other” people. It can be anyone, she said, and it can be the teens in the club or one of their friends.

A concerned parent pushing for prevention, Pam Pearce is part of an emerging trend in Oregon, where, according to federal data, at least 354 youths have died from drug overdoses since the start of 2018 as fentanyl has spread through the drug supply.

Oregon schools enjoy wide autonomy in what they teach, and that includes their substance use prevention strategies. A recent six-month investigation into prevention in Oregon classrooms from The Lund Report found that many schools rely on little more than a chapter in a health textbook to get the job of prevention done.

The state provides little support or accountability when it comes to in-school prevention, records and interviews show. So in districts where more robust prevention is happening, it’s often parents and individual teachers who drive it.

Mother of lost son becomes activist

In Oregon City, Michele Stroh began pushing for prevention after she lost her son, Keaton Stroh, 25, to a fentanyl-laced pill in July 2020.

“I didn’t know about fake pills; I didn’t know about any of that. And I got angry,” Stroh said. “So I ran for the Oregon City School Board.”

She wanted the district to be more proactive in the fentanyl crisis, she said. So she recruited speakers to talk at assemblies at all the Oregon City School District high schools, middle schools and charter schools. She organized a parent education night, and her efforts resulted in the overdose reversing drug Narcan being placed in all the schools, sports facilities and school buses.

“We were the first school district in Clackamas County to have a Narcan policy,” she said.

She’s approached other districts but found them to be more hesitant.

“I think it helps, the fact that the district knows me, and the teachers know me — and they knew my son,” Stroh said.

  

Jon and Jennifer Epstein were also pushed into action after losing their son Cal Epstein, 18, to a fentanyl-laced counterfeit pill in December 2020. They began advocating for fentanyl education and awareness in the Beaverton School District, where their sons attended school and Jon Epstein had taught for 10 years. The district worked with them to create a program called “Fake and Fatal,” which teaches youths about the dangers of fentanyl and counterfeit pills. Since then, at the Epsteins’ urging, Oregon legislators passed a bill to take fentanyl education statewide, and Oregon’s congressional delegation has introduced national legislation.

While some parents, such as Pearce in West Linn, had to investigate to figure out what prevention is happening at their kids’ schools, The Lund Report created a data portal that makes that information easily accessible for the first time — including what top prevention scientists say about the efficacy of programs in use at each district.

Pearce’s club at West Linn High School has grown to nearly 200 student members. The teens also advise their community prevention coalition, which Pearce — known for her advocacy — was recruited to lead. And they visit middle schools to talk to younger kids about what to expect in high school.

What teens say

The Lund Report recently sat down with some teenagers who participate in the prevention club. They said the club creates a safe space where kids can talk honestly about drugs — or go to when they don’t want to be around teens who are using.

“My view immediately changed as I set foot in this club,” said the club’s president, Jonathan Garcia, 17. “I listened to Pam in that first meeting, and I was just like, ‘Oh, my God — what have I been taught?’ It was like, number one, I haven’t been taught anything compared to what I just learned, and I’ve been taught all the wrong things.”

The club discusses topics like why a person might turn to drugs and alcohol in the first place. Some of the teens said it was the first time they learned about addiction’s root causes.

“Nothing was sugar coated,” said Aidan Sauer, 15. “Everything was just to the point.”

Growing the club at her daughter’s high school is just one way Pearce promotes prevention in the West Linn-Wilsonville school district, where all three of her kids were students.

She sends teachers information about prevention-related tools and lessons. And she lobbied her district until it agreed to participate in the state’s Student Health Survey. The survey asks students in the sixth, eighth and 11th grades about their substance use and well-being. Pearce said she “was on a mission” after she found out her local district didn’t administer the free survey.

“It also allows young people to share with you what’s happening in their environment. Like — how else are they going to tell you what’s happening?” she said.

Starting this year, every Oregon school is required to take part in the survey for the first time. Prevention scientists say the data can help districts to understand whether or not their prevention efforts are working. Many prevention programs, including clubs like the one at West Linn High School, aren’t well-researched. Others might not work in every setting and for every group of kids, so tracking the outcomes is important, experts say.

In 2020, Pearce also co-founded the first high school in Oregon for students in recovery from addiction, located in Lake Oswego.

Teaching kids self-regulation in Washington County

A prevention program called the PAX Good Behavior Game doesn’t teach kids anything about drugs and alcohol, but prevention scientists at Oregon Research Institute and Washington State University’s IMPACT Research lab contend it’s one of the best evidence-backed approaches to substance use prevention at the elementary school level.

Today, the program is in wide use across Washington County, and its successful implementation there can be traced to the efforts of a former third grade teacher at Joseph Gale Elementary School and a concerned mother who happens to work for the county.

On a foggy morning this past November, third graders in a second-floor classroom at Fern Hill Elementary in Forest Grove focused intently — and quietly — on their arithmetic. With a handful of unfamiliar adults watching the lesson, there were plenty of distractions that day. But the 8- and 9-year olds seemed un-bothered as they completed math problems on their Chromebooks.

Helping them focus was the PAX Good Behavior Game, also known as PAX. It’s a program that gives teachers a menu of techniques for helping kids self-regulate and practice self control.

At the core of the system is a game, and in some studies, playing that game in elementary school reduced substance use and other problems among students years later.

The teacher sets a length of time the game will be played, and if kids are able to stay on task, they’re rewarded a goofy dance or some other non-material prize when the time is up. While the clock was ticking, third grade teacher Kayla Davidson walked around the classroom observing the students work. If someone got up or lost focus, she would give their table — not the individual student — what’s called a “spleem,” which is basically a negative point. At the end of the game, tables had the opportunity to explain collectively how they might avoid getting a spleem next time.

Before PAX, Davidson said she was more reactive in her approach to disruptive behavior. She might call a student’s parent or call out a child for their behavior in front of the class. “That could really be hurtful and harmful to the student, if they’re just being called out for bad behavior constantly,” she said.

“A lot of them are bringing things with them. It could be things like hunger or worrying about which parent they’re going with today,” Davidson said. The game gives the kids “a space and a strategy” for not having to worry about those things so they can focus on their work, she added.

Third graders in Davidson’s classroom told The Lund Report that, for the most part, they really like playing the game. For 8-year-old Aubrey Stone, “the best part about it is that you’re growing your brain.”

About 13 years ago, Kirstina Meinecke brought PAX to the Forest Grove School District when she got a job as a third grade teacher there. She had learned how to use the game when teaching in Washington on the Yakima Indian Reservation. Other teachers took interest, and it began to spread. Today, PAX is incorporated into every elementary school classroom in the Forest Grove district, and into teachers’ ways of conducting their classrooms. Meinecke’s job with the district now is primarily to provide teachers with PAX training and ongoing support as a coach.

In Oregon, parents and teachers catalyze drug prevention in schools

Forest Grove is one of four districts in Washington County that uses the PAX Good Behavior Game. While PAX was spreading there, a public health program supervisor at Washington County, Rebecca Collett, started working to spread the program into other county schools. She’d noticed a need for better classroom management while volunteering at her son’s school in the Tigard-Tualatin district.

Collett remembers asking, “Why are we doing so many programs, when there’s one evidence-based program that prevents suicide, prevents drug and alcohol use, prevents dysregulation in the classroom, prevents all this?”

Since then, the county has helped school districts fund the implementation of the PAX Good Behavior Game through a mix of county, state and federal funds. The county has trained nearly 800 teachers at 51 schools on how to use PAX since 2014.

“Once it started working, we didn’t have to sell it,” Collett said. “The teachers started sharing how well it was working in their classroom, how much healthier they were, how much easier classroom behaviors were, and management.”

The county estimated it saves $83 for every $1 spent, and the cost is about $13 per student.

Tools for parents

Pearce encourages other concerned parents to take action if they want to see better prevention programs in their kids’ schools.

“People talk, but they don’t act,” she said. “We need to stop talking, and we need to start doing.”

She said parents should start by reaching out to their county health departments to see if there is a local prevention specialist or prevention coalition they can connect with, and they should attend school board meetings, ask questions and advocate. They can even start a club like the one she leads, she said.

Parents also can share evidence-based practices and materials with their districts and teachers they know, she added.

Figuring out what prevention programs are supported by validated research can be tricky, but there are several online registries that parents and community groups can use to learn more about programs. The online database published by The Lund Report used expert ratings from these clearinghouses to rate districts’ programs.

Source: https://www.thelundreport.org/content/oregon-parents-and-teachers-catalyze-drug-prevention-schools?

Filed under: Drug use-various effects,Education,Parents,Prevention and Intervention,USA,Youth :
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 Lindsey Leake

August 27, 2024
While the modern marijuana consumer may be shedding that lazy stoner stereotype, new research shows that employees who use and abuse the drug are more likely to miss work.

The findings were published Monday in the American Journal of Preventive Medicine.

For the study, researchers at the UC San Diego School of Medicine and the New York University Grossman School of Medicine analyzed data from the 2021–22 National Survey on Drug Use and Health on 46,500 adults employed full-time in the U.S. Recent and frequent cannabis use, as well as cannabis use disorder (CUD), they found, was associated with greater workplace absenteeism.

Work absences included days missed due to illness or injury in addition to skipped days when employees “just didn’t want to be there.” Respondents were a majority or plurality white (62%), male (57%), ages 35 to 49 (35%), married (52%), had at least a college degree (42%), and had an annual household income exceeding $75,000 (55%). About 16% of employees had reported using cannabis within the last month, with about 7% of whom meeting CUD criteria (mild: 4%; moderate: 2%; severe: 1%).

People who said they had never used cannabis missed an average 0.95 days of work in the past 30 days due to illness/injury and skipped 0.28 days. Cannabis users, by comparison, recorded the following absences:

  • Past-month use: 1.47 illness/injury, 0.63 skipped
  • Mild CUD: 1.74 illness/injury, 0.62 skipped
  • Moderate CUD: 1.69 illness/injury, 0.98 skipped
  • Severe CUD: 2.02 illness/injury, 1.83 skipped

The results also showed that people who used cannabis most frequently skipped the most work. For instance, those who consumed it once or twice per month skipped 0.48 days, while those who consumed it 20 to 30 days per month skipped 0.7 days. People who used cannabis three to five days per month had the highest prevalence of missed days due to illness/injury (1.68). Cannabis use longer than a month ago had no bearing on employee absence.

“These findings highlight the need for increased monitoring, screening measures, and targeted interventions related to cannabis use and use disorder among employed adults,” researchers wrote. “Moreover, these results emphasize the need for enhanced workplace prevention policies and programs aimed at addressing and managing problematic cannabis use.”

Researchers said that while their latest work supports much of the existing literature on cannabis use and workplace absenteeism, it also contrasts with other studies. One previous study, for example, showed a decline in sickness-related absences in the wake of medical marijuana legislation, while another found no link between the two.

One limitation of the new study, the authors note, is that it relied on participants’ self-reported answers. In addition, the data don’t reflect whether cannabis was used for medicinal or recreational purposes, whether it was consumed during work hours, or address other factors that may have affected a person’s cannabis use patterns.

What are the signs of cannabis use disorder?

That marijuana isn’t addictive is a myth. People with CUD are unable to stop using cannabis even when it causes health and social problems, according to the Centers for Disease Control and Prevention (CDC). Cannabis consumers have about a 10% likelihood of developing CUD, a disorder impacting nearly a third of all users, according to previous research estimates. At higher risk are people who start using cannabis as adolescents and who use the drug more frequently.

The CDC lists these behaviors as signs of CUD:

  • Continuing to use cannabis despite physical or psychological problems
  • Continuing to use cannabis despite social or relationship problems
  • Craving cannabis
  • Giving up important activities with friends and family in favor of using cannabis
  • Needing to use more cannabis to get the same high
  • Spending a lot of time using cannabis
  • Trying but failing to quit using cannabis
  • Using cannabis even though it causes problems at home, school, or work
  • Using cannabis in high-risk situations, such as while driving a car
  • Using more cannabis than intended

In addition to interfering with everyday life, CUD has been linked to unemployment, cognitive impairment, and lower education attainment. People with CUD often have additional mental health problems, including other substance abuse disorders. In this study, for example, 14% of respondents reported having alcohol use disorder within the past year.

 

Source:  https://fortune.com/well/article/marijuana-abuse-cannabis-use-disorder-workplace-absenteeism-sick-days/

Filed under: Brain and Behaviour,Cannabis/Marijuana,Drug use-various effects,Economic,Mental Health,USA,Workplace :

Suicide prevention is a high priority for SAMHSA and a key area of focus in SAMHSA’s 2023-2026 Strategic Plan. Below is more information about SAMHSA’s suicide prevention initiatives.

Funding and Grant Programs

SAMHSA’s Suicide Prevention Branch funds discretionary grant programs focused on suicide prevention, early intervention, crisis support, treatment, recovery, and postvention for youth and adults, including:

  • Garrett Lee Smith State/Tribal: Community-based suicide prevention for youth and young adults up to age 24. This program supports states and tribes with implementing youth suicide prevention and early intervention strategies in educational settings, juvenile justice and foster care systems, substance use and mental health programs, and other organizations to: (1) increase the number of organizations that can identify and work with youth at risk of suicide; (2) increase the capacity of clinical service providers to assess, manage, and treat youth at risk of suicide; and (3) improve the continuity of care and follow-up of at-risk youth.

    • “It has been wonderful work made possible through the SAMHSA grant and we are thrilled each chance we get to share these programs with others to help support other grants and especially our youth.” – S/T Grantee

  • Garrett Lee Smith Campus: Suicide prevention initiatives for students on college campuses. This program supports a comprehensive, evidence-based public health approach that: (1) enhances mental health services for students, including those at risk for suicide, depression, serious mental illness / serious emotional disturbances, and/or substance use disorders (SUDs) that can lead to school failure; (2) prevents and reduces suicide, mental illness, and SUDs; (3) promotes help-seeking behavior; and (4) improves the identification and treatment of at-risk students so they can successfully complete their studies.

    • “This marks 3 years of enhanced mental health and wellbeing support for students. We’ve learned that high usage of after-hour support for students through our program lowers the barriers that may otherwise prevent students from seeking help.” – GLS Campus Grantee

  • Native Connections/Tribal Behavioral Health: Community-based suicide prevention for American Indian/Alaska Native (AI/AN) youth through age 24. The purpose of this program is to prevent suicide and substance misuse, reduce the impact of trauma, and promote mental health among AI/AN youth. It aims to reduce the impact of mental health and substance use disorders, foster culturally responsive models that reduce and respond to the impact of trauma in AI/AN communities, and allow AI/AN communities to facilitate collaboration among agencies to support youth through the development and implementation of an array of integrated services and supports with the involvement of AI/AN community members in all grant activities.
  • National Strategy for Suicide Prevention: Community suicide prevention for adults 18 and over. The purpose of this program is to implement suicide prevention and intervention programs for adults (with an emphasis on older adults, adults in rural areas, and AI/AN adults) that help implement the 2021 Surgeon General’s Call to Action to Implement the National Strategy for Suicide Prevention (PDF | 708 KB). This program uses a broad-based public health approach to suicide prevention by enhancing collaboration with key community stakeholders, raising awareness of suicide prevention resources, and implementing lethal means safety.

    • “The NSSP grant has not only allowed us to sustain our efforts to prevent suicide by expanding our capacity to engage in lethal means safety, connectedness, economic stability, education, and follow-up efforts across the state, but also given local partners resources to implement innovative strategies for suicide prevention.” – NSSP Grantee

  • Zero Suicide: Suicide prevention framework to implement within Health and Behavioral Health Care Systems for adults 18 and older. The purpose of this program is to implement the Zero Suicide intervention and prevention model—a comprehensive, multi-setting suicide prevention approach—for adults throughout a health system or systems. Recipients are expected to implement all seven elements of the Zero Suicide framework—Lead, Train, Identify, Engage, Treat, Transition, and Improve—incorporating health equity principles within the framework in order to reduce suicide ideation, attempts, and deaths.

    • “Emphasis of Zero Suicide has created an environment where more and more individuals are talking openly about suicide, and it is helping to shatter stigma that surrounds suicide.” – Zero Suicide Grantee

  • Community Crisis Response Partnerships: Mobile crisis units serving youth and adults across the lifespan. The purpose of this program is to create or enhance existing mobile crisis response teams to divert people experiencing mental health crises from law enforcement in high-need communities, where mobile crisis services are absent or inconsistent, most mental health crises are responded to by first responders, and/or first responders are not adequately trained or equipped to diffuse mental health crises. Grant recipients use SAMHSA’s National Guidelines for Behavioral Health Crisis Care: Best Practice Toolkit (PDF | 2.2 MB) as a guide in mobile crisis service delivery.

    • “The CCRP grant has allowed our agency to expand our mobile crisis services to a 24/7/365 program, setting us apart as the first in our state to offer around the clock mobile response. This has greatly reduced the instances of unnecessary involvement with Law Enforcement and EMS, expediting the appropriate mental health service, directly to the client.” – CCRP Grantee

  • Suicide Prevention Resource Center: Funded by SAMHSA’s Suicide Prevention Branch, SPRC is a national resource center devoted to advancing the implementation of the National Strategy for Suicide Prevention. SPRC advances suicide prevention infrastructure and capacity building through technical assistance, training, and resources to states, Native settings, colleges and universities, health systems, and other organizations involved in suicide prevention. Visit SPRC to learn more about suicide and a comprehensive approach to suicide prevention; access a searchable online library, Best Practices Registry, and set of online trainings and webinars; request technical assistance with your suicide prevention efforts; or sign up for SPRC’s weekly newsletter.

SAMHSA Initiatives in Action

  • SAMHSA’s Black Youth Suicide Prevention Initiative: Created by SAMHSA’s Center for Mental Health Services (CMHS) to address the growing rate of suicide deaths among Black youth and young adults. Utilizing mechanisms within and external to SAMHSA, the goal of the Black Youth Suicide Prevention Initiative is to reduce the suicidal thoughts, attempts, and deaths of Black youth and young adults between the ages of 5-24 across the country.

The 988 Suicide & Crisis Lifeline

The 988 Suicide & Crisis Lifeline is a free, confidential 24/7 phone line that connects individuals in crisis with trained counselors across the United States. There are also specialized lines for both Veterans and the LGBTQIA+ population.

You don’t have to be suicidal or in crisis to call the Lifeline. People call to talk about coping with lots of things: substance use, economic worries, relationships, sexual identity, illness, abuse, mental and physical illness, and loneliness. Here’s more about the 988 Suicide & Crisis Lifeline:

  • You are not alone in reaching out. In 2021, the Lifeline received 3.6 million calls, chats, and texts.
  • The 988 Suicide & Crisis Lifeline is a network of more than 200 state and local call centers supported by HHS through SAMHSA.
  • Calls to the Lifeline are routed to the nearest crisis center for connections to local resources for help.
  • Responders are trained counselors who have successfully helped to prevent suicide ideation and attempts among callers.
  • Learn what happens when you call the Lifeline network.
  • Frequently asked questions about the Lifeline.

Suicide-Related Survey Data

Data collected via SAMHSA’s National Survey of Drug Use and Health (NSDUH) provide estimates of substance use and mental illness at the national, state, and substate levels; help identify the extent of these issues among different subgroups; estimate trends over time; determine the need for treatment services; and help inform planning and early intervention programs and services. NSDUH also collects data about the prevalence of suicidal thoughts, plans, and attempts among adolescents aged 12-17 and adults aged 18 or older, described in the NSDUH national releases.

Last Updated: 08/27/2024
Source: https://www.samhsa.gov/mental-health/suicide/prevention-initiatives
Filed under: Drug use-various effects,Mental Health,Social Affairs,USA,Youth :

TogetherWeCan_InternationalOverdoseAwarenessLogo

Perhaps we’re finally turning a corner when it comes to lowering overdose deaths. While the number of people dying as a result of an overdose remains frighteningly high, a new report signals modest progress in efforts to reduce fatalities.

Updated figures from the Centers for Disease Control and Prevention (CDC) found fatal drug overdoses fell 2.4% from 2022 to 2023. The toll from the overdose crisis reached 108,317 lives last year, according to data the CDC posted Aug. 4. While that’s lower than the 111,029 overdose deaths in 2022, it still represents a massive number of preventable deaths, and there’s yet more we can do to ensure that fatalities continue to decline.

That is one of the goals of International Overdose Awareness Day, observed on August 31.

In recognition of the day, the National Council has created an informative new video to help people understand how to administer naloxone. Naloxone (often known by the brand name Narcan) is a medication that reverses opioid overdoses. It is quite literally a lifesaver.

The lower number of overdose fatalities in 2023 may be related to the Food and Drug Administration’s March 2023 decision to make naloxone available over the counter, a decision we applauded. But having naloxone available doesn’t mean everyone who may need it has access to the drug. And it doesn’t mean that everyone knows how to administer naloxone.

Let’s hope the modest drop in overdose fatalities last year was an early indication that we’re finally flattening the curve of overdose deaths.

That’s exactly why we made this video.

Everyone should carry naloxone, especially those who work with the public — whether as a teacher, ambulance driver, librarian, coach or in some other capacity.

The Substance Abuse and Mental Health Services Administration (SAMHSA) continues to promote naloxone distribution through state opioid response (SOR) grants. Naloxone distribution and saturation planning is a federal-state partnership (of sorts) to optimize naloxone distribution.

States are required to create distribution and saturation plans as part of their SOR grant; every state is required to make one. The purpose is for states to meaningfully plan and coordinate their naloxone distribution based on data and input from impacted community partners so they optimize reach, including focusing distribution efforts to those most likely to experience and/or witness an overdose.

Substance use isn’t going away anytime soon. July’s release of the 2023 National Survey on Drug Use and Health provides important new data about substance use challenges and the nature of substance use among people of all ages. For instance:

70.5 million

Among people aged 12 or older in 2023, 70.5 million people (24.9%) had used illicit drugs in the past year, up from 70.3 million people in 2022 and 61.2 million in 2021.

48.5 million

In 2023, 48.5 million people 12 or older (17.1%) had a substance use disorder in the past year, down slightly from 48.7 million in 2022.

8.9 million

In 2023, 8.9 million people 12 and older (3.1%) used opioids in a non-prescribed way in the past year, compared to 8.9 million in 2022 and 9.4 million in 2021.

This data shows us that no one is immune from a substance use challenge.

We can’t turn our backs on people with a substance use disorder or ignore the tragic consequences of substances, whether they’re considered illicit or socially acceptable, like alcohol. To support people with a substance use disorder or their loved ones, the Start With Hope project also recently published many new resources, including:

The Start With Hope project was started in November 2023 by The Ad Council, in partnership with the CDC, the National Council and Shatterproof to deliver a message of hope to those living with substance use disorders as well as those at risk of developing one.

Let’s hope the modest drop in overdose fatalities last year was an early indication that we’re finally flattening the curve of overdose deaths. When it comes to lives lost, we can’t be satisfied with modest improvements. Let’s ensure continued progress by spreading the word about lifesaving resources.

Check out our new video, and let us know what you’re doing in your communities to reduce overdose deaths and provide resources to those with a substance use disorder.

We can and will learn from one another on how to best support people and communities.

Author

Charles Ingoglia, MSW
(he/him/his) President and CEO
National Council for Mental Wellbeing
 
Source:  https://www.thenationalcouncil.org/lowering-overdose-deaths-naxolone-how-to/
Filed under: Drug use-various effects,Prevention and Intervention,Treatment and Addiction,USA,Youth :

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 :

 

Substance use and mental health are topics that touch nearly every community, with millions across the world affected each year. In 2022 alone, approximately 168 million Americans used some type of substance such as tobacco, alcohol or illicit drugs with 48.7 million reporting suffering from a substance use disorder (SUD). Among illicit drugs, marijuana was the most used, with approximately 22% of people aged 12 or older using it in the past year. But behind these numbers are real lives impacted by a complex relationship between drug use and mental health. For instance, nearly one million adolescents were found to have co-occurring major depressive disorders (MDE) and SUDs, while 21.5 million adults struggled with both a mental illness and SUD.

 

As marijuana use becomes more normalized it is important to consider the consequences on our mental well-being. Research has shown that past-year marijuana use is a significant risk factor for suicidal thoughts and behaviors among adolescents with the risks increasing as the frequency of use rises. In addition, following legalization in the state of Washington, the prevalence of marijuana use among 8th and 10th graders increased compared to pre-legalization levels. This presents further concern given the link between high potency marijuana and psychosis—a known predictor of suicidal behavior. Additionally, studies show that adolescents who recently used marijuana had nearly twice the odds of attempting suicide compared to non-users. Similar risks are present in those using amphetamines, cigarettes, and alcohol, especially when substance use begins at an early age.

 

Further research supporting these concerns have consistently found that individuals who engage in substance use are at an increased risk for suicidal ideation attempts. For example, studies suggest that drug use can impair judgement and diminish impulse control, making users more vulnerable to suicidal thoughts and behaviors. This is further supported by findings showing that individuals with substance use disorders are six times more likely to attempt suicide compared to those who do not use substances. The combination of altered brain chemistry, mental health struggles, and poor decision-making can create a dangerous spiral, leading to devastating outcomes.

 

As substance use and suicide remain closely intertwined, with research consistently showing a strong correlation between the two, it becomes essential to raise awareness, promote early interventions, and ensure access to comprehensive treatment so we can help save lives and provide hope to those in need.

 

If you or someone you know is struggling with substance use or suicidal thoughts, please reach out for help. The National Suicide and Crisis Lifeline is available 24/7 at no cost, call 988 if you need to talk to someone. The Substance Abuse and Mental Health Service Administration (SAMHSA) offers a helpline at 1-800-662-HELP (4357).

 

Source: Drug Free America Foundation | 333 3rd Ave N Suite 200 | St. Petersburg, FL 33701 US
Filed under: Cannabis/Marijuana,Drug use-various effects,Mental Health,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 :

The following is an extract from an email by Stuart Reece to Drug Watch International (DWI)

It seems to me that the main pillars of this argument rest on the following primary evidentiary supports:

  1. AGEING (spelt “aging” in the USA)  is often defined as an accumulation of deleterious changes over time.  What is the toxicopathology of cannabis characterized by?? An accumulation of deleterious changes over time – which is obviously the same;
  2. The multi-system and panorganismal nature of the cannabis related changes is strong clinical evidence that rather than a process limited just to one organ – such as the brain – what we are actually seeing is indicative of a deeper change across all cells, which likely manifests in certain organ specific ways.  This is the list of organ damage below.
  3. A concatenation of age-defining illnesses:
  1. The arterial toxicity of cannabis is a very big deal because it is one of the major hallmarks of ageing – most people in industrialized nations die from stroke or heart attack, and arterial ageing is the major surrogate for organismal / biological ageing.  So arterial ageing – far from being a curiosity in the cannabis literature – assumes massive importance in general medical terms
  2. The association of cannabis with ten cancers is massive.  Cancer is also an age defining disease.  So one cannot say that cancer is associated with cannabis and so what – this is a very big deal indeed.  Cancer is one of the major age defining diseases
  3. Immunopathy.  By stimulating the immune system cannabis increases one of the major ageing pathways.  The pro-inflammatory actions of     cannabis are now well documented.  In ageing medicine this is described as “inflamm-aging.”  It is a major pathway to ageing and age related disease, and is known to be linked with high death rates.  Cannabis is usually described as being immunosuppressive.  But we are learning that the immune system is a very complex place.  It is like a trampoline mat.  If it goes down in one place it will go up in another.  Hence patients with immune compromising disorders like rheumatoid arthritis and systemic lupus get immune complications and autoimmune diseases – including cancer.
  4. Negative effect on stem cell division.  Obviously we need our stem cells healthy so that we can stay healthy.  Cannabis advocates cannot have their cake and eat it too.  They propose it as a cancer remedy because it stops cell division.  Well if you accept that argument then you must also accept that its effect on cell division is negative which has a catastrophic implication for general stem cell health in all tissue beds
  5. The effects on children.  If children are born with mental compromise, paediatric cancers, and foetal malformations then that is a sign of infantile induction of ageing both by definition – since cancer defines age related disease – and since this is obviously an accumulation of deleterious ages in the paediatric age group.
  6. Genotoxicity. The association of cannabis with both cancer, congenital malformations, mental retardation in offspring and congenital cancers becomes strong presumptive evidence for genotoxicity.  This is one of the best described pathways to cellular and organismal ageing.  Congenital cancers (rhabdomyosarcoma, leukaemia and neuroblastoma) are ALWAYS due to genetic defects inherited from parents or earlier generations
  7. Epigenotoxicity.  As you are aware it is now a matter of record that cannabis has now well documented epigenetic changes (Szutorisz 2018; Neuroscience Behav Rev 85: 93).  The epigenetic levels is one of the strongest hypothesized levels for ageing.  In truth it interacts strongly with the metabolome (since that supplies its substrates) and the genome (since epigenetics seems to often determine sites of DNA cutting and gene splicing both in normal cells and in cancer).  The epigenetic signature of cannabis has even been traced through sperm (Lombard).  Hence ageing has an epigenetic signature and so too does cannabis.  Whilst the two have NOT been formally compared to my knowledge, in view of the above it seems more than likely that significant overlap will be found. Indeed cannabis induced changes in some major epigenetic enzymes, particularly Sirt2 – likely the best age-documented enzyme ever – were documented by Quinn (2008; Neuropsychopharmacology 33:1113).  Inheritable epigenetic immunotoxicity was also documented by Lombard C (2011; JPET 339:607)

Source: Email from Stuart Reece to Drug Watch International drug-watch-international@googlegroups.com February 2018

Filed under: Cannabis/Marijuana,Drug use-various effects,Genes :
by Lauraine Langreo, Writer,  Education Week

August 28, 2024

 

There have been “promising” declines in high school students’ overall use of illicit substances, concludes a report from the federal Centers for Disease Control and Prevention.

Since 2013, the percentage of students who reported drinking alcohol, using marijuana, or using select illicit drugs at any point has decreased. Since 2017 and 2019, respectively, the percentage of students who had ever misused or currently are misusing prescription opioids decreased, according to the CDC’s Youth Risk Behavior Survey.

That survey draws on data collected every two years among a nationally representative sample of U.S. high school students. The 2023 survey had more than 20,000 respondents and was conducted in the spring.

Still, many students continue to use substances and the lack of progress in some areas is concerning, according to the report.

The findings come as schools continue to face challenges in curbing students’ substance abuse, which could negatively affect learning, memory, and attention, according to experts. It could also be a sign of mental health challenges.

                                                                                                                   

 

While student substance abuse isn’t a new challenge for school districts, the substances that adolescents are experimenting with now are much more dangerous, said Darrell Sampson, the executive director of student services for the Arlington public schools in Virginia.

“It’s not necessarily that more kids are using substances than in prior years,” Sampson said. “It’s the lethality of the substance itself that has caused higher levels of concern.”

 

Research has shown rising overdose deaths among teens even as their substance use is declining. Those deaths have been linked to the increase in illicit fentanyl and other synthetic opioids. School districts have been pursuing several strands of legal action against companies that manufactured and marketed addictive opioids that have led to tens of thousands of deaths and countless more addiction struggles in the last two decades.

Beyond the legal actions, schools also continue to provide prevention and education programming for students and families, Sampson said. There’s “a glimmer of hope” that those measures are working, he said, based on the declines in the CDC data.

Experts recommend starting education about substance abuse as early as possible

In the Arlington, Va., district, students in grades 6 through 10 learn about substance abuse challenges as part of the health curriculum, Sampson said. The district has also slowly expanded that program to 5th and 4th grades and are looking into whether there’s capacity to start that education as early as 3rd grade.

“We know that the more we can at least open that conversation with our families and our students, the better off our students are going to be,” Sampson said. “It’s not just a message [they’re hearing] starting in middle school, but it’s a message [they’re hearing] over time.”

The district is expanding programming with 11th and 12th graders, too, because the information they got when they were in 10th grade could be outdated by then, Sampson said.

In addition, the district has substance abuse counselors who meet with students and try to explore the reasons they might be using substances, Sampson said.

Experts say it’s also important to think about how to incorporate student voice in any prevention or intervention programming.

Teens are more than twice as likely to go to their friends or peers for help or support when experiencing distress from their substance use than they are to go to a behavioral health provider or a family member, according to a survey from the Bipartisan Policy Center conducted in June among 932 teens (13- to 17-year-olds) and 1,062 young adults (18- to 26-year-olds). More than a quarter of teens said they didn’t go to anyone for help or support when they experienced distress from substance use.

Sophie Szew, a junior at Stanford University and the Bipartisan Policy Center’s mental health and substance use task force youth adviser, said those survey results “really underscore the importance of investing in those peer support networks and resources.”

DATA SOURCE: Bipartisan Policy Center

Source: https://www.edweek.org/leadership/teen-substance-use-is-declining-but-more-dangerous-drug-abuse-is-emerging/2024/08

Filed under: Drug use-various effects,Prevalence,USA,Youth :

by Perkins and Ranalli, ETR. Aug 28, 2024

ABOUT THE EXPERTS

Laura Perkins, MLS (she/her/hers) is a Product Editor at ETR and has over 20 years of experience in editorial content and health literacy.

Lauren Ranalli, MPH (she/her/hers) is the Director of Communications and Public Affairs at ETR and has over 20 years of experience in public health and adolescent health services.

Source: https://www.physiciansweekly.com/addressing-prescription-drug-misuse-among-adolescents/

Filed under: Drug use-various effects,Prescription Drugs,Prevention and Intervention,USA,Youth :

Oct 29, 2014

The last week of October is Red Ribbon Week, celebrating a drug-free life (redribbon.org). It’s also the culmination of National Substance Abuse Prevention Month.

So why is substance abuse prevention important? According to the Office of National Drug Control Policy (ONDCP) Acting Director Michael Botticelli, “Preventing drug use before it begins – particularly among young people – is the most cost-effective way to reduce drug use and its consequences.” This matters to us as members of our community and our society.

But as parents, friends, family members – human beings – it’s not all about the money. Botticelli recognizes the cost of drug abuse is far-reaching beyond just our wallets. He goes on to say, “The best approach to reducing the tremendous toll substance abuse exacts from individuals, families and communities is to prevent the damage before it occurs.”

Parents want to help their kids avoid this “tremendous toll,” which could involve their health (physical or mental), family, other relationships, schooling, employment – the list goes on. Parents, however, often find themselves learning about a new drug trend and feel it’s just “one more thing to worry about.” One example would be the current heroin epidemic, especially among people who may have become addicted to prescription pain killers.

The good news is that parents don’t have to resort to worrying. Research has shown repeatedly that parents are a key factor in preventing drug abuse. When parents have open two-way communication with their kids and seek to provide accurate information, many are surprised to discover how much influence they can actually have. And young people are less likely to abuse drugs when they know their parents care, and that they have specific rules or expectations regarding drug use.

Some websites with helpful information on heroin and other drugs, as well as tips for talking to kids, include: www.fda.gov; www.cdc.gov; www.drugfree.org; teenshealth.org/teen; www.drugfreeactionalliance.org/know; combatheroin.ny.gov; and www.drugabuse.gov.

Even when there has been substance abuse with resultant problems, it’s never too late to seek help. People recover from addiction every day and lead healthy, productive lives.

HFM Prevention Council, Johnstown

Source: https://www.dailygazette.com/leader_herald/opinion/letters/prevention-is-important/article_c5769b46-83c7-5907-a49b-bb4cf191f7aa.html?=/&subcategory=640%7CConcert

Filed under: Drug use-various effects,Prevalence,Prevention and Intervention,USA :

By Sandee LaMotte, CNN  / Sat August 10, 2024

Using marijuana daily for years may raise the overall risk of head and neck cancers three- to five-fold, according to a new study that analyzed millions of medical records.

“Our research shows that people who use cannabis, particularly those with a cannabis use disorder, are significantly more likely to develop head and neck cancers compared to those who do not use cannabis,” said senior study author Dr. Niels Kokot, a professor of clinical otolaryngology-head and neck surgery at the Keck School of Medicine at the University of Southern California in Los Angeles.

Cannabis use disorder is diagnosed when a person has two or more of such symptoms as craving weed, becoming tolerant to its effects, using more than intended, using marijuana even though it causes problems in life, using it in high-risk situations, experiencing withdrawal and being unable to quit, according to the US Centers for Disease Control and Prevention.

“While our study did not differentiate between methods of cannabis consumption, cannabis is most commonly consumed by smoking,” Kokot said in an email. “The association we found likely pertains mainly to smoked cannabis.”

Some 69% of people with a diagnosis of oral or throat cancer will survive five years or longer after their diagnosis, according to the National Cancer Institute. If the cancer metastasizes, however, that rate drops to 14%. About 61% of people diagnosed with cancer of the larynx will be alive five years later — a rate that drops to 16% if the cancer spreads.

The study used insurance data to look at the association of cannabis use disorder with head and neck cancers, said Dr. Joseph Califano, the Iris and Matthew Strauss Chancellor’s Endowed Chair in Head and Neck Surgery at the University of California, San Diego. He was not involved in the study.

“The researchers used a huge, huge dataset, which is really extraordinary, and there is enormous power in looking at numbers this large when we typically only see small studies,” said Califano, who is also the director of UC San Diego’s Hanna and Mark Gleiberman Head and Neck Cancer Center.

“On average, people with cannabis use disorder smoke about a joint today and do so for at least a couple years, if not longer,” said Califano, who coauthored an editorial published Thursday in JAMA Otolaryngology–Head & Neck Surgery in conjunction with the new study.

However, he added, the study does not find an association between “the occasional recreational use of marijuana and head and neck cancer.”

Just like tobacco, smoking marijuana raise the risk of head and neck cancers, experts say.

Causes of head and neck cancers

In the United States, head and neck cancers make up 4% of all cancers, with more than 71,000 new cases and more than 16,000 deaths expected in 2024, according to the National Foundation for Cancer Research.

Tobacco use, which includes smoking cigarettes, cigars, pipes and smokeless tobacco, and the use of alcohol are the two most common causes of head and neck cancers, experts say. Other risk factors include poor oral hygiene;gastroesophageal reflux disease, or GERD; a weakened immune system; and a diet low in fruits and vegetables. Occupational risk factors include exposure to asbestos and wood dust.

A growing number of head and neck cancers are due to infection with the human papillomavirus or HPV, or the Epstein-Barr virus, or EBV, which are DNA viruses that affect genes, making them susceptible to malignancies.

Epstein-Barr virus is linked to infectious mononucleosis, also called the “kissing disease,” as well as various cancers. Researchers estimate that 90% of the world’s population is infected with EBV.  A vaccine is available for HPV, which is linked to a high risk of developing cervical cancer and some non-Hodgkin lymphomas.

It’s possible to be infected with both viruses at once, and that combination is responsible for 38% of all virus-associated cancers, according to research.

How might cannabis cause cancers?

The study, published Thursday in JAMA Otolaryngology–Head & Neck Surgery, analyzed a database of 4 million electronic health records and found more than 116,000 diagnoses of cannabis use disorder among people with head and neck cancers. Those men and women, whose average age was 46, were then matched with people who also had head and neck cancers but were not diagnosed with cannabis use disorder.

The analysis showed that people with cannabis use disorder were about 2.5 times more likely to develop an oral cancer; nearly five times more likely to develop oropharyngeal cancer, which is cancer of the soft palate, tonsils and back of the throat; and over eight times more likely to develop cancer of the larynx. The findings held true for all age groups, according to the study.

Smoke is one key reason for the association between smoking weed and head and neck cancers, experts say. Smoking tobacco doubles the risk of developing head and neck squamous cell carcinoma, which makes up 90% of all head and neck cancers.  Heavier tobacco use leads to even higher risk, and when alcohol is added, the risk is even greater.

Due to the way marijuana is smoked — unfiltered and breathed in deeply and held in the lungs and throat for a few seconds — the risk from cannabis smoke could be even greater, experts say.

Another key to the puzzle of how cannabis causes cancer: Research has found a link between various cannabinoids and tumor growth. There are more than 100 cannabinoids — biological compounds in the cannabis plant that bind to cannabinoid receptors in the human body, according to the National Center for Complementary and Integrative Health. All told, there are about 540 chemicals in each marijuana plant.

Tetrahydrocannabinol, or THC, is the substance that makes one euphoric, while cannabidiol, or CBD, has been shown to have medicinal uses for childhood seizures and epilepsy.

“Part of the research we have already published shows that THC or THC-like compounds can certainly accelerate tumor growth,” Califano said. “We also have some data to show that cannabinoids enhance the growth of HPV-related throat cancers.”

With the use of marijuana rising, there is concern that diagnoses of head and neck cancers could increase in coming years, Kokot said.

“Especially as (marijuana) becomes more widely legalized and socially accepted, we may see a corresponding rise in head and neck cancer cases if the association is confirmed,” he said.

“This underscores the importance to inform people about the potential risks and conduct further research to understand the long-term impacts of cannabis use on cancer development.”

Source:  https://edition.cnn.com/2024/08/08/health/marijuana-head-and-neck-cancer-wellness/index.html

 

Filed under: Cannabis/Marijuana,Drug use-various effects,Health,USA :

by Dan Krauth WABC logoabc Channel 7

Tuesday, August 13, 2024
Dan Krauth has the details on a new and potentially lethal narcotic that is creeping into the NYC area from Latin America.

NEW YORK (WABC) — There’s a new mystery drug that’s hitting the club scene in New York City and the ease of how it’s pouring into the area may surprise you.

It’s called pink cocaine.

While its bright color from food coloring stays the same, what’s inside can change from day to day and from dealer to dealer.

“You have no idea what you’re taking,” said NYC Special Narcotics Prosecutor Bridget Brennan. “I’ve never seen the drug supply as lethal as the one we’re in today.”

In cases the Special Narcotics Prosecutor and DEA have seen, when its lab tested, it actually has very little to no cocaine in it at all. Instead they’re finding cheaper manmade drugs from ketamine to ecstasy. It can be a dangerous and even deadly mixture of uppers and downers.

“When you see that mixture of your body being pulled in two directions, being amped up with a methamphetamine or cocaine and being sedated with something like ketamine, that’s a recipe for a terrible, terrible effect on the body,” said Brennan.

The Special Agent in Charge of the DEA in New York said in some cases the deadliest of drugs, fentanyl, is also getting mixed in, where even a tiny amount can be lethal.

“They’re mixing fentanyl in because they want to increase addiction, they want to increase their customer base they want more people to come back and buy their drug and it’s something every parent should be concerned about,” said Frank Tarentino, Special Agent in Charge of the Drug Enforcement Administration’s New York Division.

The drugs aren’t being sold in shady places or dark street corners as you might imagine. Prosecutors busted a New York City woman this summer for allegedly selling pink cocaine, and other drugs, over a messaging app on her cell phone. She’s accused of then shipping the drugs through the mail to customers. She has pleaded not guilty to the charges.

“You have this criminal underworld that has weaponized social media to push their poison to the far corners of the United States and across the world,” said Tarentino.

According to law enforcement sources, with the use of technology and social media, the mystery mixtures are easier to get than ever before and there are more drug overdose deaths reported than ever before. They say there’s no longer any such thing as safe experimentation, no matter how colorful the drug might be.

Pink cocaine also goes by the name Tusi.

Prosecutors say it’s a drug that’s difficult to track but was first spotted in the New York City area in January of 2023.

Source: https://abc7ny.com/post/pink-cocaine-nyc-new-mystery-drug-hitting-club-scene-new-york/15176935/

Filed under: Cocaine,Drug use-various effects,Fentanyl,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 :

Course curriculum including testimonials from addicts, health workers and cops would bring big benefits for not very much cost

Author of the article:  Herbert Grubel, Special to Financial Post  (Canada) –  Published Aug 22, 2024

Last year British Columbia recorded 2,511 deaths suspected of being caused by illicit drugs, an average of nearly seven per day and an increase of five per cent from 2022. That’s a blemish on Canadian society and a cause of deep frustration: no matter how hard our governments and private charities have tried, we have not been able to end this carnage.

There has been no shortage of effort. To shrink the total number of users, we punish the possession, production, importation and dealing of drugs with fines and prison. To shrink the number of deaths caused by use of contaminated needles and drugs, we have provided safe injection sites and, in some provinces, free, safe opioids. To save users who have overdosed, we have made Naloxone readily available and put emergency medical teams on standby to take them to hospitals for treatment. To get users to give up their addiction, we offer them free mental health care and rehabilitation services.

What else can we do? We live in a free society. We cannot jail users or enrol them against their will in rehabilitation. We can always improve existing policies and apply more resources to them, but we may well have reached the limits of these policies in terms of financial commitment and political acceptability.

There is one policy, however, that has not been tried in Canada: Require all young Canadians to learn about the risk of death and other harms from using addictive recreational drugs and make them document their knowledge of these risks to receive their high-school graduation diploma.

This would not affect the current number of addicts but it should reduce the number of Canadians who become addicts in the future. Young people who understand the consequences of addiction will be better able to resist social pressures, sales pitches from drug dealers and the temptation to self-medicate the mental and emotional turmoil that afflicts many teenagers.

We know that providing the public with information about the consequences of personal actions is effective. That is why we have information campaigns about the effects of teen pregnancies, drunk driving and hiking in the back country without proper gear. Health Canada conducts regular campaigns informing the public about the risks of certain lifestyle choices and the failure to get vaccinated against the threat of infections.

Canada has many teachers, psychologists and media experts who could produce a curriculum that could effectively provide students with information about the consequences and risks of drug use. One does not have to be an expert to imagine the contents of such a curriculum.

One set of lectures would involve testimonials from addicts, whether in person or via video, about how hard it is to get a regular supply of drugs and find the money to pay for them, and how addiction led to homelessness and broken relationships with family and friends. They would discuss the trauma of seeing friends go into comas or die and discovering that their own mental acuity and health are diminishing.

Accounts by addicts of how they were induced to try their first dose would also be important, as well as testimony about the fleeting and decreasing pleasures they get from each successive hit.

The school curriculum might also include medical professionals talking about their experiences dealing with overdose victims, their inability to revive many of them and the persistent damage to users’ quality of life and mental and physical health.

Films could show parts of cities where addicts live in misery, inject drugs and sprawl motionlessly on the ground while under the influence. They could show medics attending to addicts in distress, with ambulance lights flashing in the dark background. They could show family members and friends attending funerals and mourning the death of overdose victims, or addicts being taken to jail in handcuffs by the police after committing crimes against property and persons.

No doubt there would be opposition to such a policy from Canadians who do not want to see time taken away from teaching traditional subjects or who are concerned that their children will be traumatized by the presentations or perhaps even encouraged to try drugs. These are legitimate concerns that need to be addressed in public discussions and ultimately government-arranged hearings about the benefits and costs of the proposed policy — as should be the practice with all government policies. But it seems to me the returns to the drug-abuse education are so high we should at least have public discussions about it.

Financial Post

Herbert Grubel is an emeritus professor of economics at Simon Fraser University.

Source:  https://financialpost.com/opinion/make-drug-awareness-requirement-graduate-high-school

Filed under: Canada,Drug use-various effects,Drug use-various effects on foetus, babies, children and youth,Education,Youth :
by Zachary Pottle |- Addiction Center

Remaining Sober In College

With August underway, many college students will be heading back to campuses across the country for another school year. For many, college is an exciting experience where young adults can learn, make friends, grow into their own, and of course attend the occasional party. However, for some students, returning to campus can present a host of challenges, especially those in recovery who may be worried about maintaining their sobriety.

It’s no secret college students experiment with substances. Now more than ever, college campuses are filled with drugs and alcohol. According to the 2023 National Survey on Drug Use and Health (NSDUH), 45.3% of male and 48.5% of female full-time college students ages 18 to 22 drank alcohol in the past month. Additionally, roughly 40% of both male and female college students said they had tried an illicit substance within the past year; with the most common being marijuana, cocaine, hallucinogens, and prescription drugs.

If you’re a student dealing with addiction, you might worry about being pressured to use drugs, attend parties where alcohol is prevalent, or spend time with people who engage in substance use. However, college doesn’t have to be overwhelming. By taking proactive steps to avoid substance use temptations, you can still enjoy your college experience.

Tips For Staying Sober On Campus

For students who are entering back into the college space after receiving treatment or in the earlier stages of recovery, campuses can be a stressful environment. Learning how to guard your sobriety while in environments ripe with drug and alcohol use can be hard, but fortunately many colleges have resources available to help keep you sober and engaged with your peers.

Avoid Popular “Party” Spots

While it likely goes without saying, avoiding places where drugs and alcohol are likely to be present is one of the best ways to stay sober in college. Many colleges have places that are synonymous with these types of activities; like popular local bars, fraternity or sorority houses, and other similar spaces. If you know that exposure to drugs or alcohol may trigger cravings or put your sobriety at risk, avoiding these spaces is key.

However, avoiding these places doesn’t mean that you have to have a “boring” college experience. For every bar or nightclub there’s an equal amount of spaces where social gatherings happen free of drugs and alcohol. Libraries, activity centers, sports facilities, and other places on campus are all great for avoiding triggers while also being a part of campus life.

Join A Club Or Campus Organization

While Greek life organizations are often associated with drug and alcohol use, many are involved in campus life and hold fundraisers, events, and other activities for all students on campus. Joining a fraternity or sorority can also be a great way to meet and connect with others, especially groups that focus on campus life and academic performance.

Many colleges also have a plethora of clubs and organizations for students to join. These include groups like student government, intramural sports, arts clubs, cultural clubs, and community service groups. Joining a group is a great way to stay involved with campus life while remaining sober.

Start An Exercise Routine

One of the most beneficial things you can do for your health is to exercise. Exercise can be especially helpful for those struggling with cravings or mental health conditions like anxiety or depression, both of which can be common for young adults struggling with their sobriety. Research shows that people who exercise regularly have better mental health and emotional wellbeing, and lower rates of mental illness.

Exercise doesn’t have to be strenuous or take a long time. Studies show low or moderate intensity exercise is enough to make a difference in terms of your mood and thinking patterns. The Centers for Disease Control and Prevention (CDC) recommends young adults aged 18-25 engage in 150 minutes of moderate-intensity physical activity a week. This can also be 75 minutes of vigorous-intensity or an equivalent combination of moderate- and vigorous-intensity physical activity. For additional benefits, the CDC recommends an extra two days of muscle-strengthening each week.

Utilize Campus Resources

Safeguarding your sobriety can be difficult, especially when your mental health is lacking. Without proper mental health care, depression, anxiety, stress or other mental health concerns can lead even the strongest of those in recovery into relapse. As our understanding of the importance of mental health has increased over the years, so too has our access to mental health care across the country.

Many colleges, especially larger state-sponsored schools with large student bodies, have counseling and other psychological services free of charge for enrolled students. Colleges that offer these types of services typically do so either online or in-person, and usually operate on a scheduling basis. If you’re unsure about whether or not your college offers counseling services, contact your admissions office or campus resource center to find out more.

Additional Resources For College Students In Recovery

While counseling services and campus organizations can both be beneficial to students in recovery, the reality is that many people experience relapses. Studies show that between 40 to 60 percent of individuals in treatment for substance abuse will relapse. It’s important to remember; however, that a relapse is not a sign of failure. Rather, relapses are a part of the recovery process.

Relapses can be a slight “bump in the road” for some, while for others relapses may require a bit of extra help to get them back on track. Treating chronic diseases requires changing long-established behaviors, and relapse doesn’t signify failure. When someone in recovery from addiction relapses, it’s a sign that they should consult their doctor to restart treatment, adjust it, or explore other options.

For students who may need extra resources, services like outpatient rehab may be a viable option to help keep you in school while also addressing relapse concerns. Outpatient programs provide young adults with the flexibility to receive treatment for part of the day while returning to campus each night. These programs vary, including day programs, intensive outpatient programs (IOP), and continued care. An addiction specialist can help determine which option best suits your needs.

Finding Help

Addiction is often seen by many as a lifelong disease; one that requires constant dedication, mindfulness, and strength. You should never be ashamed of needing support, regardless of how much or how frequent it is. If you’re struggling to stay sober, reaching out for help is always better than sacrificing your hard-earned sobriety. For additional resources and support, contact a treatment provider today to learn about your options.

Source: https://www.addictioncenter.com/community/stay-sober-college/

Filed under: Alcohol,Drug use-various effects,Drug use-various effects on foetus, babies, children and youth,Education,Prevention and Intervention,USA,Youth :

As the population ages, we have to face a growing, generally overlooked crisis of drug abuse among seniors.

What once were considered problems for the younger generation are increasingly found in our older population. The reasons behind this troubling trend are complex and multifaceted, but understanding them holds the key to developing effective prevention strategies.

According to statistics from the United Nations Department of Economic and Social Affairs (2019), there are approximately 2.2 million people aged 60 years and above in Kenya.

Globally, one of the major reasons cited as being behind the increasing cases of drug abuse among elderly people is an increased incidence of chronic pain. As one grows older, the body becomes more prone to a whole range of problems, from arthritis to back issues.

Doctors prescribe very strong opioids for treating the related pain. Where they are highly effective in delivering relief, they come with the dangerous possibility of dependence. Too often, many of these seniors are caught in this vicious circle of addiction when all they were looking for was relief from physical suffering.

There is also the emotional wear and tear associated with growing older. This may be an empty feeling—lack of purpose and loss of social contacts—with retirement, even when well-planned.

A state of depression or anxiety can result from the death of the spouse or friend, or reduced mobility and increasing isolation. Some turn to alcohol or drugs, mistakenly seeking temporary relief from the pain of loneliness or fear of mortality.

Furthermore, stigma against mental health conditions in elderly persons often acts as a barrier to care. The vast majority were raised in an era where little, if any, emotional matters were discussed, and as such, self-medication was the rule rather than the presence of professionals. This lack of dealing directly with issues of mental health can perpetuate substance abuse problems.

It can also be a factor of financial stress. With fixed incomes and increasing healthcare costs, some seniors might turn to cheaper, illicit drugs to manage pain or emotional stress when they can no longer afford prescribed medications. Such substitution is dangerous and, therefore, leads to many other additional serious health and legal problems.

This means we must consider the intergenerational effects of attitudes in their relationships with drugs from one generation to the next.

The baby-boomer generation is entering old age now, but they were raised during times of increased experimentation with drugs. Some carry this behavior over into old age and may view recreational drug use as normal in life, rather than a potential danger. This is a complex issue that calls for a multi-faceted approach. First, there is a dire need to promote education and awareness of the dangers of drug abuse among seniors. This would involve not only the seniors themselves but also their families, caregivers, and even healthcare providers.

Substantial training should be provided to healthcare professionals regarding spotting the symptoms of substance abuse in older patients and looking for alternative methods for managing pain with lower addiction risks.

Steps could include physical therapy, acupuncture, or using pain relievers not having opioids. Regular medication review identifies potential drug interactions and minimises the risk of possible misuse in cases of accidental ingestion or use.

We have a lot of work to do in taking away the stigma associated with mental health treatment for older adults. Encourage seniors to seek counseling or support groups, giving them a healthy outlet to deal with life.

Community centers and senior living facilities can also play important roles in the creation of social connections and engaging activities to replace isolation and boredom. Underpin systems of financial support allow seniors to afford needed medication and treatments; otherwise, they may resort to dangerous alternatives. This could be done through Medicare coverage expansion or the creation of subsidies for essential prescriptions.

The need to educate family members and caregivers about the warning signs and symptoms of drug abuse among seniors is of the essence, and fostering an open, non-judgmental conversation regarding substance use is called for.

A supportive environment shall therefore have to be set up so that a senior feels comfortable discussing difficulties to be able to carry out early intervention effectively.

Such senior preventive programs should be designed and practiced universally. These can consist of workshops on healthy aging, handling stressful situations, and medication alternatives to alleviate pain. Peer support groups led by recovered senior addicts could serve as a powerful testimony and mentorship.

We have to change the attitude toward aging in our society. If we teach people that the later years of life can be the growth time, learning period, and the beginning of new experiences, then the older persons continue to feel a sense of purpose and identity in life. All this optimism can work very strongly against substance abuse.

Treatment of drug abuse in seniors is not just a public health imperative, it is also a moral one. A group of people who have contributed so much to our society all their lives deserve to enjoy their later years with dignity and support.

Understanding the roots of senior drug abuse and implementing comprehensive strategies of prevention can help ensure that our elders experience the quality of life they deserve.

Mr. Mwangi is Deputy Director, Corporate Communications, NACADA 

Source: Simon Mwangi 

Filed under: Drug use-various effects,Mental Health,Others (International News),Prevalence :

Published: August 11, 2024

Abstract

Shivering is a frequently encountered perioperative complication in patients undergoing spinal anesthesia. Numerous different pharmacological agents have been employed to mitigate this issue. This scoping review aims to evaluate the efficacy of ketamine in mitigating the incidence of shivering. This review process utilized PubMed, JAMA, and Cochrane as primary databases. Searches were performed using combinations of key terms: “Ketamine,” “Shivering,” “Spinal Anesthesia,” and “Hypothermia.” Reviews of reference lists for additional pertinent data were performed. When ketamine was compared against a saline control, three out of five studies found ketamine to be more effective (p < 0.05, p < 0.001, p < 0.001) in the prevention of shivering. When compared with tramadol, two studies found ketamine to be more effective (p < 0.001, p < 0.001), one found no difference (p = 0.261), and one found tramadol to be more effective (p < 0.001). Two studies found dexmedetomidine more effective (p < 0.022, p < 0.027) than ketamine and tramadol. When comparing ketamine, ondansetron, and meperidine, all three were effective (p < 0.001) versus saline, with no significant difference between the three. Meperidine demonstrated more efficacy (p < 0.05) in reducing the intensity of shivering than ketamine. Ketamine’s effects on hemodynamics were shown to be equivocal or more favorable across several studies. While there is mixed evidence on whether it is better than other treatments, ketamine may have advantages from a hemodynamic standpoint. Dosages of 0.2-0.5 mg/kg with or without a subsequent infusion of 0.1 mg/kg per hour may aid in the prevention of perioperative shivering. Overall, ketamine is a safe and effective drug for the prevention of perioperative shivering. However, other drugs may be equally or more effective; therefore, patient population, hemodynamic status, patient preferences, and provider familiarity with different agents should be considered.

Introduction & Background

Shivering is an involuntary somatic muscle response typically triggered by prolonged exposure to cold environments or fever to raise body temperature by generating heat through repetitive contraction of skeletal muscles. Shivering is primarily controlled by the median preoptic nucleus (MnPO) in the anterior thalamus of the brain which contains the central efferent pathways for cold-defensive and febrile shivering. Some common causes of shivering include movement disorders, excitement, fear, stress, tremors, low blood sugar, anxiety, fever, cold exposure, postanesthetic shivering, and shivering with spinal anesthesia.

Patients frequently experience shivering following surgery with general or spinal anesthesia. This shivering may be due to a natural thermoregulatory response to central hypothermia or as a result of the release of cytokines throughout the surgical process [1]. This is unpleasant for the patient and occurs following surgery in 30-65% of patients who have received general anesthetics [1].

The exact mechanism underlying post-spinal anesthesia shivering is not fully understood but may involve thermoregulatory responses to hypothermia, affecting neurons in specific brain regions. Shivering with spinal anesthesia is an involuntary, oscillatory muscular activity that significantly increases metabolic heat production by up to 600% and increases oxygen consumption up to 400% [2]. This may lead to arterial hypoxia and is associated with an increased risk to patients with myocardial infarction [1]. These sequelae of shivering may prolong post-operative recovery time and contribute to poor patient outcomes.

A variety of medications have been studied to prevent or treat post-anesthesia shivering; recent studies indicate ketamine shows promise in controlling shivering. Ketamine is a competitive N-methyl-D-aspartate (NMDA) receptor antagonist and is involved in the regulation of heat. As a NMDA agonist, it increases the rate of neuronal discharge in the anterior hypothalamic preoptic region modulating serotonergic and noradrenergic neurons in the locus coeruleus [3]. The mechanism of action by which ketamine controls shivering has yet to be determined, but it is believed that it regulates shivering by producing non-vibration-induced heat, acting on the hypothalamus and beta-adrenergic effects.

As there is not yet a determined most effective agent this scoping review of current literature was conducted to determine the benefits of ketamine in the prevention of perioperative spinal anesthetic shivering. Hemodynamic effects of ketamine and other anesthetic agents were examined as a secondary objective.

The full article is available to read by clicking the source link below:

Source:  https://www.cureus.com/articles/277061-a-scoping-review-ketamine-for-the-prevention-of-perioperative-shivering-in-patients-undergoing-spinal-anesthesia#!/

Filed under: Drug use-various effects,Health,Ketamine :

One of the most pressing issues for businesses in states where marijuana use is legal is determining employee impairment before taking any adverse action. Unlike alcohol, where a simple breathalyzer test can gauge impairment, marijuana’s effects vary significantly based on consumption method, strain, and user tolerance.

Studies have shown that THC—the psychoactive compound in cannabis—and its metabolites can linger in the body long after the “high” has worn off. Recognizing this, many states have enacted laws requiring employers to prove impairment, not just the presence of THC. Traditional drug tests like urinalysis, oral fluid tests, hair tests, and even emerging breath THC tests only indicate prior use, not current impairment.

This means that zero-tolerance policies based solely on the detection of THC metabolites are no longer viable in many states. Instead, employers must place more focus on assessing fitness for duty through reasonable suspicion training for supervisors and consider adopting impairment detection technology.

Given that measuring THC levels cannot be the sole indicator of impairment, new tools have emerged to detect impairment from drug and alcohol use. Advanced impairment detection technologies offer more accurate insights into an employee’s current state of impairment. These devices measure psychological and/or physical indicators, allowing employers to make informed decisions about workplace safety. Leading solutions are portable, scientifically defensible, and provide results within minutes.

However, these technologies alone are not enough. Supervisors play a crucial role in identifying and documenting impairment. Proper training in recognizing the signs of impairment and documenting these observations is essential. Supervisors must be equipped to take appropriate action based on their assessments, ensuring that safety and performance standards are upheld. We here at NDWA can help provide trainings for your supervisors – find out more here.

Employees must understand that they are not exempt from workplace safety regulations regardless of their state’s marijuana laws. Being under the influence at work can endanger themselves and their colleagues, and impact work quality and efficiency. It is the responsibility of employees to ensure their marijuana use doesn’t impair their fitness for duty. They must arrive at work sober and ready to perform.

Advanced impairment detection technology is promising, but isn’t a singular solution. By training supervisors to document regular behavior and performance, businesses can maintain safe and productive work environments.

 

Source:  NATIONAL DRUG-FREE WORKPLACE ALLIANCE

Filed under: Cannabis/Marijuana,Drug use-various effects,Prescription Drugs,Prevention and Intervention,USA,Workplace :
  • 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 :

BY JULIA MARNIN –  AUGUST 02, 2024

 

A New Jersey man caused the diversion of a flight due to his dangerous behavior and was arrested when the plane landed, feds say. Jan Rosolino via Unsplash An American Airlines passenger forced a Dallas-bound flight to land in a different city because of his “violent” and dangerous behavior, including repeated attempts to open the plane’s doors and his assault on a flight attendant, federal prosecutors said. The flight crew and passengers had to restrain Eric Nicholas Gapco’s hands and feet with flexible restraints until the flight from Seattle landed in Salt Lake City on July 18, according to the U.S. Attorney’s Office for the District of Utah. Gapco, 26, of Delanco, New Jersey, was arrested when the flight landed, according to prosecutors. Gapco continued “to engage in violent and erratic behavior” at the Salt Lake City International Airport, where he smashed the glass door of a holding cell, court documents say. He denied consuming illegal drugs or prescription medication, but later told his arresting officers he ate “approximately ten marijuana edibles,” according to a motion for his detention. Gapco said he didn’t know how much THC, a psychoactive component of the cannabis plant, was in each edible, the motion says. Gapco was indicted July 31 on charges of interference with a flight crew and attempted damage to an aircraft, the U.S. Attorney’s office said in a news release. His federal public defender didn’t immediately respond to McClatchy News’ request for comment on Aug. 1. On the July 18 flight, prosecutors said Gapco wouldn’t stay in his seat, tried to take a flight attendant’s seat, “propositioned a flight attendant for sex,” was loud, yelling, vaping and disrupting others. He also locked himself in a plane bathroom, went on to try to open the flight’s doors and is accused of trying to hand another passenger a bag of pills, according to prosecutors. Gapco “assaulted and intimated a flight attendant and aircraft crew members,” prosecutors said. “The safety and security of our customers and team members is our top priority,” American Airlines told McClatchy News in a statement on Aug. 1. “We thank our team members for their professionalism and our customers for their understanding.” American Airlines didn’t immediately respond to McClatchy News’ request for comment on Aug. 1. After Gapco broke a glass door at the Salt Lake City airport following his arrest, Gapco was taken to a hospital to be medically evaluated, according to prosecutors. “He continued to be belligerent” and “combative with medical staff and the police,” prosecutors wrote in the motion for his detention. “At one point, he spat on an officer.” Galco’s temporary detention was granted on July 23, court records show. He is due to appear for his initial appearance in court the afternoon of Aug. 1, prosecutors said.

Source: https://www.sacbee.com/news/nation-world/national/article290654789.html

 

Filed under: Brain and Behaviour,Cannabis/Marijuana,Crime/Violence/Prison,Drug use-various effects,USA :

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 :

Aug 5 2024

Drug-involved overdose deaths increased by over 500 percent in 2022 according to a study at Columbia University Mailman School of Public Health, with trends attributed to synthetic opioids. National data shows that fentanyl and heroin in particular attributed substantially to the rise particularly since 2014. However, the study also reports that income protection policies, can have a supportive role in preventing fatal drug overdoses. The findings are reported in the International Journal of Drug Policy.

Over 73,000 people died from an overdose in 2020, which subsequently increased to 106,699 people in 2021, a record for the highest number of overdose deaths in one year.

And in fact, more recently, we entered a fourth wave of the overdose crisis, characterized by fatal overdoses in the context of polysubstance use.”

Silvia Martins, MD, PhD, Professor of Epidemiology at Columbia Public Health

The COVID-19 pandemic exacerbated economic hardship; and as a result, the U.S, government enacted income protection programs in conjunction with existing unemployment insurance (UI) to dampen COVID-19-related economic consequences.

“In the context of financial and economic stressors which are known to increase overdose risk we hypothesized that we would observe lower levels of overall overdose and opioid deaths given that robust unemployment insurance benefits could be a buffer,” said Martins., who is also director of the Substance Use Epidemiology Unit of the Department of Epidemiology at Columbia.

The researchers used data based on responses of 89,914 individuals 18 years of age or older from the pooled 2014 – 2020 Detailed Restricted Mortality files for all counties from the Centers for Disease Control and Prevention, aggregating at the county-quarter level. Included were deaths from any drug overdose, any opioid overdose, and any stimulant overdose. Data on unemployment insurance were obtained from the U.S. Department of Labor as well as statutes by the individual states.

Data from 30 states collected by the CDC indicate rates were persistently stable or even increasing, suggesting that increases in overdose deaths observed after the start of the pandemic show minimal signs of abating. “In fact, treatment disruptions and closures of harm reduction organizations in compliance with social distancing ordinances may have also contributed to worsening substance use morbidity and mortality during this period,” noted Martins.

“We also theorized that states and counties with limited safety net policies may increase an individual’s social, psychological, and biological vulnerability to develop a drug use disorder, including opioid and stimulant use disorders. Such policies likely play a significant role in substance use initiation and subsequent development of substance use disorders as well as treatment access for such disorders,” Martins noted.

An earlier study that examined the relationship between state-level UI robustness and fatal opioid overdoses from 1999 to 2012 support the current findings although the research used data from earlier in the overdose epidemic and also different methods were used.

“While their earlier analysis shows that, between 1999 to 2012, UI was associated with lower rates of opioid overdoses, our study builds and expands on findings from that research, as we examined the relationship between UI and any drug-involved mortality — including all other drug overdoses and stimulant overdoses — during the 4th wave of the epidemic intertwined with the COVID-19 period,” observed Martins. In addition, the earlier study only examined fatal overdoses among “prime-age” people aged 25-54, whereas Martins and her team expanded our inclusion criteria to include everyone ages 18 and older.

“Our results therefore reinforce the notion in a call for a broader discussion on the protective role of the safety net programs to buffer drug-related harms,” stated Martins.

Co-authors are Luis E. Segura, Megan E. Marziali, Emilie Bruzelius,Natalie S. Levy, Sarah Gutkind, and Kristen Santarin, Columbia Mailman School of Public Health; Katherine Sacks, Milken Institute; and Ashley Fox, University at Albany, SUNY.

The study was funded by the Columbia University Mailman School of Public Health Calderone Health Equity Award and NIH-NIDA grants R01DA059376 and T32DA031099.

Source: https://www.news-medical.net/news/20240805/Study-Drug-involved-overdose-deaths-increased-by-over-50025-in-2022.aspx

Filed under: Drug use-various effects,Prevalence,USA :

As the new school year starts, officials are alerting parents to be vigilant of innovative ways kids might conceal drugs, such as in candy boxes and soda cans

Published August 12, 2024

With the onset of the new school year, there’s a growing concern among school officials about the creative methods some students might use to conceal drugs. Parents are being asked to stay alert to the possibility of everyday items being used for these purposes.

Creative Concealments

During a recent awareness campaign, officials highlighted how items that appear mundane, like candy boxes, soda cans, and water bottles, can actually be specialized containers designed to hide drugs. “At first glance, these items might look like ordinary snacks or drinks, but they’re increasingly being used to conceal substances,” noted a spokesperson from the organization SCAN, which is dedicated to substance abuse prevention.

Types of Disguised Containers

The variety of containers mentioned includes those designed to look like everyday objects. Water bottles, soda containers, and even chip bags can be modified with hidden compartments. These products are often marketed discreetly and can be easily overlooked by the untrained eye.

Signs of Substance Abuse

In addition to being aware of potential hidden containers, officials are advising parents to watch for changes in their child’s behavior which may indicate substance abuse. “Changes in attitude, energy, and social circles can be red flags,” the spokesperson added, emphasizing the importance of open communication and observation.

Community and School Involvement

Schools are working closely with local law enforcement and organizations like SCAN to provide resources and education to parents. Workshops, informational meetings, and resource materials are being offered to help parents and guardians recognize both the signs of drug use and the unlikely places drugs might be hidden.

Call to Action

Parents and guardians are encouraged to engage with their children about the dangers of drugs and the pressures they may face. By maintaining an open dialogue and staying informed about the latest drug concealment methods, parents can play a crucial role in preventing drug abuse.

For more tips on how to detect hidden drug containers and support children in staying drug-free, stay with Fox News Rio Grande Valley and follow us on your favorite social network.

Source: https://foxrgv.tv/hidden-in-plain-sight-officials-warn-parents-of-disguised-drug-containers/

Filed under: Drug use-various effects,Education,Others (International News),Prevalence,USA,Youth :
Harm reduction encompasses interventions, programmes and policies that seek to reduce the health, social and economic harms of drug use to individuals, communities and societies. On this page, you can find the latest analysis of harm reduction interventions in Europe, including key data on opioid agonist treatment, naloxone programmes, drug consumption rooms and more. 

This page is part of the European Drug Report 2024, the EMCDDA’s annual overview of the drug situation in Europe.

Evolving drug problems pose a broader set of challenges for harm reduction

The use of illicit drugs is a recognised contributor to the global burden of disease. Interventions designed to reduce this burden include prevention activities, intended to reduce or slow the rate at which drug use may be initiated, and the offer of treatment to those who have developed drug problems. A complementary set of approaches goes under the general heading of harm reduction. Here the emphasis is on working non-judgementally with people who use drugs in order to reduce the risks associated with behaviours that are mostly associated with adverse health outcomes, and more generally to promote health and well-being. Probably the best known of these is the provision of sterile injecting equipment to people who inject drugs, with the aim of reducing the risk of contracting an infectious disease. Over time these sorts of approaches appear to have contributed to the relatively low rate, by international standards, of new HIV infections now associated with injecting drug use in Europe. Over the last decade, as patterns of drug use have changed and the characteristics of those who use drugs have also evolved, to some extent, harm reduction interventions have also needed to adapt to address a broader set of health outcomes and risk behaviours. Prominent among these are reducing the risk of drug overdose and addressing the often-considerable and complex health and social problems faced by people who use drugs in more marginalised and socially excluded populations.

A spectrum of responses is needed to reduce changing drug-related harms

Chronic and acute health problems are associated with the use of illicit drugs, and these can be compounded by factors such as the properties of the substances, the route of administration, individual vulnerability and the social context in which drugs are consumed. Chronic problems include dependence and drug-related infectious disease, while there is a range of acute harms, of which drug overdose is perhaps the best documented. Although relatively rare at the population level, the use of opioids still accounts for much of the morbidity and mortality associated with drug use. Injecting drug use also increases risks. Correspondingly, working with opioid users and those who inject drugs has been historically an important target for harm reduction interventions and also the area where service delivery models are most developed and evaluated.

Reflecting this, some harm reduction services have become increasingly integrated into the mainstream of healthcare provision for people who use drugs in Europe over the last three decades. Initially, the focus was on expanding access to opioid agonist treatment and needle and syringe programmes as a part of the response to high-risk drug use, primarily targeting injecting use of heroin and the HIV/AIDS epidemic. Recent joint EMCDDA-ECDC guidance on the prevention and control of infectious diseases among people who inject drugs recommends providing opioid agonist treatment to prevent hepatitis C and HIV, as well as to reduce injecting risk behaviours and injecting frequency, in both the community and prison settings. The guidelines also recommend the provision of sterile injecting equipment alongside opioid agonist treatment to maximise the coverage and effectiveness of the interventions among people who inject opioids.

 

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

Source: https://www.euda.europa.eu/publications/european-drug-report/2024/harm-reduction_en

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

The European Drug Report 2024: Trends and Developments presents the EMCDDA’s latest analysis of the drug situation in Europe. Focusing on illicit drug use, related harms and drug supply, the report provides a comprehensive set of national data across these themes, as well as on specialist drug treatment and key harm reduction interventions.

This report is based on information provided to the EMCDDA by the EU Member States, the candidate country Türkiye, and Norway, in an annual reporting process.

The purpose of the current report is to provide an overview and summary of the European drug situation up to the end of 2023. All grouping, aggregates and labels therefore reflect the situation based on the available data in 2023 in respect to the composition of the European Union and the countries participating in EMCDDA reporting exercises. However, not all data will cover the full period. Due to the time needed to compile and submit data, many of the annual national data sets included here are from the reference year January to December 2022. Analysis of trends is based only on those countries providing sufficient data to describe changes over the period specified. The reader should also be aware that monitoring patterns and trends in a hidden and stigmatised behaviour such as drug use is both practically and methodologically challenging. For this reason, multiple sources of data are used for the purposes of analysis in this report. Although considerable improvements can be noted, both nationally and in respect to what is possible to achieve in a European-level analysis, the methodological difficulties in this area must be acknowledged. Caution is therefore required in interpretation, in particular when countries are compared on any single measure. Caveats relating to the data are to be found in the online Statistical Bulletin 2024, which contains detailed information on methodology, qualifications on analysis and comments on the limitations in the information set available. Information is also available there on the methods and data used for European-level estimates, where interpolation may be used.

Content

The drug situation in Europe up to 2024

This page draws on the latest data available to provide an overview of the current situation and emerging drug issues affecting Europe, with a focus on the year up to the end of 2023. The analysis presented here highlights some developments that may have important implications for drug policy and practitioners in Europe.
Understanding Europe’s drug situation in 2024 – key developments

Drug supply, production and precursors

Analysis of the supply-related indicators for commonly used illicit drugs in the European Union suggests that availability remains high across all substance types. On this page, you can find an overview of drug supply in Europe based on the latest data, supported by the latest time trends in drug seizures and drug law offences, together with 2022 data on drug production and precursor seizures.
Drug supply, production and precursors – the current situation in Europe 

Cannabis

Cannabis remains by far the most commonly consumed illicit drug in Europe. On this page, you can find the latest analysis of the drug situation for cannabis in Europe, including prevalence of use, treatment demand, seizures, price and purity, harms and more.
Cannabis – the current situation in Europe 

Cocaine

Cocaine is, after cannabis, the second most commonly used illicit drug in Europe, although prevalence levels and patterns of use differ considerably between countries. On this page, you can find the latest analysis of the drug situation for cocaine in Europe, including prevalence of use, treatment demand, seizures, price and purity, harms and more.
Cocaine – the current situation in Europe 

Synthetic stimulants

Amphetamine, methamphetamine and, more recently, synthetic cathinones are all synthetic central nervous system stimulants available on the drug market in Europe. On this page, you can find the latest analysis of the drug situation for synthetic stimulants in Europe, including prevalence of use, treatment demand, seizures, price and purity, harms and more
Synthetic stimulants – the current situation in Europe 

MDMA

MDMA is a synthetic drug chemically related to the amphetamines, but with somewhat different effects. In Europe, MDMA use has generally been associated with episodic patterns of consumption in the context of nightlife and entertainment settings. On this page, you can find the latest analysis of the drug situation for MDMA in Europe, including prevalence of use, seizures, price and purity and more.
MDMA – the current situation in Europe 

Heroin and other opioids

Heroin remains Europe’s most commonly used illicit opioid and is responsible for a large share of the health burden attributed to illicit drug consumption. Europe’s opioid problem, however, continues to evolve in ways that are likely to have important implications for how we address issues in this area. On this page, you can find the latest analysis of the drug situation for heroin and other opioids in Europe, including prevalence of use, treatment demand, seizures, price and purity, harms and more.
Heroin and other opioids – the current situation in Europe 

New psychoactive substances

The market for new psychoactive substances is characterised by the large number of substances that have emerged, with new ones being detected each year. On this page, you can find an overview of the drug situation for new psychoactive substances in Europe, supported by information from the EU Early Warning System on seizures and substances detected for the first time in Europe. New substances covered include synthetic and semi-synthetic cannabinoids, synthetic cathinones, new synthetic opioids and nitazenes.
New psychoactive substances – the current situation in Europe 

Other drugs

Alongside the more well-known substances available on illicit drug markets, a number of other substances with hallucinogenic, anaesthetic, dissociative or depressant properties are used in Europe: these include LSD, hallucinogenic mushrooms, ketamine, GHB and nitrous oxide. On this page, you can find the latest analysis of the situation regarding these substances in Europe, including seizures, prevalence and patterns of use, treatment entry, harms and more.
Other drugs – the current situation in Europe 

Injecting drug use

Despite a continued decline in injecting drug use over the past decade in the European Union, this behaviour is still responsible for a disproportionate level of both acute and chronic health harms associated with the consumption of illicit drugs. On this page, you can find the latest analysis of injecting drug use in Europe, including key data on prevalence at national level and among clients entering specialist treatment, as well as insights from studies on syringe residue analysis and more.
Injecting drug use – the current situation in Europe 

Drug-related infectious diseases

People who inject drugs are at risk of contracting infections through the sharing of drug use paraphernalia. On this page, you can find the latest analysis of drug-related infectious diseases in Europe, including key data on infections with HIV and hepatitis B and C viruses.
Drug-related infectious diseases – the current situation in Europe 

Drug-induced deaths

Estimating the mortality attributable to drug use is critical for understanding the public health impact of drug use and how this may be changing over time. On this page, you can find the latest analysis of drug-induced deaths in Europe, including key data on overdose deaths, substances implicated and more.
Drug-induced deaths – the current situation in Europe 

Opioid agonist treatment

Opioid users represent the largest group undergoing specialised drug treatment, mainly in the form of opioid agonist treatment. On this page, you can find the latest analysis of the provision of opioid agonist treatment in Europe, including key data on coverage, the number of people in treatment, pathways to treatment and more.
Opioid agonist treatment – the current situation in Europe 

Harm reduction

Harm reduction encompasses interventions, programmes and policies that seek to reduce the health, social and economic harms of drug use to individuals, communities and societies. On this page, you can find the latest analysis of harm reduction interventions in Europe, including key data on opioid agonist treatment, naloxone programmes, drug consumption rooms and more.
Harm reduction – the current situation in Europe 

PDF version of full report

The European Drug Report 2024 was designed as a digital-first product, structured by modules, and optimised for online reading. Within each chapter, you may download a PDF version of the page. We are also making available here  a PDF version of the full report (all modules and annex tables combined). Please note that some errors may have occurred during the transformation process and that it is possible that this version does not contain all corrections made since the report was first published (please check the last updated date).

Download full PDF version of the European Drug Report 2024 (16 MB, last updated 14.06.2024)

Source: https://www.euda.europa.eu/publications/european-drug-report/2024_en

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

As marijuana policies change across the nation, the conversation around its impact often centers on human health. However, it is critical to consider the impact on animals as a new study published in the Journal of the American Veterinarian Medical Association sheds light on the concern of marijuana toxicity in dogs.

Currently, the gold standard confirmatory testing for THC toxicity in dogs is costly, not easily accessible, and takes time to receive results. Thus, veterinarians often use the human urine multidrug test (HUMT) for point-of-care testing, which is unfortunately, unreliable in dogs. To rule out serious and severe conditions, HUMT is done in conjunction with additional tests such as bloodwork and advanced imaging.

To understand the history, physical, neurological, and clinical-pathological findings associated with marijuana toxicity in dogs, this study analyzed the medical records of 223 dogs diagnosed with THC toxicity between January 2017 and July 2021 from a university teaching hospital.

Key findings include:

  • Demographics: The median age of the exposed dogs was 1 year, and the breeds varied, with mixed breeds being the most common.
  • Owner Denial: Most dog owners denied the possibility of marijuana ingestion. Common stories reported were that their dog began “acting abnormal after going outside or to a public space” and when asked about marijuana being in the home, 55.6% claimed “absolutely no marijuana is in the house”.
  • Clinical Signs: Most dogs developed clinical signs of toxicity within four hours of ingestion. Common clinical signs included ataxia (88.3%), hyperesthesia (75.3%), lethargy (62.8%), urinary incontinence (45.7%), and vomiting (26%). The majority (70.4%) experienced both ataxia (abnormal movement/lack of coordination) and hyperesthesia (increased sensitivity).
  • Vitals and Bloodwork: While most dogs had normal vitals like heart rate, respiratory rate, and body temperature, common abnormalities included systemic hypertension (60.7%), tachycardia (37%), and hyperthermia (22.6%). Common electrolyte abnormalities included mild hyperkalemia (51.3%) and mild hypercalcemia (79.1%), with the researchers noting that this study was the first to report such abnormalities in dogs.
  • Prognosis: Fortunately, all dogs survived; however, 22% were hospitalized.

The denial of dog owners in disclosing the possibility of marijuana exposure can lead to delays in diagnosis and treatment, resulting in needless testing, increased costs, and undue stress. Educating pet owners on the risks and signs of marijuana exposure and ensuring veterinarians are equipped with the tools and resources to diagnosis marijuana toxicity, are critically needed. These findings underscore the need for policies to prioritize the health and safety of pets, especially considering that many of these cases occurred within the same year as legalization in the area where the university hospital is located, as the researchers point out.

Source: Save Our Society From Drugs | 333 3rd Ave N Suite 200 | St. Petersburg, FL 33701 US

 

Filed under: Animals,Cannabis/Marijuana,Drug use-various effects,USA :
A recent poll, conducted by Gallup, found that there has been a shift in public opinion regarding marijuana.

This is SAM’s  The Drug Report’s Friday Fact report
 

The first asked the question, “What effect do you think the use of marijuana has on most people who use it – very positive, somewhat positive, somewhat negative or very negative?” Gallup focused on several demographic subgroups and found that all of them were less likely in 2024 than in 2022 to say that marijuana had a positive effect on users. Here’s a breakdown for each subgroup:
This poll revealed a 12% drop among Independents, a 7% drop among young adults,  and a 13% drop among nonreligious people. Likewise, as the percentage of Americans that say marijuana has a positive effect on most people who use it has declined, there has been an increase in the percentage that say it has a negative effect on them. This increased from 45% in 2022 to 51% in 2024, with the remainder answering that they had “no opinion.” A majority of Americans now recognize that marijuana has harmful effects on users, which include cannabis use disorder, depression, anxiety, and impairment, among others.

 

A second question asked, “What effect do you think the use of marijuana has on society – very positive, somewhat positive, somewhat negative or very negative?” It found that the percentage of Americans that thought it was “very negative” or “somewhat negative” increased from 50% in 2022 to 54% in 2024, as the percentage that thought it had a “very positive” or “somewhat positive” effect declined from 49% to 41%.

 

More and more Americans are waking up to the harmful effects of marijuana. Now a majority of Americans believe that marijuana is harmful for both users and society. Public opinion is clearly shifting as more families have seen first-hand the results of marijuana use.

Source: Smart Approaches to Marijuana (SAM) – Friday Fact – Fri 30/08/2024
Filed under: Cannabis/Marijuana,Drug use-various effects,Prevalence,USA :

By Dr. Liji Thomas, MDReviewed by Benedette Cuffari, M.Sc.  Aug 28 2024

How can modern psychedelic research and traditional approaches integrate to address substance use disorders and mental health challenges?

A recent study published in the Journal of Studies on Alcohol and Drugs discusses the history and current state of psychedelic research for the treatment of substance abuse disorders (SUDs).

Psychedelics

Psychedelics are consciousness-altering drugs, some of which include lysergic acid diethylamide (LSD), dimethyltryptamine (DMT), psilocybin, and mescaline. Methylenedioxymethamphetamine (MDMA) and ketamine are also considered psychedelics; however, these drugs have different mechanisms of action.

Although psychedelics have been exploited for centuries to induce altered states of consciousness, their use, as opposed to their abuse, has largely been unexplored in modern medicine. In fact, several studies have indicated the potential utility of psychedelics for individuals who have mental illness due to traumatic experiences, false beliefs, and unhealthy behavioral patterns, such as posttraumatic stress disorder (PTSD) and depression.

The recent coronavirus disease 2019 (COVID-19) pandemic led to global changes in the use of methamphetamine, alcohol, and cannabis, as well as a significant increase in opioid overdoses in the United States. Thus, another promising application of psychedelics is their potential use for treating SUDs.

However, restrictive policies, poor funding, lack of equitable and diverse recruitment and access, as well as the multiplicity of small-scale psychedelic research programs have prevented researchers from effectively investigating the effects of psychedelics in the treatment of SUDs.

Overview

Over the past seven decades, researchers have become increasingly interested in examining the potential use of psychedelics in traditional medicine. Despite federal policies banning recreational drug use, researchers have elucidated some of the biological effects of psychedelics on the central nervous system (CNS) and their potential role in the treatment of SUDs. Nevertheless, there remains a lack of well-controlled multi-center trials and systematic reviews in this area.

As researchers continue to examine the pharmacological potential of these drugs, it is crucial to address their addiction and abuse potential, the legalization of recreational drugs, and the attempts of pharmaceutical companies to introduce high-selling psychedelics as therapies for mental illness.

History and current use of psychedelics

Psychedelics like ayahuasca, Peyote, and psilocybin-containing mushrooms have been used throughout history by traditional healers and indigenous communities for both spiritual and health purposes. By recognizing these contributions, researchers can benefit from the potential benefits of traditional usage patterns while investigating the use of these drugs for treating SUDs and other mental health disorders.

For example, a hybridized SUD therapy program in Peru utilizes ayahuasca to treat alcohol and drug use. At one year following treatment, reduced depression and anxiety, higher quality of life, and reduced severity of addiction have been reported.

One notable contribution is the acknowledgment that key experiences of treatment participants might provide more insight than the search for putative “active ingredients” of interventions as complex as psychedelic-assisted treatment.”

Purging in psychedelic treatment

Psychedelic use, specifically ayahuasca use, is closely linked to vomiting as a means of purging the body. This is reported to have spiritual, Amazonian, and clinical benefits.

Conclusions

The optimal approach to psychedelic-assisted treatment involves mutual respect for and recognition of the value of both traditional and modern applications. Thus, mixed-methods research is crucial, as traditional approaches may help identify a better therapeutic agent or program than traditional approaches to identifying and isolating active ingredients.

However, it is essential to evaluate and quantify the success rates of traditional approaches to psychedelic use, as well as elucidate the biological mechanisms that may contribute to their therapeutic effects. Researchers must recognize and credit traditional history and practices throughout these efforts to protect these cultures from being exploited, ignored, and suppressed by pharmaceutical industries.

The rush to patent processes in psychedelic treatments of addiction and other psychiatric conditions reflects the enormous greed of private commercial entities to benefit financially from vulnerable patients in need of effective therapies.

Thus, regulatory control of psychedelic therapies is vital to establish rigorous research standards that can lead to the generation of sufficient evidence in this area. Without this type of overview, private corporate interests may seek to exploit governmental support for crucial research needed to address these mental health issues.

Source:  https://www.news-medical.net/news/20240828/Psychedelics-A-new-hope-for-substance-abuse-treatment.aspx

Filed under: Brain and Behaviour,Drug use-various effects,Health,Methamphetamine/GHB/Hallucinogens/Oxycodone,Prevention and Intervention,Psychiatric drugs,USA :
By Lauraine Langreo, Staff Writer,  Education Week — August 28, 2024  

There have been “promising” declines in high school students’ overall use of illicit substances, concludes a report from the federal Centers for Disease Control and Prevention.

Since 2013, the percentage of students who reported drinking alcohol, using marijuana, or using select illicit drugs at any point has decreased. Since 2017 and 2019, respectively, the percentage of students who had ever misused or currently are misusing prescription opioids decreased, according to the CDC’s Youth Risk Behavior Survey.

That survey draws on data collected every two years among a nationally representative sample of U.S. high school students. The 2023 survey had more than 20,000 respondents and was conducted in the spring.

Still, many students continue to use substances and the lack of progress in some areas is concerning, according to the report.

The findings come as schools continue to face challenges in curbing students’ substance abuse, which could negatively affect learning, memory, and attention, according to experts. It could also be a sign of mental health challenges.

___________________________________________________________________________________________________________

Teen substance use

Percentage of high school students who ...

*Question introduced in 2017.
**Question introduced in 2019.

DATA SOURCE: CDC

____________________________________________________________________________

While student substance abuse isn’t a new challenge for school districts, the substances that adolescents are experimenting with now are much more dangerous, said Darrell Sampson, the executive director of student services for the Arlington public schools in Virginia.

“It’s not necessarily that more kids are using substances than in prior years,” Sampson said. “It’s the lethality of the substance itself that has caused higher levels of concern.”

Research has shown rising overdose deaths among teens even as their substance use is declining. Those deaths have been linked to the increase in illicit fentanyl and other synthetic opioids. School districts have been pursuing several strands of legal action against companies that manufactured and marketed addictive opioids that have led to tens of thousands of deaths and countless more addiction struggles in the last two decades.

Beyond the legal actions, schools also continue to provide prevention and education programming for students and families, Sampson said. There’s “a glimmer of hope” that those measures are working, he said, based on the declines in the CDC data.

Experts recommend starting education about substance abuse as early as possible

In the Arlington, Va., district, students in grades 6 through 10 learn about substance abuse challenges as part of the health curriculum, Sampson said. The district has also slowly expanded that program to 5th and 4th grades and are looking into whether there’s capacity to start that education as early as 3rd grade.

“We know that the more we can at least open that conversation with our families and our students, the better off our students are going to be,” Sampson said. “It’s not just a message [they’re hearing] starting in middle school, but it’s a message [they’re hearing] over time.”

The district is expanding programming with 11th and 12th graders, too, because the information they got when they were in 10th grade could be outdated by then, Sampson said.

In addition, the district has substance abuse counselors who meet with students and try to explore the reasons they might be using substances, Sampson said.

Experts say it’s also important to think about how to incorporate student voice in any prevention or intervention programming.

Teens are more than twice as likely to go to their friends or peers for help or support when experiencing distress from their substance use than they are to go to a behavioral health provider or a family member, according to a survey from the Bipartisan Policy Center conducted in June among 932 teens (13- to 17-year-olds) and 1,062 young adults (18- to 26-year-olds). More than a quarter of teens said they didn’t go to anyone for help or support when they experienced distress from substance use.

Sophie Szew, a junior at Stanford University and the Bipartisan Policy Center’s mental health and substance use task force youth adviser, said those survey results “really underscore the importance of investing in those peer support networks and resources.”

______________________________________________________________________________________________

Teenagers who have experienced distress from substance use

Who have teens gone to for help/support when experiencing distress from substance use?

Category Percent

Friend/peer                                                             43

Behavioural health provider                                 19

Parent, care givers, other family members        18

Primary care provider                                              9

Religious/spiritual leader                                       9

School counsellor                                                     8

Teacher                                                                       6

Coach/mentor                                                           6

Crisis services (988, crisis text line)                     5

Virtual app or website services                             4

Other adult n the community                               8

Other                                                                         2

No one                                                                    27

____________________________________________________________________________
Source: https://www.edweek.org/leadership/teen-substance-use-is-declining-but-more-dangerous-drug-abuse-is-emerging/2024/08

Filed under: Alcohol,Drug use-various effects,Education,Prevalence,USA,Youth :
  • A 48-year-old woman in California developed meningitis after between three and six medical marijuana blunts contaminated by a fungus daily
  • Meningitis causes potentially fatal brain and spinal cord inflammation 
  • This is the first known case of meningitis coming from cannabis 
  • The soil in Bakersfield, where the woman lived is known to be contaminated with another fungus that causes the flu-like ‘valley fever’ 
  • The dispensary and area soil are being investigated, though similar infections are unlikely for healthy people who smoke smaller quantities    

A 48-year-old woman in California contracted a potentially deadly meningitis infection in 2016 from smoking her favourite medical marijuana strain three to six times a day, according to a British Medical Journal case study report published last month. 

The infection came from a fungus, called cryptococcus, that most people contract from inhaling contaminated dust or eating food that mouse faeces have touched. 

Meningitis is the most common illness to develop from exposure to cryptococcus, and causes potentially fatal inflammation in the brain and spinal cord. 

Dr Bryan Shapiro, who treated the woman, says that cannabis smokers in California should be sure to know where their marijuana came from, especially if their immune systems are compromised in any way, as meningitis could be lethal for them. 

The unnamed woman’s sister brought her to the Cedars-Sinai Medical Center (CSMC) in Los Angeles, California. She had ‘strange symptoms,’ Dr Shapiro said, including being dizzy, tired, struggling to recall even her own name, and behaving aggressively. 

In fact, her behaviour had become so erratic that she was fired from her job as an administrative assistant before being admitted to the hospital. 

At CSMC, the emergency room team could not figure out what was ailing the otherwise healthy patient. When she assaulted a nurse, the team called in the psychiatric department.  

‘We thought it might be catatonia [abnormal movement triggered by mental issues], and it took us some time to rule out a psychiatric illness,’ Dr Shapiro said. 

Still unable to diagnose her, they took a sample of her brain fluid, which tested positive for Cryptococcus neoformans, ‘a rare fungal infection usually only seen in people with late stage HIV or transplant patients,’ Dr Shapiro explained. 

But the woman was otherwise in reasonably good health. The only things that stood out in her medical history were high blood pressure and a significant marijuana habit. 

‘She said she had smoked between three and six marijuana blunts about daily since her teenage years,’ Shapiro said, ‘I’ve never known a patient who smokes that heavily and wondered if there could be a link between her heavy cannabis use for a lifetime.’ 

They treated the woman for meningitis, but if they hadn’t done so ‘prudently…there is a strong possibility she would have died, she was very, very severe at the time we saw her,’ he says. 

As she was recovering, Dr Shapiro and his team investigated her favourite medical marijuana dispensary in Bakersfield where she always purchased one of the shop’s cheaper strains, which was grown locally outdoors.

DNA sequencing of nine samples revealed small amounts of the rare fungus. 

‘That lent credibility to the idea that the cryptococcus in the cannabis may have caused the woman’s systemic malfunction, and smoking might actually predispose someone to invasive fungal infection,’ Dr Shapiro said. 

Fungus spores are actually grow on cannabis quite commonly. 

A study conducted last year identified evidence of mould, pesticides and other contaminants on much of the weed grown in the state.  

More than 90 percent of the marijuana plants tested were contaminated with pesticides, and crops from 20 farms were positive for mold. 

The soil in Bakersfield and the surrounding Central Valley area is known to be a breeding ground for another fungus called Coccidioides immitis, which is to blame for a slew of cases of an infection, dubbed ‘valley fever.’ 

Valley fever is a potentially sever lung infection and its symptoms can mirror those of the flu that has killed nearly 100 people in California since the start of the year. 

The prevalence of the valley fever fungus – which causes infection when it is inhaled – in the area ‘raised suspicions’ for Dr Shapiro and his team that the soil could harbour cryptococcus as well. 

The spores of these fungi are very heat resistant, so they survive even as the weed they are attached to is smoked. 

Even so, it is rare for someone with an otherwise healthy immune system to get such an infection, and Dr Shapiro points to other research that has suggested that THC – the psychoactive component of weed – may itself suppress the immune system. 

‘So, the more you smoke, the greater the exposure [to the fungus and] the more likely it is that your body is unable to fight off the infection,’ he says. 

Dr Shapiro was unable to disclose the name of the particular dispensary that the contaminated marijuana came from, but said that it is under investigation.

This case was the first of its kind that Dr Shapiro or his team had seen, so it’s too early to make formal recommendations, he says, but advises: ‘Make sure you know where your marijuana is coming from. 

‘I recommend buying indoor-grown strains and, for people who are immuno-compromised like those with HIV or other infections, I would recommend avoiding inhaled marijuana products,’ he says. Edible products, on the other hand are probably safer for consumption.     

Source: https://www.dailymail.co.uk/health/article-5327367/California-woman-caught-meningitis-CANNABIS.html January 2018

Filed under: Cannabis/Marijuana,Drug use-various effects,Health,Marijuana and Medicine :
Open Access: https://en.wikipedia.org/wiki/Open_access
Published:July 25, 2024 DOI:https://doi.org/10.1016/S2666-7568(24)00108-9
The article as uploaded shows link to tables e.g.(Table X) which, for brevity, have been deleted. Please therefore ignore these links!

Summary

Background

Cancer, coronary heart disease, dementia, and stroke are major contributors to morbidity and mortality in England. We aimed to assess the economic burden (including health-care, social care, and informal care costs, as well as productivity losses) of these four conditions in England in 2018, and forecast this cost to 2050 using population projections.

Methods

We used individual patient-level data from the Clinical Practice Research Datalink (CPRD) Aurum, which contains primary care electronic health records of patients from 738 general practices in England, to calculate health-care and residential and nursing home resource use, and data from the English Longitudinal Study on Ageing (ELSA) to calculate informal and formal care costs. From CPRD Aurum, we included patients registered on Jan 1, 2018, in a CPRD general practice with Hospital Episode Statistics (HES)-linked records, omitting all children younger than 1 year. From ELSA, we included data collected from wave 9 (2018–19). Aggregate English resource use data on morbidity, mortality, and health-care, social care, and informal care were obtained and apportioned, using multivariable regression analyses, to cancer, coronary heart disease, dementia, and stroke.

Findings

We included 4 161 558 patients from CPRD Aurum with HES-linked data (mean age 41 years [SD 23], with 2 079 679 [50·0%] men and 2 081 879 [50·0%] women) and 8736 patients in ELSA (68 years [11], with 4882 [55·9 %] men and 3854 [44·1%] women). In 2018, the total cost was £18·9 billion (95% CI 18·4–19·4) for cancer, £12·7 billion (12·3–13·0) for coronary heart disease, £11·7 billion (9·6–12·7) for dementia, and £8·6 billion (8·2–9·0) for stroke. Using 2050 English population projections, we estimated that costs would rise by 40% (39–41) for cancer, 54% (53–55) for coronary heart disease, 100% (97–102) for dementia, and 85% (84–86) for stroke, for a total of £26·5 billion (25·7–27·3), £19·6 billion (18·9–20·2), £23·5 billion (19·3–25·3), and £16·0 billion (15·3–16·6), respectively.

Interpretation

This study provides contemporary estimates of the wide-ranging impact of the most important chronic conditions on all aspects of the economy in England. The data will help to inform evidence-based polices to reduce the impact of chronic disease, promoting care access, better health outcomes, and economic sustainability.

Introduction

Public health initiatives and the development of cardioprotective medications have led to an increase in life expectancy in the past six decades, giving rise to an ageing population.

This ageing population is suffering from a different set of medical issues than the population a century ago, with cancer, coronary heart disease, dementia, and stroke being the four leading causes for mortality and morbidity in England.

In 2019, these four conditions accounted for 59% of all deaths and 5·1 million disability-adjusted life-years in England.

Research investment is essential to combat major public health challenges, facilitating the development of new treatments and interventions that can improve rates of prevention, treatment, or management of diseases, enhancing quality of life and reducing their economic burden. However, it is important that the distribution of research funding across diseases is proportionate to their respective impact on society. In 2008, a UK study (Dementia 2010) evaluated the economic costs of, and research investment into dementia, and compared these costs and investments with those for cancer, coronary heart disease, and stroke.

Such estimates are important to inform health policy and identify diseases in need of greater investment,

with successive UK Governments having placed a greater priority for research funding in dementia.

However, previous studies that quantified the costs of these four chronic conditions had several important limitations, including that care resource use for each of the four conditions was apportioned based on assumptions and estimates from the literature, with methods differing between conditions. With representative cohorts from England, we are now able to estimate the economic burden of these conditions using individual patient-level data and a consistent methodology across conditions. Therefore, we aimed to estimate the economic burden of cancer, coronary heart disease, dementia, and stroke in England in 2018, and forecast this cost to 2050 using population projections.
Research in context
Evidence before this study
We conducted a systematic review of the literature to identify studies evaluating the costs of dementia. We searched MEDLINE, Embase, Cochrane Database of Systematic Reviews, Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, EconLit, Cost-Effectiveness Analysis Registry, Turning Research Into Practice, NHS Economic Evaluation Database, Science Citation Index, Research Papers in Economics, and OpenGrey Repository from Jan 1, 2000, to Aug 31, 2023. Search terms included “dementia”, “Alzheimer’s disease”, “cognitive impairment”, “costs”, and “resources”, among others. Except for one study conducted for the year 2008, we did not find any current study evaluating and contrasting the costs of the four chronic conditions with the highest mortality and morbidity burden in England—namely, cancer, coronary heart disease, dementia, and stroke. This study found that the total costs of dementia in England were £23·4 billion, followed by cancer (£12·0 billion), coronary heart disease (£7·8 billion), and stroke (£5·0 billion). However, these estimates were not estimated concurrently, with methodologies and sources of data varying considerably across conditions, including from generally small studies, which did not capture the impact of comorbidities on the levels of care provided. Therefore, results for each of the four conditions are probably not comparable.
Added value of this study
Our study assesses the total costs of cancer, coronary heart disease, dementia, and stroke, concurrently using patient-level data from two representative English cohorts: the Clinical Practice Research Datalink Aurum and the English Longitudinal Study on Ageing. We show that cancer, coronary heart disease, and dementia had similar overall health-care and social care costs, but when other costs were included, cancer had the highest overall economic burden. Using age-specific and gender-specific population projections to 2050, we found that the costs of the four conditions increased by 64% due to population ageing alone, with social care costs increasing by 104% between 2018 and 2050.
Implications of all the available evidence
Our study sheds light on the significant consequences of the four most important chronic conditions in terms of mortality and morbidity in England on various sectors of the economy. The data we present not only emphasise the magnitude of the economic burden caused by cancer, coronary heart disease, dementia, and stroke but also provide valuable insights for public health decision makers. By identifying the specific areas that require targeted interventions, our findings can guide policy makers in implementing strategic measures to alleviate the economic burden of these four conditions. With a projected increase in costs of 64% by 2050, our research findings can aid in directing governmental research expenditure to areas that hold the greatest potential for advancing the prevention, diagnosis, and treatment of disease, further reducing its economic impact on England.

Methods

Analysis framework and data sources

We adopted a societal perspective for our analyses, with inclusion of the following costs: health care, social care (defined as residential and nursing home, and formal care costs), informal care, and productivity losses. We used an annual timeframe that included all costs for 2018, irrespective of the time of disease onset. We obtained England-specific aggregate resource use data on health and social care, mortality, morbidity, and prevalence of disease. To apportion aggregate data on health, and residential and nursing home resource use to each of the four conditions, we analysed individual patient-level data from the Clinical Practice Research Datalink (CPRD) Aurum linked to National Health Service Hospital Episode Statistics (HES).

CPRD Aurum is a large database of routinely recorded primary care electronic health records of patients from 738 general practices in England (10% of practices), covering 13% of the population.

The database contains information on symptoms, diagnoses, prescriptions, referrals, tests, immunisation, and medical staff. Primary care and secondary care diagnosis codes were used to identify the four conditions of interest. CPRD Aurum codes used to diagnose patients in primary care are reported in the appendix (pp 2–55). CPRD records were then linked to secondary care records contained in HES using Aurum (version 2.3) from August, 2019. In secondary care records, cancer was defined by ICD-10 category codes I00–I99, coronary heart disease by codes I20–I25, dementia by codes F00–F03 and G30, and stroke by codes I60–I69. The use of CPRD Aurum for this study was approved by the independent scientific advisory committee for CPRD research (protocol reference CPRD00120051). CPRD obtains annual research ethics approval from the UK’s Health Research Authority Research Ethics Committee (05/MRE04/87) to receive and supply patient data for public health research. No further ethical permissions were required for the analyses of these anonymised patient-level data. The analysis was based on 4 161 588 patients registered on Jan 1, 2018, in a CPRD general practice with HES-linked records, omitting all children younger than 1 year (appendix pp 56–57).

Informal and formal care information was obtained from the English Longitudinal Study on Ageing (ELSA).

ELSA collects data from people older than 50 years, with spouses from age 40 years also included, to understand all aspects of ageing in England. More than 18 000 people have taken part in the study since it started in 2002, with the same people re-interviewed every 2 years. For this study, we used information on wave 9 (2018–19; appendix pp 58–59). Access to ELSA, through the UK Data Service, was obtained as part of the UK Access Management Federation. ELSA has been approved by the National Research Ethics Service (London Multicentre Research Ethics Committee [MREC/01/2/91]).

Health-care resource costs

Primary care consisted of visits with general practitioners and practice nurses in health-care facilities or in patients’ homes. Accident and emergency care consisted of all hospital emergency visits. Outpatient care consisted of specialist consultations and treatments in outpatient wards, clinics, or patients’ homes. Hospital care consisted of hospital admissions, including day cases and inpatient stays. Pharmaceutical expenditure included the costs of all prescriptions dispensed in the community (eg, pharmacies), but excluded costs of medications administered in secondary care settings, which were included in the costs of inpatient care.
We obtained the overall total number of all-cause health-care contacts with each type of service and medication expenditure in England (table 1; appendix p 60). Patient-level data from CPRD Aurum with HES linkage were then used to apportion all-cause health-care contacts and pharmaceutical expenditure in England to cancer, coronary heart disease, dementia, and stroke. All resource use was valued using relevant unit costs.

Nursing and residential care home costs

We included resources associated with living in a nursing home (requiring 24 h nursing care) or residential home (accommodation supporting people who are not able to manage everyday tasks).

Of the more than 10 million people in England aged 65 years or older in 2018, 5% were living in a nursing or residential care home.

Using patient-level data from CPRD Aurum, we apportioned the proportion of people living in a nursing or residential care home in England due to cancer, coronary heart disease, dementia, and stroke (table 1; appendix pp 65–66). Nursing and residential home care home cost was valued at £837 per week,

taking into account the relative proportions of people living in nursing and residential homes,

and the local authority, not-for profit, and profit sector provision case mix.

Informal and formal care

Informal care costs were equivalent to the opportunity cost of unpaid care (ie, the time [work, leisure, or both] that carers forgo), valued in monetary terms, to provide unpaid care for relatives or friends with cancer, coronary heart disease, dementia, or stroke, and based on the conservative assumption that only patients limited in daily activities received care. We valued informal care using the proxy good method, in which an hour of informal care provided was valued using the labour market price of a close market substitute

(i,e. the mean hourly wage for a home care assistant [£7·85]).

Hence, for informal care, we multiplied the age-specific and gender-specific products of age-specific and gender-specific prevalence of cancer, coronary heart disease, dementia, and stroke in England;

the probability of living in the community (appendix p 66); the probability of being severely limited in daily activities as a result of each of the four conditions under study (appendix p 67); the probability of receiving informal care conditional on being limited in daily activities (appendix p 67); and the hours of informal care received, conditional on being limited in daily activities and receiving informal care (appendix p 67).

Formal care costs included the costs associated with paid care for patients living in the community, which was valued at £27·00 per h.

For formal care, we multiplied the age-specific and gender-specific products of age-specific and gender-specific prevalence of cancer, coronary heart disease, dementia, and stroke in England;

the probability of living in the community (appendix p 66); the probability of receiving formal care (appendix p 68); and the hours of formal care received, conditional on receiving formal care (appendix p 68).

Given that ELSA had no participants younger than 40 years, care was only estimated for those aged 40 years or older.

Morbidity losses

Morbidity losses were determined to be the cost associated with temporary or permanent absence from work in patients with cancer, coronary heart disease, dementia, or stroke.

Annual days off sick were obtained from the European Working Conditions Surveys.

To the total number of days of work due to sickness, we applied the proportion of absence that was attributable to cancer, coronary heart disease, dementia, and stroke, which was obtained from the UK Department of Works and Pensions (personal communication).

To calculate permanent absence from work due to sickness or disability, information on the numbers of working-age individuals receiving incapacity or disability benefits and not being able to work was obtained, including recipients of the disability living allowance, employment support allowance (ESA), and incapacity benefit by condition.

Given that recipients of ESA can work up to 45·82% of their time, we only included the proportion of time that was not worked.

Days of absence from work due to sickness or disability were multiplied by mean daily earnings.

Furthermore, for permanent absence, we used the friction period approach because absent workers are likely to be replaced, whereby only the first 90 days of work absence were counted.

Mortality losses

We assumed an initial working age of 15 years and a maximum age of retirement of 79 years. Age-specific and gender-specific deaths due to cancer, coronary heart disease, dementia, and stroke were obtained.

The number of potential working years lost was then estimated as the difference between the age at death and maximum age of retirement. Each lost year of working life was valued using average annual earnings.

However, not all of the population is economically active until age 79 years; hence, age-specific and gender-specific unemployment and activity rates

were applied to the potential foregone earnings. Following UK-recommended guidelines, future earnings lost due to mortality were discounted to present values using a 3·5% annual rate.

Statistical analysis

CPRD Aurum data analyses informed the age-specific and gender-specific health-care resource use and nursing or residential care home use associated with cancer, coronary heart disease, dementia, and stroke. ELSA data analyses were used to derive the age-specific and gender-specific estimates needed to inform the calculations of informal and formal care received associated with the four conditions. To achieve this, we used regression analyses (Poisson, logistic, and generalised linear models) for each type of resource use, adjusting for history of cancer, coronary heart disease, dementia, or stroke; Elixhauser comorbidity index; age; and gender. Together with data on disease prevalence, we used the derived models to estimate the total costs associated with each condition. For more details, see the appendix (pp 60–68).

Finally, we projected the costs estimated for 2018 to 2050 based on future projections of the population alone,

excluding other factors such as epidemiological trends of the four conditions under investigation, risk factor prevalence rates, and life expectancy.

For this, we applied age-specific and gender-specific rates of resource use, prevalence, mortality, and disability observed in 2018 to the predicted distribution of the population in 2050. We valued resource use in 2050 using 2018 costs. For more details, see the appendix (pp 69–71).

Total resource use estimates and costs are reported alongside 95% CIs, which were derived using 1000 bootstrap estimates of all resource use regressions undertaken in CPRD Aurum and ELSA. Given that country-wide productivity loss estimates were obtained (eg, disease-specific working days lost, disability claims, and deaths), sampling uncertainty was not required, and these cost estimates are provided as point estimates. Population projections were not provided with uncertainty levels so these are also treated as point estimates. Significance was set at a p value of less than 0·05.
All analyses were conducted in STATA (version 15, 64-bit).

Role of the funding source

The funder of the study had no role in the study design; the collection, analysis, and interpretation of data; the writing of the report; or in the decision to submit the paper for publication.

Results

The analyses to apportion total all-cause health-care and nursing and residential care home resource use in England to cancer, coronary heart disease, dementia, and stroke was based on 4 161 558 patients in CPRD Aurum with linked HES data (mean age 41 years [SD 23]), with 2 079 679 (50·0%) men and 2 081 879 (50·0%) women. Of these patients, 174 942 (4·2%) had a history of cancer either in primary or secondary care records, 191 603 (4·6%) of coronary heart disease, 52 862 (1·3%) of dementia, and 61 509 (1·5%) of stroke (appendix p 56).
To estimate total hours of formal and informal care in England due to cancer, coronary heart disease, dementia, and stroke, analyses were based on 8736 patients in ELSA (mean age 68 years [SD 11]), with 4882 (55·9%) men and 3854 (44·1%) women. Of these patients, 744 (8·5%) had a history of cancer, 423 (4·8%) of coronary heart disease, 211 (2·4%) of dementia, and 313 (3·6%) of stroke (appendix p 58).
Of all admissions to hospitals (including day cases and inpatient stays) in 2018, 2 164 000 (95% CI 2 083 000–2 243 000) admissions were found to be associated with patients with cancer, followed by coronary heart disease (1 081 000 [1 053 000–1 110 000]), stroke (517 000 [497 000–535 000]), and dementia (234 000 [224 000–244 000]; table 2). The condition with the highest prescribed pharmaceutical expenditure was coronary heart disease (£982 million [95% CI 968–998]), followed by cancer (£925 million [909–940]), stroke (£451 million [437–464]), and dementia (£277 million [269–285]). Overall, the health-care costs associated with these conditions in England were £8·1 billion (95% CI 8·0–8·2) for cancer, £6·7 billion (6·6–6·7) for coronary heart disease, £1·5 billion (1·5–1·6) for dementia, and £3·4 billion (3·4–3·5) for stroke.
About 133 000 (95% CI 126 000–141 000) people older than 65 years with dementia were living in residential or nursing homes in 2018. This estimate was higher than for stroke (75 000 [95% CI 70 000–80 000]), coronary heart disease (52 000 [49 000–54 000]), and cancer (33 000 [31 000–35 000]). Living in residential or nursing homes accounted for costs of £5·8 billion (95% CI 5·5–6·1) for dementia, £3·2 billion (3·1–3·4) for stroke, £2·2 billion (2·1–2·4) for coronary heart disease, and £1·4 billion (1·4–1·5) for cancer (table 2).
Overall health-care and social care costs were £9·7 billion (95% CI 9·5–9·9) for cancer, £8·9 billion (8·8–9·0) for coronary heart disease, £8·0 billion (7·3–8·6) for dementia, and £6·9 billion (6·6–7·1) for stroke (table 2). This resulted in costs of £174 (95% CI 171–178) per capita for cancer, £162 (158–164) for coronary heart disease, £144 (132–155) for dementia, and £124 (120–129) for stroke (appendix p 72). Per person with the condition, the highest health-care and social care costs were associated with stroke at £12 923 (95% CI 12 491–13 399), followed by dementia at £11 641 (10 680–12 558), cancer at £6660 (6526–6803), and coronary heart disease at £5530 (5437–5625).
Friends and family spent a total of 115 million h (95% CI 62–175) providing informal care for patients with cancer; 95 million h (46–137) for those with coronary heart disease, 461 million h (224–561) for those with dementia, and 75 million h (37–110) for those with stroke (table 2). Total informal care costs were £905 million (95% CI 486–1374) for cancer, £748 million (365–1758) for coronary heart disease, £3619 million (1758–4405) for dementia, and £587 million (291–865) for stroke.
More than 271 000 working years were lost due to cancer, 80 000 due to coronary heart disease, 3000 due to dementia, and 37 000 due to stroke, with corresponding mortality losses of £7·8 billion, £2·6 billion, £0·1 billion, and £0·8 billion, respectively (table 2). Losses due to temporary and permanent absence from work due to illness and disability for the conditions under study were £497 million for cancer, £378 million for coronary heart disease, £49 million for dementia, and £362 million for stroke. Overall, productivity losses were highest for cancer (£8·3 billion), followed by coronary heart disease (£3·0 billion), stroke (£1·2 billion), and dementia (£0·1 billion).
The overall costs in England in 2018 were £18·9 billion (95% CI 18·4–19·4) for cancer, £12·7 billion (12·3–13·0) for coronary heart disease, £11·7 billion (9·6–12·7) for dementia, and £8·6 billion (8·2–9·0) for stroke (table 2). Per case, patients with dementia had the highest costs at £17 145 (95% CI 13 998–18 604), followed by stroke at £16 224 (15 482–16 954), cancer at £13 031 (12 681–13 393), and coronary heart disease at £7857 (7599–8068; appendix p 72).
The way costs were distributed among cost categories varied considerably by condition (table 2; figure 1). The proportion of total costs due to health care varied from 52% (£6·7 billion) for coronary heart disease to 13% (£1·5 billion) for dementia. Although productivity losses accounted for 44% (£8·3 billion) of the total costs for cancer, for dementia these accounted for 1% (£145 million) of total costs.
Figure 1 – Distribution of total costs in patients with cancer, coronary heart disease, dementia, and stroke in England in 2018

 

The population of England, excluding those younger than 1 year, is expected to increase from 55 million in 2018 to 65 million in 2050 (18% increase), with the population aged 65 years or older projected to increase by 49% (from 10 million to 15 million).

Assuming no changes in age-specific and gender-specific prevalence rates, this population increase will increase the number of people with cancer by 39% (2·0 million), coronary heart disease by 45% (2·3 million), dementia by 81% (1·2 million), and stroke by 41% (0·8 million; appendix p 69).

These increases in the overall disease prevalence will result in cost increases between 2018 and 2050 of 40% (95% CI 39–41) to £26·5 billion (25·7–27·3) for cancer, 54% (53–55) to £19·6 billion (18·9–20·2) for coronary heart disease, 100% (97–102) to £23·5 billion (19·3–25·3) for dementia, and 85% (84–86) to £16·0 billion (15·3–16·6) for stroke (table 3). Costs with the highest increases are those related to social care, which are projected to rise between 2018 and 2050 by 88% (95% CI 86–90) to £2·9 billion (2·7–3·3) for cancer, 91% (90–92) to £4·4 billion (4·1–4·6) for coronary heart disease, 110% (109–111) to £13·5 billion (12·1–14·8) for dementia, and 109% (107–108) to £7·1 billion (6·6–7·5) for stroke (figure 2).

Figure 2 – Total costs of cancer, coronary heart disease, dementia, and stroke in England in 2018 and the projected costs in 2050 due to demographic change alone

Discussion

Whereas a previous study has assessed the overall costs of chronic conditions, our study made use of individual patient-level data to generate more precise cost estimates for cancer, coronary heart disease, dementia, and stroke, using the same methodology and sources across conditions. Previously the total costs of dementia in the UK were calculated as £23·4 billion, followed by cancer (£12·0 billion), coronary heart disease (£7·8 billion), and stroke (£5·0 billion).

These estimates are not comparable with the findings in this study, possibly due to methodologies and sources of data varying considerably across conditions.

Our results show that the areas of the economy bearing these costs differed substantially by disease area. For example, health-care costs of dementia accounted for 13% (£1·5 billion) of the total, with most costs being borne by the social care system (£6·4 billion, 55% of total costs). By contrast, in cancer, the majority of costs were borne by the labour market, with £8·3 billion in lost productivity (44% of total costs). These findings are notable in that they further emphasise the need for interventions designed to prevent or screen for early-stage disease. For cancer and, to a lesser extent, coronary heart disease, with so much of the cost borne by the labour market, interventions that prevent the disease will not only increase the health of the population and reduce health-care costs, but also improve labour productivity. However, these findings also raise important questions about perceived fairness and equality.

In the UK, about 90% of hospital cases, which according to our findings is where most of the care of patients with cancer or coronary heart disease takes place, is funded by the government (data are from the Eurostat database). By contrast, for dementia and, to a lesser extent, stroke, most of the care takes place in either the social care system, of which 60% is funded by the government, or by relatives and friends through informal care (data are from the Eurostat database). Therefore, patients with dementia and stroke are substantially at higher risk of having to fund their care themselves than those with cancer or coronary heart disease.

Our study also shows the effect of the projected population ageing over the coming decades. On the basis of demographic change alone, we project that the costs of cancer will increase by 40%, those of coronary heart disease by 54%, those of dementia by 100%, and those of stroke by 85%. With the population aged 65 years or older projected to increase by 49%, the costs with the fastest projected rise will be, averaged across all four conditions, for social care, with a 104% projected increase in costs, and informal care, with a projected increase of 78%. Therefore, research funding into interventions aimed to prevent, treat, and care for disease are required as a way to help to reduce or mitigate this projected increase in costs and improve health, especially in those conditions—ie, stroke and dementia—seeing the fastest increase in costs, and that historically have received the lowest levels of research funding.

The limitations of this study should be noted. Our results are based on diagnostic coding from both primary and secondary care records, rather than on careful ascertainment of patients through multiple and overlapping methods such as in population-based cohort studies. Therefore, our results might not reflect the absolute prevalence and costs of disease. Given that there is no single and simple diagnostic test for dementia, this under-ascertainment of disease in routinely collected health data or surveys might be most prevalent in dementia.

The failure to identify these undiagnosed cases might explain the relatively low levels of health-care resource use identified in CPRD Aurum due to dementia.

For diseases affecting cognitive ability, such as dementia and stroke, supervision will be a major component of any informal care provided.

However, in ELSA, respondents were not explicitly asked for supervisory activities received, with our results likely to be an underestimate. We were unable to quantify the costs of formal and informal care in people younger than 40 years. This will, inevitably, have reduced our total estimates of costs, especially for cancer and stroke, where people younger than 40 years account for 6% (110 000) and 8% (60 000) of cases, respectively, compared with 2% (41 000) for coronary heart disease and less than 1% (5000) for dementia.

Finally, our projection of costs from 2018 to 2050 was based on future projections of the population alone, and might be considered simplistic. Our projections did not include other factors, such as epidemiological trends of the four conditions under investigation or the predicted rise in comorbidities predicted for England.

For example, analyses based on ELSA have projected the costs of dementia in the future based on current trends in cardiovascular disease incidence rates.

In addition, new treatments that prevent, slow progression, or successfully treat the four conditions under study, will undoubtedly affect the projected costs estimated in this study.

In conclusion, our study sheds light on the substantial consequences of the four most important chronic conditions in terms of mortality and morbidity in England on various sectors of the economy. These data not only emphasise the magnitude of the economic burden but also provide valuable insights for public health decision makers. By identifying the specific areas that require targeted interventions, our findings can guide policy makers in implementing strategic measures to alleviate the economic burden of these four conditions and improve patient health outcomes. With a projected increase in costs of more than 60% across the four conditions by 2050, our research findings can aid in directing governmental research expenditure in areas that hold the greatest potential for advancing the prevention, diagnosis, and treatment of disease, further reducing its economic impact.

Source: https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(24)00108-9/fulltext

Filed under: Drug use-various effects,Economic,Europe,Treatment and Addiction :

By Kalleen Rose Ozanic, Staff Writer  July 20, 2024

 

NORWALK — While drug overdoses have decreased year over year in the Nutmeg state, the city’s Family and Children’s Agency is concerned about how new popular substances will impact the state and its clients.

Two substances in particular, xylazine and kratom, worry Jess Vivenzio, behavioral health director at Family and Children’s Agency. She said nearly half of the clients in its outpatient program self-reported using kratom, a U.S Food and Drug Administration-unregulated substance associated with five Connecticut overdoses last year, a state Department of Public Health representative said.

And about three of the clients’ drug screens were positive for xylazine, also known by street name “tranq;” they were shocked to learn their drugs had been cut with it, she said.

“Very surprised, scared, concerned,” Vivenzio said. “A lot of them do have some trust in who they’re purchasing their drugs from, and so sometimes there’s a lot of feelings of guilt and shame there, as well.”

Xylazine caused 284 deaths statewide last year and over 100 people have overdosed from the drug from January to May this year, DPH data show.

Kratom is a powdery substance made from a tropic tree grown in Southeast Asia, the U.S. Drug Enforcement Agency reports. Because the substance isn’t regulated by the FDA, it can easily be purchased at gas stations, convenience stores, smoke and vape shops.

“Just because it’s natural doesn’t mean it’s safe,” Vivenzio said.

Family and Children’s Agency is a charitable nonprofit that aids children and families throughout Fairfield County with after-school and summer programming, foster care, and intensive psychiatric services, education, family guidance, adoption, mental health counseling, substance abuse treatment, and homelessness prevention through wraparound support and partnerships with other local aid groups.

Vivenzio said increasing awareness about both xylazine and kratom are among FCA’s priorities this year, in hopes of limiting its harms and preventing more overdoses.

Project Reward

FCA’s outpatient program, Project Reward, aids its 27 clients in their journeys to sobriety with treatment recommendations, referrals, medication management, intervention, drug and alcohol screens, early intervention programming, and a 10-week intensive outpatient program where patients meet for nine hours of group therapy each week, Vivenzio said.

“We’re a gender-specific and trauma-informed, co-occurring substance use and mental health treatment program for women,” Vivenzio said. “We really provide as much wraparound support as possible, connecting (clients) with other resources and recovery support.”

The program, over everything, prioritizes trust, she said. Many women in the program have histories fraught with trauma, abuse and domestic violence.

Project Reward reveals the frequent intersection of drug abuse and other traumas, Vivenzio said; no patients were available to speak with Hearst Connecticut Media Group in the interest of protecting their privacy and not interrupting their progress in the recovery program.

Much of the program revolves around psychoeducation, which is “really just a fancy word for information, but it’s a little bit more therapeutic,” Vivenzio said.

Program staff equip patients with the resources and knowledge to approach sobriety as well as educate them on the risks of drugs, including substances like xylazine and kratom.

‘Kratom is not something we should be sleeping on’

Chris Boyle, Department of Public Health communications director, said that last year kratom was the sole cause of one overdose death last year and was among other substances in four other overdose deaths.

“Kratom use affects the central nervous system and causes mind-altering symptoms,”  Boyle said in an email. “The symptoms include dizziness; drowsiness; hallucinations; delusions; depression; trouble breathing; confusion, tremors and seizures.”

Users report that kratom acts as a stimulant, according to Mayo Clinic. It can also produce opioid-like effects in high doses, the Centers for Disease Control and Prevention report.

“Kratom is more along the lines of alcohol, in that it is legal, but that doesn’t mean that it’s not addictive, and that doesn’t mean that it can’t cause a problem for some people,” Vivenzio said. “(That) can make it more dangerous, because you can use it responsibly. And so people need to understand that there is the risk that your responsible use will turn into something that you can’t control.”

She’s concerned that increased kratom use can cause tragic outcomes, like that of a Florida father that overdosed and died, leaving a high-needs daughter and wife behind.

In data the CDC referenced from July 2016 to December 2017, 152 overdoses where at least kratom was reported in the toxicology report were identified; in 91 of them, kratom was determined to be a cause of death.

“Kratom is not something we should be sleeping on,” Vivenzio said.

Boyle said that DPH has no current efforts with prevention of kratom associated overdoses, but directed Hearst to the state’s Department of Mental Health and Addiction Services.

While Krystin DeLucia, DMHAS communications and legislative program manager, did not articulate any kratom-specific programming in an email, she said that the department is aware of the drug and monitors its impact.

“The Department of Mental Health and Addiction Services routinely reviews the state of knowledge about the impact of Kratom on mental health and its potentially dangerous adverse effects, as well as how to identify and manage Kratom withdrawal,” the DMHAS statement said. “DMHAS remains vigilant to identify trends related to the devastating crisis of opioid misuse and overdose in our state.”

Xylazine in Connecticut

Vivenzio said xylazine use is among FCA’s top priorities and Boyle said the state tracks its use.

“DPH shares updated surveillance and trend data on xylazine-involved drug overdose deaths with state stakeholders, opioid task forces and local health departments to create awareness about the dangers of using xylazine,” he said.

“Tranq” can extend the “high” that results from fentanyl — a drug that lasts a shorter time compared to heroin and other opioids, Boyle said.

He echoed Vivenzio’s concerns about clients not knowing their drugs contain xylazine.

“Not everyone who uses fentanyl is intentionally seeking out xylazine,” Boyle said. “In many cases, people are not aware that xylazine is in the drugs they are buying and using.”

Now, the Connecticut Public Health Lab is testing urine from those who report to emergency rooms in the state for nonfatal overdoses for xylazine, among other illicit substances, Boyle said.

Vivenzio said that the drug is “across the board, it’s incredibly risky,” especially because it is not an opioid and its effects cannot be reversed with Narcan.

The drug is responsible for 1,252 overdose deaths from 2015 to 2025, DPH reports — with five in Norwalk.

To address the harms of drug use in Connecticut and in FCA’s resident city, Vivenzio said programs like Project Reward need more funding to increase advocacy efforts, harm reduction tools and intervention strategies.

Kalleen Rose Ozanic

Reporter

Kalleen Rose Ozanic is a local reporter at the Norwalk Hour. She covers health, business, cannabis and education. She previously covered cannabis at WSHU Public Radio in Fairfield, Connecticut. She graduated with a B.A. and M.S in Journalism in 2022 and 2023 from Quinnipiac University. She loves to read, snorkel, try new foods and go to Mets games.

 

Source: https://www.ctinsider.com/news/article/norwalk-family-childrens-agency-kratom-xylazine-19564963.php

Filed under: Drug use-various effects,Prevalence,Prevention and Intervention,USA :

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 :

It’s become one of the most startling signs of the fentanyl crisis happening across California: Seemingly zombified drug users slumped over in awkward positions. 

Alternately called “the fentanyl fold” or “the fentanyl bend over,” videos and photos of people reportedly using the drug have spread through social media.

What is the ‘fentanyl fold’?

If you have ever witnessed what looks like seemingly intoxicated people bent over or frozen in place on sidewalks or in parks, you might be seeing someone in the throes of opioid use.

But why do the people look hunched over or moving like zombies?

“It’s a degree of loss of consciousness and a degree of lost muscular control,” Dr. Daniel Ciccarone, a UCSF professor of addiction medicine, told ABC7 San Francisco.

The “fentanyl fold” effect can reportedly kick in within two or three minutes after taking the drug, Ciccarone said.

And how long will the awkward body position last?

“Fentanyl can be a short-action drug and a long-acting drug. So some people they’re back upright in 45 minutes to an hour. Some people could be longer than that,” Ciccarone said.

Fentanyl abuse isn’t the only opioid that can cause the awkward body reaction, Ciccarone said. Any opioid can have the same effect on users.

How many people have died of fentanyl poisoning in California and the United States?

Deaths related to fentanyl began to rise around 2019, according to the California Department of Health. In the last detailed study in 2022, the CDPH estimated nearly 6,000 opioid-related overdose deaths in California.

Nationwide, the Center for Disease Control and Prevention numbers show 84,181 opioid overdose deaths in 2022 to 81,083 and 81,083 in 2023. 

What are the signs of a fentanyl overdose?

The CDPH advises people who suspect a friend or family of opioid abuse should look at for:

  • Falling asleep or losing consciousness 
  • Not responding to stimuli like shouting, a pinch or sternum rub
  • Slow, weak or no breathing 
  • Choking or gurgling sounds 
  • Limp body 
  • Cold and/or clammy skin 
  • Discolored skin (especially in lips and nails)  
  • ​​​​Small, constricted “pinpoint pupils” ​

The CDPH and doctors advise people who use opioids or suspect family or friends are abusing opioids to carry Naloxone, a nasal spray medication that can reverse an opioid overdose.

Naloxone is safe and easy to use and works almost immediately, the CDPH says. It is available over the counter, without a prescription at pharmacies and other stores.

Source: https://eu.desertsun.com/story/news/nation/california/2024/07/19/what-is-the-fentanyl-fold-how-to-treat-opioid-overdoses/74471357007/ July 2024

Filed under: Drug use-various effects,Fentanyl :

A silent revolution is taking place in the heart of Pakistan where communities are tightly knit and traditions run deep. Grassroots and community-based initiatives are emerging as beacons of hope in the fight against drug abuse, transforming lives and fostering resilience in ways top-down approaches often cannot achieve.

Pakistan faces a significant drug abuse problem, with millions affected by the scourge of addiction. The United Nations Office on Drugs and Crime estimates that 40 per cent of all heroin and morphine trafficked out of Afghanistan transits through Pakistan. This has contributed to a rise in addiction rates and related health issues, including the spread of HIV. Health professionals report an increasing number of new HIV positive cases each year, emphasising the urgent need for effective intervention strategies.

The International Narcotics Control Board annual report stresses the importance of governments giving greater attention to fighting drug abuse, particularly the rising use of date-rape drugs. The INCB has called for the implementation of a 2009 resolution to combat the misuse of pharmaceutical products for sexual assault and to remain vigilant about the increase in date-rape drug abuse.

Amidst this crisis, numerous grassroots organisations have sprung up, leveraging the power of community and local knowledge to combat drug abuse. These initiatives are often founded by passionate individuals who have witnessed the devastating effects of addiction firsthand. Their work is characterised by personalised care, cultural sensitivity and a deep understanding of the local context.

One such initiative is Nai Zindagi (New Life). The organisation has been at the forefront of drug rehabilitation and harm reduction since 1989. Nai Zindagi focuses on providing health and social services to people who inject drugs (PWID) and their families. Their approach includes needle exchange programmes; HIV testing and counseling; and vocational training to help individuals reintegrate into society.

Through community outreach and peer-led education, Nai Zindagi has significantly reduced the spread of HIV among the PWID. Their model emphasises dignity and respect, fostering an environment where individuals feel safe and supported in their journey towards recovery.

At the forefront of these efforts is Akmal Ovaisi, head of Tanzeem-al Fajr, a prominent NGO in Pakistan. Under his leadership, Tanzeem-al Fajr has become a pivotal force in drug prevention efforts across the country. Ovaisi’s vision and dedication have galvanised a movement, bringing together diverse organisations to tackle drug abuse through a unified approach.

Akmal Ovaisi believes in the power of community involvement in addressing drug abuse. By engaging local leaders, volunteers and affected families, Tanzeem-al Fajr creates a support system that fosters recovery and prevention.

Ovaisi prioritises educational campaigns to raise awareness about the dangers of drug abuse. These campaigns target schools, colleges and community centres, aiming to reach young people before they fall into the trap of addiction.

Recognising that no single organisation can combat drug abuse alone, Ovaisi has built a strong network of NGOs that collaborate and share resources. This network enhances the capacity to deliver comprehensive services, from rehabilitation to vocational training.

Ovaisi actively engages with policymakers to advocate for stronger drug prevention policies and better support systems for addicts. His efforts have been instrumental in shaping national strategies that reflect the needs of those on the ground.

Aghaz-i-Nau (New Beginning) is another remarkable community-based initiative dedicated to drug abuse prevention and rehabilitation. Located in Islamabad, Aghaz-i-Nau has a holistic approach to addiction treatment, combining medical care, psychological support and spiritual healing. Their residential treatment programme is tailored to meet the needs of each individual, ensuring that recovery is sustainable.

Aghaz-i-Nau also works extensively on awareness campaigns, targeting schools and colleges to educate young people about the dangers of drug abuse. By fostering a dialogue on addiction and breaking down stigmas, they empower communities to tackle the issue head-on.

Rozan, a non-profit organisation based in Islamabad, addresses the psychological and emotional aspects of drug abuse. Their programmes are designed to build emotional health and resilience, particularly among vulnerable populations such as women and children. Rozan’s community-based approach involves training local volunteers to provide psychological first aid and support to individuals affected by drug abuse.

Through workshops, counselling sessions and community events, Rozan helps individuals develop coping mechanisms and rebuild their lives. Their work highlights the importance of addressing the root causes of addiction, such as trauma and mental health issues, in order to achieve lasting recovery.

The success of these grassroots initiatives lies in their ability to mobilise community resources and create networks of support. Unlike large-scale interventions, which can often feel impersonal, community-based programs are deeply embedded in the local context. This allows them to respond more effectively to the specific needs and challenges of their communities.

These initiatives often adopt a multi-faceted approach, addressing not just the symptoms of addiction but also its underlying causes. By providing education, vocational training and emotional support, they help individuals build a foundation for a healthier, drug-free life.

Despite their successes, grassroots organisations in Pakistan face numerous challenges. Limited funding, societal stigma and bureaucratic hurdles can often obstruct their efforts. However, their resilience and innovation continue to inspire hope.

There is a pressing need for greater collaboration between government bodies, international organisations and community-based initiatives. By pooling resources and sharing best practices, it is possible to create a more coordinated and effective response to drug abuse.

In the fight against drug abuse, Pakistan’s grassroots and community-based initiatives are making a profound difference. Through their dedication, empathy and ingenuity, they are transforming lives and creating a ripple effect of positive change. As these pioneers continue their work, they remind us that the strength of a community lies in its ability to come together and support its most vulnerable members.

Support these initiatives by volunteering, donating or spreading awareness about their work.

Source: https://www.thenews.com.pk/tns/detail/1204770-pioneering-drug-abuse-prevention-and-support

Filed under: Drug use-various effects,Others (International News),Prevalence,Prevention and Intervention :

It seems as if every community, big or small, has been impacted by the problems associated with substance use and drug overdose. Within communities, these problems can extend into the family unit, with people often becoming addicted and dying because of drugs.

However, community drug education and prevention programs can be a first line of defense. There is hope for the younger generations as they have more access to prevention and education resources to help them make informed decisions. In addition, more information is available for parents to equip them with the tools to help their kids understand the dangers and risks associated with drugs and alcohol.

In California, the California Department of Education offers information on resources for health services, student assistance programs and alcohol and substance abuse prevention. The California School-Based Health Alliance provides school-based health centers and wellness centers to prevent and treat substance use.

Fortunately, more and more people are seeking treatment. According to the California Health Care Almanac, between 2017 and 2019, the number of facilities offering residential care for substance use treatment grew by 68%, and the number of facilities offering hospital inpatient care more than doubled.

The more people who seek treatment and become aware of the dangers, the more people are saved from an overdose. According to drug abuse statistics, there is an average of 6,100 drug overdose deaths per year in the state. Overdose deaths increased at an annual rate of 10.37% over the last three years. However, this remains below the national average death rate.

Prevention and education information is valuable, especially during Fourth of July celebrations. Binge drinking around Independence Day is typical, and it is known as one of the heaviest drinking holidays of the year. In social settings, it becomes easy to consume too much alcohol, and this could potentially lead to other drug use.

Parents play an essential role when providing drug education. They can take the initiative to create an inclusive and supportive environment with their children. This can equip them with the tools they need to make knowledgeable decisions surrounding alcohol and drug use.

Teens and adults all use drugs and alcohol for different reasons. Much of their use is linked to peer pressure, whether from peers, in a social setting, or in the case of someone they look up to who they see drinking or using drugs.

Stress is also a common factor and alcohol or drugs can seem like an easy escape from the problems of life.

Additionally, environment and family history are contributing factors. Children, for example, who grow up in households with heavy drinking and recreational drug use are more likely to experiment with drugs.

Any parents wondering what to do should consider starting the conversation about alcohol and drug use early. It is also essential to be calm, loving and supportive. Seek out specialized resources, such as those offered by county or nonprofit organizations providing prevention and education.

Additionally, parents want to focus on making it safe for their children to tell them anything and never end the conversation, keeping it going regardless of age.

Local drug education resources are here to help with the goal of helping people of all ages make knowledgeable decisions about drugs and alcohol.

Jody Boulay is a mother of two with a passion for helping others. She currently works as a community outreach coordinator for DRS to help spread awareness of the dangers of drugs and alcohol. She can be reached at jboulay@addicted.org.

 

Source: https://eu.desertsun.com/story/opinion/contributors/valley-voice/2024/07/01/parents-talk-to-your-kids-about-drugs-and-alcohol/74233477007/

Filed under: Alcohol,Drug use-various effects,Parents,Social Affairs,USA,Youth :

July 7, 2024 6:05 am

The Glamorization of Drugs: A Contravention of Islamic Values

By constantly talking about drugs, we may be inadvertently glamorizing them, which goes against Islamic values. Young Muslims, in particular, may be drawn to the thrill and excitement associated with drug use, neglecting the Islamic emphasis on self-care and preservation (Hifz).

The Danger of Glamorization

Glamorizing drug addiction can have severe consequences, including:

– Normalizing drug use among young people

– Encouraging experimentation and risky behavior

– Creating a culture of sympathy for drug users, rather than support for recovery

– Distracting from the real issues and solutions

Instead of perpetuating the glamorization of drug addiction, we must focus on promoting a culture of recovery, support, and Islamic values.

Promoting Islamic Values and Support

Rather than solely focusing on the dangers of drugs, let’s shift our attention to promoting Islamic values and supporting those who have overcome addiction. By sharing stories of hope and resilience, we can create a more positive narrative and inspire others to seek help. This approach acknowledges the complexities of addiction and offers a more comprehensive solution, aligned with Islamic principles:

– Tawakkul (Trust in Allah): Encouraging individuals to trust in Allah’s mercy and guidance

– Sabr (Patience): Supporting individuals in their struggles and recovery

– Shukr (Gratitude): Fostering gratitude for health and well-being

– Ihsan (Excellence): Promoting self-care and personal growth

Additional Content

– The Prophet Muhammad (peace be upon him) said, “A person who guides others to virtue will receive a reward similar to that of the one who follows it, without lessening the reward of either.” (Muslim)

– Islam teaches us to care for our physical and mental health, as part of our duty to preserve our faith (Deen) and our bodies (Badaan)

– The Quran emphasizes the importance of seeking help and support from others, saying, “And help one another in goodness and righteousness.” (5:2)

By incorporating these Islamic principles and values, we can create a more comprehensive and effective approach to drug abuse prevention and recovery.

Source: https://www.greaterkashmir.com/opinion/islamic-perspective-to-drug-abuse-prevention/

 

Filed under: Drug use-various effects,Others (International News),Prevalence,Prevention and Intervention :

By FOX TV Digital Team

Published  July 8, 2024 7:26am EDT

 

Demand for high-potency marijuana causing concerns

Cary Quashen, Owner of Action Family Counseling, joins LiveNOW’s Austin Westfall to dive deep into concerns over the rising demand for high-potency marijuana.

As marijuana use becomes more prevalent, a severe illness linked to frequent cannabis use is also on the rise. 

Cannabinoid (or Cannabis) hyperemesis syndrome, also known as CHS, is an often debilitating condition that affects a small but growing number of chronic marijuana users. 

People with CHS experience severe nausea and vomiting, in some cases 20-24 times a day. It can last days or even weeks and is hard to control – often the only thing that brings relief is a hot shower or bath. 

RELATED: Frequent marijuana use linked to increase in heart attack and stroke risk

Signs of cannabis hyperemesis syndrome

In National Library of Medicine literature, doctors outlined the following criteria for diagnosing CHS: 

  • Long-term cannabis use (often daily)
  • Cyclic nausea and vomiting
  • Relief when stopping marijuana
  • Hot showers/baths relieve symptoms
  • Abdominal pain

RELATED: Teen use of delta-8, an unregulated marijuana alternative, is rising

Ironically, marijuana is often used to treat two key symptoms of CHS: Recent data compiled by the U.S. Food and Drug Administration concluded there is “credible scientific support” for the use of marijuana to treat pain, anorexia, nausea and vomiting. 

Doctors are seeing a rise in serious illness linked to heavy marijuana use (Photo by Lauren DeCicca/Getty Images)

Three cycles of cannabis hyperemesis syndrome

There are three phases of CHS, according to Connecticut state’s Adult Cannabis Use website: 

  • Prodromal – Nausea and vomiting following long-term cannabis use. This often leads to a person using more cannabis to reduce nausea.
  • Hyperemetic – Triggered by increased cannabis use, nausea, abdominal pains and vomiting increase
  • Recovery – Once a person stops using cannabis, symptoms may take several weeks to decrease and disappear until they begin using again, which starts the cycle over.

What causes cannabis hyperemesis syndrome?

Researchers are still early in their exploration of what causes CHS. Dr. Sushrut Jangi, a gastroenterologist at Tufts Medical Center, told The Boston Globe it has something to do with the “somewhat mysterious” endocannabinoid system, which regulates critical bodily functions like sleep, mood, pain control, immune response, appetite and more. 

READ MORE: Michigan dog attacks, nearly kills owner after being fed THC gummy

A lot of receptors in the brain and the gut bind to THC, the substance in cannabis that makes people feel high. Those receptors evolve after long-term cannabis use, Jangi told The Globe. 

Jangi said although it’s hard to calculate, he estimates somewhere between 5% and 20% of chronic marijuana users will experience CHS. 

According to the National Library of Medicine, after Colorado legalized recreational marijuana, ER visits for cyclic vomiting nearly doubled.

 

Source: https://www.livenowfox.com/tag/cannabis

Filed under: Cannabis/Marijuana,Drug use-various effects,Prevalence,USA :

The city is gripped in an opioid crisis worse than America’s. Locals say overly liberal drug laws have sparked a catastrophe

in British Columbia /

“Yes, I feel fine,” she replies.

“Okay, hold still.”

Eyes wide and hands trembling, Larry, 32, flicks the syringe’s needle before crouching over his friend and injecting a mixture of fentanyl and benzodiazepines into a prominent vein in her neck.

Hailey, 38, is lying on a grimy pavement, surrounded by graffiti, filth, and other drug users. She inhales deeply, curls into a foetal position, and sucks on her thumb to hold her breath.

As the discoloured liquid enters her bloodstream, her body relaxes and her eyes lose focus.

“June 7th,” she murmurs. “I’m counting down the days until I can finally go to detox.”

Hailey and Larry are two of approximately 5,000 active drug users who reside in Vancouver’s Downtown Eastside, a 10-block corridor that runs through the heart of the city along Hastings Street.

Walking the half-mile stretch is profoundly shocking. Bodies lie scattered on the tree-lined streets, some scarcely breathing. Discarded needles are everywhere, and the detritus from makeshift encampments – tents, cardboard, sleeping bags – clutter alleys and verges. The scream of sirens is unrelenting.

The crisis is being fuelled by fentanyl, a synthetic opioid that is 50 times stronger than heroin. Manufactured in numerous illicit labs in Canada’s wilderness, fentanyl is now so common in Vancouver’s Downtown Eastside that you can literally pick it up off the street.

Vancouver once topped the charts of the world’s “most desirable places to live”. Its reputation is that of a city which provides the perfect balance – a metropolis “perched on the edge of nature” combining “outdoor recreation and a great cultural diversity”, as one local website puts it.

But a landmark experiment to decriminalise the possession of certain drugs in public – including fentanyl, heroin, cocaine, methamphetamines, and ecstasy – has allowed an opioid crisis to take hold that surpasses even the epidemic in the United States.

In April, David Eby, British Columbia’s premier announced that halfway into the three-year trial, the province would recriminalise drug use in public spaces.

With a severe backlash from police, politicians, and the public showing no sign of abating, Mr Eby is now under pressure to scrap the pilot scheme altogether.

Since last month, police once again have the power to approach and arrest drug users in hospitals, restaurants, parks, and beaches. But people are still able to legally consume 2.5 grams of hard drugs in their homes and in designated public shelters. It also remains unclear how the revised rules will be meaningfully enforced by the police.

Despite the province’s best efforts, opioid overdoses have become the leading cause of death for people aged 10-59 in British Columbia, and now account for more deaths than homicides, suicides, accidents, and natural diseases combined.

Last year, the province recorded 2,511 drug-related overdoses, 87 per cent of them down to fentanyl. The death rate in Vancouver itself now stands at 56 per 100,000 people – nearly three times the national average. And in the Downtown Eastside, the rate is nearly 30 times higher than the rest of the country.

For comparison, England and Wales have a drug-related mortality rate of 8.4 per 100,000 people. In Scotland – the worst in Europe – it stands at 19.8. The only G7 country with anything close to a comparable rate is the United States, at 32.6 per 100,000 people.

With the city gripped in an opioid epidemic nearly twice as fatal as America’s, the Downtown Eastside is becoming a key battleground for the province’s decriminalisation debate. As overdose numbers continue to rise, many view the liberal rollout as fuel to the fire. Yet others argue there are wider societal issues at play that are far more insidious than fentanyl.

Now entrenched in a public health emergency, Canadians of nearly all political stripes are asking, “How did we get here?”

Decriminalisation ‘not about drugs anymore’

In the first year of British Columbia’s decriminalisation rollout, public drug use exploded – with reports of people injecting heroin on family beaches and smoking crack in maternity wards.

Fiona Wilson, the deputy chief constable of the Vancouver Police Department, says the experiment has tied the hands of police across the city, leaving the wider community at risk. Despite having seized over 1,000 kilos of fentanyl from dealers in 2023 alone, officers are powerless to intervene when they see it used on the streets.

“Decriminalisation has been a massive challenge for the police because it’s taken away our ability to arrest someone. We don’t have any grounds to approach a person who is publicly using illicit drugs in the absence of any other criminality,” she says.

“If someone is sitting at a coffee shop and wants to snort a line of cocaine, we don’t have any authority to intervene in that situation. This presents a real problem because families don’t necessarily want to sit next to somebody in a restaurant who’s shooting up fentanyl.”

On the other side of the debate, left-wing advocates for liberalisation have sought to frame the debate around privilege and class.

Brittany Graham, the executive director of the Vancouver Area Network of Drug Users (VANDU), says bigger societal issues – namely, a lack of housing and inadequate welfare services – are to blame.

“Decriminalisation will always exist for the upper class. When someone has enough money to snort cocaine in the privacy of their own home, the police are never going to get them. What we are witnessing right now is a homelessness crisis on top of a toxic and unregulated drug supply.

“The right-wing is blaming everything on decriminalisation, but the reality is Vancouver has seen a 32 per cent increase in homelessness since the beginning of Covid. But the government continues to label poor drug users as the scapegoats for everything wrong in our province.

“Decriminalisation is not about drugs anymore, it’s about power and control. Drugs have been killing people for decades, now it’s toxic politics.”

Elenore Sturko, the shadow minister for mental health and addictions, says decriminalisation has been a “dangerous and disastrous” policy failure.

“The entire policy was politically motivated. Clearly, the government didn’t do the work on decriminalisation. In fact, they ignored the advice of the police. Now, we end up where we are today – not only failing to reduce death and overdoses, but actually causing increased harm.”

‘I never wanted to use fentanyl’

Beyond the issue of decriminalisation, British Columbia has introduced a raft of “harm reduction” measures in a bid to solve the public health emergency – but these too have proved controversial.

The backbone of the province’s harm reduction project revolves around “safe injection sites” where users can access clean needles and a regulated supply of drugs. In these government-run locations, drug users are able to consume their illicit substance of choice – predominantly fentanyl – while being monitored by healthcare workers with an opioid antidote on hand.

Tiffany, 37, says VANDU’s safe injection site has saved her life many times over. Shortly after moving to Vancouver at 15, she got hooked on heroin. Now, almost two decades later, fentanyl is her drug of choice.

“I never wanted to switch over to fentanyl, but it’s everywhere,” says Tiffany, preparing her needle at VANDU’s site. She’s already crushed and melted down her mixture of benzodiazepines and fentanyl.

“I use drugs as a way of coping with my emotions, and being separated from my son. But I do love myself – that’s why I can’t do this anymore. I refuse to become another statistic,” she says.

Vancouver has long been a pioneer in harm reduction. Over 30 years ago, during the heroin and HIV epidemic, the city opened its first safe injection facility in the Downtown Eastside – the only one of its kind in North America.

But what once helped stem the tide of HIV does not appear to be working now.

Some policymakers claim that harm reduction initiatives have become politicised and are perpetuating the problems of addiction, homelessness, and public disorder – specifically in the Downtown Eastside, which they argue has become a death trap for drug users.

Ms Graham from VANDU accepts that harm reduction can be hard to quantify, but continues to believe Vancouver’s clinics do some good.

“In principle, harm reduction is meeting a person where they’re at, no matter what substance they’re using or harm they’re causing. Inherently, we know that drugs are harmful, so it’s crucial to help them mitigate that harm – for example, providing clean needles and a sanitary space,” she says.

Tiffany shoots up twice in the VANDU facility before slumping over. As the mix of fentanyl and benzodiazepines takes control of her senses, she whispers, “The high feels like a warm hug.”

‘No question’ of drug diversion

While many users like Tiffany in the Downtown Eastside source their drugs from the street, the government has launched a “safer supply” program which allows users to receive pharmaceutical-grade opioids free of charge from a physician.

The initiative is “preventing overdoses, saving lives, and connecting drug users to health and social services”, the province says.

But according to those on the ground, safer supply has created many unexpected consequences. The Vancouver Police Department says a significant portion of the opioids being freely prescribed by doctors are not actually being consumed by their intended recipients.

Instead, the drugs are being resold on the black market at rock-bottom prices – in a process called “diversion” – typically to fund the ongoing purchase of fentanyl.

Deputy Wilson says “there is no question” that these drugs are being diverted to the streets, specifically the Downtown Eastside. In fact, she says that 50 per cent of hydromorphone seizures in British Columbia have originated from the government.

Not only are safer supply drugs being diverted to active users, there are also reports of these powerful opioids falling into the hands of children. Ms Sturko explains that highly addictive drugs are freely going out into every corner of the community, allowing new users to develop opioid use disorders.

“Parents in Vancouver are telling me stories of their children using high quantities of dillies [hydromorphone] because they thought the opioid was ‘safe’ under the government’s label of ‘safer supply’,” she says.

“It’s horrifying. It makes me angry because we’re talking about the lives of our children who may start experimenting with an opioid that won’t kill them, but it eventually leads them to use fentanyl which will kill them.

“It’s a potential pathway of serious addiction. These safer supply drugs are subsidising the fentanyl market.”

But Ms Graham from VANDU claims that banning safer supply drugs is not the answer. She says removing government-regulated opioids from the system would taint the drug supply to an even greater degree.

“It’s clear that stamping out the [regulated] drug supply doesn’t stop people from using the substances. It just makes the quality of the substances they can access less reliable.”

Ms Graham goes as far as to claim that the police are against a regulated drugs market and because it threatens their jobs.

“We need to solve the toxic drugs crisis by providing the substances,” she insists.

Stuck in a ‘detox limbo’

Andrew, a paramedic in the Downtown Eastside, has responded to hundreds – if not thousands – of overdose calls during his time as a first responder. In his view, the government is “subsidising and enabling” the fentanyl crisis by throwing money at it instead of solving it.

He says he can only speak anonymously, as the local health authority has cracked down on interviews in the lead up to the provincial election later this year.

“This is all our fault. We’ve created a system where people can wake up and get high everyday – why would they want to leave the Downtown Eastside? It’s a free ride in life that’s funded by taxpayers.

“You would never see anything like this in a poor country. The government is giving people enough slack so they don’t have to change – this perpetuates the problem that will never be solved.

“The Downtown Eastside is like a warzone. It’s unbelievable the depravity people will endure to simply exist.”

But getting clean is certainly not easy.

Mark Ng Shun from Vancouver Detox explains that “walk-ins” are not permitted in government-funded locations. Instead, drug users are told to join a waiting list that can average anywhere from three to six weeks.

To secure a spot, it’s mandatory to call every day, and users must start detoxing before being admitted.

“Vancouver’s detox system is not working for those who need it the most,” says Mr Ng Shun.

“Many Downtown Eastside residents are stuck in the ‘detox limbo’ – they have a desire to seek a different kind of life, but they’re told they have to wait six weeks. Many people can give up during that time.

“Plus, there is still a stigma attached to Downtown Eastside residents who are seeking help. The services themselves are tailored towards upper- and middle-class white people.

“Only certain lives are supported in detox. The system is oppressive. People who are the least advantaged have the least access to it.”

Lisa Weih lost her 29-year-old daughter, Renée, to an opioid overdose in 2020. She says the city’s detox and recovery systems are inadequate.

“Renée never stopped trying to get better. She put herself through the tortures of detox several times, but there was nothing there for her afterwards… our leaders want to get away with murder.”

On the frontlines of Vancouver’s fentanyl crisis, there is not much sign of change.

Ms Graham, who witnesses the carnage of the Downtown Eastside on a daily basis, says hope is the one thing she can’t afford to lose sight of.

“I’ve lost a school bus full of people to opioids. But there is a way forward, and it’s increased harm reduction,” she insists.

“This isn’t a political debate, it’s a human rights debate.”

Source:  https://www.telegraph.co.uk/global-health/climate-and-people/vancouver-opioid-crisis-drug-addiction-british-columbia-canada/

Filed under: Canada,Drug use-various effects,Fentanyl,Prevalence :
 Law and Crime Prevention

The UN agency tackling crime and drug abuse (UNODC) released its annual World Drug Report on Wednesday warning that there are now nearly 300 million users globally, alongside an increase in trafficking.

The International Day against Drug Abuse and Illicit Trafficking, or World Drug Day, is commemorated every year on June 26 and aims to increase action in achieving a drug-free world.

This year’s campaign recognises that “effective drug policies must be rooted in science, research, full respect for human rights, compassion, and a deep understanding of the social, economic, and health implications of drug use”.

Ghada Waly, Executive Director of UNODC, said that providing evidence-based treatment and support to all those affected by drug use is needed, “while targeting the illicit drug market and investing much more in prevention”.

New threat from nitazenes

Drug production, trafficking, and use continue to exacerbate instability and inequality, while causing untold harm to people’s health, safety and well-being.
— Ghada Waly

In the decade to 2022, the number of people using illicit drugs increased to 292 million, the UNODC report says.

It noted that most users worldwide consume cannabis – 228 million people – while 60 million people worldwide consume opioids, 30 million people use amphetamines, 23 million use cocaine and 20 million take ecstasy.

Further, UNODC found that there was an increase in overdose deaths following the emergence of nitazenes – a group of synthetic opioids potentially more dangerous than fentanyl – in several high-income countries.

Trafficking in the Triangle

The drug report noted that traffickers in the Golden Triangle, a region in Southeast Asia, have found ways to integrate themselves into other illegal markets, such as wildlife trafficking, financial fraud, and illegal resource extraction.

“Displaced, poor and migrant communities” bear the brunt of this criminal activity and on occasion are forced to engage in opium farming or illegal resource extraction for their survival; this can lead to civilians becoming drug users or fall into debt at the mercy of crime groups.

Environmental fallout

These illegal crimes contribute to environmental degradation via deforestation, toxic waste dumping and chemical contamination.

“Drug production, trafficking, and use continue to exacerbate instability and inequality, while causing untold harm to people’s health, safety and well-being,” UNODC’s Ms. Waly said.

The potency of cannabis has increased by as much as four times in parts of the world over the last 24 years.

Cocaine surge and cannabis legalisation

In 2022, cocaine production hit a record high with 2,757 tons produced – a 20 per cent increase from 2021.

The increase in supply and demand of the product was accompanied by a surge of violence in nations along the supply chain, especially in Ecuador and Caribbean countries. There was also a spike in health problems within some destination countries in Western and Central Europe.

Similarly, harmful usage of cannabis surged as the product was legalized across Canada, Uruguay, and 27 jurisdictions in the United States, much of which was laced with high-THC (delta9-tetrahydrocannabinol) content – which is believed to be the main ingredient behind the psychoactive effect of the drug.

This led to an increase in the rate of attempted suicides among regular cannabis users in Canada and the US.

The hope for World Drug Day

The UNODC report highlights that 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”.

UNODC’s calls for governments, organizations and communities to collaborate on establishing evidence-based plans that will fight against drug trafficking and organized crime.

The agency also hopes communities will assist in “fostering resilience against drug use and promoting community-led solutions”.

Source: https://news.un.org/en/story/2024/06/1151446

 

Filed under: Cannabis/Marijuana,Cocaine,Crime/Violence/Prison,Drug use-various effects,Others (International News),Synthetics :

BY LAUREN IRWIN – 06/01/24 1:10 PM ET

 

Containers depicting OxyContin prescription pill bottles rest on the ground amid a protest over over-prescription of opioids, Friday, April 5, 2019, in front of the Department of Health and Human Services’ headquarters in Washington, D.C. (AP Photo/Patrick Semansky)

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

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

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

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

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

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

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

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

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

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

 

Source: https://thehill.com/tag/overdose-deaths/

Filed under: Drug Specifics,Drug use-various effects,USA :

By Priyanjana Pramanik, MSc.Jun 11 2024

Reviewed by Lily Ramsey, LLM

In a recent study published in JAMA Network Open, researchers explored whether cannabis use is linked to mortality from all causes, cancer and cardiovascular disease (CVD).

Their findings indicate that heavy cannabis use is associated with a significantly higher risk of CVD mortality among females. However, they observed no association between cancer and all-cause mortality among the entire sample of males and females.

Background

Cannabis is the most commonly used illegal drug worldwide, and its increasing legalization underscores the need to understand its health impacts.

Previous research has suggested potential cardiovascular risks associated with cannabis use, but these studies often focused on specific populations, limiting the generalizability of their findings.

Furthermore, there has been a lack of research examining the differential effects of cannabis on males and females. Although cannabis use for medical purposes is expanding, its safety and efficacy for various conditions remain unclear.

Some studies have suggested a link between heavy cannabis use and increased all-cause and cardiovascular mortality. Still, others have found no such associations, often constrained by methodological limitations like small sample sizes, short follow-up periods, or limited age ranges of participants.

Only one prior study explored the relationship between cannabis use and cancer mortality, finding no significant link.

About the study

This study addressed existing gaps by examining sex-stratified links of lifetime cannabis use to CVD, cancer, and all-cause mortality in a large general population sample.

The cohort study utilized data from the UK Biobank, a large-scale biomedical database comprising 502,478 individuals aged 40 to 69, recruited from 2006 to 2010 from 22 cities across the UK.

Participants provided detailed health information through questionnaires, interviews, physical assessments, and biological samples, and their data was linked to mortality records up to December 19, 2020.

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Cannabis use was self-reported and categorized into never, low, moderate, and heavy use based on lifetime frequency.

The study assessed the association between cannabis use and mortality using Cox proportional hazards regression models, adjusting for clinical and demographic variables.

Analyses were stratified by sex to address potential differences between males and females. Mortality outcomes were defined using codes from the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, and various covariates such as age, education, income, smoking history, alcohol use, hypertension, diabetes, dyslipidemia, body mass index (BMI), prior CVDs, and antidepressant use were included in the models.

The study employed Kaplan-Meier survival analyses, considering two-sided P values less than 0.05 as significant.

Findings

The study analyzed 121,895 UK Biobank participants, aged 55.15 years on average for females and 56.46 years for males.

Among the participants, 3.88% of males and 1.94% of females were heavy cannabis users. Over a median follow-up of 11.8 years, there were 2,375 deaths, including 440 due to cancer and 1,411 due to CVD.

Heavy cannabis use in males was associated with an increased risk of all-cause mortality, with a hazard ratio (HR) of 1.28, but not significantly with CVD or cancer mortality after adjusting for all factors.

In females, heavy use of cannabis was associated with a higher risk of mortality from CVD (HR 2.67) and a non-significant increase in all-cause and cancer mortality after full adjustment.

Notably, among female tobacco users, heavy cannabis use significantly increased risks for all-cause mortality (HR 2.25), CVD mortality (HR 2.56), and cancer mortality (HR 3.52).

In contrast, male tobacco users saw an increased risk only for cancer mortality (HR 2.44). Excluding participants with comorbidities showed no significant associations between heavy use of cannabis and mortality.

The findings suggest a sex-specific impact of heavy cannabis use on mortality, particularly in females.

Conclusions

This study diverges from previous research that largely examined all-cause mortality among younger populations, showing a heightened risk associated with cannabis use.

Few studies addressed the link between cannabis use and CVD mortality, with mixed findings. Some studies indicated a significant association, while others did not.

The study’s strengths include a large sample size and standardized data collection protocols from the UK Biobank. However, the cross-sectional design limits causal inference, and the low response rate might introduce participant bias.

The study’s focus on middle-aged UK participants limits generalizability to other demographics.

Self-reported data on cannabis use and lack of recent usage patterns, dosage information, and follow-up on cannabis use during the study period are significant limitations.

Future research should involve longitudinal studies to explore the possible causal impact of cannabis use on mortality, with a focus on precise measurements of cannabis use, including frequency, dosage, and methods of consumption.

These studies should also aim to understand the sex-specific impacts and the links between of cannabis use and cancer mortality, given the ambiguous current evidence.

 

Source: https://www.news-medical.net/news/20240611/Heavy-cannabis-use-increases-the-risk-of-cardiovascular-disease-for-women-study-finds.aspx

Filed under: Cannabis/Marijuana,Drug use-various effects,Effects of Drugs :

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 :

The web-based and social media campaigns aim to educate youth, families and adults about the dangers of fentanyl and risk of overdose deaths and addiction

BY:  – MAY 7, 2024 4:02 PM
A national nonprofit organization released a new program on Tuesday to help families navigate the hazards of fentanyl and prevent deaths of young people as Oregon continues to battle the lethal drug epidemic.

Song for Charlie, a nonprofit focused on raising awareness about fake fentanyl pills, launched The New Drug Talk Oregon, an educational web-based platform with free information about the risks of fentanyl and the dangers of self-medication and experimentation. The program also gives families guidance on how to discuss the drug, which is highly lethal and commonly found in counterfeit prescription drugs and sold illegally.

The campaign was one of several in Oregon to start on Tuesday and coincides with National Fentanyl Awareness Day. The Oregon Health Authority launched a five-week campaign to educate Oregonians about fentanyl risks, harm reduction strategies like fentanyl test strips and how to respond to an overdose. The state’s campaign will unfold on the health authority’s English and Spanish-language Facebook accounts.

Multnomah County also launched a fentanyl awareness campaign, called Expect Fentanyl, targeting Portland-area youth.

More information

For more information about the educational program for families, visit thenewdrugtalk.org/oregon.

Visit the Oregon Health Authority site for a list of syringe and needle exchange services available in Oregon.

More than 300 young Oregonians 15 to 24 years old have died of drug overdoses in the last five years, many of them from fentanyl, according to Centers for Disease Control and Prevention data. The rate of teen drug-related deaths has increased in the state nearly sixfold, and Oregon now has the fifth-worst per capita rate of drug deaths among teenagers, according to CDC data compiled by Song for Charlie.

Meanwhile, a survey of Oregon parents and youth commissioned by Song for Charlie found persistent gaps in how families are responding to the crisis. Nearly three-quarters of Oregon parents said they talked to their children about the dangers of prescription pills laced with fentanyl. But only about 40% of young people said they remember having this conversation.

And just three in five Oregon youth – teenagers and young adults – consider the misuse of prescription pills a serious issue. The survey, completed in the spring, is based on interviews of more than 1,300 teenagers, young adults and parents in Oregon, and has a margin of error of 4 to 5.65 percentage points.

‘Ongoing conversations’

The New Drug Talk Oregon program was backed by a $1 million grant from Trillium Community Health Plan, a Medicaid insurer for about 90,000 people on the Oregon Health Plan in the Portland area and Lane County. That funding means the Song for Charlie’s program is available to Oregonians at no cost.

A Washington County resident, Jennifer Epstein, director of strategic programs for Song for Charlie, is involved with the program. She became an advocate to increase awareness and education about fentanyl after her 18-year-old son Cal died in 2020 after he ingested a counterfeit pill with fentanyl.

“What we want to do is encourage parents to have ongoing conversations with young people,” Epstein said in an interview.

The program’s site has articles and videos that guide parents through talking to their children about fentanyl, staying safe on social media or the death of someone from an overdose.

Epstein said if the resource had been available before her son died, it could have saved his life.

“I certainly think that this could have changed what happened to our family if we had been able to have conversations about fentanyl and the risks it poses and the danger of self-medicating,” Epstein said.

Source:  https://oregoncapitalchronicle.com/2024/05/07/fentanyl-awareness-campaigns-kick-off-in-oregon-amid-an-overdose-epidemic/

Filed under: Drug use-various effects,Education,Fentanyl,USA :

Federal study shows lives lost from overdose crisis are felt across generations, emphasizing need to include children and families in support

May 8, 2024

An estimated 321,566 children in the United States lost a parent to drug overdose from 2011 to 2021, according to a study published in JAMA Psychiatry. The rate of children who experienced this loss more than doubled during this period, from approximately 27 to 63 children per 100,000. The highest number of affected children were those with non-Hispanic white parents, but communities of color and tribal communities were disproportionately affected. The study was a collaborative effort led by researchers at the National Institutes of Health’s (NIH) National Institute on Drug Abuse (NIDA), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Centers for Disease Control and Prevention (CDC).

Children with non-Hispanic American Indian/Alaska Native parents consistently experienced the highest rate of loss of a parent from overdose from 2011 to 2021 – with 187 per 100,000 children affected in this group in 2021, more than double the rate among non-Hispanic white children (76.5 per 100,000) and among non-Hispanic Black children (73 per 100,000). While the number of affected children increased from 2011 to 2021 across all racial and ethnic populations, children with young non-Hispanic Black parents (18 to 25 years old) experienced the highest – roughly 24% – increase in rate of loss every year. Overall, children lost more fathers than mothers (192,459 compared to 129,107 children) during this period.

“It is devastating to see that almost half of the people who died of a drug overdose had a child. No family should lose their loved one to an overdose, and each of these deaths represents a tragic loss that could have been prevented,” said Nora Volkow, M.D., NIDA director. “These findings emphasize the need to better support parents in accessing prevention, treatment, and recovery services. In addition, any child who loses a parent to overdose must receive the care and support they need to navigate this painful and traumatic experience.”

From 2011 to 2021, 649,599 people aged 18 to 64 died from a drug overdose. Despite these tragic numbers, no national study had previously estimated the number of children who lost a parent among these deaths. To address this gap, researchers used data about people aged 18 to 64 participating in the 2010 to 2019 National Surveys on Drug Use and Health (NSDUH) to determine the number of children younger than 18 years living with a parent 18 to 64 years old with past-year drug use. NSDUH defines a parent as biological parent, adoptive parent, stepparent, or adult guardian.

The researchers then used these data to estimate the number of children of the nearly 650,000 people who died of an overdose in 2011 to 2021 based on the national mortality data from the CDC National Vital Statistics System. The data were examined by age group (18 to 25, 26 to 40, and 41 to 64 years old), sex, and self-reported race and ethnicity.

The researchers found that among the estimated 321,566 American children who lost a parent to overdose from 2011 to 2021, the highest numbers of deaths were among parents aged 26 to 40 (175,355 children) and among non-Hispanic white parents (234,164). The next highest numbers were children with Hispanic parents (40,062) and children with non-Hispanic Black parents (35,743), who also experienced the highest rate of loss and highest year-to-year rate increase, respectively. The racial and ethnic disparities seen here are consistent with overall increases in overdose deaths among non-Hispanic American Indian/Alaska Native and Black Americans in recent years, and highlight disproportionate impacts of the overdose crisis on minority communities.

“This first-of-its-kind study allows us to better understand the tragic magnitude of the overdose crisis and the reverberations it has among children and families,” said Miriam E. Delphin-Rittmon, Ph.D., HHS Assistant Secretary for Mental Health and Substance Use and the leader of SAMHSA. “These data illustrate that not only are communities of color experiencing overdose death disparities, but also underscore the need for responses to the overdose crisis moving forward to comprehensively address the needs of individuals, families and communities.”

Based on their findings, the researchers emphasize the importance of whole-person health care that treats a person with substance use disorder as a parent or family member first and foremost, and provides prevention resources accordingly to support families and break generational cycles of substance use. The study also points to the need to incorporate culturally-informed approaches in prevention, treatment, recovery, and harm reduction services, and to dismantle racial and ethnic inequities in access to these services.

“Children who lose a parent to overdose not only feel personal grief but also may experience ripple effects, such as further family instability,” said Allison Arwady, M.D., M.P.H., director of CDC’s National Center for Injury Prevention and Control. “We need to ensure that families have the resources and support to prevent an overdose from happening in the first place and manage such a traumatic event.”

Reference:

About the National Institute on Drug Abuse (NIDA): NIDA is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world’s research on the health aspects of drug use and addiction. The Institute carries out a large variety of programs to inform policy, improve practice, and advance addiction science. For more information about NIDA and its programs, visit www.nida.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

About substance use disorders: Substance use disorders are chronic, treatable conditions from which people can recover. In 2022, nearly 49 million people in the United States had at least one substance use disorder. Substance use disorders are defined in part by continued use of substances despite negative consequences. They are also relapsing conditions, in which periods of abstinence (not using substances) can be followed by a return to use. Stigma can make individuals with substance use disorders less likely to seek treatment. Using preferred language can help accurately report on substance use and addiction. View NIDA’s online guide.

Source: www.nih.gov.  NIH…Turning Discovery Into Health®

Filed under: Drug use-various effects,Parents,USA :

May 09, 2024

WASHINGTON – Today, DEA Administrator Anne Milgram announced the release of the 2024 National Drug Threat Assessment (NDTA), DEA’s comprehensive strategic assessment of illicit drug threats and trafficking trends endangering the United States.

 

For more than a decade, DEA’s NDTA has been a trusted resource for law enforcement agencies, policy makers, and prevention and treatment specialists and has been integral in informing policies and laws. It also serves as a critical tool to inform and educate the public.

 

DEA’s top priority is reducing the supply of deadly drugs in our country and defeating the two cartels responsible for the vast majority of drug trafficking in the United States. The drug poisoning crisis remains a public safety, public health, and national security issue, which requires a new approach.

 

“The shift from plant-based drugs, like heroin and cocaine, to synthetic, chemical-based drugs, like fentanyl and methamphetamine, has resulted in the most dangerous and deadly drug crisis the United States has ever faced,” said DEA Administrator Anne Milgram. “At the heart of the synthetic drug crisis are the Sinaloa and Jalisco cartels and their associates, who DEA is tracking world-wide. The suppliers, manufacturers, distributors, and money launderers all play a role in the web of deliberate and calculated treachery orchestrated by these cartels. DEA will continue to use all available resources to target these networks and save American lives.”

Drug-related deaths claimed 107,941 American lives in 2022, according to the Centers for Disease Control and Prevention (CDC). Fentanyl and other synthetic opioids are responsible for approximately 70% of lives lost, while methamphetamine and other synthetic stimulants are responsible for approximately 30% of deaths.

 

Fentanyl is the nation’s greatest and most urgent drug threat. Two milligrams (mg) of fentanyl is considered a potentially fatal dose. Pills tested in DEA laboratories average 2.4 mg of fentanyl, but have ranged from 0.2 mg to as high as 9 mg. The advent of fentanyl mixtures to include other synthetic opioids, such as nitazenes, or the veterinary sedative xylazine have increased the harms associated with fentanyl.

Seizures of fentanyl, in both powder and pill form, are at record levels. Over the past two years seizures of fentanyl powder nearly doubled. DEA seized 13,176 kilograms (29,048 pounds) in 2023. Meanwhile, the more than 79 million fentanyl pills seized by DEA in 2023 is almost triple what was seized in 2021. Last year, 30% of the fentanyl powder seized by DEA contained xylazine. That is up from 25% in 2022.

 

Social media platforms and encrypted apps extend the cartels’ reach into every community in the United States and across nearly 50 countries worldwide. Drug traffickers and their associates use technology to advertise and sell their products, collect payment, recruit and train couriers, and deliver drugs to customers without having to meet face-to-face. This new age of digital drug dealing has pushed the peddling of drugs off the streets of America and into our pockets and purses.

 

The cartels have built mutually profitable partnerships with China-based precursor chemical companies to obtain the necessary ingredients to manufacturer synthetic drugs. They also work in partnership with Chinese money laundering organizations to launder drug proceeds and are increasingly using cryptocurrency.

 

Nearly all the methamphetamines sold in the United States today is manufactured in Mexico, and it is purer and more potent than in years past. The shift to Mexican-manufactured methamphetamine is evidenced by the dramatic decline in domestic clandestine lab seizures. In 2023, DEA’s El Paso Intelligence Center (EPIC) documented 60 domestic methamphetamine clandestine lab seizures, which is a stark comparison to 2004 when 23,700 clandestine methamphetamine labs were seized in the United States.

 

DEA’s NDTA gathers information from many data sources, such as drug investigations and seizures, drug purity, laboratory analysis, and information on transnational and domestic criminal groups.

To read the DEA’s Threat Assessment report:

  1. Click on this link – An image of the report cover will appear
  2. Click on the image – The report will display

Source: https://www.dea.gov/press-releases/2024/05/09/dea-releases-2024-national-drug-threat-assessment

Filed under: Drug Specifics,Drug use-various effects,Environment,Prevalence,USA :

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.”

Source:  https://www.wsj.com/articles/what-you-arent-reading-about-marijuana-permanent-brain-damage-biden-schedule-iii-9660395e

Filed under: Cannabis/Marijuana,Drug use-various effects,Health,USA :

First, the good news: According to the U.S. Centers for Disease Control and Prevention, the number of fatal overdoses in the U.S. decreased last year — down 3% from 2022.

Now, the not so great news: That’s still 107,500 people who died at the hands of a decades-long substance abuse epidemic; and those same CDC researchers say the last time there was such a decrease, the number of fatal overdoses increased dramatically in the following year.

Further, Brandon Marshall, a Brown University researcher who studies overdose trends, offered some less-than-comforting reasons for the decrease that have little to do with winning the fight against this monster.

Shifts in the drug supply and use habits (smoking or mixing with other drugs rather than injecting, for example) could be one reason for the change. Another is simply that the epidemic has killed so many people already there are fewer to die.

That doesn’t mean prevention and recovery support efforts are not vital. And it does not mean there is any less need to support the families of those who have lost loved ones to this plague.

The Journal of the American Medical Association — Psychiatry, reported earlier this month that more than 321,000 U.S. children lost a parent to fatal drug overdose from 2011 to 2021.

“These children need support,” and are at a higher risk of mental health and drug use disorders themselves, said Dr. Nora Volkow, director of the National Institute on Drug Abuse. “It’s not just a loss of a person. It’s also the implications that loss has for the family left behind.”

Meanwhile, the fact that so many experts are reluctant to be optimistic about a small decrease could mean they understand something continues to fuel this epidemic. Yes, there is as much supply as demanded. That is one part of the problem. But the other is understanding what drives so many into the arms of this beast. How do we provide people the economic, mental health and social hope and support to break cycles? How do we encourage them to embrace a bright future, rather than being unable to see past a bleak present they can hardly bear?

“My hope is 2023 is the beginning of a turning point,” said Dr. Daniel Ciccarone of the University of California, San Francisco.

Imagine the possibilities if we all took a comprehensive, informed, compassionate approach to actually making that happen.

Source: https://www.journal-news.net/journal-news/imagine-the-possibilities/article_330d84dc-7bbb-557f-ab5d-2eff8bd12fc5.html

Filed under: Drug Specifics,Drug use-various effects,Social Affairs,USA :

April 24, 2024

The Australian community deserve a clear picture of all persons whose Mental Health has come to the attention of the police, hospitals and the community.

When cannabis genotoxicity effects are added to cannabis neurotoxicity effects the argument against the widespread use of cannabis for everything becomes very robust indeed.

The drug prevention taskforce outlines below our real concerns regarding the Stabbing rampage at Sydney.  It does appear that here in Australia our State and Federal Medical Department has been testing toxic factors using blood and not using the much better hair test.

Most of the cannabis (80-90%) is excreted within 5 days as hydroxylated and carboxylated metabolites. See attached (Chemistry and Toxicology of cannabis).

Because 90% of THC is gone in 80 minutes from blood. Please demand hair testing of the subject for marijuana use (blood test may not be positive due to rapid clearance).  This is very indicative of cannabis induced psychosis most of the cannabis (80-90%) is excreted within 5 days as hydroxylated and carboxylated metabolites . There are eighteen acidic metabolites as per Goulle JP, Saussereau E, Lacroix C. [Delta-9-tetrahydrocannabinol pharmacokinetics]. Ann Pharm Fr 2008; 66: 232-244. Studies attached.

Drug Free Australia is seeking to bring urgent attention to Australian whether Federal or State, regarding extremely important research relating to Mental Health and cannabis use.  It appears that Australian public policies have moved from concern for the health and wellbeing of society – by improving and promoting good health – to pushing unnecessary drug use for profiteers while charging the tab to society-at-large.  DFA believes that it is time for governments worldwide to promote research and media publicity which avoids the cherry-picked faux studies used by those wanting to legalise cannabis.  Rather, the focus should be on its serious harms to mental and physical health particularly related to early use.

TOP 15 RISKS OF MARIJUANA ON HEALTH   https://iasic1.org. The Drug Free Australian paper (MENTAL HEALTH AND CANNABIS USE) see attached.  (A Panel Study of the Effect of Cannabis Use on Mental Health, Depression and Suicide in the 50 States)see attached.

 EXCLUSIVE: Regular cannabis use in people’s mid-20s can cause permanent damage to the brain development and legalizing the drug has WRONGLY presented it as harmless, drug safety expert Dr Nora Volkow, director of the National Institute on Drug Abuse, warned cannabis use among young adults was a ‘concern’. She called for ‘urgent’ research into the potential health risks of the drug. Several papers have suggested regular use could be damaging mental development and affecting users’ social life

But these often also include people regularly using alcohol and tobacco, making it difficult to deduce whether cannabis is behind the changes. About 48million Americans use cannabis annually, a number that is rising. https://www.dailymail.co.uk/health/article-11138001/Taking-cannabis-mid-20s-damages-cognitive-development-NIH-expert-warns.html

  1. Prohibition has worked globally for more than 100 years since the UN Drug Conventions began. These have kept illicit drug use down to 5% use worldwide, whereas legalised tobacco and alcohol have much higher rates.
  2. Legalising and decriminalizing substances inevitably gives a green light for use (as we have seen with increased use of cannabis in parts of the United States where it has been made legal.
  3. Global illicit drug industries are responsible for an enormous amount of environmental destruction

(Illegal Marijuana growers poison forests-these people fight back) https://www.nationalgeographic.com/environment/article/illegal-marijuana-growing-threatens-california-national-forests (Green But Not Green: How Pot Farms Trash the Environment) http://www.slate.com/articles/news_and_politics/uc_breakthroughs_2014/2014/04/green_but_not_green_how_pot_farms_trash_the_environment.html

 

RECOMMENDATIONS THAT CAN HELP PREVENT THE AUSTRALIAN “LOST GENERATION DYING”

 All Australian Governments and community leaders need to take this evidence regarding Mental Health very seriously.  The issue of cannabis-caused violence needs to be addressed. For example, the Australian Government must consider organising several Mental Health teams working 24/7 to evaluate the mental health and wellbeing of those involved in animal cruelty, road rage, spousal abuse and child fatalities. These teams should have the authority to place these individuals into detox and rehabilitation centres for three to twelve months according to their progress. They will also need to be constantly reminded that they are very important to the Australian community’s future.  Here in Queensland, we have one centre available. .and a third that could be built. They could be equipped at minimum cost and run with existing staff for this mental health program.

The Australian National Drug Strategy 2017-2026 identifies cannabis as a priority substance for action, noting 20% of Australian drug and alcohol treatment services are provided to people identifying cannabis as their principal drug of concern. DFA believes that the number is higher for those under 25 years of age.

We greatly appreciate your time in responding to these extremely important matters in terms of community health, welfare and safety and would value your response early Should you require further information and/or a face-to-face meeting we would be very pleased to accommodate.

Kind Regards

Herschel Baker, International Liaison Director,

>>>>>>>>>>>>>>>>>>>>>>>

Please click on the links below to read the reports:

  • When you click on the link an image of the report cover will appear
  • Then please click on the report cover image to open the report.
  1. DFA Mental Health Cannabis Use 18-08-22
  2. DFAF-Study-FINAL-A-panel-study-of-the-effect-of-cannabis-use-on-mental-health-depression-and-suicide-in-the-50-states-3
  3. Hair testing test for THC OH 2018 Drug Testing and Analysis Franz
  4. Paddock hair toxicology results
  5. Postmortum diagnosis and toxicology validation of illicit substance use hair sampling Addict Biol 2008 Huestis
Filed under: Australia,Cannabis/Marijuana,Drug use-various effects,Health,Mental Health :
By Madeleine Cummings · CBC News · 
The City of Edmonton has stopped funding a pilot program that saw teams of nurses and outreach workers preventing and responding to overdoses on downtown streets.

Teams from Boyle Street Community Services had been assigned to walk around the Stanley Milner Library, downtown malls and pedways and the LRT system. Their duties focused on responding to drug poisonings but they also helped educate business owners, pick up needles and refer people to services.

The city funded the first phase of the pilot, which began in the spring of 2022, then extended its funding in December 2023, but Jen Flaman, deputy city manager of community services, told city council in a May 27 memo that there were no administrative funds available to extend it further.

The memo said the city submitted a funding request to the provincial government but was unsuccessful and has applied to a Health Canada program but has not heard back.

The pilot cost $3.3 million, and included funding for a data analyst at Boyle Street.

Marliss Taylor, who is Boyle Street’s director of Streetworks and health services and oversaw the pilot, said it was a success.

She said the teams responded to more than 440 drug poisonings, distributed more than 20,000 naloxone kits, disposed of more than 7,000 sharp objects, and referred 2,500 people to detox or supervised consumption services.

“We absolutely were able to save some lives and I think that’s critically important,” Taylor said.

‘It never gets easier,’ says overdose prevention nurse, Tabatha Plesuk, a nurse based at the Stanley Milner Library in Edmonton. She said the teams also helped security guards and demonstrated friendly, respectful ways of interacting with vulnerable people in public places.

EMS responses to opioid-related events surged in Edmonton in recent years and a record 1,867 people died in Alberta because of opioid poisoning last year.

Though the rate of drug poisoning deaths in the province has slowed since 2023, Taylor said the number of overdoses in Edmonton is still high. According to the province’s substance use surveillance data, there were 148 drug poisoning deaths in the city between January and March of this year.

Taylor said she is worried about what could happen if the overdose prevention teams stop running.

“What we don’t want is for people to be injured or die of an unintentional drug overdose in spaces where people are not sure how to react,” she said.

In an emailed statement, Michelle Steele, a city spokesperson, said the teams were funded as a response to the worsening drug poisoning crisis in 2022 “with the recognition that the funding was not permanent.”

The city memo said funding ended on June 30 and the team’s services would be closing, but Taylor said the teams are still working for now.

She said Boyle Street is seeking other funding sources, with help from nearby businesses and organizations.

Madeleine Cummings

Madeleine Cummings is a reporter with CBC Edmonton. She covers local news for CBC Edmonton’s web, radio and TV platforms. You can reach her at madeleine.cummings@cbc.ca.

Source: https://www.cbc.ca/news/canada/edmonton/edmonton-stops-funding-drug-overdose-prevention-pilot-1.7254667

Filed under: Canada,Drug use-various effects,Harm Reduction including HIV (Papers),Prevention and Intervention :

UNIVERSITY OF BATH, UK – Last updated on Tuesday 26 March 2024

There is no evidence that CBD products reduce chronic pain, and taking them is a waste of money and potentially harmful to health, new research finds.

CBD oil may be popular for treating pain but taking it appears to be a waste of money

There is no evidence that CBD products reduce chronic pain, and taking them is a waste of money and potentially harmful to health, according to new research led by the University of Bath.CBD (short for cannabidiol) is one of many chemicals found naturally in the cannabis plant. It’s a popular alternative treatment for pain and is readily available in shops and online in the form of oils, tinctures, vapes, topical creams, edibles (such as gummy bears) and soft drinks.However, consumers would do well to steer clear of these products, according to the new study.“CBD presents consumers with a big problem,” said Professor Chris Eccleston, who led the research from the Centre for Pain Research at Bath. “It’s touted as a cure for all pain but there’s a complete lack of quality evidence that it has any positive effects.”

He added: “It’s almost as if chronic pain patients don’t matter, and that we’re happy for people to trade on hope and despair.”

For their study, published this week in The Journal of Pain, the team – which included researchers from the Universities of Bath, Oxford and Alberta in Canada – examined research relevant to using CBD to treat pain and published in scientific journals up to late 2023.

They found:

  • CBD products sold direct to consumers contain varying amounts of CBD, from none to much more than advertised.
  • CBD products sold direct to consumers may contain chemicals other than CBD, some of which may be harmful and some illegal in some jurisdictions. Such chemicals include THC (tetrahydrocannabinol), the main psychoactive component of the cannabis plant.
  • Of the 16 randomised controlled trials that have explored the link between pain and pharmaceutical-grade CBD, 15 have shown no positive results, with CBD being no better than placebo at relieving pain.
  • A meta-analysis (which combines data from multiple studies and plays a fundamental role in evidence-based healthcare) links CBD to increased rates of serious adverse events, including liver toxicity.

Medical vs non-medical CBD

In the UK, medical cannabis is the only CBD product that is subject to regulatory approval. It’s occasionally prescribed for people with severe forms of epilepsy, adults with chemotherapy-related nausea and people with multiple sclerosis.

Non-medical CBD is freely available in the UK (as well as in the US and many European countries) so long as it contains negligible quantities of THC or none at all. However, CBD products sold on the retail market are not covered by trade standards, meaning there is no requirement for them to be consistent in content or quality.

Most CBD products bought online – including popular CBD oils – are known to contain very small amounts of CBD. Moreover, any given product may be illegal to possess or supply, as there’s a good chance it will contain forbidden quantities of THC.

Chronic pain

An estimated 20% of the adult population lives with chronic pain, and sufferers are often desperate for help to alleviate their symptoms. It’s no surprise then that many people reach for CBD products, despite their high price tag and the lack of evidence of their effectiveness or safety.

Dr Andrew Moore, study co-author and former senior pain researcher in the Nuffield Division of Anaesthetics at the University of Oxford, said: “For too many people with chronic pain, there’s no medicine that manages their pain. Chronic pain can be awful, so people are very motivated to find pain relief by any means. This makes them vulnerable to the wild promises made about CBD.”

He added that healthcare regulators appear reluctant to act against the spurious claims made by some manufacturers of CBD products, possibly because they don’t want to interfere in a booming market (the global CBD product market was estimated at US$3 billion in 2021 or £2.4 billion and is anticipated to reach US$60 billion by 2030 or £48 billion) especially when the product on sale is widely regarded as harmless.

“What this means is that there are no consumer protections,” said Dr Moore. “And without a countervailing body to keep the CBD sellers in check, it’s unlikely that the false promises being made about the analgesic effects of CBD will slow down in the years ahead.”

The study’s authors are calling for chronic pain to be taken more seriously, with consumer protection becoming a priority.

“Untreated chronic pain is known to seriously damage quality of life, and many people live with pain every day and for the rest of their lives,” said Professor Eccleston. “Pain deserves investment in serious science to find serious solutions.”

 

Source: https://www.bath.ac.uk/announcements/cbd-products-dont-ease-pain-and-are-potentially-harmful-new-study-finds/

Filed under: Cannabis/Marijuana,Drug Specifics,Drug use-various effects,Europe :
MURRAY, Ky. — Around 200 people gathered Tuesday in Wrather Hall on the campus of Murray State University for a roundtable discussion about the drug epidemic locally and across the country.

The event was sponsored by the School of Nursing and Health Professions, and featured speakers from the law enforcement, legal, political, and healthcare communities

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.

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

By Zara Abrams    Date created: March 1, 2024. 14 min read

For years, students in middle and high schools across the country were urged to “just say no” to drugs and alcohol. But it’s no secret that the Drug Abuse Resistance Education (D.A.R.E.) program, which was typically delivered by police officers who urged total abstinence, didn’t work. A meta-analysis found the program largely ineffective and one study even showed that kids who completed D.A.R.E. were more likely than their peers to take drugs (Ennett, S. T., et al., American Journal of Public Health, Vol. 84, No. 9, 1994; Rosenbaum, D. P., & Hanson, G. S., Journal of Research in Crime and Delinquency, Vol. 35, No. 4, 1998).

“We know that the ‘Just Say No’ campaign doesn’t work. It’s based in pure risks, and that doesn’t resonate with teens,” said developmental psychologist Bonnie Halpern-Felsher, PhD, a professor of pediatrics and founder and executive director of several substance use prevention and intervention curriculums at Stanford University. “There are real and perceived benefits to using drugs, as well as risks, such as coping with stress or liking the ‘high.’ If we only talk about the negatives, we lose our credibility.”

Partially because of the lessons learned from D.A.R.E., many communities are taking a different approach to addressing youth substance use. They’re also responding to very real changes in the drug landscape. Aside from vaping, adolescent use of illicit substances has dropped substantially over the past few decades, but more teens are overdosing than ever—largely because of contamination of the drug supply with fentanyl, as well as the availability of stronger substances (Most reported substance use among adolescents held steady in 2022, National Institute on Drug Abuse).

“The goal is to impress upon youth that far and away the healthiest choice is not to put these substances in your body, while at the same time acknowledging that some kids are still going to try them,” said Aaron Weiner, PhD, ABPP, a licensed clinical psychologist based in Lake Forest, Illinois, and immediate past-president of APA’s Division 50 (Society of Addiction Psychology). “If that’s the case, we want to help them avoid the worst consequences.”

While that approach, which incorporates principles of harm reduction, is not universally accepted, evidence is growing for its ability to protect youth from accidental overdoses and other consequences of substance use, including addiction, justice involvement, and problems at school. Psychologists have been a key part of the effort to create, test, and administer developmentally appropriate, evidence-based programs that approach prevention in a holistic, nonstigmatizing way.

“Drugs cannot be this taboo thing that young people can’t ask about anymore,” said Nina Christie, PhD, a postdoctoral research fellow in the Center on Alcohol, Substance Use, and Addictions at the University of New Mexico. “That’s just a recipe for young people dying, and we can’t continue to allow that.”

Changes in drug use

In 2022, about 1 in 3 high school seniors, 1 in 5 sophomores, and 1 in 10 eighth graders reported using an illicit substance in the past year, according to the National Institute on Drug Abuse’s (NIDA) annual survey (Monitoring the Future: National Survey Results on Drug Use, 1975–2022: Secondary School Students, NIDA, 2023 [PDF, 7.78MB]). Those numbers were down significantly from prepandemic levels and essentially at their lowest point in decades.

Substance use during adolescence is particularly dangerous because psychoactive substances, including nicotine, cannabis, and alcohol, can interfere with healthy brain development (Winters, K. C., & Arria, A., Prevention Research, Vol. 18, No. 2, 2011). Young people who use substances early and frequently also face a higher risk of developing a substance use disorder in adulthood (McCabe, S. E., et al., JAMA Network Open, Vol. 5, No. 4, 2022). Kids who avoid regular substance use are more likely to succeed in school and to avoid problems with the juvenile justice system (Public policy statement on prevention, American Society of Addiction Medicine, 2023).

“The longer we can get kids to go without using substances regularly, the better their chances of having an optimal life trajectory,” Weiner said.

The drugs young people are using—and the way they’re using them—have also changed, and psychologists say this needs to inform educational efforts around substance use. Alcohol and cocaine are less popular than they were in the 1990s; use of cannabis and hallucinogens, which are now more salient and easier to obtain, were higher than ever among young adults in 2021 (Marijuana and hallucinogen use among young adults reached all-time high in 2021, NIDA).

“Gen Z is drinking less alcohol than previous generations, but they seem to be increasingly interested in psychedelics and cannabis,” Christie said. “Those substances have kind of replaced alcohol as the cool thing to be doing.”

Young people are also seeing and sharing content about substance use on social media, with a rise in posts and influencers promoting vaping on TikTok and other platforms (Vassey, J., et al., Nicotine & Tobacco Research, 2023). Research suggests that adolescents and young adults who see tobacco or nicotine content on social media are more likely to later start using it (Donaldson, S. I., et al., JAMA Pediatrics, Vol. 176, No. 9, 2022).

A more holistic view

Concern for youth well-being is what drove the well-intentioned, but ultimately ineffective, “mad rush for abstinence,” as Robert Schwebel, PhD, calls it. Though that approach has been unsuccessful in many settings, a large number of communities still employ it, said Schwebel, a clinical psychologist who created the Seven Challenges Program for treating substance use in youth.

But increasingly, those working to prevent and treat youth substance use are taking a different approach—one that aligns with principles Schwebel helped popularize through Seven Challenges.

A key tenet of modern prevention and treatment programs is empowering youth to make their own decisions around substance use in a developmentally appropriate way. Adolescents are exploring their identities (including how they personally relate to drugs), learning how to weigh the consequences of their actions, and preparing for adulthood, which involves making choices about their future. The Seven Challenges Program, for example, uses supportive journaling exercises, combined with counseling, to help young people practice informed decision-making around substance use with those processes in mind.

“You can insist until you’re blue in the face, but that’s not going to make people abstinent. They ultimately have to make their own decisions,” Schwebel said.

Today’s prevention efforts also tend to be more holistic than their predecessors, accounting for the ways drug use relates to other addictive behaviors, such as gaming and gambling, or risky choices, such as fighting, drag racing, and having unprotected sex. Risk factors for substance use—which include trauma, adverse childhood experiences, parental history of substance misuse, and personality factors such as impulsivity and sensation seeking—overlap with many of those behaviors, so it often makes sense to address them collectively.

[Related: Psychologists are innovating to tackle substance use]

“We’ve become more sophisticated in understanding the biopsychosocial determinants of alcohol and drug use and moving beyond this idea that it’s a disease and the only solution is medication,” said James Murphy, PhD, a professor of psychology at the University of Memphis who studies addictive behaviors and how to intervene.

Modern prevention programs also acknowledge that young people use substances to serve a purpose—typically either social or emotional in nature—and if adults expect them not to use, they should help teens learn to fulfill those needs in a different way, Weiner said.

“Youth are generally using substances to gain friends, avoid losing them, or to cope with emotional problems that they’re having,” he said. “Effective prevention efforts need to offer healthy alternatives for achieving those goals.”

Just say “know”

At times, the tenets of harm reduction and substance use prevention seem inherently misaligned. Harm reduction, born out of a response to the AIDS crisis, prioritizes bodily autonomy and meeting people where they are without judgment. For some harm reductionists, actively encouraging teens against using drugs could violate the principle of respecting autonomy, Weiner said.

On the other hand, traditional prevention advocates may feel that teaching adolescents how to use fentanyl test strips or encouraging them not to use drugs alone undermines the idea that they can choose not to use substances. But Weiner says both approaches can be part of the solution.

“It doesn’t have to be either prevention or harm reduction, and we lose really important tools when we say it has to be one or the other,” he said.

In adults, harm reduction approaches save lives, prevent disease transmission, and help people connect with substance use treatment (Harm Reduction, NIDA, 2022). Early evidence shows similar interventions can help adolescents improve their knowledge and decision-making around drug use (Fischer, N. R., Substance Abuse Treatment, Prevention, and Policy, Vol. 17, 2022). Teens are enthusiastic about these programs, which experts often call “Just Say Know” to contrast them with the traditional “Just Say No” approach. In one pilot study, 94% of students said a “Just Say Know” program provided helpful information and 92% said it might influence their approach to substance use (Meredith, L. R., et al., The American Journal of Drug and Alcohol Abuse, Vol. 47, No. 1, 2021).

“Obviously, it’s the healthiest thing if we remove substance use from kids’ lives while their brains are developing. At the same time, my preference is that we do something that will have a positive impact on these kids’ health and behaviors,” said Nora Charles, PhD, an associate professor and head of the Youth Substance Use and Risky Behavior Lab at the University of Southern Mississippi. “If the way to do that is to encourage more sensible and careful engagement with illicit substances, that is still better than not addressing the problem.”

One thing not to do is to overly normalize drug use or to imply that it is widespread, Weiner said. Data show that it’s not accurate to say that most teens have used drugs in the past year or that drugs are “just a part of high school life.” In fact, students tend to overestimate how many of their peers use substances (Dumas, T. M., et al., Addictive Behaviors, Vol. 90, 2019; Helms, S. W., et al., Developmental Psychology, Vol. 50, No. 12, 2014).

A way to incorporate both harm reduction and traditional prevention is to customize solutions to the needs of various communities. For example, in 2022, five Alabama high school students overdosed on a substance laced with fentanyl, suggesting that harm reduction strategies could save lives in that community. Other schools with less reported substance use might benefit more from a primary prevention-style program.

At Stanford, Halpern-Felsher’s Research and Education to Empower Adolescents and Young Adults to Choose Health (REACH) Lab has developed a series of free, evidence-based programs through community-based participatory research that can help populations with different needs. The REACH Lab offers activity-based prevention, intervention, and cessation programs for elementary, middle, and high school students, including curricula on alcohol, vaping, cannabis, fentanyl, and other drugs (Current Problems in Pediatric and Adolescent Health Care, Vol. 52, No. 6, 2022). They’re also working on custom curricula for high-risk groups, including sexual and gender minorities.

The REACH Lab programs, including the comprehensive Safety First curriculum, incorporate honest discussion about the risks and benefits of using substances. For example: Drugs are one way to cope with stress, but exercise, sleep, and eating well can also help. Because many young people care about the environment, one lesson explores how cannabis and tobacco production causes environmental harm.

The programs also dispel myths about how many adolescents are using substances and help them practice skills, such as how to decline an offer to use drugs in a way that resonates with them. They learn about the developing brain in a positive way—whereas teens were long told they can’t make good decisions, Safety First empowers them to choose to protect their brains and bodies by making healthy choices across the board.

“Teens can make good decisions,” Halpern-Felsher said. “The equation is just different because they care more about certain things—peers, relationships—compared to adults.”

Motivating young people

Because substance use and mental health are so intertwined, some programs can do prevention successfully with very little drug-focused content. In one of the PreVenture Program’s workshops for teens, only half a page in a 35-page workbook explicitly mentions substances.

“That’s what’s fascinating about the evidence base for PreVenture,” said clinical psychologist Patricia Conrod, PhD, a professor of psychiatry at the University of Montreal who developed the program. “You can have quite a dramatic effect on young people’s substance use without even talking about it.”

PreVenture offers a series of 90-minute workshops that apply cognitive behavioral insights upstream (addressing the root causes of a potential issue rather than waiting for symptoms to emerge) to help young people explore their personality traits and develop healthy coping strategies to achieve their long-term goals.

Adolescents high in impulsivity, hopelessness, thrill-seeking, or anxiety sensitivity face higher risks of mental health difficulties and substance use, so the personalized material helps them practice healthy coping based on their personality type. For example, the PreVenture workshop that targets anxiety sensitivity helps young people learn to challenge cognitive distortions that can cause stress, then ties that skill back to their own goals.

The intervention can be customized to the needs of a given community (in one trial, drag racing outstripped substance use as the most problematic thrill-seeking behavior). In several randomized controlled trials of PreVenture, adolescents who completed the program started using substances later than peers who did not receive the intervention and faced fewer alcohol-related harms (Newton, N. C., et al., JAMA Network Open, Vol. 5, No. 11, 2022). The program has also been shown to reduce the likelihood that adolescents will experiment with illicit substances, which relates to the current overdose crisis in North America, Conrod said (Archives of General Psychiatry, Vol. 67, No. 1, 2010).

“People shouldn’t shy away from a targeted approach like this,” Conrod said. “Young people report that having the words and skills to manage their traits is actually helpful, and the research shows that at behavioral level, it really does protect them.”

As young people leave secondary school and enter college or adult life, about 30% will binge drink, 8% will engage in heavy alcohol use, and 20% will use illicit drugs (Alcohol and Young Adults Ages 18 to 24, National Institute on Alcohol Abuse and Alcoholism, 2023; SAMHSA announces national survey on drug use and health (NSDUH) results detailing mental illness and substance use levels in 2021). But young people are very unlikely to seek help, even if those activities cause them distress, Murphy said. For that reason, brief interventions that leverage motivational interviewing and can be delivered in a school, work, or medical setting can make a big difference.

In an intervention Murphy and his colleagues are testing, young adults complete a questionnaire about how often they drink or use drugs, how much money they spend on substances, and negative things that have happened as a result of those choices (getting into an argument or having a hangover, for example).

In an hour-long counseling session, they then have a nonjudgmental conversation about their substance use, where the counselor gently amplifies any statements the young person makes about negative outcomes or a desire to change their behavior. Participants also see charts that quantify how much money and time they spend on substances, including recovering from being intoxicated, and how that stacks up against other things they value, such as exercise, family time, and hobbies.

“For many young people, when they look at what they allocate to drinking and drug use, relative to these other things that they view as much more important, it’s often very motivating,” Murphy said.

A meta-analysis of brief alcohol interventions shows that they can reduce the average amount participants drink for at least 6 months (Mun, E.Y., et al., Prevention Science, Vol. 24, No. 8, 2023). Even a small reduction in alcohol use can be life-altering, Murphy said. The fourth or fifth drink on a night out, for example, could be the one that leads to negative consequences—so reducing intake to just three drinks may make a big difference for young people.

Conrod and her colleagues have also adapted the PreVenture Program for university students; they are currently testing its efficacy in a randomized trial across multiple institutions.

Christie is also focused on the young adult population. As a policy intern with Students for Sensible Drug Policy, she created a handbook of evidence-based policies that college campuses can use to reduce harm among students but still remain compliant with federal law. For example, the Drug Free Schools and Communities Act mandates that higher education institutions formally state that illegal drug use is not allowed on campus but does not bar universities from taking an educational or harm reduction-based approach if students violate that policy.

“One low-hanging fruit is for universities to implement a Good Samaritan policy, where students can call for help during a medical emergency and won’t get in trouble, even if illegal substance use is underway,” she said.

Ultimately, taking a step back to keep the larger goals in focus—as well as staying dedicated to prevention and intervention approaches backed by science—is what will help keep young people healthy and safe, Weiner said.

“What everyone can agree on is that we want kids to have the best life they can,” he said. “If we can start there, what tools do we have available to help?”

 

Filed under: Drug use-various effects,Education Sector,Mental Health,Prevention (Papers),Prevention and Intervention,Social Affairs,USA :

May 29, 2024  Contact: Kristen Govostes  Phone Number: (617) 557-2100

BOSTON – The U.S. Drug Enforcement Administration’s New England Field Division will team up with college esports teams from across New England to host the first of its kind, hybrid One Pill Can Kill Game Over Tournament. This event aims to meet a critical moment in time by using the esports platform to help educate young people about the dangers of fentanyl.

Twenty-two teenagers between the ages of 14 and 18 die every week from a drug poisoning or overdose death, according to a recent study by the New England Journal of Medicine.  To more effectively reach this important audience, DEA has teamed up with actress, founder of the Devon Michael Foundation, and influencer Ava Michelle and eight esports teams across the region to take an innovative new approach to fentanyl outreach and awareness.  With an overwhelming 97% of Americans between the ages of 12 and 17 engaged in video gaming, DEA is looking to reach young people where they often spend time – in the virtual world.

The One Pill Can Kill Game Over Tournament will be hosted by Clark University Esports on Thursday, June 6, 2024, from 7 to 9 p.m. ET on Twitch (twitch.tv/onepillcankill).  Access to view the tournament will also be available at DEA One Pill Can Kill Game Over Tournament | DEA.gov.  Joining Clark University for this Rocket League battle will be esports teams from Worcester Polytechnic Institute, University of Massachusetts Amherst, Boston University, Emerson College, Post University, University of New Hampshire, and the University of Southern Maine.

DEA will host an in-person pre-tournament program and live gameplay for invited guests at the state-of-the-art gaming center, All Systems Go, on Thursday, June 6, 2024, beginning at 4:30 p.m. Attendees will include high school aged students, community groups and dignitaries.  Media should plan to arrive around 5:45 p.m. for b-roll opportunities ahead of the press event, which will include remarks from DEA Associate Administrator Jon DeLena, Worcester County Sheriff Lew Evangelidis, Ava Michele and more. All Systems Go gaming center is located at 225 Shrewsbury Street, Worcester, Mass., 02604.

Fentanyl is a synthetic opioid, which is now involved in a majority of drug poisonings and overdose deaths.  Fentanyl is 50 times more potent than heroin, and just two milligrams – the amount that can fit on the tip of a pencil – can be deadly.  Often, people buy what they think is a legitimate prescription pill like Percocet or Xanax on social media, but it turns out, they’ve unknowingly purchased a fentanyl pill.  DEA laboratory testing indicates 7 out of 10 fentanyl pills seized contain a potentially deadly dose.  In 2023, DEA seized approximately 15.7 million potentially lethal doses of fentanyl in New England alone.

“I am thrilled we are able to team up with these amazing esports teams to host this One Pill Can Kill Game Over Tournament in New England and increase awareness about the dangers of fentanyl,” said DEA Associate Administrator Jon DeLena. “This event is extremely personal to me.  I know how much my own kids enjoy playing video games, so knowing they are also learning valuable, life-saving information while doing what they love is so important. I want to encourage any family with a gamer to join us – either virtually or in-person – watch the competition and then talk about what you’ve learned. It could be the most important talk you have as a family.”

“Connecting with people in an environment where they are having fun and are open to learning has been an incredible experience. Raising awareness and providing education about the fentanyl epidemic is absolutely crucial—I genuinely believe we are saving lives.” –  Ava Michelle Cota, Actress, and Founder, Devon Michael Foundation.

The One Pill Can Kill Game Over Tournament in New England will be the third tournament in this series.  The first tournament was held in the DEA’s New Orleans Field Division in January and reached more than 285,500 viewers. The second tournament was hosted by DEA Philadelphia in March and was viewed by more than 146,800. B-roll and soundbites from the previous events is available here. The New England event is the first to offer an in-person outreach event ahead of the tournament.

DEA would like to thank the participating teams, All Systems Go, The Rendon Group, and the esports community for their involvement and support of DEA’s One Pill Can Kill Game Over Tournaments.

 

Drug Enforcement Administration

Stephen Belleau, Acting Special Agent in Charge – New England

@DEANewEngland

Source: https://www.dea.gov/press-releases/2024/05/29/dea-brings-its-one-pill-can-kill-game-over-tournament-new-england-first

Filed under: Drug use-various effects,Mental Health,USA,Youth :

Associate Professor | Department Chair | Director, Forensic Science Research Center

Department of Criminal Justice, California State University

The opioid epidemic is a public health and safety emergency that is killing thousands and destroying the quality of life for hundreds of thousands of Americans and those who care about them. Fentanyl and other opioids affect all age ranges, ethnicities, and communities, including our most vulnerable population, children. Producing fentanyl is increasingly cheap, costing pennies for a fatal dose, with the opioid intentionally or unintentionally mixed with common illicit street drugs and pressed into counterfeit pills. Fentanyl is odorless and tasteless, making it nearly untraceable when mixed with other drugs. Extremely small doses of fentanyl, roughly equivalent to a few grains of salt, can be fatal, while carfentanil, a large animal tranquilizer, is 100 times more potent than fentanyl and fatal at an even smaller amount.

The Biden-Harris Administration should do even more to fund opioid-related prevention, treatment, eradication, and interdiction efforts to save lives in the United States. The 2022 Executive Order to Address the Opioid Epidemic and Support Recovery awarded $1.5 billion to states and territories to expand treatment access, enhance services in rural communities, and fund law enforcement efforts. In his 2023 State of the Union address, President Biden highlighted reducing opioid overdoses as part of his bipartisan Unity Agenda, pledging to disrupt trafficking and sales of fentanyl and focus on prevention and harm reduction. Despite extensive funding, opioid-related overdoses have not significantly decreased, showing that a different strategy is needed to save lives.

Opioid-related deaths have been estimated cost the U.S. nearly $4 trillion over the past seven years—not including the human aspect of the deaths. The cost of fatal overdoses was determined to be $550 billion in 2017. The cost of the opioid epidemic in 2020 alone was an estimated $1.5 trillion, up 37% from 2017. About two-thirds of the cost was due to the value of lives lost and opioid use disorder, with $35 billion spent on healthcare and opioid-related treatments and about $15 billion spent on criminal justice involvement. In 2017, per capita costs of opioid use disorder and opioid toxicity-related deaths were as high as $7247, with the cost per case of opioid use disorder over $221,000. With inflation in November 2023 at $1.26 compared to $1 in 2017, not including increases in healthcare costs and the significant increase in drug toxicity-related deaths, the total rate of $693 billion is likely significantly understated for fatal overdoses in 2023. Even with extensive funding, opioid-related deaths continue to rise.

With fatal opioid-related deaths being underreported, the Centers for Disease Control and Prevention (CDC) must take a primary role in real-time surveillance of opioid-related fatal and non-fatal overdoses by funding expanded toxicology testing, training first responder and medicolegal professionals, and ensuring compliance with data submission. The Department of Justice (DOJ) should support enforcement efforts to reduce drug toxicity-related morbidity and mortality, with the Department of Homeland Security (DHS) and the Department of the Treasury (TREAS) assisting with enforcement and sanctions, to prevent future overdoses. Key recommendations for reducing opioid-related morbidity and mortality include:

  • Funding research to determine the efficacy of current efforts in opioid misuse reduction and prevention.
  • Modernizing data systems and surveillance to provide real-time information.
  • Increasing overdose awareness, prevention education, and availability of naloxone.
  • Improve training of first responders and medicolegal death investigators.
  • Funding rapid and thorough toxicology testing in emergency departments and coroner/medical examiner agencies.
  • Enhancing prevention and enforcement efforts.

Challenge And Opportunity

Opioids are a class of drugs, including pain relievers that can be illegally prescribed and the illicit drug heroin. There are three defined waves of the opioid crisis, starting in the early 1990s as physicians increasingly prescribed opioids for pain control. The uptick in prescriptions stemmed from pharmaceutical companies promising physicians that these medications had low addiction rates and medical professionals adding pain levels being added to objective vital signs for treatment. From 1999 to 2010, prescription opioid sales quadrupled—and opioid-related deaths doubled. During this time frame when the relationship between drug abuse and misuse was linked to opioids, a significant push was made to limit physicians from prescribing opioids. This contributed to the second wave of the epidemic, when heroin abuse increased as former opioid patients sought relief. Heroin-related deaths increased 286% from 2002 to 2013, with about 80% of heroin users acknowledging that they misused prescription opioids before using heroin.  The third wave of the opioid crisis came in 2013 with an increase in illegally manufactured fentanyl, a synthetic opioid used to treat severe pain that is up to 100 times stronger than morphine, and carfentanil, which is 100 times more potent than fentanyl.

In 2022, nearly 110,000 people in the United States died from drug toxicity, with about 75% of the deaths involving opioids. In 2021, six times as many people died from drug overdoses as in 1999, with a 16% increase from 2020 to 2021 alone. While heroin-related deaths decreased by over 30% from 2020 to 2021, opioid-related deaths increased by 15%, with synthetic opioid-involved deaths like fentanyl increasing by over 22%. Over 700,000 people have died of opioid-related drug toxicity since 1999, and since 2021 45 people have died every day from a prescription opioid overdose. Opioid-related deaths have increased tenfold since 1999, with no signs of slowing down. The District of Columbia declared a public emergency in November 2023 to draw more attention to the opioid crisis.

In 2023, we are at the precipice of the fourth wave of the crisis, as synthetic opioids like fentanyl are combined with a stimulant, commonly methamphetamine. Speedballs have been common for decades, using stimulants to counterbalance the fatigue that occurs with opiates. The fatal combination of fentanyl and a stimulant was responsible for just 0.6% of overdose deaths in 2010 but 32.3% of opioid deaths in 2021, an over fifty-fold increase in 12 years. Fentanyl, originally used in end-of-life and cancer care, is commonly manufactured in Mexico with precursor chemicals from China. Fentanyl is also commonly added to pressed pills made to look like legitimate prescription medications. In the first nine months of 2023, the Drug Enforcement Agency (DEA) seized over 62 million counterfeit pills and nearly five tons of powdered fentanyl, which equates to over 287 million fatal doses. These staggering seizure numbers do not include local law enforcement efforts, with the New York City Police Department recovering 13 kilos of fentanyl in the Bronx, enough powder to kill 6.5 million people. 

The ease of creating and trafficking fentanyl and similar opioids has led to an epidemic in the United States. Currently, fentanyl can be made for pennies and sold for as little as 40 cents in Washington State. The ease of availability has led to deaths in our most vulnerable population—children. Between June and September 2023, there were three fatal overdoses of children five years and younger in Portland, OR. In a high-profile case in New York City, investigators found a kilogram of fentanyl powder in a day care facility after a 1-year-old died and three others became critically ill.

The Biden Administration has responding to the crisis in part by placing sanctions against and indicting executives in Chinese companies for manufacturing and distributing precursor chemicals, which are commonly sold to Mexican drug cartels to create fentanyl. The drug is then trafficked into the United States for sale and use. There are also concerns about fentanyl being used as a weapon of mass destruction, similar to the anthrax concerns in the early 2000s.

The daily concerns of opioid overdoses have plagued public health and law enforcement professionals for years. In Seattle, WA, alone, there are 15 non-fatal overdoses daily, straining the emergency medical systems. There were nearly 5,000 non-fatal overdoses in the first seven months of 2023 in King County, WA, an increase of 70% compared to 2022. In a landmark decision, in March 2023 the Food and Drug Administration (FDA) approved naloxone, a drug to reverse the effects of opioid overdoses, as an over-the-counter nasal spray in an attempt to reduce overdose deaths. Naloxone nasal spray was initially approved for prescription use only in 2015 , significantly limiting access to first responders and available to high-risk patients when prescribed opioids. In New York, physicians have been required to prescribe naloxone to patients at risk of overdose since 2022. Although naloxone is now available without a prescription, access is still limited by price, with one dose costing as much as $65, and some people requiring more than one dose to reverse the overdose. Citing budget concerns, Governor Newsom vetoed California’s proposed AB 1060, which would have limited the cost of naloxone to $10 per dose. Fentanyl testing strips that can be used to test substances for the presence of fentanyl before use show promise in preventing unwanted fentanyl-adulterated overdoses. The Expanding Nationwide Access to Test Strips Act, which was introduced to the Senate in July 2023, would decriminalize the testing strips as an inexpensive way to reduce overdose while following evidence-based harm-reduction theories.

Illicit drugs are also one of the top threats to national security. Law enforcement agencies are dealing with a triple epidemic of gun violence, the opioid crisis, and critical staffing levels. Crime prevention is tied directly to increased police staffing, with lower staffing limiting crime control tactics, such as using interagency task forces, to focus on a specific crime problem. Police are at the forefront of the opioid crisis, expected to provide an emergency response to potential overdoses and ensure public safety while disrupting and investigating drug-related crimes. Phoenix Police Department seized over 500,000 fentanyl pills in June 2023 as part of Operation Summer Shield, showing law enforcement’s central role in fighting the opioid crisis. DHS created a comprehensive interdiction plan to reduce the national and international supply of opioids, working with the private sector to decrease drugs brought into the United States and increasing task forces to focus on drug traffickers.

Prosecutors are starting to charge drug dealers and parents of children exposed to fentanyl in their residences in fatal overdose cases. In an unprecedented action, Attorney General Merrick Garland recently charged Mexican cartel members with trafficking fentanyl and indicting Chinese companies and their executives for creating and selling precursor chemicals. In November 2023, sanctions were placed against the Sinaloa cartel and four firms from Mexico suspected of drug trafficking to the United States, removing their ability to legally access the American banking system. Despite this work, criminal justice-related efforts alone are not reducing overdoses and deaths, showing a need for a multifaceted approach to save lives.

While these numbers of opioid overdoses are appalling, they are likely underreported. Accurate reporting of fatal overdoses varies dramatically across the country, with the lack of training of medicolegal death investigators to recognize potential drug toxicity-related deaths, coupled with the shortage of forensic pathologists and the high costs of toxicology testing, leading to inaccurate cause of death information. The data ecosystem is changing, with agencies and their valuable data remaining disjointed and unable to communicate across systems. A new model could be found in the CDC’s Data Modernization Initiative, which tracked millions of COVID-19 cases across all states and districts, including data from emergency departments and medicolegal offices. This robust initiative to modernize data transfer and accessibility could be transformative for public health. The electronic case reporting system and strong surveillance systems that are now in place can be used for other public health outbreaks, although they have not been institutionalized for the opioid epidemic.

Toxicology testing can take upwards of 8–10 weeks to receive, then weeks more for interpretation and final reporting of the cause of death. The CDC’s State Unintentional Drug Overdose Reporting System receives data from 47 states from death certificates and coroner/medical examiner reports. Even with the CDC’s extensive efforts, the data-sharing is voluntary, and submission is rarely timely enough for tracking real-time outbreaks of overdoses and newly emerging drugs. The increase of novel psychoactive substances, including the addition of the animal tranquilizer xylazineto other drugs, is commonly not included in toxicology panels, leaving early fatal drug interactions undetected and slowing notification of emerging drugs regionally. The data from medicolegal reports is extremely valuable for interdisciplinary overdose fatality review teams at the regional level that bring together healthcare, social services, criminal justice, and medicolegal personnel to review deaths and determine potential intervention points. Overdose fatality review teams can use the data to inform prevention efforts, as has been successful with infant sleeping position recommendations formed through infant mortality review teams.

Plan Of Action

Reducing opioid misuse and saving lives requires a multi-stage, multi-agency approach. This includes expanding real-time opioid surveillance efforts; funding for overdose awareness, prevention, and education; and improved training of first responders and medicolegal personnel on recognizing, responding to, and reporting overdoses. Nationwide, improved toxicology testing and reporting is essential for accurate reporting of overdose-involved drugs and determining the efficacy of efforts to combat the opioid epidemic.

Agency Role
Department of Education (ED) ED creates policies for educational institutions, administers educational programs, promotes equity, and improves the quality of education.

ED should increase resources for creating and implementing evidence-based preventative education for youth and provide resources for drug misuse with access to naloxone.
Department of Justice (DOJ) DOJ is responsible for keeping our country safe by upholding the law and protecting civil rights. The DOJ houses the Office of Justice Programs and the Drug Enforcement Agency (DEA), which are instrumental in the opioid crisis.

DOJ should be the principal enforcement agency, with the DEA leading drug-related enforcement actions. The Attorney General should continue to initiate new sanctions and a wider range of indictments to assist with interdiction and eradication efforts.
Department of Health and Human Services (HHS) HHS houses the Centers for Disease Control and Prevention (CDC), the nation’s health protection and preventative agency, and collects and analyzes vital data to save lives and protect people from health threats.

The CDC should be the primary agency to focus on robust real-time opioid-related overdose surveillance and fund local public health departments to collect and submit data. HHS should fund grants to enhance community efforts to reduce opioid-related overdoses and provide resources and outreach to increase awareness.
Department of Homeland Security (DHS) DHS focuses on crime prevention and safety at our borders, including interdiction and eradication efforts, while monitoring security threats and strengthening preparedness.

DHS should continue leading international investigations of fentanyl production and trafficking. Additional funding should be provided to allow DHS and its investigative agencies to focus more on producers of opioids, sales of precursors, and trafficking to assist with lessening the supply available in the United States.
Department of the Treasury (TREAS) TREAS is responsible for maintaining financial infrastructure systems, collecting revenue and dispersing payments, and creating international economic policies.

TREAS should continue efforts to sanction countries producing precursors to create opioids and trafficking drugs into the U.S. while prohibiting business ties with companies participating in drug trades. Additional funding should be available to support E.O. 14059 to counter transnational organized crime’s relation to illicit drugs.
Bureau of Prisons (BOP) The BOP provides protection for public safety by providing a safe and humane facility for federal offenders to serve their prescribed time while providing appropriate programming for reentry to ease a transition back to communities.

The BOP should provide treatment for opioid use disorders, including the option for medication-assisted treatment, to assist in reducing relapse and overdoses, coupled with intensive case management.
State Department (DOS) The DOS spearheads foreign policy by creating agreements, negotiating treaties, and advocating for the United States internationally.

The DOS should receive additional funding to continue to work with the United Nations to disrupt the trafficking of drugs and limit precursors used to make illicit opioids. The DOS also assists Mexico and other countries fight drug trafficking and production.

Recommendation 1. Fund research to determine the efficacy of current efforts in opioid misuse reduction and prevention.

DOJ should provide grant funding for researchers to outline all known current efforts of opioid misuse reduction and prevention by law enforcement, public health, community programs, and other agencies. The efforts, including the use of suboxone and methadone, should be evaluated to determine if they follow evidence-based practices, how the programs are funded, and their known effect on the community. The findings should be shared widely and without paywalls with practitioners, researchers, and government agencies to hone their future work to known successful efforts and to be used as a foundation for future evidence-based, innovative program implementation.

Recommendation 2. Modernize data systems and surveillance to provide real-time information.

City, county, regional, and state first responder agencies work across different platforms, as do social service agencies, hospitals, private physicians, clinics, and medicolegal offices. A single fatal drug toxicity-related death has associated reports from a law enforcement officer, fire department personnel, emergency medical services, an emergency department, and a medicolegal agency. Additional reports and information are sought from hospitals and clinics, prior treating clinicians, and social service agencies. Even if all of these reports can be obtained, data received and reviewed is not real-time and not accessible across all of the systems.

Medicolegal agencies are arguably the most underprepared for data and surveillance modernization. Only 43% of medicolegal agencies had a computerized case management system in 2018, which was an increase from 31% in 2004. Outside of county or state property, only 75% of medicolegal personnel had internet access from personal devices. The lack of computerized case management systems and limited access to the internet can greatly hinder case reporting and providing timely information to public health and other reporting agencies.

With the availability and use of naloxone by private persons, the Public Naloxone Administration Dashboard from the National EMS Information System (NEMSIS) should be supported and expanded to include community member administration of naloxone. The emergency medical services data can be aligned with the anonymous upload of when, where, and basic demographics for the recipient of naloxone, which can also be made accessible to emergency departments and medicolegal death investigation agencies. While the database likely will not be used for all naloxone administrations, it can provide hot spot information and notify social services of potential areas for intervention and assistance. The database should be tied to the first responder/hospital/medicolegal database to assist in robust surveillance of the opioid epidemic.

Recommendation 3. Increase overdose awareness, prevention education, and availability of naloxone.

Awareness of the likelihood of poisoning and potential death from the use of fentanyl or counterfeit pills is key in prevention. The DEA declared August 21 National Fentanyl Prevention and Awareness Day to increase knowledge of the dangers of fentanyl, with the Senate adopting a resolution to formally recognize the day in 2023. Many states have opioid and fentanyl prevention tactics on their public health websites, and the CDC has educational campaigns designed to reach young adults, though the education needs to be specifically sought out. Funding should be made available to community organizations and city/county governments to create public awareness campaigns about fentanyl and opioid usage, including billboards, television and streaming ads, and highly visible spaces like buses and grocery carts.

ED allows evidence-based prevention programs in school settings to assist in reducing risk factors associated with drug use and misuse. The San Diego Board of Supervisors approved a proposal to add education focused on fentanyl awareness after 12 juveniles died of fentanyl toxicity in 2021. The district attorney supported the education and sought funding to sponsor drug and alcohol training on school campuses. Schools in Arlington, VA, note the rise in overdoses but recognize that preventative education, when present, is insufficient. ED should create prevention programs at grade-appropriate levels that can be adapted for use in classrooms nationwide.

With the legalization of over-the-counter naloxone, funding is needed to provide subsidized or free access to this life-saving medication. Powerful fentanyl analogs require higher doses of naloxone to reverse the toxicity, commonly requiring multiple naloxone administrations, which may not be available to an intervening community member. The State of Washington’s Department of Public Health offers free naloxone kits by mail and at certain pharmacies and community organizations, while Santa Clara University in California has a vending machine that distributes naloxone for free. While naloxone reverses the effects of opioids for a short period, once it wears off, there is a risk of a secondary overdose from the initial ingestion of the opioid, which is why seeking medical attention after an overdose is paramount to survival. Increasing access to naloxone in highly accessible locations—and via mail for more rural locations—can save lives. Naloxone access and basic training on signs of an opioid overdose may increase recognition of opioid misuse and empower the community to provide immediate, lifesaving action.

However, there are concerns that naloxone may end up in a shortage. With its over-the-counter access, naloxone may still be unavailable for those who need it most due to cost (approximately $20 per dose) or access to pharmacies. There is a national push for increasing naloxone distribution, though there are concerns of precursor shortages that will limit or halt production of naloxone. Governmental support of naloxone manufacturing and distribution can assist with meeting demand and ensuring sustainability in the supply chain.

Recommendation 4. Improve training of first responders and medicolegal death investigators.

Most first responders receive training on recognizing signs and symptoms of a potential overdose, and emergency medical and firefighting personnel generally receive additional training for providing medical treatment for those who are under the influence. To avoid exposure to fentanyl, potentially causing a deadly situation for the first responder, additional training is needed about what to do during exposure and how to safely provide naloxone or other medical care. DEA’s safety guide for fentanyl specifically outlines a history of inconsistent and misinformation about fentanyl exposure and treatment. Creating an evidence-based training program that can be distributed virtually and allow first responders to earn continuing education credit can decrease exposure incidents and increase care and responsiveness for those who have overdosed.

While the focus is rightfully placed on first responders as the frontline of the opioid epidemic, medicolegal death investigators also serve a vital function at the intersection of public health and criminal justice. As the professionals who respond to scenes to investigate the circumstances (including cause and manner) surrounding death, medicolegal death investigators must be able to recognize signs of drug toxicity. Training is needed to provide foundational knowledge on deciphering evidence of potential overdose-related deaths, photographing scenes and evidence to share with forensic pathologists, and memorializing the findings to provide an accurate manner of death. Causes of death, as determined by forensic pathologists, need appropriate postmortem examinations and toxicology testing for accuracy, incorporated with standardized wording for death certificates to reflect the drugs contributing to the death. Statistics on drug-related deaths collected by the CDC and public health departments nationwide rely on accurate death certificates to determine trends.

The CDC created the Collaborating Office for Medical Examiners and Coroners (COMEC) in 2022 to provide public health support for medicolegal death investigation professionals. COMEC coordinates health surveillance efforts in the medicolegal community and champions quality investigations and accurate certification of death. The CDC offers free virtual, asynchronous training for investigating and certifying drug toxicity deaths, though the program is not well known or advertised, and there is no ability to ask questions of professionals to aid in understanding the content. Funding is needed to provide no-cost, live instruction, preferably in person, to medicolegal offices, as well as continuing education hours and thorough training on investigating potential drug toxicity-related deaths and accurately certifying death certificates.

Cumulatively, the roughly 2,000 medicolegal death investigation agencies nationwide investigated more than 600,000 deaths in 2018, running on an average budget of $470,000 per agency. Of these agencies, less than 45% had a computerized case management system, which can significantly delay data sharing with public health and allied agencies and reduce reporting accuracy, and only 75% had access to the internet outside of their personally owned devices. Funding is needed to modernize and extend the infrastructure for medicolegal agencies to allow basic functions such as computerized case management systems and internet access, similar to grant funding from the National Network of Public Health Institutes.

Recommendation 5. Fund rapid and thorough toxicology testing in emergency departments and coroner/medical examiner agencies.

Rapid, accurate toxicology testing in an emergency department setting can be the difference between life and death treatment for a patient. Urine toxicology testing is fast, economical, and can be done at the bedside, though it cannot quantify the amount of drug and is not inclusive for emerging drugs. Funding for enhanced accurate toxicology testing in hospitals with emergency departments, including for novel psychoactive substances and opioid analogs, is necessary to provide critical information to attending physicians in a timely manner to allow reversal agents or other vital medical care to be performed.

With the limited resources medicolegal death investigation agencies have nationally and the average cost of $3000 per autopsy performed, administrators need to triage which deaths receive toxicology testing and how in-depth the testing will be. Advanced panels, including ever-changing novel psychoactive substances, are costly and can result in inaccurate cause of death reporting if not performed routinely. Funding should be provided to medicolegal death investigating agencies to subsidize toxicology testing costs to provide the most accurate drugs involved in the death. Accurate cause of death reporting will allow for timely public health surveillance to determine trends and surges of specific drugs. Precise cause of death information and detailed death investigations can significantly contribute to regional multidisciplinary overdose fatality review task forces that can identify potential intervention points to strengthen services and create evidence to build future life-saving action plans.

Recommendation 6. Enhance prevention and enforcement efforts.

DOJ should fund municipal and state law enforcement grants to use evidence-based practices to prevent and enforce drug-related crimes. Grant applications should include a review of the National Institute of Justice’s CrimeSolutions.gov practices in determining potential effectiveness or using foundational knowledge to build innovative, region-specific efforts. The funding should be through competitive grants, requiring an analysis of local trends and efforts and a detailed evaluation and research dissemination plan. Competitive grant funding should also be available for community groups and programs focusing on prevention and access to naloxone.

An often overlooked area of prevention is for justice-involved individuals who enter jail or prison with substance use disorders. Approximately 65% of prisoners in the United States have a substance abuse order, and an additional 20% of prisoners were under the influence of drugs or alcohol when they committed their crime. About 15% of the incarcerated population was formally diagnosed with an opioid use disorder. Medications are available to assist with opioid use disorder treatments that can reduce relapses and post-incarceration toxicity-related deaths, though less than 15% of correctional systems offer medication-assisted opioid use treatments. Extensive case management coupled with trained professionals to prescribe medication-assisted treatment can help reduce opioid-related relapses and overdoses when justice-involved individuals are released to their communities, with the potential to reduce recidivism if treatment is maintained.

DEA should lead local and state law enforcement training on recognizing drug trends, creating regional taskforces for data-sharing and enforcement focus, and organizing drug takeback days. Removing unused prescription medications from homes can reduce overdoses and remove access to unauthorized users, including children and adolescents. Funding to increase collection sites, assist in the expensive process of properly destroying drugs, and advertising takeback days and locations can reduce the amount of available prescription medications that can result in an overdose.

DHS, TREAS, and DOS should expand their current efforts in international trafficking investigations, create additional sanctions against businesses and individuals illegally selling precursor chemicals, and collaborate with countries to universally reduce drug production.

Budget Proposal

A budget of $800 million is proposed to evaluate the current efficacy of drug prevention and enforcement efforts, fund prevention and enforcement efforts, improve training for first responders and medicolegal death investigators, increase rapid and accurate toxicology testing in emergency and medicolegal settings, and enhance collaboration between law enforcement agencies. The foundational research on the efficacy of current enforcement, preventative efforts, and surveillance should receive $25 million, with findings transparently available and shared with practitioners, lawmakers, and community members to hone current practices.

DOJ should receive $375 million to fund grants; collaborative enforcement efforts between local, state, and federal agencies; preventative strategies and programs; training for first responders; and safe drug disposal programs.

CDC should receive $250 million to fund the training of medicolegal death investigators to recognize and appropriately document potential drug toxicity-related deaths, modernize data and reporting systems to assist with accurate surveillance, and provide improved toxicology testing options to emergency departments and medicolegal offices to assist with appropriate diagnoses. Funding should also be used to enhance current data collection efforts with the Overdose to Action program34 by encouraging timely submissions, simplifying the submission process, and helping create or support overdose fatality review teams to determine potential intervention points.

ED should receive $75 million to develop curricula for K-12 and colleges to raise awareness of the dangers of opioids and prevent usage. The curriculum should be made publicly available for access by parents, community groups, and other organizations to increase its usage and reach as many people as possible.

BOP should receive $25 million to provide opioid use disorder medication-assisted treatments by trained clinicians and extensive case management to assist in reducing post-incarceration relapse and drug toxicity-related deaths. The policies, procedures, and steps to create medication-assisted programming should be shared with state corrections departments and county jails to build into their programming to expand use in carceral settings and assist in reducing drug toxicity-related deaths at all incarceration levels.

DOS, DHS, and TREAS should jointly receive $50 million to strengthen their current international investigations and collaborations to stop drug trafficking, the manufacture and sales of precursors, and combating organized crime’s association with the illegal drug markets.

Conclusion

Opioid-related overdoses and deaths continue to needlessly and negatively affect society, with parents burying children, sometimes infants, in an unnatural order. With the low cost of fentanyl production and the high return on investment, fentanyl is commonly added to illicit drugs and counterfeit, real-looking prescription pills. Opioid addiction and fatal overdoses affect all genders, races, ethnicities, and socioeconomic statuses, with no end to this deadly path in sight. Combining public health surveillance with enforcement actions, preventative education, and innovative programming is the most promising framework for saving lives nationally.

 

FEDERATION OF AMERICAN SCIENTISTS © 2024
Source: https://fas.org/publication/underscoring-opioid-epidemic/
Filed under: Drug Specifics,Drug use-various effects,Effects of Drugs,Fentanyl,Heroin/Methadone,USA :

As the workplace evolves, so do the challenges that organizations face in maintaining a safe and productive environment.

 

A Surge in Drug Test Tampering

 

According to Quest Diagnostics’ latest report, the percentage of employees in the general U.S. workforce showing signs of tampered drug tests increased dramatically in 2023. Instances of substituted urine specimens surged by over 600%, while invalid urine specimens rose by 45.2%. These unprecedented numbers indicate a significant increase in efforts to circumvent drug testing protocols.

 

Suhash Harwani, Ph.D., Senior Director of Science for Workforce Health Solutions at Quest Diagnostics, noted, “The increased rate of both substituted and invalid specimens indicates that some American workers are going to great lengths to attempt to subvert the drug testing process.” This trend underscores a growing issue where the normalization of drug use may be influencing employees to believe they can bypass drug tests without considering the consequences for workplace safety.

 

Historic Highs in Drug Positivity Rates

 

The overall drug positivity rate in the general U.S. workforce (those who do not work federally mandated, safety-sensitive positions) remained steady at 5.7% in 2023, maintaining historically high levels. The combined U.S. workforce (general workforce + federal mandated, safety-sensitive positions) also showed a persistent drug positivity rate of 4.6%, the highest in over two decades. Post-accident marijuana positivity has climbed sharply, with an increase of 114.3% between 2015 and 2023.

 

Marijuana Use and Legalization

 

Marijuana positivity tests continued to increase, particularly in states where recreational use is legal. In the general workforce, marijuana positivity increased by 4.7% in 2023, reaching a new peak. Over the past five years, this rate has risen by 45.2%. Despite the decrease in marijuana positivity among federally mandated, safety-sensitive workers, the data suggests that broader legalization might be contributing to increased usage and associated workplace risks.

 

Rising Drug Use in Office-Based Industries

 

Interestingly, the Quest Diagnostics report also highlights a rise in drug positivity rates within traditionally office-based industries. Real estate, lending, professional services, and education sectors all saw significant increases in drug positivity. This trend may reflect the broader impacts of the pandemic, such as increased stress and isolation from work-from-home policies, potentially leading to higher drug use.

 

Sam Sphar, Vice President and General Manager of Workforce Health Solutions at Quest Diagnostics, pointed out the importance of mental health support and drug education programs in these sectors: “The results underscore the growing need for mental health support and drug education programs to ensure employees are safe and productive, whether working at home or in the office.”

 

The Need for Comprehensive Drug Testing Programs

 

The findings from the Quest Diagnostics Drug Testing Index highlight the critical importance of effective drug testing programs. Such programs not only help maintain a safer work environment but also act as a deterrent against drug use. Dr. Harwani noted that the mere expectation of drug testing can dissuade individuals from using drugs or applying for positions where testing is standard practice.

 

In conclusion, as drug use continues to evolve and adapt to societal changes, organizations must remain vigilant. Implementing robust drug testing and support programs is essential to ensure a safe, healthy, and productive workplace.

 

Source: Workforce drug test cheating surged in 2023, finds Quest Diagnostics Drug Testing Index analysis of nearly 10 million drug tests. (2024, May 15). Quest Diagnostics Newsroom. https://newsroom.questdiagnostics.com/2024-05-15-Workforce-Drug-Test-Cheating-Surged-in-2023,-Finds-Quest-Diagnostics-Drug-Testing-Index-Analysis-of-Nearly-10-Million-Drug-Tests

Filed under: Drug use-various effects,Effects of Drugs,USA :

There are several principal pathways to inheritable genotoxicity, mutagenicity and teratogenesis induced by cannabis which are known and well established at this time including the following. These three papers discuss different aspects of these effects.

1. Stops Brain Waves and Thinking
The brain has both stimulatory and inhibitory pathways.  GABA is the main brain inhibitory pathway. Brain centres talk to each other on gamma (about 40 cycles/sec) and theta frequencies (about 5 cycles/sec), where the theta waves are used as the carrier waves for the gamma wave which then interacts like harmonics in music.  The degree to which the waves are in and out of phase carries information which can be monitored externally.  GABA (γ-aminobutyric acid) inhibition is key to the generation of the synchronized firing which underpins these various brain oscillations. These GABA transmissions are controlled presynaptically by type 1 cannabinoid receptors (CB1R’s) and CB1R stimulation shuts them down. This is why cannabis users forget and fall asleep.

2. Blocks GABA Pathway and Brain Formation
GABA is also a key neurotransmitter in brain formation in that it guides and direct neural stem cell formation and transmission and development and growth of the cerebral cortex and other major brain areas. Gamma and theta brain waves also direct neural stem cell formation, sculpting and connectivity. Derangements then of GABA physiology imply that the brain will not form properly.  Thin frontal cortical plate measurements have been shown in humans prenatally exposed to cannabis by fMRI. This implies that their brains can never be structurally normal which then explains the long lasting and persistent defects identified into adulthood.

3. Epigenetic Damage
DNA not only carries the genetic hardware of our genetic code but it also carries the software of the code which works like traffic lights along the sequence of DNA bases to direct when to switch the genes on and off. This is known as the “epigenetic code”. Fetal alcohol syndrome is
believed to be due to damage to the software epigenetic code. The long lasting intellectual, mood regulation, attention and concentration defects which have been described after in utero cannabis exposure in the primary, middle and high schools and as college age young adults
are likely due to these defects. Epigenetics “sets in stone” the errors of brain structure made in (2) above.

4. Arterial Damage
Cannabis has a well described effect to damage arteries through (CB1R’s) (American Heart Association 2007) which they carry in high concentration (Nature Reviews Cardiology 2018). In adults this causes heart attack (500% elevation in the first hour after smoking), stroke,
severe cardiac arrhythmias including sudden cardiac death; but in developing babies CB1R’s acting on the developing heart tissues can lead to at least six major cardiac defects (Atrial- ventricular- and mixed atrioventricular and septal defects, Tetralogy of Fallot, Epstein’s deformity amongst others), whilst constriction of various babies’ arteries can lead to serious side effects such as gastroschisis (bowels hanging out) and possibly absent limbs (in at least one series).

5. Disruption of Mitotic Spindle
When cells divide the separating chromosomes actually slide along “train tracks” which are long chains made of tubulin. The tubulin chains are called “microtubules” and the whole football-shaped structure is called a “mitotic spindle”. Cannabis inhibits tubulin formation,
disrupting microtubules and the mitotic spindle causing the separating chromosomes to become cut off in tiny micronuclei, where they eventually become smashed up and pulverized into “genetic junk”, which leads to foetal malformations, cancer and cell death. High rates of
Down’s syndrome, chromosomal anomalies and cancers in cannabis exposed babies provide clinical evidence of this.

6. Defective Energy Generation & Downstream DNA Damage
DNA is the crown jewel of the cell and its most complex molecule. Maintaining it in good repair is a very energy intensive process. Without energy DNA cannot be properly maintained. Cannabis has been known to reduce cellular energy production by the cell’s power plants,
mitochondria, for many decades now. This has now been firmly linked with increased DNA damage, cancer formation and aging of the cells and indeed the whole organism. As it is known to occur in eggs and sperm, this will also damage the quality of the germ cells which go into forming the baby and lead directly to damaged babies and babies lost and wasted through spontaneous miscarriage and therapeutic termination for severe deformities.

7. Cancer induction
Cannabis causes 12 cancers and has been identified as a carcinogen by the California Environmental Protection agency (2009). This makes it also a mutagen. 4 of these cancers are inheritable to children; i.e. inheritable carcinogenicity and mutagenicity. All four studies in
testicular cancer are strongly positive (elevation by three fold). Carcinogen = mutagen = teratogen.

8. Colorado’s Teratology Profile
From the above described teratological profile we would expect exactly the profile of congenital defects which have been identified in Colorado(higher total defects and heart defects, and chromosomal defects) and Ottawa in Canada (long lasting and persistent brain
damage seen on both functional testing and fMRI brain scans in children exposed in utero) where cannabis use has become common. Gastroschisis was shown to be higher in all seven studies looking at this; and including in Canada, carefully controlled studies. Moreover in
Australia, Canada, North Carolina, Colorado, Mexico and New Zealand, gastroschisis and sometimes other major congenital defects cluster where cannabis use is highest. Colorado 2000-2013 has experienced an extra 20,152 severely abnormal births above the rates prior to
cannabis liberalization which if applied to the whole USA would equate to more than 83,000 abnormal babies live born annually (and probably about that number again therapeutically aborted); actually much more since both the number of users and concentration of cannabis have risen sharply since 2013, and cannabis has been well proven to be much more severely genotoxic at higher doses.

9. Cannabidiol is also Ge